Latest / Becker’s Healthcare Podcast / David Kelly, Chief of Ambulatory Operations and Vice President of Revenue Cycle at Mary Rutan Health

Transcript

David Kelly, Chief of Ambulatory Operations and Vice President of Revenue Cycle at Mary Rutan Health · Becker’s Healthcare Podcast

• 0:02
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• 1:00
  - This is Laura Dirda with the Becker's Healthcare
• 1:03
  - podcast.
• 1:04
  - I'm thrilled today to be joined by David
• 1:05
  - Kelly, chief of ambulatory operations and vice president
• 1:08
  - of revenue cycle at Mary Rutan Health. David,
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  - it's a pleasure to have you on the
• 1:12
  - podcast today.
• 1:13
  - Thank you very much. I'm glad to be
• 1:15
  - here and to speak to your audience.
• 1:17
  - Absolutely. Now I'm excited for our conversation. I
• 1:19
  - know we're gonna dig into some of the
• 1:20
  - cool things that you're doing at Mary Rutan
• 1:22
  - Health and how you're thinking about the future.
• 1:24
  - But before we dive in, can you tell
• 1:25
  - us a little bit more about yourself and
• 1:27
  - your background?
• 1:28
  - Yeah. Absolutely. I'm actually on my second stint
• 1:31
  - with Mary Rutan Health.
• 1:33
  - I was talking with somebody the other day.
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  - I've got a what seems like a career
• 1:36
  - of being a boomerang employee returning to the
• 1:38
  - same employer. I guess that's a good thing.
• 1:41
  - But my role, I have we were small
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  - hospitals, so I get to wear a fairly
• 1:45
  - unique set of hats. I run the day
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  - to day of our medical group, but then
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  - I also oversee the operations,
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  - the revenue cycle sort of at the at
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  - the strategic level. I've got a great director
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  - who helps me within executing on that vision.
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  - So,
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  - that's a lot of fun, and then, I've
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  - been been in health care for about twenty
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  - years in in one way, shape, or form.
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  - Well, that's great to hear and definitely helpful
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  - to understand,
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  - the context of, where you're coming from and
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  - everything that you're doing. Now can you tell
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  - us a little bit about your work at
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  - Mary Ruthann Health? What are you working on
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  - right now, and and what are you most
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  - proud of from the last year or so?
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  - Well, we're working on a ton of stuff.
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  - What I what I think I would be
• 2:23
  - most proud of is not necessarily the one
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  - a lot of times, the road cycle folks,
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  - you know, they
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  - we will talk about those things that bring
• 2:29
  - the most money to the organization. But, actually,
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  - I I I wanna talk about something where
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  - we're we're actually,
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  - getting money away for the organization, which is
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  - to say that,
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  - in in early
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  - twenty twenty five, late twenty four, my CEO
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  - came to me that and this was before
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  - the OBA,
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  - was even sort of, mentioned
• 2:47
  - and said, hey. We're not, we're not we're
• 2:50
  - not doing enough. We want I I want
• 2:51
  - us to do more for our community. I
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  - want us to enhance,
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  - our charity programs because, you know, we put
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  - this out there. We do the things that
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  - we need to do,
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  - for for for meeting the requirements,
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  - but we're not always engaging well enough with
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  - the patients. Or or we send them their
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  - application, and they don't return it. So how
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  - do we reduce friction,
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  - on that? So we have spent about a
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  - year
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  - researching what other organizations are doing, researching,
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  - things like propensity to pay scores and implementing
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  - some of those elements to bring online,
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  - some changes in our statements to add those
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  - propensity scoring, to add presumptive charity,
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  - and really try to help patients,
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  - get the benefit of our financial programs. We've
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  - got a good foundation with, with good ways
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  - to help people that way.
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  - They've you know, our foundation has its own
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  - program that we can match people with. Our
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  - our pharmacy
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  - has wonderful things helping people with their their
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  - med costs. We just wanna link folks up.
