MUSC Health Expands to More South Carolinians with Patrick Cawley, MD

An important part of MUSC Health’s mission is to improve the lives of all South Carolinians. More people in South Carolina now have access to MUSC Health than ever before thanks to recent expansions and partnerships that touch every county in the state.

In this episode, Patrick Cawley, M.D., CEO of MUSC Health and Vice President for Health Affairs of the Medical University of South Carolina, shares exciting updates and goals for 2022 and beyond.

“In order for us to deliver on (our core mission), we have to go out into the community... You have to go meet people where they are. You just can't simply wait for them to come to you. So we're trying to get upstream. We're trying to deliver care better. We're trying to teach better. We're trying to find people to do research in their own home community. That requires us to get out of Charleston and spread our wings.”

- Patrick Cawley, M.D., CEO of MUSC Health and Vice President for Health Affairs of the Medical University of South Carolina

Topics covered in this show

• During the past decade, MUSC Health has expanded and created partnerships in smaller communities in South Carolina. Cawley says this move is critical to fulfilling the mission of the institution: providing learning, discovery and healing. Through partnerships and growth, MUSC Health is better able fulfill this mission, meeting people where they are, in their own communities.
• Innovation is at the core of MUSC Health and one area of strength in innovation is telehealth. Before the COVID-19 pandemic, MUSC Health was already a leader in telehealth, but Cawley says once the pandemic hit, in less than one month, it transitioned from a normal level of telehealth to well over 80 percent of all of visits being telehealth.
• Some specialties such as psychiatry and mental health may remain primarily telehealth-based, but Cawley expects more and more people to come back for physical exams and in-person interactions.
• In recent years MUSC Health has had the opportunity to acquire some community-based hospitals, doing so has been in line with the mission of the institution. Cawley says the plan isn’t to ‘just to get bigger’ but to build partnerships and bring MUSC resources to more South Carolinians.
• 2021 was a challenging year because of the ongoing COVID-19 pandemic. Cawley expects to be dealing with pandemic related ups and downs for the next two years. However, he says exciting programs also launch in 2021, such as In Our DNA SC.

Read the show transcript below

Erin Spain [00:00:04] Welcome to Advance with MUSC Health, I'm your host, Erin Spain. This shows the mission is to help you find ways to preserve and optimize your health and get the care you need to live well. An important part of MUSC Health's mission is to improve the lives of all South Carolinians. More people in South Carolina now have access to MUSC Health than ever before, thanks to recent expansions and partnerships that touch every county in the state. Here with details Dr. Patrick Cawley, CEO of MUSC Health and Vice President for Health Affairs of the Medical University of South Carolina. Welcome.

Patrick J. Cawley [00:00:45] Thank you, Erin. I'm very happy to be here today. I would start off saying that MUSC has been in the health business for a long time. I mean, we're almost 225 years old. But that has changed over time. And many people that are currently living maybe remember a different kind of emergency, a MUSC that predominantly was on the peninsula of Charleston. It was a place you went to if you needed a certain kind of specialized care you traveled to there in order to get that care. And there might have been a little bit of outreach in which an occasional MUSC physician came to your community or you knew MUSC because you had somebody in your family go there to school. Or maybe even you knew MUSC because you took part in a research enterprise that has been going on for a long time. Those are core things what we do. We still do all of those things. But what has changed in the last 10 years? In order for us to deliver on all of those things, we have to go out into the community to deliver on those things. You have to go meet people where they are at. You just can't simply wait for them to come to you. So we're trying to get upstream. We're trying to deliver care better. We're trying to teach better. We're trying to find people to do research in their own home community. So that requires us to get out of Charleston and spread our wings. And that's what people are seeing. And they're asking, Why is that happening? Well, it's happening because we're just simply trying to fulfill the mission that we've been doing for over 200 years. And the way we live today and modern, modern health care requires us to do things differently.

Erin Spain [00:02:32] Well, some of those things have happened in the past decade at MUSC Health in terms of expanding and offering more innovation and services, talk a little bit about the past decade of growth.

