Culture, Innovation, & Resilience: Lessons From a Servant Leader
In Episode 12 of the “Achieving Health” podcast, host Chad Mulvany shares the latest healthcare policy and legislative updates for the week of November 16, 2025. Then, Kevin Locke, managing principal of our Healthcare Consulting practice, joins the podcast for a conversation with special guest Tom Strauss, senior partner at CEO Advisory Network and former health system CEO. Tom shares lessons on culture, innovation, resilience, and service from a 50-year career in healthcare leadership.
Transcript
CHAD MULVANY
On today’s episode of Achieving Health, I’ve got the latest policy and legislative updates from Washington, D.C., for the week of November 16th, 2025. Then, my colleague Kevin Locke, managing principal for Healthcare Consulting at Forvis Mazars, will join the podcast for a conversation with Tom Strauss, co-founder and Senior Partner at CEO Advisory Network. Tom is also the former CEO of Summa Healthcare System and Sisters of Charity Health System.
Tom will share lessons on culture, innovation, resilience, and service from his distinguished career in healthcare leadership. It’s a fascinating conversation. Please stay tuned.
ANNOUNCER
This is Achieving Health, a podcast from Forvis Mazars, where we delve into the topics that matter most to healthcare organizations across the continuum of care. Our goal is to help you navigate the dynamic healthcare landscape and achieve health at your organization. Here’s your host, Chad Mulvany.
CHAD MULVANY
Welcome to Achieving Health. I’m Chad Mulvany, director in the Healthcare Practice at Mazars. Thank you for joining me. We’ll begin the day with our Washington Watch segment, where I share updates on the most recent actions of federal policymakers and their anticipated impact on healthcare providers and payers. Today’s Washington Watch reflects information as of 10 a.m. Eastern Time on Friday, November 14th, 2025.
My comments on these discussions are based on what’s being reported by the D.C. trade press at the time of the conversation, mixed with a lot of judgment about where things may go, based on my experience in D.C. So, today’s remarks reflect information as of this moment and will likely change.
As far as our agenda is concerned. I’m happy to report that Congress passed legislation that has lifted the government shutdown, extends key healthcare policies until January 30th, 2026, and mitigates the potential PayGo 4% sequester that might have otherwise been implemented due to the deficit increase as a result of OB3. Unfortunately, an extension of the enhanced exchange subsidies was not included in the bill, and the prospects for an extension are still up in the air.
We’ll also talk about efforts to improve affordability, which are related to, kind of, the shutdown drama. And even though an extension of the enhanced subsidies wasn’t included in the package that was passed in November 10th, senate Democrats are expressing confidence that they can reach a bipartisan agreement to extend them before they expire at the end of the year. However, Republicans are reportedly working on an alternative package to address healthcare affordability.
On a bit of economic news that has implications for out-of-pocket collections, there are a record number of subprime borrowers that are missing car payments in October, and so delinquencies among some private auto borrowers have reached a record high, with 6.65% of loans at least 60 days past due in October, according to Fitch Ratings.
We also, on October 31st, since we last spoke, had the CMS physician fee schedule final rule released for calendar year 2026, and we’ll cover a couple of the key changes at a high level. And then finally, we’ll talk about employer sponsored insurance sticker shock. The 165 million Americans with employer sponsored insurance are expected to face a 6.5% average increase in healthcare costs, making these the steepest rise in 15 years.
And again, I anticipate that this could potentially show up both in future contract negotiations as additional pressure on rates and at the point of service as increased uncompensated care.
Finally, last thing before we dig in, just want to note that as of this morning, as of Friday morning, 11/14, we are still waiting on the Outpatient Prospective Payment System final rule. I would have thought that given that PFS came out two weeks ago, we would have it by now. But as soon as we get it, we’ll put out a FORsight on it, and we’ll certainly cover it in the next episode.
So, with that agenda laid out, let’s get into our program.
In terms of the shutdown, or the ending of the shutdown, on November 12th, 2025, President Trump signed legislation ending the partial government shutdown. The package includes three full-year spending bills and includes a short-term continuing resolution to fund the other government departments not included in the full-year spending bills through January 2026. So this now gives Congress a little bit of time (not much) to potentially negotiate the rest of those spending titles. The bill also, as I mentioned, extended key health policies through January 30th, 2026 and wipes the PAYGO scorecard clean, or the SPAYGO scorecard clean.
