Baptist Heart Institute’s New CAO, continued

“Every Wednesday I try to put scrubs on and try to do something,” said Wills, a veteran healthcare executive who rose from the nursing ranks. Wills remains as comfortable in hygienic medical uniforms as a suit and tie.

His Wednesday routine is not about keeping up his nursing skills but keeping in touch with the front line of patient care at the comprehensive cardiovascular medical provider.

“I’ll go to the cardiac catheterization laboratory, I’ll go to the electrophysiology lab, I’ll go to the operating room, I’ll go around to the intensive care unit and check on the nurses,” Wills said. “I just try to get out of the office and go where the doctors are.”

Pinnacle of cardiovascular services

Wills is an Army veteran who has 29 years of experience in health care, including as a critical-care nurse. He arrived last summer at Baptist Heart Institute.

“I’d call it the pinnacle of cardiovascular services,” he said of his organization.

The institute provides everything from heart transplants — two transplant surgeons are on staff — and implanted ventricular-assist devices, to treatment for myocardial infarction, aka heart attacks.

“So, we provide from the beginning to the ultimate of cardiovascular services,” he said.

In the last fiscal year that ended Oct. 1, doctors at the heart institute performed 31 ventricular-assist device implants and 20 heart transplants.

This fiscal year, the institute has a goal to perform 35 ventricular assist device implants. Eight were completed by mid-February. Meanwhile, the institute had performed five heart transplants since Oct. 1 with a goal of doing 25 this fiscal year.

To reach those goals, Wills said, “you have to have a robust system that brings referrals. So, it’s a really delicate dance of education and outreach and awareness, and that’s what we’re really trying to focus on this year.”

A culture, not walls

Wills estimates the number of fulltime equivalent employees involved with the institute to be nearly 1,000, but counting is complex. Physical space, or walls, don’t define the institute. “Our institute spans everything from partnership with our Emergency Department staff and physicians all the way to our transplant ICU nurses and patient-care assistants,” he said.

The institute also partners with Stern Cardiovascular, bringing another 90-plus providers.

The heart institute, he said, “is more a culture of how we take care of our patients. We have all our employed providers that are hospitalists who help take care of our patients at the bedside in addition to all our Stern Cardiovascular partners. We have our Baptist Medical Group partners, and we have Memphis Lung, which is our pulmonary intensivist group that we work closely with.”

Nursing looked more exciting Service in the military as well as in health care runs deep in Wills’ family. His father is a retired military officer, and Wills followed in his footsteps by joining the Army during his college years. He retired from the Army after 25 years in the infantry and Army Nurse Corps. He earned a nursing degree from Methodist Hospital School of Nursing in Lubbock, Texas, a bachelor of science degree in nursing from the University of Texas at Austin and a master’s in public and private management from BirminghamSouthern College.

Wills initially intended to be a physical therapist, but switched to nursing after meeting his future wife, Michelle, a nursing school student. To him, her career path “looked more exciting than mine,” he recalls.

He eventually transitioned into management for a simple reason: “By supporting the staff that was by the bedsides I can make decisions that affect hundreds of patients a day rather than six or seven,” he said.

The couple has two adult children, Matthew, who is serving overseas in the Army, and Grace, who recently graduated from nursing school.

Wills came to Baptist Heart Institute after seven years in Jackson, Miss., first as executive director of University Heart Services at the University of Mississippi Medical Center and more recently as chief operating officer at Merit Health. Previously, he held leadership roles at major healthcare organizations such as HCA Healthcare and Tenet Healthcare.

Macromanager

His hands-on regimen on Wednesdays does not mean that Wills micromanages.

“I actually describe my philosophy as macromanagement, which is the whole other spectrum,” he said. “I try to lead by empowering the people who report to me to do their very best, by allowing them to do their job and not have me to tell them how to do their job.”

Even when employees might make “marginal decisions” when there’s no time for them to call for help, “you can’t chop their knees out from under them,” Wills said. He has never forgotten what a West Texas cardiologist told him years ago: “Good judgment comes from bad experience from bad judgment.” from page 1

His leadership style places a premium on recruiting and retaining high-quality nurses, doctors and other team members.

Wills cited an important resource for retaining staff: The culture at Baptist Memorial Hospital. “Baptist is very different,” he said. “I’ve worked for three of the top four health care companies in the country during my career. One thing I can unequivocally tell you is that Baptist is different. They treat their employees different.”

For example, Wills said, “We start our major senior meetings with prayer. I have been at just one other facility that did that. That’s unique in today’s world.”

And, he said, the hospital is “just very transparent.” For example, Wills said, Baptist Memorial Health Care president and chief executive Jason Little shares information “at a different level than other corporate CEOs I’ve seen. It’s just a real cool environment.”

