The Becker's team is excited to announce the launch of our new CFO and Revenue Cycle podcast. Tune in for conversations with finance experts from the top hospitals and health systems. We'll discuss key trends and ideas to drive meaningful change in the industry. Look for Becker's CFO and revenue cycle podcast wherever you listen to episodes. Hello, and welcome to the Becker's Healthcare podcast recorded live at the twelfth annual CEO and CFO roundtable in Chicago. I'm joined today by Doug Pogue, president of BJC Medical Group. Doug, would you start the interview by telling us a little bit about yourself, your background, and your organization? Yeah. Thanks very much. It's really a pleasure to be here. So, yeah, I'm part of BJC HealthCare, which is a large health system in St. Louis, Missouri. We're affiliated with Washington University School of Medicine and with St. Luke's Health System in the Kansas City area. And I've been, there for twenty five years, mostly as a primary care physician, and, then the last seven years, I've had the privilege of leading our, our employed provider organization, which is about 700 or so, providers. And we have about a 53 clinics or so in the greater St. Louis area. So, cybersecurity among hospitals and health systems is something that's been in the news more and more with hacks and ransomware. As a leader, how do you prioritize cybersecurity investments against other critical needs within the hospital? Yeah. We've we've really had a a big challenge with this. We get about 18 to 20,000 attacks a day. Oh, wow. And so it's been enormously important for us to be aggressive around, shutting our systems, well, closing our systems up and tightening the security that we have in them. Because that can get very expensive very quickly, we've been focusing on structural designs that have been, been helpful. For instance, we've had to lock all of our computers, down to the point that they are for work purposes only. It used to be that if you had a work laptop, you could, on a Saturday, check a email, from, your Google or some other account. You could stream something. You could do some other kinds of of work on it if you if you needed to. We have to lock all that stuff down to ensure that there's really no ability for folks to, in it, you know, kind of unwittingly ingest something that, you know, some kind of malware that then could get into our systems. Mhmm. And I'm sure, you know, as a leader and as an organization, you don't wanna deal with the bad press around one of these big breaches as well as, you know, it's important to kinda keep that trust with the patients as well. So can you do maybe a little bit, of a deeper dive into, you know, some of the recent cybersecurity initiatives that, maybe required a big financial investment, and decision making effort on your end? So part of, the investments we make are to simplify so that we can strengthen and fortify. For instance, we had, over a hundred different kinds of websites, in our health system that, were used for different purposes by different hospitals or different entities. And so coning all that down into just a few websites that have internal type controls and a lot of firewalls in them, strengthens our security. The same thing with applications. We've had to spend a significant amount of money. We had over 600, different applications, for different things that are used in our system. And so spending money to try to consolidate those to really simplify down into fewer where we can maintain them better, we can keep up with whatever the latest updates and security patches are, and, so that we really understand and know what our vulnerabilities are so that we can, you know, adjust for those and and fortify those, has been very, very helpful. But that's taken a lot of a lot of, people hours, and it's taken a lot of money to be able to to do that to kind of, you know, pay money to bring in systems that would then bring, you know, make make some of those other systems obsolete and simplify. So shifting gears a little bit, but still staying within the realm of technology. You know, we're at the Becker's Healthcare CEO CFO roundtable, and I'm sure the hottest topic here as well as the hottest topic in any, you know, sort of news article around health care is AI and, you know, its current and future use cases. Are there any AI innovations or automations that you're, particularly excited about potentially deploying into 2025 as well as, you know, your concern any concerns around their potential impact? Yeah. You know, it is it is the hot topic, but it definitely, for folks that dive into it, it's not a it's doesn't fix everything. And so we focus our priorities on a few things. One is safety first. We cannot have, changes in care or bad medical care, because we've used a tool inappropriately or without appropriate supervision. But then we've kind of gone for wellness second. So the second priority is being being the wellness of our caregivers as opposed to, you know, financial gains or other kinds of things. And so in the wellness space, a couple of things. On the medical group side, where I am, we have four pilots running, currently, and we're gonna deploy kind of a large scale here in the next couple of months. Our ambient listening, program, to basically, listen to the the appointment and and put things into the, our electronic