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    Epidemiology has taken center stage this year in the healthcare arena due to the global COVID-19 pandemic. In this episode of the MGMA Insights podcast, we’re joined by David Gutierrez, MBA, MHA, assistant operations officer, Alamo Osteopathic. Gutierrez brings a unique perspective to medical practice operations due to his background in epidemiology, his experience in stem cell biology, and his research into the future of workspace and how the digital age impacts job performance and organizational culture.

    Give us an idea of the size and scope of your practice.
    I currently work for Alamo Osteopathic, which is one of the largest single-proprietorship companies in Texas. We are a family practice with seven locations across San Antonio and New Braunfels area. And we focus on osteopathic medicine, since most of our physicians are DOs. My current title in the company is assistant COO, so I tend to oversee the whole company.

    What is your primary focus as assistant COO?
    With healthcare being such a volatile environment, I believe I change my primary focus multiple times a day. But overall, my primary focus is to look for any type of deficiencies in the company and develop strategies and protocols to optimize our patient care and satisfaction, while keeping our company healthy and running.

    What are the biggest challenges that the practice is facing right now?
    I believe this year has brought a lot of challenges that we did not take into consideration before: How to keep patients healthy while keeping their risk of COVID exposure at minimum. In April, when the pandemic really started to pick up in Texas, fear of COVID exposure kept patients away from the practice, especially in our older population, which are the most vulnerable, but as well, they're the sickest.

    The use of telemedicine has really helped in this situation and has increased dramatically in our patients since the pandemic started, but it's still hard to really assess a patient over a camera, especially if they're not very tech savvy, like our older population. Or, if they're required to do labs every one to three months, depending on their chronic conditions, it's very hard for the provider to really assess the patient. And sadly, we have seen a decline in patient compliance and an increase in patient visits to the emergency room and hospitals, which decreases our standard of care, and our value-based scores across all insurances.

    Has there been anything you guys have been doing to try to combat that?
    We’ve actually been working closely with the insurances. And they actually have a lot of community workers. … They make sure to call the patients to remind them to take the medication, to remind them to go pick up the medication. For example, Humana has this mail-in medicine, that patients don't really have to go out to the pharmacy, they can just obtain the medication on their doorstep. Another way, I guess, we can tackle it, is home health. We assign them to a home health company if patients feel comfortable enough to let them into their house. They're able to draw the blood so we can know exactly what's going on, how the medication is functioning in their system.

    You haven't always been just on the business side of healthcare. Your academic work and earlier career is in epidemiology. How has that background helped inform your mindset about healthcare, and how have you been able to apply some of that background in helping create a safe environment at your practice?
    What do you picture when you hear the word “healthcare?”

    I think about it from the perspective of meeting with a doctor, going to a clinic and getting those checkups… I kind of think about it in those terms.
    That's usually the most common answer I get. Doctors, hospitals, nurses, treatments, medicine. But what if I told you that 70% of deaths globally are actually caused by noncommunicable diseases? Most of them, of course, being cardiovascular disease, cancer, chronic respiratory disease. Doctors and nurses do take care of those chronic conditions, but how do you think we lower or reduce all these chronic conditions in the first place? What if we can avoid childhood obesity? What if we can lower our lung cancer by reducing smoking? What if we can avoid diabetes by eating healthier?

    [In public health] our main goal is to reduce health risk with research and community education and health policies. I apply such factors to the company by encouraging physicians not only to treat but to educate our patients. I make sure to always be able to provide patients with educational documents on their chronic conditions every time they come in. And this is what healthcare is really transitioning into. This is what insurances are embracing nowadays. We are switching from a fee-for-service to a value-based care service. Instead of just treating these chronic conditions, it's better to just prevent them.

    Is there such thing as a typical day for you?
    Typical days are very rare in healthcare. … I'm thinking of a schedule of things to do, but in reality, things can just change in a matter of seconds to accommodate a given situation. ... Some days, I can be on a computer, responding to emails, being on my phone. Other days, I can find myself in the back, triaging patients, doing bloodwork and labs. Other days, I'm traveling to different offices to look at their workflow, seeing any struggles that they're going through and training the staff members to improve the current system. If you want a typical workflow day, I believe healthcare might not be in your best interest.

    So how do you stay organized?
    I strongly suggest a calendar. I specifically have a notebook-sized calendar that I keep with me through the entire day. When receiving phone calls, emails, there's always something to remember. So I make sure to write down, because if I don't, it’s gone.

    Another way I stay organized, specifically on my emails, is by creating folders. You know, I believe every email system now has the capability of creating folders. I make sure to label them, by every provider, office manager, staff member; I have over 30 folders at this point. Every conversation that I have, that I know I might need in the future, I put into a folder. Instead of scrolling through pages of emails … I just got into that folder, and it takes me just a second to find what I need.

    What is your secret to keeping the team motivated, keeping them efficient and in a positive mood with so much going on?
    Staff communication is key to a transparent organization. With seven offices, sometimes it's hard to communicate with everyone in a single week. We make sure to have a time on Mondays to talk and discuss any changes or updates in the practice. You want to make sure that they feel listened to, your office staff, managers and employees. We are also implementing a system where we obtain benchmarks of everyone's average performance, and encourage them to go above and beyond. … You want to make sure they are acknowledged. You want to make sure you give them positive feedback. It could be as little as throwing a little surprise lunch or a little incentive here and there. … That's one of the biggest parts as a leader.

    In 2018, you published a paper, “The Future of Workspace: How will the digital age impact job performance in organizational culture?” What is the central theme that emerged from your research?
    Technology advancements nowadays are doing most of the muscle-power jobs. Our society is now transitioning into more of caring jobs. For example, from 1990 to 2010, the top five growing industries were healthcare, education, community workers, technology or A.I. or IT, and of course, marketing —all of it, we target as just an individual. A.I. and programming have simplified tasks where previously extensive education and experience was necessary.

    A great example is medical equipment. We have simplified the diagnostic testing. Before, companies had to hire and train technicians to know how to operate and handle the testing equipment. Now, you can train an MA to perform such tests. … In our clinic, it took us two days to train our offices’ staff on how to use retinal imaging equipment, which targets diabetic patients for retinopathy.

    We have seen jobs that are able to be performed outside of the office now. For example, Twitter CEO Jack Dorsey, he publicly stated that most of their employees are able to work from home even after the pandemic. And many companies across the globe have started to embrace this new culture. In the upcoming years, we will see a decline in office establishments and an increase in home offices, which has been shown to be actually very beneficial. Research from Stanford University showed that working from home increased productivity by 13%, which is a great tradeoff for business owners, because you have the reduction in overhead spending, facility payments, maintenance. Also, employees are happier with their jobs when offered remote working, compared to their counterparts as full-time office workers.

    Technology is really pushing us into a more practical way of doing things. You don't really have to leave your house anymore to get groceries, see providers. It's just really making it more simple for daily living.
    This episode is sponsored by:
    Be sure to click here to register for an upcoming free MGMA webinar on "Improving Patient Satisfaction and Boosting Collections Through Cost of Care Conversations at the Point of Care." The webinar is eligible for ACMPE, ACHE, CME and CEU credits.

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    The MGMA Insights podcast is produced by Daniel Williams, Rob Ketcham and Decklan McGee. 

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