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Dr. Jay Woody of Legacy ER & Urgent Care: 5 Things We Must Do To Improve the US Healthcare System

An Interview With Luke Kervin

Patient Treatment — We started Intuitive Health to address the way we treated patients in the health care space. That initial goal quickly expanded into other systematic changes that needed to happen. Patients come to a doctor to get the care they need without judgment and fear. We’re here to help them get better, and we want the entire process and experience of walking into one of our partner systems to be pleasant, with as little stress as possible. We want patients to get better in an environment that is supportive of their recovery.

As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Dr. Jay Woody.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the health care industry. The pandemic showed the resilience of the U.S. health care system, but it also pointed out some crucial areas in need of improvement. In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The U.S. Health care System”, we are interviewing doctors, hospital administrators, nursing home administrators and health care leaders who share lessons learned from the pandemic and thoughts about how we can improve the health care system in the United States.

As a part of this series, I had the pleasure to interview Dr. Jay Woody, MD, FACEP. Dr. Woody is Chief Medical Officer of Intuitive Health and founder of Legacy ER & Urgent Care. A well-known and widely-respected authority in the field of emergency medicine and freestanding ERs and Urgent Cares.

Jay Woody, MD, FACEP, is the chief medical officer of Intuitive Health and a Legacy ER & Urgent Care co-founder. He is a well-known and widely published authority in the field of emergency medicine. Dr. Woody is the former Regional Medical Director of a freestanding emergency medical facility and a sought-after speaker and peer reviewer for the Texas Medical Foundation. Dr. Woody has contributed to such vital references sources as the Prehospital and Disaster Medicine Journal, the Journal of the Society of Academic Emergency Medicine, and the Texas Emergency Bulletin and as well as two textbooks — Medical Response to Terrorism: Preparedness and Clinical Practice, and AAEM Emergency Medical and Family Health. Also, he has been a featured presenter at the Southeast Society of Academic Emergency Medicine, the Nordic Congress on Disaster and Emergency Medicine, and the Clinical Excellence in Emergency Medicine Conference. Dr. Woody teaches frequently and has helped advance emergency medical practices alongside his peers at U.T. Southwestern Medical Center in the Department of Emergency Medicine.

Thank you so much for joining us in this interview series. Before we dive into our interview, our readers would like to get to know you. Can you tell us a bit about your backstory? What brought you to this specific career path?

Funny enough, initially, I didn’t pursue medicine. Instead, I was interested in getting my Ph.D. in pharmacology. I interviewed with a program and offered a full scholarship, but everything changed when I got stuck in the Dallas-Fort Worth airport one night. Because it was weather-related, the airlines would not pay for a hotel, and I was a broke college student. I only had $20 in my pocket. So, I slept on the floor at the airport that night. But I didn’t do much sleeping because that is also when they vacuum the airport. While I was sitting there all night, I had an epiphany. I thought, “I think I want to be a doctor.”

I’d always thought pre-med was not for me as I was interested in life sciences. When I decided to pursue pre-med, unfortunately, I hadn’t taken all the prerequisites for medical school, so I had to do another year of school and take the MCAT. I ended up getting accepted into medical school at U.T. Southwestern, and that’s how I ended up in Dallas. I didn’t know then that I specifically wanted to be an ER physician. However, in your third and fourth year of medical school, you do clerkships, where you rotate through many different departments and core specialties, such as pediatric surgery, orthopedic surgery and trauma, and I enjoyed all of them.

I liked a bit of every single clerkship I did. That’s essentially what emergency medicine is because you never know what’s coming through the door. You get to deliver a baby occasionally, and you get to do some orthopedic surgery sometimes. You get to do some pediatrics and a whole mix of things. So, for me, it was an exciting challenge to be prepared and trained to do many different things and then figure out how to take care of all the people who came through the door. So, I thought that seemed exciting, and that’s how I ended up in emergency medicine.

Can you share the most interesting story that happened to you since you began your career? Can you tell us what lesson you learned from that?

I finished my residency in 2001 and went into a traditional emergency medicine practice, working at Dallas’ Parkland Hospital and several other prominent hospitals. I was super busy and enjoyed what I was doing, but within five years or so, I thought, “Wow, okay, I’m doing some cool medicine and taking great care of a lot of people, but this system is not always kind to our patients. They get good medical care, but the patient experience is lacking.”

