This week I am talking to Darin Vercillo, MD, chief medical officer and co-founder of ABOUT Healthcare, Inc (@ABOUT_est2005) who offer intelligent access and coordination across healthcare networks.
Darin is a board-certified and practicing hospitalist who describes sitting in an ER department with a colleague, where as usual the hospital was full with patients backing up in the ER, ambulances lining up outside and he watched while the ER doctor made 27 phone calls trying to find other hospitals to take patients he was unable to admit due to staffing shortages.
😱 It is hard to imagine the frustration and time wasted with 27 phone calls!
We talk about the success in Arizona that created a real time transfer system before the pandemic unfolded on to our world and brought the healthcare system to its knees. Some of the key insights to help drive towards a real solution were similar to the leadership found in NASA and epitomized by Gene Kranz who is famous for saying
Failure is Not and Option (we must be tough and competent)
As Darin describes with the right leadership and vision that was all inclusive the ability to transfer patients in and out of a system successfully was no longer a detractor but rather a differentiator of great service for health systems in Arizona. SO much so they had no need to opening tent hospitals and were taking out of state transfers to help adjoining states out.
Healthcare Needs to be Tough and Competent
We discuss the essential need for ‘Load Balancing’ in healthcare. A term some might be familiar with from the internet and even experience if you see something from Cloudflare or F5. We see load balancing in many other industries – airlines have been managing loads successfully and predicting travel demand pretty accurately (COVID impact aside which has made many of the proviso algorithms and systems less accurate). Their ability to predict is seen in the highly malleable price of an airline ticket that is driven by demand pricing
Darrin explains that the barriers to successfully getting to a better coordinated offering is rarely the economic drivers with a paper that showed that on a national average, a transferred patient provides $10,800 in profit, that’s contribution margin per transfer for the accepting side.
Listen in to hear Darrin’s incremental steps to remove the barriers and allow all parts of the healthcare system to do what is best for the patient and create a frictionless experience.
“get started on a consultative basis to see what is that next natural step, which can be evolutionary, can be innovative, but doesn’t necessarily have to be disruptive to the organization”
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Dr. Darin Vercillo who is the chief medical officer and co founder of about healthcare. Darren, thanks for joining me today.
Darin Vercillo
Good morning, Nick, good to be here with you.
Nick van Terheyden
So, as I always do, it’s helpful to understand a little bit of the background and obviously the context to the conversation. You’re a practicing physician, you work at the frontlines. Tell us a little bit about your journey to that point, and also how you got into the other areas that we’re going to talk about.
Darin Vercillo
Sounds great. Well, again, pleasure to be here with you, and you’ve been chatting with you a little bit before we started this recording your background as an ER doctor, my background in hospitalist medicine, I think, work hand in glove. And that has been a huge driver in my experience, both as a practitioner where I still practice in the Salt Lake City area, and seeing things in the trenches in the front lines and how they’ve evolved over these past two decades of my practice. But that also is what drove me to being a co founder of about healthcare, and really what is our passion and my passion and continues to be in what we do. I think we both experienced it, many providers and certainly healthcare systems continue to experience this. And the pandemic has certainly exacerbated the issue of the ability to find the appropriate timing and place and level of care. For patients we focus and have focused on patient transfers for many years. But in the in the realm of patient access. And I’m not talking case management access, but in literally the accessibility to the care that patients need for their for their needs. The pandemic has shown us where these mismatches are at their worst. And also the the nursing shortages that we’re facing now have even further exacerbated this issue where no longer is it finding a bed, it’s finding a nurse that staffing a bed where you can get a patient where they need to go whether it’s from an ER or from an inpatient to inpatient transfer, or if they’re in a provider’s office as a direct admission, and then on the back end to getting people out of the hospital to post acute care to places where we can decant the, the bottleneck where we’re currently seeing. So in my in my world, as I started practicing, I had personal experiences early on, where I had patients who were decompensating in the hospital, and that I got calls at night when I was on call from a nursing this patient is going downhill. And they needed a service that we didn’t provide in the 200 bed community hospital where I was practicing and we needed to get them to that tertiary care center, and then suffering through the next three to four hours as they called location after location. And doctor after doctor who had all different sorts of opinions as to whether or not the patient should be transferred. And the Were there other things they wanted to see happen before we move the patient all the while watching my patient get worse and worse. And swearing that I would never call that hospital back again after what they put me through personally and realizing that doesn’t have to be the case. Additionally, as recently as just a couple of weeks ago, being down in the ER in the hospital where I attend, sitting next to one of my colleagues, ER doctors and seeing his frustration and asking him what’s going on, and having him telling me he’s on the 27th hospital that he’s calling to try and get a patient transferred out of the ER because everybody’s full or they’re guarding their beds for their pacu or for their own er, and thinking okay, what hospital do I call next? What sort of use of time is that for, you know, a board certified physician that has a full yard to attend to. And then just on a personal note, my my own father currently is sitting in a hospital down in Southern California and Arcadia, where, where I grew up where the hospital where I was born, interestingly enough, and he’s on day 10 now waiting for a transfer for cardiac ablation that he needs. And it’s because there’s no capacity, and I realized that LA is a big area and there are a lot of different hospitals that could be called. And so just the coordination of this to be able to provide acceptable care. Great care at the right places, benefits the patients because they get there faster where they need to go. And that’s our passion is to get patients where they need to be as quickly as possible in the right way efficiently. But this benefits the hospital systems so well, as well, being able to provide their services and and bring those patients in to their health care systems.
