Latest / Becker’s Healthcare Podcast / Strengthening Rural Healthcare Through Partnership and Trust with Dave Estorge

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Strengthening Rural Healthcare Through Partnership and Trust with Dave Estorge · Becker’s Healthcare Podcast

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• 1:00
  - This is Kristen Kuchna with the Becker's Healthcare
• 1:03
  - Podcast.
• 1:03
  - And today, I'm joined by David Storj, vice
• 1:06
  - president of rural strategy at FMOL Health. Dave,
• 1:09
  - thank you for being here. Hey. It's a
• 1:11
  - pleasure to be here. Thank you for having
• 1:12
  - me. Could you introduce yourself and share a
• 1:15
  - bit about your career journey and how it
• 1:17
  - led you to this role at FMOL Health?
• 1:20
  - Yeah. So
• 1:21
  - I I wish I could give you,
• 1:23
  - I wish I could tell you that I
• 1:25
  - had I woke up one day and I
• 1:26
  - said, gosh. I wanna be vice president of
• 1:28
  - rural health strategy,
• 1:30
  - for a large health care system. That that's
• 1:32
  - just not how it happened.
• 1:34
  - It's it's all sort of happened accidentally.
• 1:37
  - And,
• 1:39
  - I was brought to FMOL
• 1:41
  - in 2021
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  - as vice president of,
• 1:45
  - governmental relations and business development.
• 1:48
  - And,
• 1:49
  - that led to a number of different roles,
• 1:51
  - at St. Dominic, which is a hospital in
• 1:53
  - Jackson, Mississippi
• 1:55
  - within FMOL Health.
• 1:57
  - And,
• 1:58
  - that evolved to me being chief operating officer.
• 2:01
  - We led a turnaround here at this facility
• 2:03
  - of about $65,000,000,
• 2:05
  - not only a financial turnaround, but it was
• 2:07
  - a it was a cultural turnaround as well.
• 2:09
  - And, when that turnaround had had had been
• 2:12
  - completed,
• 2:14
  - an another need started to develop within the
• 2:17
  - health system.
• 2:19
  - And we saw,
• 2:20
  - a number of hospitals in Louisiana struggling,
• 2:24
  - and we saw our hospitals
• 2:27
  - looking at the need to build relationships
• 2:31
  - with these rural hospitals.
• 2:33
  - And, golly, when they started talking about, god,
• 2:36
  - who who could we put in this role,
• 2:38
  - a lot of the market presence who I
• 2:40
  - was close with,
• 2:42
  - decided that I would be the best person
• 2:43
  - for this role.
• 2:45
  - And, thankfully, about fourteen months ago, they put
• 2:47
  - me in it, and it's been a lot
• 2:49
  - of fun
• 2:51
  - since.
• 2:52
  - And so I've got a lot of, history
• 2:54
  - in Mississippi. I've been in health care in
• 2:56
  - Mississippi, both at Memorial Hospital in Gulfport
• 2:59
  - and University of Mississippi Medical Center. I've worked
• 3:01
  - in various roles in both of those hospitals.
• 3:03
  - And so I've got relationships
• 3:05
  - going back, you know, twenty years with a
• 3:08
  - lot of the administrators in Mississippi.
• 3:10
  - And then I was born in Louisiana, and
• 3:13
  - I actually lived in Baton Rouge. And so
• 3:15
  - my roots are in,
• 3:18
  - Louisiana. So it's been a really cool
• 3:20
  - journey for me
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  - to have my roots in Louisiana and my
• 3:25
  - business network sort of just meet and catch
• 3:27
  - up to each other.
• 3:29
  - Great. I appreciate you sharing that. You've described
• 3:31
  - treating the health system as a group of
• 3:33
  - beds rather than separate markets.
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  - What did that mindset mindset shift actually look
• 3:38
  - like in practice?
• 3:40
  - Yeah. I I think it was mainly out
• 3:41
  - of necessity.
• 3:43
  - We began to start looking at,
• 3:45
  - every transfer that all of our hospitals were
• 3:48
  - not only receiving,
• 3:49
  - but sending out.
• 3:51
  - And we noticed, goodness gracious, we are sending
• 3:54
  - out a lot of patients to hospitals that
• 3:56
  - are not within our health system.
• 3:59
  - And so,
• 4:00
  - we did some pretty innovative things on the
• 4:03
  - transfer center side
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  - where we developed
• 4:06
  - a transfer center on the I 20 Corridor
• 4:09
  - for our two hospitals there
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  - and on our I 10 Corridor where we
• 4:13
  - rolled all of our,
• 4:15
  - Louisiana hospitals into one transfer center. And then,
• 4:19
  - we began to work on capacity projects
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  - at all of our hospitals
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  - and really began to staff all available beds.
