In the seventh podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Michael Regier, General Counsel and Secretary, Vanderbilt University Medical Center, and David DeSimone, Senior Vice President of Organizational Transformation and Chief Legal Officer, CentraState Healthcare System, about how their jobs have changed during the COVID-19 pandemic. The speakers discuss how the public health emergency has affected themselves and their hospitals, including how they are handling and preparing for patient surges, managing their workforce, and establishing a new normal. The podcast also discusses how delayed care due to fear of infection has affected patients. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In the seventh podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Michael Regier, General Counsel and Secretary, Vanderbilt University Medical Center, and David DeSimone, Senior Vice President of Organizational Transformation and Chief Legal Officer, CentraState Healthcare System, about how their jobs have changed during the COVID-19 pandemic. The speakers discuss how the public health emergency has affected themselves and their hospitals, including how they are handling and preparing for patient surges, managing their workforce, and establishing a new normal. The podcast also discusses how delayed care due to fear of infection has affected patients. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Welcome everybody to today's, uh, GC round table. Uh, today is July 21st, 2020. My name's Sarah Swink from the law firm of Nixon Kiba out of the Washington DC office. And today we have two amazing general counsels here to talk to us. Michael, do you wanna introduce yourself?
Speaker 2:Sure. This is Michael Regi. I'm the General counsel and corporate secretary for Vanderbilt University Medical Center, um, in Nashville. So, uh, you probably know Vanderbilt, but we're an academic medical center, um, about 5.3 billion in revenue, 30,000 employees. We have, um, about 3000 billing clinicians, um, and, uh, and, uh, sprawl across about six states now.
Speaker 1:Great. And David?
Speaker 3:Hi, this is David Des Simone. I'm the Senior Vice President of Organizational Transformation and Chief Legal Officer of Central State Healthcare System, central State's, a small healthcare system in comparison to Vanderbilt. We're located in central New Jersey. We're about$300 million a year in revenue, about about 2,400 employees and range, you know, from small hospital, I mean a medium sized hospital, several senior care facilities, and a whole bunch of other assorted affiliate healthcare entities.
Speaker 1:Excellent. Well, I'm really excited to have both of you here today to talk to, to us about, uh, being a general counsel during this time of Covid. Uh, so Steven, h how much of your time are you spending on Covid matters and has that changed from the beginning of, we'll say like maybe March timeframe to now? And and how's your summer going?
Speaker 3:Right? Uh, it's definitely evolved. Um, New Jersey was hit hard, we're, we're about an hour from New York City, so we're hit hard as New Jersey and New York and Connecticut. Uh, were some of the early earliest, uh, surges of covid, um, around March 15th ish, I would say I was spending about 99% of my time on covid. And now as we, uh, tape this in July, I'm spending about, depends on the day, somewhere 30 to 50% of my time on Covid activities. Um, I'm not sure if that answers your question or if there was so more
Speaker 1:You would that's, yeah, no, that's great. And, um, and I like a hundred million percentage of your time on covid in March. Right. And now it's like, but your time's gotten bigger. So if it says 20%, but you're spending more hours, does that really count as Right, right. Working harder? Right. Um, how about, how about you Michael? How much time are you spending on Covid matters and has that changed a lot from, well say the March timeframe through, um, the summer?
Speaker 2:Yeah, it's definitely been, um, an, um, an up down and now up again phenomenon. So we, um, we actually started preparing pretty seriously for the pandemic here in, um, early February because, uh, we have some researchers that are very focused on coronavirus issues. And so we started doing capacity planning, labor pool planning, um, and uh, and um, developing testing and assessment sites, um, in February in anticipation of a surge that, frankly, here in Tennessee, at least in Middle Tennessee, never really happened. At least not to the extent that we saw things happening dramatically in, uh, in New York, New Jersey, Connecticut, and uh, and in Washington state. Um, certainly the pandemic, um, hit here. Um, and so it was fast and furious in late February and, and through much of March, both with the federal legislation, the state public health emergency acts, all of the work that, uh, the team was doing to try to get the organization prepared to handle the anticipated huge surge of patients. Um, there was a, a plateau that we, I think got to in the April may timeframe here in Middle Tennessee, because we went under a stay-at-home order in, um, third week in March. And now, of course, with the south being a region that has reopened sooner and faster than much rest of the country, we're now seeing, um, a rise, uh, again in new cases, in depths, in hospitalizations. We now have about two times as many patients hospitalized with Covid as we did a month ago. Um, so, um, that's, that's certainly not a good trend, but it's not much different than what you're seeing in many other states in the south.
Speaker 1:Yeah. So it's interesting cuz we have this sort of, it feels like prepare, respond, then it's like the reopening and now we're in, I, it feels like we're in something else cuz I don't know if it feels like we're still in the reopening, but it, it seems like sentiment is changing, cases are going up in different parts of the country that were not maybe as impacted as before. Or, um, I know David, you, you know, were an hour outside of New York. What, you know, what did it look like, you know, well, well, some people were in the, you know, still preparing stage, you were in the responding stage. What was that like to be an attorney at one of those hospitals? That quote really impacted?
