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Medical debt is an enormous problem, as more than half of all U.S. adults have gone into debt because of medical or dental bills, according to the Kaiser Family Foundation.

In our latest episode of the “Data Book” podcast, we talked about medical debt with Ryne Natzke, the chief revenue officer of Sphere. Sphere is a technology company that works with health systems on patient billing systems.

Ryne discussed the difficulties for patients. And he says medical debt could be considered a social determinant of health.

“Medical debt is the largest overall contributor to personal debt,” Natzke says.

We also talked about the challenges for providers. Healthcare providers, which are facing tremendous financial pressures in the pandemic, also need to collect as much as possible from patients, Natzke adds.

“Hospitals don’t love having all this money sitting out there uncollected,” he says.

We talked about how health systems can sustain their operations without leaving their patients with catastrophic debt. He talks about the need for health systems to use technology to help determine which patients may be facing financial hardships due to their medical costs, and how to help them. 

But systems also need to give patients the human touch, and allow them to reach a person when they truly need assistance.

Reminder: You can subscribe to Data Book on Apple, Spotify, Google, iHeart Radio and virtually everywhere you get your podcasts.

In our latest episode, Ryne Natzke of Sphere talks about how providers need to take different approaches to ensure they are getting paid without leaving patients with heavy debt.

Data Book podcast: Medical debt and the impact on patients and providers 

Kevin Olson certainly knows about multi-tasking in a crisis.

Olson is the chief information officer of Jupiter Medical Center, one of the top hospitals in south Florida. In this episode of the Data Book podcast, Olson discusses managing digital transformation amidst the COVID-19 pandemic.

“It’s been a unique challenge that I think we’ve never faced before,” Olson says.

He talked about the challenge of his role in the COVID-19 pandemic, while meeting the needs of caregivers taking care of patients and being agile to tackle important tasks.

Olson also discusses dealing with cyberattacks, a problem that has affected many hospitals. The medical center has worked with partners to fortify the medical center’s defenses.

“We’ve had an unprecedented amount of cyberattacks going on,” he says.

Olson stressed the importance of senior leadership and the board in changing the culture and getting everyone in the organization to take cybersecurity seriously.

And he talked about making it easier for consumers to engage with the healthcare system, and why patients of all ages are embracing technology.

Kevin Olson is the chief information officer of Jupiter Medical Center, one of south Florida's top hospitals. He talks about digital transformation, cybersecurity and helping patients. 

Data Book Podcast: Talking with Kevin Olson of Jupiter Medical Center

On this episode of Healthy Bottom Line, we spoke with Mark Spinner, CEO of AccessOne, a patient financing solutions company that conducted a survey on the needs and concerns patients have regarding healthcare financing. We discussed some of the results from this survey as well as how hospitals and health systems can address the issues that were mentioned by patients. We also talked about the importance of having clear communication and price transparency between providers and patients.

To read more about AccessOne’s recent survey, click 

Mark Spinner, CEO of AccessOne, discusses some of the financing concerns that patients expressed in a recent AccessOne survey as well as some solutions that hospitals and health systems can implement to improve communication and price transparency.

Healthy Bottom Line: The Critical Need for Better Communication, Price Transparency in Healthcare

In this episode of Healthy Bottom Line, we spoke with Joe Polaris, senior vice president of product and technology at R1 RCM, a revenue cycle management company providing technology-based solutions to improve the patient experience and the financial performance of healthcare organizations. We discussed the effect that concerns over healthcare costs can have on patients’ willingness to seek out care and how price transparency can help. We also talked about CMS’ recent hospital price transparency rule as well as other avenues health systems can take to address cost concerns.

Joe Polaris, senior vice president of product and technology at R1 RCM, discussed how price transparency can increase hospital revenues and address patient concerns regarding exorbitant healthcare costs as well as the impact that CMS’ new price transparency rule could have on hospitals.

