The repercussions of a historic pandemic continue to be felt throughout the region’s healthcare industry. Still, the CEOs of our three locally bred hospital systems are finding plenty of reasons to be cautiously optimistic. Gathering for a recent Zoom chat moderated by Main Line Today managing editor Kim Douglas, Crozer Health’s Anthony Esposito, Chester County Hospital’s Michael Duncan and Main Line Health’s John Lynch discussed everything from pandemic-birthed innovations to the continued disparities in patient care to their overwhelming admiration for the frontline workers they see every day.
Anthony Esposito: Our employees have shown—and continue to show—unwavering care for people. That’s what really excites us and keeps us coming back every day.
John Lynch: The pandemic underscored for me that many in our community are essential workers—roles that had nothing to do with healthcare. What makes me passionate about healthcare is that we, like first responders, are here 24/7.
Michael Duncan: I agree. It’s the joy of serving your community in their time of need. I’ll add that it’s really wonderful to see how we can intervene to restore a full life. It’s amazing that, after heart surgery or a new hip or knee, people can play with their grandkids again.
Duncan: We learned the importance of senior management being on the floors with the people who were at the bedside. We were so restricted from getting things to the bedside. We kept innovating, but we needed to be out there asking questions. How can we make this better? Most of the innovations were driven by bedside nurses, doctors and caregivers.
Esposito: I agree. We learned who essential workers were—from materials management all the way to the doctors and nurses. Everyone was scared—and, like Michael said, we needed to be out there rounding, making sure they were safe and helping them in every way we could.
Lynch: Before the pandemic, I had this concept of employees leaving their metaphorical backpack of home stuff in their car—challenges with the kids, their relationships, health issues—to perform their best for patients and their colleagues. And all the stuff from an employee’s shift needed to be left in their locker before they went home. I was wrong—it’s not realistic. When you come to work and your kids are homeschooling, your spouse may have lost their job and you’re worried whether you’ll get sick—all of that is with you in the backpack at work. We need to be supportive and out on the floor with staff.
Secondly, we had staff members at every institution who weren’t used to caring for dying patients. Now they may be routinely caring for dying patients or taking patients to the morgue. That doesn’t end at the end of your shift. We did all we could to provide emotional support. I’m so appreciative of the resilience of the staff. We worked together, and the staff pounded it out. These regional hospitals figured it out. They have unbelievable capability and resilience.
Lynch: I’d love to wake up one day and realize we’ve eliminated all disparities of care—that literally everybody who shows up in an emergency room or doctor’s oﬃce receives the same level of equitable care they deserve, that disenfranchised people aren’t afraid to seek healthcare, that people of different races and ethnicities don’t perceive bias in the care they’re receiving. We’re a long way from that, but at least we’re talking about it in this country now. All of our institutions are committed to it and are working hard at that.
Duncan: I’d add that we have a huge behavioral health crisis. We used to think of healthcare as finding a bed for someone who showed up in our ER. Now the behavioral health crisis is inside and outside our institutions—our employees took such a heavy hit. The pandemic was 24/7 for them. We all did a lot of work to put systems into place that support our staff.
Esposito: It’s not just seeing the dying patients, but the struggles of friends and family members—and that underscores the burnout of the staff. Behavioral health continues to be a crisis.
Esposito: The shift to telehealth medicine, digital front doors and meeting patients where they need to be met is where the future is heading—less brick and mortar.
Duncan: All of us shifted to telemedicine surprisingly quickly. It’s very effective in getting a patient to a provider faster.
Lynch: For many years, systems were critiqued as being over-bedded. But over the last decade, 1,000 beds have been closed in this region, and the demand for traditional services has outstripped the inpatient bed capacity. So any innovation that allows us to safely care for patients in an alternative environment will be good for the community and help lower costs.
Duncan: It’s been a positive for CCH, which joined Penn Medicine nine years ago. It gave us access to capital—but the bigger gain is the intellectual capital. I have five other CEOs to consult with. My chief medical oﬃcer and nursing oﬃcers have a group of colleagues to call. It creates a learning organization where we can innovate very quickly.
Lynch: I’d echo that. Riddle joining Main Line Health made Riddle stronger. We’re building a $327 million pavilion that they never would’ve accomplished independently. But the big question is: If you [consolidate] two $5 billion or two $2 billion organizations, can you really remove hundreds of millions in expenses? Size isn’t proving out to be the solution.
Esposito: I think clinical partnerships instead of full-out acquisitions are how we’ll better work together to provide care, instead of competing. There are too many headwinds in healthcare to compete. We have to get to the table together.
Lynch: When you see systems posting billion-dollar losses for the first time in an organization’s history, there’s a problem. I’m very worried that the economic challenges our systems are facing are going to make it even more challenging to eliminate disparities of care. Frankly, every person is going to wait longer in an ER because of capacity challenges, hospitals closing and staﬃng challenges.
And the challenges to meet the needs of the uninsured have been exacerbated, especially in the COVID aftermath. We’ve had unprecedented cost increases in labor, supplies and pharmaceuticals. Even more dramatic, we can’t pass one nickel of our cost increase on to our consumers because 90 to 100% is being reimbursed at a per-case rate, which has nothing to do with what it costs us to provide care.
Esposito: Short-term costs have hindered us. We need more remote patient monitoring. That keeps patients at home and outside a facility, which seems counterintuitive. What used to be “heads in beds” is now caring for the health of the community—keeping them healthy and out of hospitals. It’s a paradigm shift.
Lynch: Our industry has to do a better job creating excitement around career opportunities. We’re the only industry where, as the cost of hiring goes up, we have no one to pass on the cost to. The easy solution would be to raise wages, but we don’t have the ability to raise wages without taking it off our bottom line. People need to talk about how great healthcare is. We’ve got to excite more people.
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