Introduction and Episode Overview
[00:00:00] Stacey Richter: Take Two. "The Just Spend Everything You're Given Trap—Lessons in True Provider Fiscal Discipline That Make You Go, Hmm, No Matter Who You Are." Today I am speaking with Gary Campbell.
Exploring FQHCs and Fiscal Discipline
[00:00:29] Stacey Richter: This episode is part of the “Inches Are All Around Us” series looking for all the little pockets, inches, if you will, that comprise the greater than $1 trillion in healthcare waste in this country annually.
Many of these inches, if we hack them out, will actually improve patient care because these inches are just like the friction that's in the middle.
To this end, I started thinking about FQHCs, federally qualified health centers, which are these FQHCs in this context, if you think about it, kind of a great laboratory for scrappy and amazing case studies about finding and cutting out waste with some serious fiscal discipline.
The thing with FQHCs and why they are great places to I spy inches of waste is really because if an FQHC has a budget shortfall, they cannot solve it by cost shifting to commercial patients, commercial members, commercial plans, they have no commercial patients.
Also, they have a patient population that many would consider challenging and they cannot restrict access. They gotta make do with what they have. They must have actually true fiscal discipline. They either figure out how to be efficient, or their patient population does not get care.
But what tipped me over the edge to revisit this episode from 2021 with Gary Campbell, who is the CEO of an FQHC, by the way, I picked the show to revisit because of my conversation with Nikki King that I had earlier this year.
Nikki and I caught up and she is now the CEO of an FQHC in Indiana. I had interviewed Nikki, by the way, about rural health a few years ago [EP338]. So go back and listen to that if anything I say today, you find intriguing for other reasons.
Tribe, this is interesting to think about what I'm about to tell you. Really, I've been thinking about it for six months.
Nikki King's Innovative Solutions
[00:02:35] Stacey Richter: I wanna start out here recapping my aforementioned catchup conversation with Nikki King as the lead in to my conversation with Gary Campbell to follow.
And to be specific here, Gary Campbell is the CEO of an FQHC in Virginia called Johnson Health Center and Nikki King is CEO at Alliance Health Centers in Indiana.
Let me tell you one thing that Nikki King did. There are many things that she did, but here's one that she told me about. Nikki realized after talking and listening to their patients, that one of the biggest barriers to getting care at her FQHC for patients was no transportation.
Also as most FQHCs, they were short on funds. So doing things like free Ubers or something like that was not an option. So you know what Nikki did, she thought about where her patients are. For example, most referrals to their addiction treatment services came from the courthouse. A judge remanding, if that's the right word, someone to treatment.
So two birds with one stone style, Nikki marched over to the courthouse facilities person and asked if they had any open office space at the courthouse, you know, work from home and all of that. Maybe there were some open offices. Well, the courthouse did. They had some open offices. So now rent free or almost rent free, I don't, I'm not sure. When a judge says to somebody, go get addiction treatment, that judge can also point down the hall and the patient can just walk over.
Nikki did the same thing, setting up a clinic in a daycare center. She set up a clinic in a homeless shelter and right by a big basketball court.
You compare and contrast this, I don't know, “just get it done” approach to all of the times that you hear about in “some cash strapped entity” who decides the best thing to do immediately is new construction. Pay to build brick and mortar. And then in perpetuity, of course, pay all the costs and the snow removal and the security and the utilities and repair for that new construction.
And they could be an FQHC building new buildings, one of the less scrappy ones, but it also could be a big consolidated health system or anybody in between. It's amazing how many times you hear "razor thin margins" and then you hear new construction in the same sentence.
I'm like, yeah. Gotcha. Upsize. Call it my Pennsylvania, Dutch and Bronx heritage. But yeah. Head exploding. That was a tangent.
Bottom line, however, I say all this to say, FQHCs, the ones with great leadership at least, are a wonderful case study to look for insights on how to operate in an environment that cannot rely on, again, raising commercial rates and cost shifting to balance the budget, right?