Patrick J. Cawley [00:02:42] Well, first of all, innovation is in our core. We see our part of our mission to be innovative and in fact, many other health care entities across MUSC, when new things come along, one of the first questions we will get is, are you guys doing this yet? So we plan that we want to make sure that we're the first to do everything that's part of who we are. In the last 10 years, probably the biggest change at MUSC is one that that maybe not everybody realizes, but that has to do with our telehealth program. Approximately 10 years ago, the South Carolina state legislator started giving MUSC funds in order to deliver and develop telehealth, and we have consistently done that and we have well over 80 programs at this point. Some programs people are probably familiar with, maybe their family member had a stroke. We have a stroke program that goes across the entire state. We have school-based telehealth. We have any number of other telehealth programs as well. And that's grown into a program that is now one of two national telehealth centers for excellence in the United States. The other thing that's changed a lot in the last 10 years is that we now have hospitals outside of Charleston, so we have hospitals in Florence and Marion and Lancaster, Chester. We're now up in the Columbia area and Kershaw in Fairfield County. And then we have several new hospitals we're building in Berkeley County, in the northern part of Lancaster County in Williamsburg County, and we're developing other relationships across the state as well. So all of that stuff is new in the past 10 years.

Erin Spain [00:04:23] I want to go back to that part about telehealth, and MUSC is a national leader, as you said, in telehealth, and this was something that was so critical in the past year and half of the pandemic as well. So tell me about that and about your commitment to continuing cutting edge telehealth.

Patrick J. Cawley [00:04:40] We've been very, very familiar with telehealth. In fact, MUSC is kind of known in the telehealth community as how to start and develop telehealth. So when the pandemic came along and all of a sudden people weren't coming to us, it really did not take much of a pivot for us to get all of our health care specialties up on telehealth. We had a lot of them already up on it. But when the pandemic came, we had to get everybody up on it, so we pivoted just a little bit. We already have the technology. We knew what had to be done and really less than a month went from our normal level of telehealth to well over 80 percent of all of our visits being telehealth.

Erin Spain [00:05:21] And has that continued now that people are coming back into the healthcare system in person? Are some people still choosing to do telehealth? And is this a new way that we're going to see forward?

Patrick J. Cawley [00:05:33] It's come back because, you know, a lot of people still want to see their doctor see their provider, but it's not come back to the level we saw prior to the pandemic, and I don't think it's going to come back to the previous number. In fact, I'll give you an example. Almost all of our psychiatry and mental health is being done on telehealth at this point. People prefer it. They like it in terms of privacy. They've tried it even more during the pandemic, and I don't think that's going to change at all. Some other specialties that maybe weren't in the telehealth, they're starting to do more. But there's some things that just, you know, you really do need your doctor to see you in person to do a physical exam so it won't get back to all the way, but it's going to continue to change and morph.

Erin Spain [00:06:20] So you also touched on the fact that now MUSC Health is all over the state and these different partnerships and affiliates and new hospitals. And I want you to tell me a little bit about this growth and not just growing in size, but expanding your reach as far as being a teaching and training hospital.

Patrick J. Cawley [00:06:39] Well, first I'll say right up front, some hospitals, some health systems get big just to get bigger, and we did not do that. All that was not in our mindset. We right from the beginning, right from our board of trustees all the way down through the organization. It was always about bringing more of what we do out to the rest of South Carolina and meeting people where they're at. We had a mantra, we called it partnership and presence, and it didn't require us, if you're going to be out somewhere, it didn't require us to own that. So it was all really about partnership. However, there were some opportunities that came forward. Community Health Systems, which is a for-profit health system in the United States in 2018, approached us and said, 'You know, we're looking to divest ourselves for hospitals in South Carolina. Would you be interested in acquiring them?' And so at the time, if they weren't going to be purchased by somebody, there was a high likelihood they might go under. And we started looking at those communities and said, 'Boy, this is this is something we have to do. This is in our mission.' So we went ahead and did that. When the time came in this past year, we had a similar episode occur with LifePoint Health System. They had three hospitals in South Carolina, up in the Midlands area. They said the same thing. Those hospitals were struggling in some ways and in ways they couldn't fix, but we know we could fix. And that was an opportunity that came about. So those are opportunities in which we acquired hospitals, but that is not our number one go to strategy. Our number one go to strategy is partnering up with local providers, hospitals, doctors, whoever is providing health care in that area and helping them with presence and presence could be MUSC providers come to that community. It could be providing telehealth. It could be doing more education. It could be doing more research. So we engage in a conversation and we find that every community is a little bit different. Every community needs something maybe different from MUSC, and we try to meet those folks where they're at.

Erin Spain [00:08:50] Let's talk about the rural areas of the state. Has that been a challenge getting into those areas? And what's the plan for the future to reach our rural South Carolinians?

