Join Mike Scribner and Jason Crosby for Part 2 of our interview with Damien Scott, CEO of Emanuel Medical Center in Swainsboro Georgia. As we wrap our conversation, we continue talking with Damien about how organizational culture has evolved, what he and his team have found most impactful, how staffing challenges in today’s environment impacts their planning, and how payers and their respective plan evolution is embraced strategically.
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 Stethoscope, Vital Conversations with SHP. I’m your host, Jason Crosby. Today. I’m joined with SHP principal Mike Scribner as we wrap up our interview with our guest, Damien Scott. If you recall, Damien is the CEO of Emanuel Medical Center in Swainsboro, Georgia. In today’s conversation we talk about, not only has healthcare changed because of COVID, but the culture around healthcare has rapidly changed as well. Are you ready for this vital conversation?
Mike Scribner:
You had spoken earlier about one of the other threats to rural hospital as the can be an aging physician population. Can you speak to your situation and what you’re doing to mitigate any risk around that?
Damien Scott:
I’ve heard several employees, leaders, and managers, say that one of the challenges they have is the generational difference between their older employees and their younger employees. This is definitely true on our physicians. So there’s so much here. Mike, an older physician, when they came into the role, they were offered a salary and that salary, by the way, included call, and they also included going and checking on your patients in the hospital. So it used to be a primary care would get calls through the night. They’d get up in the morning They’d go talk around on their patients. They’d go to the clinic. They’d see patients all day. They’d go by the hospital at night and then they’d get calls all night. Well, today’s physician that’s coming out, the modern physician they don’t want that. They would like to have some more work-life balance, and I don’t blame them. I mean, I wouldn’t want to do that in my life as well. But the problem is that now, because of that, if they do call at night, they want some increased compensation for it. We also specialize, so now you have outpatient primary care and you have a hospitalist. So now you’re paying two physicians for what we used to pay one, and they don’t want to work the 24-7. They want to have a day person and a night person. So, as a result, what’s happened is that we have the older physicians feel like, well, these younger ones, they can’t cut it. And the younger ones are like I don’t want to do that. And the CEOs are like how am I going to pay for this? Because now everything’s costing so much more. So, although I understand what the younger physicians are wanting, I don’t want to work 24-7. It does come with an increased cost, and then also, we’re seeing this in all kinds of positions within healthcare. But it’s costing 30% to 40% more now to have to hire a physician, and that’s a problem. That’s a real problem, and I feel like the state’s trying to do some things to help it. I’m a big fan of Mercer Medical School. I’m a big fan of the program that they’re putting in place that’s directing people into rural areas after they finish. I think that’s going to be a real big help. MCG is doing the same thing. Both of those are great programs that will make it easier to recruit physicians back to rural area. But it doesn’t matter if it’s easy, if we can’t afford it. And I’ve learned a little bit about the PA and nurse practitioner practice acts in Georgia. Just do a quick Google and you’ll find that we’re some of the most strict practice acts, whereas states like Washington and New Mexico are probably some of the most liberal practice acts. And the reason why especially New Mexico did that is because they wanted to put nurse practitioners in a rural area so that there could be access to healthcare. And I think the state needs to really look at what do we need to change within the practice acts to make it so that nurse practitioners, especially in a rural area, could have a little bit more autonomy so that there is access to care.
Aaron C Higgins:
And I can hear the physicians right now.
Damien Scott:
Well, that’s not good care. You know it’s got to have a physician involvement and you know what? I agree with you. But having a nurse practitioner in there is certainly far superior to having no provider if you can’t afford the physician. So I think there’s got to be a solution that is made where we have a little bit more autonomy for nurse practitioners and PAs.
Jason Crosby:
Damien, keep going on that path if you will. So you touched on a little bit on the mid-level side. As you talk to other hospital CEOs or really any industry, that is, post a COVID world, what other staff challenges have you been facing and what other maybe creative solutions or other culture type initiatives would you say has helped with those sort of staffing challenges in this post COVID world?
Damien Scott:
We’re talking about physicians, but the salary pressures on every position have definitely been there. We made a decision early on that ended up paying off for us and I’m probably gonna step on some toes here but we decided to not utilize travel agency and we did everything in our power. The problem is, once you start using travel agency, you can’t stop. It’s very hard to stop and it creates an environment, I think, where you’ve got your local skilled population is irritable because they know you’re paying that person sitting next to them who’s not totally engaged with the organization. You’re paying them a lot more. We tried really hard to not do that. And then how did we accomplish that? We decided, well, we will do some one time and short term things, and we defined it early on very clearly, because it’s really easy for this stuff to get out of hand. Hey, we’re gonna pay you this amount and we’re gonna pay you this instead of using travelers, and we can’t do this forever. So we understand human nature is to get used to that and not wanna give it up, but this is just a short term. We can’t afford it forever, but we can afford it for a little bit. And so we were able to go through COVID and in a post COVID world where we didn’t really rely on a travel agency for any of our positions. The other thing and we didn’t really have any control over this, Jason, but we’re very fortunate right across the street from me is Southeastern Tech, and Southeastern Tech has a nursing program and I have all of their students. Actually, they have a lab tech nursing tech and I have all of their students in my building almost every day. The president, Larry Calhoun, told me yesterday they placed 100% of their graduates. But you know what the problem is? Not enough people go to tech school.
