Days after stepping into her new role as CEO of Augusta University Health System, Katrina Keefer joins The Means Report. She shares the background that led her to Augusta and her focus for patient centered care across the AU Health System.

Brad Means: Hello everybody and welcome once again to The Means Report. We appreciate you spending part of your day with us. Do you remember just a few short months ago when brand new Governor-to-be Brian Kemp was our special guest? It was really almost on the eve of his inauguration. Well we have a similar situation today, we have another CEO in our midst. She is just taken the reigns of Augusta University’s Healthcare System and she is also the Executive Vice President of Health Affairs at Augusta University.

We are so pleased that Katrina Keefer is here, and unlike the Governor, Katrina, he was about to take his job. You’ve been on the job as of this recording for four days?

Katrina Keefer: Three and a half.

Brad Means: Three and a half days.

Katrina Keefer: Absolutely, this is my fourth day.

Brad Means: Well, we welcome you to Augusta

Katrina Keefer: Thank you.

Brad Means: and to this region. I’m glad you’re here. I’m happier that you came from a place that I love, the great state of Alabama–

Katrina Keefer: Absolutely.

Brad Means: where you worked for the Baptist Healthcare System, part of the University of Alabama at Birmingham, a great name in healthcare. Are we kinda similar to that setup?

Katrina Keefer: Actually yes and no. The UAB health system is a large academic medical center and Baptist Health was a large community partner managed by the UAB health system and owned by the University of Alabama Board of Trustees who love both their hospital and their football team.

Brad Means: Darn right.

Katrina Keefer: So, Augusta doesn’t have a football team but does love their hospital. So the health system here also has branch campuses for the Medical College of Georgia. And so although maybe not closely affiliated with those hospitals, it’s a little bit of a blend. A lot feels similar but I wouldn’t say it’s exactly the same but it’s great to continue to be involved with a great academic medical center associated with such a great school of medicine, school of nursing and allied professionals.

Brad Means: Well, it is and we’re getting more on the map everyday. People know about us in this nation and around the world. Is that kind of one of your goals, is to grow it more and to AU a name that everybody knows and that students and others, physicians seek?

Katrina Keefer: Absolutely, the healthcare enterprise of Augusta University Health System is not large enough currently to alone continue to support the growing needs of the Medical College of Georgia, the eighth largest medical school in the country. We need to find additional opportunities for clinical training for the next general of physician leaders and really looking forward to partnership opportunities really throughout the state. The Medical College of Georgia really provides so many of those, that next generation. So, we can’t do it alone here in Augusta but through partnerships I’m certain that we can.

Brad Means: We talk a lot on this broadcast, on our news, about the shortage of doctors in rural areas. I know that’s a mission of Dean Hess and others over at your school, your enterprise. Is that something that you’re gonna pursue as well, making sure that more doctors are there in our outlying areas?

Katrina Keefer: Yeah, healthcare is local and healthcare needs to remain local and it’s gonna be really important for the State of Georgia that we provide avenues for physicians to be in rural areas. For physicians to practice, they need to have hospitals and hospitals need physicians. And that’s that unique partnership and relationship that I think Augusta University Health System could bring. Whether it’s purchasing power or reimbursement negotiation power that we could do if we had more formal affiliations with the hospitals that also serve as campuses for our students to learn. So, the residency programs, often when a student goes to a branch campus, to practice in the community for their third and fourth years, they are more likely to remain in those areas. So, although academic medicine is great, most people don’t want to stay there forever. So when we provide them opportunities in outlying communities, but it’s hard to make a living in healthcare right now. So we’ve gotta help those hospitals continue to stay in business as we’re gonna be working hard to keep ourselves there. So, lots going on in that space, lots going on throughout the healthcare industry as we continue to advance the missions that we seek to provide.

Brad Means: Well, picture a small town hospital then as one of your ways to help them keep going strong to acquire them?