Speaker 3:Sure. It's like, it was like that old adage about trying to drink from a fire hose. You know, things were coming fast and furious. Central State unfortunately had an early cluster of Covid folks that we, you know, really launders trying to understand what Covid was in the middle of March. We had unfortunately the second death, uh, in the state of New Jersey, and ultimately that person was connected to a family where they lost four other family members and over 10 other people were contracted Covid. So it was a crazy time in terms of trying to figure out in a kind of bedroom community of New York City, uh, how, how this could be happening and what could we be doing So clearly in the middle of March through, you know, probably early May, um, it was all hands on deck and, you know, seven days a week in terms of dealing with legal and other, uh, you know, other issues to try and support the Covid response.
Speaker 1:You know, it's interesting, I just, I just, um, anyone who's on LinkedIn with me, I just posted, um, a Washington Post article that I thought was really sad, but I thought it was really impactful to me to read about these three children. One, I think is a teenager, and like we had two, maybe two teenagers and maybe one adult teenager, and someone that was 20 and they lost both of their parents. And to read the human impact of that, um, they lost them to Covid and they're like our age. The parents were our age, and it was, it was, I mean, it was really sad, but I think we almost, I I felt like it's almost a must read because of that to to hear that human side of that impact.
Speaker 3:Right. And it very much impacted the staff and, you know, in the sense of, uh, some of these folks that, you know, they were on ventilators for a long, long time, for even those who were covered that might've lost a spouse or a sibling or brothers, you know, sisters, uh, cousin, whatever, they didn't know how their family members progressed. So in terms of the healthcare staff, you know, they're trying to keep up, you know, therapeutically and maybe because of, uh, hipaa, you know, not to necessarily let them know right. As they were coming out and little bewildered from being on ventilators or being in, you know, a drug-induced comas. It was, uh, like very surreal, um, and, uh, you know, tough on the staff, tough on the community, and obviously tough on the patients and their families who were struggling through this.
Speaker 1:So David, what were some of the numbers that in your area, I think it might be helpful for the audience to hear what that looks like and where are you now? Like where, where are you as the summer's progressing?
Speaker 3:Sure. We, we built up to, uh, what center state, I should say, first of all, is a, about a 280 bed hospital. Normally we have a census about 200 inpatients. We built up from March 13th to April 13th to 140 inpatients, uh, of Covid patients. So completely transformed the, the hospital. And we also have about, uh, 300 beds of, um, long-term care. And so at some point we had, you know, 50 to 75 long-term care residents with covid. So, uh, it was, um, it was overwhelming. Um, and, um, you know, the community was in shock, um, because there, there were their jobs, a lot of them work in New York City. They were seeing, you know, folks get sick in the city. They thought, oh, maybe we'll be protected by going back to the suburbs. Um, and clearly we, we were not, we were clearly, uh, having surges just like folks in the, in the inner city were having.
Speaker 1:So, Michael, you're in the Nashville area, but you have a footprint that's across a lot of states too. Um, it felt like maybe around the time that, that David and was working through those issues in New Jersey that it might have been a more, was it more quiet? Was it in, in the Tennessee, Nashville area and like, has that changed with the reopening?
Speaker 2:You know, it's, it's interesting. It, I would say it was, our clinical staff I think initially experienced it as being unusually quiet, in part because, um, we canceled all elective surgical procedures ahead of the, um, the governor's executive order here in Tennessee to, um, prepare. We wound up seeing emergency department volumes tail off, and, and we, we in Nashville, just, you know, um, a lot of people call it the IT city, but it's, it's a very popular, very rapidly growing city. And we've had problems that are not the problems many, um, hospitals face up to covid. That is, we run in about 95% capacity and frankly haven't been able to build beds fast enough to be able to accommodate the growth in the community. Um, which leads to an extraordinarily busy emergency department, extraordinary surgery volumes and, and very high census all the time. What we saw was, um, uh, extraordinary drop in, um, ed volume. Um, and, and frankly, I think our clinical staff felt like they'd spent a lot of time getting ready and getting ready and getting ready. And we did not see on a level, blessedly didn't see the level of patient volume at that time. My staff, however, were my, my late mother would say, you know, busier than a one arm wallpaper hangar. Um, you know, we, we actually, we had to do work to support the bed capacity planning that our operations team was doing staffing capacity and preparations. Um, we helped the mayor's office and the public health department, um, we advised them on the stay at home order, or the safer at home order that the metro Nashville ultimately initiated. We worked really hard to get emergency medical licensure for our clinicians in several neighboring states, Kentucky, Alabama, and Mississippi for telehealth purposes, because we were trying to convert as much as we could to telehealth for continuity of care and, and to try to just keep the operations going. The same time, we had a wave of folks from the community, uh, you know, clinicians, physicians, nurses coming in and saying, we want to volunteer. So we had to create a emergency credentialing process for disaster privileges for these volunteers as well as competency training and cross-training. We worked with the State Hospital Association on a, a federal, uh, 1135 waiver. We worked with the state hospital associating the governor's office on state licensing standards, waivers, you know, to be able to double up bids if needed. We negotiated backup childcare, um, agreements because, you know, we had staff, you know, suddenly with kids who are outta school, but needed to be here to work and had no place for their kids to go. So we, we, um, went out and, and basically rented childcare facilities for our staff. We, um, ramped up our employee wellness services and our occupational health team to do the contact tracing for our own teams. We negotiated with nearby hotels, which were empty to provide accommodations for our staff who might have somebody at home who was uniquely vulnerable and they wouldn't want to go home when they've been involved in caring for covid patients. Oh, and n ran through and negotiated 450 million worth of temporary credit, um, to give us cash in anticipation of both, you know, federal payer slowdowns and commercial payer slowdowns. So that period, frankly, is a blur. It, it, it, it's the single busiest professional period I've ever been through. Um, I've never been prouder of a team of people who worked almost continuously and as fast as things were coming in the door. Um, so it was, it was an amazing time.
