Michael Brant-Zawadzki, MD, FACR, serves as Senior Physician Executive at Hoag Hospital; The Ron and Sandi Simon Endowed Chair, Executive Medical Director for Pickup Family Neurosciences Institute.

On April 7th, Dr. Brant-Zawadzki will give a presentation on "Creating a Viable, Community Based Memory and Cognitive Care Program" at Becker's Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place on April 6-9, 2020 in Chicago.

To learn more about the conference and Dr. Brant-Zawadzki's session, click here.

Question: What, from your perspective, is the biggest challenge about the future of work for hospitals, and what can they do about it? (i.e. automation, desire for more flexibility, clinician shortages, etc.)?

Michael Brant-Zawadzki: The biggest challenge facing hospitals in the near future is bridging the gap between inpatient and post-acute care including at home, SNFF services. Taking “ownership” of the patient’s journey following discharge from the hospital, navigating that journey to optimize longer-term outcomes, prevent unnecessary readmissions, and improve the quality of life is the Manhattan project for healthcare systems. This is particularly true for the senior population, as approximately 60% of all health care expenses occur in that demographic. Costs of a Medicare patient are triple those of the pre-65 individual. Particularly, seniors with mental conditions such as cognitive impairment, and mental health disorders, triple the cost of non-impaired seniors. Therefore, integrating cognitive and mental health care with chronic medical conditions will be necessary. All of this is crucial if bundled payments for specific Medicare DRGs will continue to be enacted.

Q: How can hospitals reconcile the need to maintain inpatient volumes with the mission to keep people healthier and out of the hospital?

MBZ: The challenge of maintaining inpatient volumes in the face of keeping patients healthier and out of the hospital should not be a great one. Given the inexorable demographics of aging, with ten thousand people turning 65 every day in this country and also living longer, inpatient volumes will be maintained, if not grow. That said, acuity of inpatients, and lengths of stay will likely increase as the average age of inpatients increases. Health policy legislators need to understand the transformation of hospitals into intensive care units is just beginning. This dovetails with the need to expand hospital services to the post-acute, outpatient space that will hopefully partially offset the potential unmanageable growth of the inpatient volume and acuity.

Q: Healthcare has had calls for disruption, innovation and transformation for years now. Do you feel we are seeing that change? Why or why not?

MBZ: Calls for disruption, innovation, and transformation in health care have never been as urgent as today. Given the dramatic rise of the senior population, the need for unsustainable health care cost containment, and at the same time providing improved experience and quality of life for consumers is leading to disruptive innovation, if not creative destruction. Transformation based on Porter’s Value Equation - better health per dollar spent - is becoming imperative. Evidence-based appropriateness studies are critical. A good example of the culture change necessary is the recent publication of the Ischemia trial data showing that many invasive coronary artery procedures do not prolong life, only produce a better quality of life in selected patients with the unstable disease. These types of studies will receive increasing attention and should be incentivized. Many examples of waste in healthcare delivery exist.

Q: What do you see as the most exciting opportunity in healthcare right now?

MBZ: The most concerning, exciting and overall compelling opportunity in health care today is the appropriate utilization of the knowledge workers that represent the means of production in the healthcare industry. Given looming physician shortages, appropriate utilization of physician extenders, and the use of primary care physicians for prevention and wellness maintenance is one example. What we learned from the early ACO projects is the critical need for integrating specialists into best-practice care delivery care pathway design, as the “leakage” from accountable organizations occurred predominantly by patients seeking specialized services.

Peter Drucker famously observed that the best organizations are composed of well-integrated specialists. Knowledge workers can carry the means of production out the door with them, especially in a competitive employment market, thus appropriately incentivizing them through true leadership partnerships for a sense of common purpose, some degree of autonomy, and “skin in the game” with accountability will determine which organizations succeed, and which will fail. Commoditizing knowledge workers through mechanistic employment will lead to cynicism, and cynicism erodes professional values.

To view the original Becker's Hospital Review article, please click here.