In this two-part interview, Jason is joined by SHP Principal Mike Scribner as they interview Damien Scott, CEO of Emanuel Medical Center in Swainsboro Georgia.
They discuss his unique background and how he got into healthcare administration, which includes his experience as a Physical Therapist. This unusual approach to leadership has provided him with some unique insights into healthcare works from the clinical perspective, as well as well as how it should work to best meet the needs of a rural community.
Join us as we talk through quality, the challenges in finding providers, and how the healthcare scene continues to change.
Guest: Damien Scott, CEO of Emanuel Medical Center
Damien Scott, PT, MBA, MS, FACHE currently serves as the Chief Executive Officer at Emanuel Medical Center (EMC). He has been with EMC since November 2014.
Damien has 25 years of experience in healthcare including teaching, physical therapy, and administration. He serves as the chair of Georgia Hospital Association’s center for rural health, as the chair of the Georgia Hospital Health Services board, as the president of the Swainsboro Exchange Club, and as a board member for the Emanuel County Chamber of Commerce.
Damien earned a bachelor’s degree and master’s degree in Biology, and a degree in Physical Therapy from the University of New Mexico. He earned an MBA from Georgia Southern University in 2018.
Damien and his wife, Heather Scott, a professor at Georgia Southern University, have 3 mostly grown children. His interests outside of work include family, church, birdwatching and competitive SwimRun.
Transcript
Jason Crosby:
Welcome to Beyond the Stealthus Goat Vile Conversations with SHP. I’m your host, jason Crosby. Today. I’m joined with SHP Principal, mike Scrivener as we interview our guest, damien Scott. Damien is the CEO of a manual medical center in Swainsboro, georgia. He came into this role, however, from the provider side. This unusual approach to leadership has provided us with unique insights into how not just how healthcare works from the business perspective, but from the clinical perspective as well. The only thing we talk through quality is the challenges in finding providers and how the healthcare scene is changing. Are you ready for this vital conversation? Let’s get started. Hey everyone, this is Jason Crosby with Beyond the Stealthus Goat. We’re joined today by Damien Scott, ceo of a manual medical center in Swainsboro, georgia. Hey Damien, how are you?
Damien Scott:
I’m good. How are you doing?
Jason Crosby:
Fantastic, fantastic. And with me today is Mike Scrivener, who you guys have heard before in previous episodes, principal of SHP, and Mike and I will go back and forth drilling Damien on some of his background, some of the challenges he’s faced as CEO here in the last several years. So, Damien, kind of kick us off. How did you evolve into your role sort of a career snapshot, if you will where you started on the clinical side, Because that brings a pretty unique perspective. How did your career start and evolve into the position you’re in now?
Damien Scott:
Jason, I’m going to back up even further. I aspired to be a biology professor and I got down that road, at least part of the way. I finished a master’s degree in biology. I was teaching at a community college and several of my students I was teaching for health sciences, and several of my students were physical therapy aspirants, and the more I heard them talk about it, the more that just really aligned with what I believed in. One of them showed a video that showed what physical therapists do, and when I saw that, I definitely knew that that’s what I wanted to be a part of. So even just a month later, I had applied to the physical therapy program. I’m from Albuquerque, new Mexico, originally, so that’s where I was and went to school at UNM Colobos. But I went to physical therapy school and not long after that I moved to Georgia and I started as a weekend physical therapist at Candler County Hospital, and just every year I took on more and more responsibility there, to the point where I had several departments that worked for me, and when the position came open to being an assistant administrator, I took it. I had that for about eight months before I became the CEO of Candler County Hospital, where I was the CEO for one year before I came to Emanuel Medical Center, which is my current position that I’ve held now for nine years.
Mike Scribner:
Damien, this is Mike. So how do you think that that kind of clinical background has impacted kind of your perspective on your current job?
Damien Scott:
Well, really, I think both the science background and the clinical background have really helped me. When we’re having clinical discussions and I understand the science aspect of it from my biology days and two just being a clinician one it helps me understand some of the clinical issues that my clinical team is facing. But I think, in particular, as a PT PT’s are trained to do evaluations of people and then to collaborate with those patients on a problem list and some shared goals. And really, as a CEO, rather than doing that on an individual basis with a patient, I’m doing that either on a departmental level or on a facility level. So, for example, we may look at a hospital OK, these are the problems that we’re seeing here in the hospital team. Let’s come up with some measurable goals, some objective goals that we can do together. That measurable part is so important as a physical therapist, but it’s also important as a CEO and say, OK, here’s where we are now, this is where we want to be. How can we, what kinds of treatment plan for a patient or what kind of strategy do we want to implement for the hospital to meet our goals? So I think it carried over very, very nicely to go from physical therapist to CEO because of that background.