Speaker 1:So to to say this is probably understatement. You're a little tired. Like we all are<laugh>,
Speaker 2:We're a little, everybody's, everybody is burned out. And and that's not just our organization, you know, everybody. Um, I frankly think that's part of the reason that we're seeing, um, the kind of non-compliance that we're seeing, you know, in addition to the politicization of the masking requirement, which is just, yeah, I can't get that one through my head, but, um, but, but I think people are frankly just so tired of the changes to their lives and, and there's a level at which they're wanting to rebel, rebel against that a bit.
Speaker 1:Yeah. It's interesting cuz it's, um, so David, this idea of like being tired or, or, you know, or we know right now, like you, you, you, you were in the thick of it. It's, it's slowed down in some extent over the summer, but we're going into fall and we don't know what's going to happen. We have, you know, we're talking about school reopenings, um, some offices are opening back up, we see bars and, um, other, um, businesses opening back up. Some are closing back down in certain states, like how do you keep yourself and staff and how, and doctors, how do you keep everyone motivated or, or rested going knowing that we might be going into something in the fall or winter that may be just as exhausting or maybe worse?
Speaker 3:Well, I, I think that as a communication was the key in terms of, and continues to be the key with daily huddles and daily meetings on where we are, what are the most pressing issues, how, how can we help. Um, I think we try to be very supportive of our, of our, our workforce. Um, some of our, uh, kind of, um, colleagues, you know, other institutions in New Jersey, New York area have had some layoffs. We've tried very hard to not only, uh, reinforce the staff that they'll have, that their jobs are safe and we're gonna continue to, you know, stand by them. Um, but, uh, you know, try and celebrate successes, uh, in terms of as we saw the first patient walk out of here after being on a ventilator for 35 days and really celebrate, uh, with the staff, you know, clapping out, uh, the, the, the, um, the patient and their, to their family as they, as they left or maybe went off to rehab. Um, so we just tried different things. We a, to be transparent and try and get as much up to date information as possible. And it wasn't always positive news. Some, you know, we limited vacations and things like that in the, in the, during the biggest crisis hours. And we really had the message to our employees like, Hey, this isn't going away, but we just need all hands on deck right now. We brought in, you know, you know, uh, reinforcement, so to say in terms of staff, different staffing contracts that we did in all different areas of the company. Uh, physicians, nurses, respiratory therapists, lab techs, things like that. So we're constantly, we're trying to reinforce to our employees that we're in this together and that this is new for all of us, and that it's okay to be scared and to be stressed, but if we kind of think through this, we're smart people. Um, we can, we can rely upon each other. We can rely upon resources out in the community. We're, you know, we're gonna figure out how to get through this. So that, that kind of got us through kind of the acute stage, I guess I would say from March through May now as we're kind of, we transition in May and June to open up elective and non-essential non-emergent services. Um, you know, there's a new, you know, new work effort, new new piece, and, and I think folks that maybe were on the sidelines, um, or you know, only at a supportive capacity are now in the forefront. And those who maybe were on the, on the forefront in the acute care areas are, are, um, you know, able to kind of take a little bit of a breath right now. But we're all building towards, um, you know, trying to prepare for flu season, um, which will hit New Jersey, uh, you know, October, November, December, and thinking that there's a potential surge ahead of us. So we're taking our breath, we're trying to get people, uh, to take vacation time and, uh, you know, kind of recharge their batteries before we kind of charge into the middle to late fall.
Speaker 1:So are you, so David, are you doing anything, do you have any tips for your, like what you're doing to re generate yourself and refresh yourself? Or you, you know, we talk about, you know, physician burnout and all and um, clinician burnout and they're ab that's absolutely, I think, really important in the forefront of my mind, but we will, you know, talking about our, our wellbeing of all of us. I'm just, just curious, what are some of the things that you do to try to, um, stay refreshed or, or crisp during these times?