However, again, does not extend the enhanced exchange subsidies. Those tax credits are scheduled to expire on December 31st, 2025. In exchange for voting to advance the measure, Senate Majority Leader John Thune has committed to holding a vote on extending the tax credits in the coming weeks. Speaker Johnson in the House has not promised a similar vote, and I am increasingly skeptical that these will be extended.
The Urban Institute estimates an expiration of the enhanced subsidies would increase uncompensated care nationwide by $7.7 billion. That’s 12% relative to the $66.7 billion baseline. The burden of additional uncompensated care would fall on the following provider types: $2.2 billion on hospitals. $1 billion on physician offices, $3.1 billion on other services, and $1.5 billion on physician drugs with non-expansion states more heavily impacted. As the likelihood of an extension of the enhanced ACA subsidies decreases, providers will want to focus on improving processes to connect patients with other sources of coverage, improving upfront patient liability collections for non-emergent services, and consider reevaluating financial assistance policies.
We explored many of these revenue cycle improvement strategies in the third installment of our OB3 Tuesdays series, and the link for that is included in the show notes. We also have a FORsight article that unpacks how hospitals may want to reevaluate their financial assistance policies, and we’ve also dropped that into the show notes as well, in case you’re interested.
In terms of the extenders, while the legislation doesn’t extend the credits, it does include language that addresses a number of key issues and extends them through Jan 30th, 2026. These include, but are not limited to, a further delay of the ACA’s Medicaid Disproportionate Share Hospital cuts, extending the Medicare dependent and low volume adjustment programs, continuing the telehealth, geographic and originating site waivers, along with the other COVID-era flexibilities provided through the Consolidated Appropriations Act of 2023, extending the Medicare Hospital at Home waiver, extending the Medicare Geographic index floor, and also providing $1.4 billion in Community Health Center funding.
The cost of extending these policies is offset, not surprisingly, by a one-month extension to the 2% sequester and an additional $400 million reduction in the Medicare Improvement Fund. Last piece of this, that was included, and certainly a big win for providers, was the statutory SPAYGO Medicare sequester.
So in addition to providing short-term extensions of the health policies we just discussed, plus a few others, the legislation wipes clean the SPAYGO scorecard. So this eliminates the risk of a 4% sequester that could have been applied to all Medicare payments in 2026, due to the $3.4 trillion increase in the deficit projected by the CBO that’s attributed to OB3.
Given the results of the election on Tuesday, November 4th, there’s certainly becoming a more focused emphasis on affordability. Obviously, Democrats have been focused on addressing affordability through extending the enhanced exchange subsidies. Republicans now are becoming aware of the exposure that they may have through the midterm elections, if they don’t do something about it. And so, what you have now is Senate Democrats continuing to express confidence that they can reach a bipartisan agreement to extend them before the end of the year.
However, there are some Democrats that are starting to acknowledge that the premium hikes in 2026 may already be unavoidable. The other piece, kind of from the Democrats side, is that even if Senate Democrats can craft a bipartisan deal, the House presents another obstacle. Speaker Mike Johnson has not committed to advancing an ACA subsidy extension bill, and Republicans are pushing for conservative modifications, such as lowering income eligibility caps or restricting subsidies from covering certain services.
And these are provisions that are unlikely to gain Democratic support. A handful of House Republicans, as I mentioned, do see some political risk in letting those subsidies go and are considering a discharge petition that could force a vote. But it remains uncertain whether they would do this and sort of go against President Trump’s wishes.
As the deadline approaches, both chambers face mounting pressure to balance those ideological differences to prevent steep premium increases for millions of Americans. You have a handful, also alternatively, of GOP figures, including senators Bill Cassidy and Rick Scott, that are advocating for alternatives to an extension of the ACA subsidies. These would include things like giving money to individuals through tax-advantaged savings accounts that would allow individuals to manage their own health spending directly.
President Trump has endorsed this approach, arguing the funds should, instead of being directed to insurance companies, should go to consumers. However, Republicans still remain divided, and they’re currently holding listening sessions. Certainly, you’ve got more moderates, those who are in swing districts, favoring a temporary extension of the subsidies to buy time for broader reform, while others are pushing for a more ambitious overhaul of the healthcare system.
The challenge for Democrats will be keeping Republicans focused on compromise around the ACA credits, while Republicans weigh whether to pursue collaboration or pursue independent proposals. It’s unclear what, if any, legislative package will emerge at this point. It’s possible that an expansion of Medicare site-neutral payments and the No UPCODE Act affecting Medicare Advantage plans might be included as offsets.
