Category: Podcasts

Project ECHO: Behavioral Health [Podcast]

Posted on

Dr. Jennifer McWilliams, Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Nebraska in Omaha, provides details on Project ECHO Behavioral Health.

project echo logo

Topic Breakdown

2:25 — Project ECHO offers resources to primary care providers to address pediatric mental health provider shortage in Nebraska

4:32 — Project ECHO will look at common issues, such as depression, anxiety, and ADHD

8:15 — Why it’s crucial for providers to address common mental health issues in children early on

9:02 — Screening for mental health concerns in primary care settings

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Jennifer McWilliams, who is the Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Nebraska in Omaha, Nebraska.

We are talking to her about Project ECHO Behavioral Health, which goes from all of 2018 to the spring of 2019. Thanks so much for being here.

Dr. Jennifer McWilliams: Thank you for having me.

CHN News: In a nutshell, can you describe Project ECHO generally, and then a little more specifically about the Behavioral Health ECHO?

Dr. McWilliams: Absolutely. ECHO is a really exciting program that’s spread throughout the country, where specialists engage with primary care providers through a series of talks and case studies to help support primary care providers with feeling more comfortable with a specific specialty area.

So, as an example, what we’re going to be doing in behavioral health is a series of 11 lectures — or 11 sessions, rather — which are going to be comprised of a 15- to 20-minute lecture where an expert in a topic from Children’s will be discussing that area — whether it be depression, anxiety, etc.

The next 20 minutes of the session will be a case study where people will be able to present cases — real patients that they’re dealing with — so that the group as a whole can talk through those concerns and what they’re experiencing, and how to handle them.

And then, finally, we end each session with a question and answer time period where people can ask other questions that may have come up.

The goal overall is that as the 11-session series goes on, the primary care providers will not only begin to feel more comfortable in treating pediatric patients with mental health concerns, but they’ll also develop a network of colleagues with whom they can share their experiences and bounce ideas off of.

We’re really trying to build a community of learning as much as providing direct knowledge.

CHN News: Why is this so important for primary care providers, especially pediatricians in Nebraska?

Dr. McWilliams: One of the biggest challenges that we’re facing in Nebraska — and even in the Omaha area — is that there simply aren’t enough pediatric mental health providers. Similarly, looking at psychiatrists, there are only a handful of us in the state of Nebraska. And while we all are dedicated to seeing patients and love our work, we recognize that it’s really hard for patients to get in and see us in a timely manner.

As a result, a lot of primary care providers are left in the trenches having to manage these kids on a day-to-day basis. Many times, they end up feeling overwhelmed, undereducated, unsupported — and this is an opportunity for us to try to help build up that foundation, so that they can feel more comfortable with treating the kids that they end up seeing on a day-to-day basis.

CHN News: Is this something that has been going on for a while in Nebraska — this shortage of child psychiatrists and behavioral health specialists?

Dr. McWilliams: Unfortunately, it’s a chronic problem that’s going on across the country, not even in just Nebraska. The areas of the country that have the highest per-capita population of child mentalists and psychiatrists are still woefully underserved.

But in Nebraska, it’s particularly profound because of some of our geographic issues. Almost all of the child mentalists and psychiatrists live and work primarily in Omaha and Lincoln, leaving the vast majority of the state with virtually no access to pediatric mental health care or pediatric care — unless the patient is willing to drive to Omaha.

CHN News: So, these sessions are particularly useful for pediatricians in rural areas?

Dr. McWilliams: Absolutely. We’re offering it to pediatricians across the state, including the Omaha area, but my goal is that we’ll be able to reach out to our colleagues who are practicing in rural parts of the state.

CHN News: What are some of the topics that you’re going to be covering?

Dr. McWilliams: We’re looking really at a lot of the bread-and-butter disorders that affect kids, realizing that primary care providers are never going to want to be in the position — nor would we want them to be in the position — to treat some of the more significant, chronic mental health concerns like schizophrenia and bipolar disorder, etc.

So, we’re focusing on depression, anxiety, ADHD. We’re going to have a session touching on autism, a session on disruptive behavior disorders. We’re also going to be looking at some more processed-based things: How to do a suicide risk assessment, how to screen for mental health concerns in the primary care setting, looking at the effects of adverse childhood experiences.

CHN News: Are these sessions eligible for CME credit?

Dr. McWilliams: Yes. We have gotten each of the sessions approved for CME credit through Children’s Nebraska. CME will be offered for each session individually. And in addition, providers who participate in a certain number of the sessions will be able to participate in a maintenance of certification project, which will give them credit towards board certification and recertification.

CHN News: Since this is very beneficial for rural providers, are they going to have to come into Omaha to do this, or is this through teleconferencing — how does it work, exactly?

