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In this episode, we sit down with Jay Anders, a physician executive, to discuss the evolving landscape of health care. We explore his unique insights on leadership, the challenges facing today’s medical professionals, and the critical role of technology in shaping the future of patient care. Tune in for an engaging conversation that highlights the intersection of medicine, management, and innovation.

Jay Anders is a physician executive.

He discusses the KevinMD article, “Revitalizing rural health care with technology and policy.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jay Anders. He’s a physician executive. Today’s KevinMD article is “Revitalizing rural health care with technology and policy.” And I was talking to Jay offline, I think we last had him about a year and a half ago. Jay, how are you doing?

Jay Anders: Very well. How are you, Kevin?

Kevin Pho: Pretty good. So for those who didn’t get a chance to listen to your first episode early last year, just briefly share a little bit about yourself.

Jay Anders: Well, I’m an internist by training. I practiced in general internal medicine for the first 20 years of my career, then got into health care IT through several companies. Now at Medicomp, mdtech.com, that’s our website, and been there for the last 10 years.

I got started in that part of the business because there was a total lack of physician input in health care IT at that point in time, and I was asked by a company that was almost a startup at the time to give them some consultation as to where they need to go. So I started with them, went on to another company called Med3000, and on to another company that you probably know called McKesson, and then to Medicomp.

So people ask me one kind of question a lot these days is, why did you get into this? And I said, well, as an internist I got to see maybe 5,000 patients a year, got to affect that many lives, had a pretty busy practice. I said, in this job though, I get to affect the lives and conditions of hundreds of thousands of people if we get this right. So I really enjoy interacting with physicians in health care IT and trying to advance that, and advancing patient care through technology.

Kevin Pho: Now do you feel that your physician voice and expertise is valued in that health IT space?

Jay Anders: It is more now than it was when I first started. There seemed to be a real, almost a wall against asking clinicians what they really wanted from any of these health care IT systems. It’s still kind of there.

Now we’ve got a different specter of all this AI coming on board and its lack of, I think, direction right now, and it’s kind of like a solution looking for a problem. But people are starting to come around. And with the ONC coming out with new regulations that are starting to put boxes around things and really start to augment the sharing of medical information and how that’s going to be used, and then the transparency of all this electronic decision support as well as the AI decision support, is I think really going to advance health care IT over the next several years.

Kevin Pho: All right, so today we’re going to talk about the intersection between health IT and rural health care. Your KevinMD article is “Revitalizing rural health care with technology and policy.” Tell us how this article came together, and for those of you who didn’t get a chance to read it, a little bit about the article itself.

Jay Anders: So I was asked because of some of my background. I grew up in a town of 19,000 people. We had at that point in time two big hospitals in this little town of 19,000. Roll forward several years and now they have one hospital that is a regional spur of a more centrally general system, and the second hospital in town is closed. It’s a derelict building, it looks absolutely horrifying to drive by it now, and it’s actually where I had my tonsils out and where I was born. And so it was a real hub of the rural type of community.

I’ve stayed in touch with the health care leaders of the existing hospital now and some of the regional hospitals. And I got interested in this back when I was a resident and a beginning physician. I spent several shifts working in small rural hospital emergency rooms, and if the clinicians out there have ever done that, know exactly what I’m talking about. It’s a wholly different experience, because you don’t have all the bells, whistles, and specialty backup that you have in a major medical center.

That is dying right now, slowly, painfully going away. These hospitals are being absorbed by larger systems and then basically being downconverted to what I would call a glorified aid station. And that’s not right. People need health care locally. They don’t need to go 90 miles down the road to visit Grandma because she had an open heart procedure and the only place you do that is some major medical center. That’s not convenient.

The other issue that I’ve been told and been privy of is these hospitals’ cost structures are such that their profitability is so low or non-existent that they just can’t make ends meet. So I kind of got interested in that. And then we’ve got this whole technology layer that is expensive, and with AI coming on board I think it’s going to become a little more expensive, and these hospitals just can’t afford that kind of technology right now, and no one’s asking them what they need. So I kind of got interested and started talking to folks about that and try to put my voice to getting some change and getting some people focused on it.

Kevin Pho: So in the context of all those challenges that face rural health care institutions, what are some technology solutions that you see that can help some of these obstacles?

Jay Anders: Well, interoperability in and of itself will help. Get a complete medical record when you need it anywhere is going to be a real step forward.

The other thing that can happen if you’ve got the right technology is there are all types of remote monitoring systems. So you can have ICU beds set up in a smaller hospital but being monitored by an intensivist at some major center somewhere. So there’s that type of technology. And there’s also teleconferencing and teleconsultation from specialty care that also, if you have a complete medical record, can be very, very helpful in a rural setting.

So these systems that everybody’s been talking about since meaningful use have trickled out to most practitioners in the United States right now. The problem is they’re not very well connected still, and there’s really no infrastructure out there to really start to support that. It’s changing, it’s getting a little bit better, but not nearly fast enough.

Kevin Pho: Give an example in a rural health care setting where interoperability isn’t where you’d like it to be and how that affects patient care. Tell us a story for those who can’t quite grasp that, and contextualize it to a real life scenario.

Jay Anders: Well, think about the emergency room situation. So you’ve got somebody who, you’re usually in a rural area, so there are a lot of farmers, there are a lot of people that are kind of not in a community, comes into an emergency room and he’s unconscious. He fell in a grain bin and he was found under the corn. Now he’s been brought in here, you have absolutely no information whatsoever as to what this patient has or what they’re taking or anything else for that matter.

And then usually you have a family member, and this is a true story, I actually lived this, will try to tell you what you need to know to get this person fixed. I mean, after you get them intubated and stabilized, but what are they on, do they have a heart condition, are they diabetic, are they hypertensive? You try to get that information out of them. If you had that type of information you could actually treat them more quickly and more completely, if you had everything you need to know as a clinician in that rural setting.