Katrina Keefer: I don’t know. I don’t know that I want to acquire in a hospital. Being in the hospital business is a tough business. I do think that we need to redefine and rethink about the way that we think about hospitals in rural communities. We need to have great lines, direct transfers, and be a welcoming place for primary care and secondary care, but then send the tertiary care to the academic medical centers. And if we can provide those avenues, I do think that we can keep those rural hospitals alive and well and keep the kind of practitioners there that they need. But I think we’re gonna have to think a little bit differently about how those outlying centers are. And then that helps the health of our institution as we have the sicker patients in our hospitals which allows for teaching for sub-specialties. So, it really continues to be a snowball effect if we can keep the less acute folks in their rural communities or in their small towns in their own hospitals and keep the higher acuity ready for our physicians.

Brad Means: Do we have enough physicians and nurses in Augusta right now? We talk a lot about the outlying areas, what about here in town?

Katrina Keefer: Gosh, there’s a nursing shortage nationwide, so Augusta is no different and right now, we need over 200 nurses. Just within our region, probably 400. But nurses now can go anywhere. So you used to have to apply for a job and take a day off and go interview. Now, if you’ve had a bad day and you look at your phone, somebody will offer you a job across town for a big sign on bonus for 13 weeks and you go pay down your debt, and then you come back home.

Brad Means: Seriously? I mean it sounds like that’s what you should study if your a young person watching or a parent watching. Get your child in nursing.

Katrina Keefer: Yes, right. That’s the good part and the bad part. Everybody does wanna go to nursing school and the limited slots available for nursing students because of the limited supply of nursing professors. So, if you don’t have nursing professors, you can’t have nursing students. So the classes are getting larger and larger, and in most situations, you have to have a 4.0 to even get into nursing school. So, it’s again, a snowball effect that if you can’t train enough, then you don’t only train them for those in your own hospital and for your outlying services and your physician practices and your ambulatory space, then there’s a lot of competition for that. So, if I had to do it over again, I’d be a nurse.

Brad Means: Yeah, I would too.

Katrina Keefer: Yeah.

Brad Means: Either a nurse or something in the cyber field which is booming, as I’m sure you know.

Katrina Keefer: Right.

Brad Means: And will learn more as you continue to stay here. Do we have enough beds at AU health?

Katrina Keefer: We do. I think we need to look to fully complement, have the full complement open. Some of that has to do with nursing shortages but we’ve gotta find the right mix and you know, we are gonna have to continue to grow but whether that is within the hospital space and the acute in-patient environment or whether it’s in outlying areas to be feeders, it is day four, I look forward to figuring it out.

Brad Means: No, I’m telling ya, I feel guilty asking you all these questions. Feel free at any time to say look man, it’s day four as I–

Katrina Keefer: Drinking from a firehose. But there’s so many committed people there’s so many committed people to doing such great work and taking such great care of patients that it’s just so exciting and it’s fun to drink from the fire hose.

Brad Means: Well, let me change my fire hose-esqe question from do you want to acquire a merge with University Hospital across the street to this, do we have too many hospitals in Augusta?

Katrina Keefer: I don’t know.

Brad Means: It’s early.

Katrina Keefer: I don’t know, it is early.

Brad Means: But there’s been talk of that, you know, AU and University coming together.

Katrina Keefer: Right.

Brad Means: Nothing concrete. But nothing on your radar at this point?

Katrina Keefer: No, I will say that we have started a new joint cancer operation that is continuing to be refined as I understand it. You know, we can reach across the street and help each other out and I hope that we’ll be good neighbors and I look forward to meeting their leaders and seeing what the next iteration of those discussions could look like. Let’s talk about patient care, you mentioned the purchasing power of an enterprise as big as AU. Can that help us save money on pharmaceuticals? Can you get em to us cheaper because you’re so big?

Brad Means: The pharmaceutical answer has more to do with the excess of access to 340 B eligibility, which is the national drug discount program. You can only qualify for that program if you sustain higher amounts of charity care than the national average and so that allows us to access pharmaceuticals at a lower cost; but even with 340 B access, which Augusta University Health System does have through the medical center, the drug expenses are going crazy everywhere.

Katrina Keefer: They are.