Let's not forget, there are two very different ways to end up with no profit. One is genuine struggle. The other is simply being very good at spending every dollar that is given to you.
For plan sponsors, this is a vital distinction, regardless of how loud anybody cries, poor, any clinical partner who lacks fiscal discipline isn't struggling, they're inefficient. And we do not have a market in healthcare to be able to tell who's struggling versus who is inefficient.
So yeah. Keep that in mind and listen to episode 490 and 492 after this one with Shane Cerone and Dr. Sam Flanders for more on the whole, There's no market theme as well as more on the fiscal discipline topic.
But again, this is why FQHCs are such a good case study here, because there's an upper limit to how much money they have, and most circumstances, I mean, barring some big donation or something like that, but under most circumstances, they have a revenue cap that they have to be disciplined enough to work within.
[00:07:30] Stacey Richter: Okay. One last thing before we kick into the show today. I wanna be really clear here. Fiscal discipline isn't something that any individual doctor or nurse, or other clinician can tackle in a vacuum or even any given administrator. It is a leadership imperative.
Great leadership doesn't just manage the clinical side. It takes accountability for the administrative waste that keeps margins thin and prices high.
So here's actionable advice for anybody listening, regardless of what you may or may not have to do with FQHCs. If you're a plan sponsor looking for a clinical partner, consider like what Nikki King is doing and the thinking that Gary Campbell is gonna talk about as a benchmark.
Real value comes from finding the organizations that treat fiscal discipline as kind of a mission critical strategy because these days with all the affordability issues, it is financial toxicity is clinical toxicity. I mean, maybe you can find an organization that actually does unit cost accounting. Listen to the show with Dr. Mick Connors.
Gary Campbell's Insights on FQHCs
[00:08:32] Stacey Richter: Okay. As I said earlier, my guest today is Gary Campbell, who I spoke with in 2021, so this is a deep cut from the archives, but it's also a really great show. Gary, as I said earlier, is CEO of Johnson Health Center, which is an FQHC, a federally qualified health center in Lynchburg, Virginia.
He's also the president of Impact2Lead.
My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Gary Campbell, welcome to Relentless Health Value.
[00:09:01] Gary Campbell: Thank you for having me, Stacey. It is an honor to be here.
[00:09:04] Stacey Richter: There's no opportunity to cost shift for inefficiencies between the commercially insured patient population and then the uninsured and Medicaid patient population in a federally qualified health center.
[00:09:18] Gary Campbell: No, you can't. We cannot refuse access to care for anyone, and we do not.
[00:09:23] Stacey Richter: I'm talking about financials here. But at the same time, there are other consequences to inefficiencies besides just running outta money and then not being able to serve the patient population that you're trying to serve. If a facility, a care delivery entity is running pretty inefficiently, what winds up happening.
[00:09:40] Gary Campbell: Well, that's a great question because typically the first thing somebody would wanna do is throw a body at it or throw two bodies at it. That always tends to be the first response for if there's workflow inefficiencies that are happening within a clinic or one of our practice sites. And it's always, “Hey, we had this person doing this, or we could get one more resource here.”
But have you workflowed it? Have you applied a Six Sigma approach to it? You can overstaff yourself in a way that your cost per patient goes way up and then that draws your margins at the very bottom line much closer together. You really have to look at things in greater detail, and it's a broader spectrum than just, you know, adding cost or adding technologies or adding, you know, more people to the picture.
[00:10:23] Stacey Richter: It's funny because a lot of times if you say take a Six Sigma approach, you have clinicians across the country feeling like this is an excuse to cut staff beyond which what is, and make their lives miserable and, and increase patient loads untenably for example.
So maybe you wanna just drill into a little bit, we're kind of using the Six Sigma as a sort of broad stroke here, but what are the highest level things that are required so that patients receive the best care but doing it in a financially responsible way?