Healthy Bottom Line: Why More Price Transparency Is Needed to Address Healthcare Cost Concerns

On this week's episode of Data Book, Chief Healthcare Executive spoke with Tomer Shussman and Hila Glick of OneStep, a physical therapy app. We discussed the challenges with traditional physical therapy, how OneStep improves the proportion of patients who complete their therapy, as well as future uses for the technology being utilized in the app.

Tomer Shussman and Hila Glick of OneStep, a physical therapy app, discussed the challenges with traditional physical therapy, how OneStep improves the proportion of patients who complete their therapy, and more.

Podcast: Moving Healthier With the OneStep App

On this episode of Healthy Bottom Line, Chief Executive Healthcare spoke with Erica Coletti, CEO of the Alliance for Better Health. We discussed some of the current problems associated with programs addressing social determinants of health (SDOH) and how the Alliance’s social Independent Practice Association (IPA) model can help tackle these issues. We’re also talked about the financial benefits hospitals and health systems can see when implementing policy changes that seek to improve SDOH programs.

Several problems exist with current programs that address social determinants of health (SDOH); however, a new social model aims to combat these issues and improve the programs’ effectiveness.

Healthy Bottom Line: The Trouble With SDOH Programs and the Secret to Improving Them 

On this week's episode of Data Book, Clay Ritchey, CEO of Verato, a next-generation patient-matching solution for healthcare, speaks with Chief Healthcare Executive. He discusses how patient-matching technology can alleviate stress for providers and improve patient care. He also talks about the financial benefits this technology can have for hospitals and health systems, as well as potential data privacy concerns.

Clay Ritchey, CEO of Verato, highlights the administrative and financial benefits that patient-matching technology can provide hospitals and health systems, as well as how it can improve the patient experience.

Podcast: Match Made in Hospitals — Patient-Matching Technology Can Improve Healthcare

On this week's episode of Data Book, Chief Healthcare Executive spoke with Terri Casterton, Director of Healthcare Product and Strategy at Bottle Rocket, a consultancy that provides business strategy, product, design and technology services. We discussed the latest Apple Watch features, the use of patient supplied data in healthcare and the use of technological innovations in healthcare.

Terri Casterton, director of Healthcare Product and Strategy at Bottle Rocket, discussed the latest Apple Watch features, the use of patient supplied data in healthcare and the use of technological innovations in healthcare.

Podcast: Getting Health Systems and Hospitals to Utilize Data From Wearables

On this week's episode of Data Book, Chief Healthcare Executive spoke with Steve Wigginton, CEO of Icario, platform that promotes health action to connect everyone to better health. We discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Steve Wigginton, CEO of Icario, discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Podcast: Joining Technology and Value-Based Care to Provide More Personal Care

On this week's episode of Data Book, Chief Healthcare Executive™ spoke Blair Childs, senior vice president of public affairs at Premier. We discussed potential for the Improving Seniors’ Timely Access to Care Act (

) to be signed into law and how it will improve access to care for patients by changing how prior authorizations are done. We also talked about how machine learning and artificial intelligence (AI) technologies can help health systems adjust if the bill is signed into law and how they can help automate prior authorizations.

Blair Childs, senior vice president of public affairs at Premier, explains how the Improving Seniors’ Timely Access to Care Act could revolutionize how prior authorizations are conducted and how machine learning technologies can help health systems adapt if it is signed into law.

Podcast: How AI and the Improving Seniors’ Timely Access to Care Act Can Revolutionize Prior Authorizations

In the COVID-19 pandemic, the number of hospitals offering acute care at home has surged. Chief Healthcare Executive spoke with doctors and leaders around the country about their experiences.

Hospital at home: Why health systems are banking on this model | Special Report

Experts say they’re alarmed by the increase in maternal mortality during the COVID-19 pandemic. Black women are much more likely to die of pregnancy-related complications.

After ‘stunning’ 40% rise in maternal deaths, health leaders demand action

Nearly half of adults with medical debt have been contacted by collection agencies, and some patients with lower-incomes aren’t getting discounted rates, according to the Urban Institute.

Most adults with medical debt owe money to hospitals: Report

ECRI, a nonprofit focused on protecting patients, releases its annual list of the most pressing concerns. Marcus Schabacker, CEO of ECRI, talked with us about the leading issues.

