Camille Baxter:
Hello and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Camille Baxter. And today we are speaking with Dr. James Swift, chief executive officer of Pediatrix Medical Group. Dr. Swift is a pediatric specialist who joined Pediatrix in 2009 following the acquisition of Children's Healthcare Network, a multi-state pediatric specialty practice he founded in 1996. Dr. Swift was appointed CEO of pediatrics at the end of last year after most recently serving as chief operating officer, where he led all aspects of the company's growth strategy and the design and launch of its new Primary + Urgent Care service line.
Today we are talking to Dr. Swift about how partnerships with medical groups like Pediatrix can help providers build sustainable business models. Before we dive in, we'd like to thank the sponsor of this episode, Pediatrix Medical Group. Pediatrix Medical Group is one of the nation's leading providers of highly specialized healthcare for women, babies and children.
Dr. Swift, thank you so much for being here today. Tell me about writing the book, Pediatric Hospital Medicine: Textbook of Inpatient Management. That was a first of its kind, wasn't it?
Dr. Swift:
Hey, Camille. Yeah, so good to be here today with Modern Healthcare. I appreciate the time. Really, that book was a genesis coming out of the fact that there was a movement back in 1996, '97 for pediatric hospital medicine of pediatric hospitalists, which had not really been identified, was on the adult side. And so the genesis of the book came out for those providers serving just in the hospital and specifically on the pediatric floor, and I have to give a large amount of credit to Dr. Ronald Perkin, who was a mentor of mine and also a pediatric intensive care physician, that we worked in many research opportunities and more importantly on this book. So it was the first of its kind, did a second edition of the book, and I'd like to think that it's contributed highly to what we have done in pediatric hospital medicine across the country.
Camille Baxter:
What a great educational tool, and it's so exciting to have you here with us today. To kick us off, can you share with our listeners a bit about your background and about the many roles that you've had over the course of your career?
Dr. Swift:
Sure. I trained uniquely when it was brand new in internal medicine and pediatrics combined residency program, and eventually went on to train in pediatric and adult critical care. As I left training, I had the opportunity with some hospital partners to look at a new model of care both in the pediatric intensive care unit and across the pediatric landscape. So I founded Children's Healthcare Network, which was a company that really serviced hospitals and clinicians who were providing care at the bedside in the hospital, in pediatric ICU, in pediatric hospitalists, and pediatric ER. We eventually evolved into providing both neonatal care and pediatric subspecialty care.
In 2009, we caught the attention of Pediatrix Medical Group, which at the time was the leading provider of neonatal services and maternal fetal medicine services in the United States, but they did not do the types of services that we did. So at that time, we merged together and really developed really a platform to expand the care in the hospital in the areas where we resided in pediatric intensive care.
Over the course of the time that I've been with the company, I serve really in a role that really expanded those services through relationships with hospitals and large relationships with the hospitals that I had. And on top of that, I eventually moved into a more direct role and development as a chief development officer and then became the COO of the company a little over a year ago, and then finally becoming CEO of the company. What's unique about Pediatrix is we've always been a physician led company. And as I call it, we are our really a physician centric, patient focus company that really provides care at a high level. So within our organization, not just at the bedside, but in our operations team, there are clinicians all the way through the organization and then up to the top with me as a CEO of the company that is focused primarily on the provision of care for women and children in the United States.
Camille Baxter:
Congrats on your climb across the organization and the value that you've brought to Pediatrix.
So we know that nationwide hospitals and health systems continue to face serious staffing shortages. From your perspective, what are some key considerations as partners work to rebuild their workforce? Is a pure physician model sustainable long term or should there be more of a focus on expanding non-physician staff?
Dr. Swift:
In this field we certainly have been the leader in advancing support for allied health professionals, in particular for neonatal nurse practitioners early on within the organization. We are a physician organization, but I will say we're a clinician organization. Meaning that we have physicians, we have nurse practitioners, we have PAs, we have other allied providers, nurses and MAs, who are integral to the services we provide. When we look at our relationship and one of the biggest relationships we have obviously is with hospital partners across the country, there is a stress on the system. We all have heard about it and read about it coming out of the pandemic of the burnout faced by many clinicians, nurses at the bedside, nurses in the ambulatory setting, physicians at the bedside. So our goal has been to work both externally with our hospital partners of how we can provide resources on a clinician front in those cases where maybe the hospital employs those clinicians. But we feel that we have a focus clearly on the clinician, not that the hospitals don't, they are very supportive, but our focus is really around the providers that we have and expanding the provision of care that we've provide.
