Rush CEO puts patient journey front and center 

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Rush University Medical Center stands at No. 17 on U.S. News and World Report's hospital honor roll, and CMS recently awarded one of the system's hospitals with five stars. After a challenging year in healthcare, CEO Ranga Krishnan, MD, spoke with Becker's about what lies ahead for the award-winning health system.

Interview has been edited lightly for length and clarity.

Question: What are some of the biggest challenges Rush faced as a health system during the pandemic? 

Dr. Ranga Krishnan: They were probably the same as all the other health systems. I mean, you had an issue with the PPE supply chain. Second, there was a shift between not being able to do elective procedures, which had a major financial impact. And third is the type of patients coming in changed; people that were very ill didn't come in because of fears.

Q: What are some of the trends you've noticed throughout the pandemic?

RK: Many of the trends that we're seeing across the country just accelerated during COVID. You knew those trends were there. One is the shift from inpatient to outpatient that happened not so much in the acute phase, but there were more and more outpatient recoveries.

All these trends were in place prior to COVID, telehealth being an obvious example. Telehealth visits were not so common prior to COVID, but increased a lot during COVID, then came back down. But now you have a blend. Some people like telehealth and you have some who still want to come in. I'd say that currently it's a blend. And I think it's similar to what's happening across the country in terms of both the workplace and how people seek healthcare. 

And the financial impacts are pretty significant. When you move from inpatient surgical to outpatient surgical, the decline in margins can be significant. You have to be able to adapt to build the right quality infrastructure, to manage outpatient compared to inpatient. And also the patient experience, and how you run these things are different when you have a higher volume coming through a different part of the system. These are all things that you have to adapt and manage. 

So the way I see COVID is the trends were in place prior to COVID. It accelerated during COVID. It has sort of reverted back to some extent, but the overall trend line is the same. Directionally it's exactly the same as what we would have predicted. And in one way, it changed patient acceptance. If you had asked before, telehealth visits were not something patients really wanted. Now they like the convenience of it, and it works pretty well in most instances. 

Q: What do you think telehealth is going to look like from an insurance standpoint? 

RK: I think you're going to see a blend. Some companies and the federal government are clearly accepting it. What the rate will be … that's where the difference is going to come. And I would say that what happened during COVID in terms of how payment works is likely to stay.

Q: What are your main priorities as you are seeing Rush out of the pandemic? 

RK: So I started the role as CEO in 2019, just eight or nine months before the pandemic hit. So when we planned it out, our plan was to build, if you want to call it, the entire patient journey, with wellness on one end and post-acute recovery on the other end. 

Most health systems don't focus on post-acute care, and post-acute care is going to be an increasing requirement because patients are leaving hospitals earlier. And now with COVID, long-term acute care needs will increase. So we entered into a partnership with Select Medical, and opened up about 60 locations across the state, and that certainly makes a difference. It complements the patient journey with exactly what they need closer to where they live. 

So we were planning it anyway, but as we came out of the pandemic, we just started to put it into place more rapidly. 

Another example of our mission is our partnership with Lurie Children's Hospital. Children need specialists and they need subspecialists, but a single health system usually cannot afford to have every one of those in place, so we now have a partnership with Lurie so that we can do the best for kids no matter which part of the health system they enter. So it's not so much about us, but it's about our real mission, which is to improve healthcare. 

A lot of health systems are heavily hospital-centric, meaning your main concern in many ways is making sure patients come into the hospital so you can keep things running. When you flip it around, you really want to ask the question, how much can you keep people out of hospitals?

Now, when we move to the outpatient and ambulatory and multiple locations, the focus will be, how do you extend what happened in a hospital-centric environment to a multi-location environment? And that's a challenge, and that's what we're doing and it will happen over the next two years. 

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