In November, the Birmingham MGMA held a roundtable discussion with the Chief Executive Officers of three Birmingham Hospitals:

Jason Alexander,
CEO Ascension St Vincent’s

Jeremy Clark,
SEO Brookwood Baptist

Daniel McKinney,
CEO Grandview

What follows are a few of the topics discussed.

Moderator:  Has the quality of healthcare changed since the pandemic?

Daniel McKinney: I haven’t seen anything that would diminish the quality of healthcare that’s being provided. The priorities of our patients may be a little different because of the pandemic experiences. For example, I’d say our patients are more aware of the cleanliness of their environment. They’re expecting to maybe come into an environment that’s short-staffed because they see that in other places. Nonetheless, the industry quality indicators are still very strong.

Jason Alexander: I don’t know that clinical quality has changed as much as patients’ definition of quality. I would say that access has become very important, along with patients’ desire to not have to come through the big box acute care hospital.

Jeremy Clark: I agree. I don’t think our clinical indicators have fallen off.  Our organization is still absolutely focused on these and working to improve them. Over the last couple of years, we all had visitor restrictions in some form, and that changes a patient’s perception of care.

Moderator: There is a lot of competition for employees today. How are you managing to maintain your workforce?

Jason Alexander: Our salary dollars are up 30 percent over the last three years. That’s not more people, it’s just paying more dollars – and that’s when we can get the staff. This is not sustainable long-term. So we’re more likely to close beds or close ORs than compromise quality. That is happening now which means you guys (administrators) have unhappy doctors because they can’t get their surgeries scheduled or their patients admitted, but it’s an either or situation - either we compromise, to some extent, quality by keeping beds and ORs open by staffing too lean, which we won’t do, or close some beds or ORs. And we’re all dealing with that.

With staff, it’s a combination of can’t afford them and can’t find them. Some doctors called me just this morning, saying they couldn’t understand why they can’t get their surgeries scheduled tomorrow. It’s staffing.

Jeremy Clark: We all have a desperate need for staff. So we’re taking on a lot more new graduates in areas that we didn’t always hire them in. That takes more training to bring them up to speed. For years, we’ve been hearing that a nursing and staff shortage would be coming, but to see it accelerate as quickly as it did over the last few years has impressed upon all of us the need to recruit and to invest in staff and try to keep them in our organization.

Daniel McKinney: We see these same issues with our staffing. We have a lot of new graduates.

We recently created a new position, hiring someone we call a Nursing Advisor, who is an additional touchpoint for our new nurses to help them navigate the resources within our organization. This is an additional touchpoint, someone who is not their director, so that they can feel a little more comfortable having an open conversation. This allows us to tailor some training to the individual based on what she feels she needs help with.

We’ve all had to be incredibly creative in how we address training new clinicians in our facilities.

Jason Alexander: I think we’ll see the advent of some type of new position between a certified medical assistant and an RN because there won’t be enough RNs in the market long-term. Facilities will probably experiment with that, trying to figure out where the sweet spot is to let RNs do what they were trained to do, while the other person does the rest. They wouldn’t be clinical, but we can get them trained pretty quickly.

Moderator:  There seem to be supply chain issues for certain medications that are affecting cases. What are you doing to address the drugs we need for surgeons to be able to do procedures in your facilities?

Jeremy Clark: The supply chain has been a problem for two to three years and it’s a challenge across the industry. We’ve all had to be flexible to work with our physician customers for alternatives. Being part of a large company has helped us have access to more resources and alternatives.

Daniel McKinney: I’d add that consolidation within that industry has presented a lot of challenges. Consolidation is great until there is disruption along with supply chain.

We’ve been able to pull from our sister hospitals at times, not just with medicines, but with supplies across all categories.

Jason Alexander: We were literally running jets during COVID to pick up supplies. I could not imagine being a stand-alone hospital over the last three years. We were actually helping supply UAB – they’re big, but not national.

Moderator: What is the trend toward employee providers in your facilities?

Daniel McKinney: I think each opportunity is unique. It depends on the service line and what that provider is looking for. I would venture to say that none of us wake up every day and try to go sign up a bunch of provider employees. But sometimes the circumstances dictate that there is a better economic outcome for a doctor with a hospital. In that case, we have to ask whether it’s a good fit for us and for the provider. And is it the right thing for our patients?

Jason Alexander: I have a cynical opinion on this. I started in healthcare in the 1990s and the mandate with my first job was to employ as many physicians as I could. I did that for about five years and I left just before the whole thing imploded, at which time all the employed physicians returned to private practice and they were very angry about it. I still carry that mindset, and I say publicly that I don’t ever want to employ a physician if we don’t have to. If a physician determines that this is their preference or if it’s necessary, then we’ll do it. But for me, it’s not a strategy at all. Alignment is the strategy and this can come in many ways other than employment. So we want to define the best way to form relationships between physicians and hospitals and if that happens to be employment, then okay.

Jeremy Clark: We’re fortunate in Birmingham to have so many independent groups. That’s not always the norm in other communities where a wave of health system employment has taken over. I think having independent groups along with health system employee groups is a good mix.

Moderator: Some practices are struggling to recruit providers. Is the pipeline thinner?

Jason Alexander: This is specialty specific. There are some specialties in which you can’t find needed providers anywhere in the country. Beyond that, it depends on the market. If the market is viewed as desirable, you won’t have problems finding doctors. That was the case when I was in Charleston. In Birmingham, we’re pretty lucky. We train a lot of doctors here, and by the time they’re done, they’ve come to like the city and will consider staying. I’ve been in markets that weren’t so desirable and it’s much harder. So it’s specialty specific and market specific.

Moderator:  What kind of technology impacted your business during covid and is now here to stay?

Daniel McKinney: Telehealth. We just mentioned how difficult it is for some communities to attract really talented providers. Rural market telehealth will continue to drive a lot of our strategy.

Jeremy Clark: with outlying facilities that are a little more distant, some specialties really have difficulty providing local care. So we think there are telehealth applications with neurological issues and psychiatric. Even tele-ICU and tele-infectious disease are possible. There are a lot of applications that some other groups are providing now that we may be able to better provide internally somewhere down the road.