The Coronavirus, enrollment, and recruiting researchers: an inside look at Augusta University Health

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Katrina Keefer, the CEO of Augusta University Health System, returns to The Means Report under much different circumstances. Her first appearance was mere days after she took the job. Now she’s gotten some experience under he belt, six months in, and she’ll talk to us about all of the things on her agenda at AU Health, including the expansion of primary care and how important that is to make sure that a doctor is always within reach, the growth in revenue when it comes to surgeries and outpatient procedures, and how that impacts AU Health’s ability to operate, and of course the possibility of a new hospital in Columbia County that’s been in the news for a long time, and especially lately. We’ll review those things and so many more with Katrina Keefer.

Brad Means: Katrina, thank you so much for coming back, I appreciate it.

Katrina Keefer: Absolutely. Thank you, it’s great to be back.

Brad Means: And congratulation on the six-month mark. We talked before the show, it’s flown by.

Katrina Keefer: It really has. A lot has gone on in the last six months for sure.

Brad Means: We’re all talking about the coronavirus.

Katrina Keefer: Yes.

Brad Means: I know we haven’t seen it at your hospital, thank goodness. Yeah, no, knock on wood. Are you all prepared for it? Have there been conversations?

Katrina Keefer: Absolutely. We always wanna be in a ready, state of readiness and preparedness. Our infectious disease leaders continue to, under Dr. Vasquez’s leadership, continue to prepare us to be thinking about plans for if a potential case would present, and how we would isolate them, and all the downstream effects that go with that for the patient and their caregivers. So lots of documentation and buttoning up plans, and revising those that probably haven’t been out since the Ebola potential several years back.

Brad Means: Wow. So, if it happened, goodness forbid, we read it on the news that night, we could also know that you all were prepared to help the person and keep them away from everybody else.

Katrina Keefer: That’s right.

Brad Means: What about the flu? It’s that time of year.

Katrina Keefer: It’s here.

Brad Means: It seems like it peeked early.

Katrina Keefer: It did.

Brad Means: And have you had to, have all your beds gotten full from it yet?

Katrina Keefer: Yes. We have been, like many of the area hospitals on diversion, we’re always the last one to go, but we’ve seen a lot of flu, not only the A strain, but the B strain earlier in the year, which particularly also effects our pediatric population. So when it starts early with strain B, it usually means that it’s gonna be a longer, deep, harder flu season. So when we’ve opened an ED fast track to try to get some of the less acute patients in that might otherwise be treated in a primary care or urgent care setting that don’t have that access. So we continue to try to work through and manage through that, but the flu is here.

Brad Means: But you’re handling it.

Katrina Keefer: Absolutely.

Brad Means: And you’re treating it. But what does it mean when you’re on diversion? Do you say to someone when they come to the door you cannot come here? Or do the ambulances and others know not to send people to you in the first place?

Katrina Keefer: The ambulances know, unless it’s a trauma situation, we are the American College of Surgeons Verified Level One Trauma Center for Adults, and level two for pediatrics. The only in the area, and the only outside of Atlanta for pediatrics. So if there’s a trauma we accept them. But traditionally there are many levels of diversion. You can be on ICU diversion, you can be on med/surg diversion, or just on EMS diversion. So the caregivers and the other hospitals, and the way that we communicate with each other, and the way that our pre and post providers that bring us patients, they understand that. If someone presents to the emergency room and just walks up though, we of course would care for them.

Brad Means: Okay, no one’s left out in the cold.

Katrina Keefer: Correct.

Brad Means: Are we getting older and sicker? You read that sometimes and it feels like we are. And if we are, how’s that for business at AU Health?

Katrina Keefer: Well, we are getting older and sicker, but we also are doing a better job of diagnosis chronic diseases earlier. So it’s not just older and sicker, which are traditional Medicare patients, which we, you know, that’s not a bad business to have. But really learning to manage and treat chronic care patients outside of the four walls of the hospital is really also where we wanna focus our time and energy from a population health standpoint to do the right thing for our community and those patients.

Brad Means: As we’ve mentioned, it’s been a busy six months. Let’s look at your efforts, and they used efforts to expand primary care. What can we expect on that front? And will it mean more doctors?

Katrina Keefer: Well, actually it’s really the deployment of doctors and the access to our physicians. We need to make it easier to get an appointment. It doesn’t matter if they’re downtown, or they’re at Grovetown or Grovetown Two, or out in Columbia, County. So really the deployment of physicians, the deployment of our subspecialists, particularly within our pediatric ranks. We need to make it easier and more convenient for patients throughout the community for both primary care and specialty care services.

