Looking Beyond Headcount: Rethinking Access, Workflows, and Telehealth with Drs. Pamela Ograbisz and Jamie Threatt
Download MP3Well, hi, everyone, and welcome to the MGMA Insights Podcast. I'm your host, Daniel Williams. Today, we're going to be talking about care model design and what it really takes to improve care delivery across an organization. Today, I'm joined by Doctor. Pamela Ograbisz and Doctor.
Daniel Williams:Jamie Threatt from locumtenens.com who are gonna shed light on that topic. Doctors, I want to welcome you to the show.
Pamela Ograbisz:Oh, thank you, Daniel. We're excited to be here.
Jamie Threatt:Thank you. All
Daniel Williams:right. So Doctor. Ograbisz, I'm going to start with you. We're going to get deep into care model design, but just to let our listeners know a little bit about your background and what you're working on right now.
Pamela Ograbisz:Absolutely. So have been a cardiothoracic nurse practitioner for twenty seven years, practicing out in the field, and have been with locumtenens.com and LT Telehealth for the last eight years. I serve as the vice president of clinical operations here. And for the most part, I would say the work that we do spans several different planes. We build full scale telehealth programs.
Pamela Ograbisz:We also are in charge of all things APP. So, right, how do advanced practice providers fit into formulations for care model design, working and designing formats that utilize doctors and nurse practitioners and PAs appropriately. And then we also do a tremendous amount of advocacy work on behalf of both telehealth legislation as well as pushing forward nurse practitioner and PA agendas across the country.
Daniel Williams:All right. Thank you so much for that. Doctor. Threatt, same question, just a little bit of background to get to know you better before we take a deep dive into care model design.
Jamie Threatt:Sure. Well, I'm an acute care nurse practitioner. I've been a nurse practitioner for over ten years now. My background is in emergency medicine and trauma neurology and pulmonary critical care. I joined LT in 2024 when I had the opportunity to broaden my impact by building and scaling telehealth programs.
Jamie Threatt:My role as telehealth program director really lends a clinical lens to the programs that we're building to make sure that we are keeping in mind the patient care, making sure that we're building safe and effective programs. And then one thing I'd mention just about the unique role that Pam and I serve is we are locumtenens.com is the only staffing agency that actually has nurse practitioners in leadership positions. And I think that really lends a unique perspective to how we work with clients. And I think it speaks to the scope of this conversation pretty clearly.
Daniel Williams:Yeah. Thank you so much for that. Doctor. Ograbisz, you shared with us, you've spent years building telehealth, APP programs. When you look at care delivery today, where are you seeing the gaps?
Daniel Williams:Where are you answering questions and problem solving for practices and others out there?
Pamela Ograbisz:Absolutely. Well, I think the nice thing is since I entered the market many, many moons ago as a practicing provider, there's been a huge shift. Now there's not a hospital system or a clinic across the country that's not utilizing advanced practice providers. What I would say is this, I don't think everyone's using them as wisely or as effectively as they could. And with the physician shortage and lack of access to subspecialty care, especially when you look at diabetes, infectious disease, the terrible maternal deserts that we see across the country where people don't have access to basic OB care, that's where I really honestly see the biggest gaps, right?
Pamela Ograbisz:We could utilize and better position physician and APP teams to increase access. And I think systems are struggling to figure out how to do that well.
Daniel Williams:Okay. Jamie, next question is for you. Where are you seeing the issues? Where are you seeing care delivery break down on a day to day basis?
Jamie Threatt:I think the genesis of the problem is that we've developed, or health systems in general have developed their subspecialty care and their virtual care services completely siloed. And so I think where the pandemic did a lot to change the landscape of the healthcare system, one of the things it did was kind of cause hospital systems to see that they needed virtual care services, but it's not in an integrated approach. It's in a completely separate vein in a lot of the organizations that we work with. And I think that that creates barriers to integrating telehealth into subspecialty care, which when Pam and I kind of vision board out like where we think subspecialty care or telehealth can have the greatest impact in subspecialty care, a lot of times we're having conversations with people and they've never even considered that a solution to a problem they're trying to solve. And I think the other thing that I would say in terms of breakdown in the day to day is I think a lot of times hospitals don't necessarily consider what the patient's journey is from start to finish.
