From CFO to Cancer Research–A Conversation About Challenging Assumptions [PODCAST]

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From CFO to Cancer Research — A Conversation About Challenging Assumptions

In this episode, Ted Giovanis, President of the Jayne Koskinas Ted Giovanis Foundation for Health and Policy, discusses from CFO to cancer research, a conversation about challenging assumptions.

Highlights of this episode include:

• What drives hospital CFOs to keep taking on entirely new challenges
• One thing about how healthcare operates today that we should fundamentally rethink
• A question about healthcare we’re still not asking
• Return on investment when it comes to scientific research that may take years to pay off
• Which is more expensive for healthcare, trying something new that might fail or continuing to do things the way we’ve always done them?
• What lessons to apply for improving healthcare and cancer research

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Ted Giovanis. Ted has been the president of the Jayne Koskinas Ted Giovanis Foundation for Health and Policy, which conducts research in metastatic breast cancer and health policy. He is also a professional race driver and team owner in the International Motorsports Association Racing Series. Examples of health policy research that their foundation has conducted include research on the value of hospital tax exemptions relative to hospital-provided charity free care, how to explain health plan prices and quality information to individuals with varying degrees of numeracy and literacy, and defining meaningful quality measures, including the weighting of those measures into aggregate measures for communication to patients. While in practice, Ted was involved in several legislative efforts that resulted in the establishment and implementation of several payment mechanisms, including the Medicare Geographic Review Board and Section 508 reclassification process, the policy for the payment of the certified registered nurse anesthetists, and the long-term care payment systems for various states. Most notably, Ted discovered and prosecuted the Medicare budget neutrality error, which was the basis of the rural floor budget neutrality appeal and related settlements that at the time was the largest settlement Medicare had lost.

In this episode, we’re discussing from CFO to cancer research, a conversation about challenging assumptions. Welcome, and thank you for joining us, Ted.

Ted Giovanis: Oh, thanks, Kelly. Thanks. Good to be here.

Kelly: So, let’s go ahead and jump in. So, you’ve been a hospital CFO. You’ve helped shape healthcare policy, been part of a landmark court case, written books, and now race professionally and fund cancer research. What drives you to keep taking on entirely new challenges?

Ted: Well, that’s a really good question. So, I can tell you as far back as I can remember, I’ve had this drive to achieve. Maybe it was the fact I was an only child, and we didn’t have any money. But to achieve, you need to be very goal-oriented. And in this sense, I’m the typical Capricorn. I set goals and I locomote towards them. I started in healthcare and finance and worked my way up, setting goals all the way along the line. And somewhere around 1978, I became acquainted with a guy named Mike Vance, who was an influential thought leader and author. And he was the one that instilled in me a commitment to a lifetime of continuous learning and growth. And ever since then, that’s sort of what I’ve been doing. That curiosity has led me to ask a lot of questions that others wouldn’t ask, which brought me to the lawsuit, ironically, and has also led me to cancer research. So, asking questions prompts you to try to find the answers. And if you don’t know the answers, you talk to other people and you try to find them from them. So, you look up to people that can give you the answers.

So as a bonus, as it turns out, as you age, learning more and staying mentally active is a big plus. A long time ago, Henry Ford once said, “Anyone who stops growing is old, whether that happens at 20 or 80.” I just turned 80, and I don’t plan on stopping anytime soon. And Henry Ford also said, “Anyone who keeps growing becomes more valuable, regardless of physical capacity.” So, I hope I’m becoming and learning and growing and becoming more valuable.

Kelly: Yeah, I love that committing to a lifetime of learning and growth. That is great advice. After decades in healthcare finance, what’s one thing about how healthcare operates today that you think we should fundamentally rethink?

Ted: Well, I think there’s one thing we need to rethink. It’s actually how to lead there’s a lot of people in healthcare today that are talking about being patient-centered, patient-centric, but too often they don’t think patient-centric in the way they make decisions. So, we need leaders willing to challenge the status quo. And more importantly, willing to be introspective, look within oneself of how they can improve. And remember, remember the definition of insanity is doing the same things over and over again and expecting something different. And I think that’s what we do a little bit. I support now much research. And so, I can use that as a little bit of an example. The goal of most healthcare research is ultimately on our side, is to help patients, to find cures, to determine better treatments. If we look at healthcare organizations, there’s things that they can do to lead and to streamline things, including in the administrative cost area, in the near term. To me, indirect costs are something that we can manage now. In many cases, they’ve got out of control. There’s a lot more to do all the way along the line, but I think indirect costs are something that we can deal with to get started.

Kelly: No, I love what you said about challenging the status quo. I think that is really important, especially in healthcare. Ted, you’ve often said that breakthroughs start with asking better questions. What’s a question about healthcare that you think we’re still not asking?

Ted: That’s a good question. The question we’re really not asking is, do we really understand how X or how something works, or are we assuming too much? I mentioned before, putting patients at the center, that to do that well, we need to understand what those patients are experiencing virtually at every level, from diagnosis, treatment, to billing, and follow-ups. So, for me, I’m looking specifically at breast cancer and within breast cancer, specifically at metastasis. How does it spread? Why does it spread? And we’re down into the minutiae of intercellular communications. But as a country, we don’t fund research in basic science to find out these kinds of things and to find out how things work. We tend to ask questions we think we know the answers to, but rarely do we throw money behind something that we truly don’t know or understand. And so, I think we’ve got that a little backwards. If we know how things work, then we can model it and we can experiment in the model to identify a path to diagnosis, treatments, and prevention. We really need to change our thinking. And I’ll paraphrase it in racing. There’s a concept called ocular driving. You drive where you look and where you can see. The farther you can see ahead and anticipate, that’s where you’ll go. The same thing is in healthcare with our thinking. We need to change our frame of reference and our thinking. And so that’s sort of the framework that will let us design patient flows of the future. And those patient flows need to be adaptable. Because the one thing is for sure, care will change again within the next decade. And so, adaptability and resilience is going to be key.

