Improving the public good: Health administration at the Bloustein School

On this episode of EJBTalks, Stuart Shapiro welcomes Vince Joseph, Professor of Practice in the Bloustein School’s Master of Health Administration program and former Executive Vice President at Robert Wood Johnson hospital. Stuart and Vince discuss the pandemic’s impact on hospital administration and education. They explore the strong connection between the Bloustein School’s mission of improving the public good and its rapidly growing health administration program. Vince highlights the role hospitals play in community needs assessment, and showcases some of the many ways that current hospital administrators work to improve community access to health care. The episode makes clear that Professor Joseph and his colleagues are preparing Bloustein School students to tackle these issues in a rapidly changing field.  

Stuart Shapiro
Welcome to EJB Talks. I’m Stuart Shapiro, the Associate Dean of Faculty at the Bloustein School, and the purpose of this podcast is to highlight the work of my colleagues and our alumni in the fields of policy, planning, and health, and what they’re doing to make the world, the country, and New Jersey a better place.

Today, I’m very happy to be speaking with Vince Joseph, a former executive vice president at Robert Wood Johnson Hospital, and one of our star professors in our rapidly growing Health Administration program. Welcome to the podcast, Vince.

Vince Joseph
Thank you very much, Stuart, I’m looking forward to it.

Stuart Shapiro
Let’s start with the basics. For our audience, which may be a little policy/planning skewed, what is health administration and why has it become such an attractive field?

Vince Joseph
Well, health administration has changed dramatically in the 40 years that I’ve been in the field. When I first got in the field, your average hospital ran about $100 to $200 million budgets. The last hospital that I ran was $1 billion. And in the old days, you used to… your job was just to manage things and make sure things were functioning well. But today’s world to be in health administration, it’s totally different. You have to be on top of laws and legislation, lots of changes, which we’ll talk about in the field over the last 10-15 years. And you have to be very versed in medicine and medical technology.

There are many times that as a CEO — and I was a CEO for 30 years of my 40-year career, either CEO or CFO — I many times got into legal issues. Members of staff, we’re working with the President and the medical staff, somebody may, we want to get them off the staff or bring them on this, they have all of these issues. And then you’re dealing a lot with funding for programs and new innovations for the community. And this emphasis has changed a lot from the four walls of the hospital now to the whole community. And we’re very, very involved with the community. I had a new experience when I came to Robert Wood working with a medical school, and we fund that medical school out of the hospital proceeds by the sum of $60 million.

And so Health Administration, the easiest way of saying it is, managing the whole operation. But it’s changed dramatically. You know, you have to negotiate, you have to know labor laws, you have to make sure you’re planning for your staff. And we’ll talk about that a little bit because now we’re dealing with burnout after COVID. So we have to really deal with that.

Stuart Shapiro
So you’ve got to be a lawyer, you’ve got to be an expert in finance….

Vince Joseph
Yes.

Stuart Shapiro
You’ve got to be a manager, you’ve got to be a technology expert.

Vince Joseph
Yes

Stuart Shapiro
It’s a whole wide variety of things.

Vince Joseph
One of the reasons the students, I think, are coming to, and we’re doing so well at Bloustein, is because there’s a lot of opportunities. And I mean, I’m a perfect example. I’m a baby boomer and I retired from actively running hospitals in 2016 came to Bloustein in January 2017 full time. I also do consulting around the country, for hospitals that are in trouble. But now pharma has opened up, outpatient settings are exploding.

I’ll give you a couple of examples for the audience. I have one student that was in my first MHA graduating class at Bloustein. She now… she worked in the medical staff office at a big hospital. Now she runs the largest cardiac group in Middlesex County. Another one of my students, got his master’s and did a little bit of work in the hospital and talked to me and he’s thinking about pharma. So we talked it out. He went to pharma. He’s had three promotions. He’s now a director in pharma. And he said the information he got from Bloustein it helps them deal with the HR issues he has, financial issues, etc. And another student just talked to me the other day. He’s been in New York City working for healthcare since he graduated from our program. And now he’s interviewing for what I would call an assistant vice president job of a large hospital in New Jersey. So it’s really working. Our students are really growing in the field and it’s terrific.

Stuart Shapiro
So what led you to come back to higher education to Bloustein after spending this career and seeing all these massive changes occur?

Vince Joseph
Well, you know, Stuart, when I was CEO of Monmouth Medical Center down in Monmouth County, I did some teaching in the undergraduate after work. I did one class every semester. And I loved it, just loved it. And when I was CEO of St. Barnabas Medical Center, I did the same thing, I still taught a little remote. And then I went out and ran a large system out in Pennsylvania. But when I came back to New Jersey in 2009, I started actively teaching again, in the undergraduate program for Health Administration. And then when I retired, I was lucky enough to work with Ray and Ann Maire to develop the MHA graduate program and kick it off. And I’ve just loved it. I mean, and I have to tell you, the opportunities are out there. And the students constantly are in touch with us as to should I take this job, what do you think about that. And it’s really very, very rewarding. I consider them my second family.