Brad Means: What’s that gonna look like? Are you gonna build more facilities? Are you gonna just, how will that accessibility improve for all of us, where we can just pick up the phone and hopefully instantly get an appointment?

Katrina Keefer: Right. Or and drive up and have convenient parking.

Brad Means: Yeah.

Katrina Keefer: Many of those facilities are already underway. So there are signs that will say coming AU Health that are being designed now. So there won’t be large buildings being built, they’ll just be really reconfigurations of some lease space that we have, and then trying to also accommodate services where we may already have leased the first floor, where we may want to add a second floor and expand that lease so we can do it in a cost effective way, and to do it sooner.

Brad Means: So are we going away from the traditional hospital model? It sounds like we are, where you just don’t go downtown to the main facility and get treated, you can just go where you are.

Katrina Keefer: You’re always gonna need to go downtown for the highest acuity, and for your higher acuity surgeries and for many of the subspecialties, and many of the things that the Medical College of Georgia is known for training the next generation of physicians. So, an academic medical center is always gonna have, for us, it is a downtown presence. However, getting out into the community, we are gonna need full service hospitals. The Columbia County Hospital for which we hold a certificate of need and have since 2014. You know we really look forward to being able to service Columbia County in that way. However, we need to do, offer services to the community and to our patients that are convenient for them to the extent that it’s appropriate. So the right care, in right setting is usually a lower cost for our patients. And so really trying to accommodate the needs where the patients need it the most.

Brad Means: When are we gonna see that Columbia County Hospital? Any feel for how that’s gonna play out?

Katrina Keefer: Well, we thought that there would be two options. We thought that the Georgia Supreme Court would either hear the case, or that the Georgia Supreme Court would support all of the other appellate mechanisms until then. I think we won on four levels of appeal and legal battles, that they would grant us that CON. On December the 23rd, they said nope, we’re gonna send it back to the Court of Civil Appeals in light of a ruling in May of this year. So we’re waiting to get on the Court of Civil Appeals docket, and look forward to being able to break ground as quickly as they have heard the case and found in our favor.

Brad Means: What’s it like behind the scenes? Are you all impatient? Frustrated?

Katrina Keefer: Um, behind the scenes we’re preparing. We’re continuing to expand into Columbia County. We’re expanding our services there. We also acquired fully the Surgery Center of Columbia County, increasing our ownership percentage from 33% to 100%. So we’re continuing to do those things for the residents of Columbia County that I mentioned, those things that can be done outside of a hospital. So the, and continuing to move physicians and having the new presence, and all of the, much of the new growth out there to meet our physicians and our specialists so that when the Columbia County Hospital is opened it’ll be a natural progression for their care.

Brad Means: That surgery center is very popular. Now that y’all own it, should we notice any differences or expect any changes there?

Katrina Keefer: Well, I think it’s gonna be a lot busier. I will say I was one of the first patients when the Augusta University Medical Associates Anesthesiologists took over, I was the first patient they put to sleep. And luckily they woke me up.

Brad Means: Thank goodness. This wasn’t your foot, wasn’t it?

Katrina Keefer: Yes, my foot. I have a plate and five screws in my fifth metatarsal. So I got the best care from my orthopedic surgeons and our anesthesiologists and the care providers that are out there. So we look forward to it being more busy and more convenient. Those services that can be performed at that surgery center are a great example of why we don’t need our patients to come get clogged up in an academic medical center and the parking and downtown, and everything that’s hard about an outpatient surgery at our downtown location, to be able to provide that care in the surgery center.

Brad Means: Are you worried about Doctor’s Hospital winning this fight and getting to build a hospital themselves? They’ve just purchased land to, or filed a certificate of need to, filed for a certificate of need to build a free standing emergency room in Columbia County, how do y’all react to that?

Katrina Keefer: Well, if they think the residents of Columbia County need access to care, we’re confused why they would have challenged and continue to challenge our certificate of need for a full service hospital. The resident’s of Columbia County do deserve a full service hospital. So luckily those two things take different tracks. And we’ll have to see if their CON would be granted or not. There’s a lot of, HCA not only filed for certificate of need in this community, but in other, several other rural areas of the state. And there’s a coalition that’s coming together to talk about is that really the best care for our patients, or are traditional hospitals that way? So I think that the jury’s still out. They just filed for that certificate of need. We had seen the letter of intent. And you know we’ll manage through it.

Brad Means: Is there any chance that y’all could work together on this or that one of y’all might purchase the other?