medical record, is saving our providers about an hour or more a day, like, every day. And so that changes dramatically, the amount of out of work time, you know, updating in the in the electronic medical record, and and people are kind of home for dinner, if you would, and they're done. And they and that's that's really been transformative for them. Interestingly, as we as we employ some listening software, it catches things that the patient is trying to tell the doctor or the caregiver that the the caregiver then is missing later on. And so we've actually found that the care is more complete, not just more easily documented. So you're really using AI to to supplement that as instead of just kind of replacing it. How how would you say the AI can and is improving the patient experience overall? It really does. So the, the important thing for us is that when you're having an encounter with a patient, the patient is the most important person in the room. And so eyes locked on, and focused really listening carefully to what the patient is trying to tell you and kind of having a great interaction and not being distracted, by the computer is an important thing. The patient the patient satisfaction scores are going up, in places where we're using the the these pilots, mostly because, again, they're having a better interaction, individually with the person, and they're not, seeing the doctor kind of kind of listen to them, but then get computer screen, trying to figure out where to click and all those kind of things. With that taken away, it's a much more personal interaction. The patients like it a lot. A %. And we talked a little bit about kind of what you're looking at for next year. What partnerships, alliances, or ecosystem strategies are you considering to, potentially enhance your position, serve new markets, and or expand your services in 2025? Yeah. Well, that that yeah. That that's a there's a lot there. So, a couple things. One is we've we've, figured out that, doing things in a targeted way has been much more impactful than trying to go for general solutions. So as we try to form partnerships or other kinds of of tech enabled things, there's a number of companies that wanna come and and provide us with very broad comprehensive solutions, that hasn't been nearly as helpful as as very targeted impactful things. So we've been focusing on on on key issues that we wanna we wanna, go after. Mostly, again, provider wellness, provider, productivity, and then the experience of care for the patients. And so we've been we've been focused there. From an expansion standpoint, we did acquire, in the last, you know, eighteen months, a new health system partner, over in the Kansas City area, St. Luke's Health System, which is a just a fantastic organization. And as we're doing that, we're starting to kind of rethink through how do we understand, true best practices in the different organizations and really come, to adopt those in in every direction. And so, we've been focusing our our growth plans mostly on how to make the things that we have or that we're associated with now, how to make those work as best as possible and and create sustainability, create, you know, kind of an effective margin, other kinds of things in those spots, before we get any larger or take on anything else. And so, so our focus has really been on operational soundness and and and effectiveness, as opposed to just growth and expansion alone. So, you know, you talked about your your priorities and goals for next year a bit. What KPIs or financial metrics are you tracking to ensure your targets are being met? Yeah. One of the things we're seeing in our markets that I think are probably true across the country is as the baby boomers are getting older, they're retiring, at at speeds greater than they're being replaced, in the current, Gen z and, millennial generations in the workplace. What that means for health systems is is your commercial market share is probably slowly going down, and your Medicare and other other governmental payers are going up. From a profitability standpoint, that directly threatens the bottom line margins of many hospitals. And so, we're starting to to take more action around how to take each of those segments and make them, either more profitable or just our expenses and and the way we do care, to help. So for instance, Medicare Advantage offers potentially the the possibility of, of getting paid in a different way, so that you can actually maintain your margins because the global budgets, if you can make money in there, then you can that supplements maybe some operating losses at the hospital. We're also being more aggressive from a triage standpoint of really understanding who's gotta come in our hospital and who doesn't and not admitting people who, who really could be very effectively and and appropriately cared for in in other lower cost sites of care. Because the cost, of, of bringing someone in, particularly if they're an observation status into a hospital, It doesn't really need to be there, is tremendous, and you end up continuing to lose money on on those patients. And the the care is good, and it's important to take care of somebody, but we really could do that in a place that be financially more sustainable someplace else. Mhmm. Mhmm. So one of the the themes that we're consistently hearing here