Episode 22: COVID-19
Normal Does Not Return Until Confidence is Restored
Joseph Impicciche, JD, President and CEO, Ascension
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In this episode of Fireside Chat, we sat down with Joseph Impicciche, JD, President and CEO, Ascension to talk about telemedicine, communication with the board of directors, and looking ahead and re-opening under the new normal after the pandemic.

Please note: The number of COVID-19 cases and the situation referenced in this episode were based on reported data at the time of the interview and are subject to change.

Please note: The number of COVID-19 cases and the situation referenced in this episode were based on reported data at the time of the interview and are subject to change.

Joseph Impicciche, JD, MHA, serves as President and Chief Executive Officer of Ascension, leading the Ascension Leadership Team to advance the health system’s Mission of providing compassionate, personalized care to all, especially those most in need. He previously served as President and Chief Operating Officer and earlier as Executive Vice President and General Counsel.

As President and CEO of Ascension, Mr. Impicciche has been an advocate on numerous issues including the importance of greater access to care – especially for those who are underserved, gun violence as a public health issue, the need to reduce drug costs, and the use of technology to spur healthcare innovation. He also has represented Ascension at Scottsdale Institute and spoke in 2020 at The Twenty-Seventh Workshop for Bishops by The National Catholic Bioethics Center. Mr. Impicciche was named one of the Most Influential People in Healthcare by Modern Healthcare in 2019.

He has served on the Boards of numerous organizations and currently serves on the Board of the Catholic Health Association of the United States, National Catholic Bioethics Center, the Society of St. Vincent de Paul National Foundation, the St. Louis Regional Business Council, the United Way of Greater St. Louis, and the St. Louis Regional Chamber.

Mr. Impicciche earned a Juris Doctorate from Indiana University School of Law, Indianapolis, and a Master of Healthcare Administration from Indiana University. He received a bachelor’s degree from Wabash College, Crawfordsville, Indiana, where he was a Lilly Scholar.

Transcription

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Joe Impicciche 0:02
I don’t think normal returns until confidence is restored. We can reopen our elective surgeries and we can reopen service lines. But that’s not going to change what healthcare systems are experiencing unless confidence is restored.

Gary Bisbee 0:24
That was Joe Impicciche, President and CEO Ascension, speaking about how we’ll return to the new normal. I’m Gary Bisbee and this is Fireside Chat. In this wide-ranging conversation, Joe spoke about how Ascension, one of the largest not for profit health systems with over 150 hospitals in 20 states and the District of Columbia, has coped with the COVID-19 crisis. The surge is highly regional, and essentially, hospitals are located in both high surge and lowered surge locations, leading to opportunities for balancing people and caregivers among the hospitals. Let’s now listen to Joe on the ascension board of directors.

Joe Impicciche 1:04
We very early on started holding virtual update sessions on a weekly basis. The time is used exclusively to update the board on what is happening in our ministry.

Gary Bisbee 1:15
In response to this COVID crisis, Joe spoke about the board and how frequently management communicates with them what questions they ask and what are their top priorities spoiler alert, patient care, and associate protection. Similar to other health systems. telehealth has provided a huge assist in allowing the hospitals and physicians to focus more on managing COVID patients essential has gone from 500 telehealth visits a day before COVID to 10,000 visits daily after I’m delighted to welcome Joe Joe Impicciche to the microphone. Good morning, Joe. We’re pleased to have you at the microphone. Welcome.

Joe Impicciche 1:56
Thank you.

Gary Bisbee 1:56
Our pleasure. Of course, we’re all facing challenges due to the covid 19 pandemic. And we’ve learned the surge is highly variable by region. As we were speaking before, Ascension has hospitals in 20 states and in the District of Columbia, how do you even think about the status of the surge across all those states?

