Catholic Health CEO aims to ‘bend the disease curve’

As a licensed pilot, Dr. Patrick O’Shaughnessy understands dealing with changing conditions.

That is helpful as the head of a health system during a turbulent period for the industry.

O’Shaughnessy, the president and CEO of Catholic Health in Long Island, leads a $3.2 billion health system with six acute care hospitals and a host of other facilities. He relishes the position, but he also acknowledges the difficulties for the health system with rising expenses and insufficient reimbursements from Medicare and Medicaid.

In an interview with Chief Healthcare Executive, O’Shaughnessy says the key to navigating the storm is helping people stay healthy, and to help those with chronic illnesses to manage their condition to avoid lengthy and expensive hospital stays.

“The only way to bend the cost curve is to bend the disease curve,” O’Shaughnessy says. “So we've got to get upstream of it.”

But looming cuts in Medicaid are going to add to the system’s financial challenges, he says.

(See part of our conversation with Dr. O’Shaughnessy. The story continues below.)

Seeing what’s broken

O’Shaughnessy spent two decades practicing emergency medicine, working in inner city hospitals to smaller departments.

His time in emergency medicine informs his leadership.

“You get to see the successes of the healthcare system, meaning how new technologies and drugs and treatment paradigms are helping to improve lives,” he says. “But perhaps even more importantly, you see where it's broken, and you see all of the challenges that we have to provide greater continuity of care, prevention and wellness, to improve efficiencies and outcomes.”

O’Shaughnessy has been president and CEO of Catholic Health for nearly five years. He says he initially didn’t set a goal of becoming a health system executive, but he says that a mentor’s guidance left a lasting impression.

Even on a busy day in the emergency department, he would only be able to help so many people each day. By putting the stethoscope down and pursuing a leadership post, he’d gain the chance to touch thousands of lives each day.

“I never thought I would be doing this type of work, and it's been very rewarding,” he says. “It's very challenging. There's no question about it. It is a very, very fiscally challenged and operationally challenging industry, but the rewards are great, and so I'm very blessed and happy to be doing what I'm doing.”

The challenges have only grown since the COVID-19 pandemic, as expenses have risen significantly. Insufficient Medicare and Medicaid reimbursements have been posing problems for years, but the challenges have magnified with higher costs for supplies and labor in recent years.

Now, the health system is looking at the prospect of reduced support from Medicaid and the expected increase in patients without any insurance.

‘Going to be very tough’

Congress and President Trump approved a tax and spending package that will bring substantial changes to Medicaid programs in the coming years. Over the next decade, Medicaid spending is expected to drop by about $1 trillion and more than 10 million Americans are projected to lose coverage. Hospital and healthcare leaders have widely condemned the legislation and the unprecedented cuts in health care funding.

Catholic Health projects a negative impact of $30 million to $40 million for the Long Island system.

“In an already fiscally distressed operating environment, it's going to be very tough to bear those changes,” O’Shaughnessy says.

While stressing the problems of insufficient aid have existed for years and that he’s speaking in a nonpartisan fashion, O’Shaughnessy says the healthcare system “is at a fiscal cliff.”

Catholic Health has been working to cut costs and do more with less, he says.

“We're working very hard on our end, to do our part to reduce expenses, but at the same time improve efficiencies and keep the patient first, without impacting quality, safety or experience of care,” O’Shaughnessy says.

“We're pivoting the way we deliver care to ambulatory environments and other sites of service so that they're less expensive,” he adds. “We're leveraging technology, leveraging AI. We're reducing drug spend. We're doing all the things that we need to do.”

As O’Shaughnessy talks with elected officials, he says he works to get them to understand that innovation and slashing spending will only do so much.

“I think there's a thought that healthcare is rich with opportunity and it's inefficient, and that we can carve our way out of this,” he says. “And I think that's a mistake to think that.”

Crowded emergency rooms

As an emergency room physician, O’Shaughnessy says he understands that some people go to the hospital when they’re sick because they have no other place to get care.

But with more people losing Medicaid coverage and being unable to see primary care doctors, he joins other hospital leaders in projecting that emergency rooms will get even more crowded.

“Unfortunately, that leads to higher cost of care,” O’Shaughnessy says.

More than ever, it’s important for health systems to be engaging patients and getting them seeing doctors for wellness visits and helping them manage conditions before they end up with a $15,000 emergency department bill.

“If we can avoid a potential ER admission by getting to that patient sooner, that doesn't mean denying care. It means giving them access to care,” he says.

O’Shaughnessy thinks more providers are working hard to help patients move away from “episodic intervention” to continual care.

But he also remains committed to ensuring that Catholic Health’s emergency rooms serve all who need them.

“Our emergency rooms are the last gateway, an island of hope for people, and we need to take care of them, and we will whether, whether we make money or lose money,” he says. “We always do the right thing for our patients, but we have to create margin, right? We have to have some degree of margin to be able to provide care for those that are unable to care for themselves and that do not have coverage.”

Care traffic control

Catholic Health isn’t planning to cut any services even with reduced funding from Medicaid.

But he also says he’s worried about the expiration of tax credits supporting the Affordable Care Act. The tax credits expire at the end of the year, and millions may not be able to afford rising premiums without the coverage.

O’Shaughnessy says the Affordable Care Act has helped people get access to primary care and specialty care “that could help them stay healthy and well or manage disease.”

If the tax credits lapse, he says, “I think it would have a negative impact on our overall health and longevity and certainly put additional fiscal pressure on the system.”

Catholic Health is working to reach out to vulnerable patients, including Medicaid patients, about the need to schedule wellness visits.

He says the system’s call center is referred to as “Care Traffic Control,” which is fitting for a pilot.

“We have to have more wraparound care, and that's exactly what we're doing,” he says. “The more we contact our patients, the more we stay in touch with them, the more we empower them to be the ones that are in control of their care.”