Stuart Shapiro
That’s great. And I know they feel the same about you. And we’re very lucky to have you. You talked about the massive change that the healthcare industry has gone over decades, and we could probably spend hours going through each of them. But the past year has seemed like a decade too many of us.

Vince Joseph
Absolutely.

Stuart Shapiro
What has COVID wrought in the healthcare industry?

Vince Joseph
Well, COVID has… see we always, not always, but let’s go back to the 1990s. We got into a lot of universal precautions, it was called. So that’s when AIDS and HIV came out. And we had to learn how to be very thorough in sterilizing ourselves, not allowing infection to spread. And in health care facilities, it was a radical change. We had to put sanitizers at every room, you had to guarantee that you wash your hands when you walked in, and when you walked out of a patient’s room every time. And we took on a lot more of that.

Now COVID hit and infection control is now on steroids. When I was at the hospital, as CEO, my infection control people were advisory. Now they’re operational. They say no, you can’t do that. This is the only safe sanitary way you can do it. So the whole dynamic has changed now dramatically. And one of the other side effects of COVID that I think your listeners will be very, very interested in. About a week or two ago, under the clear blue sky, I got a call from a program director of a residency. And they were talking to me and wanted some advice on running the residency because I’ve written articles on running a good residency.

And one of the things that they said to me was, because of COVID, and this program director has been a pro in teaching and running residencies for probably 15 years. But with COVID, for the first time, she said I sent half of my resonance to EAP, many of them have huge anxiety, great depression, because they’re dealing with all of these very sick patients, which who remember, didn’t have any family members in the rooms with them, they were…

Stuart Shapiro
Right.

Vince Joseph
…dealing with it, and many of them passed away alone. And it took a big toll on them. And the interesting thing is one of our students, in our first MHA graduating class did a paper for medical staff on physician burnout. And they came up with many strategies to help physicians with physician burnout, because not only is it a very demanding time for physicians, but it’s also a very depressing time. You know, you’re dealing with these people who are by themselves. There’s no family member to talk to, and they’re struggling with this illness. And it’s really changed everything. And I spoke to one of my old vice presidents, and he was telling me the other day, that housekeeping now, the budget is doubled what it was because everything has to be sanitized five times a day, and everything else and it’s huge. It’s really huge.

Stuart Shapiro
What about… we’ve seen a lot about telehealth and becoming an increasing role because those people without COVID didn’t want to go into the hospital. I know I’ve been reluctant to get my checkup. You know, I’ve timed it for when the rates were low and things like that. So I’ve got to imagine that that’s another major change.

Vince Joseph
Oh, it is, it’s a huge change. And at first, people were very reluctant, especially practices, because they didn’t think they were going to get paid for seeing patients. But Medicare allows for billing of the virtual visit. And most insurance companies now do. And so, it was funny, I talked to that cardiology group that our former student is now the manager and running… big group. And one of the doctors in the group is a friend of mine, and he said that he spends about 40% of his day doing virtual visits.

Stuart Shapiro
Wow.

Vince Joseph
He says, I have some patients that don’t want to come into the office at any expense, so I do a virtual visit with them. But if I’m concerned that I want to listen to their heart or hear other stuff, he says, I have to send out a visiting nurse. And she calls me and says, Okay, this is what I’m seeing, this is what I’m finding, etc. So you’re right, it exploded. And, as far as specialty care, when I was doing my consulting, I did a consulting job in Arkansas last year for a large system, and they had a number of rural hospitals. And what we set up there was, we roll in a cart in a rural hospital emergency room, contact the mothership, and say, okay, we need a neurologist on the zoom call. And they see if the patient’s having a stroke or not, they ask them certain questions, they tell the doctor on the site, what meds to give them, and then transport the patient. So telehealth has just exploded.

Stuart Shapiro
Yeah, that was certainly my impression. Let’s go back to the MHA program for a minute here, and talk about what are the key things you hope HA students take out from their time with us.

Vince Joseph
So when we, and I say we, Ray, myself, Mike McDonough, and Ann Marie. When we started developing the MHA program, one of the things that our advisory board told us, which is made up of CEOs and other medical leaders around the state told us, we don’t want our students to be great at theory. They’ve got to be able to hit the ground running when they get out of your program. And it’s interesting, there’s a CEO of a large hospital in New Jersey, that said to us, maybe three years ago, I got my MHA at a not to be mentioned other University. And he said it was all theory. And he said, and I did not feel like I was competent enough to be a COO or a CEO, because everything was the theory. So he went back to school and went to a program that was more oriented for experiential learning. And that’s what we did from day one.

And our advisory board still says, you know, you got to teach how to deal with labor, you got to teach them how to manage costs, you got to teach them medical technology and how to invest in it. And that’s what we attempt to do because our goal is our students should be able to come out, be very knowledgeable about how healthcare organizations… And when we say Health Administration, we’re talking about community health departments, we’re talking about pharma, we’re talking about hospitals, we’re talking about physician groups, all of those that I just mentioned, we have graduates in right now.