Dr. McWilliams: That’s what makes ECHO so cool. We recognize that it’d be impossible to get everybody to come and even spend a day with us. The way the sessions are structured is that we use web-based technology — Zoom technology. So, it’s all on people’s local desktops or some groups, if there’s more than one provider in a setting that want to sit down together in a conference room and project the screen, all they have to do is be able to log into the web.

And then, for better or worse, they’ll be able to see us as we give our presentations and we go through the case reviews. They’ll be able to participate and work with us through the video conference call — all from the comfort of their office or their home.

We’ve tried to set the sessions up so that they’re consistently going to be on Thursdays from noon until 1:15, with the hope that over the lunch hour we’ll hopefully be least restrictive for people — and we’ll do that every few weeks.

CHN News: Can people listen in afterward if they aren’t able to attend?

Dr. McWilliams: Yes, we’re going to be recording all of the sessions and then posting them on our website so that eventually we’ll have the full series up there for people to review. Currently, we have the sessions from the ECHO series that we did on pediatric obesity on the web as well.

So, long-term, our goal is to have an archive of different topics that people can refer back to.

CHN News: Which of these topics are you most excited about? Which topic do you think is going to be the most surprising for people who are participating?

Dr. McWilliams: That’s hard, but obviously I’m a child psychiatrist and mentalist, so I love it all. I think really focusing on depression and anxiety — I think those two sets of topics are going to be the most profound. I think there’s a lot of misperceptions among providers that it’s risky and dangerous to treat kids with those disorders.

In reality, the sooner kids can get treatment for depression and anxiety, the sooner they respond, the better their long-term outcomes. And the treatment options that we have are very safe and very effective. So I’m really hoping, personally, that we can hit home what a huge population health problem depression and anxiety are for children and adolescents — and how important it is that we all work together to treat these kids as early and as effectively as possible.

CHN News: How do you anticipate participation in these sessions will impact patient care?

Dr. McWilliams: One of the topics that we’re going to be talking about is screening in primary care settings. We’re going to be specifically looking at the PHQ-9, which is a depression screening tool that a lot of primary care providers are already aware of, if not completely comfortable with.

Our goal — and we’re actually folding this into the maintenance of certification piece and project — is that as people get more comfortable with using the PHQ-9 and screening more patients in their clinics, that they will recognize some of the more subtle, subclinical cases where depression is either just starting to develop or where the kids are doing a good job of masking those symptoms. So that we’ll be able to identify kids earlier and more effectively, so that we can start getting them the treatment they need.

CHN News: Do you know of any other programs in the country that have done something like this that have been successful?

Dr. McWilliams: ECHO is a nationwide program. It started out in New Mexico, I believe with adult gastroenterology. There have been ECHO projects that have been done across the US and there are a number that have been looking at behavioral health, but I’m not aware of any others that are specifically focusing on pediatric mental health.

But, the more the merrier. I think we need to get this out everywhere across the country.

CHN News: Is this program only open to primary care providers or is it open to anyone who is involved in care of children?

Dr. McWilliams: Right now our target audience is primary care providers — so pediatricians, family practice doctors, advanced nurse practitioners, physician assistants, and all of the staff that work with those folks.

CHN News: How can people get more information or sign up to participate in Project ECHO?

Dr. McWilliams: People can go to Children’s Nebraska website for Omaha and they’ll see a link to the ECHO program. The registration is linked in there. It’s free, it’s easy, and if anybody has any questions, they’re more than welcome to the Behavioral Health Department here at Children’s: 402-955-3900 and ask to speak either to myself or my partner in crime, Dr. Vance. We’d be happy to help guide people on how to get registered and participate as well.

CHN News: Dr. McWilliams, thank you so much for being here with us today.

Dr. McWilliams: Thanks for having me. I really enjoyed it!

CHN News: You have been listening to the Children’s Health Network podcast. That was Dr. Jennifer McWillams from the Children’s Nebraska in Omaha, Nebraska.

Practice Management: How To Get Ready For … Whatever Is Next From Washington [Podcast]

Posted on

As 2017 continues to unfold, the future of healthcare policy in the United States remains a mystery. What changes will Congress propose to the Affordable Care Act, how extensive will they be, and how will they affect independent physician practices?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on how physicians can prepare for the months ahead.