• 4:27
  - We started to look we we got better
• 4:29
  - at discharges. We reduced length of stay in
• 4:31
  - all of our hospitals,
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  - and,
• 4:33
  - goodness gracious,
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  - it's just it's been a grind
• 4:37
  - with capacity.
• 4:39
  - And and so, like I said, it was
• 4:41
  - it was mainly out of necessity
• 4:44
  - because we we had one of our hospitals,
• 4:47
  - transferring to another hospital where we could provide
• 4:50
  - those same services
• 4:52
  - within our health system.
• 4:54
  - And so once we started to behave like
• 4:57
  - a health system,
• 4:58
  - we were able to keep a lot more
• 5:01
  - business in the family.
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  - Definitely.
• 5:04
  - I'd love to dive deeper on the work
• 5:06
  - that you've done with teams across the system.
• 5:08
  - Over the last fourteen months, you've logged 40,000
• 5:11
  - miles visiting care teams across the four markets.
• 5:14
  - Why was that in person relationship building necessary,
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  - and what changed because of it?
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  - You know, look, I'll I'll tell you.
• 5:22
  - This has been different.
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  - There was no playbook really to take this
• 5:26
  - role on,
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  - and
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  - I I would love to tell you that,
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  - I'm I'm really smart, and I figured all
• 5:34
  - of this out. But I, honestly,
• 5:36
  - I prayed about it and asked for guidance
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  - and how to approach this job because we've
• 5:40
  - never had a a position really like this
• 5:42
  - before within our health system.
• 5:44
  - And and so, the first thing that came
• 5:46
  - to me is,
• 5:48
  - okay. Why don't we lead with our mission?
• 5:50
  - Right? And so we have a core four
• 5:53
  - of be the love, be the guide, be
• 5:55
  - the bridge, and be the catalyst.
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  - All four of those,
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  - core four are so important
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  - in rural health care. And so I thought
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  - it would be look. There's a big health
• 6:07
  - system that's gonna start reaching out to these
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  - rural hospitals. Some of them are not gonna
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  - know who I am. They're not gonna care
• 6:13
  - who I am, but this is what we're
• 6:14
  - gonna do. We're gonna say thank you.
• 6:17
  - Okay?
• 6:18
  - And then we're going to offer to check
• 6:20
  - on these patients for them,
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  - and then we're gonna offer to connect them
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  - with our care management team
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  - to see
• 6:28
  - if,
• 6:29
  - if if we can help coordinate care better
• 6:32
  - in post acute placement.
• 6:33
  - The reality is our hospitals have never been
• 6:36
  - as full as they are today.
• 6:38
  - And so we need these rural hospitals to
• 6:41
  - be successful, to be able to keep patients
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  - in their community,
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  - and and so you have to build trust.
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  - And this is something that we did over
• 6:48
  - time. And so while I'm driving down with
• 6:51
  - these hospitals,
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  - okay,
• 6:54
  - I am researching,
• 6:56
  - okay,
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  - this town has 7,000 people, but five years
• 7:00
  - ago, it had 10,000. What happened? Well, the
• 7:02
  - railroad left.
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  - So
• 7:05
  - understanding
• 7:06
  - the history of these towns,
• 7:08
  - okay,
• 7:09
  - doing a deep dive on every single hospital
• 7:12
  - and understanding what services they can and cannot
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  - offer and understand the obstacles,
• 7:18
  - to offering those services
• 7:21
  - are something that you have to understand before
• 7:23
  - you even walk in the door. And so
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  - when you have a hospital
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  - that's named,
• 7:28
  - you know, a Tyler Holmes in Winona, Mississippi,
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  - for example,
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  - Understanding who Tyler Holmes was
• 7:35
  - before you walked in is critical to that
• 7:38
  - relationship
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  - because they know you care about them.
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  - And and believe it or not, these rural
• 7:42
  - hospitals don't have,
• 7:45
  - larger health systems like us walking into their
• 7:48
  - hospital every day saying thank you
• 7:50
  - and offering generally to, one,
• 7:53
  - not say, we wanna take you over. You
• 7:56
  - know? We want no. We're we have a
• 7:58
  - little bit different of a message.
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  - We're saying thank you.
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  - We're asking them what their needs are
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  - from a telehealth standpoint,
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  - from a specialty clinic standpoint,
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  - and how can we partner to help you
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  - keep patients in your community,
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  - and then how can we improve
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  - our coordination of care when we you do
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  - have to send us a patient
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  - and, and and help get that patient
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  - back to their community to recover.