is, and you touched on it too, is just not only with AI and, you know, the the technology. It's it's a really exciting time to be in health care, but also particularly challenging as change is happening so fast, especially when it comes to things like, you know, the increasing Medicare population and things like that. What what advice would you have for other leaders in the health care space based on your experience to kind of help them with that current, climate in health care? There's several things. One is if you wanna play in the value space, pay attention to the regulatory changes, not not only that have happened in the last year, but that are likely to happen in the next kind of, federal administration. The conversion, for instance, of of v '24 to v 28, risk coding, is is really, really important. And so helping your providers, learn that system right away and to be able to fully and appropriately, code for the, you know, the actual medical complexity and risk, of their patient populations is critical if you wanna make a margin in the Medicare Advantage space and even in in just the MSSP and other other spaces like that. For hospitals, if, if they're looking at their, their kind of case mix index and their and their CDI, related improvements, that's a mixture not only of of the documentation during the admission for the DRG or for other payments that you're doing under Medicare, but at the same time, HCC scores from the outpatient arena now play into that as well in terms of understanding, does the patient have, you know, kind of a either a complicating complex condition or a major complex condition that dramatically changes the risk rating of that patient and thus the payments and the expected length of stay in the hospital. So as you as you understand that interface between the outpatient and the inpatient, it's gonna help hospital leaders be able to to effectively and appropriately, understand, who their patients are and get paid appropriately by the government for those patients. If you don't do that, then it will look like, a very sick and I'm sorry, very healthy and and uncomplicated people in your hospital having bad outcomes. And that affects lots of things downstream for the hospitals. That starts with understanding what in the world is b 24 versus b 28, and how do I teach my doctors to code that way. And so things like that that are small regulations that a Medicare Advantage company would would understand, but that your average hospital president walking around may not understand or be in tune with. Linking those kinds of things is really important to make sure that you get those downstream, metrics that are really gonna help your hospital both on payment rates and, like, your rating systems under Care Compare and those kind of things. Can you talk a little bit more about the importance of staying focused on the here and now with patient care, you know, financials, as well as, you know, keeping your eyes down the road for the future of, you know, additional change or changes and challenges that are coming in the future as well as, you know, staying up to date on any innovations that are out there. Yeah. The, the here and now has gotta run, well. And and so like many systems, we've adapted, kind of a high reliability system and framework for how we do that, and and we've got everything, you know, leaned out and and, are focusing on kind of consistent operations that you push down into the organization. But I think it's also true that as you think about care, you know, one year, three years, five years from now, the changes that are happening are not incremental small improvements on what we've always done. You know, making things a little better or helping people get better scores or being more reliable with what they do. They're really big changes. Some people here will call them transformational changes, but, to not overuse the phrase, it's just fundamentally changing what we do and the way we do things. So, I think leaders, it's critical for them to to look at what will what will change everything, as they as they think about kind of the kind of care and the the ways that they care, today for patients and adapting and embracing those big changes and figuring out how they can move their systems into that area. AI certainly is one platform in which we're gonna have a lot of those kind of changes come through. There are some others, that are out there. And so and so thinking through big fundamental changes, I think, is gonna be, you know, super important for leaders much more than a decade ago. So you talk about that. But how how significant is that difference between how fast things are changing now versus how fast they may have changed in the past? I think, now, you're going to be able to do in a year and a half or two years what would have taken you five years previously to do. And, so for instance, even if I just take a simple program like a computer that listens to the doctor and types it into Epic or into whatever your electronic medical record is, that ability to take out one to two hours of time per provider per day and fundamentally change both their productivity, but also their wellness and the efficiency of your clinics, to drop over time, other kinds of things like that. Just taking a medical clinic as a small microcosm, that's now gonna be table stakes for profitability