Mike Scribner:
On goal formation so on the flip side of that, what do you think were kind of the biggest things you had to learn to get on the administrative side of the wall and what was kind of biggest surprise that you felt coming over?
Damien Scott:
I spent several years in an investment club. That helped me learn how to read financials, so that helped me quite a bit. I think I had the opportunity to be around some really great people early on in my career to learn how to do that. I think the most challenging for me is that the healthcare paradigm really has been where the physician has, especially on the clinical side. The physician has the authority and everything flows down from that. When I was in the CEO position, that was still hard for me because I was sort of acting as if I was still in this role that was deferential to the physician. At the same time I was also their boss, and so that was really really difficult and probably something I’m still trying to learn how to do well, where I’m respectful of them but also holding them accountable for the objectives of the whole organization. I’d say that’s been the most difficult, I think, in terms of a lot of people who come from the clinical have trouble with the kind of the financial and aspects of it. I really haven’t had it and I think my MBA helped with that, but I do think that the rigor of my biology programs and the stats classes I had to take for that really helped prepare me to be able to address some of the financial aspects.
Mike Scribner:
So you’ve been there for nine years and I guess even going back to the Canterley County days. How have you seen the rural hospital setting in Georgia, rural healthcare in general, evolve? Talk two or three ways.
Damien Scott:
Yeah, well, first thing is and this is gonna be true, I think, for every single rural place the things that rural hospitals need more than anything, and that’s tenacity, and that’s just that willingness to cling on and willingness or desire to survive has gotta be there, Because you’ve gotta have people that they’re just gonna fight for that organization. I think the thing that’s really changed probably number one is we’ve seen and we’ve talked about it, but it’s really happening and that’s that shift from inpatient care to outpatient. When I practice as a physical therapist, I can remember days where people were put in the hospital for a week for back pain. Today, one, you’re never gonna be anywhere near admitted to a hospital for back pain, but even things that we would have considered ICU will probably be in med surge for a day or two now. So that’s probably the biggest change. Pretty, now, solidly, 82% of our revenue is outpatient now. So that’s a big, big change, and I think that hospitals that didn’t really start thinking about that and planning for that and strategizing around that they’re gonna be in trouble right now, and so that’s probably one big change. I think another is that there’s a much, much greater emphasis on quality, and this is good from the individual patient because we’re trying to provide quality care for them. We’re doing things like trying to manage your diabetes a little better, your hypertension. That’s better for the individual patient, but it’s also better for our practices, because the way the compensation is structured now is that our practices are given rewards based on how well we do managing that patient’s diabetes. Hey, did we do a good job ordering mammograms for our patients at the right time? Did we do a good job ordering screening colonoscopies for our patients at the right time? And there’s a third reason why that’s so important is that if we are doing a good job on that I already mentioned we’re gonna get the revenue in the clinics, but we’re also gonna get it on the downstream too. So if we’re doing a good job doing the annual wellness visits, ordering screening colonoscopies, ordering screening mammograms, then we’re gonna get that downstream revenue into the facility as well. So quality has changed dramatically. Every single payer that we’re working with, and especially the managed Medicare payers, or have some type of quality program that we can get additional revenue from. The number one change is the shift to outpatient and the number two is the shift to quality, and I think the third one is that related to telemedicine, and COVID probably accelerated that even more. But there’s so many more opportunities related to telemedicine for rural organizations. So one of the problems that happened as healthcare became more specialized is that those specialists were in urban centers and so the primary care and y’all knew them because we worked with them there were doctors who did a little bit of everything that used to be 15, 20, 25 years ago. There were doctors that did a little bit of everything that just doesn’t exist anymore. So the primary care is referring to the urban center. The patient goes there, that’s where the specialists are, that’s where the expertise is, and then what happened is then the patient said well, you know what, if this is where the expertise is, I’ll just go ahead and get all of my healthcare here. So those who had the ability to leave the community did, and so we saw in the rural communities, we saw shrinking of that market share, and it was worse than just the shrinking of the market share, because it was the people who the payer mix that was the most profitable for rural hospitals were the ones that were going off to the urban areas for their healthcare. And so what telemedicine, I think, has the ability to do is provide some of that expertise back locally. We’ve done it with admissions. We can provide critical care consults, I can provide nephrology consults. That then allows us to keep maybe a little bit more complex patient locally. So you asked for the top three things. I would say again the shift to outpatient, the emphasis on quality in the third was telemedicine.