These are the top 10 threats to patient safety in 2023

As ECRI releases its annual report on the top threats to patient safety, the organization’s leader urges hospital executives to put a higher priority on reducing preventable mistakes.

ECRI CEO Marcus Schabacker on medical errors: ‘We have become too complacent’ 

Across the country, more hospitals are offering acute care at home, and doctors leading those programs say they are impressed by how patients are responding.

They say they are seeing strong clinical outcomes, low readmission rates and high patient satisfaction. 

More than 270 hospitals in 37 states have been authorized to offer acute care at home. As part of our 

, Chief Healthcare Executive® talked to doctors leading programs about how they are helping patients. 

Clinicians and leaders say the programs require a great deal of planning and coordination to ensure patients are cared for safely. But doctors cite several advantages, including reduced risk of infection, better rest, and in some cases, reduced delirium and confusion because patients are in a familiar environment. 

As more health systems are offering acute care at home, doctors say they are seeing good results and high patient satisfaction.

Hospital at home: Leaders describe encouraging outcomes 

Gathering and having access to an enormous amount of data isn’t the most important thing; using that data at the time of need to influence care choices is crucial, said Jim Adams, chief innovation officer, AllianceRx Walgreens Prime.

How can big data be successfully used to address social determinants of health for patients with rare and chronic diseases?

We have access to an enormous amount of meaningful data. It isn't just the analysis of it, though that at a macro level should inform what we do, it's the access to it in the moment of need that becomes really, really important. Big data, being able to analyze and understand not just what factors might influence a particular outcome for a very, very specific patient, it isn't just the analysis that's important, it's our ability to consume that at the right moment to influence the patient, and the patient's decision becomes really, really important.

So, it's not just the data itself, but it's how do you contextualize something broad, massive and big, down to that very small and meaningful soundbite that we can convey to a patient during our interaction that's going to help to persuade them and care for them and take care of them in this important moment of need that they have? That's really the opportunity. It's how do you get big data down to a data point that's on a single pane of glass so that you can take care of a patient the way that they deserve.

Jim Adams Discusses Using Big Data Successfully to Care for Patients

Craig Newman, the chief strategy officer at HealthChannels for ScribeAmerica, discusses how technology can be used to help reduce the amount of time and energy providers spend doing administrative tasks.

How can technology help reduce the administrative workload for doctors so that they can provide better care to patients?

Great question. I think everything is all about how do you make it easier for physicians to focus in on patient care? The last thing we want to do is actually create new sequential processes or new workflows that take the provider away from the patient.

And so, when I think about the model itself, and this is going to be different, again, based on the care environment that the providers working in — I'll just use an ambulatory clinic — I think about segmenting that work pre-visit, during the visit, and post-visit and looking at how we can offset some of that work with technology. For some, the technology is still not up to snuff to offload everything for that provider.

So, let me give you a prime example. So, let's talk about documentation of the physician itself and doing a clinical documentation. There's a whole notion of how do we leverage artificial intelligence (artificial intelligence) to actually drive value at the point of care to help with physician documentation. AI is incredibly effective when we talk about like radiology, or coding, or billing practices because there's tremendous data and very little variability.

Think about your primary care office. You've got different voices, different templates, different processes, different people coming in and out, maybe different caregivers, a ton of variability that exists for providers today. Technology alone — AI and machine learning models — can't solve the problem. And so, I think what we're seeing happen in the market, and what we've done with our product line Speke, is actually blend front-end technology that creates a seamless workflow for the provider. Imagine being able to walk into a room, hit a single button, and it could capture the entire conversation between a patient provider. No periods, no stop phrases, no clicking around in the EMR (electronic medical record), no nothing. And then, you leave the room, you hit stop, you can verbalize something after the fact, move on to your next patient, and never be tethered to the computer. And then, within moments to 24 hours, that note is structured in the EMR.