[00:10:55] Gary Campbell: One of the things that we're doing here, and we're doing it right now, it's a matter of fact, we just put the finishing touches on our three-year strategic plan, and one of 'em is re-engineering our care teams in a practice transformation format.
That's all part of your culture. And when you have these discussions, you gotta make certain that you're including the very people who are doing the work. This is where a lot of times your providers, especially your physicians, your nurse practitioners and PAs, and you see this in a lot of places. It's, you know, the administration made this decision, but they didn't include us in the conversation.
[[00:11:24] Stacey Richter: Does this remind you of anything? Yeah, it reminded me for sure of the whole conversation with Shane Cerone and Dr. Sam Flanders in episode 490 and 492, as well as shades of the conversation with Dr. John Lee, the one with Dr. Beau Raymond, also Dr. Amy Scanlan [EP402], Eric Gallagher [EP405] from Ochsner.
They all say the same thing. Bottom line, you can't have a quality czar three states away drawing spaghetti diagrams and making executive decisions for everybody. You gotta empower those responsible for the care that doctors, nurses, clinicians, even administrators who are close to the ground to find and fix problems.
That is the only way this works. But that is a cultural paradigm shift and a leadership paradigm shift. The thing is, though, any, especially big provider organizations who are not rolling this way will have a whole lot of inches of waste and of friction that does impact patient care.]]
[00:12:26] Gary Campbell: We work very hard here not to have that be the discussion, you know, we're not perfect, but in most cases, especially as it comes to workflows and looking at, leaning out how, how a patient gets from the very first call they make into your center when they walk in the door, how they're checked in, what's the process for getting to the back?
Do we have standardized workflows? Do we have, you know, all our nurse operation and the nurses are linchpins to everything because you think about your nurses. They're in the middle of it all from the time that patient is done at the front to the time that patient walks out at the very end.
So are there standardized procedures with how the nurses are performing and a lot of times providers or physicians, I use the word providers 'cause I'm including them all, have preferences for how they wanna see, you know, their patients come in. Some providers wanna do more than maybe other providers do. So we look at everything and we involve those providers. We involve nurses in those discussions to create standards.
And that's again, what we're in the middle of now is re-engineering our care team process. The technology is a big part of it too. Half of our staff wanna use dictation software. The other half says we don't wanna touch it, but at some point we've gotta come to some decisions on how we're gonna be, you know, standardized things so it makes it easier.
My vision and goal at this health center is I want the patients to have the best experience, but I also want our staff to have the best experience in how we take care of people.
[[00:13:44] Stacey Richter: I wanna read something that Dr. Eve Cunningham wrote on LinkedIn the other day. She wrote, "Back in the day, I did a cost per case analysis for benign hysterectomy across 40 surgeons at a healthcare system and the variability was wild. We distilled down and normalized, she gives some details for how she did that, I was so excited by the discovery that we could maximize average contribution margin per case if we could align leadership around best practice implementation. Imagine the response I got, which was nothing to be clear.
"There are mountains of opportunities like this, especially in surgical care. All health systems do financial analysis of their service line and sub-service line financial performance. It's just the focus has been more in trying to capture volume and market share, ie, growth, rather than creating cost efficiency in the OR through surgical excellence.
"Surgeons who own their own ASCs know this math well and practice it religiously. When they don't own a stake, ie, hospital-based ORs, they have less incentive and support to optimize. The incentives for the hospital admin folks should be aligned to this, but it requires significant cultural overhaul, change management, strong and empowered clinical leadership, and the right technology to provide transparency that is engaging and actionable."
Link in the transcript to this comment if you wanna see this whole conversation on LinkedIn. But yeah, we've got multiple people who are pretty much saying the same kinds of things.]]
And how does standardizing in the ways that you just talked about, you know, standardizing the technology, standardizing patient flow, how does that ladder up to the best experience that patients can possibly have,.