I will note that what’s been interesting to watch over the last, call it week or so, is that there seems to be enough concern about the prospects for the No UPCODE Act by Medicare Advantage plans that just about every trade press article I’ve read over the last week or so, that’s been related to the shutdown and also sort of healthcare packages that may come out between now and next year, have included pop-up ads encouraging Congress to vote against the No UPCODE Act.
So it’s just kind of an interesting temperature check. In terms of kind of the impacts of the potential consequences of not extending the subsidies, but then providing funds through tax-advantaged accounts, economists and policy experts warn that funding directly to consumers through HSAs or FSAs could significantly reduce ACA enrollment as healthier individuals might opt out. Should this occur, it would increase premiums for those who remain in the market, potentially leading insurers to withdraw from the marketplace.
And this is probably more likely if provisions in the legislation are included, that would expand things like the availability of short-term, limited-duration insurance and association health plans. While it’s too soon to handicap the likelihood of a legislative package that includes these provisions, it certainly is something that we’ll continue to watch and bears watching.
On an economic note, as I mentioned at the top, there were a record number of subprime borrowers who missed car loan payments in October. Delinquencies among subprime auto borrowers have reached a record high, with 6.65% of loans at least 60 days past due in October. According to Fitch Ratings, this is a record dating back to the early ‘90s. Subprime borrowers are obviously those with weaker credit histories who are particularly vulnerable as high borrowing costs, rising living expenses, and dwindling savings are straining budgets. And we’re starting to see a widening gap between subprime and prime borrowers, which underscores the uneven impact of economic conditions, with vulnerable households bearing the brunt of rising costs and limited financial flexibility.
I think the implication for providers is that typically people pay their auto loans first before anything else, even typically housing. And that’s a rational thing to do if you’re in that situation because if you don’t have a car, it makes it much harder to either drive to work or look for a job if you happen to be unemployed. So, I guess my takeaway from this is that, if we’re seeing defaults on subprime auto loans, we’re likely going to be seeing, if not already seeing shortly, an increase in uncompensated care, particularly at safety net hospitals.
Same strategies that I talked about with the potential end of the enhanced exchange subsidies, like upfront collections for non-emergent services, improving efforts to connect patients with other forms of coverage, or, failing that, kind of looking at financial assistance policies, making sure they meet the community, and also thinking about how you’re connecting people with that assistance are all viable strategies for addressing these challenges.
Given what we know at this point, I’d even like to think of that as starting to become no-fail strategies. In terms of the physician fee schedule final rule, on October 31st, 2025, so Halloween, CMS released the Medicare Physician Fee Schedule Final Rule for calendar year 2026. The rule is over 2,300 pages and is detailed. What I take from this is that CMS probably also hands out pennies and floss at Halloween when you go trick or treating.
I will say this summary is not meant to be an exhaustive discussion, but I want to flag just a handful of items. Key changes in the rule include the conversion factor, the calendar year 2026 qualifying alternative payment model conversion factor. So, for those professionals that QP is $33.57, that’s decreased slightly from the proposed of $33.59 but is still a 3.77% increase from the current conversion factor of $32.35.
The calendar year 2026 non-qualifying conversion factor is $33.40. This is decreased slightly again from the proposed $33.42 and is a projected increase of 3.26%. I think one of the more controversial things that CMS finalized was that, for 2026, it includes an efficiency adjustment to work reviews and the related inter-service portion of physician time for non-time-based services, based on the assumption that efficiency in performing these services should increase with experience.
You see, CMS is using the prior five-year Medicare Economic Index productivity adjustment, which will result in an adjustment of -2.5%. In the same vein of being somewhat controversial, CMS also finalized updates to the methodology used to calculate practice expense RVUs given the decline in the number of physicians working in private practices and the increase of employment by hospitals and health systems.
For calendar year 2026, the agency will recognize greater indirect costs for practitioners in office-based settings. In terms of telehealth, CMS finalizes three significant changes to regulations related to telehealth. First is the subsequent visits and critical consultations. CMS permanently removes frequency limitations for subsequent inpatient visits, subsequent telehealth visits, and critical care consultations provided via telehealth.
In terms of direct supervision, CMS permanently redefines direct supervision to allow the physician or supervising practitioner to provide it through real-time audio and visual interactive telecommunications, so it excludes audio-only, and except for services that had a global surgery indicator of 10 or 90, virtual direct supervision may be provided for applicable incident to services diagnostic tests, pulmonary rehab services, cardiac rehab services, and intensive cardiac rehab services.