Stuart Shapiro
Yeah, that’s great. I’d like you to talk a little bit about the connection between what you’re doing in the HA program and the overall mission of the school, which is focused mainly on improving the public good. Now, it seems to me that connection is fairly obvious, but I’d like to get your perspective on how improving hospitals fit into that notion of improving the public good.

Vince Joseph
Probably the… there’s a couple of great examples. So when the Affordable Care Act was passed, one of the requirements in the Affordable Care Act is that every three years health care facilities will do a community needs assessment. When we did our first one before I left Robert Wood, it came out and it determined that the number one health problem in our community was adolescent obesity. And so we put a crew of people together, we hired a couple of people, nutritionists, and nurses, and they went out and visited every church in Middlesex County. They went out and visited all the schools and you would be shocked to see the sugary drinks and french fries that were there. And now we’re dealing with obesity as a major health issue.

Stuart Shapiro
Right.

Vince Joseph
Okay. So, our job is to do that. The other thing our job is to do is to increase access so people can get care. So I’ll give you a very good example. When I came out to Pennsylvania to run a hospital system, a five-hospital system, one of the things I really did not like was, and this was in the year 2000 to 2005, everything was hospital-centric. So if you needed outpatient x rays, you had to go to the hospital, you need physical therapy, you had to drive an hour and go to one of the main hospital campuses, etc. So we did strategic planning, which is a critical part of our job, and I said, my vision is anybody in our catchment area, that was five counties, and a driving time from the mother hospital an hour out in different ways, I said, our people should be able to come to one of our facilities outpatient within 15 minutes.

Today, that’s reality. So the system that I worked on, we have 30 satellite sites that have physical therapy, occupational therapy, primary care, and lab services, and some with radiology. So now rather than elderly people having to get in the car and drive an hour to the main campus, find a place to park and fight with that and get their care, they can now go 10-15 minutes from their house and get care. That access is critical. And we’re trying to open it more and more. And the RWJBarnabas health system, they’re opening up more and more freestanding clinics to help the indigent. You know, we have federal and qualified clinic right there in New Brunswick downtown. We now have one in Monmouth County that the Robert Wood Johnson Barnabas system runs. So we’re opening more of them in the state, because we want to help people get access to health care.

Stuart Shapiro
Yeah, I mean, we talk a lot about the social determinants of health and hearing that adolescent obesity example, it’s encouraging, because it means our hospitals are engaging in that same dialogue, that same thought process about how do we make people healthier?

Vince Joseph
And we found interesting enough, that the local churches were far more receptive in bringing people in for lectures and our talks and writing diets up for families, then even the schools.

Stuart Shapiro
Wow.

Vince Joseph
They were very, very helpful.

Stuart Shapiro
That’s an insight I never would have imagined.

Vince Joseph
Yeah.

Stuart Shapiro
Anything else you’d like to add for our audience?

Vince Joseph
I would just say that it’s still a very evolutionary time. I mean, I’m, as the old man in healthcare, I actually was in one of the first hospitals that they experimented with DRGs. That’s how Medicare pays. And I’ve lived through the Balanced Budget Act, the Affordable Care Act. Now, there was an executive order signed by President Biden last week, that he wants the Department of Justice to investigate and make the rules a little tougher for mergers and acquisitions.

And I will tell you, probably in the last five years, I’ve bought one hospital, I have negotiated three other purchases of hospitals for big systems in Georgia and Arkansas. And I think you’re gonna see mergers and acquisitions now slowed down dramatically. But you know, like in our state, there’s two systems that are the main systems, and that has its pros and cons. And, you know, the Pro is for a good example, RWJ Barnabas health, let’s take that, for example. They’ve put millions into Rutgers health, to help people. They’ve put multiple millions into the medical schools. And even in Rutgers athletics, they sponsor a whole track with Rutgers health for athletes. So they’re doing a lot to help the community, which is really where our focus should be.

Stuart Shapiro
Yeah, it is. It’s a tough question. I mean, antitrust anywhere. We’re thinking about it in social media contacts and a lot of the Biden order had to do with that, and certainly, in the hospital context, where a lot of people don’t think about these antitrust issues a lot.

Vince Joseph
Oh, yeah.

Stuart Shapiro
They’re very, very important.

Vince Joseph
I’ve had to appear before the Federal Trade Commission representatives, probably five times to assure them that these mergers that we were proposing, were not going to be monopolistic.

Stuart Shapiro
Right, exactly. Well, we could have a whole podcast just on that.

Vince Joseph
Oh, yeah absolutely.

Stuart Shapiro
Vince, thanks so much for coming.

Vince Joseph
My pleasure. It was really great.

Stuart Shapiro
And a big thank you as well to Amy Cobb and Karyn Olsen, who make sure this podcast gets out. We’ll see you all in a couple of weeks with another talk from another expert at the Bloustein School. Until then, stay safe.