Joe Impicciche 2:14
It’s certainly challenging. And we do have a broad footprint. And we have 2,600 sites of care and more than 50 senior living facilities. Not only are we in 20 states, but we’re in many, many different counties. I think you almost have to approach this on a county by county basis. From a more macro standpoint, when I look out over our system, our big surge areas really have been Michigan primarily in the Detroit area, and Illinois, primarily in the Chicago area, we’re starting to see a little bit of an uptick in Baltimore, in many of the markets today that are progressing at this point in time,

Gary Bisbee 2:52
It’s a challenge for all of us. And I was talking to somebody earlier today who was saying they’re really frustrated with the stay at home policy.

Joe Impicciche 3:01
What we’re seeing is it’s really having a major impact in a very positive way. It is absolutely flattening out the curve. And thus far, it’s allowing us as a healthcare system to stay ahead of the demand curve. So we’re hopeful that we will continue these policies in place so that we can flatten this curve, and ultimately get on the other side of this.

Gary Bisbee 3:27
When did you go to work at home? And when did you begin to affect your policies at ascension?

Joe Impicciche 3:33
We set up a command center for our COVID response. I believe it was early to mid-March. And at that point in time, one of the very first actions we took we closed our system office and enabled everyone to work from home. To the extent the course that we were able to it’s a little bit more difficult, obviously when you’re in an essential role at a hospital because we have to continue to care for patients that to the extent that you can accept that any of our associates could work from home we ask them to do so

Gary Bisbee 4:02
Well, we’re all familiar generally with Ascension but it’s always helpful to hear the CEO outline his or her health system. Can you please describe Ascension for us, Joe?

Joe Impicciche 4:12
Essentially, it’s is a leading nonprofit Catholic health system in the United States and we are committed to delivering compassionate personalized care to everyone with special attention to persons living in poverty and those that are most vulnerable in our communities. Last year alone, we provided over $2 billion in care to persons living in poverty, and community benefit essentially includes 165,000 Associates and over 40,000 line providers. We have over 2600 sites of care including 150 hospitals and more than 50 senior living facilities. And we’re in 20 states and the District of Columbia. We also provide a wide variety of support services such as clinical network services, venture capital investing Investment Management, biomedical engineering, facilities management risk management, and we have our own group purchasing organization.

Gary Bisbee 5:08
So you went through a management transition last year. Are you completely through that now? Or is that still in process?

Joe Impicciche 5:16
You’re correct. Last July, we had a leadership transition, our longtime CEO, Tony Terkini transition from his role as CEO and I became CEO at that time prior to that I was Chief Operating Officer. And then even prior to that, for about 15 years, I was the general counsel for Ascension. With the transition of Tony, other senior executives also transitioned. And we have developed a new team that we call the essential leadership team, which is comprised of a few of us old-timers, but many of our next generation leaders, and we’ve been together now for less than a year. And I can tell you, I just couldn’t be any more pleased with the team. It’s a terrific group of men and women and a very talented, high performing team.

Gary Bisbee 6:00
I’d love to at a later point in time talk about the transition from General Counsel, the chief operating officer to CEO that’s quite a ride, Joe.

Joe Impicciche 6:10
Yeah, it’s, it’s been quite a transition.

Gary Bisbee 6:13
Well done. One thing Ascension has been working on a national brand for a while. Where are you at in that journey?

Joe Impicciche 6:21
We’ve really completed the branding initiative across the session. This happened really over about a three year period. It’s been really interesting in a crisis like this, which of course, nobody would ever want to go through something like this. But there are always blessings, right? There are always blessings that come out of this. And I would say one, a real blessing for us has been an acceleration toward becoming one real organization, you can change signs, but in terms of really having the culture come together, as one, take something very special, and quite frankly, I think this particular pandemic has drawn the organization, the ministry together as one in a very special way.

Gary Bisbee 7:01
Let’s use that as a transition back to the COVID-19 crisis. Communicating with your communities and caregivers is all-important. How do you think about that show?