Jason Crosby:
Not enough to feed your system there?
Damien Scott:
You know what, you can have a really great job. Go over there. In two years you can be a lab tech. That is a great job. If you’re a science-y kind of person, like looking in microscopes, running machines, you can have a really great job and that’s just the floor. Those are good, open ways to get your in the door. We started offering scholarships to our employees. We do five to eight a semester and we left it wide open. I thought this was gonna be a good idea to leave it wide open so that maybe even in the engineering department somebody wants to get a plumbing certificate or something. So we left it wide open. But we left it so open that nobody applied. So we had to like go back and say, okay, look, these are the things that we’re looking for. If this is of interest to you to go back to school, we’ll give you a scholarship. That I think has helped in terms of retention because it helps the employees say look, okay, the hospital really values me, they wanna see me grow in my career. And we’ve had, you know, coding. We’ve had people apply for coding certificates. We’ve provided scholarships for that as well.
Jason Crosby:
So we’ve touched a lot on culture and staffing. Let’s look at the payer involvement and the environment of the payer landscape as it continues to evolve. It’s evolved throughout COVID, post COVID. How does that sort of impact your thinking now, but also thinking forward as you take EMC to that next level? How would you say that landscape has affected your thinking strategically?
Damien Scott:
One. You have to know your payers. I feel like I have the job I am the spokesman for Emanuel Medical Center and when you take that role really seriously, then that means you’re getting in there and telling your payers your story. And this is where our partnership has come in, really, I think, very valuable. You guys helped me provide some technical data, but I’m the one in there pulling up my sleeves and telling them hey, this is not fair and this is why it’s not fair. And in our case, look, you’re saying you value quality and we’re a five-star hospital, but you’re not compensating me in a way that is fair, and so we. I think that, in terms of the payer relationships, you’ve got to be the one to say that story, but also you have to be, I think, have a relationship with them as much as you’re able to as well. So that way, when there is an issue sometimes even a software issue happens and you’re having a bunch of claims rejected, you need to be able to know okay, I need to call up a payer and I know so-and-so over at that office or that shop. Let me call them and see if I can make this right. I can’t tell you how many times I’ve been able to solve a problem because of a relationship that I had with somebody on the payer side, that you’ve been able to get it done. And so I think one is go out and tell your story. Another is have relationships with them and recognize, too, that a lot of times they’re trying to meet their company’s objectives and goals and sometimes that aligns with ours, and when we can align, great. And when we differ, we just have to get in and negotiate on that. All of the payers right now are talking about quality, and so, as I mentioned earlier, that’s a good way to start a conversation with them, because if they’re saying, hey, they want quality for their members and I want quality for my community, well, how can we come together where they win, and we win, especially on the managed care? The reason why that they’re paying out quality incentives is because they’re getting quality incentives for how we do with our members. So there’s definitely been some alignment for us with those Medicare payers.
Mike Scribner:
I guess just kind of sum up organizationally or maybe answer this for you personally how do you define success? Forget just the financial bottom line, but how do you define success?