Uniquely, one of the areas that people have obviously looked at is in neonatal care and having physician assistants that have worked in other areas, but we've started a fellowship program with physician assistants to be at the bedside to compliment the neonatal nurse practitioners we have. So this is all around what we can do to develop these programs, be a partner with our hospitals and also internally to be able to provide the care that we do from an ambulatory standpoint as well.
Camille Baxter:
I'd like to focus on your partnerships and how those work. How does Pediatrix serve as a trusted partner in this challenging time post pandemic and with all of the backend issues that are still affecting systems in providing vital recruitment and staffing support?
Dr. Swift:
The major element that we look at is we're not a staffing company. I often travel the country talking about this, that the nomenclature sometimes within the broader market is that there are staffing companies, and what I like to look at and say that we're a program builder. When we engage with a hospital system or an individual hospital, we go in to find out what the hospital wants to do in the women and children's space and how we can not just bring clinicians to the table, but how do we utilize our bench, our resources to develop a program. Whether that is in a maternal program or high risk maternal fetal medicine, if that's in a OB hospitalist or pediatric hospitalist program, we like to get down with our partners and look at the needs that they have.
But ultimately what we want to make sure is we're not doing that just on a whim, we're looking at the community more broadly and the resources that the community may or may not have and how we can fill those resources. I think when we talk about partnerships, we talk about partnerships on a physician side and a partnership on the hospital side. So as we determine the program we're going to build, whether that's at the hospital or outside the hospital, then also we have a relationship and a partnership with physicians who join our organization. Some of those things that draw us kind of cut across both lines. Hospitals look at us and say, "What do you bring to the table that helps us?" And physicians do the same thing.
We're very proud of the fact that our Center for Research Education Quality and Safety has spent over $100 million in the last 25 years really looking at clinical and bench research that changes the calculus of what we're doing for patients. So I think the research is an attraction both for our clinicians, but also holds us up to our hospital partners that we stand above other peers within our space in healthcare, and we're very proud of that.
Camille Baxter:
Resources and research seem to be the key. And you're going so much far beyond just staffing, like you said, it's really a customized solution it sounds like for each of your partners. Can you talk a little bit about what you see as the key differentiators of Pediatrix for effective partnerships?
Dr. Swift:
Absolutely. Certainly, our focus is to be the undisputed leader in women and children's healthcare in the United States. When we look at it, we touch and take care of 1 out of every 4 infants in the United States, either in the newborn nursery or in the neonatal intensive care unit, and that's with 800 hospital partners in 40 states across the country. That we feel that we have a unique position to look at the continuum of care for children and for women.
As I came on with the company, again as I mentioned, we were focused primarily in neonatology and some of the inpatient specialties. But over my time with the company, we've expanded into a continuum of more than 20 different subspecialties in pediatrics with the goal to really round out and build what I'd like to think is a population health management company for children and for women.
So we look at in one of our new directions is to go into primary and urgent care for pediatrics, knowing as we manage these children in the hospital how do we move them and make sure that they have a medical home when they're discharged? And so our role in primary care and our role in pediatric urgent care is to have a safety net for those patients that have access to care.
Similarly, when we look at maternal care and when we look at women's health, we know that we are at the nexus of an important time for a woman and for a family which is the delivery of their baby. We believe that we can impact care not just in the high risk maternal fetal medicine area and an OB hospitalist, but we've moved into primary OBGYN to expand on regular, normal, as we would call it, healthcare for women. And also advancing this continuum to say we're seated in a unique space where because we're at an important time for a family that we should be a resource for that family, for the life of their children, and for really the journey of the woman. So I think that's a big focus of what we do.