Because there's a lot of people that would say standardizing care. You know, you've gotta treat the patient in front of you, not the average patient, for example. How does standardizing care actually create more personalized care potentially?
[00:15:33] Gary Campbell: Well, and I can only speak to what we're doing here.
We're set up on 15 minute and 30 minute visits for our physicians and APPs. My goal has always been I want our providers to spend more face time with our patients. So what does that look like from a standardization of care perspective? We've worked hard on standing orders for the nurse team. We've worked hard on what can be entered prior to the patient getting in the room.
As much as we like to believe the patient loves to see everybody when they get here, that patient's here to see the provider. So the optimal goal is that patient gets to spend as much time with the provider as that patient at that visit time will allow.
So from a standardization perspective, I have nine locations that I run. I want the exact process done from the time that patient calls to the time that patient walks out the door from front to back.
Now, depending on the clinical chronic conditions, depending on the complexity of the patient needs, they have autonomy and how that can look. But if we're looking at 80% of the workflows and how patients come and go, that's where I look at standards.
And the other piece of this is our clinical teams see that we care. And they know we're trying to make life easier for them. And so we are getting a lot of cooperation around that. That's what I consider standardization of care as it relates to just the, the processes.
[00:16:46] Stacey Richter: What's necessary to pull off some of the things that we're just talking about here.
[00:16:51] Gary Campbell: Well, the first thing you gotta have is a vision. If you don't have a vision for where you want to be, two and three years down the road, you're struggling because then you're gonna be stuck in the day to day and you're gonna be in the grind. And it's difficult to motivate a team behind purpose and passion if they can't see where you're going.
One of the things we've always talked about here is you don't want everybody to understand what you know, what is their why? You know, why do you do what you do? I remember three years ago we held an executive retreat and I asked that question. I asked of my executive team, I said, what's your why? This was supposed to be a 15 minute exercise, and you would've been surprised at the number of people who had difficulties coming up with their why.
You have to know why you do this work, and you have to be able to convey that to the people who are gonna help you get it done. That's the first piece, and that is gonna help drive your workplace culture.
Leadership and Organizational Culture
[00:17:39] Stacey Richter: So let's just make this a leadership objective. The leadership team is, are really the ones that have to sit down and make sure that there's a vision and purpose for the organization, but then also each individual working there is aligned with that.
If we're considering this the first step, then what's the next step?
[00:17:54] Gary Campbell: Well, I'm gonna back up to 2014. When I took over this health center. At the time, our leadership team looked much different. At the time the vision was we would become an employer of choice. And we would do it under two years. Not everyone was aligned with that.
And so when you assess your leadership team and you start digging into the purpose and the why that the existing team at the time had, and there's misalignment in their own value system, changes need to be made and changes were made.
So once we got people who were aligned with that particular vision we grew together and we've grown since then.
[00:18:28] Stacey Richter: When you came in, it sounds like you set the objective, become an employer of choice, and that's what certain people on the leadership team were not aligned with.
[00:18:36] Gary Campbell: Correct. It was a different culture and I don't believe they thought we had the particular staff to pull it off. And I don't think that, and, and frankly me coming from, you know, the for-profit sector, working for global companies, I don't believe they thought that I had the type of experience to pull that off.
At the end of the day, it's not so much the experience, it's just the passion and the ability to enable others to act and encourage people to want a better place to be. And so, you know, there were a lot of, you know, clearly hidden agendas. There were some things, there were some people who were not aligned there.
They didn't want things to change. And that's anywhere you go. Anytime you and I tell you, any of the, any listeners out there that if you're new or you're coming into a role, or if you've been in role for a long time, you have to always make sure you establish what you want to see.
[00:19:20] Stacey Richter: It definitely sounds like you came in, you took a look around and you realized to attain maybe your longer term vision, you had to have really good people.
[00:19:29] Gary Campbell: Correct
[00:19:29] Stacey Richter: So the mission was very dependent on the, the staff that was there. It definitely sounds like that is gonna certainly permeate into the culture of the organization.