I was also a little disillusioned. I thought I would be saving lives, and everyone would be happy. But, unfortunately, no one had told me about the complexities and politics of health care as we deliver it in this country. Way too many people were coming into the ER with non-ER symptoms. The amount of money wasted was mind-boggling to me. I thought there had to be a better way to do this. I chewed on that for a while, then took it up the chain of command and recognized that no one was genuinely interested in the patient experience at that time. It just wasn’t a focus.

That is when the idea of Intuitive Health started to form — a way to do health care different from anything patients have ever experienced. I thought, what if there was a way to make the patient experience a priority? What if we put patients first? I mean, really put patients first? What if we personalized our services? What if patients only had to pay for the level of care they received? What if there was a better way to handle patient billing? What if patients left feeling well both physically and mentally?

The answer to my questions became obvious: build a health care center that was both an emergency room and an urgent care staffed by emergency room physicians and staff. A healthcare center that provides patients, pediatric to adults, the same quality-of-care they receive in a hospital-based ER except for overnight stays and operating rooms. We would create objective resource criteria to determine if the patient should be billed as an emergency room patient or an urgent care patient. We would have onsite advanced imaging such as x-ray, C.T. scan and ultrasound, and a moderately complex lab; create an established set of guidelines that keep Intuitive Health staff members engaged with every patient during their visit, smiling, listening and, most of all, moving the process forward with attention to the patient’s needs.

Just eight years after my residency, in 2008, we opened the first Intuitive Health dual model system combing emergent and non-emergent services under one roof, branded as Legacy ER & Urgent Care in Frisco, Texas, a suburb of North Dallas.

Back then, few had even heard of an ER outside of a hospital, much less a combined ER and urgent care. At that time, there was no official State designation for such facilities. We had to go to Austin and fight to get legislation passed that recognized ERs outside the hospital setting and were successful. Finally, a bill was passed and went into effect in September 2009, establishing a license for freestanding ERs for the state of Texas and guidelines to meet the criterion to achieve this designation.

With this new legislation, payors would have to reimburse dual care facilities like Legacy ER & Urgent Care for the care provided at the ER level. Because there was no licensing for urgent care in Texas, establishing that part of the business was a much simpler process.

A few years after the legislation passed for ERs, things went crazy in Texas. We started seeing freestanding ERs on every corner across the metroplex when more health care companies realized they could follow this model and receive reimbursement for services rendered. From about 2010 through 2012, there was an explosion of freestanding ERs across Dallas. However, many did not survive. Unlike our Intuitive Health model that treats both emergency and urgent care, it became clear that the standalone ER was not a viable long-term model.

Intuitive Health has always had the dual billing model from day one, eliminating inappropriate emergency room utilization. We weathered the storm in the marketplace and have been successful because patients appreciate the transparency in billing, and payors appreciate the value the model offers. When they come to one of our facilities, patients trust they don’t have to pay ER prices for seemingly minor complaints but know that we have the staff and equipment to take care of them if their issue is serious. Furthermore, we have protocols and processes in place for a hospital or specialist transfer when necessary.

Let me put this into perspective, even though traditional and standalone ERs can treat all ailments, not all conditions need emergency treatment. With the Intuitive Health model, patients never need to choose if their condition requires emergency room care or where to go (ER or urgent care). Non-emergency, also known as urgent care treatment, includes non-life-threatening conditions like common colds, flu, strep throat, simple lacerations and more. Conversely, conditions in need of immediate attention require ER treatment, including chest pain, abdominal pain, dehydration, complex fractures, and much more.

Our commitment to transparent billing is of tremendous value to our customers and creates an unprecedented level of trust. Patients never need to choose where to go (ER or urgent care). Intuitive Health’s ER to non-emergency ratio is better than the national average, with approximately 20 percent of patients falling into the ER category and 80 percent billed as urgent care or non-emergency. Our patient retention rates are over 70 percent in some locations, with the average Intuitive Health facility seeing more than 100 patients every day.

The dual care model works well for health systems. It works well for the payors; it works well for patients. In health care, everybody rarely wins in that equation. Typically, somebody always loses in that triad. Patients and insurance companies alike trust the objective treatment criteria we follow that allow for our transparent billing practices. With Intuitive Health’s dual model system, everybody comes out ahead.

Can you please give us your favorite “life lesson” quote?