Joe Impicciche 7:11
Well, our general mantra is that we communicate early and often and always and daily. And I don’t think you can ever over-communicate in a situation like this. Early on, we created a command center structure to coordinate our ministry wide response to this Cyrus, the command center is based in Indianapolis. And it’s been working virtually, but it’s helped really coordinate. Our approach provides a lot of guidance to our ministries provides a lot of policies, and it’s also acting kind of as a troubleshooter. When issues arise, we recognize of course that health care is provided locally. So it still requires strong leaders in our regions and in our hospitals to be able to execute on that guidance and on those plans. And to be able to kind of translate and conform to their particular set of circumstances, it’s actually worked very well for us. We use a wide variety of tools, including not only emails but the website, we’re actually doing our own podcasts and so forth, we’re trying to find a number of different ways to be able to reach out and communicate our communication marketing, doing a terrific job. We’ve spent a lot of effort and a lot of time focusing on our caregivers because they are the true heroes in this saddle. And we want to thank them and honor their contribution.

Gary Bisbee 8:34
Joe, what is the morale among the caregivers at this point, and I realize you have a number of different markets and at different stages of the surge. But how is morale?

Joe Impicciche 8:44
I believe are the morale among our caregivers remains pretty high. Look, this is exhausting work. There’s no question about it. And at times, it can be very, very difficult. But we’re blessed to have such extraordinary and selfless caregivers. Frankly, we can never thank them enough. Early on, I made the decision to provide pay protection for our associates as well as to set up an employee hardship fund so that we can financially support associates negatively impacted by the virus. It’s been a trying time for our caregivers, especially in the surge markets. And so we’re trying to provide as much support as we can. And to help them through this time of crisis.

Gary Bisbee 9:24
We’re all interested in how each health system is responding to the crisis. And one of the things that has come up from the very beginning is testing in the capacity for testing. How have you found that to be across the ascension service areas?

Joe Impicciche 9:39
I think Vice President Pence last night at the press conference said that the country has tested over 3 million people thus far. I’m sure these numbers are a little stale. But I think our testing through our drive-up sites. I think we’ve tested maybe around 10,000 patients are in the house the hospital testing I think another 50,000 And I would say it is certainly getting better. But it’s not optimal yet. I think we still have a ways to go. But our strategy has been on testing people that show symptoms, people that are ill. And I think the country needs to add testing becomes more readily available, which I believe and I think every day it is it’s getting better every day. But we will need to kind of pivot to testing a broader group of people, not just folks who are showing up at our hospitals or who are ill.

Gary Bisbee 10:31
Joe, do you have any line of sight on that? You mentioned that it’s probably late April or May till Ascension service areas are through the surge. How does that relate to availability testing? What do you think?

Joe Impicciche 10:43
Again, I think, for now, we’ve been able to keep up with the demand. There are certainly instances where we’re running low on swabs or reagents. By and large, right, as a system, our size, we’re able to help we were you might have a shortage, and we’re able to help move things around and be able to cover for that. I think, again, I think testing is improving daily. And more and more tests are coming online. I think we’ll continue to be able to keep pace with that demand.

Gary Bisbee 11:11
Well, that’s good news for sure. What about the supply chain and particularly for PPE? How has that been?

Joe Impicciche 11:18
It’s certainly a challenge for all of us. But we are very blessed to have our own GPO which we call the resource group. And they’ve just done a tremendous job of sourcing critical supplies and making sure that we have what we need to meet the surging demand. We’ve taken proactive steps with distributors’ suppliers to ensure that we have access and they continue to arrange shipments directly from manufacturers. We’ve been very fortunate one of the advantages of being a system are sizes that we’re able to redirect PPE when necessary, to areas where that are experiencing a surge. Now, do we have as much on hand as we would like? Of course not. But to date, we have adequate supplies. And we feel like assuming we can continue to receive the shipments, I think we’ll be able to stay ahead of the curve.

Gary Bisbee 12:10
How about ICU beds and ventilators? Joe, have you been able to stay ahead of the curve there?

Joe Impicciche 12:15
We have. Yeah, we have again, many of our facilities, especially in the surge areas are maybe at 60% to 80% ICU capacity. And of course, for example, Michigan and Illinois. They’re kind of in the thick of things from a vent capacity. I think Illinois and Michigan are around 45% and capacity. But again, we’re in 20 states and we’re in probably 150 markets or more. And so we’re able to move PPE around so that we can staff up when necessary.

