How Vanderbilt is expanding access to care

Growing access to care through capital expansion projects is one of the top priorities for Nashville, Tenn.-based Vanderbilt University Medical Center. 

In July, the health system announced a $500 million expansion project. Vanderbilt CFO Cecelia Moore told Becker's that her team "is significantly focused on getting funding that we need through the bond market to make sure that we can support the expansion."

Despite the health system's mission to expand access to care, Ms. Moore said that Vanderbilt is more focused on in-house growth than acquisition activity. "We were kind of in the period of M&A and now we are in the period of building up campus but we are always scanning the market for opportunities," Ms. Moore said.

Becker's caught up with Ms. Moore to learn more about the health system's financial situation:

Editor's note: Answers have been lightly edited for clarity. 

Question: What are the top three strategic financial priorities for your health system in the next fiscal year? 

Cecelia Moore: One of our biggest strategic priorities is trying to continue to support the expansion of our health system, particularly right now. Here on campus, we're actually building a large tower, along with operating rooms and then finishing out a couple of floors on the top for our children's hospital. My team is significantly focused on getting funding that we need through the bond market, to make sure that we can support the expansion. 

Another thing we are really focused on is payer negotiations. We are trying to make sure that the rates that we are able to obtain from our payers actually can support, reasonable market-based wage increases for our clinical staff, nurses, respiratory therapists, pharmacists, all our physicians and many of our non clinical support staff who are still also really crucial for our mission as well.  To afford that we have to have our payer partners really focus on providing us with increases. 

We are also always focused on improving our processes, in our revenue cycle and our supply chain. We've already done a lot to try to automate in our revenue cycle area and are now moving into the supply chain as well.

Q: What financial challenges is your system facing?

CM: We have a psychiatric hospital and the rates in behavioral health are just not even covering our costs. That is a really large challenge for the country as a whole. You can’t have access to behavioral healthcare if you can’t even break even on that line of business. With our governmental payers, particularly Medicare, Medicare has got a proposal on the table to reduce physician payment rates this year, which doesn't support our mission and doesn't improve our ability to provide wage increases for our staff. Ongoing governmental payer increases, to at least meet the inflation rate, would be super helpful. We lobby for that, and it is always an area that we're closely looking at when those rules come out.

Q: How are you leveraging digital health tools to improve your financial position? 

CM: We're absolutely working in a number of areas on those tools. We have done virtual sitters. So that is the ability to have people remotely monitoring patients, especially patients who might be more apt to fall and hurt themselves. We have started to roll out virtual nursing. Our RN staff members really like it because it gives them an extra set of eyes, because we are still really in a clinical shortage. 

We've also changed up some of our care models in our clinics and in our acute care, medical surgical areas where we've paired more unlicensed staff, so people who are more medical assistance care partners, with our licensed professionals. This frees up nurses and other professionals to do more of the things that require a license, such as medication administration and monitoring patients. We've tried both the virtual route with technologies coupled with changing up our care models a little bit.

Outside of our clinical areas, we are pushing to get the majority of our visits scheduled online. So think about an open table concept where you can go in and even if it's for a specialist visit, make that appointment online. That will probably work for hopefully 80% to 90% of our visits. Additionally, we are introducing virtual check-in in our clinics where patients don't have to really see a person before they start to see their caregiving team. 

In our RCM processes we have replaced manual tasks with automation. That is not generative artificial intelligence but really using bot technology. We'd like to move into some generative AI, that is spinning up now, but I wouldn't say that it's in full force yet at all.

Q: What partnerships, joint ventures, mergers or acquisitions is your system exploring to strengthen its financial position or expand service offerings?

CM: We've already done some acquisitions in the past few years. We purchased some hospitals from Community Health Systems. At this point, we're always keeping our eyes and ears open in the market, but right now we felt the need to expand on campus. We just realized we've got to have the additional beds on campus to support those coronary services and we're the only ones in the region with those services. We were kind of in the period of M&A and now we are in the period of building up campus, but we are always scanning the market for opportunities.

Q: Given the unpredictability of events like global pandemics, what are you doing to ensure financial resilience and sustainability in the face of unforeseen challenges?

CM: We've done the things I think a lot of people have tried to do, such as diversify our supply chain. Although it can be challenging when there's only one or two places in the world you can get a particular item. You got to have geographic diversity. You never know when a pandemic or weather event is going to hit a particular part of the world.  We also have extended our short term liquidity. We have more ability to pull on lines of credit. We don't have the balance sheet to support ourselves through self liquidity, but we have extended the ability to utilize lines of credit because we did find that important to be able to draw on that liquidity.

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