Damien Scott:
Man, I’m so glad you asked that. So you know the turnover for hospital CEOs is like fast it turns over so quickly. I think the average time is two to three years. So if a board is looking for a CEO and you’re measuring success based on the bottom line, chances are you’re gonna have to keep looking for a CEO every year because it’s really hard. If that’s your only measurement of success, it’s gonna be really hard for almost every rural hospital like mine to be financially successful year after year. I wish it could be, but the reality is you’re gonna have to define it much more than just the bottom line. Here’s how I think that success should be defined. Are we providing high quality care to our community? And there’s lots of ways that we can measure that. The CMS 5-STAR is one of them, but there’s other ways too. Are we, when we look at the other quality measures that the other payers do, are we hearing good feedback from the community? Are we hearing good feedback from the elected representation within the community? And are we hearing good feedback from individual patients? And I think too like, are your outcomes good? So you know, sepsis is a good one. Are you actually saving lives when you treat people with sepsis. Are you getting people who show up to your ER with chest pain? Are you getting them to a cath lab in a timely manner? And so I think that’s one way that you can measure success. Another is, Mike, am I providing good jobs for this community? Am I providing good care for this community? Am I providing good jobs for this community? And then another one is am I providing services that this community wouldn’t have otherwise? So one that we subsidize heavily is. You know that we closed our labor and delivery in 2015. Since then, I’ve aspired to have outpatient OBGYN services. I had it one day a week for several years, then I got to two days a week and then gradually now, starting this year, we’re five days a week I can offer that service. How did we do that? We grew our own nurse practitioner. So one of those ladies that had worked, Denise Peebles, that had worked in the labor and delivery. She just kept going to school until she’s a nurse practitioner. So now we can offer that five days a week, and the reason I say that’s a measurement of success is that we are now being able to provide a service to a community that’s of high, high need and high, high value. And we’re being able to do that, and it comes at a cost, but it is one that is of great value. And I think the last one is is that? How do you define value? Is that we’re still here? I mean, you know, if you’re still survived, then you’re doing something right. And I think, unfortunately, boards typically are made up. I’ve got a really great balanced board, but when you have a board that’s really super focused on just the financial aspect of it, everybody’s gonna be frustrated. It’s important, absolutely important. We’ve gotta address it. But it can’t be the only thing we address. I could talk about that for a long time, but it’s so true because you just look around the state. You’ve seen it for the last 10 years. You know, if you got a guy who can’t have a winning program in a year and he’s gone, well, too bad, because guess what’s gonna happen? You’re gonna hire the next person. They’re not gonna have a winning program either, because it’s really hard to win financially when you have a payer mix, like what a Emanuel has. Can it be done? Yeah, we figured out some years, some months, we figured out how to do it, but then you gotta go back. Also, part of winning’s gotta be hey, I’m gonna go out and lobby for this subsidy or this better payer rate, or I’m gonna go out, as we talked about on a previous call. I’m gonna go out and try to convince those people who are leaving my community that I have the best possible care locally, so please take part.
Mike Scribner:
Yeah, and I know a lot of, I know a lot of, I know a lot of examples of administrators who can do the two year flip. It’s an entirely different game to be there for nine years and be able to kind of sustain that. Yes, it’s up down and financially, but there’s just there’s a lot of turnaround, artists, different skill set, entirely for it to be sustainable.
Damien Scott:
Well, you know I tried to mention this before, but you know, I’ve got some really, really great people around me and I try to think sometimes, when you’ve been at a place for nine years, you have these thoughts like well, have I done anything. There’s a handful of things that I’m that I’m, you know, super proud of, probably the biggest of which is I have a team that I genuinely believe that if, if something were to happen to me, they would be able to take it and run with it. I feel really good about that. This may sound so corny, but you know our building was built in 1952. We put the first replacement roof on it a year and a half ago and that just buys whoever follows me, at least sometime that do not have to worry about the roof. Our debt right now is really low. If you look at, like you know, in an MBA class, that would really concern people because they think, oh, you got to leverage and do all that kind of stuff. But I think in a rural hospital it’s different. As much as possible, you want to try to avoid it because you really don’t know what the next month, next year, holds. Unless there’s an absolutely clear ROI on what you’re borrowing, I just think it’s a dangerous move.
Jason Crosby:
Damien. That’s some great insight, great input. It’s been a fantastic interview. Really appreciate all the specifics and background information you’re giving us. There’s no question we need to have you back again and have another session where we can pick your brain and appreciate all the success that you’ve had with the facility and applaud you and the community there. It sounds like a great team and we really thank you for your time.
Damien Scott:
Well, thank you guys, I appreciate it. I probably over talked on some of those, but you know you kind of pull the string and I’m a go. You know, sometimes in a party or somebody asked me about like what do you think about this in healthcare? And then my wife’s like, oh no, but you know, it’s important stuff, it really is. I feel like it’s probably top three important things that a community needs to be talking about and people can tell if you really legitimately care about it. They can tell that pretty easily and we got some great rural hospital CEOs out there. We really do. These are people that almost all of them are a non-traditional model, like mine, that didn’t just go straight into healthcare and admin. They were in the trenches fighting and then earned that spot.
Jason Crosby:
So you’ve got the passion too, and we do appreciate it. So with that, we want to thank our listeners for today’s episode. We’ll have the show notes and other background information for Damien posted. We appreciate his time and thanks to Mike as well for joining us today. You’ve been listening to Beyond the Stethoscope Vital Conversations with SHP. This has been a production of Strategic Healthcare Partners.
Aaron C Higgins:
Your hosts are Jason Crosby and me, Aaron C Higgins. This episode was produced and edited by Nyla Wiebe. Our social media content producer is Jeremy Miller.
Jason Crosby:
Our executive producers are Mike Scribner and John Crew.
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 shpllc. com/ podcast. Thank you for listening.