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  - That's part of our mission,
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  - you know, and and purpose as a not
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  - for profit
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  - independent community hospital. And so I've been very
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  - proud of what we've been able to launch
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  - now over the last,
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  - twelve months. And we still have some more
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  - work to do that I anticipate will be
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  - done maybe the next quarter.
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  - And so that's a wonderful thing that I'm
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  - I'm just so proud of. And then the
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  - irony is then OVA came about, and we
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  - know that people are probably gonna struggle with
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  - Medicaid redeterminations
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  - and the you know, there's lots of forecasting
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  - that people are gonna move from Medicaid to
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  - self pay. And so how can we help
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  - those people? Well, one of them is to
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  - to try to mash them up with programs.
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  - Right? So just very excited about that and
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  - then also then the
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  - the unexpected timing and,
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  - alignment with the federal law.
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  - Absolutely. You know, that sounds incredible and absolutely
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  - important to have engagement with the community and
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  - to the population, especially those who sometimes have
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  - challenges reach reaching access to care and,
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  - being able to
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  - get the care that they need. Now can
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  - you tell me a little bit more about
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  - the foundation and some of the things that,
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  - I guess, behind the scenes you're able to
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  - do to build this programming and and make
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  - sure that,
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  - the people who stand to benefit the most
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  - from it will actually then be able to
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  - get across the line and and achieve those
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  - benefits?
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  - Yeah. The main thing with our foundation, I
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  - mean, we it's it's not some sort of
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  - billion dollar endowment or anything like that, but
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  - we've got a wonderful foundation
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  - that has existed for for, you know, nearly
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  - as long as the hospital, which has a
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  - hundred and seven year history that we're very
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  - proud of.
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  - But some people donated money in, like, the
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  - sixties
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  - to set up an endowment,
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  - for what, at that time, they called the
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  - the indigent.
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  - And,
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  - you know, when you go back and read
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  - the original documents, it it reads almost like
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  - they wanted a a a room in the
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  - hospital
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  - dedicated to the indigent. Well, that's not how
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  - a modern hospital works.
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  - But so the point is just there there
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  - are there are dollars there inside of that
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  - foundation for that. And if we can better
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  - match people to that,
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  - you know, we wanna do that. And then,
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  - of course,
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  - we actually and this is outside of the
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  - rev cycle realm now, but we've we've this
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  - month,
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  - I'm not sure when this will air, but,
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  - this month, we had a retirement and leadership
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  - of the foundation.
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  - The outbound person has done great work, but
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  - we've brought in
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  - a a wonderful person who we're looking forward
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  - to that because we also not only for
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  - the medical care of our patients, we just
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  - wanna look at what else we can do
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  - for our community. Our foundation runs the local
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  - cancer society helping people with,
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  - we don't have an oncology center. So whether
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  - it's gas cards to get down to,
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  - our partners in Columbus, Ohio
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  - and get their, you know, get their
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  - cancer treatments there or,
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  - WIGS or I mean, all sorts of different
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  - support for cancer. So that's something that we
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  - wanna continue to raise awareness of, but we
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  - just we strongly believe that there are programs
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  - and that that people aren't maybe aware of
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  - or aren't reaching.
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  - And for me personally, I think that's that's
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  - a problem for a lot of hospitals, at
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  - least from folks I've talked to.
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  - This world of health care is so complex
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  - that navigating it is challenging even for those
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  - who work in it. And so all of
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  - us, I think, can probably look at, are
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  - we matching people up with the resources?
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  - And I think particularly right now, in a
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  - lot of states, the regulators
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  - are looking at, hey. Are you justifying your
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  - nonprofit status? And I feel like, at least
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  - when I go and network with colleagues, we
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  - go, well, we have these programs. If, you
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  - know, if people don't take advantage of it,
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  - they don't take advantage of it. And I
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  - think that last phrase that I just said,
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  - I think we have to throw that out.
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  - I think we have to throw that thinking
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  - out, and we have to try to say,
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  - how do we
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  - be more proactive?
