Dr. Ravi Thadhani, executive vice president for health affairs at Emory University and executive director of Emory’s Woodruff Health Sciences Center, joins Modern Healthcare to discuss how the academic health system is grappling with higher patient volumes, staffing constraints and payer-mix shifts.
What role does Emory Healthcare play as a safety-net provider in the Atlanta area?
Emory is an academic medical center with 11 hospitals and hundreds of clinics throughout the metropolitan Atlanta area. [Grady Health System's] Grady Hospital is the safety-net hospital in Atlanta, and about 80% of the faculty there are Emory faculty. Emory has a catchment [area] of large segments of the underserved population. No question, [payer mix] continues to be a challenge in terms of serving the underserved population, which we're committed to. We're not leaving.
The closure of [Atlanta Medical Center] [by Wellstar Health System in November] represents a big challenge. That left just a few hospitals within the city and state to care for the underserved.
How has Medicaid unwinding impacted Emory?
The state and some specific counties have provided us with tremendous support, DeKalb County in particular. Medicaid reenrollment [challenges] continue to plague many a hospital. We have been pursuing a large campaign on the reenrollment front.
Our emergency rooms continue to be incredibly full. People come to get not just acute care, but chronic care in those settings. We have seen a significant rise in wait times and duration of stay for emergency services, especially [after] the closure of the other safety-net hospital, Atlanta Medical Center. We don’t see that volume letting up for our acute-care services or our obstetrics care.
When you superimpose that on the challenges that we have in terms of employees—the shortage of nurses and ancillary staff—the burden is exaggerated. It’s the worst of possibilities.
How are those labor shortages affecting daily operations, and how have you had to work around the constraints?
It affects us on many different levels. We’ve had to turn to contract labor as employees have left healthcare or retired. [Contract employees] have served this country in a time of need, so I don’t mean to dismiss that. That said, they tend to be expensive and continuity continues to be a challenge.
The number of contract laborers at Emory Healthcare peaked this March at about 1,300. There is no doubt that our medical system, along with other systems across the country, can’t sustain that number from a financial standpoint, given the razor-thin margins of academic medical centers. We decided in March to reduce contract labor, which we have by about 35%, to 800. We didn’t sacrifice patient care. We hired other staff to support non-nursing activities. We have adjusted salaries, so that traveling nurses feel that the benefits of being a permanent employee are much more advantageous. We’ve moved some contract laborers to actually being our employees. We terminated the option of local travelers. We’re refocusing on hiring frontline nurses, advanced practice practitioners, physicians and so forth, and reallocating priorities.
We still have travelers, but I think we are in a much better place.
Rural hospitals are having a hard time finding specialists and serving enough people to keep their maternity wards open. With that in mind, how is Emory trying to improve quality and safety for expecting patients and their families?
Prenatal care is vital. Some women may not be able to receive that care when they have to travel long distances. Hypertension during pregnancy disproportionately affects underrepresented women, namely African American women.
Preeclampsia accounts for the No. 2 or No. 3 cause of why women die in the U.S. during pregnancy. We completed a study of more than 1,000 women who received care in rural and urban hospitals, demonstrating that we can predict the condition, allowing women to get the care they need and allowing practitioners to triage women appropriately. The FDA approved a test that we developed that will roll out this fall.
Georgia, unfortunately, is [among the worst performers] in terms of maternal mortality, so it’s a significant area of focus for us. Access to care and food security, in conjunction with comorbid conditions, all converge to leading to this high mortality rate. We have partnerships and affiliations with other medical centers and clinics in rural communities.
One of the programs we have in place now [for all patients] is called tele-EMS, in which throughout the entire state, emergency medical service specialists are calling into our call center that is supported by Emory physicians and emergency room doctors who help with triage, assessing the patient, and in a tele-communications fashion—including video link—decide how far the patient needs to travel. They’re calling hospitals ahead of time to make sure there is a room available. [The tele-EMS program] begins to lower the burden, improve care and outcomes.
How else is Emory trying to reach patients where they are?
We have many clinics outside of the metropolitan Atlanta area that need more significant support so patients don’t have to travel into Atlanta. We also have partnerships and collaborations. We are speaking with other medical centers. I recently had a great visit with Mercer University in Macon. We have a mandate to support rural communities and establish stronger ties with those kinds of excellent schools. We need to forge stronger collaborations and partnerships as well as expand our own clinics, since we all have a responsibility to care for patients. There are no walls that separate us from our partners in collaboration, and patients should not have any boundaries.
Emory recently partnered with Dispatch Health, which helps provide acute services at patients’ homes. What does that signal for Emory in terms of shifting the site of service?
It’s important for us to reach out to a patient at their home because of the challenges they have in coming to us. Unless we drop the barriers and create relationships and partnerships, we're actually not going to be able to serve communities, especially here in the state of Georgia. We have to give things up, and understand that it’s give and take. This means partnering with an organization that otherwise would have been considered competition. We’re in a much more open-minded setting. These creative partnerships are the only way to really move forward.
This interview has been edited for length and clarity.