Katrina Keefer: There’s always a chance that we can work together. I don’t know that they want to purchase us, and I’m not sure we wanna purchase them. But I certainly am not ruling out any kind of partnership discussions with anyone. So anything’s possible.

Brad Means: Yeah, anything’s possible. I like that. The door’s open. We’re gonna talk about a lot more with Katrina Keefer, the CEO of AU Health System in a moment, including the exciting world of bone marrow transplants for children, something that you heard Dean Hess say on this very set they haven been able to do. But guess what? That’s changing. We’ll talk about that and a lot more as a busy “Means Report” continues in a moment.

Part 2

Brad Means: Welcome back to “The Means Report.” We appreciate you staying with us as we continue our conversation with AU Health System CEO Katrina Keefer. Six months into her new position, and going nonstop ever since she came to us last July. Katrina, we were talking before the break about this change at AU Health when it comes to bone marrow transplants for children. A couple of weeks ago I asked the Dean of MCG, Dean Hess, what are some things y’all don’t do over there? And he listed a very short list of things that you all don’t do, and bone marrow transplants for children was on the list. Tell me how that is gonna change soon.

Katrina Keefer: Well we hae announced the deployment of a, a new tower is possible for the ChIldren’s Hospital of Georgia. And as we think about developing the service line and being the hospital for, The CHildren’s Hospital for the rest of Georgia. You know there’s high quality care provided in the Atlanta area, but really for the rest of Georgia there’s not. And really we want to deploy our subspecialist throughout Georgia to feed the children’s hospital, and in order to do that, an expanded NICU. Our NICU is antiquated, and we take excellent care of very small, very sick babies. But to be able to transition that into each NICU room really looking more and resembling an ICU room. It is a neonatal ICU. And so to, again, be able to isolate those sick babies and have an opportunity for them, and part of patient and family-centered care, have the families there with them and have room for them to be together. And in so doing we think about cancer care and all that is going on with the Georgia Cancer Center, bone marrow transplant in children, if we’re gonna continue to be on the cutting edge and the leading edge of connecting research and clinical care and the prevention of childhood cancers, we’ve got to be in the bone marrow transplant business. And we need to be able to provide those services. So we’re hopeful that we can find room to do it and that we have the expertise to do that as we’re connecting the research that we’re doing on the medical college side, as well as the actual clinical care being provided in the facility. It’s an exciting time, and it’ll be great for Georgia.

Brad Means: You know a lot of organ transplants are losers from a financial standpoint. Is a bone marrow transplant in that category or just from a black and white revenue standpoint, is that good business for AU to get into that?

Katrina Keefer: It may be and it may not be, but it’s the right thing to do. So getting into bone marrow transplant is something we’re going to do.

Brad Means: Is there a need for a larger NICU because we’re seeing a lot more sick babies in our area, or is it just to expand your area of service where people would come here from all over the region to use your NICU?

Katrina Keefer: Oh we do wanna expand for the region, but we are seeing, we have one of the highest incidents of maternal mortality, and we also, many of our rural and outlying areas don’t have the prenatal care for the children so when the children are born they are sicker. So we are seeing many of the, the consequences of lack of access to care with only probably half of the counties in Georgia not having obstetric services. So really the downstream effects of those are more premature babies. And so until we can do more work to keep mom’s to make it to 39 weeks and to encourage their breastfeeding, and to encourage all of those good things, we are gonna have sicker babies, and we are gonna need expanded care. But not only for the babies here, but really as they come in from throughout the state.

Brad Means: How are we getting more physicians to those rural areas? We’ve heard about the three plus program, are you pleased with the way that’s playing out so far? It would seem that if all I had to do was go serve in a rural area for a while you’d pay my med school bills, that it would be an enticing prospect. What about the Interest you’re seeing?

Katrina Keefer: It is, it’s just that’s very early on.

Brad Means: Yeah, it is early.

Katrina Keefer: So the curriculum has just been approved and the students will need to come through, so that’s many years out. Right now, really the deployment of telemedicine into those facilities, tele maternal fetal medicine is an avenue that we could use. We have deployed, through an FDA grant, telemedicine which is ED to ED. So the MCG AU Health Emergency Room physicians are actually through telemedicine and just a simple computer with a camera are able to support five different rural hospitals in Georgia. So we’re rolling through that deployment now. It was an FDA grant, which was great. We’ll go back for another round of funding. So really keeping as many patients at home as we can, using our experts through telemedicine would be a way that we could do that as well.

