Kevin Mahoney has served as CEO of the six-hospital University of Pennsylvania Health System based in Philadelphia since July 2019, part of a 23-year leadership career at Penn Medicine. Mahoney recently talked with Assistant Managing Editor David May about lessons learned in the fight against COVID-19 and some policy priorities for President-elect Joe Biden. The following is an edited transcript.
MH: With the COVID surge in recent weeks, what’s different compared with the first wave? What have you learned?
Mahoney: At Penn, we’re back to our early June numbers, as we came down from our peak COVID census in the springtime. What we did during the summer was a lot of desktop planning for if the virus came back, how would we coexist with it at 10% volume, 30% volume, 40% volume of COVID patients.
We do not want to shut down care to non-COVID patients like we did back in March because we have a number of documented cases of patients that delayed care, deferred care or weren’t able to receive care. And their disease, whether it was advanced cancer or cardiology, progressed faster than it would have if they had received timely care.
In the desktop analysis, we have a scoring system for surgical procedures. It allows us to look at the next three to four days of surgery and balance the resources those patients might need. For example, ICU beds. We look at our resources versus the ability to defer care. So some might get deferred to release the pressure for the uptick in COVID cases.
Something else we learned confirms Dr. (Anthony) Fauci’s statement early this year—that humans don’t determine the virus’ timeline, the virus does. It has been unpredictable as it’s made it’s way through Philadelphia and back again. And now it’s been a long haul, trying to make sure that we protect the behavioral health and well-being of our employees.
MH: Dr. Fauci has been talking about next spring or summer as the earliest for return to any type of normalcy, depending on the vaccines. What are the challenges?
Mahoney: At Penn, we’re very proud that two of the vaccines that have shown promise so far are built on Penn technology. Dr. Drew Weissman, an immunologist at the University of Pennsylvania, developed the mRNA vaccine technology that paved the way for Pfizer’s COVID-19 vaccine.
But distribution of the vaccines will be an enormous challenge. It’s one thing to create it, but getting it distributed across the globe is turning into the main challenge. So I think Dr. Fauci and others are talking about late summer, fall. Maybe even to begin in 2022 before we see normalcy.
Another thing that was important to us as a lesson, going forward, we need to get bigger as a health system. We need managed-care contracting power and things like that.
And one thing we learned from COVID’s arrival in the spring is the necessity for a multihospital system to be tightly, clinically integrated. As we had our first surge of patients through Princeton Medical Center (in New Jersey), it wasn’t just Princeton taking it on; all the critical-care doctors across the Penn system rallied to help them out, and lessons from Princeton were utilized across the other hospitals. We really saw the value of a health system, from an economic vantage point and a clinical vantage point.
MH: Penn Medicine had already rolled out telehealth capabilities before the pandemic, correct?
Mahoney: Absolutely. I’m going to steal a line from Mauro Guillen, a professor of international management at the Wharton School and a close colleague of ours: “COVID did not create a new normal.” I mean, how could you have a normal in a pandemic? What COVID did was it accelerated trends that were already underway. So the hundreds of millions that we invested in virtual health before March came into play because we were able to quickly pivot almost seamlessly to treating patients virtually.
We didn’t start in March. We already had the platform. We were at more than 207,000 telemedicine visits at the end of April, about 340,000 by the end of May, and over 750,000 telemedicine visits in early November.
MH: Do you think patients will continue to embrace telehealth post-pandemic?
Mahoney: For sure patients will embrace it; our physicians and staff will embrace it. I think the important thing from our perspective is coordinated care is the best care. So using the electronic health record, using a network of physicians that know each other. As opposed to episodic care, coordinated care is much less expensive and the outcomes are significantly better. We see virtual health and telemedicine as another tool in the toolkit. But it doesn’t stand alone.
MH: What are some issues you would like to see high on President-elect Joe Biden’s healthcare agenda?
Mahoney: Things that improve access to care need to be high on the agenda. The barriers to entry and access show the racial divide, the digital divide in telemedicine. I’m looking for things that would simplify healthcare entry so patients can access it more efficiently and it wouldn’t cost so much.
An example: I have 44 full-time-equivalent employees doing nothing but pre-certifying X-rays. And that is condensed to roughly $4.4 million a year of spending just to process paper. I would much rather us come up with a system that is much simpler so that we could redeploy those 44 people in patient care.
I’m a believer in the public option. … That’s not popular with a lot of my colleagues, but I think it’s the right thing for America to do. And then drug pricing certainly remains top of mind for everybody.
Lastly, from an organization that has spawned over a dozen Food and Drug Administration approvals in the last three years, I hope we get back to an FDA that is evidence-based and science-based and helps us bring these novel therapies forward that can really change the world.
MH: Are you assuming the ACA is going to survive in the Supreme Court’s decision next year?
Mahoney: I very much believe the ACA will survive the latest Supreme Court challenge. What remains to be seen is what executive orders, tweaks and other things can be made. What can the new president do on his own and what does he need Congress for? And I’m hoping that he chooses to work closely with Congress so we can break down some of the divisiveness that currently exists.