Speaker 3:Well, I mean, in terms of the lawyer per se, you know, never wanna be whining, especially when you work in house, because we're not the center of attention,<laugh>, you know, we're the, we're really trying to support and, uh, help our colleagues be as successful as they can in terms of treating our community. So, yeah. But in terms of taking time for myself, uh, you know, definitely the summer as the weather's gotten better, and, um, trying to spend as much time with my family when I'm not working, um, hiking, you know, being outdoors, um, doing things like that. Um, you know, with the, one of the unique things that my wife did, I wasn't necessarily as supportive in the beginning, but it's become very successful, is that we bought four baby chicks, which, uh, I live in a suburb in development, not necessarily your ideal farm environment, but we've been raising these chickens and they've really given us a chance to focus on something other than covid and other than, uh, you know, the stresses at work or, or at school. And now, um, they're about four months old and, uh, soon to be laying eggs. So we're, we're like the proud, proud, almost parents are godparents of these chickens. So I think that having diversions and taking quality time away from a work, you know, and, and spending and, and trying to rest up and, and to, and to recharge your batteries, I think are all important things. Um, I know with my staff, I ended up coming in every day. The, I work in the C-suite, the CEO wanted us all here. I let my staff work remotely. So we have a call every day and I always try and add into that call besides identifying what the is going on in terms of covid and what our legal and risk issues we're working on together is try and to just kind of ask how they're doing and what type of things they're doing in their own personal lives to try and, uh, let them have a little downtime and not always have to be on when they're, when they're on the calls with us. So those are some examples, I guess, uh, that, that I've tried and I've tried to reinforce with my team.
Speaker 1:So I have to ask, what are the names of the chickens?
Speaker 3:Oh,<laugh><laugh>. Well, we, we, we each got the name of chicken, so my daughter named hers Penny, uh, I guess cuz she said it was a color, color of pe of a penny. Uh, one my wife named her chicken, uh, Goldie cuz it was yellow when it, when it was first born, although now it's brown. So we called it Golden Brown. My son named his Baljit after his favorite character from his, um, uh, cartoon Phineas and Ferb. And I named mine. I had a Rhode Island Red and haven't gone to college in Rhode Island at Brown. I named after my favorite teacher, Judy. So he have Judy Penny Beji, and Goldie
Speaker 1:<laugh>. Amazing, amazing. Um, so Mi Michael, uh, I'm gonna ask if you have any chickens, but No, I'm actually gonna ask, um, what either not mean,
Speaker 3:Surprisingly. No, I mean, I live in Tennessee, but I don't have any,
Speaker 1:I don't either. Um, I, I like the idea of fresh eggs though. Um, so what, what are some of the things that you've done personally to try to keep yourselves, keep you and your staff, um, you know, personally, but also your staff kind of motivated or, or relaxed or refreshed during the, during this, uh, during the summer?
Speaker 2:Yeah, we, you know, I have, so I'm responsible for the Office of Legal Affairs, the Office of Risk and Insurance Management, and then the Office of Healthcare Compliance. It's a group of about 60 people. Um, we are doing three times weekly huddles with, um, the attorneys. Um, a weekly staff meeting with the risk team, compliance team this meeting regularly as well. And, um, we sent all the non-clinical administrative folks to work from home starting the 16th of March. Um, and, and they have not come back. We're still, um, we have an internal reopening plan that we put together at the time that the mayor announced a reopening plan for Nashville. Um, but because our, um, our disease experience here has not, um, tracked the right way on the metrics, we've really not moved out of work from home. The C-Suite folks, like, as David mentioned, our CEO thought it was important that we be here. So all of us have continued to come to the office, um, every day through, um, through the experience and, and I'm sure will continue to do so. I've tried to encourage folks to take their vacation time. We're on a June 30th fiscal year, so I had a lot of folks that, um, took time in between Memorial Day and the end of June. Um, and, and people did things that were sort of within their own, um, sense of risk tolerance. And some folks that just did a staycation and stayed in town had had some folks that, um, found, you know, nice resorts that were within two or three hours where they, they had spouse, their family could just go and pull up for, um, a week, uh, and, and get away from everything. Um, some folks traveled much further to be with family or friends or folks that they felt like were, um, responsible. Um, I, I've also tried weekly, well on, on the, on the three times weekly huddle calls with the legal team. Um, I always start the call, we have a dashboard that we update daily with our, um, our, um, inpatient utilization data for Covid as well as our staff statistics for the staff who are positive and or not able to work. Um, just to make sure that, um, all of that group of folks have the latest information that's been made available to me about what our clinicians are experiencing. That's really, um, I think it's really important that they have that information so that they understand, um, the demand that we're going to be facing. And I think that that's, that's only going to increase now over the next couple of months. Um, as far as myself personally, um, you know, I love to exercise, but the gym's tend to close. We, we, we live in a condo building that has a gym that had to close and also belonged to a, a small gym that had to close, um, and converted to virtual, um, exercise classes. So between that, and I'm fortunate enough to live near Centennial Park, which is a large and very beautiful park in Nashville. And so, um, I actually have taken up running again and, um, and run at least three mornings a week, um, out in the park, uh, very early. I mean, I find that if I, I've gotta get the exercise in very early at the beginning of the day cuz I really don't have an ability effectively to control the end of the day. Um, so if I, if I tried to plan to do that at the end of the day, it very likely would not happen. Um, and then I've also last, I've tried to at least every couple of weeks send an email message out to all the folks on my team to try the best I can to help folks keep focused on the bigger picture on, uh, both what's going on that's concerning, um, within our organization. What's happening locally that they may have missed, um, you know, and what, you know, what's happening on the research front, you know, and, and as well as, um, anything that I can try to think of or find to help provide inspiration about how we continue to work through, uh, and pursue the mission in a time that's very, very difficult for everybody.