Topic Breakdown

0:38—Reaction to election results
2:44—How independent physicians can be prepared for the future
5:07—Reasons physicians don’t always get involved in public policy
7:42—How a repeal of the Affordable Care Act might impact independent practices financially
10:27—How families can protect their continuity of care

Takeaways

  • The future of US healthcare policy is widely unknown, among patients, lawmakers, and healthcare professionals alike.
  • One of the most important steps that physicians can take to prepare for the changes ahead is to get involved with local medical associations, hospitals, and managed care organizations.
  • Among the biggest frustration that physicians share is having direction for medical care dictated by policy-makers who are not physicians, and have never had experience in caring for patients.
  • “How can we do more for less?” is a conundrum for healthcare professionals as we aim to lower healthcare costs.
  • Quality care involves educating patients about health insurance, and helping them navigate it. Physicians should encourage families to stay in contact about changes to their insurance.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location to, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Neb.

What Is Happening With Healthcare Policy In The United States?

CHN News: The first topic that we want to talk to you about is, how to prepare for “whatever.” And this topic ties into the election results. We now have President Donald Trump, who is talking about — and in some cases already taking steps towards — changing a lot about our healthcare system.

First, let me ask you — do you remember what you were doing when the election results were coming through?

Dr. Brabec: Oh, boy. I was, interestingly, sitting intently in front of the TV most of the evening, listening very carefully. And then, I very clearly remember hopping into bed, getting ready to go to sleep, thinking, “Well, you know, this is probably not going to go the way we want it to.” But then, at about that time, starting to see, all of a sudden, how the election results were coming through …

And long story short — here it is, 3 a.m. and I’m still wide awake, and in disbelief in terms of what had happened with the results at that point in time.

And I’m not going to make any political comments, good or bad, about that, mind you. But at any rate, I was wondering, “What is this now going to mean for healthcare?” Because it was the same thing back in ‘94/’95, when I moved home. And again, remembering Hillary Clinton standing up there, showing her card, and saying, “You’re all going to have health insurance someday,” and thinking, “Here comes socialized medicine.”

Now, with the potential repeal of Obamacare, and with what may replace it — which will probably be known as Trumpcare or whatever — we are back into a similar mindset of the unknown that we had back in ‘94 and ‘95. And, so, again — your forecasting is going to be just as accurate as my forecasting at this point in time.

Preparing For The Whatever

CHN News: I think that’s what we want to get at. Because regardless of what side of the aisle you fall on, or what your thoughts are on the direction healthcare should take, there are always some things that independent physicians should be doing to prepare for “whatever.”

Can you talk a little bit about some of the changes, or some of the practices, that independent physicians need to just establish as habits to be prepared, regardless of what happens with the Affordable Care Act?

Dr. Brabec: Well, I think most importantly, you have to be involved in some degree or another, and not sit back and be complacent in letting it come to you, more than ever before. And I think that that comfort level and that experience comes with time.

I mean, I’m coming on 28 years in private practice this summer. I would tell everybody, regardless of whether you’re just starting out or you’ve been in practice, “You really need to stay involved. Get involved and stay involved, if you can.”

That means, certainly, with your local medical society — in Nebraska’s case, the Nebraska Medical Association. But I think also with your local healthcare systems. What are they doing to prepare for it? How are they reacting to it? Are they starting to hire more of their own physicians, or are they developing other practices?

Be involved in your pediatric divisions within the hospitals. But more importantly, try, if you can, being involved, to some degree, with the various managed care organizations that are around. So you have some idea about what’s going on.

We also have to understand that in the state of Nebraska, in particular Lancaster County, 40% of our kids, approximately, are on Medicaid. In Lancaster County and the Lincoln area, that pretty much mirrors national statistics. Approximately 40% of our kids in the United States are on Medicaid, so that’s almost every other child.

And it’s very important to be involved with the various managed care organizations. Be involved in committees that will also start to determine quality care parameters and indicators. And try to be in the forefront of those things that are happening with these various managed care organizations.

CHN News: What is the top excuse that you hear physicians give for not being involved? And not going to those meetings, and not being involved in those committees? What are the excuses that some physicians give?

Dr. Brabec: Well, I think that some of the issues you hear are that they’ve maybe been involved in the past, and they feel frustrated. That they were trying to move mountains, and just weren’t able to do so. That they weren’t being listened to.

That you have organizations that have non-medical, non-physician, and non-provider-related people making decisions about the type of care that’s going to be delivered. And I would probably say that’s the most frustrating thing you encounter as a physician, having the type of care being dictated to you.

In particular, being dictated to by somebody who is a non-provider, and hasn’t been involved in direct medical care to serve a patient, and seeing how that gets shaped and formed — and sometimes, not in the best interest of patient care.

Also, the amount of paperwork nowadays that physicians are having to fill out has become monumental. I just recently spent the other day on a child with chronic healthcare needs for a healthcare plan — I spent basically about an hour and fifteen minutes filling out the paperwork for continuing medical care on this child. And all of it obviously not being reimbursed, as well.

So there’s the amount of paperwork, and rules and regulations that have continued to get put forth here through the years, making it more frustrating. Making it more tiring to want to continue to work adequately in medicine.