When I worked with emergency medicine residents at U.T. Southwestern, I always told them, “If you do what you believe is the right thing for your patient, I will always stand behind you — even if the outcome is not what we wanted. If you genuinely believe in your heart that you’re doing what is right for your patient, I will support you a hundred percent.”

Are you working on any exciting new projects now? How do you think that will help people?

Yes! We have expanded Intuitive Health here in Texas and have grown our business nationwide based on a model that works well for patients. We’re working on more partnerships and taking the model we pioneered here in North Texas to health systems around the country — to Florida, New Mexico, Indiana, Ohio, Delaware, Arizona and Arkansas. It’s the exact model we pioneered in 2008. We’re just doing it now in partnership with many different health systems. The exciting thing for me is that this model will now be touching hundreds of thousands of people instead of just thousands. The dual model from Intuitive Health does the right thing for all those people. The impact of what we started way back then will change the face of health care in this country, which is a kind of crazy thing to say, and it’s not an exaggeration.

How would you define an “excellent health care provider”?

I would say a good provider meets the baseline medical needs of the patient and provides a good experience. If you have that package, you are going to be super successful. We do many things right at Intuitive Health. We offer many great experiences and care. We have, I believe, some of the best providers in emergency medicine, providing both the best care and a positive customer experience in the facilities we operate.

Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American health care system. Some health care systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. health care system struggle? How do you think we can correct these issues moving forward?

I think everyone, myself included, was taken by surprise by the COVID-19 pandemic. However, we were able to adjust quickly, institute new protocols, and we were able to use our resources wisely. Because of that, Intuitive Health activated a little earlier than some of the others in the market.

In general, I think the U.S. health system was overwhelmed in the areas where there was a tremendous amount of illness. We had New York, which took a hard hit, for example. In other parts of the country, they didn’t have many sick people at the time, and almost nobody was utilizing health care. Contrary to news reports, there was nothing for hospitals or providers to do. The beds were all empty. ERs were empty. There was a yo-yo type thing where it was almost feast or famine.

So, even for us at Intuitive Health, things immediately shut down for several months. Then, as testing came online, we were overwhelmed because everybody wanted to get tested. So, it was very up and down.

Another area of struggle was preparation. Many standalone urgent cares didn’t have the resources to get the gowns, the masks and other personal protective equipment (PPE) because that’s not something they ever had. Hospitals are also more prominent and have more leverage. They typically had the resources to get those things. So, when there were a minimal number of masks available, the big hospitals with leverage got the masks while the smaller urgent cares did not.

Our decision to provide PPE to everyone on our team was a game-changer. Yes, we were challenged, like everyone else, to get the proper PPE, but we could get way out ahead of that. With the PPE, we were able to keep all our facilities open and staffed at a hundred percent capacity because we had all the protective equipment. Because of that, people came to us and trusted us.

We provided all kinds of new protocols to keep patients isolated, administer treatment and comfort them, whether they were there because they were getting tested, were sick with COVID-19 or had a sprained ankle or laceration. Providing that level of comfort kept us moving throughout the pandemic and helped us come out ahead at the end.

We also purchased massive U.V. lights to help implement extra cleaning between patients and keep our staff safe to continue caring for patients. A top goal was to help patients feel comfortable coming to see us and not fear coming to a health care facility and contracting COVID-19 as a result.

Health care professionals were true heroes on the front lines of the crisis, and COVID vaccines are saving millions of lives. Can you share a few ways that our health care system really did well?

We did it well because we continued to put our patients first and provide safe care to them in our communities. We also had an extremely low employee conversion rate because we did an excellent job of protecting employees. We were also able to care for those patients that did become ill with COVID.

Testing also improved public health because those who tested positive could stay home and not spread the virus to the rest of the community. We had to change the way we treated patients to both protect them and to protect the staff. It was common to change protocols daily based on new information regarding the most current recommendations. We also had a protocol for decontaminating areas where a positive patient presented. So, for that, I would say we did very well at navigating something that no one in health care has ever navigated before.

As a health care leader, can you share changes that need to be made to improve the overall U.S. health care system? Please share a story or example for each.

Patient Treatment

We started Intuitive Health to address the way we treated patients in the health care space. That initial goal quickly expanded into other systematic changes that needed to happen. Patients come to a doctor to get the care they need without judgment and fear. We’re here to help them get better, and we want the entire process and experience of walking into one of our partner systems to be pleasant, with as little stress as possible. We want patients to get better in an environment that is supportive of their recovery.