Speaker 1:Yeah, I, it's interesting cause I, I was actually talking to a, a, a doctor yesterday, but not like for my own medical, but just he's talking about how he gets up in the morning and runs, uh, as a chief medical officer, he gets up in the morning and runs and I was like, oh boy, I don't, but I think that's because by the time I'm like, gonna think about it, it's like, okay, it's around lunch and the next thing I know it's like 3 34 in the afternoon. I don't know what is happening with time, the time continuum, um, right now. But, uh, it's hard to, I used to laugh, especially for those who are listening that are in law firms in-house time is different than law firm time because you're not keeping track of it and the day flies anyway. But now I think they're, it's just flying. And I would think about, um, the idea of work-life balance also always makes me laugh a little bit in the legal profession. Um, so I try to think instead of like, what are, what are like the covid wins? Cause we have some covid failures, I think, um, especially if you are, um, working remotely from from home. Um, uh, Brian White, who was on one of the podcasts told a story of one of his employees who, um, I think child walked in and said that the lawn was on fire. That, so now that's my new benchmark of how well my day went. Is did I, did the kids set the lawn on fire? Know, okay, I'm fire. No. Okay. I, it was good a good day. Um, but my covid win was my daughter lost her first tooth and I was up in my home office and I came down and I actually was there for it. I mean, I wouldn't have been normally and that was pretty amazing to me. Um, David, do you have any covid wins other than your chickens<laugh>, um, that you<laugh> or any war stories? Did your kids that your salon on fire? I don't know if anyone's ever gonna beat that story. I think that might be a winner, but
Speaker 3:I'm trying to think. I mean, in terms of wins, uh, I I I have to say realizing that the four of us couldn't all be at home at the same time. So having the benefit of going to the C-suite to work and having my wife, uh, who's a lawyer as well, move her practice at home and the two kids home from school, it was probably better that dad went off to work. I, I give people a lot of credit who all had to work, uh, in tight quarters with their family. Cause it's not easy. So to me, I think, uh, I realize how how fortunate I was that, that I had more of a day, uh, more of a regular life by getting in the car and commuting to work and coming to work, uh, uh, than a lot of my colleagues who, uh, you know, ended up having to work from home or yeah, not work at all. So I'm trying, I can't really think of a, a, a, a war story or a, or a success other than it when I did get a chance to be home, I made sure that we spent special time with each other, uh, to see each other. I remember my fam my parents are both alive. They're in their eighties and live about an hour and a half north of where we are. And I remember, uh, spending two months with it, not being able to see them and trying to decide as we were all under quarantine and, uh, you know, should I go up, you know, should I be checking in on them? And that, uh, when we finally got a chance to see each other in a socially distant manner, it was just great to be able to ha to do that. So, um, and we try and do that here with our nursing homes. We created visitation stations after things kind of calmed down where folks can kind of see their loved one, but in a, you know, kind of pared off area, uh, per se, just kind of think human interaction was I think the best, the best, the best success I think in terms of, uh, trying to deal with Covid.
Speaker 1:Yeah. And experience with my parents too. Michael, how about you? What did you tell my parents too? I didn't see them for like months and it was like two and a half months or something. Yeah, I think that's the, the timeframe. Um, so Michael, how about you? What are, what's your covid wins?
Speaker 2:The clear winners are our dogs. Um, you know, they, because honestly, you know, so my better half, um, actually, um, David knows this and some of your listeners will know this. I came to Atlanta, uh, to, um, Vanderbilt from Atlantic Health System in New Jersey where I was general counsel for about four years. And, and so my better half actually, um, is a writer and an educator who has taught at some of the design schools in Manhattan and still has been back and forth to New York usually four or five times a month, um, for various things with, uh, uh, museum of Fasci, F I t, and of course could not travel. And so, um, that meant that, um, even though I was coming to the office, he was at home and the dogs are the big winners. The dogs are, you
Speaker 1:Know,<laugh>
Speaker 2:Completely not ready for anything to change because now it's, you know, we get three walks a day, real walks day, not just a run outside and come back in. So, um, you know, they're probably the only ones that really like this situation.
Speaker 1:I have to ask, what are their names since I asked David his chicken's names?
Speaker 2:Um, they are, uh, pico, which is, um, short for Pico lino because he was teeny tiny when he was, um, when we got him at eight, at nine weeks. And the other one is Cortez, uh, because since a puppy, that dog has been an explorer. If it's wet, he wants to be in it. If it's smells terrible, he wants to roll around in it. If it's, um, dark and dangerous, he wants to go find it. So any,
Speaker 1:Oh, so, so here's my question cuz I feel like there's a lot of covid, puppies,<laugh>, anyone thinking about getting a puppy? Cause I know I can't and the number of people that have new have added to their fur family is, or I guess cats too, but it seems like most people that I knew are, were dogs mostly, but, um, anyone adding to their fur family at all? Cause
Speaker 2:Not at this point. And you know,
Speaker 1:<laugh>,
Speaker 2:No.