Jamie Threatt:So how is that patient encountering your health system for the very first time and how do we support them and get them through every level of care up into the point of discharge, maybe from a hospitalization or a surgical situation to, you know, the outpatient world, the chronic care management, and that care that keeps them out of emergency departments. And so, that's something I really keep centered to the conversation when I'm speaking to health systems is sort of like, well, how does the patient fit into these decisions that we're making? And I think a lot of times that kind of helps keep everybody sort of moving along the same vein. And again, if you take the patient out of the equation, you really could miss some pretty significant workflow problems, you know, down the line. And it's much better to catch those, on the forefront, than to problem solve for them once things are live.
Daniel Williams:That is such a great point. And boy, I have a project that we're working on at MGMA, we keep saying, Oh my gosh, why didn't we have this here and this here and restructure it? And it really goes to the next question that I want to ask you, Pam. So often when I'm talking to someone in healthcare, we're talking about, well, it's a staffing problem. And it so often is just because it is a staffing problem.
Daniel Williams:But you raise a question that I think is so important to address upfront. Is it a structural problem? What is the structure of the issue that we're talking about? I'd love to hear you expound on that.
Pamela Ograbisz:Absolutely. So many times, Jimmy and will get called in for basically consultations, right? So I'll give you an example. Cardiology program is struggling with workflow. So getting patients efficiently through the system and honestly, it really boils down to a issue with access.
Pamela Ograbisz:And many times when I look at it, it's the access points. How are patients getting to you and how are you funneling them through your whatever that might be, right? Your criteria for getting them, from point A to point B. It is often a staffing concern, or it looks But like that on the it's more that they're not using their resources appropriately. And so for example, why couldn't you screen all of your patients through either utilizing AI now, but also with telehealth screeners?
Pamela Ograbisz:Why are we not utilizing nurses more effectively in that opportunity? We do not need someone who can write a prescription to do any of that. Why are we not at the meeting folks that are presenting with heart attack symptoms at the door with the right team to move along the care more appropriately, holding up scanners, not being able to access a surgeon. It's so many times where we just go, If you would just lay out, you know, remove these barriers and lay out these building blocks, things would be so much more efficient. And so I think that's a big piece of it is people stand in their own way, which is so often frustrating.
Pamela Ograbisz:And I think that Jamie and I could tell you over and over again what are the biggest things that we usually put into place that help with those issues, utilizing APPs to the top of their license wherever you can, and absolutely implementing telehealth programs wherever you can.
Daniel Williams:Okay. Thank you so much for that. Jamie, I'll turn it back to you. Let's stay with that structure. When the structure is off, I want to come back to the patients, also the clinicians, what's happening at that ground level?
Daniel Williams:When the structure is wobbly, so to speak, or just not aligned, what's happening to those patients? What's happening to those clinicians?
Jamie Threatt:Sure. So, I'll take each individually because I do think it impacts both parties very differently. I think for patients, it's increased wait times. So, whether that's for delays in their scheduled surgery or access to a new specialist. I mean, we have even in, you know, large metro areas, we have some specialty lines where you've got six months of wait times.
Jamie Threatt:And that's obviously concerning on a number of levels. It delays patient care. It can impact patient outcomes depending on the specialty that we're dealing with. And I think there's also a lot of frustration, right? I think we've got so much technology in healthcare, but how are we deploying it?
Jamie Threatt:Are patients getting? Are the messages and the communication tools patients are provided with, are they landing on the right person's desk, right? Or are we using those, to Pam's point, are we using both licensed and non licensed medical office staff members appropriately to make sure patients at least get that, hi, we got your message, hi, we hear you, and we've sent it to this next person, right? So I think for a lot of times in my experience, patients will have a lot of frustration and rightly so, frankly, because there are breakdowns, both in care delivery times and in the communication pathway from the patient to that end provider that needs to get that message. And on the physician side, on the staff side, I think, inefficiency we know leads to that big, buzzword that we're all talking about is clinician burnout.