Some of the things that we've done over the years have been important. One is before there was an electronic medical record requirement in the United States, we created BabySteps, which is a really an electronic medical record that was proprietary to Pediatrix. It was less important about the electronic medical record as it was about what the tool did, which pulled out a lot of information on outcomes. And we have the largest clinical data warehouse of newborns in the world. With some 1.8 million infants enrolled in that database and 31 million patient days. It's incredible, and we don't keep that tool and say, "Hey, that's for us." What we've done is we've taken that tool and we've utilized it with other research organizations and universities to access it to see what we can do to really impact care for the newborns.
The same area in eternal fetal medicine. We have one of the largest, most robust research opportunities in the United States to look at high risk pregnancies and what we can do to impact those. I think the other element that we like to think of that draws clinicians to us is our, again as I mentioned, our really focused on research. But we're accredited with accommodation by the Accreditation Council for Continuing Medical Education, so we have our own CMEs, we have our own CEUs for our nurses and nurse practitioners. And we host the preeminent neonatal conference in the United States on an annual basis. So those are all pieces that are important.
And I have to mention one last item that people fail to think about as we're partnering with physicians. The physician landscape has changed, as we talked about in that last question about the burnout. But the other piece is the element of regulatory burden that is on clinicians now, and you look at something like the No Surprises Act, which is an absolutely important legislation to make sure that no family, no patient receives a bill unnecessarily. But at the same time, physicians don't know how to navigate some of the intricacies and, more importantly, changes in payer behavior that come up. And we've really led the way in a lot of this on the women and children's side to help both our organization, but other organizations, understand this regulatory burden and how we can help clinicians navigate it.
Camille Baxter:
As a mother, I'm so happy to hear about your focus on women and children and the family. What else can you tell us about the unique services that Pediatrix provides to create a continuum of care from pre-birth through young adulthood?
Dr. Swift:
We look at it uniquely, and I often have thought about this that, in my specialty, in pediatric intensive care, we take care of a patient at an incredibly, incredibly difficult time, both for the patient and for the family. Whether that's in the neonatal intensive care unit, in the pediatric ER or the pediatric intensive care unit. And those episodes of care end and the patients go off to the community. Oftentimes these patients have unique challenges developmentally, medically. And really we look at it as, can we be better positioned to prevent readmission, to improve on, what I say is not illness but wellness. Wellness is an important part of what we need to look at for women and children and how do we navigate primary care and how do we navigate the routine illnesses that come up?
So our movement into primary care, pediatrics, our movement into pediatric urgent care, keeping kids out of the ER, a family that has to wait three hours in an adult ER to be seen for an otitis media, an ear infection, or how do we navigate that by being in a lower stress environment like a pediatric urgent care where we've created now, I think an environment that takes the stress down. It is as if they're walking into a space where there is not multiple different things going on with other patients or other providers and trying to navigate that.
I often talk about one of the most common diseases in children, which is reactive airway disease or asthma. How do we prevent that from becoming a crisis? And we can do that by leveraging what we're trying to do, number one, by identifying those patients that are coming out of the hospital that we know will have unique challenges going forward and put them in a medical home where we can navigate that space. Same thing on the women's side. We have a mother that we meet during a pregnancy because of a challenge and our maternal fetal medicine physicians are able to impact that care. But after that, that mother who has diabetes and they want to have another child, how can we ahead of the curve manage that disease process so that when they decide to have another child they're in the best health that they can be in?
Those are the goals of what we're doing in the primary care realm in OBGYN and in primary care pediatrics. And ultimately the other part of that is we know there are going to be those children who have episodes of care that require specialists, and if we can have those specialists integrated into our platform in Pediatrix, think about that continuum, that it's the same group managing those patients in a collegial and expert way that really lowers the cost of care, improves outcomes, and ultimately returns those patients to wellness.
Camille Baxter:
I'd like to kind of focus on underserved communities and how Pediatrix supports children in underserved communities. And we know that many of those communities across the country lack access to specialized care, particularly certain pediatric specialties. How is Pediatrix collaborating with hospital partners to help alleviate staffing shortages and improve access to care in those environments?
Dr. Swift:
Camille, that is a great question and one of the biggest problems we face in the United States. The training programs for physicians, the training programs for allied health that have been impacted, and we aren't seeing the number of specialists come out of training to keep up with what our communities and more importantly what our nation needs in terms of providers for, really, world-class healthcare.