Speaker 1:Nope. Okay. I know, I, I don't know some people as when I was talking to a, a client and she was like, I think I did the most brilliant and yet the, the most ridiculous thing. And I was like, oh my gosh, you know, cause you don't know what they're gonna say. And it's like, we have a new puppy<laugh> and I had the kids at home and we're all at home cuz we're like, we're all gonna be at home. Everyone's at home. So we were like, they'll get more attention, but now none of us sleep<laugh>.
Speaker 2:I will say that, that may maybe that is a, that is a blessing too. That, and, and many people have discovered this, but with so many people working from home and working on Zoom, you know, you do have the, you know, one of my team members has two birds. And so a lot of times when she's on the call, one of the birds is on the back of her chair. You've got folks who've got, you know, cats, kids, dogs. It, it gives, I think it has given the team a fuller picture of the lives of the team members, you know, in some cases for better or for worse, right? Um, you know, there's, there's all those stories about, you know, did you really mean for, you know, the same fuller dirty dishes to be in the background while you're doing your zoom call? But, but you know, that that certainly was an unexpected benefit is it's given the team something from time to time unexpected to bond over. That's not really, that offers an opportunity for freedom from the sometimes dreadful tasks that, um, we find ourselves working on at this point in time.
Speaker 1:So I, you know, it's funny cuz we, for a while there was like the new normal, like, is this a new normal? Will we go back to normal? And now it's been, I mean it feels like it's been 300 years, but it's, it's still been, it's several months and we, we know we have, you know, a lot ahead of us. Do you think some of that will stick, like some of the workplace changes or, um, I know I was like on a call talking to somebody about, um, care Act compliance, it'd be something really kind of technical and difficult and muddy and all that. And um, but before they started the call they wanted to tell me that they were really happy that their, you know, daughters were able to go to Camp<laugh>. And it was like she was so happy with them. She's like, I just have to tell you this, you know. Um, do you think that some of that will stay? What do you think Michael?
Speaker 2:I I think that there are gonna be some permanent changes to the way people work. Um, you know, for a couple of reasons. Number one, you know, the CDC issued, um, pretty comprehensive guidance for employers on, um, on returning to work and, um, you know, our organization, I mean the, the one of the elements of that guidance is that you need to use a hundred percent outside air in your air filtration systems That's in the south. There's nobody that does that. Um, cuz you could never cool the air below about 80 degrees, um, inside the building if you did that. So I, I think certainly for our nonclinical staff, there's going to be a real legitimate question of whether, when and how many of those folks really need to come back to the office and will, you know, we were, we were in the middle, uh, preparing for, um, a consolidation of my teams into one, um, new office space, new to us anyway, that was lease space that's immediately adjacent to campus. And, um, and you know, in that move, at least technically is still in the capital plan. But you know, I've, I'm sure I'm going to have folks who, um, unless and until there's a vaccine, and probably even if there is one who may say I want an exemption from working in the physical workplace, um, you know, they may have some, um, you know, unique vulnerability, some unique, um, condition that may make them predispose that they believe to, um, to covid and, and, and, and frankly, I'm going to be inclined to say yes where we can make the determination that their job is one that can be done as effectively from the remote setting as it as it can be done, you know, in the office. So that's a change. I mean, I want to believe that people are going to continue to value each other and continue to value doing some simpler things, uh, some kinder things, some smaller things. But I also think there's going to be permanent changes in the way that we do our work that will come out of this because, you know, frankly, um, folks are not seeing productivity diminish. In fact, the number of components of our organization are one whole chunk of our IT team, I think are gonna be converted to permanent remote work jobs. A huge, um, group of our revenue cycle team. Their, their productivity's actually gone up, um, working from home and materially, so our CFO and her senior VP for revenue cycle are likely to have that team. Those folks all work from home. Now, the good news is they're in office space. It's located in a very large ambulatory care center that we have that could be repurposed for clinical care, um, which is, which is great. But you know, there, there will be changes I think that are, that are gonna be permanent in the workplace as a result of this.
Speaker 1:So David, last time I talked to you, you were about to have a board meeting and you were considering how to do that, how to facilitate that board meeting. What ended up happening with that board meeting? Um, did you have it in person Zoom? Um, how did it work? Or was it a board retreat?
