Member Spotlight: 2023 MGMA Harwick Innovation Award Winner Dr. Padma Gulur

Show Notes

In this episode of the MGMA Member Spotlight podcast, we’re joined by Dr. Padma Gulur. Dr. Gulur is Professor of Anesthesiology and Professor in Population Health Sciences at Duke University School of Medicine. Dr. Gulur is also the 2023 MGMA Harwick Innovation Award winner. The Harwick Award is designed to recognize and celebrate the success of an individual who has developed an innovative solution that positively impacts practices, providers and/or patients in their community. Dr. Gulur was selected for the Harwick Award due to creating the Anesthesia Resource Management System (ARMS). According to the nomination, ARMS “has revolutionized the way (Duke Health) manages anesthesia resources, leading to remarkable operational efficiencies and substantial cost savings.” MGMA Leaders Conference We're sponsored by the MGMA Leaders Conference, which will be held in Nashville, TN, Oct 22-25. For more information go to MGMA.com/events. #MGMALeaders Additional Leaders Resources: MGMA Leaders Conference registration: mgma.com/conferences/leaders/register Leaders Conference Schedule: mgma.com/conferences/leaders/schedule Conference Overview: mgma.com/conferences/leaders/overview WE WANT TO HEAR FROM YOU Let us know if there's a topic you want us to cover or an expert you would like us to interview. Email us at [e-mail]. If you have opportunities and resources you'd like to share with MGMA members, go to Marketing with MGMA to find out how you can connect with the MGMA audience.

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Speaker 1: 00:49

Well, hi, everyone. This is Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We have a special guest today, and that is, doctor Padma Gailour, who is our 20 20 three Harwick Innovation Award winner at MGMA, and will be presented with that award at our upcoming leaders conference in Nashville. Doctor Galore, welcome to the show.

Speaker 2: 01:17

Well, thank you, Daniel. It is a real pleasure and honor to be here. Yeah.

Speaker 1: 01:22

Now I was going over your, lengthy resume, very impressive resume. You are currently professor of anesthesiology and professor in population health sciences at Duke University School of Medicine. Talk about your role there.

Speaker 2: 01:39

Well, thank you, Daniel, for that, for that question. I do have a pretty full academic, you know, life with research, more in the, you know, the scientific aspects, but also in, operational efficiencies in the form of, for instance, the anesthesiology resource management system that we've created here.

Speaker 1: 02:00

Thank you for that. And we're gonna talk a lot about that in just a moment because I wanna I have a lot of questions, for you about that program that you helped develop. But before we get there, as I mentioned, you're at Duke right now, but tell us about your health care journey. What led you to where you are now at Duke?

Speaker 2: 02:21

Well, without giving away the age aspect of this whole thing, it has been a long journey. You know, it started, for me, a lot of my training and, subsequent work for, you know, over a decade was in the Boston area. And, so my, clinical interest, of course, are in anesthesiology and pain management. That's where, all of this started. I moved from, Mass General to the University of California, Irvine, building on that work and moving more into system level solutions, you know, for health care delivery, somewhere around there, and was recruited to Duke in 2016, to, come and, work and collaborate with the excellent minds here to come up with solutions for our future in this ever changing health care landscape.

Speaker 1: 03:17

Okay. I didn't realize the UC Irvine connection. I, worked at a building that was basically next door to the campus about twenty years well, almost twenty five years ago now from about February to 02/2003. And, guilty pleasure at the time, I would drive on to, basically, the campus where the In N Out Burger place

Speaker 2: 03:42

Oh, yes.

Speaker 1: 03:42

And have my lunch there.

Speaker 2: 03:45

I mean, what a beautiful area. What a beautiful place. I mean, it is one of, you know, a must must do, on anyone's bucket list to be in that area. We both you and I seem to have been privileged to at least live there for a few years.

Speaker 1: 03:58

Right.

Speaker 2: 03:59

And while, you know, you can speak endlessly of just the general beauty there, the weather, the fact that anywhere you turn, there's beaches and sunsets, but you're absolutely right. The hidden secret there is that In N Out burger, an absolute cult favorite.

Speaker 1: 04:14

It is. It it really is a cult favorite for sure. So thank you, for sharing that with us as well. So as I mentioned earlier, you are, and congratulations again, the recipient of the Harwick Innovation Award, and that is one of our highest honors that, we give out at MGMA. And we're basically astonished when we get the nominations in and the amazing work that's taking place at practices and around the country, in health care.

Speaker 1: 04:47

Again, I'll just say it for people who are gonna be in Nashville at our leaders conference in a few weeks that you're gonna be receiving that award at the, conference in Nashville. So I wanna talk about that a little bit more. You were picked by our selection committee for something. I wanna get this right due to creating the anesthesia resource management system or ARMs. Your nomination was lengthy.

