Ontario, Calif.-based Prime Healthcare's 2024 has been highlighted by plans to acquire nine Illinois hospitals and post-acute facilities from St. Louis-based Ascension and launching an integrated EMR system in Southern California.
Looking ahead to 2025, Prime President and Chief Medical Officer Sunny Bhatia, MD, shared his strategy for the future.
Dr. Bhatia, who is also CEO of Prime Healthcare Region I, overseeing 15 hospitals and affiliated entities in California and Nevada, discussed financial challenges, capital investment priorities, and the organization's evolving mergers and acquisitions strategy.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What do you expect to be the biggest financial challenge facing health systems in the coming year, and how are you preparing to address it?
Dr. Sunny Bhatia: One of the challenges is on reimbursement, especially from managed care and, more notably, Medicare Advantage plans. And, while we're appreciative of CMS and the two-midnight final rule, we haven't seen complete adoption yet from Medicare Advantage, and that's leading to some delays in payment or inadequate payment. The timing of these payments is prolonged, and the administrative burden required by us to provide appropriate appeals to secure adequate payment is significant. I think that's one area of ongoing concern. The full realization of the two-midnight rule is yet to be in place.
Now, as a response, we're working collaboratively with these health plans, creating more robust processes, both internal and to further collaborate with these plans. But we're absolutely trying to focus our efforts on revenue cycle management and collaborate where we can. There still seem to be some inherent delays in making the progress that we're anticipating.
Along with that, the costs of care within hospitals continue to increase. Staffing costs have gone up. Post-pandemic, length-of-stay management has improved but remains a challenge. And one dynamic that we're seeing, as it relates to managed care, is the lack of timely authorization to post-acute facilities, which leads to avoidable days in the hospital.
These dynamics are top of mind in terms of reimbursement challenges with Medicare Advantage, some utilization of bed days related to managed care. And along with that, the labor challenges that we all experienced in acute care throughout the pandemic are starting to improve. We put in extensive efforts on the labor management piece, focusing on recruitment, retention, more efficient onboarding processes and productivity review. Through a comprehensive labor task force, we've seen dramatic improvement. I think there's still some work to do in some markets, but that's also top of mind as a priority area.
Q: Given the current economic climate, how are you prioritizing capital investments for the upcoming year? In what specific areas do you see the highest ROI?
SB: Our emphasis as a physician-led, patient-centric organization is providing high-quality, compassionate care in an efficient manner — a true value-based initiative. We find opportunities to improve these clinical processes and workflows through implementing best-in-class electronic medical records. So we are continuing to transition our EMRs to Epic throughout the system.
We're going through a go-live at the moment here in Southern California. Implementing an integrated EMR throughout the system provides obvious opportunities to improve efficiency, value and strong clinical outcomes. So we then use that EMR to leverage opportunities to introduce, in a responsible way, additional technology or workflows that could decrease the burden on front-line staff, improve clinical outcomes through implementation of guideline-based protocols, and ultimately improve clinical outcomes at low costs.
With cost in mind, we're seeing increased volumes in our emergency departments, in our surgical service lines and in the acute care space, so we focus some of our efforts on the capital investment side to further improve our capacity to accommodate this growing volume and improve throughput from the moment the patient enters our facility to safe discharge. So we're focused on technology, specifically EMR, but then also on capacity management to help with throughput, so we can continue to serve our community population.
Q: How is your M&A strategy evolving to support your organization's long-term goals, and how do you determine which acquisitions will add the most value to your health system both operationally and culturally?
SB: It's an interesting story for us. We now have 44 hospitals in 14 states, serving over 600 communities. We just announced our largest acquisition to date, within hospitals in the Chicagoland area. And the focus of our M&A strategy is, how do we again serve these vulnerable communities? We really strongly believe in the community hospital model to provide high-quality, compassionate care to those communities in need.
Our presence in the western region was significant. Now, as we look at acquisition opportunities, Chicago was a perfect example of this; we were able to enter a new market with immediate scale. From an M&A perspective, those types of opportunities excite us to further diversify our geographic footprint. We would also look to expand in current markets as well, with that community hospital model in mind, and certainly want to complement our existing portfolio in those markets. But we would also have an interest in expanding our footprint in new markets, at a scale similar to what we did in this acquisition of hospitals in Chicago.