Jamie Threatt:Right? And so in the wake of the COVID-nineteen pandemic, we've seen a mass exodus of both licensed and non licensed providers fleeing healthcare, because the utilization is up and we're being asked to do more with less. And so I think that if we can create, we can eliminate inefficiencies, create better communication tools, create better workflows, you know, that may get us a little bit closer to a work life balance. I'll tell you what, there's not a clinician in the world that wouldn't appreciate some hours of admin time or some protected telehealth time, you know, built into their schedule. And so those are kinds of the questions that we say, you know, that we think about, you know, what could be done in a remote standpoint?
Jamie Threatt:What can an APP do that right now a physician is doing? You know, whether that's new patient appointments or that's all of the test results that ever come through, right? Are those being routed to the right people? So there's a lot of opportunity there to kind of fix what's broken.
Daniel Williams:I just want to say, that I have had a version of this conversation so many times, but you and Pam are allowing me to see it with new eyes, so to speak. You're bringing a new perspective to it. So I want I want to thank you so much because I am literally hearing new information after having the same sort of conversation so many times. Well, let's just be more efficient with technology. That's going to solve it.
Daniel Williams:Y'all are going, Actually, structurally, let's look at, could we design more telehealth visits in the flow to help out everyone, both patients and providers? It's just, wow, light bulb is going off over my head. Pam, I want to turn to you now. I wrote this down from correspondence with you and your team prior to the interview. Your team takes a clinician led consultative approach.
Daniel Williams:So when you do that, what does that actually look like when you do start working with an organization?
Pamela Ograbisz:Absolutely. I think honestly, and it's probably the edge that Jamie and I bring when we're able to work with clients, and that is that we've been there. So we've been on the front lines. We've done the work. We have both been on the receiving end of admin coming down and saying, Hey, by the way, we're gonna deploy this program and have fun.
Pamela Ograbisz:And no one ever asked us what we thought or gathered our input, and it's frustrating because I'm the one who has to do it. I already I think I know what's broken. I get that most of the time a lot of these decisions are driven financially, right? What are we doing with outcomes? What are we doing on our Medicare numbers?
Pamela Ograbisz:And what are we doing for CMS? I understand all of that. But I would say that why we 100% lead with a clinician led approach is because we were so often forgotten in the formula when people were trying to build things. And so every program we do, every time we meet with an organization, what I build for hospital A is I guarantee you not what I will build for hospital B. They could be similar but every hospital has their own flavor, and their own patient population and their own driving factors that really make what we do and what we should be doing, you should be building to suit.
Pamela Ograbisz:You have to talk to every single person that's going to be impacted by that program. If you're not interviewing the doctors, the NPs, the PAs, the nurses, all the way down to the tech staff, they're going to have to interact with that. And to be honest with you, if we're not talking to folks who clean the rooms and deliver the tray tables, we're also missing the boat because it takes everybody to make it run. And so for us, I think we truly want to talk to every person impacted by a program in order to make sure that we are considering what they need to make something successful. I will always say, If you don't get the nurses buy in, you're cooked.
Pamela Ograbisz:You'll never get a program up off the ground because they're the lifeblood of a hospital. So I consistently it's truly what I think of when we go in and we say, We'd like you know, someone has said, We want to build a telehealth program. Well, that's great. Let me talk to and the patients you're going to serve, how are they going to interact with it? You know, if your age if your patient population that you're zeroing in on is 65 and above, then what I build for that is very different than the pediatric program that I'm gonna build for an after hours opportunity.
Pamela Ograbisz:So so many times I think systems just desperately wanna plug and play. And if we're really gonna be successful, we truthfully have to be just more tailored and more thoughtful about how we put things together so that we're truly successful in the end.
Daniel Williams:Yeah. You're again, more light bulbs are going out. This is like a very well lit day for me, so I appreciate it, fam. Because Fantastic. You used the term build to suit, and I spent ten years in commercial real estate covering that.