Mike Scribner:
So, as you talk about telemedicine, what I hear is improved access to care, like services, specialist services being available without having to go to the urban center. What I have felt the hospitals struggle in is how you turn telemedicine into a product line, a profitable product line. What does that turn look like to you? How does it become a retainer of that ancillary revenue in the local facility?
Damien Scott:
Yeah, you bring up a really good point, mike. It’s very, very challenging because what happens is oftentimes we’re reliant on the expert who’s still in the urban area, and if there’s no real incentive for them to continue to be the expert, then we miss out. And so, time and time again, I’ve set up telemedicine programs. I had an expert on the other end of the line whose urban case law grew so much that they just said well, we don’t have time to do this anymore. And then we’re providing an expertise, and now we can’t. I don’t think the opportunity really is on an outpatient basis. I think the opportunity is primarily on an inpatient basis for us, and what I wanna be able to provide is one that when somebody comes into the local ER that our go-to reaction isn’t to transfer to that urban area, but to figure out okay, can we provide the expertise via telemedicine to keep them here locally, and that’s where we’re really gonna get it. The other part of it is is that we’ve gotta have primary care docs that feel comfortable actually treating the patients and not just farming everything out to hey, this needs to go to cardiology, hey, this needs to go to nephrology, but taking care of patients locally and only transferring out when we absolutely have to. Our work with our ACO has really helped us do that, because what we found out is that if we manage them locally, both with our own physicians and with our hospital, then we save money on the ACO and then we end up with shared savings. So we win-win, because not only were we saving the ACO money, but we were keeping the revenue right here instead of sending it to a competing hospital in another market.
Mike Scribner:
Can I go back? You’re kind of opening comment with. That whole section was related to kind of the tenacity and sort of the passion for not just enduring but having the facility thrive and interacting with so many of y’all. That’s one of the parts that I really admire the creativity that’s at that level and the passion not just to see the hospital survive but to the community benefit of that and seeing yourself as part of that. My question is how do you lead the organization in that direction? I understand you personally feel like that. How do you get your organization to sort of share that vision and passion?
Damien Scott:
Well one. You have to be passionate, like legitimately passionate, and so I think that when people see a leader that has that, they’ll follow it. And even in my early days I can remember people were complaining. But there’s going to be a lot of changes in healthcare and healthcare is falling apart and Obamacare and Affordable Care Act and blah blah. I went to them and this was when I was a physical therapist and I said look, why did you guys come into healthcare, seriously, why did you guys come into healthcare? And they’re like well, to take care of patients. Okay, well, if the rules change, do you think there’s still going to be patients there? Yeah, okay, if you came into this to treat patients. Now the rules are changing a little bit, but we’re still going to have patients to treat. Let’s go ahead and take care of patients. And I think when you have somebody that says that kind of message, it’s hard not to say, hey, yeah, I want to be a part of that. When you say, hey, when every single person who walks in this door that’s coming in for healthcare, they’re not having a great day, even if all they’re doing is having some blood work drawn. I don’t know anybody who’s like, hey, I love needles. So every single person that walks in this door, we have an opportunity to be a blessing to them and we have the opportunity to make them feel more comfortable. And I bring up a minor point, but it could be all the way to the point where somebody’s either losing their life or a loved one’s losing their life. We have an opportunity to be such a blessing to them. So, mike, when you have a leader who’s saying those things internally to people over and over and over again, the people that are already here say, yeah, I’m part of that. And when I hire somebody and I’m telling them that’s how we are and who we are and, by the way, I think there’s lots of rural hospital CEOs that are saying that same message but when a physician or a nurse hears that and they go yeah, I want to be a part of that. I want to be about healthcare, that’s about taking care of people. Sure, we have to understand the regulations. Sure, we have to understand the compensation aspect of it. We have to. Those are important. But if your primary love is let’s go out and bless and care for people, then I think people will follow that. And really, when you look at the data. Rural hospitals are the best at this. We have the best HCAPs data anywhere. If you look at the rules, they always have higher HCAPs data. We’ve earned the five-star rating three out of the last four years, and so that comes because people are really passionate about providing excellent care.
Mike Scribner:
How have you seen that permeate through the organization, like, are there other champions that have kind of arisen as well, and then they kind of take up the mantle as well?