You’ll hear doctors say, “I just want to take care of my patient. I just want to see my patient, and take care of my patient.” And then I think, you have the increasing concerns about medical legal and malpractice occurrences and situations. That, to this day, has continued to result in the practice of defensive medicine. That, also, will continue to worry many of our fellow providers.

Repeal, Replace, Reassure

CHN News: So, let’s say the Affordable Care Act is repealed. And you mentioned being able to have a strategy, you mentioned having foresight. How would you foresee that impacting independent practices financially, if the Affordable Care Act is really repealed?

Dr. Brabec: Well, what’s being talked about nowadays with many of your managed care organizations and your hospitals, and then again within your physician groups and independent physicians, is basically this concern:

We want to reduce healthcare costs. But when you’re looking at almost 18% of your gross domestic product, $3.2 trillion in healthcare expenditures in 2015, and only 11.8% of that spend being on pediatrics in particular — when you look at how you’re going to decrease the cost of care, improve the quality of care, improve the patient experience, impact the health of a population of people — you’re going to have to learn to do it with less money, in general.
Somebody’s going to have to end up getting paid less, whether it’s the hospital, whether it’s the physician. And I think that that’s the hard part for all of us to swallow, who are in practice at this point in time — how are you going to get by doing more for less? Because how else are you going to decrease the cost of care that’s being delivered to somebody?

So, I think that’s the hardest part that I see hospitals struggle with. That’s the hardest part that I see physicians struggle with.

And it’s going to take an evolution of how we deliver that care over a period of time, that needs to occur with regards to, in particular, working much more closely with the carriers.
And then, the states that administer Medicaid, see how you can achieve the triple aim, and hopefully decrease the cost of that care. It has got to be a really strong coming together at the table, more than anything.

CHN News: For the patients, who are concerned about losing their current coverage and having to go to different physicians, and reestablish those relationships—what do you tell them? What do you do to reassure them?

I certainly know of families who have had a new physician every year for the last three years. They have had to switch physicians or switch practices because their insurance changed. What can you say to those families to help ensure that their continuity of care will go uninterrupted and go smoothly, and their children can still get the care they need?

Dr. Brabec: What we appreciate is families staying in touch with us constantly about what’s happening with their health insurance. Because sometimes, we’re not aware ourselves, as providers, what’s happening, what’s being offered out there.

We just recently encountered this, as a matter of fact. In a matter of two weeks, we had nine families contact us and say, “We want to keep you as our children’s provider, and the medical practice for our children, but we have just picked a new commercial product that’s being offered and is brand new in the market. And we don’t see you on the provider list.”

And so that resulted, obviously, in phone calls to the provider. Through families contacting us and keeping us aware of situations like that — that was a situation where we were able to negotiate and contract with the commercial carrier on a product, that we had no idea what the impact could be financially to our practice. Fortunately, it wasn’t a significant issue that we had to deal with at the time.

But tell those families to let us know, and let them know: If you have any questions about your insurance — because insurance is very complicated — we want to try to be the providers who can educate our families on insurance, and hopefully help to guide them.
It’s a very, very complicated world out there at this point time with regards to how you navigate your insurance.

There was a study that was done that showed people will change their primary care physician for as little as $600 a year in savings on their health insurance plan. So that’s also something that we have to be very cognizant and mindful of.

That families who are looking for less expensive payments in their premiums, and their deductibles, and things like that — we have to realize that sometimes, despite the loyalty and care that we hope we’re providing — for some families, that is a significant dollar amount that may be necessary for them to make that choice and decision.

So, we’re hopeful that we can continue to help educate them and provide triple-aim medical care for them. And that’s an education process for these families more than anything.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

How Mobile Technology Can Drive Care Management [Podcast]

Posted on

In today’s technology-dominated world, social media and the internet are playing an increasingly larger role in healthcare. But what does this mean for physician practices and care management?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on the relationship between the internet and healthcare for both providers and patients.

Topic Breakdown

1:06—Dr. Brabec on social media and what’s next for Children’s Health Network
1:50—The role of physicians in an internet-dominated world
7:00—Challenges physicians face with electronic medical records
7:45—Managing your online reputation as a healthcare provider

Takeaways

  • The spread of misinformation online is a challenge physicians must confront head-on by engaging patients in conversations and involving them in the medical decision-making process.
  • Maintaining electronic medical records can be challenging for practices as certain systems become obsolete — but the benefits of electronic access for patients are numerous, especially if a child has complex medical needs.
  • Technology can help streamline pre-appointment information gathering, which gives providers more time to help patients in-office.
  • Online reputation management is important for providers — but not something that medical schools necessarily prepare new physicians for.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location to, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska.