Gary Bisbee 12:46
We spoke about caregivers a bit ago. But how about redeployment? Has there been a fair amount of that? Or have you needed to do that?

Joe Impicciche 12:54
We have reassigned staff within our hospitals and markets as our needs have changed. We are prepared for the event we need to redeploy clinical staff. Early on we created nursing staffing guidelines and ICU surge staffing plan and followed with acute care and Ed staffing plans. Were very well prepared to do that if necessary. Again, we have a terrific group of nurses and caregivers and selfless in the way they handled this particular crisis. And so we’re blessed to have a very, very talented group.

Gary Bisbee 13:27
How about shortages? Joe? Have you run into that in any of your markets where there’s been a high surge?

Joe Impicciche 13:33
So far, we’ve been able to keep pace, I would tell you that we have probably close to 2000 of our associates that have been quarantined because of exposures. And we’re either waiting on test results or waiting for a 14 day period to expire to bring them back. So that has created some staffing pressures. I think there are maybe 500 quarantined in Illinois, for example. So the sooner we can get those caregivers back into our hospitals, the better. But again, so far we’ve been able to keep pace.

Gary Bisbee 14:08
Telemedicine has been interesting. A number of the health systems report a dramatic increase in telemedicine encounters, how have you found that at ascension?

Joe Impicciche 14:18
That’s really been a terrific platform. For us, virtual care has been the key to how we are responding to COVID-19. And our teams are using it to provide care to patients in the comfort of their own homes and access to specialists virtually and deliver a whole host of supportive services. It’s interesting before this virus hit, I think our average virtual visits per day across the system with only about 500 visits. Today it’s well over 10,000 virtual visits daily. So we’ve seen just an incredible surge of online use, which I think it’s terrific and I believe it’s here to stay I think I don’t think our experience is unique. I think most health systems across the country are experiencing the same thing. And I think Finally, consumers are getting used to this, as well as our caregivers in our physician. Again, it’s one of those blessings. I think this is going to be here to stay.

Gary Bisbee 15:15
Have you found that the waivers that CMS has granted? Is that been helpful at all to you to Ascension in the various markets?

Joe Impicciche 15:23
It’s been terrifically helpful. I don’t think telemedicine would really be possible. Without those waivers, CMS, and administrator, Vermont’s just done a terrific job in helping to relax those regulations, and allow us to adopt this new platform. And we’re very, very thankful for the CMS engagement.

Gary Bisbee 15:45
She’s definitely getting rave reviews from among the system. So good for her. Well, thinking about elective urgent surgeries, when did you postpone them or cancel them?

Joe Impicciche 15:58
Again, that was pretty early March, we followed CDC guidelines and, and the guidance issued by the US Surgeon General American College of Surgeons and so we did postpone elective services and nonurgent medical appointments. It’s been over a month now, since we’ve done that?

Gary Bisbee 16:15
Any visibility to when that might start back up?

Joe Impicciche 16:20
I think this is going to be a market to market community analysis. I know the administration, I think is looking at it this question very closely. And we will continue to follow the guidance that the administration issues.

Gary Bisbee 16:34
Let’s move to economics, which can’t be a pretty picture for any of the health systems. How would you judge the effect on your 2020 financials of the COVID-19 outbreak?

Joe Impicciche 16:46
I think your statement is correct. It’s not pretty for anyone. When when you’re shutting down over half your business, it’s going to certainly have a big impact. But you know, we were blessed with Tony genies leadership, we were blessed with a very, very strong balance sheet. And so we’ve been able to really remain strong and with plenty of liquidity. To address these current challenges. We’ve been committed to prioritizing caring for our associates and those we’re privileged to serve. And we’ve taken a lot of action to do just that we made a decision early on to continue to pay our associates and not lay anyone off. And we’re going to continue to do that for so long as we reasonably can. We think it’s important that we continue to invest in our people during this time. And then when I feel like they need us most. And as I mentioned have, we set up a financial hardship program. Several members of our executive team have pledged portions of their salary as a donation to that Fund, which would the fund’s purpose is to help associates with ethics that are experiencing hardships, paying for rent, mortgage utilities, groceries, medications, to whatever extent these hardships should occur. It is difficult we expect April to be an especially bad month, my guess is May will likewise be an especially difficult month. But we’re still financially very, very strong. And we will absolutely weather the storm.