How did that happen? Well, we take that smart technology optimization process — sort of audio preprocessing, and speaker segmentation and machine learning — we route it to back-end labor to do QA (quality assurance) and CDI (computer design and integration) and then offload the clerical task from the doctor, doing that work behind the scenes a little bit asynchronously. Just by doing that little step, you can free up time. And getting back to that what we talked about previously around time driven activity-based cost, you've got to create time for the physician and offload those clerical tests.

We're seeing the same thing to providers, pre- and post-visit who were using technologies like chatbots or robotic process automation technologies, that can help make sure that we automate as many processes as possible. But then, we still need to make sure that there's human glue involved, who can help them with support strategies like doing comprehensive chart prep, helping tee up where there are care gaps to close, helping them with their specificity, acuity, documentation, or even making sure their charts are completed, efficient, and on time so the bills get out, so they don't have outstanding charts and their DSOs [daily sales outstanding] don't get screwed up throughout the course of the week or month.

So, I think it's a balance of technology and labor working in concert together. It's not an and/or [situation]; it's a both.

Craig Newman: How Technology Can Reduce Administrative Burden for Physicians

CHE welcomes Joann Anderson, CEO of UNC Health Southeastern, for this week's installment of Turning Points. Anderson has worked with the hospital for 14 years, and has led it through multiple hurricanes, the pandemic, and a recent acquisition with the larger UNC Health system. She says that enduring challenging situations throughout her career has taught her the value of human connection and the importance of managing your emotions. She will retire at the end of this year. 

This transcript is edited lightly for clarity.

You’ve led your health system through recovery from hurricanes and now the pandemic. What lessons did you gain from these experiences?

 The hurricanes have been a very interesting situation for us. Again, hurricanes are often short lived; you know they're coming; you prepare for them. Every hurricane or event like that, we learned something about where we possibly weren't as prepared as we needed to be. So, from those events, we always sit back afterwards and say, “What could we have done better?”

I think with the very first hurricane, Hurricane Matthew, which was one that we didn't necessarily expect, it took a turn at the last minute and came to us instead of going where they originally thought it was going to go. And we were prepared for a much smaller event. But what I learned during that is I have the most wonderful team to work with.

I had individuals that, when they knew the hurricane was coming, they left their homes, their families, unselfishly, and came prepared to stay as long as it took to care for the people who needed them most. They sacrificed their personal lives for the lives of others.

They did it out of the goodness of their heart. They didn't grumble and complain. They were tired during that time. But you know, watching them over particularly that first week—it was an extended timeframe for us—it was heartwarming to see how much they cared about each other and how far they were willing to go very unselfishly to make sure that people had what they needed in a great time of need. I saw people come together and the value of a community, not just individuals, but the community support. I saw doctors that were emptying bedpans or serving food trays. They forgot their title and what their job description was.

So more than anything, I learned the value of human connection, but also the resiliency of humans. You have to bounce back; when you go through situations like that, you have to come back and say, "I could do it over again if I need to." And with the hurricanes, we had them back-to-back within 19 months of each other, two major hurricanes. When the second one came around, there were still people who were still affected from the first one who hadn't fully recovered. And then we went through it again. But again, I saw the same thing: that people unselfishly left their homes again and came back in to do what they needed to do. So more than anything, I learned the value of connection, the value of compassion.

And really just resiliency. I hadn't thought a lot about resiliency in my previous job responsibilities at other organizations because we didn't have a lot of those types of things that occurred. But I've seen that here. You don't know how far you can be tested until you are. It was just really good to see the group come together, do what they needed to do, how much they care about each other, how much they care about their patients.

 What is the most important health delivery lesson from the pandemic that you believe will remain going forward?

There have been a lot of lessons that I've learned from the pandemic, both personally and professionally. I think from a professional perspective, is that when you're faced with something like a pandemic, which is totally new to not only you but to everyone in the environment, that you have to manage emotions.