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  - How do we reach out to people and
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  - and just meet them where they are in
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  - the sense of
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  - this stuff is is just
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  - Byzantine,
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  - and
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  - people may not be able to navigate it.
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  - You know? They
• 7:55
  - they say,
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  - we often write things or try to write
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  - things at, like, a sixth grade reading level,
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  - for example. So look at your charity application.
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  - Is it written that way? That's one of
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  - the enhancements that we're trying to do is
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  - reduce the reading level so that it's more
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  - intelligible. And that's not to speak down to
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  - people. It's just you know, there's there's studies
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  - out there and there's facts that we have
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  - to make this stuff simpler.
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  - That makes a ton of sense. And, you
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  - know, I can definitely relate no matter what.
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  - It's always hard for me to to wanna
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  - do and then complete applications with more than
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  - three questions. So I can definitely understand.
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  - But as you've gone through this process of
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  - trying to figure out how, you know, you
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  - can,
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  - make those resources more obtainable,
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  - what have you learned? And and what are
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  - you really noticing about people today and,
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  - you know, figuring out and and adjusting to
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  - so that, you know, you can,
• 8:47
  - make that more accessible overall?
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  - Well, I think the main thing that I
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  - would mention is just the the the length
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  - of the journey.
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  - You know, we're recording this in June '26.
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  - As I mentioned, my CEO came to me
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  - in late twenty four,
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  - early twenty five,
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  - you know, eighteen months ago, basically.
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  - And
• 9:11
  - somebody might say, well, that's an awful long
• 9:13
  - time to make changes. It is because
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  - the thing about
• 9:18
  - the flip side of this is that a
• 9:20
  - lot of modern hospitals are on razor thin
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  - margins. And if all of a sudden we
• 9:25
  - changed our algorithms or we changed our things
• 9:28
  - and and really
• 9:29
  - damaged our ability to be here ten years
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  - from now or twenty years from now or
• 9:33
  - another hundred and seven years from now,
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  - by perhaps being,
• 9:38
  - I hate to say it, but
• 9:40
  - overgenerous,
• 9:42
  - that can be financially damaging. Or
• 9:45
  - just there's a long tail of history at
• 9:47
  - most organizations. There's an inertia of what has
• 9:50
  - come before and how do you move away
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  - from that. You know, these are also the
• 9:53
  - things that have to be considered.
• 9:55
  - So that isn't to say that you don't
• 9:57
  - make the decisions that's right for your community,
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  - right for your patients, and right for your
• 10:00
  - mission, but you have to do it in
• 10:02
  - a thoughtful,
• 10:04
  - data driven, and
• 10:06
  - methodical way.
• 10:08
  - And when you add those
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  - steps up, it can be a long time.
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  - And and that's the main thing is I
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  - I would just say that
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  - I I would go back to the euphemism.
• 10:19
  - I I and I don't remember who's who
• 10:21
  - I'm quoting here, so I I fit I'm
• 10:22
  - gonna fail to to attribute it properly.
• 10:25
  - You know, the best time to plant a
• 10:27
  - tree was yesterday. The second best time is
• 10:29
  - is today. It's the same thing. If you
• 10:31
  - feel like you wanna enhance your mission and
• 10:33
  - your charitable
• 10:34
  - works,
• 10:35
  - then the best time was yesterday, but the
• 10:37
  - next best time today because it's a long
• 10:39
  - journey.
• 10:42
  - That makes a lot of sense. And, you
• 10:43
  - know, truly, truly great advice when you're thinking
• 10:46
  - about holistically how,
• 10:48
  - organizations
• 10:49
  - can think differently and transform what they're doing
• 10:51
  - in order to make it better for the
• 10:52
  - patients and the community.