Nick van Terheyden
You know, if people could actually see me, they would have seen me shiver. As you mentioned, the 27 calls because I’ve lived that nightmare, in the emergency room trying to place a patient based on you know, the clinical requirements, the lack of beds. And to be clear, this was pre any technology. So there was one telephone actually, there might have been more than one telephone, but they were sort of distributed, you had to find one, there was no, there was certainly no cell phones, no computer system to give you any information. And you know, sometimes it was as fast as you could dial if you heard about something that there was a bed available that you could get there. It’s just shocking. And that was years ago, we’re talking a long time. And here you are saying, and I’m making light of it. But I’m truly not. It’s It’s terrifying, that that highly qualified individual, if you think about what 27 calls in is meant to them in terms of time, prep, finding numbers, all of those things, just that’s absolutely a travesty of resource. And it gets back to the original point that you made, which is we have the resources. I mean, and that’s one of my sort of questions around this as you’re sort of deeply invested in it. Do you think the lack of matching is not so much the lack of resources, and I understand we’ll talk about the nursing and you know, the staffing of the beds, but is it a mismatch of information more than actual resources,
Darin Vercillo
you’ve, you’ve hit the nail right on the head, actually, Nick. And interestingly enough, just the day before, yesterday, I was on another call with some industry luminaries. And one of them Dr. Scott Wolf, talked about an experience that he had, where there was one hospital that he was very aware of that was currently running at 110%. They were literally that taping off in the hallways, as you’ve seen, you know, rooms for patients to be placed virtual rooms, if you want to call them that. And just a few blocks away, there was another hospital running at 56%, that had capacity to spare. And they work within that same health system. And so the the lack of visibility, even within their own network, to be able to load balance these patients to the appropriate areas was lacking. Of course, you can imagine how it is as you start crossing boundaries of healthcare systems. And so some hospitals are overwhelmed. Some hospitals can take immensely more capacity and have the capability to take care of those patients as well. When the pandemic hit the state of Arizona, they were prepared because their governor and their health department worked with about healthcare with our company to set up a statewide Transfer Center. And we linked all of their hospitals technologically. So they could see where all the capacity was in the entire state at all times in real time, without people having to update and put in additional information. And this kept them from having to turn anybody away for care, they actually were taking patients from out of state because they were managing this so well. And, and additionally, they didn’t have to build any temporary hospitals or or extend all those additional dollars other states were doing. You know, I think this is a great example of two things. One is on the technology side with what we did with about linking hospitals, creating interoperability providing a platform where all of this work could be done in the information shared, facilitate facilitated the feasibility of doing this. And and this is what not only the state of Arizona does, but where you see other large systems, whether they’re multi state systems or a dominant system, or what have you, or even a single hospital, quite frankly, we’re having the appropriate technology in place facilitates an answer to the problem. But there’s the process as well. And so technology can automate that process, right. But you bring great process in place of how do we address these issues? How do we learn from the information that’s available to us? And how do we great create great workflows? How do we avoid having to talk to I’m sure you’ve experienced this before you want to transfer a patient you have to talk to Five different doctors before somebody says yes. How do I get down that down to a single provider? Who can say yes for the group, and then everybody falls in place, or even automatically accepting a patient? Because we do it 100% of the time anyway. So process technology people, all beneficial for patients and healthcare systems.
Nick van Terheyden
You know, before we get into the solutions, and you know, it’s it. I just think it’s, it’s nice to put up a great example, and clearly Arizona is, and what I’d like to understand is, what did they do or think or who was behind? Let’s just call it from my perspective, a brilliant decision to say we have to solve this problem, not because of COVID. And, you know, everybody’s now looking at and saying we must solve this problem. There are clearly barriers because it’s not being the case. It’s been in play for a long time. Right? What did they do that others can learn from that? You say, Okay, that’s how we stepped down this pathway, because it’s clearly the right thing to do.