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  - And so I think and and then, you
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  - know, I've got just a ton of stories
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  - about how I've I've gone into,
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  - a a gas station or a local restaurant.
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  - I always make it a point to eat
• 8:39
  - at either the Mexican restaurant or the barbecue
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  - restaurant closest to the hospital
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  - because that is where the stories are told,
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  - and, that's where I can get a real
• 8:49
  - flavor for the community.
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  - And, everybody's got a story
• 8:53
  - about their interact about their experiences at one
• 8:55
  - of our hospitals.
• 8:57
  - Definitely. That's such a great point. And I
• 8:59
  - love what you said about how
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  - important these hospitals are for their communities. They're,
• 9:04
  - you know, oftentimes taking care of their neighbors,
• 9:06
  - their family, their friends. And, I think you
• 9:09
  - also might have mentioned, like, how important they
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  - are as employers, oftentimes the largest employers in
• 9:14
  - a rural community. So, yeah, it's a good
• 9:17
  - one for me. Can just maybe talk about
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  - that for another second. Mhmm. What's remarkable to
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  - me
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  - is I could tell you story after story
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  - of
• 9:25
  - the the CEO,
• 9:27
  - who was born in that hospital,
• 9:30
  - and they haven't had labor and delivery services
• 9:32
  - for twenty years.
• 9:33
  - And so I can tell you,
• 9:36
  - stories about hospitals that have had
• 9:38
  - real financial problems,
• 9:40
  - and
• 9:41
  - they were
• 9:42
  - literally on the brink of having to close,
• 9:45
  - but not a single employee left because that
• 9:47
  - is their hometown hospital.
• 9:50
  - The pride
• 9:51
  - it's so there's a lot of negativity
• 9:55
  - around rural health care. Okay? But I will
• 9:57
  - tell you
• 9:59
  - why rural health care will work and will
• 10:01
  - continue to work in in our in our
• 10:03
  - country.
• 10:04
  - It's because of the employees.
• 10:06
  - Tremendous pride that each of these employees and
• 10:09
  - leadership teams have in their respective hospitals.
• 10:13
  - It's inspiring to me,
• 10:15
  - and they are tickled
• 10:18
  - when someone actually shows up and wants to
• 10:21
  - listen to them and actually help.
• 10:24
  - Definitely. That's such a great point.
• 10:26
  - I now wanna talk about one specific market.
• 10:29
  - FML House Jackson Market saw a jump in
• 10:32
  - swing bed placements this year. Can you walk
• 10:34
  - us through what drove that? Oh, yeah. Look.
• 10:37
  - This is this is just one of the
• 10:39
  - the greatest stories,
• 10:40
  - ever. So, you know, whenever we talk about
• 10:42
  - post acute placement, always it's always about patient
• 10:45
  - choice. So you can't drive people back to,
• 10:49
  - any particular post acute facility.
• 10:52
  - But what we have done, with these hospitals
• 10:54
  - and and just kind of understanding how important,
• 10:58
  - a couple of things are. Right? So
• 11:00
  - if you take a look at really any
• 11:03
  - of our markets,
• 11:04
  - every day, you have a patient that is
• 11:07
  - being transferred from two hours or more away
• 11:09
  - to your facility.
• 11:10
  - They are traveling further than they ever have
• 11:13
  - for health care. It is more expensive. It's
• 11:16
  - more stressful,
• 11:17
  - and it's it's a real burden for the
• 11:20
  - families
• 11:21
  - to not only get to your hospital, but
• 11:23
  - stay at your hospital. So you have to
• 11:25
  - keep that in mind. And so one of
• 11:27
  - the things that we've told our employees,
• 11:29
  - especially in the Jackson market,
• 11:31
  - is not only
• 11:33
  - are patients coming to Jackson, Mississippi for the
• 11:36
  - first time, they're coming to Saint Dominic for
• 11:39
  - the first time. Okay?
• 11:41
  - And so
• 11:42
  - we have a responsibility
• 11:44
  - as a health system to meet these families
• 11:46
  - where they are.
• 11:48
  - And so,
• 11:49
  - with that said,
• 11:51
  - what becomes more complicated as a result of
• 11:53
  - the distance?
• 11:54
  - The EMS is stressed. Right?
• 11:57
  - The,
• 11:58
  - the families are stressed financially, and then your
• 12:01
  - post acute follow ups are more stressed because
• 12:04
  - you have to travel back for two hours.