Daniel Williams:And that was a buzzword and a needed one because the ice cream parlor doesn't need what the, you know, the telehealth or the medical field needs. They need they have different needs there. Jamie, the next question's for you, and it really goes again to design by what's needed. You have worked across ICU, neurology, pulmonary care, now telehealth. With the knowledge you bring into it, how does that help you build out and design better care models?
Jamie Threatt:Yeah, I think that, again, I'll hearken back to what I said about sort of keeping the patient at the center. And so having worked across the spectrum of healthcare in the emergency room, which is often the entry point for a lot of folks through an ICU, maybe an extended ICU hospitalization, and then into the outpatient world and sort of that chronic care management, you really get a unique perspective for what those pain points are throughout the entire continuum of healthcare. And I think that that's maybe part of what gets lost in translation. I talk to a lot of hospital systems where everything in the hospital is run by one team and, oh, they don't want to talk about outpatient because that's a whole another team. You know, they don't want to talk about the surgical team and they don't want to talk about the emergency team.
Jamie Threatt:And think about how much, think about the worst game of telephone that you've ever played in your life, but you're the patient, right? And it's impacting how you experience healthcare. And so if these different areas of the hospital never come together to kind of look at what that looks like from point A all the way to point Z, you know, that is how things get missed. And that is how that process breaks down for patients. And so I do think that kind of gives me a unique perspective.
Jamie Threatt:I've also taken care of ailing parents. And so also seeing it from the perspective of a consumer or a patient or a caregiver and what those friction points are for mandated in person visits when a loved one has significant mobility issues or fear of contracting something because of having to be in in a dirty waiting room. Right. And so I do think that kind of colors things as well. And I would say as I've sort of journeyed through my career and taken advantage of the things that telehealth affords us.
Jamie Threatt:So, I first encountered telehealth really when I was working in the ER and for my neurology, my neurology critical care team, because, you know, we've been doing telestroke for over thirty years now, right? It's an integrated part of ER and neurology care. And so if you take that model and you think about how you can expand it and how you can impact things, for stroke it made a lot of sense, right, because we made care more efficient. We got to, you know, we got those ten minute CT scans. We got those sixty minute decisions about, thrombolytics and things like that.
Jamie Threatt:But as I sort of journeyed into lower acuity areas where it's less high risk, how are we not thinking about how difficult it is for my geriatric patient who's oxygen dependent and doesn't have family local. Why are we not considering telehealth for that lower risk opportunity? Right. And so I do think sort of every, everything is built upon itself to kind of bring me to where I am today. And I think a lot of times people say no telehealth and I say, why not?
Jamie Threatt:Why not telehealth? Like tell me why you think telehealth won't work. If it's a procedure, I get it. We're not there yet. But, if it's, if it's a conversation, I can have that just as effectively via video screen than I can in person.
Jamie Threatt:And maybe my patient will be less grouchy because they didn't have to sit in Atlanta traffic or pay to park or deal with valet or, you know, like wrestle a wheelchair up a ridiculous ramp. Maybe they're a little bit happier to see me because I've saved them so much time.
Daniel Williams:Wow. That is brilliant. That is brilliant. For our listeners who listen to each podcast, they know that it's MGMA's one hundredth anniversary this year. The reason I bring that up is we have a historian, Dave Ganz, who's gone back into the archives.
Daniel Williams:He has notes from the first meeting in 1926, and so many of the problems that they were addressing in that first meeting in 1926, we're still talking about in 2026. Pam, alignment across teams, workflows. It's been in there, in the notes, all the way back to the 1926 era. Why is it so hard to get it right in healthcare? Why are we still talking about a 100 year old and even longer issue that we've had in the industry?
Pamela Ograbisz:Such a great point. We are incredibly siloed, always have been. I think back to even how everybody is trained. Physician, NP, nurse, doesn't matter. You're in your lane.
Pamela Ograbisz:You're in your specialty. I'll take myself for example. My entire career, from when I was a nurse, through a nurse practitioner, through my doctoral studies, all of it, has all been inside of cardiothoracic surgery. I have not ventured out, as Jamie has, to all those other lovely subspecialty areas, although I certainly consulted a lot of them across my career. But I will it is truly secondary to silos.