Gary Bisbee 18:15
It sounds like the dollars from the grants are flowing. Have you found that to be the case?

Joe Impicciche 18:22
Absolutely. Again, I think the administration’s done have done a great job getting the dollars out there we and we did receive in early April, a little over 6% of our 2019 Medicare fee for service payment. So that helped a lot. It’s a good first tranche, but it’s not going to be enough. And I know the administration knows that I know they’re intending several more trenches. And that was just the first step

Gary Bisbee 18:48
2020 is almost a last year just fighting to make sure you keep the ship moving forward. It also looks to me like, I’d love your opinion on this, 2021 is not going to be a pretty picture financially, either. I would think there’s just a lot of makeup and expenses of one kind or another that you will incur. That’ll hit the financials and 2021. Does that sound right, Joe?

Joe Impicciche 19:17
I think that’s right, of course, our fiscal year begins July one. I think it’s still too early to know that for sure. But I think that’s directionally that’s correct. 2020 I think you’re right, it’s probably going to be a wash. 2021 I’m very hopeful, depending upon the restart of the economy I think 2021 could end up being a good year. But I think it just depends on a lot of variables. So it’s would be very difficult to predict right now.

Gary Bisbee 19:42
Love your optimism and I hope that’s the case. Why don’t we bounce to the Board of Directors following the economics? How have you been communicating with the board? How often have you been communicating with them?

Joe Impicciche 19:54
Well, number one, we’re blessed with a terrific board. They’ve been very engaged from the very beginning. We have some physicians and caregivers on our board. And their top priority like mine is patient care and associate protection. And they’ve been very engaged around those topics, including surge capacity PPE, levels, ventilators, social well being and such. So we’re really fortunate to have such an engaged and committed group of people on our board. We very early on started holding virtual update sessions on a weekly basis, the time is used exclusively to update the board on what is happening in our ministry, in response to this COVID crisis, we’ve been keeping them up to date. In addition to that, we send out leadership briefings daily, to all of our leaders across the ministry, and we share that briefing with the board as well.

Gary Bisbee 20:49
So in terms of virtual board meetings, I’m asking all of the CEOs this question, any tips for how to conduct a smooth virtual board meeting?

Joe Impicciche 20:58
This is really interesting. Our first virtual board meeting was in March, we were intending effect, we were days away from jumping on a plane. And we made the decision to change that face to a face board meeting to a virtual one, our next board meetings in June, will be a virtual meeting. And quite frankly, until things become safer to travel, and we’ll probably continue to have virtual board meetings. I’ve actually been working pretty well on sentient technologies, which is our it platform, a great group of talented leaders. And we’ve been able to stand up the platform and enable our board members to engage virtually, it’s actually worked pretty well. I think, actually, the board meetings are they’re probably crisper. I think when you’re together, you’re able to spend more time, which is great. I mean, in the face to face interaction is terrific. But I think the board meetings today that we’re doing virtually are sticking to the business and prioritizing the work. And I think it’s been working really well. I think I think our board has been very pleased with the way that’s going

Gary Bisbee 22:02
Well, when things return to normal, such as normal will be, do you foresee that you might actually mix in some virtual board meetings with in-person meetings?

Joe Impicciche 22:12
Yeah, I really do. I mean, I think that’s going to be true, not only for board meetings but everything we do. It’s been interesting, again, one of the blessings has been that I think we’re all getting used to the virtual meetings and realizing there’s a lot we can do. There’s a lot we can do without having to necessarily travel or office somewhere. And so I do think that it’s going to have an impact not only in how we hold board meetings. I think just how we hold meetings in general, across our system, especially, you know, with an organization like ours, that’s in 20 states. We put our executives through quite a bit of pain when they have to travel all over the country. So maybe there’s a way we can be more efficient without having to inflict so much pain.

