Transcription:
The Business of Healthcare, and How the Healthcare System Works to Meet the Needs of Patients

Carl Maronich (Host): We are here with Phil Kambic. Phil is the President and C.E.O. of Riverside Healthcare. Phil welcome to the podcast.

Phil Kambic (Guest): Yeah, welcome thank you.

Carl: Phil you are not only President and CEO of Riverside Healthcare located in Kankakee, Illinois but your Kankakee native.

Phil: Yeah.

Carl: Not all hospitals can say their C.E.O. grew up in that community.

Phil: I think I'm one of very few. I know if you actually, other ones in the Illinois area that have done that but not very many.

Carl: So, grew up in Kankakee, went to Eastern Illinois University, undergrad and when you were sitting class there did you ever think running a hospital was in your future?

Phil: No not at all. I was a computer programmer and I got a double major in computer science and management and had no idea I would end up at a hospital.

Carl: You were in college in the early eighties. So, a computer were they using cards and punch cards still back then?

Phil: When I first got to eastern, I was using punch cards believe it or not, yeah, that’s a long time ago.

Carl: A lot of technology changes in an industry now that where technology's a real big thing. We'll talk a little bit more about that later but mentioned computer programming degree started out of college at Riverside, right out of college?

Phil: Yeah, I was actually an interesting story in that I applied for a computer programmer job. The guy who hired me had permission to hire one person and he had already hired somebody and then he liked me and was impressed with me and so he offered me a job as well. I think he got into some trouble actually, but nevertheless he hired me, and it stuck.

Carl: It worked out well for everybody it would seem. So, in computer programming, when you started and what kind of computer programming was happening in the hospital then?

Phil: I was a COBOL programmer, so the hospital had just purchased a brand new financial system, so that was all of our billing and collections systems, payroll, general ledger and we had purchased it. It was all written in COBOL. The company went out of business and so versus buying one other system they hired a few programmers like myself to maintain the system and to enhance the system.

Carl: And so, then that system gave way to others eventually obviously.

Phil: Right, right but it was a great experience for me because I got introduced to all the business functions of the hospital, worked with those directors and changes that they needed and again as a computer programmer, you understand process which really helps in today's environment as well. So, I got a very broad background in healthcare because of that.

Carl: And as you talk about hospital leadership you know, you belong to a lot of organizations of other CEO's is there a percentage that come up in the non-clinical side and at those that come up on the clinical side and I'm going to guess without knowing the answer that there may be more non-clinical than there are clinical CEOs.

Phil: No actually not. There I think more are clinical either a nursing background or physician background. There are very, very few I don't know of any other ones that came from an I.T. background. So that is pretty unusual. But a lot of times CFO's or VPs of strategy might go into CEO, but a lot times it's your nursing personnel or your physicians.

Carl: Oh interesting. Well a little personal information you actually grew up here in town and have a couple kids. Tell us quickly about your family.

Phil: Yeah, married have two children. They're both grown and out of college now. My son works out in Washington D.C. and is doing fantastic. He's actually going to get married this year, so that will be fun. And then my daughter is down in the Indianapolis area and doing well also. So, she just graduated, and he graduated with his master's last year as well.

Carl: So, two kids, both out of college, both not living at home.

Phil: Correct.

Carl: Congratulations on that.

Phil: Thank you, mostly off payroll, there is still a little bit of help there, but mostly off payroll.

Carl: I wonder if that ever happens completely.

Phil: Yeah, I don't I don't know.

Carl: Well you know we mentioned how you got into hospital work not necessarily expecting that and then here you are CEO. At some point early on, as you were here at Riverside from computer programming; you kind of started to rise up the ranks and obviously you started thinking about hospital leadership I would guess.

Phil: You know I've been very blessed. I've had some very good mentors at Riverside and so I moved up very quickly, started as a computer programmer, moved into a manager role after a couple of year, s director role after a few years after that. I was a V.P. at age twenty-seven I think. So, I was one of the youngest VPs ever in Riverside’s history and just had good mentors and good leadership and the more they gave me, the more I asked for, they gave it to me and I did well and just kept moving up.

Carl: So great opportunity to see the organization from all sides starting you know every way certainly is a positive thing and one of the things that we talked about this before we sat down today; one idea I had was to ask you when you go to dinner parties go out meet people when you meet somebody who doesn't know you and you tell me I'm the CEO of a hospital, I'm guessing you get a kind of a range of questions, a small range of questions that people ask. What are the kinds of things that people ask and wonder about?

Phil: Probably the most interesting thing and I have friends that are from overseas from Europe, etc., they always ask if I’m a doctor because again in the European model, usually you have to be a doctor to be the CEO of a hospital so that's probably the most unusual one. Outside of that, it's really a broad range of wow that's a lot of responsibility or wow that's a complex industry or are those sorts of things.

Carl: And there's a lot of complexity certainly to the hospital. The hospital business and one of the things again we talked about, we were going to talk about here is the medical group. The idea of employed physicians, now back you know when I was a kid there was a T.V. show Marcus Welby who was the family doctor who visited everybody's house and that model really is gone now. Most providers and physicians are employed by health care organizations as is the case in Riverside. When I started ten years ago I think we had twenty-five or so employed doctors. We're now nearing 150 so it's really exploded and talk about the reasons that that happens.