going forward. And so if you're not doing it, if you're not able to leverage that more quickly, I think people are gonna find themselves continuing to struggle with, just their costs as as labor costs get higher and other things. We're gonna have to get the most out of that labor if possible. And and if you don't have the right tools in place, it's gonna be very difficult to do that. Are there any, technologies coming down the pipeline in the future that may ready, you know, or that maybe aren't ready for daylight yet that you're particularly excited about? Yeah. And so I think I think people are starting to figure out that there's a lot of human decision making that goes on, in hospitals and in transitions of care that really could be enhanced with, engines that pull data from lots of different parts of the medical record and summarize that in a very clear set of of decisions for, for the patient. So for instance, we're we built one that, that automatically reads a patient's chart live while they're in the hospital and understands when they are going to meet criteria where where, palliative care and even hospice care should be, brought in, because of of trends or other kinds of things, and it actually automatically makes the consult. That resulted in, a 300 increase in conversations around goals of care. Interestingly and and not this was not the design of the pilot. Interestingly, do not resuscitate orders went up by 30%. Oh, wow. We weren't necessarily hoping for that or trying that or anything like that. It was just simply that when you have the conversation, you get these outcomes and and the patients make choices. But that was that was all done automatically, and and the and the, you know, the three x increase that we've had in those conversations was very, very important so that we were aligned with, you know, the patient's goal of care and what they wanted. And so, so that was very helpful as a as an engine. Those kind of things, I think, different companies are starting to do. We're not seeing that really on the commercial basis. I just see hospitals and health systems that think, you know what, this should really be a good idea. So whether it's building something that detects sepsis so you can intervene really quickly or other kinds of things, those those types of advancements where we're really gonna use machine learning and machine awareness, to try to, really help humans, that are caring for, for these patients act faster and be yet more impactful. I think that's really gonna be exciting on the care side. So, you know, you talked about the, the DNRs increasing by 30%. Mhmm. As you have this ability to comb through data and review data with the help of AI and automation that that's never, you know, been done before, are there any other, like, insights that you didn't expect or anything else that you've kind of gleaned from it that you, you know, that kinda caught you off guard or that you found particularly interesting? Yeah. The the, couple things. One is that when you bring in palliative care earlier, not only does patient experience get better from, like, you know, pain and and and and and other kinds of things. Interestingly, they start to live longer. They they they do better. Some of the some of the interactions that a lot of people think are just helping someone feel comfortable while they're they're going through a really bad process, turn out to be very functional and and will drive, drive some health outcomes we weren't expected. But literally, it's kinda like the same reason that we started getting people out of bed and realizing this is a lot better if you got them out of bed sooner and got them walking again and those kind of things. Some of the palliative, symptom relief approaches actually do help patients, and they do better. They get out of the hospital sooner, in some cases, live longer, than if they didn't have those those, interactions. So some of that kind of stuff actually was really impactful that we didn't expect going in, but that's been a great boom coming out of it. That's fascinating. That's absolutely fascinating. Doug, again, I really appreciate your time chatting with us today. Do you have any final thoughts you'd like to leave with our listeners? I think, the final thought I'd have is that it's a really, really exciting time to be in health care. Health care can be stressful. These jobs are difficult. But at the same time, we get the privilege of of caring for our neighbors and our communities, and we've got some crazy good tools that are coming down the way that's gonna make the the work easier, that's gonna make our impact you know, higher. And, and and we're gonna be able to do things that we just never could do, ever in your your career. Certainly, I've been I've been doing this about twenty five years, and I it's just really exciting what we think we can do in the next five. So, so I'm excited about it. I hope other people are are well, but I as well. But I would, just encourage everybody to really embrace big transformational changes because I think if we can do those and pull them off and do it right, we're really gonna be excited about the results when we get there. Well, Doug, thank you again for joining us today on the Becker's Healthcare Podcast. I hope you have an absolutely amazing rest of your day. Yeah. Thanks. It's a pleasure. Appreciate it.