We embarked upon a role that wasn't first seen as a need in rural communities, it was a need in even metropolitan areas, and we embarked upon doing telehealth. First started with telehealth from our pediatric cardiologists and our maternal fetal medicine providers, importantly that we could reach out to other primary care providers to look at a child with a murmur and be able to have a remote interaction with a clinician to help make that diagnosis. Same thing on our remote work with maternal fetal medicine with reviewing an ultrasound.
All of this accelerated, as you know, during the pandemic where many of our providers were on the front lines, and many of our ambulatory providers in these specialties really doubled down on what they needed to do on telehealth, and we enabled that with the services that we had as an organization. So it wasn't just looking at the outpatient piece, we started to do tele and ICU. We started to do tele, peds, ICU, the hospitals that were having difficulties recruiting clinicians or may have had clinicians, but they wanted another look at what a patient was doing.
So we've continued to expand in all of our specialties with a really a telemedicine option. One of the most important things in newborn medicine and neonatology is the risk of retinopathy of prematurity, blindness because they're premature and in the neonatal intensive care unit, and really they need to have their eyes examined. And so we started one largest tele-ROP programs in the United States where we remotely, we image the infant's retina, and we have providers who then make that collaboration on a diagnosis.
Same thing, one of the biggest areas of need and concern in the United States is on pediatric neurology. So we have a very unique and focused pediatric tele-neurology program in the United States that can look at those children that have seizures. Those children have other neurologic difficulties both in the hospital and in the outpatient setting, and we can manage those patients both in the rural setting and in some cases in the metropolitan setting.
I'll finish by acknowledging that women's health and OB care and the risk of maternal morbidity and mortality is rising in the United States, and it's an important, important issue that can't just be solved by saying, "Hey, let's put a provider in a rural area." It has to be solved really across the breadth of women's health. Our OBGYN physicians, our maternal fetal medicine physicians are really leveraging their telehealth capabilities to do outreach to the rural areas. But as you know, it's one thing to be able to do the primary care, but it's so important to talk about how do we get the specialized care and help or how do we get a mother to the hospital? And so we have many of our physicians who work in maternal transport to make sure that we have the options that patients know that they can get to a tertiary or quaternary center that can provide the high level care that they need and can be equally satisfied that they know they have the backup of pediatric providers that are at the bedside to help manage the child when the child is born.
So it's really a crisis in the United States, but we look forward to the role we can play in it.
Camille Baxter:
You really are providing such an impressive scope of services and reaching into those rural communities that have been lacking for so long with such innovative approaches to make sure that that care is offered across the continuum for all. This has been such a great opportunity to learn more about what Pediatrix is doing and the types of services that you're offering. What other thoughts would you like to add for our listeners?
Dr. Swift:
I've been a fan of Modern Healthcare as a publication for years, as somebody in training, and then somebody came out of training and somebody who's in the C-suite working alongside our clinicians. So I think the role that your organization plays in disseminating information is important, and I think that's the role we all play. It's not one thing just to highlight the issue or the problem, it's then to look for solutions to the problem that I think do very well, and that's what we're focused on doing. How do we solve, really, the gap in care for children, for infants, for young adults, and for mothers? And I think that that's going to be our ongoing work, and we feel that we look across the continuum, whether it be with providers, and we want to be a home for providers. We want to be a partner with hospitals. Ultimately, what we want to do is what we believe in, is we want to take great care of the patient, and we want to do that, again, not just in illness, but also in wellness.
Camille Baxter:
Dr. Swift, thank you so much for being here today and for sharing the information that you've shared. I think it's so valuable for our listeners in healthcare leadership to be able to hear about those solutions and see that there are additional solutions to the challenges they face.
Dr. Swift:
Camille, it's just been a pleasure talking today, and I appreciate the opportunity to spend time with you and look forward to the future and what you all do and what we do together.
Camille Baxter:
This has been a sponsored episode of Healthcare Insider, created in collaboration with Pediatrix Medical Group. For more information, please visit Pediatrix.com. I'm your host, Camille Baxter. Look for more episodes of Healthcare Insider under the multimedia tab at modernhealthcare.com or subscribe to your preferred pod catcher. Thanks for listening.
