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The issues — and solutions – in today’s health care

🕐 12 min read

Surviving in the modern health care environment is as tricky as fighting a wildfire but also offers the promise of medical services and systems that until now could hardly be imagined, Dr. Michael Williams, president of the UNTHSC Health Science Center, said at the Fort Worth Chamber of Commerce’s Healthcare symposium Sept. 25 at the PalmWood Event & Conference center at Frost Tower.

“I believe that ultimately there’s a bright future for health care,” Williams said, “but it will require the courage to acknowledge the habits we have, the shortcomings of our current system, and the will to transform it.

“I believe we need a renewed focus on the value that’s being returned to the stakeholder. Value should always be defined, in my opinion, around the customer, and in a well-defined system, if the customer’s value is high, the rest of the participants in the system should do well,” he said.

He told the story of the 1949 wildfire at Mann Gulch 20 miles north of Helena, Montana, where 13 young men, 12 smokejumpers and one fire guard, lost their lives in a fire that did not behave as they expected it to.

Current providers are like the smoke jumpers in Montana, he said.

“They’re caught in a chasm between the old current model, that’s continuing to change, and the forces of a brand new future model that’s changing very rapidly. And they aren’t all given the skills to make that adaptation,” Williams said.

The health care industry is the No. 1 U.S. industry, employing more than 16 million people. One in eight Americans working in health care in some capacity, he said.

“What that means is that job growth in health care as an industry is incompatible with keeping health care costs down,” Williams said.

Issues facing the industry are many and known: Changing reimbursement, physician shortages, burnout among doctors and other workers in health care, rising drug prices, the emergence of alternate delivery sites, the rise of retail medicine at companies such as Walmart and a perception that the cost of the system may be greater than the benefit.

But, he said, technological advances in artificial intelligent and other areas are proving beneficial in earlier and better detection of diseases and other medical issues.

But there are still issues that the doctor-patient relationship is too hurried and too impersonal.

It is important, he said, that the doctors of the future add empathy – once common in the process – back into their training and their practices.

For the patient, he said, the solution to the issues include care anywhere, whether it’s in the home, retail space, telemedicine, digital health delivery or the hospital, care coordination, network communication, team-based delivery, education, integration and the development of new payment models.

“We need care customization that’s based on the individual patient’s healthcare goals as we become more informed about their genetic makeup, that leads to precision medicine and wellness,” he said. “We need to have many providers who have the time, because the system has been changed to allow them to have the time, to have a human-to-human relationship with each patient.”

Those are the kinds of doctors the TCU-UNTHSC Medical School wants to train, coupling scientific excellence with a human side of medicine. And that has been taken into account in the student selection process.

“We need humans to be humans, we need machines to get smarter,” he said. “As they take over more of our tasks we need the humans to become humane again. That’s how we’ll improve health care.

“I’ll end with this: Over 2,000 years ago, Hippocrates said this, ‘It is more important to know what sort of person has a disease than to know what sort of disease a person has.’”


The panel at the Healthcare Symposium included the chief operating officers at five hospitals and health care systems:

Rick Merrill, president and CEO of Cook Children’s Healthcare System; Jyric Sims, CEO of Medical City Fort Worth; Barclay Berdan, CEO of Texas Health Resources; Robert Earley, president and CEO of JPS Health Network and Mike Sandborn, president and CEO of Baylor Scott & White All Saints Medical Center.

Marianne M. Auld, managing partner of Kelly Hart and the chair of the firm’s appellate section, was moderator.

The transcript of the hour-long session was 11,000 words, so we’ve decided rather than publish a paperback on the fly, we’ll provide selected and lightly edited comments on the current status of their organizations:

Sandborn: At Baylor Scott & White All Saints, we’ve really been focused on over the last few years, bringing things to Fort Worth that hadn’t been here before.

One of the bigger successes we’ve had is a comprehensive complex heart surgery program, primarily focused on valve surgeries. A lot of hospitals have bypass surgeons, but for a long time it was very difficult to have any kind of valve surgery, or complex structural heart surgery in Fort Worth.

We’ll probably do close to 600 heart procedures this year, and probably 85% of those are not bypass surgery. They’re really the more complex valve surgeries that need to be done. …

And a large percentage of those 600 are actually done in a minimally invasive way.

I think our liver transplant program has also been another area of growth. Probably within the next 30 days, we’ll do the first live donor liver transplant in, Fort Worth – in Tarrant County for that matter – and so that’s pretty exciting. …

We’re going to be launching in 2021 a residency program that over the subsequent five years will allow for a training of about 150 new physicians in Fort Worth. Studies show that about 80% of physicians stay where they trained, especially if they go to both medical school and a residency program in the same place. But unique to that, I’ve worked with both Robert and with Jyric because we’re not trying to compete for residencies. What we’re really trying to do is offer a compliment of residency programs that either don’t exist, or don’t exist to a great extent so that the students that are graduating here from UNT or TCU have more options here in Fort Worth and have the opportunity to be trained here. It really has been a good partnership.

Berdan: I have to say that you’ve really got two different groups of people up here. You’ve got some folks who run a hospital, and you’ve got some folks who are responsible for a system. And Texas Health Resources, while we’re operating a number of hospitals, I don’t really describe our system as a hospital system anymore and haven’t for a number of years. I describe our system as a health system.

It’s important, I think, for us to look for ways that we can provide a more integrated process, and a more integrated system for patients and to focus primarily on consumers. A lot of people don’t like us to use the word consumer in health care, but every single person in this room is a consumer.

When you’re sitting in front of a physician, you’re making some decisions as a consumer, about how long you waited, about whether your trust level is there. …The key to having a system that works for patients and consumers is having one that deals with not just episodes of care but looks for opportunities to partner with people for a lifetime of health and wellbeing.