So when I think about baby steps, number one, connectivity. You’ve got to have the internet to transmit this data. It doesn’t go by carrier pigeon. You’ve got to have internet connection out in these rural areas. That’s slow, getting better, but not near where it needs to be. And then you have to have the mechanism to share those medical records. That is a basic underlying brick to make this a lot better. So I’ve lived that life personally and it’s not fun. You get it done, but it could be a whole lot better.

Kevin Pho: It sounds like we’ve been talking about this problem of interoperability for years now, right? I think that there’s proprietary issues that arise between the competing health IT companies that kind of prevents that. So have we really moved the needle over the last five years in terms of solving this problem? Have we made it easier for patient records to be transferable between different EHR systems?

Jay Anders: We have, and it’s about to become even better. I had the privilege of talking to Jeff Smith at the ONC about their HTI-1 and HTI-2 initiatives. Both of those are geared to interoperability standards. So these big monoliths of EHRs are going to have to, by law, if they want to be in the Medicare program and they want to be able to take advantage of things like Medicare Advantage, they’ve got to be able to share their information.

So they’ve laid out now a very clear groundwork on how that’s to occur, and that was sorely needed. People were doing all kinds of different things, sending faxes and everything else under the sun to say, well, that’s interoperability. No, it isn’t.

So we finally got a set of ground rules. We also have a set of penalties. So if you withhold information about a patient that’s requested, the penalties are pretty stiff right now. So the ONC meant business when they said, here’s the rules and here’s what happens when you break those rules. And they were a long time coming, but I think they’re finally starting to get it right. So that resistance that you just talked about is probably not going to be as much, simply because the cost of resistance is going to be very, very expensive.

Kevin Pho: So it sounds like some of these solutions are on a longer term time frame. So when it comes to a rural health care setting, a rural hospital who may be in a little bit more concerning financial situation, anything on a shorter term basis from a technology standpoint that can help them out?

Jay Anders: Well, they need to be connected obviously. So other than that, the other thing that really needs to happen is policy shifting, both in the reimbursement for rural health care as well as reimbursement for providers of rural health care. They’re out there sitting in the trenches and they get sometimes more reduced pay than what someone would get in a major medical center.

So as most things in the world, it takes money. So money for health care IT, money to help clinicians earn a living. And what I mean by that, not just the clinicians but also all the allied health care and the nursing care.

And one phenomenon, I was talking to the CEO of a rural hospital about six months ago, one of his major concerns was that he can’t get nurses to practice full-time in his hospital. He has to rely on agency nurses, which he gets from a company, which is three times the cost of what a nurse would get if they were part of his system directly. So he’s been forced to staff his hospital with very expensive care simply because these companies have made a point of, we can make a lot of money on nurses and they can travel all over the place. So I was kind of shocked by that when he said that. But that’s a policy shift. We’ve got to have more money flowing into the hospitals to actually support them so they don’t go under.

We also have to have, I think, a change in our medical education system, and some states are actually doing this. Illinois is one of them, where I was born. The University of Illinois system there has a program by which, if you want to practice in a rural area, we’re actually going to augment your application, give you the tools. Now you may not be a real top tier candidate for that medical school, but we’re going to get you in, we’re going to get you trained. The only promise you have to make is you’re going to practice four to six years in a rural area. So I think that’s a marvelous idea, to incentivize graduating medical students in the United States to actually go out into these areas and actually deliver health care.

Kevin Pho: You also mentioned the possibility of remote solutions like telemedicine and remote patient monitoring, remote patient care. Where are we with that? Because I heard that the reimbursement for telemedicine isn’t what it was during the pandemic. So where do we stand when it comes to these remote solutions, and in the context of rural health care?

Jay Anders: I believe the reimbursement for telehealth is being looked at right now. They’re trying to figure out how we can get it back to what it was in the pandemic. So I think that’s number one, you’ve got to be reimbursed for telemedicine.

The other thing is having the appropriate equipment. So I can get on a little teleconference with a cardiologist in Chicago and I happen to be sitting in a tiny little town in Illinois and be able to discuss a case. So the money I talked about would go to that kind of equipment to allow that to happen. So when it comes down to what technology can do, there’s a lot there. It just has to be purchased and maintained and be affordable.

Kevin Pho: So what do you see coming with rural health care? If you look in your crystal ball in the next couple years or so, what do you anticipate the next steps to be?

Jay Anders: Well, I think this whole thing with the ONC and the new regulations will help with the interoperability part of this, at least the incentive to operate. One of my concerns is it’s not going to change very much over the next few years. I am concerned about when AI solutions come on board and they’re all tokenized and cost put into that particular practice setup, that that’s going to be a problem for them.

I do see some movement in some states where there is more money going to start to flow into those. So to me, I’ve been focusing a lot of talking to people on the policy side of this, where you’ve got to change your reimbursement policies, you’ve got to change how you support these things.

So I don’t see it changing a whole lot in the near future. I am hoping that with more technological advances and with policy changes we’re going to get a little bit better in the five to 10 year time frame. I’m hoping they all don’t close in the interim.

Kevin Pho: We’re talking to Jay Anders. He’s a physician executive. Today’s KevinMD article is “Revitalizing rural health care with technology and policy.” Jay, as always, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Jay Anders: Well, if you’re a clinician out there practicing in one of these areas, you may feel that your voice is not heard, but I would get in contact with your state representatives and start talking to them about your issues. I urge every CEO of these hospitals that are struggling to do exactly the same, and see if we can’t start to move the powers that be to help us out.

Kevin Pho: Jay, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Jay Anders: Thanks for having me.