The Evolving Role Of Physicians In A Digital World

CHN News: Our topic for this podcast is how mobile technology can drive care management. How are you seeing your patients and families use mobile apps, social media to be patients or to be healthcare consumers?

Dr. Brabec: We’re obviously seeing that more and more nowadays. Families come in and say, “Well, I was on the internet and …” Or “What about this, Dr. Brabec? I read this on the internet …” Or, unfortunately, the things that steer patients in the wrong directions — in our opinion — sometimes with their medical decision-making, such as choosing to not vaccinate their child.

It is something that we have to constantly learn to deal with. Probably the most important piece of information I could give anybody is just to make sure you develop as close of a working, medical professional relationship that you can with your families.

And also guide them in their decision-making and care. All too often, I’ll hear families say, “This doctor I went to for my care as an adult basically gave me some choices and options and left it up to me.” I try to help guide the patient’s decisions, ultimately, in terms of what they decide to do with their child.

Now, mind, you, the discussion regarding the choice to not vaccinate, I give my strong beliefs. But, ultimately, families have to make a choice and decision about what they’re going to feel most comfortable with in regards to their child. I respect that, but I also let them know that we firmly believe in the need to vaccinate, as an example.

But I think when it comes to that knowledge out there, having that relationship with your patient families is most important. Discussing in a congenial manner the information that they’ve found on the internet can help them make the best choice they can for the healthcare they’re going to receive.

There are many apps and websites out there. As a provider, I think you just have to be ready and develop a style for how you’re going to address that when it comes to you.

The Dangers And Benefits Of Technology In Healthcare

CHN News: There are some ways that your practice is using technology to understand patients better. You probably have an electronic records system. Tell me how you guys are using technology to understand your patient population and make care management decisions.

Dr. Brabec: The rudimentary Facebook we have is up and going. And I think, again, the key with that is making sure you have people who know how to use Facebook and deal with the comments as they come in from patients. I think a good, knowledgeable user who can manage that is most important as well.

After 22 years at this practice here in Lincoln, we’re actually getting ready to go to new electronic medical records. This has always been a stressful thing for physicians in terms of trying to find the ideal electronic medical records system to use in your office.

Sometimes the product that you thought was going to be around forever has been bought by a large company that is going to be shelving the product and driving practices to their product. We decided against that and spent close to 10 months looking for a new product that we’re getting ready to evolve toward that as well.

What we want to do here in our practice — and again, this has to do with the amount of time patients have to spend getting off of work to come into the office — is to drive more of the information gathering process that we all experience to before the office visit.

Things like giving your insurance card, filling out a two- or three-page form that updates demographic information, filling out a form about the child’s check-up that day — we’re hoping to drive a lot of that data gathering pre-office visit through our website or other mobile devices.

This will allow us to streamline the process and spend more time when they come into the office educating them and talking to them about their medical problems, rather than most of the visit being about collecting the data.

So for us, what’s going to be key is using the website and various apps that interact with our electronic medical record system to provide that information gathering ahead of time, so we can improve on the patient experience and the care they receive when they come in the office.

Likewise, we also have to — through federal mandates and initiatives — allow our patients access to their medical records, which will be done through the website or apps that link in with the electronic medical records.

This allows them more portability with their medical information, so that whether they’re in Lincoln or whether they’re in Orlando, Florida, if their child gets sick and has medically complex needs and medications, they are able to easily pull that information up and extend that information to other healthcare providers who may otherwise not be familiar with that child’s care.

Then, they can provide the best quality medical care, even though they’re not the child’s regular provider.

CHN News: You may have already answered this question about the greatest dangers and benefits surrounding technology and medical care. It sounds like the danger can be the misinformation that can be spread when it’s not vetted by your actual pediatrician.

Dr. Brabec: Yeah, the misinformation is huge. We all know about that because we’ve all used the internet to search for information and resources. So, first of all, misinformation is a big concern.

But another big concern is social media management of your reputation online. That’s another huge, huge issue and concern that probably drives some practices and physicians away from wanting to be involved with social media and utilizing it for their practices or themselves individually.

There are so many resources out there — Healthgrades.com is one example — where all it takes is for one negative comment to pop up and that can mean a lot for your reputation.
And it may be a situation where you provided adequate medical care but yet for some reason somebody was dissatisfied with the care or the outcome. That’s a huge concern that we’re going to have to learn to manage more and more as time goes on as well.

Transparency is something that’s being put out there more and more by everybody —including the federal government — and I don’t think there’s anything wrong with transparency. It’s just you have to be prepared to manage that.

But, when it comes to medical school, none of us were prepared for that. For those of us who have been in practice for several years now, things have evolved. These are aspects of medical education that need to occur through time.