Over this past year, we in healthcare have had to adjust, change quickly, pick up new ideas, learn new things, implement things, all for the right reason. That's tiring, physically. It's draining, just psychologically. Emotionally, it's taken a toll on the entire team. When you shift things too quickly, for anybody, it's hard to adjust. We as an organization have had to go through a lot of firsts since I've been here in North Carolina, and whether it's hurricanes or other related events, those are usually short lived. This has been such a long-term situation, that people have not had the opportunity to recover. That emotional toll has been a real learning experience. It's been a challenge from a leadership perspective to be able to help people navigate a situation that they just are not emotionally or intellectually prepared for.

I think learning over the past year from a pandemic is, when you're going into a situation like that, don't overlook the emotions behind it. We can take care of the technical issues. We're good at that in healthcare. But the emotional side of it we give so much of ourselves that once that bucket has drained, it's hard to fill it back up.

 If you could select one major healthcare advance that you knew would be important as soon as it happened, what would it be and why?

The first thing that came to mind was telehealth. We're sitting here today on Zoom, very geographically separated, but we're able to communicate. Very quickly at the beginning of the pandemic, we had to find a way to keep people safe and we had to find a way for people to access healthcare in a very different manner. Social distancing in an office was tough to do. So just the implementation, very rapid implementation of a telehealth platform, people being able to access it, I think, we knew immediately that it was going to work, and it was the right thing to do.

I think one of the things that was most interesting to me—I talked to a physician that has been in practice for over 30 years—he called me and said, "I need to talk to you about what you're having us do now through telehealth," and I thought, oh, here it comes, he's gonna tell me this is not working.

And he said, "I just have to tell you, I was skeptical at the beginning that, first of all, I didn't think I could do it, because from a technology perspective, I'm just not that astute. But I care about my patients, I wanted to make sure that they had access to me, so I tried it," he said. "It was amazing. I could still see my patients, I could still take care of them, which is important to me, and it was important to them. But I could do it in a safe environment and I learned to do it quickly. So, I'm a big fan, I just wanted you to know that I overcame my fears and I think this is going to be a way that we're going to be able to offer services to people in the future that I never thought was going to be possible or that I ever wanted to have anything to do with."

So, for me, telehealth is definitely the thing that is probably the biggest advancement and we're going to see that just expand more and more in the future.

 Can you think of a technological advance that was dismissed early on, but turned out to be important to the field of healthcare?

There's so many advances in healthcare from a technological perspective, and they're happening so rapidly, that I really can't think of one that was kind of dismissed at the beginning or that [wasn't] going to work, and then suddenly, we realized there's lots of applications for it.

There are a lot of things that have happened that we've seen expanded over time that may have had a very limited use at the beginning. One of the things [is] the drug Keytruda. When Keytruda was first introduced, it was for a very limited population, a very specific cancer, [and] it's now being used for all kinds of different things and being shown to be effective. 

I think that's the good thing about, whether it's technology, or whether it's just the science behind new products that are coming on the market—we might start with just being focused on a very specific small population or group, and then just find ways to advance those into other areas. Whether that's a robot that started being used for one specific type of surgical case, and now is being used in multiple surgical cases, or drugs like Keytruda, and that type of thing. I can't think of one that just got dismissed and then said, oh, now we can pick it up and try it again. But so many that have just expanded their use over time.

 UNC Health Southeastern was a separate health system that joined with the larger UNC Health system. What advantages are gained by being part of a larger health system?

The advantages have been resources available to us that we couldn't do on our own. When we went into the exploration process for a potential partner, there were things that we were looking for, and one of those things was listed as capital. Most people, when [they] think about capital, it's financial resources, financial capital available. Yes, that could be part of it, it is not part of our relationship with UNC today, but it could be. But what we really wanted was the access to intellectual capital, not that we don't have smart people working at our facility.

But in the complex world that healthcare is today, being able to have as many intellectual capital resources available to you with specific skills and knowledge is almost impossible in a rural location. So, for us, it was, could we find an organization that could help us advance our initiatives at a faster rate because of the resources they had available to them? That would allow us to access those resources when we needed them to help us move faster.