Speaker 3:No, it was a board meeting and, uh, they've evolved. Uh, the first board meeting we did via phone, second board meeting we did via Zoom, and then things started to kind of calm down and there was some easing of the, of the, uh, quarantine. So we've done our last two in person, but allowed folks that didn't feel as comfortable to call in. So it's really evolved. What we did do for the in-person meeting though, we have about 20 people that attend our board meeting. So we had to move into an auditorium that normally sits 150 people<laugh> and set up, uh, table so that everybody had like their own own table, uh, in a, in a horseshoe cluster type of setup, uh, to social distance. So it's evolved. Um, I think folks, uh, have appreciated the flexibility we've provided both for our, for our board and for our folks at, you know, this back office folks that can work from home if they can. Um, but I, but I think for the board meetings, um, I don't know, there was something missing about doing completely remotely, even virtually via Zoom, uh, that, uh, that I guess we, I guess we benefited from as things eased here in New Jersey that people were comfortable about coming to the hospital. We also felt it was important that is, we wanted to invite pe our community, our patients and their family members back to the hospital, that it was important for the board to set the tone, that it was comfortable to come back to the hospital. So we've really kind of evolved, uh, you know, depending upon the situation and the severity of the crisis, uh, over time in terms of how we've done our meetings. And I think that's, as you ask what new normal, I think it's really having that flexibility, whether it be allowing people to work remotely if they can. And I agree with Michael wholeheartedly. We've seen, I I've seen in my own team, uh, folks really doing a great job with that and maybe improving productivity, working on maybe their own schedule, uh, and maybe being less interrupted, uh, by the, the day-to-day things in the C-suite. And I've seen, um, you know, folks as they've come back, you know, really show the community, Hey, I'm going to the hospital for a board meeting, or I'm going to the hospital for a community meeting, it's okay to come back to the, to the hospital. Uh, it's not, you know, the, the things are safe and you can, you know, get your care there.
Speaker 2:Yeah, I mean that's, you know, it's interesting David, because I would say we, um, we convened our board weekly during the peak of this, and it was via a conference call. Um, we had our first, um, real in-person board meeting in June. Um, and, and we have a very small board. Our board has 11 members and, um, a good number of those are, I would say six or seven of them are local and the remainder are not. And the folks who were not local all participated by Zoom and the, um, the folks who were local, um, mostly Kane, we did have to move to a, a much larger room so that we could, so that we could physically distance people. And then, um, we went through a pro, the CEO and a number of us went through a process for each of the committees and for the board to identify, you know, who's going to need to be in the room for what topic, what staff members who usually are at the board meeting can, uh, participate by Zoom so that we could, you know, further limit the number of people that we're gonna be physically present inside, um, inside the room. You know, we've, we also have, um, pretty aggressively advertised to the community. Um, you know, our, we were allowed to reopen, um, and recommend surgical operations starting, um, April the 30th under the mayor's plan here. So we started doing, um, non-emergent cases for, um, healthy adults who were under age 70 at that point. And it just ramped up the rest of the surgical schedule since then. But, you know, we did find it necessary to do, you know, a public marketing campaign to say to folks, look, you know, we, we know, um, we know that you're concerned about covid and, uh, but your health is really important and there are other conditions that you can't ignore. So we don't want you to delay the kinds of routine and preventative care visits that you need that might help us identify something that could be an extraordinary problem for you later if we don't identify it and, and that we're doing things to try to make it as safe as we can under the circumstances for you to be able to come be with us. You know, whether that's, you know, changing waiting rooms and eliminating seating and reconfiguring seating and requiring masks. You know, we screen all of our patients now, our, our access center phones patients prior to their appointment to, um, assess whether they have covid symptoms, and if they do, they suggest that those folks go to one of our testing and assessment centers as opposed to coming in for their appointment. So, um, you know, it's, you know, the governing board, the governing board certainly has been very interested in trying to keep them appropriately informed in, in on a timely basis, has, has been a big challenge because the, the stuff has been happening fast and furious.
Speaker 1:Yeah, it's interesting. I'm glad you both talked about comfort level of patients come to coming to facilities. Because I know there was that New York Times article that came out that, that sort of was the, I don't remember the exact big headline, but people delayed care and everyone was okay, and it was like maybe a month or two in, or maybe straight even. Like, and, and it's like, we don't know the long term impact. I mean, uh, you know, you read about, you know, uh, the, you know, maybe, maybe it'll be difficult to get the flu shot. Maybe it won't, maybe people want it, maybe it won't. I mean, what, um, people delayed care.
Speaker 2:I would say people delayed care and they're not fine. I mean, one of the data points we know here in the Middle Tennessee area is the number of home deaths has gone up dramatically. Home deaths from heart attacks, home deaths from strokes had gone up very significantly. And it's because you had people that were afraid to come to the ed. It's not that our eds, at least, you know, knock on wood up to this point, had been totally slammed with, with, um, you know, covid patients who were sitting and waiting to be admitted. It, it's that people were afraid to come to the hospital, um, and you know, and that's very understandable, but frankly, they didn't need to be in, some of those people didn't need to die. It's, I think,
Speaker 3:Right, I agree with Michael. I mean, I can only give, I don't have research on it, but anecdotally, we saw a number of people that put off coming to the ED that then when they came in, they were much sicker. Their heart attacks or strokes, you know, their, their care was much severe. And we saw a number of folks came in with gang, gang green limbs, which you think is hard to believe. You're thinking, you're sitting there<laugh> and literally your body is telling you something is majorly wrong and you're afraid to come into the HOS hospital seek help. So you're basically making things worse. So we saw people lose some limbs based on coming in with gang green, um, related diabetes or other things they let go untreated or un you know, unchecked because of the failure, the fear to coming into the hospital.