Pamela Ograbisz:It's how we're it's it's literally how we're raised, how we're taught. You stay in your lane. If you're if you need something outside your lane, you have to put your hand up and ask for that person to come in. And then but it's right. It's it's all nothing is really yes, it's collaborative, but it's still, at the end of the day, I'm here.
Pamela Ograbisz:You're here. You're here. And where we need to move is we are one solid team. That could be a whole other podcast in itself, Daniel, to walk down what we do with that. But I do think that is what is so hard.
Pamela Ograbisz:And so not only have we siloed ourselves inside of medicine, but we've also siloed it, if you think about it, it's almost the clinical folks against the financial folks, against the administrative folks, against CMS and the payers, and that everybody has their own stake in the game. And at the end of the day, the people that lose the most are the patients because we're not all working together. And so I do believe that the conversations that Jamie and I are having, which I do view as positive, we are trying to break through the silos. And we do encourage teams to work together. And I do believe that by cross covering, making teams more effective, by utilizing folks, both licensed, non licensed, allied, all those pieces, more effectively and bringing them all to the table together, including the financial folks and the payers, When we all get in the same room, things get better.
Pamela Ograbisz:But until we break down the silos, can't happen.
Daniel Williams:Wow. Okay. For the sake of time, I want to get, like, a final health care thought from each of you. Pam, I'll stay with you. For our leaders, our healthcare leaders listening right now, they're going, Oh my gosh, my care design is not up to snuff here.
Daniel Williams:I need to do some things different. Where should they start? Because y'all make it, believe it or not, sound really elementary like, oh my gosh, all these light bulb moments I'm having. I hope our listeners are having as well, but it could get overwhelming when they get pen to paper at that stage. So where should they start?
Pamela Ograbisz:I would say if you know you have a service line that's broken or a care model that needs work or improvement, my first thing I would say is listen. Listen to your clinicians. Call a meeting. Ask the hard questions. Ask what's broken, and get it from the source.
Pamela Ograbisz:And then by all means, please use your numbers and your factors and your outcomes and all of those pieces, but start with your clinician base. And by all means, take in your satisfaction surveys and talk to your patients. That will give you, I think, a good level set playing field to start with of, Okay, here's three or four really large items that we know we need to work on both internally and externally. And then you have to find a partner that can help you do that.
Daniel Williams:Okay. Jamie, you've got a megaphone right now. What is a call to action? What's something based on what we've been discussing that you would wanna share with our listeners right now? What's something that they can take action or that you would encourage them to take action on?
Jamie Threatt:Well, I would be remiss not to use this opportunity to plug telehealth, as that is my current passion.
Daniel Williams:Yep.
Jamie Threatt:And I would say that telehealth needs to be a permanent part of your solution. I would I would ask, you know, looking at the investments that you made, whether those were technology advanced, you know, back in 2020, How are you utilizing those investments today? Are your carts and cameras sitting in a closet somewhere collecting dust? Because I would challenge that there are inefficiencies that exist within your system that could be solved with telehealth. I would look at your service lines that have the longest wait times or those job requisitions that have been the hardest for your talent acquisition folks to fill or, you know, where you're having the highest clinician turnover, what are those service lines?
Jamie Threatt:And really dig in and what are those problems? And I would challenge you that telehealth could solve some of those for you, and happy to help you understand how anytime.
Daniel Williams:All right. Jamie, I'm gonna stay with you for one more question, not healthcare related. We're gonna park healthcare over here. Y'all are both such energetic, fun people to talk to. Jamie, what do you do when you're not working?
Daniel Williams:What's something fun, a hobby, a passion? What do you got going on?
Jamie Threatt:Oh, I thought you said we were short on time. I'm much I have a lot of hobbies. I would say I love to garden, I have a very, robust, vegetable and fruit garden. I also have a pollinator garden that I could talk about a lot. And, I also run.