• 12:06
  - So one of the things that, we have
• 12:08
  - tried to do
• 12:09
  - is,
• 12:10
  - really build we built a database
• 12:13
  - of all of the,
• 12:15
  - I guess, swing beds for every rural hospital
• 12:18
  - that sends us,
• 12:20
  - patients and understanding what insurances they accept and
• 12:24
  - all of these sorts of things for our
• 12:25
  - case managers to use. Right? So I think
• 12:27
  - that's one. Number
• 12:29
  - two, we,
• 12:31
  - we connected case manager to case manager,
• 12:34
  - and, just like any other
• 12:37
  - post acute or or skilled nursing facility or
• 12:39
  - whatever, offered, them the
• 12:42
  - opportunity to come to Huddl's and introduce themselves
• 12:45
  - to our case managers
• 12:47
  - so they can understand
• 12:49
  - what
• 12:50
  - capabilities their sling beds have. Right? And then,
• 12:54
  - the other thing that we've done is we've
• 12:56
  - done an epic epic care connect with them.
• 12:59
  - And so this is not a full community
• 13:01
  - connect, but it's a build that we do
• 13:03
  - for hospitals
• 13:05
  - that transfer patients to us or any post
• 13:07
  - acute facility, any rehab facility,
• 13:10
  - whether affiliated with a hospital or not.
• 13:12
  - And what that allows you to do instead
• 13:15
  - of faxing back information on patients,
• 13:18
  - you access the patient's information through a secure
• 13:21
  - portal, and you're able to see the clinicals
• 13:24
  - real time of what's going on with that
• 13:26
  - patient. And so that is so much easier
• 13:29
  - for these smaller rural hospitals to see,
• 13:32
  - and to understand, yes, we can accept that
• 13:35
  - patient. Yes. We're comfortable
• 13:37
  - with,
• 13:38
  - the the our ability to care for that
• 13:40
  - patient.
• 13:41
  - And and so,
• 13:43
  - you know, that that is really
• 13:46
  - just creating those relationships and then
• 13:49
  - eliminating some barriers on the post acute side,
• 13:52
  - enhancing visibility
• 13:55
  - to,
• 13:56
  - the actual having clinical transparency and some connectivity
• 13:59
  - on post acute, those have been the biggest
• 14:01
  - differences. Right? And, of course, the communication that
• 14:04
  - we've done by thanking the care coordination team
• 14:07
  - at that respective hospital,
• 14:09
  - for sending their patient to us
• 14:11
  - and, connecting them to our case management so
• 14:14
  - they can communicate. Right? So I think those
• 14:17
  - have been the biggest differences.
• 14:19
  - Definitely. Those are all very exciting improvement. Yeah.
• 14:22
  - So 41%. So what does that mean? That's
• 14:24
  - like a it's I think it's a 100
• 14:25
  - and forty patients.
• 14:27
  - Wow.
• 14:27
  - Year over year that have gone back to
• 14:30
  - the rural hospital swing beds. And that's
• 14:33
  - that's real that's real numbers. That's real volume.
• 14:36
  - Definitely.
• 14:38
  - I wanna end on kind of a key
• 14:39
  - takeaway for our listeners. For maybe other health
• 14:42
  - system leaders that are managing multiple markets, what's
• 14:45
  - the first step to replicating this kind of
• 14:47
  - transfer and swing bet strategy?
• 14:50
  - You know,
• 14:51
  - you just have to be genuine.
• 14:55
  - You can't be slick.
• 14:57
  - You cannot fake your passion
• 15:00
  - for rural health care.
• 15:02
  - You can't come in and tell them that
• 15:05
  - you know better than them.
• 15:07
  - I think authenticity and leading with your hospital's
• 15:10
  - mission is first and foremost.
• 15:12
  - I'm not sure if that's what you wanted
• 15:14
  - to hear, but it is a 100% essential
• 15:18
  - to our organization
• 15:20
  - that we show up
• 15:22
  - consistent with our core four. Right?
• 15:25
  - And so I think, to me, that is
• 15:27
  - number one.
• 15:28
  - Our mission and our sincerity
• 15:31
  - and our appreciation
• 15:33
  - for the relationship
• 15:35
  - and the privilege of being able to accept
• 15:38
  - the patient that that hospital is sending to
• 15:40
  - us.
• 15:41
  - Those are the you have to lead, in
• 15:43
  - my opinion, with those two things. So you
• 15:46
  - have to be authentic, and you have to
• 15:47
  - be grateful.
• 15:49
  - Beyond that,
• 15:51
  - you've got to have,
• 15:54
  - I would say,
• 15:57
  - you've gotta build the trust with these individual
• 15:59
  - hospitals,
• 16:00
  - and you do that by the first two
• 16:02
  - things that I told you. If you're if
• 16:03
  - you're thanking them for their transfers,
• 16:06
  - you're checking on their patients for for them.