And then when it gets to residency, more education about the business of medicine and what it means for you if you’re in private practice or working for a larger hospital system. And again, social media management is something that is going to have to be implemented within our medical education system as well.

CHN News: Absolutely. Well, we look forward to getting tweets from you soon.

Dr. Brabec: We’ll start working on that, maybe, next week.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

Execution: The Key To Turning Your Business Vision Into Reality [Podcast]

Posted on

Transforming your business vision into reality might seem like a daunting task when you’re running a medical practice. That’s especially in the face of so much uncertainty about where healthcare is headed. But with the right tools, your practice’s potential can become its future.

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on what it takes to turn ideas from dreams to reality in healthcare practices.

Topic Breakdown

1:43—Dr. Brabec on the importance of leadership with healthcare experience

4:20—Seizing opportunities for growth

7:52—Understanding the past to plan for the future

11:22—Overcoming resistance to change through education

Takeaways

  • In addition to business-mindedness, experienced physician leadership is key to successful practice growth.
  • Planning for the future of your practice and knowing when to seize opportunities for growth requires an understanding of past trends in healthcare.
  • Providing opportunities for education and involvement can help hesitant providers become more open to change.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location into, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska.

Combining Business And Healthcare Experience In Leadership

CHN News: One of the things you mentioned was the importance of clinicians as leaders. You mentioned having that business management experience. And you mentioned that, so many times, there are great ideas from clinicians and great strategies that may even come about. But the execution piece is missing — they don’t always come to fruition.

So, for those independent physicians who are looking to grow — or for physicians who are looking to establish their own independent practices or even become leaders in a hospital system, what do you think is the reason that so many good ideas never actually make it to that execution step and actually become real?

Dr. Brabec: I think that nowadays in some of our hospital systems and commercial carriers and managed care organizations, finding leadership — and not just an executive type of leadership, like someone who has a lot of business experience or a Master’s in healthcare administration or anything like that — but someone who has physician leadership is becoming key.

When you have that experience of having actually been in the trenches, so to speak, and having cared for patients and seen what that takes in terms of the time and effort to provide good customer service and good quality care for your families, I think that physician leadership is more and more key nowadays.

Organizations have to provide not only good business-mindedness, but also the clinical side of healthcare and experience in delivering that, too.

You’re seeing a fair number of physicians nowadays who are going off and getting Master’s in healthcare administration, which is certainly very helpful as well. And then you see physicians who have surrounded themselves with good people who have good business experience.

And that’s what’s been key for our practice in particular: having a good business-minded healthcare administrator who is very strong financially at forecasting and helping develop the business plan in terms of growth and how you look at your practice’s statistics.

So, I think having a good chief financial officer of sorts has been very key for our practice in terms of our ability to do forecasting and sort of predict that growth — and then hit it accurately.

If you just try to go about blindly without looking at numbers and statistics and information that’s coming in, you’re not going to be very successful. You have to be very calculated about growth in medicine today.

Planning For Growth

CHN News: You are a doctor, but you also own several practices. So, you’re also an entrepreneur. How on earth do you balance those two? Do you have certain days where you have your administrator hat on and then other days when you have your physician hat on?

Dr. Brabec: We just recently had a retreat to address that. We went from being a practice with myself and four employees in one office to, currently, four offices with 140 employees: 17 pediatricians, 9 physician extenders, 5 child psychologists, a couple of hospitalists.

That desire to grow came from my former partner in Seattle who was very business-minded. So, when I moved back home, my initial desire was just to move my family back here to raise them around family.

But then I saw that I didn’t have an opportunity to get into any of the other practices. They said, “We need more pediatricians but right now we just don’t have any more room to grow within our practice.”

So, I set out and went to the bank to borrow so money to open up my own practice. I spent time talking to some of the local commercial insurance carriers about products they were offering and how they were having a hard time getting some of the pediatric practices to sign up for their products — particularly an HMO product that was first offered in Nebraska.

I could see that there was opportunity to grow and develop practices.

And the other big experience I brought from just being in a practice where my fellow partners had that entrepreneurial spirit, was that we had also built our own office building out there in Washington.

So, part of the business plan when we built our third office location in Lincoln, Nebraska — after initially being in a couple of buildings where we paid rent to somebody else — the idea was “we’re going to be at this for a while, so why don’t we just pay ourselves?” So, we currently own three of the four buildings.

We’ve also developed a real estate entity for what we’re doing. We’ll basically own four buildings and one of those will be paid off in a couple of years.

Again, that comes from experiences I had with prior mentors to see that opportunity.
Then, in 2006, I also developed a company called Midwest Children’s Health Research Institute that currently performs clinical trials — in particular with regards to vaccines, drugs, and various commercial products like baby formula or diapers that also provides a revenue stream.