Patrick J. Cawley [00:08:59] Well, rural health care is really a unique challenge. It's uniquely challenged because of the number of people and the distance that those places are from more care or more technology. So we think a great leveler is telehealth. That's the first thing. The second thing is, we think, working with that local community to find out what they need the most. And sometimes it's not always a hospital. Sometimes it's they need more ambulatory care, they need more presence to specialists. So you've really got to also meet them where where they are at. At the same time, we have purchased a few rural hospitals that has put MUSC very into the rural health rural hospital business, so we know what it takes to deliver on that. We know the special challenges there as well. Not everything we do in rural areas is for hospitals we own. We have a very unique relationship with Hampton Regional Hospital down in Hampton, South Carolina. And that's a relationship in which that's a community hospital, they remain a community hospital, but what we're doing with them is we're bringing telehealth support to them at a level that allows them to provide more services at that hospital. And people don't leave Hampton County because they're able to get those services locally now.

Erin Spain [00:10:23] I want you to explain the concept of an academic medical center, and MUSC is the only comprehensive academic medical center in South Carolina. Tell me about that important designation and what you can bring as an academic medical center to people all over the state.

Patrick J. Cawley [00:10:40] Well, an academic medical center is really an institution that delivers on three missions, and I mentioned this a little bit earlier, but it delivers on teaching. So, at MUSC, we teach medical students, pharmacy students, nursing students and a whole number of other students. We have 3000 students at MUSC. Number two, we do research, so we do cutting edge research in order to advance science. Some of that is what we call very basic science very, very early. And some of its things that are just how to do things better in a clinic or maybe how to deliver care a little bit differently. So, there's all kinds of research activities as well. And the third area is to deliver clinical care. So, we have physicians and providers who see patients and help take care of them longitudinally. So, those three things are really the core of what MUSC does. We don't do any of those things without talking about the other things. So yes, I mainly do the clinical side, but I work very, very closely with my colleagues who do the teaching and who do the research at MUSC to develop those things at any place. We're doing clinical care. So, I mean, you almost have to live it to understand it. But those three things are who we are and we live and breathe each and every one of them every day.

Erin Spain [00:12:05] And from a patient perspective, there may be more opportunities for a clinical trial, perhaps or something else that you just can't get at another health care system. Is that right

Patrick J. Cawley [00:12:16] Sure. I think it is a place for probably the best care because particularly if you have something that maybe is not a treatment today that maybe, maybe we need to study your issue, that you have access to that immediately. The other thing is, as part of being a teaching center, these are the doctors who teach the students. So, typically, you know, your teachers are some of your best doctors, so you're being exposed to doctors who teach doctors who live these things every day. So, I personally think it's it is the best care. Can you get that best care in community hospitals? You can get pretty close to it, but it's not the same. I've worked in community hospitals, I've worked in academic hospitals and I'd have to give the edge to the academic facilities.

Erin Spain [00:13:07] I want to go back to innovation. We talked about telemedicine. What other innovations are happening right now at MUSC Health to improve the patient experience and patient health?

Patrick J. Cawley [00:13:18] Wow, that's a tough question because there are every single day at MUSC a 100 innovations going at it. Once again, I talked earlier about the core of who we are innovating and doing things first and trying things and developing things is also who we are. You know, one example I'll show you that's just come up. In the last few months, we had a conversation around how do we reach patients better? Not every patient wants to reach us through a patient portal. Everybody's familiar with what a patient portal is.

Erin Spain [00:13:49] My Chart?

Patrick J. Cawley [00:13:50] Yeah, it's it's My Chart at MUSC. But there are other kinds of patient portals. But it turns out that only about half the patients typically use a patient portal. So we asked the question 'Are there other ways to reach a patient?' And we developed a relationship with the company that we're going to be delivering some new ways of connecting with patients in the next few months that we hope begins to, you know, attack that other 50 percent problem that are not being reached by the portal. So that's just one example that came out of a discussion with a few board members at MUSC, and we started to attack it and said, 'Yeah, there is a better way to do that.' So, we developed it.

Erin Spain [00:14:30] How do we measure success at MUSC Health?

Patrick J. Cawley [00:14:33] Well, I measure success in a lot of different ways. One way is you are, you're developing your plan and then you're committing and your plan is implemented. Probably the better way I like to measure it, which is a little closer to the patient, is we measure just about everything we do at MUSC. We have what we call six pillars that we measure. One of them is service, that means about what our patients think about us? Number two is people, meaning how to our people feel about us at MUSC, how are things going? The third way is through quality and safety, which is just what you heard. We also measure by finance. If you're not at least breaking even you can't do all the wonderful things that that you want to do. The fifth way is growth, so we're committed to growing at all times and further developing ourselves. And then the sixth way we measure innovation. So, we actually measure new ideas that we develop your at your and ideas that we implement. So, those six pillars are the way I'd like to measure it the best because it's very, very close to our patients.