Speaker 1: 05:15

There was a lot of great information in there, but I'll just quote one piece. It says that ARMS has revolutionized the way Duke Health manages anesthesia resources, leading to some remarkable operational efficiencies, and this is always important in health care, substantial cost savings. So tell us about this system. What was the origin to it in the first place? And and tell us a little bit more about it.

Speaker 2: 05:43

Well, thank you, Daniel, for those kind words. I mean, it's an incredible honor to be recognized for this, and I think it underscores the importance of innovation in health care, you know, especially in optimizing resource allocations and reducing, like, systemic inefficiencies, which in turn, honestly, allow us to focus where our focus should be, which is on improving, patient care and provider well-being, you know, which is the other unsaid many times. That's an equally important part of healthcare delivery. And so to answer the question, you know, how did this start, all of us in healthcare are facing you know, multiple challenges, ever increasing costs, reducing, you know, revenue, all in the setting of not being a business while being a business because we're in the business of health care, which is taking care of each other. And when we're in the, you know, in the in that process, it brings its own unique, challenges, a lot of satisfaction.

Speaker 2: 06:46

Don't get me wrong there. That's why we're all in this space. Right?

Speaker 1: 06:49

Yeah.

Speaker 2: 06:50

But, does have its own challenges when you're looking after people. And then the pandemic, that kinda threw us for a loop and really highlighted those holes, you know, that needed to be addressed. And so the for us, we were fortunate. We had already been prior to the pandemic working on this. And, its true value is magnified because we actually implemented this through the pandemic when we were faced with a lot of the challenges, that, you know, just across the country, everyone did.

Speaker 2: 07:19

And those were, you know, essentially, how do you provide the care continue to provide this care while looking out for provider safety and well-being because people were getting, honestly stressed, stretched, and burnt out, you know, our providers as well. And so we really, really had to come up with a solution that continued to make this you know, make their ability to provide meaningful work, you know, possible. And in order to do that, we had to come up with a way where we were at, you know, utilizing our resources. There was immense staff shortages, as I'm sure everyone's experience has tried to go into a health system. Even up until now, you will, you know, recognize that it was not easy because we're not always fully staffed.

Speaker 2: 08:03

So it became even more important to figure out, like, where is the need? How do we drive our resources to those needs, so that we can continue not just critical operations, but, you know, honestly, continue to provide access to our community so they can get the health care that they need. Right? And so we're not pushing people into not getting preventative care, not getting, you know, maintenance care, and then they end up in critical care situations. So how do we continue to do that?

Speaker 2: 08:33

An anesthesiology resource, management system, while focused at anesthesiology, I do wanna stress, is nonetheless based on some sound principles that allow it to be, you know, applicable across. And so what it does is we identified that our traditional methods of, of addressing staffing, our operating rooms, etcetera, did not factor a few things cohesively. For instance, one thing, our growth outside of the operating rooms and our need the need for anesthesia services outside the Operating Rooms has just grown exponentially. The community wants care where they are. And so you're gonna see the sprouting of ambulatory surgery centers across, you know, the geography, procedure suites within, you know, doctors' offices, etcetera.

Speaker 2: 09:21

And if we can provide the anesthesia serve services across this platform, it allows patients to get care, appropriately closer to where they are in a cost effective way, very honestly, so they don't have to take on the expense of, you know, that comes with coming into larger institutions. So, but that created its challenges with, you know, we were losing economies of scale. We were, you know, there was this hub and spoke, model developing, and we ended up moving to what we will call staffing to capacity. So when you try to staff to capacity, you need a lot of people who may or may not, have, you know, work at their local site to do, but then there are other sites that are short staffed, for example, just to give you that. So what what this system does, it allows us to take a look at the entire picture, at one go and which allows them for, you know, appropriate staffing across these platforms.

Speaker 2: 10:17

So we're not having a feast or famine situation, because the, the work itself is variable. You know? Who who gets sick and who comes in is not always the most predictable thing.

Speaker 1: 10:29

Okay. That is just remarkable what y'all have been able to put together there. So I did wanna follow-up. Duke is in a unique situation. So can this be replicated in the practices across the country, that aren't Duke, so to speak?

Speaker 1: 10:48

We have a lot of independent practices. We have other types of specialties, other types of health systems and, independent practices, other types of ownership models. So can it be replicated?

Speaker 2: 11:02

Absolutely. I mean, it's you know, Duke is an ivory tower. And you're absolutely right that many times the solutions for Duke are not necessarily something that a smaller, unit can can, you know, scale in. But this is actually able to this is actually a model that can both scale up and down. Now, also, you know, while the there is this perception that Duke is one large entity, and this, you know, this huge system, we're actually made up of a lot of different hospitals, a lot of different community sites, and ambulatory surgery centers, procedure suites within the community.

Speaker 2: 11:35

So the beauty of this system is that it's been tried and tested in all those settings, and it is modular. So you can actually create this in your own environment, And, you know, following some basic, principles and guide you know, guiding models, this can really be implemented in just about any site and provide value.