Brad Means: All right, so telemedicine for the rural folks out there who need this care, it’s when you go to see your doctor and then he or she needs to consult or needs more expertise, and then instead of having to call somebody else in because they’re not there, then you use the telemedicine? Is that how it works?

Katrina Keefer: It can. Emergency room telemedicine is when someone goes into the emergency room and there isn’t an emergency room physician to cover. And in many rural settings that can be the case. They may have one or two physicians, but not enough to cover 24/7 and/or have additional capacity. So it can be used in that way where a physician utilizes just an ongoing physician for physician. However, you also could have, like Dr. Hess’ baby, was the REACH program. and so that is a specialist neurologist who whenever an emergency room physician thinks they may have stroke on their hands, they’re able to call in to the neurology clinic, which is a very specialized kind of physician that most rural communities would not have access to, and they can consult with a physician, and either go ahead and start them on a protocol to get them transferred, or say gosh, no, I don’t think that’s a stroke, and help the local physician rule it out. That way the patient doesn’t have to travel unnecessarily and any care that can be provided in the local community can stay.

Brad Means: So it’s possible that you might go to an understaffed ER and a doctor would interview you perhaps or discus your symptoms with you through telemedicine, sitting there on a laptop talking to you, FaceTiming with you?

Katrina Keefer: Correct.

Brad Means: Okay.

Katrina Keefer: But let’s don’t say FaceTime because that’s not HIPAA compliant, but yes, in like technology.

Brad Means: Like technology. Okay, thank you. No, I appreciate that. Accreditation efforts, in particular for your heart and trauma programs, what can you tell me about how that’s going? I know it’s extremely important.

Katrina Keefer: Yes. So I mentioned The American College of Surgeons actually verified our trauma system earlier this summer, which we were super excited about. Here to for the state had always just designated level one or level two trauma centers. Now the American College of Surgeons has verified the Augusta University Mescal Center for level one adults, level two for peds. Again, for pediatric care it’s only one of, it’s the only one outside of Atlanta. Super excited about The American College of Cardiologists though that came to certify our EP lab. And it’s not just the first outside of Atlanta, it’s the first in the state of Georgia. Only sixth in the country for these highly specialized cardiac services so we’ve got a lot going on in the cardiothoracic space as we’re building our cardiothoracic surgical program, the cardiology that feeds that, and the ECMO, both on the adult side and the peds side. As we continue to develop those programs it’s really gonna be a game changer for AU Health.

Brad Means: Medicare and Medicaid love when you’re accredited, right? I mean that’s good news for y’all too from a patient treatment and a financial standpoint. It really does sound like we don’t need to leave this area for a lot of things. It sounds like from what you’ve been saying.

Katrina Keefer: You don’t need to leave this area for anything.

Brad Means: No, we can go there and all the treatment is there. It’s exciting. And not only here in Augusta, but also through our outlying areas as well. What about recruitment? When it comes to getting doctors to come here and being appealing to them and their families? Can you update us on that front?

Katrina Keefer: Well I’ll just tell you, and I’ve mentioned it in several of my civic organizations that I have had the opportunity to participate in. Many people who have been in Augusta for a long time act like it’s really hard to recruit here. But for young energetic people who see all of the energy and the potential of the city, my being among them. I guess I’ll put myself in the young range, although I think I’ve aged a lot in the last six months.

Brad Means: No, no.

Katrina Keefer: But I do think this is a really attractive place. We’re close to the water, we’re close to the mountains. There’s just, the green way is beautiful. And the Medical College of Georgia is growing, and it is a really neat place to be. And so recruitment efforts have been very favorable. And so we’re continuing to recruit those specialists really to compliment our education platform to continue to educate the best and the brightest. And then their classroom is my hospital. And so we have to grow those things together. And we do so through strategic planning and see the business plans of what would materialize, and what the investments would be. Many of those recruits come with requests, with specific equipment they’d like to train the next generation on. So anyway we have to look at it in total, but overall I would say we’ve been very successful so far this year.

Brad Means: Well I’m glad you mentioned that too. I consider this place appealing, and a place where people would like to come. And so I’m glad that you’re seeing that, and the recruits are seeing that as well.

Katrina Keefer: Yeah.

Brad Means: Thanks for being here.

Katrina Keefer: Thank you.

Brad Means: I appreciate it. And I hope you’ll come back. Congratulations again on six solid months.

Katrina Keefer: Thank you.

Brad Means: And may you be here for a long time to come.

Katrina Keefer: Thank you, I hope so.

Brad Means: Katrina Keefer, she is the CEO of the AU Health System. Extremely busy and that’s good for all of us because the care is right here at home, where we need it.

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