Adapting To Change

CHN News: There are so many things you’ve already mentioned that you’ve done: “We want to buy a building for our practice. We want to open more locations.” For so many physicians, those stop at the idea stage. They don’t necessarily keep moving forward. What steps can doctors or practice managers take to make sure that their projects do indeed move forward and become actual goals?

Dr. Brabec: Again, I think the most important part of that is really being very careful and calculated in the things that you do in this day and age. Compared to 28 years ago when I started to do this, and seeing that we weren’t going to head into socialized medicine, we’ve kind of circled back around now with different terms and mnemonics: Integrated Delivery Systems as opposed to Health Maintenance Organizations, and PPOs and PHOs.

I think of us as physicians feel like we’re just circling back around to what already was in the mid 90s and what was being described back in the 70s. I think the difference today with regards to what’s going to happen with healthcare — and the concerns in the 90s were the same: that I’d have to do more but get paid less — but this time I think people really mean it.
CMS means it, Medicaid means it, our commercial carriers mean it. We have to mean it on behalf of our patients and the cost of care more than anything else. We cannot continue to sustain the level of cost of care that’s occurring and how strapped it is for some families as well.

In terms of these opportunities to own your own building and still have your practice exist, I think you’re going to have to be very cautious about growth. I think we’re going to see a fair amount of our care being replaced with telehealth.

I actually foresee that potentially in 3 to 5 or maybe 7 years at the latest, I’m not going to need four office locations anymore. I think I’ll need maybe only three office locations.

Why? Because the care management that I’m going to have to start to deliver to my families — what’s known as the patient centered medical home — and PCMH came about because of the American Academy of Pediatrics being started on behalf of children with chronic healthcare needs — is going be to care management on steroids, if you will.

We’ll start to deliver more and more of that care through telehealth and working to keep patients from having to come into the office. So I think I’ll be delivering even more effective, higher quality, lower cost care by means other than having the patient come to my office all of the time.

CHN News: Whenever goals are set or a vision is put out there, there’s always resistance to change. Healthcare is known as an old, stodgy industry where people often don’t embrace change and innovation as quickly as the market does. How do you counteract that?

When you put forth a vision to your team members and say, “Here’s the direction we’re going,” how do you deal with those folks who may not be on board or may be resistant to change?

Dr. Brabec: Well, I think what’s most important when you see that happening is to try to engage them the best you can to help them understand the change and why it has to happen.
When you look at approximately $9,900 per capita cost in the United States compared to some other countries whose longevity may even be a bit longer than ours but with per capita costs being half of what we spend — though many of those are socialized medicine — I think it’s important to engage and educate rather than letting people sit back and formulate their own opinions that allow their fears to happen.

I think it’s important to be involved wherever you’re at — in particular with an organization that’s going to continue to provide you with the education that’s going to help you evolve towards less fear and less panic in terms of what’s happening with medical care in the United States.

And I think the more informed you are by being involved in an organization that gives you that opportunity and, to some degree, hopefully help to shape what happens, will result in a lot less fear and panic than if you just sit back and let it happen to you.

Right now, there are, unfortunately, a lot of physicians who are close enough to retirement who I have seen even at some of the local hospitals here, when they switched to electronic medical records, and these were good physicians, but they said, “I’m done. I’m not going to do this. It’s just not what I’m used to.”

So, constant education and getting them involved rather than all of sudden — for lack of a better way of putting it — ramming it down their throats and forcing it at them is going to result in a lot less anxiety and fear.

Our medical schools also have to to be involved at the forefront by providing some history of medical care in the United States as well. I think that they will be better prepared. I never had that in medical school. But if I could have seen how the terms and the type of care and how insurance even came about, that understanding would result in a more well-rounded and better prepared physician for the changes that this industry is undergoing and will continue to undergo for years to come.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

Patient Experience 10.0: What Can Physicians Learn From The Hottest Companies? [Podcast]

Posted on

Top notch. World class. Gold standard. Such expressions are often used to describe a positive customer experience with good outcomes. But what does that experience actually look like, and how can we apply that to patients in healthcare?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, offers some insights.

Topic Breakdown

1:37 — Dr. Brabec on how the service in his favorite restaurant inspired him on running a healthcare practice

3:40 — Be respectful of your patient’s time

4:56 — Avoid redundancy

5:30 — Provide the value perceived by your patients

Takeaways

  • Running a healthcare practice is no different from running a restaurant in terms of providing a good customer experience. Fostering a culture of working as a team is important.
  • To provide the ultimate patient experience, be attentive to their needs, respectful of their time, and aim to reduce redundancy in information gathering.
  • 99% of the referrals are word of mouth. Quality care and positive experience bring more business to your practice.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec. Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health that I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location into, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska, as well.