Darin Vercillo
Exactly, exactly. Well, I think they were, they captured a great vision, a great vision of a strategy that could be beneficial to all parties involved. I get it. Health care organizations are looking to provide great patient care, but they’re also businesses, and they have their secret sauce. And interestingly enough, a lot of times their transfer and access strategy is their secret sauce. We’re going to provide that so we get referrals and where the path of least resistance. But in the in the case of Arizona, I think some of the larger and more influential call them the dominant healthcare systems in the state. They’ll remain nameless for the purpose of this. Were very influential and saying, You know what we can work together. And they fed that vision to the Health Department, where Lisa Villa Ruelle, the, the head of this project at the State Department level took that vision and ran with it. So it needs a catalyst of mindshare. It certainly needs an advocate in this case in Arizona, it was within the health department. It needs leadership backing, the governor signed a an order to essentially require all organizations within the state to run their COVID transfers through the Arizona surge line. And, and then, and I think this is the greatest part of all. Then as they got all this together, all of the health systems agreed that they were going to have representatives get on a call one two or three times a week, it vary depending on how bad this the COVID surge was going on. They got on the phone and they talked through the issues they were facing. We feel like we’re getting too many transfers, or we’re not getting enough transfers, or it’s taking too long to get this donor here’s a great idea that we think we can have. And with literally dozens of healthcare organizations represented on these calls, they were able to sort out their issues, they were able to share best practices create mindshare, and all boats rose with the tide. And it just took off and was tremendously successful for those organizations and for the residents of Arizona as well.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Darin Vercillo. He is the chief medical officer and co founder of about healthcare, we were just talking about what it takes to bring people together to help solve a problem. And as I listened to you, all I could think of was NASA, Apollo 13. And Gene Kranz. And the inspiration if you’ve followed or tracked any of that I grew up as a space kid totally inspired me got me to where I am in many respects. And his book failure is not an option was so much about bringing people together, we don’t accept the status quo, we must get those three astronauts back lots has been written about that. But I think the inspiration of that, around that problem and what Arizona did for me, is part of the driver to allow for this to get together it sure there’s economic drivers, but you know, as you mentioned, rightly so, being good at this can actually be a differentiator to allow you to access more patients and maybe the appropriate patients for you know, your resources. So, I think fantastic opportunity. So let’s talk a little bit about those resources and you separated it out. And you said well, it’s not just the beds or the transfer, it’s actually the staffing and you know, Just pause for a second. For folks that don’t realize this, the idea that tape becomes a virtual room in an open space for a patient. Imagine that as an experience, you know, just put that to one side. But it’s about the staffing. So okay, so you create it, but you don’t? How do we go about approaching that? And what are the specifics around that?
Darin Vercillo
Well, yeah, wouldn’t it be great if we could create a whole a whole cadre of nursing staff out of tape, but that’s not going to happen? You know, it’s last time I heard or read or checked, I think we were down somewhere between 40 and 50,000, nurses nationally, since the beginning of the pandemic, you know, the great resignation has touched the healthcare environment as much as any other and and so we just have to get that much smarter about how we leverage those resources. And, you know, to the point of my er, doctor friend calling 27 hospitals, obviously, that’s not a great utilization of his resource time. But, but that touches on the nurses as well. And I think about this in two ways, both the coming and, and the going. If we’re able to one load balance patients to the appropriate levels of care and appropriate locations, then we can have all of those, all of those staff resources, operating at top of license, whether they’re in a rural hospital, or a community hospital or tertiary care center level one trauma center, attending to and taking care of the patients that are within their wheelhouse, and then getting them back out of there to the next phase of their care. So we can free up that resource for the next patient that comes in. And, you know, this affects of course, those metrics like length of stay that we’re looking at, you know, if a patient comes in like my dad waiting for his a ablation, you know, one, one way would be to bring them in and, and get as a ablation done and complete his care there and then go home and in other ways to transfer him back, get him closer to home getting closer to family, my mom’s concerned about going down into downtown Los Angeles from Arcadia, keep them close to home for the remainder of his convalescence, and then free up that bed and the tertiary care center. So there is a tremendous amount that we can do of appropriately moving patients around. So the staff resource is, is used to its most efficient level. The other ability is to as we move patients out. And and there’s a variety of strategies that we’re using, we’re using multidisciplinary rounds, we’re looking at discharge from the time of admission, or creating stronger links electronically and process wise to post acute care facilities and home care. As we streamline the outbound process, we shave a day we shave two days, we make weekends a possibility to actually get things done, and move patients along. Then we can, again, leverage those resources for the patients who need them, and not leverage them to babysit or watch patients who are waiting to get to their next step. Because we aren’t set up to efficiently do so. And I love your I love your your your analogy for NASA, you know frequently as we go in and we work with healthcare organizations, they’re bringing together these different pods have capabilities, nursing capacity, and bed control case management, transfer, putting them together and what they’ll call a command center, a NASA mission control sort of environment where they can talk and collaborate and see data jointly and break down the silos and work together on these very things.