The heart institute claims the distinction of offering the Mid-South’s only certified programs for adult heart transplants and for extracorporeal membrane oxygenation, which uses two large intravenous lines to remove the patient’s blood, oxygenate it, and return the blood to the patient.

Growth and new technology

The institute is carrying out a number of technology and strategic initiatives, including the relatively new Barostim implant treatment. The therapy stimulates the body’s natural sensors to tell the brain how to regulate the heart, relieving symptoms of heart failure. “We’ve done some treatments with patients here and have had very good outcomes,” Wills said. “It’s not done everywhere. We’re working on some stories to get that out to the public.”

The heart institute also will hire a new outreach coordinator as it continues expanding its Mid-South footprint. A new outreach clinic was to open in March in Tupelo, Miss., in partnership with Tupelo-based Cardiology Associates of North Mississippi.

“We were asked to come and provide an additional, higher level of care,” Wills said. “They referred us a couple of patients who we did very well with. We treated them and referred them back to their primary cardiologist.

“And that’s what we want to be, is the specialist. The last thing we want to do is steal patients,” he said.

God’s work

Among the specialists at the heart institute is surgeon Dr. H. Edward Garrett Jr., whom Wills got to watch in action during one of his Wednesday scrubs days.

“Sometimes I have a hard time just talking and walking,” which is not the case for the surgeons like Garrett, Wills said. “Until you stand next to someone who is actually delivering the care, I don’t think you really appreciate” their skills, he said.

“Dr. Garrett, he was raised in Texas, so we talk about music and Texas things. So, he’ll be standing there sewing a bypass vessel onto someone’s heart and we’ll be talking about music… And he doesn’t miss a beat.

“Dr. Garrett, Dr. Brad Wolf, Dr. Brian Bruckner, all these guys are just so good.

“It’s really humbling to see those guys work and to know they are doing God’s work and taking care of people.”

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The No Surprises Act, continued from page 5

Rather, they pause the acceptance of offers upon receipt of new disputes. It’s been very difficult to communicate with the IDR entities, as most don’t respond to phone calls or emails.”

Physicians will not only need to become savvy at submitting bids to receive more favorable reimbursements, but also because the loser in the arbitration may be required to cover fees for both parties, said D’Orazio.

To add to the uncertainty, the IDR rules keep changing.

“Early (in 2022), several state medical associations and air ambulance companies filed suits about the interim final rule that bases appropriate reimbursements on insurers’ qualifying payment amounts (QPA),” he said. “In April, CMS retracted its stance on just how much weight QPAs should carry in arbitrators’ decision-making.”

More Legal Woes

Last February, Eastern District of Texas Judge Jeremy Kernodle agreed with the Texas Medical Association that the Department of Health and Human Services (HHS) interim final rule governing the IDR process conflicted with the NSA statute when it created a rebuttable presumption that the QPA was the correct out-ofnetwork rate for purposes of the IDR process, explained Cooper.

In September, the Tennessee Advisory Commission on Intergovernmental Relations revealed that it was studying “the overall effect on health insurance prices when reference-based pricing is used.” Tennessee may be the latest state to adopt reference-based pricing to control healthcare costs, noted Cooper. (The final report had not been presented by press time.)

“Several other states have adopted reference-based pricing and are successfully using it,” said Cooper. “The most well-known is Montana, which became the first state to use reference-based pricing for all of its employees’ health benefits. Other states that have adopted referencebased pricing include California, Oregon, Colorado, and Washington. Each of these states was armed with the experience of Montana.”

Reference-based pricing is a way to avoid the uncertainty the NSA is creating, said Cooper.

“We anticipate seeing a broader adoption of reference-based pricing plan design both for public entities and private corporations,” she said. “It’s a true cost control mechanism that brings uncertainty to the plans and the providers.”

Woes Before NSA Became Law

In November 2021, congressional doctors, their medical associations and members of Congress led the charge that the rule released by the Biden Administration two months earlier for implementing the law, favored insurers and didn’t follow the spirit of the legislation, wrote Michael McAuliff for Kaiser Health News.

“The Administration’s recently proposed regulation to begin implementing the law doesn’t uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close, thus limiting patients’ access to care,” wrote Rep. Larry Bucshon (R-Indiana). Roughly half of the 152 lawmakers who signed the letter were Democrats.

“The doctors in Congress are furious about this,” a staff member told McAuliff.

Cooper said it was clear that providers would take issue with the language in the Rule creating a rebuttable presumption that the payor’s median contracted rate is the proper reimbursement rate for claims governed by the NSA, ignoring the other factors listed in the NSA.

“The median contracted rate is solely within control of the payors and it stripped the providers of any say,” said Cooper. “In addition, the providers likely understood that the IDR entities would naturally select the offer closest to the median contracted rate because they’re on a tight timeline and couldn’t reasonably process the number of claims they would be receiving if they had to evaluate each factor listed in the NSA and provide a written opinion as to why they deviated from the median contracted rate.”