We had a lot of things that we wanted to accomplish. I have an executive team of five other members, so there were six of us who were trying to compete in a world with the mega organizations like UNC, or Novant or Atrium, who have an army of people behind them. If they need a specific issue, they've got an expert they can call upon. We didn't have that and didn't have access to that in any way. So, for us, the partnership with UNC has allowed us to tap into that intellectual capital. We have resources available to us today from an analytics perspective that we didn't have available before.

Just again, using the pandemic as an example: predictive analytics as to when the peak would occur in terms of inpatient hospitalizations, we didn't have the resources to do that. But immediately they did. Immediately they took our data, plugged it into their algorithm, and could help us plan with a certain degree of certainty what our resource needs were going to be in terms of human resources to meet the needs of the peak census. We didn't have that available.

At the beginning of the pandemic, certain drugs and certain supplies were only available to the larger institutions. And for us, since we didn't have access to that, we needed to find a resource for it. I remember we needed syringes to give vaccines and didn't have access to syringes. So, we called UNC and said, "Do you have any idea where we might find syringes?" and the next day we had syringes. It's that type of accessibility to resources that we just didn't have available.

They have clinical experts in every field, so my medical staff are so excited about the ability to tap into people who have written the textbooks, or who are doing the research, or that type of thing that they just didn't have access to before. For us on the administrative level, it's the analytical data that might be available.

I had a leader within the organization that actually left before we made the decision to go with UNC. He left because he said, "I'm one person of one. I have to be the expert. Every time there's a question about my field, I am the only person that can give that answer. That's a heavy burden to bear. When the organization may be turning to you for that expertise, and you feel the burden that 'if I make the wrong decision, or tell them the wrong thing, then I'm the one that did that,' I don't have anybody there to back me up."

The relationship with UNC has allowed us to have a peer group for everybody in the organization. They've got someone that they can call upon to just talk over a situation. We don't have to create something from scratch, there's probably someone in the organization who has experienced many of the same things that we may be getting ready to experience, they can tell us what their experience was, what they would have done different. Learning from them has been a tremendous value for us.

We're seven months into it, so I'm sure there's gonna be bumps along the road somewhere in the future. But so far, the relationship has been very, very positive, just for those reasons. Just having the resources available and to feel like you're not on an island by yourself, that you've got somebody else you can call upon who will be there to support you and to help you work through your decisions or provide resources or whatever.

The other thing we've learned through this is that we're farther advanced in some things than they are and they're learning from us. That gives my team a good sense of their value as well. We didn't want to go to an organization where we felt like we were taking everything, we needed to contribute as well. 

My team has got a sense of renewed spirit because they've gotten positive feedback from their peers at UNC who have said, "Wow, I'm glad you shared that with me because we've been dealing with that issue and you've already resolved it." Just being able to share with a peer group is a very positive thing.

 What advances will patients at UNC Health Southeastern see over the next five years?

I think our advances will actually be more in the arena of the expansion of some of the services that we're providing. Simply because we do have access to clinical experts at UNC, we're going to be able to introduce a broader array of services, go a little bit deeper into some specialty services, and what we're currently doing today.

Because we may have available to us technology that we couldn't have afforded on our own, there probably will be some technology advances as well. We've not identified all of those just yet. But again, through purchasing agreements and things like that, financially we might be able to afford some things today that we couldn't have afforded in the past simply because of that relationship with UNC. But it's going to be more about the expansion of the services that we currently have rather than introducing a lot of new types of things to the area.

 What advice do you have for someone considering a career in healthcare administration?

You need lots of stamina. You need a lot of patience.

I didn't set out to be in hospital administration, I actually started my career as a nurse. My intent was to be at the bedside taking care of people. What you find with that is there's immediate gratification because you see the fruits of your labor, you see what you've done, you can check off the tasks that you've done for the day, you get gratification from that. It's just a good feeling to know that you helped one individual or multiple individuals throughout your shift.

Administration is in many ways the same way because your patient is actually the organization of the community that you serve. My leadership role today is from the standpoint that if I were caring for this organization, or for this population, these are the things that I would need to do for it. Understanding that my outcomes are not going to be immediate, I'm not going to see an immediate reaction or a response to any action that I take, but I'm building on that for the future. It might take five years before I see a response to anything that I've done today. Or my decision making maybe about what we're looking at five years from now, not what we're doing today. Actually, what we're doing today, I needed to have thought about five years ago. If I'd known the pandemic was coming, I could have been better prepared.