Phil: You know in communities like ours, and in most communities, I would say outside of the major urban areas, you had doctors that were solo practitioners or maybe they had a partner right and so they had one or two man groups and that was great. Kids coming out today, they want to have more call coverage and so that's one of the key reasons that that we started employing. We couldn't recruit physicians to our community and secondarily, that one in two-man groups, if they had to recruit a physician that's making literally hundreds of thousands of dollars that was cash flow out of their own pocket and they simply couldn't afford to do it. So, they stopped recruiting, so our medical staff was shrinking. So, Riverside got into the business of employing physicians. That's kind of how it started and now it's just escalated. If we want certain specialties in our community, we have to go out and employ them, because they're not just going to come and open up, put up a shingle and open up a shop. It's a very complex business today so between the hiring of people, the computer systems, electronic medical records systems they have to have; it's very complicated and so for us we got into this model as you said 10-12 years ago we probably had 25 now we have 150. We're really, it's really coming together nicely. The physicians feel like they're integrated into the organization. We have a governance structure for the physicians and it's going very, very well for us. So, I guess it's a key strategy as we go forward one of one of our most important strategies as truly an integrated health system.

Carl: I mentioned Marcus Welby, you talked about physicians wanting to have a one partner maybe. He had a partner; do you remember his name.

Phil: I do not.

Carl: Marcus Welby’s partner. I believe it was Steve Kiley was the guy’s name, played by James Brolin.

Phil: Oh, okay, oh yeah.

Carl: That’s all the trivia I have about Marcus Welby there. All right talking about recruiting physicians and these kids we will call them that come out of school, because they seem like kids nowadays but are they - their needs what they want - the model that they want to practice in, their lifestyle, is that affecting how you're able to recruit providers.

Phil: Oh, absolutely big time. And again, everything in medicine is changing. Everything in health care is changing. These new kids coming out, they want to they want a work life balance. Very talented, very smart, hardworking. So, you know millennials always get a bad rap, millennial physicians get a bad rap as well. But these kids are bright. They are top notch, good practitioners. They want to work life balance. They don't want to come to the hospital in the morning and see their patients, go to their clinic see patients all day, come back to the hospital, maybe go to the nursing home. They don't want to work tw12-16 hours a day. They want to have balance and so in today's environment as we recruit then, one of the things we're doing is many of the new physicians, primary care physicians will be outpatient only. They never come to the hospital and then we have certain physicians called hospitalists and that's all they do, they stay in the hospital setting. So, it's very much a different blend of what we're seeing but again very highly skilled, very intelligent people.

Carl: I’m glad you brought up the hospitalist issue. I was talking to Dr. Ansari, a provider in the community and he talked about his patients in the shift to hospitalists. A lot of patients don't they don't maybe fully understand it and it worries them a little bit. But talk a little bit about hospitalists and how that's really reshaped a lot of what the hospital does.

Phil: Yeah, it definitely has, and we have hospitalists that are just for inpatients right. So inpatient primary care hospitalists. We have hospitalists at Riverside for behavioral health. We have hospitalists for Neurology patients. We have hospitalists just for the intensive care. So, we have lots of different types of hospitalists and for Pediatrics, as well. But what happens, and I will say this not as a negative, our older patients are used to that Marcus Welby approach. They're used to seeing their doctor in the clinic. They are used to seeing the same doctor in the hospital. The younger patients, they're more fluid. They get on their phone they'll do an e-visit, they'll go to an immediate care, they’ll come to the hospital. They have a different position or provider every touch point and they're OK with that. So, it really depends on partly on what you grew up being used to and the other piece is really that individual physician. So, we try to recruit hospitalists that are that are not only high quality, but are very good from a patient satisfaction friendliness standpoint and that will help put some of our patients, our senior patients especially more at ease if they have a provider that they can relate to them. That will be friendly to them that they that they understand and can get to know a little bit.

Carl: So really in the long run it works out well for all concerned.

Phil: It really does and that hospitalist all they do are see patients in the hospital. So, they can see that patient two or three times a day potentially versus that one time late at night after they have done their clinic visits. So again, it does work out. It's been very successful for Riverside. From a patient satisfaction, from a quality, from every standpoint.

Carl: I’m going to tell you now, I'm going to ask a bit of a longer question which gives you an opportunity to get drink of water if you would like. The light makes it kind of warm, so the water is kind of nice, but you know we started talking about the fact you grew up here, you are a community guy so Riverside can be called a community hospital, although that has a that has a connotation that makes it a small kind of you know local hospital. We've grown really beyond that point, but obviously being concerned about the community and providing for the community is really what we're all about. How has that idea changed over the years and trying to keep the community in the community for their health care.