Along with the acute-care space, I think what we're finding is an interesting opportunity. We certainly emphasize the role of acute-care community hospitals, but over recent years, we've expanded our portfolio in many markets to include ambulatory surgery centers, medical groups, urgent care centers, outpatient infusion centers and a more robust telehealth program. This expanded, integrated model will serve the needs of the growing elderly population and certainly improve access to high-quality healthcare within a more robust network.
Q: How do you expect hospital M&A to evolve in the coming years as healthcare moves toward a "multi-region model" with more systems pursuing out-of-market hospital acquisitions?
SB: You're seeing some health systems and hospitals thriving and improving over the last couple of years post-COVID, and you're seeing many struggle. I do think those that are struggling face challenges that may be difficult to overcome with the reimbursement issues or rising costs of care. Those that have scale and the experience to weather those storms have an opportunity, then, for more successful systems like ours — and we consider ourselves one of them — to grow appropriately and responsibly, looking at other market opportunities that a few years ago may not have existed. We are seeing numerous opportunities throughout the country to support more distressed hospitals.
We ourselves are being very thoughtful and diligent about the approach to ensure that it's the right fit for our portfolio. Other health systems are certainly exiting markets where they don't have scale or certain competitive advantages, and that may present opportunities for other systems to address those challenges as potential opportunities for themselves.
Q: What strategic moves is your organization making to expand outpatient and ambulatory services, and how do you plan to balance this with maintaining inpatient care?
SB: There are certainly some unmet needs in our vulnerable communities. But along with it, we see an opportunity to be more integrated, providing high-quality care across the entire continuum. So, in many markets, we have invested in ambulatory surgery centers, ambulatory medical groups. We think telehealth is an interesting opportunity, especially for providing service to our other community partners that otherwise wouldn't have access to care.
Acute care is still our focus, but we have now seen opportunities in pre-acute and post-acute involvement in clinically integrated network accountable care organizations as well, and this helps provide a more robust healthcare delivery model to our communities. But still, the emphasis will be on the acute-care community hospitals.
Q: What specific strategies will your health system deploy in the coming year to improve employee retention, particularly in critical front-line roles?
SB: Our front-line caregivers have been through quite a bit — they're true heroes in every sense of the word. We're proud of the work we've done so far, and there's even more opportunity. Our emphasis has been on high-quality, compassionate care. We want to attract and retain the highest level of talent, especially in those critical front-line roles.
We introduced what we think is a novel opportunity for ongoing learning and education. It's called PrimE-Academy, a virtual, on-demand classroom, which is a great, unique opportunity for our staff at all levels, for on-demand learning and growth.
I talked about our EMR strategy and implementing best-in-class technology. We think there are also unique opportunities to integrate some other platforms, in a responsible, appropriate manner, which will allow staff to really focus on patients at the bedside, rather than being in a nurse station charting.
That opportunity allows them to really function at their highest level, being at the bedside, spending time with patients and families. And so, using this type of technology, I think, will ultimately improve employee experience — the front-line experience — but then also, certainly, patient experience and clinical outcomes. And the overarching theme for us is fostering an environment and culture of learning, inclusivity, and growth and advancement.
Q: How are strategic partnerships with community organizations and other healthcare institutions shaping your efforts to address key challenges within your health system and drive long-term success?
SB: We're strong believers in being community partners in every sense of the word, and for us, it can extend to academic programs. Our foundation started one of the newest medical schools in the country: California University of Science and Medicine. We've implemented numerous residency programs and emphasized the training of physicians, both in medical school and postgraduate training, residency programs and fellowship programs. That also extends to nursing schools and partnering with nursing schools throughout the country to promote education, integrating them into our hospitals as well for further training and hopeful retention. So, front-line staff development has been a key area of focus, and that could extend to pharmacy or radiology as well.
There is an opportunity that we've really cherished: to work with the federally qualified health centers. The challenging population that they're treating really aligns with our mission of serving and taking care of those vulnerable populations, emphasizing opportunities to grow maternal health programs and behavioral health programs through these collaborative efforts.
We've emphasized opportunities for vaccination programs, screening programs, and cancer screening programs throughout the communities, assessing community needs that we can further support. That makes sense in the pre-acute and post-acute space — various clinics and, on the post-acute side, skilled nursing facilities, assisted living, and memory care — where you have a fairly vulnerable population. And how best do we address those needs that historically have been unmet? We believe in and value our role in managing that patient population.