Jamie Threatt:I, run a race every month of varying different, different lengths. Those are kind of mine. And then I've got two kiddos that keep me really busy. So
Daniel Williams:Let me go back to the garden then because there's been I don't know what it's been like in Atlanta this year. In Denver, we didn't have any snow, so it's made it a real challenge for certain things to grow. What's just blooming in the garden? What are you excited about this year?
Jamie Threatt:This has been an absolutely wonderful tomato season for me. So despite we have gotten a tremendous amount of either periods of drought in Atlanta or just massive amounts of rain, which typically is not what you want for your, for your tomato garden on. But my team can attest to the insane number of tomatoes that I have brought in to share because we have run out of things to do with them at my house. So we have all the frozen spaghetti sauce and salsa that we can absolutely handle. Then I would say the thing that has not done well in my garden this year, which is surprising, is my zucchini.
Daniel Williams:Okay. Okay.
Jamie Threatt:But tomatoes. It's been a big tomato year
Daniel Williams:That's for so interesting because my brother has a garden. He lives in Birmingham, right down the road from you, and he keeps sending me just random pictures of these zucchini that I'm going, Dude, you need to put that in the Guinness book or something. This is crazy.
Jamie Threatt:Yeah. I think I harvested I think it's July 14. I believe I may have harvested two zucchini this whole year, which is done. Sad. It's really sad.
Jamie Threatt:Like, to the point where I think we just I think we just call it done.
Daniel Williams:Okay. Pam, cheer us up. What give us something that you've got going on that's not work related.
Pamela Ograbisz:I don't have a good old lady hobby like that, which is what I Jamie knows. I I tease her about that all the time. I I very much am the recipient of all of her extra tomatoes
Daniel Williams:Okay.
Pamela Ograbisz:Which I greatly appreciate. I do not have the green thumb. I'm a pretty avid tennis player, so I spend a lot of my time doing that. I also I have two children, but I have two girls that now my last one is heading off to Auburn in the fall. Great.
Pamela Ograbisz:And so everyone, yeah, empty nester. I think I'm gonna have to figure out a few more hobbies. Maybe I'll try and grow a zucchini. I don't know. Okay.
Pamela Ograbisz:The world's my oyster. So- It really is.\ See, place keeps me pretty busy. I travel a fair amount for this. My husband's a pilot, so we do harken around. But I would say probably for your audience, I highly recommend tennis, pickleball.
Pamela Ograbisz:Get out there. Be active. It's always good good for the soul.
Daniel Williams:It sure is. If you ever want empty nester advice, ask me. It's usually me in a fetal position crying because I'm missing my daughter so much. She has just graduated from college, so tomorrow morning at 7AM, I'm flying to San Diego to fill up a U Haul to move her back here where she's gonna be parked for a month until she starts grad school, then we'd get to do another U Haul in a month. Is parenting It one zero one is.
Pamela Ograbisz:It is. And then, know, you're and it's so lovely to watch them grow do all the things. You know, I I don't know if I if I appreciate all the tuition bills, but, you know, I I I'm sure LT really does because they're like, you know, she's not going anywhere. But I I think the the but, yes, it's a it's an exciting time. You know, James gets really young, and I I really remember enjoying those days.
Pamela Ograbisz:But it is really fun to watch them grow and become the people that you hoped they would be. And when they do, it's really exciting.
Daniel Williams:It really is.
Jamie Threatt:Yeah. We're my girls are headed to, fourth and first grade, so I've got I've some got some time.
Daniel Williams:It goes fast. Cherish every moment. Cherish every moment. That's my unsolicited advice. Pam, Jamie, what a pleasure to get to hang out with y'all, learn about care design, gardening, parenting, empty nesting, all the things.
Daniel Williams:So y'all are awesome. Thank you for joining us today.
Pamela Ograbisz:Thank you. Yeah.
Daniel Williams:All right. Everyone listening, we're gonna put a lot of links because we have given y'all so much advice today that are about things you probably have no idea. So we're gonna give you some tomato recipes, some care design links, all the things will be on there. Until then, thank you all so much for being MGMA Podcast listeners.