Brad Means: And particularly within cancer treatment drugs, but I do think that AU health’s specialty pharmacy accreditation and that opens distribution channels to additional pharmaceutical distributors that might otherwise be limited. So, there’s that riddle. The enterprise buying power that brings supply cost down is unique at AU because we are a teaching facility. So, all of the wizbang implantable whether it’s cardiac or orthopedic, all of those companies really want to get their devices in the hands of our students because our students are gonna go across the country and build them market share. So, if they can give us deep discounts or additional rebates, better for us because we get the benefit of the discount and then they have a new set of liaisons that they get to send out into the world because as someone who receives those physicians, in my former life, they really are very dedicated to what they were trained on. So, if your trained with, I guess I shouldn’t call company names, but if you’re trained with device A, you really want device A and you don’t want to use device B, you’re not comfortable with it. So, although an implantable knee is not an implantable knee is not an implantable knee. The nuances between those get very large when a physician that you’re recruiting to your hospital really wants his piece. So, there are different ways we can get at that but I think that we’re gonna have to come up with a comprehensive plan about how we address the supply and pharmaceutical expense cost.

Brad Means: I just know that sometimes, if I’m in the hospital, God forbid, or if somebody I know or love is, they’re fearful of the $100 dollar Tylenol or the super expensive treatment that’s coming toward them, almost to the point where they would just reject it or resist it and say look, I don’t want that on my bill. Are the days of the $100 dollar Aspirin over?

Katrina Keefer: The days of the $100 dollar Aspirin will never be over because of the history of the payment systems. So, we’re in a billion dollar business where there is little relationship between cost, charge, and reimbursement. That $100 dollars is not what that pill costs, that hundred dollars is what the hospital has to charge because the hospital used to get paid as a percent of charges and now they don’t. So, it’s a counterintuitive riddle that is a harder discussion than this segment could last but it is one of those things that I call the practical application of the academic exercise. Hospital people don’t have good sound bites because it’s complicated, but that doesn’t give us an excuse not to get out into the community and help educate others. And I hope to have the opportunity to come back and really articulate to your audience succinctly about how we can work on this together and how we can be more transparent and how we can help patients understand their patient responsibility before they get to the hospital and understand how they can work with us after their discharge to ensure their financial well-being and their healthcare well-being.

Brad Means: What do you think of the Children’s Hospital of Georgia?

Katrina Keefer: So exciting.

Brad Means: It’s awesome isn’t it?

Katrina Keefer: It is so exciting, yes.

Brad Means: That’s a bright future for them. You’re invested in them as their leader, right?

Katrina Keefer: Yes, very bright future. Had the opportunity to meet Dr. Hudson yesterday at our health system management team. Just all of the great, and she has family from Monrovia, Alabama which is where I grew up. So, it’s just exciting to be a part of the Children’s Hospital of Georgia. This is my first four eight into actually the children’s hospital world so I’m really excited about the opportunity to continue to get to know the people there and to roam the halls and to meet the patients and their families.

Brad Means: Yeah, great institution. Another one is the Georgia War Veterans Nursing Home,

Katrina Keefer: Yes.

Brad Means: You oversee that in your new job.

Katrina Keefer: I do.

Brad Means: Anything that you can say to us about your goals or your hopes for our veterans who have to go there and the care that they receive?

Katrina Keefer: Well, veterans care is so incredibly important and coming from Montgomery, which was somewhat ground zero for the Air Force, similar to cyber security here for the Army. So important that we take care of our veterans. And those numbers are gonna continue to grow so I think we’ve got to figure out how we allocate our bed complement, how we serve those patients, whether it’s in the facility or we come up with other ways to provide for their care. I’ll tell you, I have not been in the facility yet. I look at it from across the street, across my window, but I have not yet roamed the halls. So, I’m really looking forward to meeting the people there and getting to know more about their challenges and how we may, as a greater health system, be able to address that.

Brad Means: What is executive vice president for health affairs at Augusta University mean? Will ya teach? What is your role there?

Katrina Keefer: I’ll do whatever Dr. Keel asks me to do.

Brad Means: Sure. No, I get that.

Katrina Keefer: Actually that’s a title that the former CEO of the medical center held and now has become part of my title as I’ve taken on the CEO of the health system role. So, I would expect to serve as a part of the President’s Executive Cabinet and advise as we think about how all of the schools and all of the parts of the university come together and how we collaborate and really, from a responsibility of the well-being of our students, and our patients, and our community, and our region, but I’m sure Dr. Keel will tell me about that.