CHN News: Talking about patient experience, as you know that’s sort of a huge distinguishing factor for many companies. You know, everybody watches movies, for example. But for some reason, there’s something about Netflix that took over and now there’s no more Blockbuster. And it’s not that it’s so much that there are so many different movies. It’s the experiences are different. And we started to see a lot of that translate into healthcare, just focusing more on the actual patient experience. Before we talk about the healthcare part of it though, can you think of a company you really admire because of the experience they give their customers?

Dr. Brabec: Well, you know I love food, so one of them that comes to my mind immediately was, when we moved from Seattle, Washington to the Midwest, particularly Lincoln, Nebraska, we saw a distinct difference in the level of customer service you received in a restaurant. Any by that, people who constantly fill up your water, people who take dirty plates right away, people who took your order right away. All of those things. Yeah, one of our favorite restaurants here in Lincoln, Nebraska, called Lazol’s, provided an incredible level of service, customer service that we even found to be in paralleled some of the finer restaurants in Seattle, Washington. And what did they, [it’s] what makes you want to come here eating there, doesn’t it? So, what did they put forth that created that experience or fostered that culture?

And that’s what’s important, culture. They all work together as a team. So, whether you are actually waiting the table and taking the order, or you are that person who was assigned that table but you are walking by another table you are not assigned to, for instance. One of the several key initiatives to be working efficiently and providing excellent experience was that you never come back to this kitchen without a dirty plate in your hand. So, even though I just took the order over here, I walk by that table, they are on my way back and even though it’s not my table, I pick up the dirty dish that I see right away.

So anyway, providing that ultimate level of service and customer care, and to this day, that restaurant is what I put in front of my staff and say what do you think about the Lazlo’s experience, and what we need to provide here in terms of the customer services and experience for our families? Because it’s really no different. One of the first things we should say is “How can I help you?” And being able to follow through with how can I help you by giving them a solution once they started to tell you about what their needs are. I never want to hear, for instance, somebody schedule and say “You know I’m sorry. All of our appointments are filled up for the day. If your child needs to be seen today, you have take him somewhere else.” You just don’t want to do that. You just absolutely don’t want to do that.

You find a way to help the patient for the day with the child who has ear infection rather than make them wait until tomorrow and saying all the appointments are filled for the day and you have to take them to the urgent care center. So customer experience, all too often, there just hasn’t enough attention paid to that obviously in terms of providing the ultimate customer service and experience. Time is of the essence for them just like it for anybody else, so being respectful of their time more than anything is very very important, number one.

Number two, also trying to avoid redundancy in the care we deliver or in information gather. I alluded to that early on about the forms you constantly having filled out and filled out again, we need to get better reducing redundancy in the healthcare because we see that happening. Why do I just got to tell them that doctor about that, now I have to tell you again about this. So, trying to reduce the redundancy there and trying to deliver again good quality healthcare, being able to spend more time talking and educating on the reason and the problem why you came to the office today as well.

I tell my nurses, when you go to call the family back and you see there’s a mom with a toddler and also happens to have a little baby and a carrier. Help the mom. Offer to take the carrier. Take the diaper bag. Take the toddler by the hand and help guide them back as well. Get patients back to the exam room right away rather than having them sit out and hustling and bustling waiting room with others. Children who are sick and their child isn’t sick.

There’s a lot of different aspects to customer service and experience. And basically when you look at the AAA. What’s the value, what’s the value of the medicine I’m receiving today? Everybody defines value differently and we have to cognize that, of that varying definition of value for everybody and try to serve the perception of what value is to all of our families in the way they perceive that.

CHN News: And that’s great for the patient. Like you said you know what gives them a good experience, they feel valued. How does that help the practice to focus on the patient experience?

Dr. Brabec: Now they again too, Lincoln again there’s a time when you know our growth here and practice continue to be good as well, but our local hospital systems both of them have continued to employ their own physicians and open up their own practices. Other pediatric practices have continued to add pediatricians to their practices as well. So, we are competing more and more in particular for the commercial paying patients and for the Medicaid patients as well. So, you want to provide again AAA medicine. You want to be able to provide good service and good quality care. And I founded this practice here when we started to look at how people got referred to the practice. Literally 99% of referrals were word of mouth. It’s not putting an ad in the paper that’s getting patients to come to our practice. It’s word-of-mouth referral. So, you know a good experience will be told through for others. A bad experience will be told to others.

CHN News: That’s right. That’s absolutely right.

Dr. Brabec: So, provide a good experience and care that you put forth in your practice and the customer service that you are giving as well.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, Nebraska, and Chairman of Children’s Health Network.

Give Feedback

X

Search the Children's Nebraska Website

Looking for a provider?