Kelly: Yeah, no, I love what you said about we have to change our thinking. I think that’s very true. As a former CFO, how do you think about return on investment when it comes to scientific research that may take years to pay off?

Ted: I’ve learned that the best return on investment comes from understanding how things work first and then leveraging on that knowledge. That’s true in racing and it’s true in research. And I’m sure it’s true in healthcare organizations and in the provision of care. In racing, it’s how you get an edge on your competition. At first, you look for the bigger things, and of course, you take care of them. But over time, it’s the small adjustments, the steady improvements that combine to improve your performance. We take the same approach to research. We invest in foundational science and talented people who ask the right questions or challenge the status quo. It’s investing early before answers are no, and that’s important. Those investments may take some time to pay off, but they create the knowledge that foster future breakthroughs. And we need to be good financial stewards. It’s about making investments today that make some things possible tomorrow. So that’s sort of the mantra that we’ve adopted in our foundation, knowing how it works.

Kelly: That makes a lot of sense. So, which is more expensive for healthcare? Trying something new that might fail or continuing to do things the way we’ve always done them?

Ted: I think, Kelly, first of all, it comes back to maybe it’s another problem with our thinking, and that we are afraid of failure. Finding out you’re wrong isn’t a failure. It’s information. It’s learning. It tells you where to adjust before you’ve invested years heading in the wrong direction. So, research, metaphorically, is like moving a football down the field. You can’t score without first moving the ball and without investment at the beginning of a drive, so to speak, you’ll never reach the end zone at the other end. Every study, every experiment, every lesson learned hits another first nail. So, if you want to look at that metaphorically, that’s the way it is. Or I’ll give you another one. If we’re going from Richmond, Virginia, to San Francisco, California, which is in a direct line, better figure out your one degree off early, or you’re not going to be anywhere near San Francisco. Today, much attention and funding go towards research that’s already near the gold line. Folks like me think we’re a little too drug-centric. And that’s where the glory is, down that end of the field. That’s where the ROI is. But we need to invest earlier, where scientists are asking fundamental questions about how diseases work. How do they come to be? And that’s where the discoveries begin, even if the path isn’t always obvious. And that’s really the problem that we have with moving into the basics of how things work, we just don’t see or cognize what the payoff is. So, with today’s limited resources, on the other hand, it’s expensive to be wrong. And I understand, but that’s why we need to take a chance to learn to take thoughtful risks early. And it helps us move down the field more efficiently and ultimately delivers better, more effective care for patients. And that’s sort of how we work in our foundation.

Kelly: Yeah, I agree. Most of us are driven by that fear of failure. I completely can relate to that. For you, racing…it’s a constant search for small advantages. What lessons from your race career apply to improving healthcare and cancer research?

Ted: Racing, again, has taught me that success rarely comes from one big breakthrough. It comes from continually getting better. And yes, granted, you need to take care of those big opportunities and fix big problems, or to take advantage of them. But it’s the small refinements to improve your performance, too, because I’ve always said with me as far as driving, my comparative is always me versus me. Because if I focus on improving me, me versus the other guy will take care of itself because you’re looking for small improvements in yourself that they’re not looking. So, healthcare works the same way. We need more ideas we also need continuous improvement, rethinking things that others overlook. And then healthcare hasn’t really dealt appropriately in effect with the big or small things. I mentioned indirect costs earlier. That’s one place to look, but it’s– and it’s good because it doesn’t involve bricks and mortar or new equipment. So, it’s something that we could effectively change.

Kelly: Yeah, I agree, like the continuous improvement piece, that is certainly key in racing and in healthcare. If you could give one piece of advice to healthcare leaders trying to build a better system for the next generation, what would that be?

Ted: Well, I don’t know if it’s– I don’t know if there’s just one piece, but I’ll give them a couple. I tell them to never stop learning and never assume you have all the answers. Be introspective enough to challenge your own assumptions. Commit to continuous improvement instead of defending the status quo. That would be sort of another one. And we have what we call in racing situational awareness. Know where you are, where you’re going, and be aware of everything that’s around you. So, you have a context for where you sit, so you know what’s happening on the playing field, so to speak, or on the racetrack. Be adaptable because healthcare will continue to evolve. Be resilient because meaningful change will take time. And you’ll have to play through that time as it happens. And maybe most importantly, adopt a collaborative mindset, recognizing that no one person has all the answers. And that’s sort of implicit in being introspective because you’re admitting in a way being introspective that you don’t know everything. And these things will make you not just better at what you do, but better at who you are. So, there are these kinds of things. These would be the things that you will take with you if you adopt that. I mean, what I do personally, I read a lot. I read a lot of everything, all different types of topics. And what that does is it gives me more, what I said, situational awareness. I understand the context of things that are happening. And so, it allows me to interpret better.

Kelly: No, that’s some great advice. Thank you. I love the never stop learning. Well, thank you so much, Ted, for sharing your insights with us on from CFO to cancer research, a conversation about challenging assumptions. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Ted: They can go to my LinkedIn page, Ted Giovanis, or on Instagram. I’m on there to Ted Giovannis, or I have a website, tedgiovanis.com, and it’ll tell you all the kinds of things that I’m involved in. You can message me through the social platforms.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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