In administration, you have to be able to see the future, you can't just focus on what's happening today. It's not really about what's happening today. We're planners, we're facilitators, we're conveners, we're educators. That's what you have to be prepared for in administration.

I have two sons, and they grew up on the floor of my office early in my career. My oldest son is now a healthcare administrator as well.

Early on when he wanted to go into healthcare, he said, "I want to do what you do."

And I said, "What do you think I do all day?"

He said, "You get to go to work, and you just talk to people all day long."

But those that do take it seriously. You have to mean what you say, you have to be willing to back what you say, but you also have to be willing to realize that sometimes what you say is not the right thing. And that it's okay to be vulnerable and to say, "Okay, I didn't make the right decision." You have to be able to back up and say, "Based on what you now have shared with me, or the additional information that I have received, I'm going to reverse my decision and go in a different direction."

You know, healthcare administration can be very humbling at times. And I decided that my leadership team all the time, we all have titles. Everybody has a title. Every job has a title that goes with it. I have a title, but I'm only one person in the organization. I don't believe anyone in healthcare administration needs to feel that they are so important that you know everything stops because of them.

I can be out of the office and very few people notice if I've done my job correctly because other people are doing what they need to be doing. My job is to communicate with them what the vision is, what our mission is for the day, where their guardrails are, how to stay within those guardrails. And then they do their jobs effectively. Let the people do their jobs, don't feel like you have to micromanage or dictate what's happening because you've got great people working for you in health care.

So if you're going into hospital administration, I say go for it. We're going to need some great people leading our healthcare system in the future. It's going to be complex. It's going to be fast paced. It's going to demand a lot of brainpower, flexibility, [and] analytical skill sets.

[It's] very different from when I started. Just the pace itself, because of the amount of information that's out there available to us today. The way we communicate today is very different than when I started. The internet and the advances in telecommunications are much faster than anything that I experienced early in my career. I would encourage anybody to go into healthcare administration if you're willing to be in an environment that's going to make a difference for a lot of people. That's going to be fast paced, high demand, but very high reward.

 What are you looking forward to in retirement?

I am looking forward to reconnecting with my family. I've always been at a distance, geographically, from my family and I'm looking forward to having some uninterrupted time with them. I have seven grandchildren, so I want to have a relationship with those grandchildren and get to know them as individuals over a period of time. I'm not going to be their babysitter, but I do want to have a relationship with them that sometimes I've had to forgo because of the demands of the job. I want that flexibility.

Quite honestly, I want some me-time. Over my career, I think there have been times when I've sacrificed personal issues, family time, and that type of thing in lieu of my career or in lieu of the responsibility associated with the roles that I had in the organizations. I don't regret that, I feel good about what I've done, and my family is not regretful of that either. But we're all looking forward to having time where we don't have to worry about balancing the responsibilities between the job and family. So, family time, I think is probably going to be the best.

I know a lot of people say when they retire, "I'm going to travel"—maybe I'll travel, maybe I won't. I don't think I will just quit; I still have a passion for rural healthcare in particular. So, I'm looking forward to choosing what I want to be involved in and not necessarily doing it because it's a responsibility that I have to do. It's a choice. So, there'll be some joy in making those decisions. I can make a difference here and I will do it because I choose to do it, not because I have to do it. 

Just looking forward to, for the first month, sleeping, [getting] an interrupted sleep. And just not having that burden of carrying the organization and knowing that it's my responsibility to make sure everything's okay. I think I'm ready for something different.

The fifth installment of Turning Points, a Chief Healthcare Executive™ video series in which retiring CEOs reflect on changes they've witnessed throughout their career and discuss the future of healthcare for aspiring healthcare professionals. 