Damien Scott:
Yes, and right now I couldn’t tell you how I’m more excited than ever before on my executive team because I have that Mike. We started a team that we call the React team. It’s been around for years, and this React team is an employee-led team that honors their fellow employees, and they meet monthly. One of the members on there, anna Powell she was the newspaper editor in high school, so she does a monthly newsletter. They bring in a food truck every Friday. They do a brag board and brag about the employees. They do two employees of the month every month. They also go and buy the Christmas presents for kids. They just do a lot of really cool stuff, and so what I love about that is they’ve taken the culture that I’ve wanted to have here and made it so much more. And we also have Mike, an employee that, when we hired her as a care coordinator back in 2015, she realized that there was a social element that was missing, and so she kept coming to her fellow employees and saying, hey, does anybody have an extra wheelchair? Or does anybody? Hey, I’ve got this patient who doesn’t even have a refrigerator Does anybody have an extra refrigerator? And that was great at first, but she realized it was growing much. The demands were greater than what her fellow EMC employees could provide and so she started going out and talking to churches and now they formed. Well, it was the EMC Resource Center. Now it’s the Emanuel County Resource Center because it grew bigger than us. So now multiple churches have partnered with her. They have a warehouse she has, they do clothing giveaways, she can outfit somebody with a hospital bed, she can do all kinds of things to help meet the social determinants of health. So your question about how do you spread that to other people? one you’ve got to be so passionate about it. I think that will attract other people that are already within your organization, but it will also attract people outside of your organization. That says you know what? That’s what I want to be about, and I really feel like it’s rewarding at the end of the day. When people talk about whether that was a good day at work, they’re not talking about an easy day at work. They’re talking about a day where they made a difference, and the reality is that work is work. So there’s going to be some hard days, but I think what people really find value is not some job that’s super easy, but a job that they feel like okay. At the end of the day, I really made a difference in my organization. I made a difference in the people’s lives around me.
Mike Scribner:
That’s awesome. So another hard left. What are the sort of the top unsolved problems? What’s next for you guys? What are the biggest challenges that you see, whether or not you think you’ve got a bead on solving it or not?
Damien Scott:
I think one balancing act for every rural CEO is your constituents. So I enjoy operations, I enjoy working with employees, I like some of the stuff we were talking about motivating employees, inspiring employees, but the reality is that the rural hospital CEO also has two other major groups of constituents. One is the local community and the other is our Atlanta and maybe even Washington. We have got to be the ones out there communicating locally and also communicating at the state level and at the national level. For a manual medical center, we spend about, and it fluctuates, but we spend between $380 and $480,000 a month on uncompensated care. That’s our costs. And so here’s a really important philosophical question for us as a nation who’s responsible for that? Is it the individual? Is it our churches and charities? Is it the government? But what we pretty much decided in the US is that it’s going to be the hospital’s responsibility, and although we do get some subsidies, you know that it doesn’t cover that full cost of that. And so who is ultimately taking on that responsibility? It’s the hospitals, and it’s especially the hospitals that have a high amount of indigent care, like the rural hospitals, and so hospital CEOs definitely have to be out talking to their community, explaining that stress or that tension and definitely need to be in Atlanta explaining that clearly to our state legislators and I think also nationally need to be talking about how do we address this situation, because ultimately it will become an access situation. It will become an equity situation if a hospital does have to close. Beckers, I saw in Beckers yesterday. Hospital in Kansas announced yesterday that they were closing and they closed that day. Wow, and they said you know what? We’ll stay open another couple of days so that people can come get their medical records. And this is a hospital that had been open since 1919. And so if that doesn’t just hit you in the gut, you know that that was obviously a place that had been had an important role in that community for over 100 years and now it’s gone. And my guess is you know a lot of it. If you look at the rural hospitals that struggle, it’s because they got a high uncompensated care cost. And how do they address that and deal with that? I think that the subsidies out there are great in hospital, especially rural hospital. Ceos need to be promoting ideas that would help maybe make that so it’s less of a blow on them.
Jason Crosby:
You’ve been listening to Beyond the Stealth School Fiddle Conversations with SHB. This has been our production of Strategies and Health Care Partners.
Aaron C Higgins:
Your hosts are Jason Crosby and me, Aaron C Higgins. This episode was produced and edited by Nile and Weaver. Our social media content producer is Jeremy Miller.
Jason Crosby:
The transcribers Heather McLean, and our executive producers are Mike Scribner and John Currie.
Aaron C Higgins:
For more information about SHP, the services we offer, including the back library of episodes, episode transcripts, links to resources that we discussed, and much more, please visit our website at shpllccom. Thank you for listening.