This change also applies to FQHCs and RHCs. And then finally under telehealth, kind of under that same bucket of supervision, related to residence, the COVID-era policy allowing teaching physicians to provide virtual supervision to residents in all teaching settings was set to expire on December 31st, 2025.
CMS did not initially propose extending this policy. However, based on comments, CMS finalizes a policy that permanently allows virtual supervision of residents, but only for cases in which the service itself is virtually furnished. And so, beyond kind of the policy change there, I think that underscores not only the importance of submitting comments when CMS issues regs, but even if they don’t address a particular issue, if it’s something that’s important to you, please make sure you write a paragraph or 12 on it.
For FQHCs and RHCs, the rule allows them to use optional add-on codes for APCM to bill for behavioral integration and COCM services when RHCs and FQHCs provide advanced primary care management. In addition, effective July 1st, 2026, RHCs and FQs are required to report HCPCS codes G0512 and G0071 that make up both the COCM and communications-based technology services and remote evaluation services.
In terms of the alternative payment models, CMS finalized a mandatory payment model, the Ambulatory Specialty Model, for physicians treating Medicare fee-for-service patients with heart failure and low back pain. It runs for five years, so performance year 2027 to 2031, and will impact payments occurring from 2029 to 2033. The model aims to incentivize chronic disease prevention and management through performance-based adjustments. The adjustment range will start at +/-9% and increase to +/-12%. The model is not budget neutral and so similar to the Home Health Value-based purchasing model, CMS will retain a portion of the savings, in this case 15%, of the withhold to guarantee savings for the program. The model will draft specialists in 25% of core based statistical areas.
CMS will release additional guidance about participant eligibility criteria following publication of the final rule. So I would anticipate that either any time now or sometime in December. The final rule also notes this calendar year 2027 performance year participant list will be released in early 2026 through the CMS website. A couple of thoughts on the PFS final rule. The positive payment update stems from provisions in MACRA and the recently passed OB3.
It’s important to remember that the change in OB3 was one year only for 2026. So in 2027, physicians will have to again lobby Congress to get a more generous payment update. In terms of what MACRA required on this, obviously it requires different conversion factors based on whether you’re qualifying or not qualifying in APMs and so the portion of the update related to QPing is 0.75%. And for those that are nonqualifying, it’s 0.25%.
So obviously there’s some value there in beyond kind of the experience, the savings that you could possibly generate. There’s value in participating in alternative payment models. Groups representing physicians are going to continue, given the issues we just talked about, to advocate for more durable reforms to the conversion factor, if this point still hasn’t seen legislation on what that might look like.
I know some of the associations representing the docs have been working on this but haven’t seen anything yet that’s hit paper or hit The Hill yet as draft legislation. While the payment update is positive, some specialties could see a decrease in per-service Medicare revenue due to the changes in practice expense RVUs and the implementation of an efficiency adjustment.
The efficiency adjustment will negatively impact providers who mostly bill non-time-based CPT codes, while benefiting those who bill time-based codes. And then the change in practice expense RVUs will negatively impact hospital-based providers while benefiting those remaining independent office-based providers. Regarding the ambulatory specialty model, given it’s mandatory and CMS will retain a portion of the withhold, it’s hard for me to see how it’s not going to generate savings.
Therefore, it’s likely that CMS will not only expand the current incarnation to other geographies. So low back pain, heart failure gets expanded to other CBSAs, but I would imagine that as they look at those high volume, chronic conditions that aren’t low back pain or heart failure, that we will see an expansion to other conditions. We have a detailed FORsight coming that will unpack the rule and we’ll make that available as soon as we have that finalized.
Last thing I want to cover: employer-sponsored insurance sticker shock. While price hikes in the exchanges have received a lot of the trade press oxygen, the same phenomena, though for different reasons, is occurring in the employer-sponsored market. This fall as open enrollment begins, the 165 million Americans with ESI are expected to face a 6.5% average increase in healthcare costs per employee, making this the steepest rise in 15 years.
As a result, many employers plan to offset these costs by raising premiums, deductibles, co-pays, and out-of-pocket maximums, shifting more of the financial burden onto workers. Employers can expect paycheck deductions for health coverage to climb between 6% and 7%, and that’s nearly double the projected 3.1% average merit raise.
This widening gap between healthcare costs and wage growth could lead to significant financial strain for many insured workers. Hospitals should prepare for continued contentious rate negotiations with employers and their TPAs. They will need to use price transparency data that’s available through the transparency and coverage requirements to benchmark their existing rates to peers to help make the case for why they need additional rate increases.
