Q&A with Palomar Medical Center's CAO

December 19, 2012
by Diana Bradley, Staff Writer
Palomar Medical Center officially opened its doors in August. Two months in, Gerald Bracht revealed the challenges that come with being the chief administrative officer of a brand new facility to DOTmed News.

DMBN: Tell us a bit about your background.
I started my career in the supply chain arena, made my way through the ranks and decided I wanted to get into administration. From there, I got my MBA, had an opportunity and took it. I have been with Palomar Health since February 2000.

DMBN: With the Medical Center’s recent opening, your hands must be pretty full. What are some of your goals for the institution?
Our ultimate aim is to grow programs and attract physicians to this facility.

But my goal for the foreseeable future, or at least the next year, is stabilizing the operation. If you consider the stress of moving into a new residence, unpacking, living out of boxes and stuff like that – magnify that multiple times and you have the stress of moving into a complex organization like a hospital.

We don’t have 10 people we have just hired that are going to be integrated into a 1,500-plus organization; we have 1,500 people who have just moved into a brand new place. On top of this, we have new people coming on board while we are responding to increases in activity and trying to orient them at the same time we are orienting people who are already here. Every day is a little bit better, but it is going to take time for Palomar Medical Center to become a well-oiled machine. Our collective hands are full, and I have a phenomenal team leading the mission.

DMBN: With reimbursement cuts and the current economic issues going on, what actions will your facility take to cut costs and curb spending?
We pride ourselves as an organization that has always been good stewards of the resources we have to work with. We have a very engaged board of directors, whom we report to regularly on our financial performance and how we are doing against that. The one thing we did a little over a year ago is evaluating our profitability based purely on Medicare reimbursement. In other words: can we survive living at Medicare reimbursement levels? If not, what do we need to do to be able to get ourselves there if the entire industry is moving in that direction? We are doing pretty well at that.

We are also looking at standardizing products and working with our surgeons and medical staff to streamline physician preference items. In addition, we are seeking standardization on major expenditure categories, so we are not carrying every single product there is, but narrowing it down to a select few, or standardizing on a price and then allowing the physician to use whatever he wants, as long at the vendor is willing to meet that price. We are also looking at the entire operation for efficiency.

On top of all this, we have employed “adaptive design” – a rapid problem solving methodology that seeks to pull waste out of the system one problem at a time.

DMBN: Do you find interacting with leaders (CEOs, CAOs, etc) from other hospitals/health care facilities will be beneficial to your center? How so?
Absolutely; Palomar Health does that already. We are a member of the VHA Inc. — a national network of not-for-profit health care organizations that work together to drive maximum savings in the supply chain arena. We work closely with purchasing cooperatives that have expanded into other areas, actively striving to standardize products, and get, with member hospitals, the best price we can for certain products and services we utilize.

In my case, the CAOs and CEOs get together on a quarterly basis and address various topics important to us individually, sharing experiences and strategies going forward. This has been instrumental in getting ahead of things and not falling into the same traps others may have fallen into that have come before us. And that’s in addition to the California Hospital Association (CHA) or the American Hospital Association (AHA), who are also addressing these issues, but tend to be more focused at the legislative level — AHA nationally and CHA statewide.