Erin Spain [00:15:37] So how does MUSC fund its growth and all these partnerships and collaborations that you've been talking about?

Patrick J. Cawley [00:15:43] Well, we fund our growth through our revenues that we get from patient care, the education side of MUSC is a business that just breaks even. The research side of MUSC loses money, so we have to try to make that up on a regular basis. That's pretty common throughout the United States, so that leaves only the clinical side. And so we fund all our growth through our clinical activities. And if we have any margin left over at the end of the year, we plow it right back into all these different efforts. We do get a small fund from the state of South Carolina for certain projects, things like telehealth. They want us to develop telehealth. And so that's an example of that. We also get some dollars to maybe teach students, but they're very, very specific. But for the most part, we fund all of our growth through our revenues from patient care activities.

Erin Spain [00:16:39] It's a new year, and this is always a good time to reflect and share plans for the future. Tell me about 2021, some of the highs and lows and share with me your vision for MUSC Health and its presence across the state this year and years to come.

Patrick J. Cawley [00:16:55] Well, 2021 has been an interesting year. I have to say one of the more interesting ones in my career, given that we had a pandemic going on, we had several major growth activities happening at MUSC and some new things at the same time. So, 21, I have to say might be right up there with the craziest then and a lot of different ways. But let me mention a couple of things. So first of all, the pandemic, so MUSC continues to be very, very focused on the pandemic. We don't see that quite going away. We think it'll continue to be a problem for the next two years. It may not be a severe problem, but I think it'll continue to linger and we're going to continue to go through these ups and downs for the next two years. We got to get to a different place there. One of the things that we're heavily, heavily focused on in 21, which we rolled out just a couple of months ago, kind of a quiet rollout is our new work in precision health, where some people know as genetics and genomics. We've teamed up with a company called Helix in which we're going to be rolling out an effort to try to get 100000 South Carolinians to get their genes sequenced for free in the next four years. So we're heavily, heavily focused on that. And then we're heavily focused on telehealth. We're trying to further develop telehealth. We think that is the way the future and you're going to see more activity coming out of MUSC at that realm as well.

Erin Spain [00:18:27] Your background is interesting. You're a physician and you also have an MBA. Tell me about your career path to being CEO and that sort of yin and yang of having a business degree and being a physician and a hospitalist. Tell me how those two sides of your academic career come together and the work that you do here at MUSC Health?

Patrick J. Cawley [00:18:49] That interest in both the science side and the business side of health care goes back a long, long way. My father was a physician and I was always interested in the business side of his practice. And but at the same time, I really liked the science when I went to undergrad. I actually double majored in a business degree and a biology degree, and so I finished undergrad at that time with a plan to get my MBA. At the same time, I was getting my medical degree. That didn't work out because about the last thing you want to do after the first two years of medical school is go back to the classroom more. So I decided not to get my business degree at that time. I went back later and got it, but I finished medical school. I did residency. I always had a big interest in the business side. They also had a big interest in quality and performance improvement. And you know, you just start to work small projects, small projects become big projects before you know it, you have even bigger positions. I came to MUSC as the associate chief medical officer. Then I became the chief medical officer and then I took on this big expanded chief medical officer role. And then I became the CEO in 2013. So it was a natural progression, it wasn't anything sudden, but you find yourself in these positions over time, and I've continued to enjoy both sides and I'm happy to talk science one minute and talk the business the other minute.

Erin Spain [00:20:16] The last question today, this is the question we ask everybody on the show. What do you do to optimize your health and live well?

Patrick J. Cawley [00:20:23] Well, it's always a struggle because I love to work and I put in long, long hours, but I try to eat the right things. I do workout regularly. I do a program called the F45, and I also do some spinning classes on a fairly regular basis and think I'm really working on these days just to make sure I sleep better. So, that's been a decade long problem. I'm always awake and I do need to learn to sleep better. So, all of us have an opportunity for improvement, and that's that's the one I'm working on the most.

Erin Spain [00:20:55] Well, here's to more sleep in 2022. For more information on this podcast, check out advance.muschealth.com.