[00:19:39] Gary Campbell: That is true. And it, it's like anything else. You, you have to do it in steps and in phases. So, when I mentioned the employer of choice piece, you know, we went with the original Employer of Choice Certification that Joyce Goia and Roger Herman wrote the book on.
We wanted our employees to, to rate what they perceived of leadership and how they felt about being here. And by the time we got there, we had scored some of the highest culture scores that they had seen. Now, fast forward, you've built an employer choice culture. The work gets much harder because. Now you've established yourselves as this is where the bar is.
And so as you add people to this bar, they don't know what it was like before. They know what it's like coming in. So you know, you have to continually keep your leadership team engaged in the process of doing a lot of listening, being empathetic, helping develop their own staff, succession planning for their own positions, but being intentional about everything.
We use a lot of coaching and mentoring here at this health center. I'm very adamant about our executive team down through our senior leadership team to be visible with their people. You see your people, you stay engaged with your people. You know it goes, I go back to workplace culture. If you don't keep a finger on the pulse and keep active with what's happening in your culture, it will manage you.
[00:20:51] Stacey Richter: As they say, culture eats strategy for breakfast, lunch, and dinner, right? So, obviously it's something that maybe people need to spend more time thinking about than it appears they often do.
[00:21:03] Gary Campbell: Agreed.
[00:21:04] Stacey Richter: Okay, so we've got vision, we've got culture. You know, one of the things that you've said is a lot of times overhead can be self-inflicted.
Challenges and Strategies in Healthcare
[00:21:11] Stacey Richter: How do we get from culture to ensuring that we have processes and procedures which help make any given organization a great place to work. Because a place, even if it had their best culture in the world, if it had horrible processes and procedures that everybody hated, then obviously it's not gonna be a great place to work.
[00:21:32] Gary Campbell: Correct. I think you hit it right on the head. Those two go hand in hand. If you think about what impacts someone's wanting to be here, wanting to, you know, practice medicine here. How are procedures set up? How are the workflows set up? Does it make my world easier? Do I go home pulling my hair out at nights?
If you have the expertise in house, then you involve those clinicians. You constantly having conversations around it, whether you do it with your continuous improvement committee, your quality committees. Whether you're doing focus groups, if you just tackle one practice location at a time, I like to look at it from the viewpoint. You have to take a step back and take two steps forward.
You may have to forego some revenue for a short period of time to slow the processes down to see where you have some opportunity to improve them.
[00:22:16] Stacey Richter: Could you give an example of a case where revenue took a hit in the short term in pursuit of a longer term goal?
[00:22:22] Gary Campbell: What we have done here is we've committed to pulling providers off of the floor to get involved in projects. At the end of the day, you know, reimbursements are tied to the physician visits of how many patients we get to see and how will we take care of them. So if we're looking at a, at a major project, this care team reengineering process is a pretty major project.
What that's going to mean is we're going to have to pull practicing clinicians off the floor for half a day at a time so that we can work on, you know, first of all getting their input. But secondly, once we have their input and once we've built some pilots around them, then if we're tying technology to this, if we're integrating with our in-house pharmacies or our mental health team, we have a dental practice as well.
So how are we integrating all these services together? So who all has to come off the floor to help us build these things out? You are foregoing revenue for that, but the goal there is you're gonna optimize it on the back end.
The other thing we just recently did is we created an additional layer of leadership between our medical director and the provider staff. We now have associate directors at our pediatric practice and also in our adult family medicine practice, and we gave each one of them an administrative day as well because they are able to really look at this thing from a boots on the ground perspective and help give us some opportunity to make improvements. But it also gives their peers and people who are practicing medicine the opportunity for direct and quick feedback.
Again, you forego a little bit of the revenues on one side with the hopes that you, number one, you retain staff this way too, because if there's more opportunity to provide feedback and to be able to solicit input, in a lot of cases, that's what, especially our provider population's looking for.