• 10:54
  - Now I'm curious. You mentioned,
• 10:56
  - just the OBBBA
• 10:59
  - and,
• 11:00
  - some of the different things are happening with
• 11:02
  - Medicaid redeterminations
• 11:03
  - in the next year and,
• 11:06
  - other challenges as well. So Mhmm. Morning, can
• 11:08
  - you talk a little bit about that? What
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  - have you seen at the federal level, and
• 11:11
  - what are you preparing for,
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  - as you look into 2027
• 11:15
  - and beyond?
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  - So for for us, you know, our our
• 11:20
  - leadership, our CEO is is very engaged,
• 11:24
  - you know, at the at the state level
• 11:26
  - in in trying to make sure we're we're
• 11:28
  - responding to,
• 11:30
  - pursuit of rural health transformation grants and and
• 11:34
  - engaging on that front.
• 11:36
  - That's our current focus.
• 11:38
  - One of the other elements of focus for
• 11:39
  - us is we're starting conversations about maybe could
• 11:42
  - we step up our volunteer program. You know,
• 11:44
  - one of the things with Medicaid
• 11:46
  - is work requirements, but also a parallel to
• 11:48
  - work requirements is volunteer requirements.
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  - And, you know, as as a nonprofit, we've
• 11:53
  - got plenty of room for volunteers, and lots
• 11:55
  - of folks in our community might have room
• 11:57
  - for volunteers that we could again, maybe we
• 12:00
  - don't have to do it ourselves, but we
• 12:01
  - could be a leader to match people up
• 12:04
  - with volunteer opportunities
• 12:06
  - so that they can retain that Medicaid.
• 12:08
  - And so that's we're in very preliminary conversations.
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  - Don't get me wrong.
• 12:12
  - But very preliminary
• 12:14
  - conversations
• 12:15
  - about that,
• 12:16
  - and I think that that might be a
• 12:18
  - good way to to help people.
• 12:21
  - And beyond that then, that's that's about where
• 12:24
  - our prep has stopped, and and a lot
• 12:26
  - of that's just our resourcing capability in order
• 12:29
  - to to to be ready. And then, of
• 12:31
  - course, we're we're keeping an eye or we
• 12:33
  - will be keeping an eye on things like
• 12:35
  - payermex and so forth to to see how
• 12:36
  - we see a shift, whether it's from Medicaid
• 12:39
  - to self pay or perhaps to exchange plans.
• 12:41
  - We might you know, I I haven't heard
• 12:43
  - a lot of people talk about that, but
• 12:44
  - I would forecast that some of that might
• 12:46
  - happen,
• 12:47
  - as well as for Medicaid to self pay.
• 12:49
  - So just try and keep an eye on
• 12:51
  - that while doing those other couple of things
• 12:52
  - for readiness.
• 12:56
  - Absolutely. I think that makes a lot of
• 12:58
  - sense. And, it it's will certainly be a
• 13:01
  - a change, but then also having that preparation
• 13:04
  - makes a difference. And, you know, you talked
• 13:06
  - about the rural health transformation
• 13:08
  - program and and funding.
• 13:10
  - What's that been like? I I know it
• 13:12
  - can be
• 13:13
  - different state by state, and so I'm curious
• 13:16
  - what types of projects are you pursuing, and
• 13:18
  - how has the process been going?
• 13:21
  - So,
• 13:21
  - it's it's a bit early. Ohio just released
• 13:24
  - some of, the RFP stuff that recently,
• 13:28
  - and I think there's some more to come.
• 13:30
  - And, of course, as you mentioned, every state's
• 13:32
  - doing it differently. Some, I think, aren't even
• 13:34
  - even out there yet, but they've got deadlines
• 13:36
  - to do so. So we'll see how that
• 13:38
  - evolves across the country.
• 13:40
  - You know, for us, there's some work around,
• 13:42
  - essentially care coordination and case management,
• 13:45
  - to try to help people, again,
• 13:47
  - make sure we're they're they're following up. They're
• 13:49
  - getting the care that they need.
• 13:51
  - Ohio's,
• 13:53
  - elements have some work around rural CINs to
• 13:56
  - try to improve care that way, and Meritin
• 13:58
  - is, participating in that.