That is our vision statement now.

We look to partner with you for a lifetime of health and wellbeing. Only about 6% of the population will actually come into a hospital in any one particular year, so there’s not a lot of opportunity in a hospital setting to create a relationship with people.

We’ve been expanding the ambulatory world, if you will. We’ve been expanding physician practices that are a part of our system, and we’ve created a clinically integrated network with UT Southwestern, and where we’ve combined our population health management services together, we’re developing those together.

You’ve all heard and talked about the age wave. … We are at the peak of that right now with so many people hitting Medicare age and that’s a federal program that we have to figure out how to pay for. The federal government has done more experimentation in value-based systems, than really any of the commercial payers have. Our clinically integrated network with UT Southwestern has participated in a number of those very successfully, and created savings for the federal government, and created a high-quality performance at the same time for that patient population. So, we think of ourselves not as a hospital system, but as a health system that provides a variety of places and points for people to access the system.

How people will do that now, and in the future, is changing pretty dramatically. We’re investing in a lot of capabilities in the digital arenas, because, basically, people want today, health care to be available just like Amazon or Favor. When you want it, you pull out your phone, and order it. Sometimes we forget that it was only a decade or so ago, when these phones were first introduced. So, we only had a little bit of experience.

Earley: Let’s talk a second about the bond package because it’s a very interesting time for JPS to be in with the wonderful gift that you all gave us of an $800 million bond package.

Our question now is how many more beds do you build?

Elder care in the future is probably going to be in the setting of a home, not the setting of that really difficult situation that you have to make for your parents or your grandparents of putting them in a nursing home or putting them in a facility that doesn’t create the quality of life in some cases that they may well want.

That is a challenge at right now. What do we build? It’s not just buildings; it’s the importance of not only what goes in the buildings, but the training of those giving the care.

You can’t run a health care network unless you have physician engagement, … and we had a really hard time at JPS getting physician engagement.

We went to TCU. We picked 15 doctors, and it was hard to pick them because we tried to figure out who was talking to us, and we said, “Nobody’s talking to us. Who’s coming to our meetings without food? No one.”

We took 15 doctors and put them in a TCU program and taught them about what it’s like to have a return on investment and what it’s like to talk to your patients and what it’s like to communicate, and what it’s like to do a $1.2 billion dollar budget when you don’t just get whatever you want. And that began to make a difference. Now, we have over 45 doctors who have been in the program who are engaged with JPS and about 60 more that want to be.

It’s engagement of the public, it’s engagement of the people you have in your own backyard.

The amazing thing is we have health care networks in Tarrant County that are communicating with each other about the continuum of a person’s care. And that’s really important.

Merrill: I would say one of the challenges though that all of us face is just keeping up with the rapid population growth of this entire area. Cook Children’s has been very deliberate about making sure that we create ease of access, for our families, and the children that we serve. And so, we are in a brick and mortar movement right now and have been for quite some time.

We just finished this past year our south tower, a six story, 450,000 square foot building, to round out our inpatient services at the main campus that actually tripled the size of the footprint from what we had 10 years ago. On that same campus in the fall, excuse me, in the spring, we will be breaking ground for expanding our multi-specialty clinic, the Dodson Specialty Clinics, and expanding that about 80 plus thousand square feet.

We are opening a new facility in Walsh Ranch, just right off of I-30, with a new urgent care center, a primary care practice, and a multi-specialty clinic, starting with a sports medicine gym.

And probably the biggest announcement around growth and keeping up with the population and creating access is our north campus up in Prosper, 60 miles from Fort Worth.

This fall, we’ll be opening up an urgent care center that’s already well under construction, a primary care practice office, and in the spring, we’ll be opening up a large multi-specialty, subspecialty clinic there, as well as relocating our Plano Surgery Center, which is a joint venture ambulatory surgery center up in that area. And then later in the spring, we will be having a groundbreaking, a new children’s hospital in Prosper. It will be a short stay, primary, secondary and some limited tertiary care services.

Sims: We’ve invested right at about $160 million into our campus and our system over the last two years, that came by way of a $65 million new tower, which includes our new emergency room, a neuroscientist floor on our second floor and our third floor shield for future growth, which we’ll be looking to build that out towards the Q1 of next year. That is really seen about a 20% growth in our volume year over year, which has made way for us to be able to really care for more in our community quite frankly.

We treat quite a few patients from out west and bringing those patients into our system allows us the ability for our physicians and our nurses and our care providers to provide exceptional care to every patient every day.

We’re honored to have 83 residents and fellows in combination with UNT Health Science Center and soon to be with TCU, so we’re really looking at educating and growing the next generation of physicians

But if we really get underneath what I’m most proud about, I can talk about our new freestanding emergency room in White Settlement. We’re just seeing about 30 patients a day right now.

When I look at the quality improvement, and service improvements we’ve made year over year – our turnover rate is close to 10%, whereas historically it’s been up around 36%; the septic mortality rate being cut in half.

I can go on and on about the hospital system, we’re but just happy to be in the community. We’ve been in the community now 43 years.

Our vision statement is to be the destination of choice for health care excellence. And we mean that for our physicians. … Our service to our employees and our service to our patients is ultimately what I’m proud of. It’s a great time to be in Fort Worth.

Paul Harral
Paul is a lifelong journalist with experience in wire service, newspaper, magazine, local and network television and digital media. He was vice president and editor of the editorial page of the Fort Worth Star-Telegram and editor of Fort Worth, Texas magazine before joining the Business Press. What he likes best is writing about people in detail and introducing them to others in the community. Specific areas of passion are homelessness, human trafficking, health care and aerospace.

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