So that's what we do here and, and it hasn't hurt us at the end of the day, it. It's been a big benefit for us.
[00:24:07] Stacey Richter: Like a lot of this is on leadership's shoulders. It definitely sounds like like C-suite level, for example, vision across the entire organization, the culture that is established and the emphasis on it, and then operationally.
Many complaints rise up from, yeah, I sat on all these committees and I made all these recommendations and then nothing happened.
Like that's almost worse than not having the meeting to begin with because everybody feels like not only did nothing change, but I wasted a ton of my time.
[00:24:33] Gary Campbell: When there's change, there's committees, there's meetings that happen and then all this work gets done and nothing comes out of it.
What we do here, and I learned this way back in, in other places, you have to project plan things out that you want. If you're serious, if people are meeting on something, you better have a project plan. You better have deliverables. You better have the dates. You better have who's responsible, and there better be an outcome.
Because unless there's a project plan with an end date and an outcome associated with it. I don't wanna see it. I don't want our people meeting on it, and it's a waste of time.
So that does provide some credibility. When we involve people in teams here, they know something's gonna come out of that.
[00:25:12] Stacey Richter: And that again, seems to ladder up to leadership. If the C-suite is the one that is calling these meetings, or it's the C-suite that's not sending a clear organizational message like, “Hey, don't waste everybody's time with meeting fatigue.” Then you're gonna have lots of meetings and people checking boxes 'cause they met about it, not because anything actionable actually happened.
[00:25:34] Gary Campbell: Yes. And we've all been through that.
[00:25:35] Stacey Richter: That we have.
So operationally there definitely also seems to be aspects here that, again, ladder up to leadership, which reminds me of, you know, Dr. Robert Pearl, either in his first book or his second one, and others have said early and often they don't teach leadership in most medical schools.
So it's super hard for doctors a lot of times to lead teams or maybe necessarily understand what needs to happen in order for change to happen.
So a lot of times they'll tend to micromanage and think they have to do everything themselves solo, because if you aren't confident in your ability to rely on others to do really, really important things, and we've got patient lives at stake, so the stakes are super high here, then you wind up not necessarily with the strong organizational aspects that you're talking about here.
[00:26:29] Gary Campbell: You're right. One of the things, and you mentioned, and Dr. Pearl says what we all know, and physicians will tell you the same thing. They don't get the types of leadership training. They're busy. I mean, but most of the folks in the, that go through the, their medical school or the residency and the work that's all part of that. That's a lot.
[[00:26:46] Stacey Richter: Literally, last night I started reading that Dr. Peter Atia book "Outlive", that like 90 people have recommended to me, and in chapter one he gives an example of being a resident, making a well considered evidence-based decision that unquestionably saved a patient's life. Then he got screamed at by the attending physician because he didn't do it just the way that they had always done it.
Here's what he wrote: "I was getting screamed at, even threatened with being fired for trying to improve the way that we delivered medicine to a very sick patient".
And then he wrote. "The attending’s tirade stunned me. Shouldn't we always be looking for better ways to do things?"
He went on to quit his first residencies. He later went back, but he quit his first residency because of so many examples like this. As he wrote, he's like, I signed up to serve patients, not some kind of command and control hierarchy. This feels like a very, very different culture than what I am discussing here with Gary Campbell.]]
[00:27:45] Gary Campbell: And I've come to appreciate what my clinical peers go through, and I would encourage anyone who's listening as an administrative role, administrative leadership role is get to know, I mean, truly get to know these clinicians on a level that is authentic. That's a big part of it.
The other piece is, have some ability to educate them and give them, if it's just nothing more than the methodology of what your system subscribes to and educate them yourself.
One of the things we've launched here is a leadership academy with 19 courses, 13 of which are core and they're leadership oriented, and we are enrolling our providers in this program. And a host of those classes because they didn't get this, and there's a lot that are excited about it.