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This week, CHE welcomes Will Ferniany, PhD, CEO of the University of Alabama at Birmingham Health System (UABHS), for the fourth installment of Turning Points. Ferniany has led the 11-hospital, $5 billion system for 13 years. As the CEO of UABHS, Ferniany has spearheaded healthcare equity campaigns and expanded healthcare delivery throughout Alabama, including rural areas. He will retire at the end of the year. 

This transcript is lightly edited for clarity. 

 Can you describe the evolution of the health system during your tenure?

I've been here since 2008. I would say there's two major changes that have taken place. One is growth; we have grown from being a little over a $1 billion system to close to $6 billion, and we've grown from two hospitals to 11.

But that's not the main thing that I'm proud of—what I'm mostly proud of is the alignment. This is an academic health system, and as an academic health system, we have three missions. One is clinical, one is research, and one is education. When I got here, these were not very well aligned. Those three missions are very well aligned now. [They're] pretty much of equal importance, and in  just about everything we do, we consider all three of those missions.

I'm very proud to work here at this institution, and I've always been proud of the people that work here. It's a wonderful institution in the sense that it takes every patient complaint extremely [seriously], and we have one of the highest patient satisfaction [rates] in the country. That is something I'm also proud of [that we did not have] when I got here. We have strong engagement; the health system and the university together, were voted the best employer in the country by Forbes. That's of everybody, that's of General Motors, Amazon, which is pretty amazing. We take every patient complaint very seriously and respond to it and deal with it, every one of them.

We make sure we don't do things that are what I call "gray;" we're always compliant with the law. We don't do anything that we don't want to see in the newspaper. 

 UABHS oversees 11 hospitals. Can you discuss how an expanding health system balances the need for quality standards across the system with maintaining the individual character of each hospital?

The main reason [why] we have expanded into other areas, particularly in the rural areas, is [because] the University of Alabama at Birmingham, our School of Medicine, and our health system has a responsibility to the care of the state and to the health status of the state. That's hard to implement if you're just in one location, if you're just in Birmingham. So, having other facilities throughout the state allows us to implement them.

The way we've set this system up is not a very rigid system. So, part of your question is easy to answer in the sense that we maintain the individual character and boards of all of our facilities. We work together where it's to our benefit to work together, such as in maintaining quality standards. Supply chain is a classic case where we do things together. We take the advantages on our debt ratings and stuff like that, but we don't impose. We're not like a lot of systems that are cookie cutter. Let's say we're all wrestling with whether we mandate vaccines or not right now, and if we do mandate vaccines, maybe not all of our facilities will follow. They have different issues they have to deal with. We balance it by keeping the locus on the local facility. All healthcare is local, really.

Within its system, UABHS manages 4 rural hospitals. Are there policies you would like to see in place to help stabilize finances for rural healthcare delivery?

This is an area very dear to my heart. I really believe that rural healthcare, the way we finance and operate rural healthcare, does not work. We expect these rural hospitals to apply the same rules and regulations, like price transparency, [and it's] very difficult for rural hospitals to implement. What I believe needs to happen is the way we fund rural hospitals needs to change and the type of licensures and requirements for rural hospitals needs to change. Right now, rural hospitals' number one rule is do everything they can to keep the door open, regardless of whether that is the right health care they should be providing for that community. If you implemented a system like they have in Maryland, or what they're experimenting with in Pennsylvania, [like] global budgeting, or what the government now has a grant out for called the 

, [Community Health Access and Rural Transformation] if you were to do that and fund these institutions, globally, or almost like a per capita basis, they can provide the care they need to provide that's right for that community and not worry about where the next dollar comes from.

The second thing is, they should be allowed to be more flexible in what's in a hospital. Many of these communities only need an emergency room, imaging, physician offices, observation beds. In many states, Alabama included, there's no licensing for them. Supposedly, there's a new federal program that goes into effect, I think January of '22, might be January '23, that will allow those. There's a lot that can be done in rural health care.

 What is the role of the hospital in a community, and how has that changed?

In the fourth installment of the Chief Healthcare Executive™ video series Turning Points, the retiring leader of Alabama's largest academic health system discusses the need for healthcare equity and the mission to improve the health of everyone in the state.