Speaker 1: 11:54

Okay. The follow-up to that then is, is it specific to anesthesiology, or can it be carried over to other specialties as well?

Speaker 2: 12:04

Oh, absolutely. I mean, right now, I would say that, you know, we ourselves are growing it within the same perioperative platform to where it's it's you know, we're starting to incorporate nursing, tech you know, our techs, our, floor, you know, connection to the, the, inpatient beds, etcetera. We're developing all of those systems. So truly, it is scalable and applicable, to more than just anesthesiology.

Speaker 1: 12:31

Okay. Let's get into the practical aspect of this then. What are the steps a decision maker at a practice would need to take to bring this over to, their practice?

Speaker 2: 12:45

I mean, the most important thing to recognize is where, you know, every environment is unique. And so the first phase is, of course, discovery. We need to understand what and the leaders should understand what are is their current state, what are their current, you know, gaps. And once that analysis has been done, honestly, applying these principles to help address those gaps, would be the next step. And so you can, leverage the experience that's already you know, the model and the experience that's already been done here at Duke and apply it to your own environment.

Speaker 2: 13:16

So, really, the first part will be discovery. They can do that on their own. They can do it, with us. You know? Everybody it's a health care is a community.

Speaker 2: 13:25

We're here to help each other. So absolutely.

Speaker 1: 13:28

Okay. The other important question is, what's the time frame we're looking at in implementing this system? Is there additional training? Do you need to hire new staff to be able to handle this?

Speaker 2: 13:42

No. Actually, you know, what what is really needed is really the, there is an upfront investment in the build. You know, you've gotta build the system in in there. Many institutions have their own IT infrastructure that can incorporate this, or they can outsource it to you know, in fact, we outsource a portion of our own predictive algorithm to to develop this. So, yeah, there will be an investment upfront, not so much in manpower.

Speaker 2: 14:07

In fact, you may not need, I do not think we we had did not have to hire anyone. We were actually able to use a lot of our folks in other sites and, you know, cover shortages for for that matter. So, as far as training, there it's it's a it's not a steep learning curve at all, because the graphic user interface, which is what the, folks on the ground will have to deal with, is very, very intuitive.

Speaker 1: 14:31

Okay. You mentioned something that caught my attention. You said even Duke, outsourced some of this. So what was the decision making there? What what where did you make come to that conclusion where, hey, we could do this in house, but we might have to hire additional staff.

Speaker 1: 14:49

So what led to outsourcing parts of that?

Speaker 2: 14:52

So as far as the development's concerned, you know, AI con you know, developing, AI models, etcetera, bringing in someone with expertise, in that space, obviously, you know, helps you develop it faster. And so for that aspect, for instance, rather than, reinvent the wheel, we, we chose to go with folks who had, a lot of experience in the space and and could help us accelerate the development.

Speaker 1: 15:17

Okay. Final couple of questions here then. So at MGMA, we've made it our mission, to transform health care. It's very strong in in our mission, vision, and values here at MGMA. And this is part of the Harwick Innovation Award here.

Speaker 1: 15:34

So how does this program aid in that mission?

Speaker 2: 15:39

You know, arms directly contributes to MGA's mission in terms of both, you know, transforming health care and innovation. You know, it it's enhancing operational efficiencies. It's reducing costs, of course, as you mentioned. But most importantly, it's also alleviating, provider burnout by creating a more transparent and equitable system, you know, that predictable and manageable work environment, which, you know, just leads to so much more, in terms of, you know, value, in terms of both recruitment and retention of our workforce. So I do think that it is truly, you know, truly making a difference there.

Speaker 2: 16:16

By managing our resources optimally, we also, you know, prevent health care costs from rising, which is obviously a huge problem. And the institutions can then invest, dollars where they're really needed, as opposed to, on, you know, potentially areas where we're not getting as much return.

Speaker 1: 16:37

Okay. Final thought then. Anything that it didn't ask about arms that, you might wanna share with us before we sign off?

Speaker 2: 16:46

I mean, the only thing I would say is that, you know, while arms can be viewed as a data driven, you know, solution, to, you know, resource management, It's really more than that. I mean, it's our approach. Yeah. There's a cultural change, and then, you know, to where we're being more transparent, accountable, you know, in in this era and, focusing on provider well-being and, you know, and burnout just as much as we are on operational efficiencies and, you know, cost, effectiveness. Right?

Speaker 2: 17:18

And so I do think that there's more to this than a singular focus on on, just efficiencies and cost.

Speaker 1: 17:27

Okay. Well, doctor Padma Gelur, 2023 MGMA Harwick Innovation Award winner. Thanks for joining us today on the show.

Speaker 2: 17:37

Well, thank you very much for having me.

Speaker 1: 17:39

Alright. Well, that is gonna do it for this episode of MGMA's Insights podcast. Thanks again to doctor Galore for joining us, and thanks for being a listener of the MGMA Podcast Network. If you like the work we're doing, please consider becoming an MGMA member. Learn more at mgma.com/membership.