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. To listen to the full conversation, click here.
The following is a transcription of the interview:
Joe Impicciche 0:03
I don’t think normal returns until confidence is restored. We can reopen. 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 0:25
That was Joe Impicciche, President and CEO for Ascension speaking about how we will 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 120 hospitals in 20 states in the District of Columbia, has coped with the COVID-19 crisis. The surge is highly regional and Ascension’s hospitals are located in both high surge and lower surge locations, leading to opportunities for balancing PPE and caregivers among the hospitals.
Joe Impicciche 1:00
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.
Gary Bisbee 1:14
Joe spoke about the Central Board of Directors 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. Ascension has gone from 500 telehealth visits a day before COVID to 10,000 visits daily after. I’m delighted to welcome Joe Impicciche to the microphone. Good morning, Joe. We’re pleased to have you at the microphone. Welcome.
Joe Impicciche 1:53
Gary Bisbee 1:53
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 the District of Columbia, how do you even think about the status of the surge across all those states?
Joe Impicciche 2:11
It’s certainly challenging. We do have a broad footprint. We have 2600 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 us 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. We’re hopeful that we will continue those 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 the working 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, but to the extent that you can and to the extent 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 informational to hear the CEO outline his or her health system. Can you please describe Ascension for us Joe?
Joe Impicciche 4:12
Ascension is a leading nonprofit Catholic health system in the United States, and we are committed to delivering compassionate personalized care to everyone. We give 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 for persons living in poverty and community benefit. Ascension 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 District of Columbia. We also provide a wide variety of support services such as clinical and 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 we went through a management transition last year. Are you completely through that now? Or is that still in process?
Joe Impicciche 5:15
You’re correct. Last July, we had a leadership transition, our longtime CEO Tony Tersigni, transitioned 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. So we have developed a new team that we call the “Ascension 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 a little 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 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, to Chief Operating Officer to CEO. That’s quite a ride, Joe.
Joe Impicciche 6:11
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 ascension. 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’s always blessings right? There are all these blessings that come out of this. And I would say one, 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, Joe?
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 virus. The command center is based in Indianapolis, and it’s been working virtually, but it’s helped really coordinate our approach. It provides a lot of guidance to our ministries, provides a lot of policies, and it also acts kind of as a troubleshooter when issues arise. We recognize of course, that healthcare 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 translate to 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 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 are 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 battle, and we want to thank them and honor their contribution.
Gary Bisbee 8:33
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 the 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 and the capacity for testing. How have you found that to be across the Ascension service areas?
Joe Impicciche 9:38
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 house. The hospital testing i think is another 50,000 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 as testing becomes more readily available, which I believe and I think every day it is. It’s getting better every 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? Do you think?
Joe Impicciche 10:42
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 re-agents. By by and large, right as a system, our size, we’re able to help where we 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 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 supply chain and particularly for PPE? How is that been?
Joe Impicciche 11:17
It’s certainly a challenge for all of us but we are very blessed to have our own “GPO” which 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 surge 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 our size is that we’re able to redirect PPE when necessary, to areas that are experiencing 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. Of course, for example, Michigan and Illinois. They’re kind of in the thick of things from a vent capacity. I think Illinois, Michigan are around 45% 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 12:45
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 to the event we need to redeploy clinical staff. Early on, we created a nursing staffing guidelines, an ICU surge staffing plan, and followed with an 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 that are 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 13:32
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’s 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 14:07
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 14:17
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 service. 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 is terrific. And I believe it’s here to stay. 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 have granted has 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 Verma has 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 the guidance issued by the US Surgeon General American College of Surgeons and, and so we we did postpone elective services and non urgent medical appointments. It’s been over a month now, since we’ve done that.
Gary Bisbee 16:16
Any visibility when that might start back up?
Joe Impicciche 16:19
I think this is gonna be a market to market community to community analysis. I know the administration, I think, is looking at this question very closely. And we will continue to follow the guidance that the administration issues.
Gary Bisbee 16:33
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 16:45
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 Tersigni’s 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, we have, we set up a financial hardship program, several members of our executive team to pledge portions of their salary as a donation to that fund, which with the funds purpose to help associates that are experiencing hardships, paying for rent, mortgage, utilities, groceries, medications, to whatever extent these hardships should have occur. It is difficult we expect April to be an especially, especially bad month. My guess is may will likewise be 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 cared grants are flowing. Yeah. Have you found that to be the case?
Joe Impicciche 18:22
Absolutely. Again, I think the administration’s Done, 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. 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 crunches, and that was just the first the first step.
Gary Bisbee 18:48
Feels to me like for everyone, 2020 is almost a last year just fighting to make sure you keep the ship moving forward. It also looks to me like 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 in 2021. Does that sound right, Joe?
Joe Impicciche 19:17
I think that’s right. Of course, our fiscal year begin 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 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 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 19:53
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, associate 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’ve sent 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, in fact, we were days away from jumping on a plane, and we made the decision to change that face to face board meeting to a virtual one. Our next board meetings in June, it will be a virtual meeting. And quite frankly, until things become safer to travel, we’ll probably continue to have virtual board meetings. It’s actually been working pretty well. Ascension Technologies, which is our it platform, have 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, they’re probably more crisp. 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 it’s going to have an impact not only in how we hold board meetings, but 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 22:57
I know that you know, they have some some major challenges.
Gary Bisbee 23:01
Well, in terms of 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, Joe?
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 23:48
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 24:11
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 are 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 that 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 gonna 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 emerge from this and what does that “reopening” look like? What does that new normal look like? We continue to work on that. Now, I would say in a more broader perspective, that I don’t think normal returns until confidence is restored. We can reopen. We can reopen our elective surgeries and we can reopen service lines. But that’s not going to change what health care systems are experiencing unless confidence is restored. And so you have to get to a place where not only the American worker, but the American consumer, they have confidence, 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 going to have to become 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 “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 26:56
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. I mentioned earlier 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 on how long the pandemic lasts in terms of how much society really ends up changing.
Gary Bisbee 27:26
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 27:37
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 capitol 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 Bisby’s brief. For questions and suggestions about Fireside Chat contact me through our website, firesidechatpodcast.com or Gary at HMAcademy.com. Thanks for listening.
Transcribed by Otter