Further, given that employers are shifting more of these cost increases on to their employees, again, they’re going to need to improve processes for collections of cost sharing at the point of service for non-emergent services. They’re also going to need to revisit their processes for qualifying individuals for financial assistance, to ensure those who are qualifying or should qualify will not get billed. I feel like there’s kind of a theme to this episode.
This concludes today’s Washington Watch. Up next, we’ll have a conversation between my colleague Kevin Locke and our special guest, Tom Strauss.
I’d like to welcome back to the podcast Kevin Locke, our managing principal for healthcare consulting at Forvis Mazars, for a conversation with Tom Strauss. Tom is a founder and senior partner at SEO Advisory Network, and previously served as CEO of Summa Health System and Sisters of Charity Health System. Tom is also the 2025 recipient of our Charis Executive Impact Award, which Forvis Mazars presents annually to a healthcare leader who has demonstrated the qualities of grace, kindness, and life over the course of a distinguished career.
CHAD MULVANY
Kevin, I’ll turn it over to you and look forward to the conversation.
KEVIN LOCKE
Thanks, Chad. It’s always fun to join you on your podcast. I think you do a great job with it, and it’s always an honor to be a guest. And it’s even more of an honor to be joined by Tom Strauss. Tom, you and I go back in our careers a long way, and you were honored this year with the 2025 Charis Executive Impact Award, which Chad just mentioned. And, congratulations on that. It’s been really fun to kind of share a bit of our professional journey together so, congratulations.
TOM STRAUSS
Well, Kevin, first of all, thank you for inviting me to come on and chat. Kevin and I go back many, many years, probably more years than we want to comment.
KEVIN LOCKE
Let me just spend a couple of seconds on the Charis Healthcare Impact Award, and then we certainly want to talk about your career a bit on today’s podcast. And you know this well, but for the sake of the folks joining us, our Charis Health Executive Impact Award is given annually to someone who’s had a long and distinguished career in the healthcare field.
And we built the award around three key themes: grace, kindness, and life. And grace, we talked about things like serving as a generous ambassador for the organization and for a healthcare industry. Kindness. We talk about things like living out, caring and compassionate spirit. Which I know as part of, Tom, been your healthcare journey and a lot of why you ended up in healthcare. And then in life we talk about leading an organization forward, right? Breathing life into the organization.
So as you think about those three things, grace, kindness, life, I think, Tom, they’ve described your career pretty meaningfully, but maybe spend a minute or two just kind of sharing your career highlights for the sake of the folks joining us today.
TOM STRAUSS
Sounds great, I’d love to. So I grew up in Pittsburgh. I’m the son of a steelworker, so I really have very much of a blue-collar background. I worked five years while in college for pharmacy at Duquesne University in the U.S. Steel mills and was a hooker and a mobile equipment operator. So I saw firsthand, one, the work of unions and some of the activities. there.
But secondly, the need and the interest for me to stay in the professional area. So I went to school to be a pharmacist. I worked in many of the hospitals in Cleveland, I mean, in Pittsburgh. And then I was recruited by American Hospital Supply Corporation in 1983 to start one of the first home infusion pharmacies in the country in Pittsburgh called American Continue Care.
And three mergers and four name changes later, in six years, I was vice president of Caremark for central U.S, but in 1989, I left Pittsburgh to come to the Meridian Health System. I really wanted to come back into hospitals. That was my love. And I decided to come to Cleveland and it was tough as a Pittsburgh Steelers fan, I want you to know. I enjoyed that involvement.
We had four hospitals in Cleveland, and I was president of the Meridia Institute, which was actually a business incubator. So innovation has always been a part of my, what I loved. And we started 13 companies during that period, everything from home infusion to home nursing to mobile MRI. And in ‘92, I took over my first hospital, which was Meridia Suburban Hospital, a hospital that had been struggling, losing money, and we were able to do a turnaround and finally grew to the point where we needed more space.
And I ended up merging with the hospital next door called Brentwood Hospital. The merger was a DO and an MD merger, which was somewhat unusual at the time. And in seven months, we renovated one at Brentwood and converted Suburban into an outpatient facility, and the new hospital was called Meridia South Point. It was one of the most challenging things I ever did in the seven months.
I went on to run the service lines at all four of the Meridia hospitals. But in ‘95, somewhere around there, we merged with the Cleveland Clinic, and I was then recruited to come down to Summa Health System in April of ‘99, became CEO in January of 2000, and had a 15-year career, which was really one of the most pleasurable times I ever had.