Phil: You know I think it's only changed for the better from a community hospital standpoint. We're not that small community hospital anymore. We’re getting to be very large from a from a revenue standpoint, from a service standpoint and so I think it's been very positive on that community. What I look at and data is key, right data analytics, is in every industry now including health care, I look at patients that live within a certain radius of the hospital and where do they go. Do they go outside of the community for their health care? So if they live in Bourbonnais and they're going up to Rush in Chicago or they're going up to Northwestern why? What services are they getting up there that we're not providing here? And so, then I try to say okay, can we provide that service at a very high-quality level here in Kankakee and if we can; that's what we start to pursue. We start to pursue the technology. We start to pursue the physicians, the other clinical support staff that we need, and we bring that service to Kankakee. So, that's kind of how it works from my standpoint. I believe health care is local and how can we keep our patients from this local area here from a high-quality patient safety, patient satisfaction standpoint?

Carl: And another big thing that we talk about a lot is access and making sure the community has access to health care and one of the tools that have played into that are immediate cares is in the opening that we've added several. We have 8 this year open right? Talk a little about that philosophy kind of feeds everything else.

Phil: We have eight immediate cares as you said, and we have them in a lot of the smaller outlying communities. Those communities don't have a physician and so we open up a clinic, it's staffed by nurse practitioners very competent, very skilled and we run them seven days a week, three hundred sixty-four days, they're open almost every day except for Christmas and they run twelve hours a day Monday through Friday, they run eight hours on Saturday and Sunday. So great access for people in those communities. They go for an urgent visit not an emergent visit an urgent care visit. They see a nurse practitioner. She will address their concerns. If they need something more then she can refer them on to a specialist at Riverside, on to a diagnostic test at one of Riverside facilities etc. but it's that quick convenient access within their home town and it's been very, very successful, very highly regarded. I was looking at patient satisfaction numbers there on the ninety fifth percentile or above from a patient satisfaction standpoint. They do very, very well.

Carl: Outstanding, so a model that's worked well. Again, kind of for everybody, for the community. I'm going to now ask an ultimate question, which isn't the last question but the second to last question I believe if I'm using that word correctly, but Riverside is an independent organization. We hear a lot of hospital mergers, systems coming together, but Riverside has stayed independent. Do you see that continuing in Riverside’s future?

Phil: You know independence is not a strategy of Riverside, it's an outcome of the work that we do. There really has not been a driving factor that would say Riverside you need it you need to join another organization, another network of physicians, right. As the environment changes, if the government does something crazy right, the Medicare Medicaid system, if we can't recruit physicians. Those are some of the needs that we would have to look to a system for. But we don't have those issues today. So, my expectation is that we're going to stay independent going into the future.

Carl: I fibbed because there’s going to be another question here real quick. One thing I wanted to bring up and ask you a little bit about, Riverside is the largest employer in Kankakee County with three thousand or so employees. So that means of the work you do you not only could have to think about the patients and all that to serve them but you've got a lot of employees that you have to think about because you obviously want the best employees and want to make sure your employees are happy and stay and all that so that's a real tough balance I would guess.

Phil: Right no absolutely. Again, it's a tough balance but it all fits together. You have happy employees, you have happy patients right. It kind of fits together. If you have unhappy employees, they're not going to your patients, you’re going to have unhappy patients, you’re going to have unhappy visitors. So, we do lots and lots of different things. We have been named one of the healthiest employers in the country because of some of our wellness programs that we put out there for our employees because again if you have sick employees you're not going to have happy employees, so we really focus on wellness. We focus on job satisfaction. We do employ engagement surveys on an annual basis and then we actually take the data from those surveys and act on it. So, we have very high patient or very high employee satisfaction, very high employee wellness and that all fits together. So again, it's a big task but we've got great people working at Riverside. It's not just one person, it's an entire team and we work well together, and we've accomplished some great things.

Carl: Then lastly, I guess I want to give you the opportunity if anything we didn't talk about that you want to make sure the community, those listening to this understand about kind of the Riverside philosophy and what we're trying to do for the community.

Phil: Yeah absolutely. I think the message I would send we are a high-quality organization. You know I think was Ford or one of the car companies’ quality is job one. That's how I feel at Riverside. If you provide a great quality product, people are going to want to come back to you right. So great quality means not only good outcomes and safe care and positive patient satisfaction; all those things rolled into it. If you focus on great quality everything else kind of falls into line and Riverside has been recognized as a top 100 hospital nationwide. We have been recognized as a top 50 cardiovascular hospital. We've gotten all sorts of awards for heart, for ortho, for our neurosurgery programs. So that's really what we focus on and I find that if we focus on quality all the other stuff kind of falls behind and comes in the place.

Carl: Very good. We call this podcast Well Within Reach. After some of the things we've talked about we might want to change it to Marcus Welby within reach because we brought him up a couple of times.

Phil: You’re dating yourself Carl.

Carl: I am.

Phil: Some of our listeners out there I don't think they're going to know who the heck Marcus Welby is.

Carl: They're going to run, and check go on You Tube though and find old Marcus Welby episodes. Well Phil we appreciate you joining us.

Phil: Yeah Carl, thank you very much. I appreciate being here.