Career Growth

We want physicians, nurses and staff to enjoy what they’re doing. When health care workers enjoy a high quality of life, that translates to better care when they’re on the floor serving patients. However, when individuals are overworked or facing challenges to expanding their knowledge and progressing in their careers, it feels frustrating and overwhelming. These feelings don’t fulfill why many individuals choose to get into the health care industry. At Intuitive Health, we encourage the importance of caring for the health and well-being of our staff members just as we would for our patients. Opportunities for career advancement lead to more significant change, a better health care system and a more engaged and passionate workforce.

Cost Containment and Transparency

Most of the time, nobody knows how much anything costs in health care. Nor are you given an option to shop it, as you do with everything else in your life. When a patient is assessed at one of our facilities, they are designated as an urgent care patient or an emergency room patient. Patients have the option to continue with the level of care they need, with the understanding that they will only pay for the level of care they receive — no more and no less. Patients also have every right to opt-out of emergency services, even if we deem them ER patients. We understand health care costs are often tremendously high. At Intuitive Health, we want our patients to have a clear idea about how our system is different and why. We want them to understand how it can help them get the care they need without the excessive bills you often hear about.

Navigating Insurance

The cool thing about our dual care model, which combines emergency room and urgent care services under a single roof, is that it solves recent changes in the insurance industry. An example could be some health insurance companies refusing to cover ER services if they’re deemed non-emergent. Such policies put undue stress and pressure on individuals to become medical experts. With our system, if it’s not an emergent problem, you’ll be seen and billed for urgent care, which insurance will not deny. Our model provides a workaround to this situation where some of the more prominent players in the insurance industry try to put policies into place to prevent patients from seeking care.

Health Care Access

One of the things that our model accomplishes is that it allows an extensive health system to have a footprint in an area where there’s no space to build a hospital or in a place where it would be cost-prohibitive to do so. We give health systems the ability to go into a community, in turn, providing another access point for patients. If patients need a higher level of service or specialty services, they can come to the main campus, but they also don’t have to go to the main campus to be seen or treated. We are providing expanded access and convenience without sacrificing the quality of care.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

It depends on the physician’s specialty. For example, in emergency medicine, the experts are predicting there is going to be a surplus. In recent years, many new programs have been created for ER physicians, and, in about five to eight years, there could be too many. I think the shortages we may see in emergency physicians will be in rural areas, not in big cities. Given this situation, one thing that can be done is redistributing physicians from high- to low-density areas. We can incentivize physicians who are willing to go into underserved communities. I think that’s the real issue we have.

How do you think we can address the issue of physician burnout?

Burnout is widespread coming out of the pandemic after two years of non-stop work. Preventing burnout is part of what we accomplish through the Intuitive Health model and why we must be a physician-led company: nobody knows physicians better than physicians. But, unfortunately, sometimes you get corporate people in there who don’t understand the psychological repercussions of burnout that health care workers experience due to the stress that comes from caring for sick people.

We’ve also been able to offer career growth opportunities that help alleviate physician burnout. We have brought physician leaders into our organization, allowing physicians not to do a hundred percent clinical work, which is what typically leads to burnout. It’s not administrative work that creates burnout. For example, Dr. Murphy, a colleague who works very closely with me, still works a heavy clinical load, but he’s also doing a lot of non-clinical work. That’s less stressful. Having the ability to avoid life and death challenges every day can help make it easier to enjoy what we do when we are in the emergency room.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?

The movement I would love to inspire that would bring the most good to the most people is health care billing transparency. If we could get an Intuitive Health center in every major city, we would make significant headway with billing transparency. I think that would solve all kinds of problems. So much good would trickle down from that.

How can our readers further follow your work online?

You can find more information about our dual model and our mission at Intuitive Health by visiting our websites below:

Intuitive Health

Website: https://www.iheruc.com

LinkedIn: https://www.linkedin.com/company/intuitivehealth/

You can also learn about Intuitive Health’s partners:

Thank you so much for these insights. This was very inspirational, and we wish you continued success in your great work.

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Luke Kervin, Co-Founder of Tebra

Luke Kervin, Co-Founder of Tebra

Luke Kervin is the Co-Founder and Chief Innovation Officer of Tebra