We consider that big as we, you talk about looking over the horizon for the next few years. We gotta do that. That's what in healthcare, you know, if you go back and read some of Dr. Pearl's work, that's precisely what he's speaking to. So it is incumbent on us to listen and do those kind of things.
[00:28:45] Stacey Richter: I think it definitely takes some humility on both sides is, is what I'm hearing. We have administrators who often get looked down upon, oh my God, it's those MBAs running around doing things.
But the science of leadership and management is actually a thing. But at the same time, obviously we've got clinicians who have unimpeachable knowledge of what it takes to actually care for patients. That also needs to be given the greatest respect.
It sounds like in a best case scenario, we've got everyone understanding and appreciating each other's unique skill sets, for sure, doing some cross learning maybe so that everybody can even better understands and collaborate. It sounds like.
[00:29:28] Gary Campbell: The other piece that I didn't really allude to is the core values. And you know, what I get to learn in a lot of my travels is a lot of institutions have core values, but nobody can really cite what they are.
From a core values perspective, you can make every single decision from a leadership perspective, from a clinical perspective, from a lot of different perspectives on core values. Whatever they are to your organization.
We have made a commitment here and we live them in everything we do. That has helped a lot, when we look at our leadership at all levels. Clinical, administrative, operational. And we always start with those values.
We built them 10 years ago. We built them with our staff. They're the ones that created 'em. They're embedded in everything we do. So I just wanted to make sure I added that because we talked about passion, we talked about purpose, we talked about knowing your why, but all of that is underpinned with your values.
[00:30:19] Stacey Richter: So at the top of this conversation, you were talking about how you made it a goal to be a, an employer of choice. I could see that in a very competitive labor market that we're sitting in right now, and I'm assuming that if you work for an FQ, that you're not necessarily getting paid top dollar. And correct me if I'm wrong, how do you attract talent in that environment? In this environment?
[00:30:45] Gary Campbell: So you've said all the, all the right things. Thankfully the dollars have come up some, but again, it's still a very difficult market, especially now.
You have to create a value proposition. Especially in FQHC or really, I would say any private practice that's outpatient oriented because, you know, primary care physicians and providers are really, they're the most difficult to find these days.
And in nurses, that's another big challenge. I mean, that's become almost a greater challenge. So you have to focus on. If you can't pay the highest dollar, and there's a lot of places that really do struggle if you can't pay those same dollars, you have to determine what that value proposition is.
What do people want? Is it your benefits? Is it the culture? Is it the work-life balance? Do you make certain that you put the employees first? So, you have to look at every competitive angle you can when money is not going to be the top one.
[00:31:36] Stacey Richter: Well, I could see that maximizing face time with patients, if you're a clinician who is really, has a “why” of actually improving patient lives and patient outcomes that that could be compelling. If honestly, that's their why.
[00:31:50] Gary Campbell: That's true and that's why it's incumbent on us. That's part of the vision is to create that environment. I mean, we don't have, you know, I've gotten to know a lot about this side of medicine since I've been in this role, and I know some systems are tougher than others.
You know, we see a lot of patients here. I don't think that's any, any secret for really any place that takes care of the kind of patients we take care of. But the vision here is to create a compelling employment opportunity for people so that they can do more of their why and really bring some of the joy back into the practice of medicine.
I really do want that for our people. I've always wanted that for our people. We're gonna work tirelessly until we get there.
[00:32:30] Stacey Richter: Well, speaking of the complete opposite end of the spectrum, from a federally qualified health center, I'm talking about One Medical. It's interesting because they also don't necessarily pay their PCPs potentially as much as a PCP might make, who's a servant of a health system trying to play the RVU game.
[00:32:49] Gary Campbell: Mm-hmm.
[00:32:49] Stacey Richter: What their value proposition is to PCPs is, again, it's the mission, it's the ability to spend time with patients. It's ability to feel like that the organization is in, in alignment with their values.