Gary Bisbee 22:53
The airlines probably aren’t going to want to hear that. But it does sound right.

Joe Impicciche 22:58
They have some major challenges.

Gary Bisbee 23:02
Well, in terms of the global supply chain, many of your colleagues are talking about that, from the standpoint that should we think about not being dependent upon a global supply chain for some of these supplies that are really critical for American lives. What feeling do you have about that job?

Joe Impicciche 23:21
Well, again, we’re very fortunate to have one of the largest provider-owned GPOs, a resource group within ascension. And that’s really helped us manage our supply chain and our inventory. And because of our size, and having our GPO we’ve been able to mitigate some of those supply issues that others are facing. Now, having said that, I would agree with you I think there’s a real opportunity here to be less dependent on some of the historical traditional supply chains.

Gary Bisbee 23:49
Another issue that’s come up is health insurance reimbursement. And, of course, the premiums are continuing to flow to the health plans, but they haven’t had the elective surgery to pay. So there’s some discussion about maybe there should be a way to share the response that the health systems have been making. Any thoughts about that, Joe?

Joe Impicciche 24:12
I think I read somewhere that one of the major insurers yesterday or the day before announced they had one of the best quarters ever. So to your point, health insurance is part of the healthcare ecosystem. And I feel like we’re all in this together. Each one of us, including health insurance companies, have a responsibility when it comes to defeating this pandemic. And I was pleased to see many insurance companies waive co-pays and deductibles related to covid testing and treatment. But I do think now more than ever, commercial payers, government payers, providers need to work together to make sure that we end this pandemic and then we reimagine the way a healthcare system in a post COVID world will be convenient and affordable for all. We’re all part of that ecosystem. I think we all have a responsibility to make this work and we’re all going to have to come together to do that.

Gary Bisbee 25:03
Reopening is a term that doesn’t exactly apply to our hospitals. But to the extent that it does apply, how are you thinking about reopening or getting back to normal?

Joe Impicciche 25:15
It’s a great question. We do have a team I mentioned earlier, we created and set up this COVID command center. But in addition to that, a few weeks back, we set up a team to begin looking at how we emerged from this, and what does that, quote reopening look like? What does that new normal look like? We continue to work on that. Now, I would say in a broader perspective, that I don’t think normal returns until confidence is restored, we can reopen. Right, we can reopen our elective surgeries and we can reopen service lines. But that’s not going to change. I don’t think what healthcare systems are experiencing unless competence is restored. And so you have to get to a place where not only the American worker, but the American consumer, they have competence, not only going to hospitals but going to restaurants and shopping and so on. And I think that’s going to take a number of things, I think one testing is gonna have to come a lot more available, we’re gonna have to test on a much broader basis. And then we’ll continue to pray for a vaccine or therapy to reduce risk, again, very hopeful. And I know we have a lot of brilliant men and women thinking about this daily. And I’m very hopeful that we will find that answer soon.

Gary Bisbee 26:36
Joe, this has been a terrific interview. We appreciate your time. One last question. We’ve talked about the new normal. And Mark McClellan at this microphone brought that up three weeks or so ago. When you think about changes in the healthcare system coming out of COVID-19. What are some of the things that you think about?

Joe Impicciche 26:57
Well, there’s no doubt that healthcare delivery and the health care system overall will look differently in a post COVID world? In fact, I think society will look differently. women, generally there’s accelerated adoption of telemedicine, and have more contactless approach to care delivery experience. So absolutely agree that there will be this new normal. And I think a lot depends on how long the pandemic last in terms of how much society really ends up changing.

Gary Bisbee 27:27
Joe, thanks so much for your time today. Absolutely terrific interview. And good luck to you and all of your Ascension colleagues.

Joe Impicciche 27:34
Thank you. Thanks. Thanks for inviting me.

Gary Bisbee 27:38
This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat, contact me through our website, firesidechatpodcast.com, or gary@hmacademy.com. Thanks for listening.

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