• 16:09
  - I cannot tell you
• 16:11
  - the number of times now that I am
• 16:14
  - getting phone phone calls, text messages. Two of
• 16:17
  - them happened today. Will you please check on
• 16:19
  - this patient that we transferred to your hospital?
• 16:22
  - And and I will go on there or
• 16:25
  - or if it's another market,
• 16:27
  - I've been able to partner with our pastoral
• 16:29
  - care team.
• 16:30
  - They go in and pray with these patients.
• 16:34
  - And so we the pastoral care is a
• 16:36
  - whole different conversation.
• 16:37
  - They visit most rooms or almost every room
• 16:40
  - in in in every hospital that we have.
• 16:43
  - But when there's a story attached and we
• 16:45
  - know sort of the connectivity,
• 16:47
  - it's a different conversation because we visit on
• 16:50
  - behalf of those hospitals
• 16:52
  - that that send the patients to us. So
• 16:55
  - if we go back to the beginning,
• 16:57
  - if we if we show up with humility,
• 17:00
  - I would say,
• 17:02
  - if we say thank you for the transfer,
• 17:05
  - if we offer to check on these patients
• 17:08
  - for them and then report back to them
• 17:10
  - on how they're doing,
• 17:12
  - okay, and then we,
• 17:14
  - work with their care coordination team to facilitate
• 17:19
  - the,
• 17:20
  - best possible,
• 17:22
  - placement post discharge, and if happens to be
• 17:24
  - their swing bed,
• 17:25
  - in a lot of cases, it is.
• 17:28
  - Why wouldn't these hospitals want to send their
• 17:30
  - patients to you?
• 17:32
  - Right?
• 17:33
  - And so
• 17:34
  - that's how we've really built this.
• 17:37
  - It's nothing flashy. I I I really wish
• 17:39
  - I could give you a bunch of secrets,
• 17:41
  - but,
• 17:43
  - it is
• 17:44
  - when when these hospitals call, I answer the
• 17:46
  - phone immediately.
• 17:48
  - When they text, I respond.
• 17:50
  - And so they know that they've got people
• 17:53
  - at FML
• 17:55
  - that they can call when they need help.
• 17:59
  - So I think, really, that's the key here.
• 18:02
  - And and the the post acute is is
• 18:04
  - just it's purely relationship based. Epic is obviously
• 18:07
  - a huge piece of that. And then I
• 18:10
  - would be remiss if I didn't say, you
• 18:12
  - have to accept their patients.
• 18:14
  - And one of our, one of our, you
• 18:17
  - know, key things here is our our transfer
• 18:19
  - acceptance rate
• 18:21
  - really went from sixty seven and a half
• 18:22
  - percent to to almost eighty percent in one
• 18:25
  - year. And so if you can't say yes
• 18:27
  - to their patients, none of that really matters.
• 18:29
  - Right?
• 18:31
  - But, again,
• 18:32
  - you have got to be humble. You've gotta
• 18:34
  - be sincere.
• 18:35
  - You gotta genuinely care about these people. I'll
• 18:37
  - tell you one more thing about the swing
• 18:39
  - beds that really,
• 18:41
  - that really sold me.
• 18:43
  - One of my colleagues, Dan Woods, who's a
• 18:45
  - senior director of our transfer center for I
• 18:48
  - ten and I twenty, he and I are
• 18:49
  - visiting a a hospital in Mississippi.
• 18:52
  - And
• 18:54
  - as we're walking out, we're noticing
• 18:57
  - a, there's a older gentleman who's sitting outside
• 18:59
  - eating his lunch, and then there's a a
• 19:02
  - younger man walking a dog
• 19:04
  - over to that man. And I we asked
• 19:06
  - the CNO, like, what is going on there?
• 19:09
  - Well, that's his dog from home, and his
• 19:12
  - son's bringing his dog to go see him.
• 19:15
  - And so that was the moment that grabbed
• 19:18
  - me when it came to rural hospitals.
• 19:20
  - It's like, okay. I get it.
• 19:23
  - Y'all are treating family. You're treating friends. You're
• 19:26
  - treating neighbors.
• 19:28
  - And
• 19:30
  - that's special
• 19:31
  - because they know everybody in their community. Right?
• 19:34
  - And they're willing to go the extra mile
• 19:36
  - to be able to take care of them.
• 19:39
  - Absolutely.
• 19:40
  - Thank you again for joining us. We appreciate
• 19:43
  - your time and look forward to following the
• 19:45
  - work FMLA Health is doing in rural communities.