[00:33:01] Gary Campbell: Ideally, that's what we would like to have. In reality, PCPs do see a lot of patients and we have seen salaries for those physicians escalate. Really, all the providers.
Health centers have had to get on a much more competitive level with the private practices.
Hospital systems, it's a little bit different. We have, we even have a tough time with that here, but again, that's where the value proposition gets promoted. It's important for leaders of the health centers FQs all over the country to recognize that whether if it's RVU based or if it's value-based, you have to say two years ahead of where things are today.
And if you don't and you, you're gonna be in reaction mode all the time. So we're constantly looking at ways to incentivize our providers, incentivize our staff to want to pick Johnson Health Center to continue with their career or start their career.
[00:33:47] Stacey Richter: And or if we're just talking about trying to rebalance the cost curve, something that you've said earlier, which is a lot of times if there's something wrong, leadership's first instinct is to throw a body at it.
So you're paying a lot of people that maybe you could pay a fewer number of people more, for example, or reallocate people into in more productive ways.
One of the things that is often cited as being really inefficient is I think they have, on average there's four full-time employees per physician that's working on administrative tasks, like for billing, for example, and that ratio is increasing.
Do you feel like that is potentially an area that could be streamlined for everyone's benefit?
[00:34:26] Gary Campbell: Yeah, it can be streamlined. What we're seeing, and it goes back to the complexities of healthcare in general. There's more being thrown at the clinicians as it relates to electronic medical records. What has to be entered? The data that has to be captured.
So what has happened in healthcare is you have to have more support for that clinician just to get the work done and just to meet the requirements and some of the regulatory pieces and the payer pieces. Going back to the efficiencies and how your processes are, are oriented and making sure you don't have waste in the practice itself.
But you brought up a good point. You have to look at. Your administrative support staff and determine what are their flows. You know, I learned some of the Six Sigma concepts working as the head of procurement at Bayer Corporation and that's some of the work we're gonna do here after we're done with the clinical piece of it.
So it is constantly having a look at these things and determining ways in which you can enrich your practice. But also making sure you're not overloaded in, you know, one area versus another, 'cause that's a cost item.
[00:35:24] Stacey Richter: Yeah. I had interviewed Jerry Durham on the show about making the front desk more efficient.
And basically if you do that, how many downstream, I'm gonna say irritants don't become issues for the clinicians downstream because they're handled upstream.
Conclusion and Final Thoughts
[00:35:40] Stacey Richter: What advice do you really have for individuals, executives who are in the care delivery business? Is there anything sort of overarchingly that you would tell them?
[00:35:54] Gary Campbell: First and foremost, be visible and that is impossible to do with large systems or large practices as it relates to being on the floor or making rounds. Although that doesn't preclude you from doing that at some point.
But be visible with your staff. Be visible with your direct reports and your peers and make certain that at, if you're at the very highest level, don't isolate yourself from the external world either, because that's important.
You know, you hear the story, it can get lonely at the top, but just be visible. That's probably the first and foremost thing I would recommend. Have a strategic plan, have a vision.
Make sure you, you know where you're going, and make sure that you're able to inspire that with the people that work with you and alongside you. Then don't be afraid to move people along that are pulling you down or pulling you back. So those are just some, some real high level takeaways.
[00:36:42] Stacey Richter: Gary, I know you do also some leadership coaching and training. Where can people find out more information about that?
[00:36:49] Gary Campbell: You can find out more at impact2lead.com. Impact2Lead. The healthcare piece is, I'm passionate about it. I do care about it because it's where my values are and that's really where, where my why is love to hear from you if you have questions or thoughts or comments, I'm always willing to learn more.
[00:37:08] Stacey Richter: Gary Campbell, thank you so much for being on Relentless Health Value Today.
[00:37:11] Gary Campbell: Thank you. My pleasure. Thanks for having me.