• 14:01
  - And a lot of rural hospitals are are
• 14:03
  - participating,
• 14:04
  - in in,
• 14:06
  - stand up of a rural CIN in the
• 14:08
  - state.
• 14:09
  - And then,
• 14:10
  - you know, some other elements that that we're,
• 14:13
  - you know, looking at is how do we
• 14:15
  - continue to have maternity care? We I know
• 14:18
  - a lot of hospitals have moved away from
• 14:19
  - that. We still have a birth center.
• 14:22
  - We still have a a a our our
• 14:23
  - center for women and children,
• 14:25
  - and we wanna be able to keep that.
• 14:28
  - So we're still working through exactly what that
• 14:29
  - might look like from the RHT perspective and
• 14:32
  - what we could maybe apply for grants for
• 14:33
  - or not.
• 14:35
  - But but at the end of the day,
• 14:36
  - that's definitely something that we believe strongly.
• 14:40
  - If that care is not close to home,
• 14:42
  - it is a it is a big negative
• 14:44
  - on the health of women, the health of
• 14:45
  - the community. And so how can we keep
• 14:47
  - it local and are there dollars there that
• 14:49
  - we could do so?
• 14:51
  - That's a great
• 14:53
  - program to be investing in and certainly so
• 14:55
  - important to the growth of
• 14:57
  - any community in in having the women and
• 14:59
  - children's,
• 15:00
  - and birthing center,
• 15:02
  - there in local and accessible. As you mentioned,
• 15:05
  - you know, it's certainly something that a lot
• 15:07
  - of hospitals are finding challenging. And, you know,
• 15:09
  - really, it seems like health systems are are
• 15:12
  - trying to figure out, you know, what their
• 15:14
  - core,
• 15:15
  - specialties or or places that they can double
• 15:18
  - down on will be in the next few
• 15:19
  - years. Are you thinking about any,
• 15:22
  - you know,
• 15:23
  - different whether it's partnerships or revenue sources or
• 15:26
  - just different things that you're trying to do
• 15:28
  - as,
• 15:29
  - you know, health care transforms a bit and
• 15:31
  - and,
• 15:32
  - trying to make sure that you're able to
• 15:35
  - survive and and thrive in the future?
• 15:37
  - Yeah. I mean, I would say that partnerships
• 15:39
  - are key. I don't know that we're thinking
• 15:41
  - differently about any of those, but, you know,
• 15:43
  - continuing on that that road and and recognizing
• 15:46
  - that,
• 15:48
  - you know, you can't do everything yourself.
• 15:50
  - So,
• 15:52
  - we have,
• 15:54
  - in in the OB space,
• 15:55
  - in May no. April,
• 15:57
  - we we, you know, we put out to
• 15:59
  - LinkedIn into the world that we have partnered,
• 16:01
  - for example, with a group called the OB
• 16:03
  - Hospitalist Group,
• 16:04
  - to help us with a staffing model. That's
• 16:06
  - not just laborist, but but true staffing to
• 16:08
  - help us with that and keep that maternity
• 16:10
  - care local. But we've got long standing partnerships
• 16:13
  - with Ohio State, with OhioHealth,
• 16:16
  - on, elements of telehealth,
• 16:18
  - you know, teleneuro, telestroke,
• 16:21
  - all these types of things because that's what
• 16:23
  - enables us to take care of patients and
• 16:26
  - keep allow them to stay close to home
• 16:28
  - when appropriate
• 16:29
  - at our facility, but also then have a
• 16:31
  - pathway to referral for things that, you know,
• 16:33
  - a community hospital is just never gonna take
• 16:35
  - care of. We're not gonna be doing TAVRs.
• 16:37
  - We're not doing brain surgery. We're not doing
• 16:39
  - open heart. You know, those those things need
• 16:41
  - to go, but,
• 16:42
  - to to to the the tertiary care center.