Speaker 1:So going into the winter, um, and, and being, well, I guess followed winter, being forward booking. Um, what are, what are, what's some advice that you would give people that are, you know, in-house at hospitals to, or, or, you know, give advice, you know, look forward thinking to, to other hospitals who maybe haven't been through what you had, but what, what, what, what the next six months might look like or what we might like turning into 2021, which is like really hard for me to believe it's gonna be 2021, not. Um, and we'll, you know, what, what, what would be like a piece of advice that you would give them, David?
Speaker 3:Well, I think from an in-house perspective, and, and I think that what's great about Vanderbilt and Center State is where such difference in size and, and, and, and, and scope per se. I work for community health system. Michael's working for a large academic, uh, you know, research institution, but at the end of the day, we all had the same or similar problems. Um, Michael has a staff of 60, I have a staff of three<laugh>, four, maybe if you include the two people that share one of the paralegal jobs. So I would say, you know, part of the success, I guess, in trying to help people get through this is to don't panic. Realize that no matter how many resources you have in in-house, even if they're limited, you know, there's people throughout the system and throughout your kind of personal network of folks in government, in private practice, in, you know, a H L A that are kind of help extend some of these questions that would come in every day. Were so unique, um, that not to panic and basically say, look, I gotta, I have a network, I have a resource, I have people that can help me through this. And, you know, figuring out what's the most practical answers on the fly. And I think sometimes just realizing that there's not gonna be an answer, and sometimes you, you're gonna have to be bold as an attorney to say, look, the cost benefit, the risk benefit analysis is X or Y and based upon training or whatever, here's my recommendation, but you know what, that might change tomorrow based upon an executive order or, or a waiver or something we learn. Um, so I think part of it is, you know, not panicking, understanding that you gotta deal, roll with the punches, seeking out knowing other people are in the same boat, even if they don't work with you. You know, reaching out, calling on the phone, emailing whatever, uh, your colleagues to kind of swap ideas. Um, you know, I think those are some of the things I would suggest in terms of, you know, preparing as an in in-house council. Um, and I think the, the, the biggest thing is, you know, I mean I've been doing this for 25 years, of which at least two thirds of that have been in house. You gotta base, you gotta go based on what you've learned and, and, uh, and your training and, and hope that the folks that you're working with, uh, you know, understand that there's no right answer all the time. Um, and with that, that you're gonna make some mistakes, but hopefully you quickly learn from them.
Speaker 1:Yeah, I think this is, there's been a common theme about, uh, collaboration and even among competitors, or even among what I mean, just this idea of trying to get information out and trying to, um, to figure out what the right, the right answer might be. And believe me, it's every given moment cuz I, I I, it happened to be again that I didn't think it would, which was I was on the phone with a client about one thing in the morning and later I saw like the Medicaid distribution, um, application was extended, you know, Friday after, or Friday after I got the call call. So even when I'm like doing some, the next client I talked to you, I'm like, oh wait, it's actually changed since this morning. Um, so you just don't know what's gonna happen even, even now when it's not as fast and furious. Um, Michael, what would you, what would you like advice would you like to give, um, those in-house people that are listening? Um, um, what might be coming in the future and how to prepare for it?
Speaker 2:Um, I, uh, you know, I I think it's gonna be a very difficult, um, fall and winter. Um, and so I would say, um, if you're leading teams of people, I would be honest with them about that. Um, and I would try to listen to them and make space, um, in the work environment that you have with them, even though it's virtual in, in all likelihood. Um, for people to just own that. We've, we've actually started using, um, one of our, um, internal resources here who does, um, sort of post-traumatic stress debriefings for clinical teams where there's been a very difficult case to just come in and, and, um, lead those conversations with our, our teams of attorneys and our teams of risk managers so that folks have got a place with each other to own, um, the way that they feel and the challenges that they're experiencing. I think that's gonna be extraordinarily important as we go into what I, I fear will be a very, um, difficult fall and winter season for both covid and flu. I I think one thing David said that really resonates with me as well is this will be the season of taking calculated risks. Um, there is gonna be no perfect decision. There will be no risk-free decision. It's going to be, um, uh, helping the business people make the best decision that can be made on the data that's available about the risk that you're going to choose to run. That's gonna be particularly true when you come to managing capacity, managing staffing, managing the allocation of obs scarce resources. Um, if, if as your organization encounters that, and the last things I would say are wash your hands, wear your mask and keep your distance. Those three things more than anything else that we have right now are going to help keep people safe and healthy and engaged and working
Speaker 1:Well. Um, David and Michael, thank you both, um, so much for joining us today. And Michael, you're beautiful. Clock us in the background. Um, I I you both have been really, it's been<laugh>. We knew it was gonna happen. Everybody in the audience, we knew it was gonna happen. Thanks<laugh>. It's a gorgeous, I can't, you have to send me a picture after the podcast. Um, but I really wanna thank you both for coming and I wanna thank the audience. Um, anyone who's listening who is not an an American Health Law Association member, sign up, um, sign up for the in-house, PG if you're in-house or even if you're not. Um, and definitely go to the covid, uh, the coronavirus hub for a H L A because we will be updating it. I know I'm personally gonna update the, the hospital response checklist as fall going into the fall and def and look for resources there. Um, we really all will need each other, um, uh, coming through and I hope everyone else has a great day. Thank you so much.
Speaker 4:Thank you. Thank you guys.