I had the opportunity to retire at the end of 2014, came out and immediately flunked retirement. Called a bunch of my friends that had run health systems and said, look, you’re a lousy golfer. Let’s go do something together. And we put together what today is called the CEO Advisory Network. Really, to give back to the industry.
Shortly after that, in 2017, I was approached by a headhunter for the Sisters of Charity, and I knew the congregational leader, Sister Judith Ann. And I called her and said, sister, look, don’t bring in a new CEO that doesn’t know this market, let me do this for you. And you don’t have to sign a contract or anything like that. I thought I’d be there a year or two. I was there five years, and we were able to sell a hospital to the Cleveland Clinic.
We were able to pay off all the debt and, really, created three community foundations working on the social determinants of care. Now, today, I’m back at the CEO Advisory Network, continuing to flunk my retirement, but have enjoyed it thoroughly and enjoy giving back to healthcare.
KEVIN LOCKE
Well Tom, again, it’s been fun to walk alongside that journey with you for at least parts of that career you just described. And you highlighted a couple of things that I want to pull on a little bit here, Tom. One is innovation. One is service to the community. I know that was a really big focal point for you at both Summa and at Sisters of Charity and I’m sure prior to those stops in your career.
So, innovation, community service, and then another one that I want to talk a little bit about is culture, because I know you spent a lot of your career in developing really dedicated and committed cultures within the organizations that you led. So maybe just talk about each of those three themes a little bit, how you kind of approach innovation, your commitment and passion regarding community service, and then how you build a culture in a great organization.
TOM STRAUSS
Yeah. Maybe I could start with culture, because that’s really what, in my opinion, the most important thing you can do to live your, you know, values, mission, vision and values and instill those in the organization is a critical piece of the future. So if you think about healthcare, it is a right and it’s a noble profession, and we care for patients in their most vulnerable time.
So those patients that we care for deserve our best. And I’ve always had the interest to create a vision around providing the highest quality but compassionate care to our patients and to contribute to a healthier community. And one of those philosophies we’ve had, and I’ve had it for years, is called servant leadership.
You remember Robert Greenleaf started that way back in the ‘70s, but it basically says that, and we had a motto at Summa Health System where we flipped the organizational chart upside down, and I was at the bottom, the patient was at the top, and our job was to support those people at the bedside. And we had a motto that we said that if you’re not serving the patient, you better be serving someone who is. And we worked extremely hard, not only at the senior level, but at the management level to educate every employee around the philosophies of Summa and how this servant leadership is something that was important for the future.
So, and then we took that one step forward, and that is to improve the health status of the communities we served. And because at Summa, we had our own health plan, we were able to go at risk to improve the health status of those people that we served. And look at total cost of care, which I know, Kevin, you believe is the future direction.
KEVIN LOCKE
I do.
TOM STRAUSS
But that authentic value-based leadership is so critical. And, in fact, I just this week was reading Warren Buffett’s retirement letter. I don’t know if you had a chance to see it?
KEVIN LOCKE
I have not, no.
TOM STRAUSS
And he talks about that greatness does not come through accumulation of great amounts of money, great amounts of publicity, or a great amount of power in government. When you help someone in any of thousands of ways, you help the world. And that kindness is costless, but also priceless. Whether you are a religious person or not, it’s hard to beat the Golden Rule.
And as a guide to behavior, don’t beat yourself up over the past mistakes. Learn at least a little from them and move on. It’s never too late to improve. And I thought that philosophy was amazing. So, spoken by the General.
KEVIN LOCKE
That’s really great and great timing to pull that in, right as he’s kind of going through his own process here this week and, Tom, again, I’ll just recognize and give you credit. You have done many of those things at every step of your career: building culture, kindness, leading with kindness, Golden Rule, putting others first, flipping organizational charts on their head. All of those things have been core to who you’ve been. So I want to thank you for that level of service that you’ve provided to, really, the healthcare industry and the communities that you’ve served.
Let’s maybe pivot a little bit, Tom, and a little less look back and a little more look forward. As you sort of take some of those lessons learned in the career that you’ve had and the leadership principles that you’ve brought and shared with us even today, what would you kind of take and say, you know, the insight, or one or two key insights or lessons learned that although you look back on your career and say, that’s what I learned, can also serve us moving forward, right? What are those one or two critical lessons learned that today’s leaders in today’s healthcare environment should be working on and taking into the future that we’re headed into?