• 16:44
  - But other stuff, if we have those relationships,
• 16:47
  - can stay. And that's better for the family,
• 16:49
  - and and as long as we're delivering quality
• 16:51
  - care, which we are,
• 16:54
  - then it's it's better for the patient too.
• 16:58
  - That makes a ton of sense. Now,
• 17:01
  - I'm curious. When you look ahead into the
• 17:02
  - future, I mean, there's a lot unknown, but
• 17:04
  - I can imagine a lot to be excited
• 17:06
  - for. What do you see ahead, and and
• 17:08
  - what are you most excited about the future
• 17:10
  - for at Merrywood Can Help?
• 17:14
  - What I am
• 17:16
  - most excited about,
• 17:17
  - at at Mary Ruthann is is a couple
• 17:19
  - things that I probably,
• 17:22
  - you know, because they're they're still in the
• 17:23
  - works, can't talk about. So I'll go to,
• 17:25
  - like, my my second string,
• 17:28
  - elements of excitement.
• 17:29
  - You know, we continue to have just,
• 17:33
  - excellent quality.
• 17:35
  - Becker's,
• 17:36
  - had recently recognized us as a top recommended
• 17:39
  - hospital. Forbes,
• 17:40
  - recommended us.
• 17:42
  - We improved our star rating this last time
• 17:44
  - around.
• 17:46
  - And and so I I I just think
• 17:48
  - that
• 17:49
  - the quality we give you know, I I
• 17:52
  - routinely try to my parents don't live near
• 17:54
  - the hospital. They live about an hour and
• 17:56
  - fifteen minutes away. I'll routine routinely try to
• 17:58
  - get them to drive up. I mean, it's
• 18:00
  - it's just it's the place that I would
• 18:01
  - recommend to folks.
• 18:03
  - And I'm excited about the fact that, you
• 18:05
  - know, I keep I keep hearing,
• 18:09
  - you know, stories about long waits, long delays
• 18:11
  - for specialists
• 18:16
  - waits because
• 18:17
  - in order to even offer the care, right,
• 18:20
  - we bring in one specialist,
• 18:21
  - just one,
• 18:23
  - but maybe the volumes are only there for,
• 18:25
  - you know, half or or three quarters of
• 18:28
  - a specialist, and it's a tough thing. It's
• 18:30
  - it's it's a rural subsidy that we pay
• 18:32
  - to have a specialty in a in a
• 18:33
  - local community. Well, that may mean that we
• 18:36
  - have capacity, not just at Meritan, but other
• 18:38
  - rural hospitals.
• 18:39
  - I hope that people out there and I
• 18:41
  - feel like maybe people will see that, hey.
• 18:43
  - A forty minute drive
• 18:45
  - to a a quality
• 18:47
  - rural community,
• 18:48
  - and you can get your specialty care faster.
• 18:50
  - And I just I don't know. Maybe I'm
• 18:52
  - just making that up, in my own mind,
• 18:55
  - but I feel like
• 18:56
  - the the the finger on the pulse of
• 18:58
  - society is people don't like weights. People are
• 19:00
  - tired of weights. And so I think there's
• 19:02
  - a bright future, not just for maritime, but
• 19:03
  - for rural hospitals who whose problem might be,
• 19:08
  - that they've got capacity but but are barely
• 19:10
  - getting by on the volumes,
• 19:12
  - maybe that'll be a a quarter we turn
• 19:14
  - over the next three years.
• 19:16
  - I don't know. Again, maybe I'm imagining that.
• 19:20
  - No. I mean, I I think there's definitely
• 19:21
  - something to that because as we've been
• 19:23
  - interviewing more and more rural health care leaders
• 19:26
  - and,
• 19:27
  - thinking through and and talking with them about
• 19:29
  - what their vision for the future is, it
• 19:31
  - seems like there
• 19:32
  - is more and more of that appetite
• 19:35
  - to bring a specialist in or or to
• 19:37
  - have folks, with that are able to provide
• 19:40
  - care closer to home and, you know, looking
• 19:42
  - at that capacity for those specialists and those
• 19:45
  - leaders within the institutions plus understanding just the
• 19:47
  - culture of, you know, what you get when
• 19:49
  - you're coming into a rural health care facility
• 19:52
  - versus, you know, some of the big,
• 19:54
  - urban settings or academic health centers. It can
• 19:57
  - make a big difference in what people are
• 19:59
  - looking for often, it seems, are,
• 20:01
  - a health care experience that is personalized and
• 20:03
  - that does have,
• 20:05
  - you know, that very much,
• 20:07
  - person to person and in caring feel.