Nick van Terheyden
You know, it’s interesting, you bring up a point that I think in some instances, people resist a little bit of the transfer notion because it puts people away from their home environment. And I think it’s elegant, to sort of see that as it’s not always it doesn’t have to be as negative as it’s perceived by many patients, which is oh my god, I’m not going to be able to visit it’s a foreign places, you know, I’m isolated, but it’s really only for a segment of that activity. And then, you know, convalescent that’s then local and supported and supported by it by tele support and even remote monitoring. I think the elements of this that I think is still a struggle is you’ve got to catch up with the revenue because then you’ve got to split things. And I know you can’t solve that, but I think it has to be part of the element of that that says, We’ve got to be big boys about this and Share in the resource that has contributed to the overall care. Have you seen any progress in that? Are there any standouts around that area?
Darin Vercillo
You know, it’s really interesting that you bring that up, Nick. And in the work that I’ve done, interestingly enough, I’ve actually found that to be less of a problem than you would think it is. To your point, our goal is great patient care, and, and also great provider satisfaction. And I think that’s part of what comes in there. When you have a situation where provider is looking to move a patient to their next venue of care, it’s usually because that patient isn’t appropriate for where they are right now, whether that’s a move up or move down, and you know, acuity level of care, but let’s take the move up situation, if I have a patient that’s under my care, and they’re outstripping the capabilities of me or my organization, I want to move that patient to the next level of care, my administration wants me to move that patient to the next level of care, because that’s risk for us. That’s not the best care for the patient. Of course, many of us live in the communities where we provide care, we want the best for those around us. And, and for those who are looking to receive those patients who are referral centers, or who provide service lines or want to build service lines, to accept those patients. Not only is it great for them to be able to provide those service to services to the patient, but it’s tremendously lucrative to them as well. We commissioned a national study several years ago, which showed that on a national average, a transferred patient provides $10,800 in profit, that’s contribution margin per transfer. For the accepting side. Now, there is some revenue split, but that’s their portion in the end. So again, not to make this a you know, a greedy capitalist sort of thing as far as the financial side is concerned, but there is a very strong driving, compelling reason here from the financial side, to be the path of least resistance to bring those patients in, by the ones that 10s The dozens, the hundreds, on a monthly basis, because there are many providers who are more than willing and happy to transfer those patients so they get the care they need.
Nick van Terheyden
You know, it’s interesting, you highlight that, and it’s, it’s reassuring, I guess, in some respects, not surprising, because I always start with the premise that everybody enters into their job, especially in healthcare with the best intentions, we all want to deliver the best care do the right thing, all of those things. And in most instances, almost all of them, the reason that we fail at that is not because of the intent, but because of the surrounding systems that are failing to allow them to deliver the appropriate care. With that in mind, I mean, I think you you brought some great insights, there’s some tremendous potential, what would you leave people with, as a thought of, you know, what are the next steps to get to this point, because we all want that you want it as a son, you want it as a parent, you want it as a physician, and not all of us want it? How do we get there?
Darin Vercillo
I think there are some natural steps that can be taken in any organization, and I love just the very, the very name of of your broadcast, the incrementalist. These are not way out there massive changes that need to be made by the vast majority of healthcare systems. The way that about healthcare works with organizations varies depending on where they are in their journey. They may just be starting out with this and thinking we want to attract more patients. And whether it’s setting up their own access and orchestration strategy and Access Center Transfer Center, or outsourcing it with us and having us bear that. That burden and that, that work for them on their behalf. That can be their first incremental step. Whether it’s an organization that’s been doing this for years, that is already transferring hundreds, if not 1000s of patients on a monthly basis, who need to, to your point, improve process and improve technology integration interoperability. We come in there and take that next step with them. So they can get that incremental improvement of stopping leakage within their organization or bringing in more or not missing opportunities along the way and then even at the inter system level on a state level working with a state for instance, to address a COVID pandemic, which hasn’t gone away yet I wish it would, or a behavioral health strategy to to make those resources available invisible. I think it’s it’s a get started. It’s talked to about health care and on a consultative basis to see what is that next natural step, which can be evolutionary can be innovative, but doesn’t necessarily have to be disruptive to the organization in their next step of their strategy.
Nick van Terheyden
Well, I unfortunately, we’ve run out of time, but you know, you’re singing my song. And I appreciate that. I think, you know, the next natural step of progress in this, you know, tremendously important given COVID But, you know, for all sorts of other reasons. Darren, thanks for joining me on the show today.
Darin Vercillo
Thank you, Nick. This has been a pleasure