TOM STRAUSS
I think what’s critical is you can’t rest on what you’ve been successful at in the past. Honestly, if you think about where we’re heading, and I know we’re going to talk about this, but the challenges we face today in healthcare are beyond anything that I’ve ever seen in my 50 years in healthcare. The OBBBA, if you look at the results of that, it’s going to be more than $911 billion in Medicaid spending reductions over 10 years.
We’re going to see a 21% increase in the uninsured population of the country, and over 24 million Americans could see their insurance premiums increase by almost 93% on average. So this oversight of our health system has to change. So we have to evolve innovation, speaking of that. Artificial intelligence is going to be a critical piece of our future.
You know, the statistics of the shortage of healthcare providers, you know, a recent study showed that 340 million people in the U.S. and about a million active physicians as of 2023; however, they predict a shortfall of 328,000 nurses, registered nurses, 42,000 licensed practical nurses and 33,000 nurse practitioners through 2032. So, there’s no way we can repeat what we’ve done in the past.
We must innovate, and a lot of those innovations are going to work around artificial intelligence. I would say that’s probably the most important piece. The other piece is, you know, there’s a lot of burnout, with our staff and our physicians, and we have to employ the ideas of empathy and respect and supporting those people at the frontlines, giving them answers and creating a noble vision that they can get excited about and move forward with. So I would say those are sort of the two areas that I would go.
KEVIN LOCKE
That’s really well said. And you mentioned your 50-year career, it’s been characterized by lots of change over time. And certainly, we’re in yet another period of change, as you mentioned, the OBBBA and all of the impact that’s going to have. You mentioned artificial intelligence. You mentioned innovation. So it’s yet another period of change that hospital administrators and leaders in all industries are facing.
So, thank you for those insights. Let me, let me take this idea of kind of OBBBA and current change in our market, Tom, and pull it a little bit further. What do you think is kind of an opportunity that maybe some of your peers, some of the folks that are leading hospitals today, what do you think are one or two of the opportunities out there that they might be overlooking? Opportunities to tap into for better outcomes, for access, for growth, for cost efficiency, those kinds of things?
So, yes, we’re in a period of change. Yes, we’re in a period of challenge related to the OBBBA, but what are some of the opportunities that exist in the marketplace as well?
TOM STRAUSS
I would say probably the biggest opportunity is to improve the way healthcare is delivered. And I think some of that may be underappreciated, among healthcare leaders today, I think you’re aware the new CMS administration is aggressively planning to reduce healthcare cost and move Medicare to 100% value-based payment system, and Medicaid, over the next few years.
And I believe that every health system must develop a strategy and financial approach to building value-based payment, including the development of clinically integrated networks or accountable care organizations. So we have embarked upon that, and I know, Kevin, you’ve been a champion of this for years to help health systems really look at what are the fundamental priorities in that movement, from fee-for-service to value, and what are the accomplishments in the categories that they have to work on, because you can get in a lot of trouble if you go a little too early, but you can’t sit back.
And that’s why so many people today are trying to figure out what they’re going to do with Medicare Advantage. Medicare Advantage is not going to go away, but you must find a way to work with these payers in a new way. And I’ve seen some wonderful examples.
I can tell you, Mark Clement from Tri Health in Cincinnati is one of the health systems that historically has done very well on fee-for-service but has completely moved the organization to value-based contracting and is now doing extremely well in both. And he’s created a culture around that that has really engaged the workforce, engaged the medical staff, which is another critical priority to be successful for the future. So that’s just one example of something that’s worked really well.
KEVIN LOCKE
And a great one. And you’re right, you and I and others have been very passionate and dedicated and committed to this idea of helping the industry make the transition from volume to value. Of course, we’ve been talking for a long time about it and just trying to create the momentum behind it. And I totally agree with you that anything we can do, any partnerships, any ideas, the Tri Health example, that you learn from and drive that forward is absolutely going to be critical in the coming years, and I think has been over the last few as well.
You know, you in your role and any kind of healthcare leader, there’s this dynamic of leading the organization, but also kind of interacting with other community leaders that are critical to hospitals and to communities. And then there’s also policymakers and regulators and others. So there’s this really intimate dynamic between the organizations, the community leaders, the policymakers, etc.
What advice would you give to health system leaders to more effectively connect the dots between themselves, community leaders, policymakers, etc., to better understand and move these initiatives within healthcare forward? How would you kind of help folks connect those dots a little bit better?