• 20:10
  - So I I definitely think you're on to
• 20:12
  - something.
• 20:14
  - Well, thank you. And and, again, none of
• 20:15
  - that is, of course, to dismerge the besmerge
• 20:18
  - those large tertiary center centers, the academics.
• 20:21
  - We need them in in our health care
• 20:24
  - ecosystem
• 20:25
  - as well,
• 20:26
  - of course.
• 20:27
  - But as you alluded to, the the culture
• 20:29
  - can be very different, and the culture of
• 20:32
  - the care delivery is really what I mean.
• 20:34
  - So I think it it,
• 20:36
  - you know, it it is truly a health
• 20:38
  - delivery ecosystem, and and all the pieces are
• 20:41
  - needed.
• 20:43
  - Absolutely.
• 20:44
  - Definitely have a place for all and certainly
• 20:48
  - to your point, you know, being able to
• 20:49
  - fit in where you can fit in and,
• 20:51
  - serve the community well. I I think it
• 20:53
  - seems like most organizations' goals and to to
• 20:56
  - work in within that ecosystem,
• 20:59
  - is critical.
• 21:01
  - Absolutely.
• 21:02
  - Fully agree.
• 21:03
  - Well, David, thank you so much for your
• 21:04
  - time today. Is there anything else you wanna
• 21:06
  - leave our listeners with?
• 21:08
  - No. I mean, we we focused on some
• 21:10
  - of the the the focus on, patient engagement,
• 21:13
  - patient transparency, and charitable works. There there's always
• 21:17
  - so much going on in any institution. I
• 21:19
  - could probably talk to you for several hours
• 21:21
  - about the different things going on, but I
• 21:23
  - understand
• 21:24
  - that, a, it would probably put half your
• 21:26
  - audience to sleep, and, b,
• 21:28
  - the the the target duration here is is
• 21:31
  - not gonna sustain itself for a several hour
• 21:33
  - conversation, of course. But I just
• 21:37
  - wanna wanna acknowledge what what all my colleagues
• 21:40
  - and folks out there are doing
• 21:42
  - so so much just to keep up with
• 21:44
  - the pace of change in the modern era.
• 21:45
  - It's it's fun. It's tough. It's challenging.
• 21:49
  - But, you know, everybody out there, I see
• 21:51
  - folks at conferences at different stages of excitement
• 21:54
  - versus burnout versus whatever. It it is just
• 21:57
  - I I I think that we have to
• 21:59
  - continue to to work on this together
• 22:02
  - inside of our organizations, across organizations because the
• 22:05
  - affordability,
• 22:07
  - of health care in the modern era is
• 22:09
  - is tough. And,
• 22:11
  - peep people are having a tough time with
• 22:14
  - grocery bills, much less health care bills.
• 22:16
  - But we gotta just keep fighting that fight.
• 22:18
  - So so everybody out there who's working in
• 22:21
  - this space, keep it up. And if you're
• 22:22
  - listening and not in this space, just know
• 22:25
  - that there are people out there trying to
• 22:26
  - solve for this.
• 22:29
  - I love that, David. Thank you so much
• 22:31
  - for joining us on the podcast today. This
• 22:32
  - has been such a fun conversation. The passion
• 22:34
  - for what you do is really coming through.
• 22:37
  - I appreciate your time and look forward to
• 22:38
  - connecting with you again soon.
• 22:40
  - Thank you, Laura, and thanks to the Becker's
• 22:42
  - team.