Brad Means: Listen, your predecessor may have lost her job because of accounting issues. I don’t know if she did or not. I wasn’t in any of those meetings. What’d they tell you when they hired you, about making sure those books are solid?

Katrina Keefer: Well, actually, I read the newspaper–

Brad Means: You did? We had it to so you read the news. It was a couple of days after. We had it first. But just so you know about it.

Katrina Keefer: Yeah, absolutely. And I think this is such an interesting time to be at Augusta health system. What we do is complicated, what they did with a transaction to bring together the medical group in the hospital, it was complicated, changed the way the accounting worked. And then as those reports were consolidated, we haven’t closed the year yet into June 30th, so we don’t know where that is but we’re also working on the budget for 2020 and so I expect to see that soon. And so we’ll know more once everything gets closed out but I don’t have concerns that we can’t figure this out. We have solvable problems and if this is an accounting issue, okay, we’ll figure out what our game plan is for correcting that going forward, but at this point, I just don’t know the answer and look forward to learning more for sure.

Brad Means: Y’all are leading the way in cancer care.

Katrina Keefer: Absolutely.

Brad Means: I expect that to continue. Is that a big part of your list of goals at this early stage as well?

Katrina Keefer: Yes, absolutely. The new research platform and building and facility that Dr. Hess spent a lot of time on and can’t wait for the new leader to be here with us. I actually have toured that facility and seen the new space for the additional researchers on both the second and third floors. It is a beautiful space. If I were gonna be a cancer researcher, it would have to be Augusta University. So yes, and cancer is a good business to be in. And so it’ll be important to the health of the AU health system to continue to be in that business and to continue to grow that business.

Brad Means: Yeah, people don’t have to really go out of town as much for that care because of the quality that’s here at home. What about patient care, one more question on that. Can you help us with making our stays shorter, making it easier to register or be admitted, any of the red tape stuff that we patients, we regular people hate. Can you help us?

Katrina Keefer: I hope so. I think that the team that I met with yesterday, the health system, I don’t know all the acronyms, the health system management team, we usually end at TLAs, third letter acronyms, but this one is four. I met with that group yesterday, and just such energy about, we are gonna be innovative, and we’re gonna try things and we’re gonna do things differently. We need to answer the phone and let our patients get appointments; When they get here, we’re gonna greet them with a smile; We’re gonna walk through the halls; We’re gonna be upbeat; and then we’re going to adjudicate claims fairly and appropriately, make sure their bills are correct and on time; and just really focus on what is is like to be a patient; what does it feel like when you’re on hold; what does it feel like when a referring physician can’t get their patient into our facility? And so, how do we streamline that? So, from a patient experience standpoint, I think the team will be focused on that and we need to not overly complicate things. Hospitals are horrible about overly complicating things. And so, whether it’s on the ambulatory side within the physician group or whether it’s on the hospital side trying to find the front door, we need to be a lot more patient-centered and patient-friendly and really sort of step on the other side of the table and say what does it feel like when I can’t get an appointment? And understand that that snowballs and I get that, we get that, and I know that the dedicated professionals that I met with yesterday, and all those that skipped the meeting, but I’ll forgive them this time, I’m sure they’ll be there next time.

Brad Means: No, they’re testing you.

Katrina Keefer: Yeah, well they missed the show. Anyways, yes that’s clearly a focus. If we’re gonna grow our enterprise, we have to be more efficient, so instead of spending money on buildings, we get more efficient and can move more patients through more quickly and create capacity without having to have bricks and mortar. So absolutely we’ve got to do that.

Brad Means: I’m telling you, all those little things, and you know this, add up and create a positive impression because that hospital experience, any hospital–

Katrina Keefer: Right.

Brad Means: can be dreadful and stress-inducing and if you just have those little things that you just listed, it can really change it.

Katrina Keefer: Yes.

Brad Means: Well, congratulations on your new job.

Katrina Keefer: Thank you.

Brad Means: And thank you for taking the time to be with us.

Katrina Keefer: bsolutely.

Brad Means: We appreciate it, hope you’ll come back.

Katrina Keefer: I would love to. Thank you so much, great to meet you.

Brad Means: Well, great to meet you. My pleasure. Katrina Keefer, CEO of Augusta University Health System, our special guest today, day four and did a great job of updating us on what’s happening during these early stages.