TOM STRAUSS
Well, first of all, that’s a great question. And it’s a key priority for not only the CEOs of health systems, but other people on that C team. And, I think you understand that today, healthcare institutions are not only responsible for advancing the well-being of patients and employees but also ensuring trust and transparency with their care networks.
And unfortunately, today, that trust has been tested. I think you know, a statistic only 25% of Americans believe that hospitals’ priorities are patient care over profits. And that’s a drop of over 50 percentage points since 2021. And I recently read an article about, I think it was in Becker’s, where Damon Boatright, who’s the president and CEO of Hospital Sisters Health System in Illinois, a great leader.
He outlined the message of what we can do to try to do that, we have to engage not only with our own employees and physicians, but also with the public. And that, he gave a couple points. One is model transparency in every communication. Two, champion integrity by ensuring that our teams have the tools and support to communicate truthfully and respectfully.
Three is to give intentionally, especially by ensuring that our community benefit efforts are measurably addressing the community needs and then promoting that out into the community. Fourth is to lead with empathy and acknowledge that events like cyber breaches are unsettling. Five, bring clarity and offer consistent opportunities for conversation. Stay visible at the bedside, on the floor, in the boardroom, and in the community.
And then finally, six, reinforce financial accountability through transparency by continuously reviewing and sharing billing and collection practices. So, as an example, at Summa, we actually created a white coat session for the community. We would invite community leaders in from government, from business leaders, and we would have them spend a day with us in our health system.
We would give them a white coat. We would spend the day; they would tie up with one of our physicians. So, they saw the good, the bad, and the ugly of the challenges. And at the end of the day, we would have a summation of that. And it was probably the most impactful thing that they experienced and tied them to our organization to create, to restore and strengthen the trust that is foundational to our country, at least, so we can lead with clarity, courage, and conviction. That’s really what we need to do.
KEVIN LOCKE
That’s that’s great stuff. And I’m going to give you maybe one more chance here to summarize, Tom, just maybe with a final question. As you kind of look back and maybe think about the very beginning part of your career, there are others, right, entering the healthcare industry for the first time. There are others who are stepping into hospital and health system leadership roles right now, maybe for the first time in their careers. There are folks who are taking on the challenges that you and I have been talking about for the last 20 or 25 minutes, really, for the first time in their careers.
So maybe think about that group of folks early in their career, stepping into the environment that you’ve been describing with the challenges, with the opportunities that we’ve talked about. What’s maybe the one piece of advice you would give to someone in that spot right now stepping into a leadership role, maybe for the first time in healthcare, in the environment that we’re in today? What piece of advice would you give?
TOM STRAUSS
I would say probably the most important thing is you are taking on a blessing, an opportunity to serve people in their most vulnerable time. So the work you’re going to do is noble work. But also, nobody ever said it was going to be easy. And so, you got to be prepared and develop resilience to be able to move this thing forward.
And you have to model the values of your organization. And that includes ethics and integrity and individual responsibility and servant leadership. And be prepared to adjust and correct, because there will be times when you make mistakes, you will learn from those mistakes and move on. And you need to know that you won’t have all the answers. You must surround yourself with a team of people and give them the ability and the authority to challenge you if we get off track.
And the last piece is I, when I was at Duquesne, I had a poster in my room that had a picture of the ocean with the sun setting over the sea and it said, the important thing is this: to give up what you are for what you can become, so that courage and resilience is going to be critical in your future, and enjoy the ride.
Take time to support yourself. You need to, you know, continue to have whatever your release is. Running, your faith, your family, your friends. But, if you love what you do, and I hope you do, you will never work a day in your lives. So that would be the summary.
KEVIN LOCKE
That’s awesome, Tom. And thank you so much for your thoughts today. Thank you for your long and distinguished career. Thank you that when you talk about the kinds of things you just summarized, they’re real to you and they really have defined your career over a long and distinguished time period. So thank you for that career. And, congratulations on the Forvis Mazars Charis Executive Impact Award for 2025. And thanks for joining us today, Tom.
TOM STRAUSS
Thank you all. I appreciate it. And, Kevin, look forward to working with you in the future, my brother.
CHAD MULVANY
Tom, Kevin, I want to thank you both for joining this episode. Had a great time listening to your conversation, and I know our listeners will enjoy it as well. I also want to thank our listeners for tuning in and following Achieving Health wherever you listen to podcasts. If you want to learn more about the topics we discuss here, be sure to check out the show notes for related content and information about how to get in touch with me and the team at Forvis Mazars. I hope you’ll join me in two weeks for the next episode of Achieving Health.
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