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68 THOUGHT LEADERSHIP 6 Questions With Dr. Mike Schatzlein of Ascension Health By Tamara Rosin M ichael Schatzlein, MD, is a man of many hats. So many, it's a wonder he has time to wear them all. Dr. Schatzlein has more than 40 years of healthcare experience, both as a physician and an administrator. Currently, he serves as senior vice president and group operat- ing executive for St. Louis-based Ascension Health, as well as president and CEO of St. Vincent's HealthCare in Jacksonville, Fla. At Ascension, he oversees operational and financial performance, quality outcomes and strategic growth in the Indiana, Jacksonville and Tennessee markets, and is a leader and advocate of population health management. At home, he is a husband, father, grandfather, music produc- er, remix engineer, keyboardist and trumpet player. In fact, Dr. Schatzlein joked he almost tried to become a professional trumpet player, but aer hearing Wynton Marsalis play, he decided he had no hope. He went to medical school instead. Aer earning his medical degree from Indiana University, Dr. Schatzlein practiced cardiothoracic and vascular surgery from 1980 to 1994, performing the first heart transplant in northern In- diana in 1985. He has worked in the administrative side of health- care since 1994. Dr. Schatzlein took the time to answer some of our questions. Note: Responses have been edited for length and clarity. How does your clinical background and experience inform your methods and strategies in your current role? I have been concerned about the discontinuity in healthcare — the lack of overall coordination — since I was in practice. My desire to develop clinically integrated systems of care goes back to the 1980s and 1990s, and that is why I'm focused today on popu- lation health. I am also a student of Edward Deming, who went to Japan aer World War II to help rebuild their economy. He is the father of the Toyota Way of process improvement. His principles are to reduce variation, waste and rework, though he applied these principles to manufacturing. When you do these three things in healthcare, you can lower cost and raise quality. e idea is to streamline processes to improve the consistency and quality of the outcomes, and cost goes down as a byproduct. My second passion aer population health is improving pro- cesses and safety in hospitals. If you go into an American hospital — with 300,000 preventable deaths occurring across all hospitals — and you look at all of the thousands of processes with the eye of an automotive process engineer, as well as the eye of a physician who believes in evidence-based medicine, you will be astonished. I'm overwhelmed by the opportunities to improve those process- es and improve safety. My experience as a physician led me to population health as the best solution for delivery, and process improvement as the best solution for cost and quality. In your opinion, where do the greatest obstacles in health- care lie? e obstacles in the population health arena are things most people don't talk about. It's the fact that society expects and de- mands more and different healthcare services than they need. If we were to magically switch to 100 percent evidence-based med- icine in this country, doing only things that are shown to make people better, we would save one-third of the nearly $3 billion we spend on healthcare. Quality would go up — and the public would be in full revolt. A symbiotic relationship between physicians and the pop- ulation has developed over the last five decades. Fee-for-service reimbursement models have something to do with it, but I don't know a doctor who intentionally does unnecessary operations. But there is this push-pull going on. For example, I'm a big fan of [rookie quarterback] Marcus Mariota of the Tennessee Titans. If he gets his knee banged up getting tackled on a Sunday aernoon, he'll get an MRI right then. at has led to every pickup basketball player who bangs his knee thinking he needs an MRI right now, too. I was told by a physi- cian that the evidence-based treatment for that injury is six weeks of physical therapy, applied heat and an ACE wrap. If the patient hasn't totally recovered at the end of six weeks, then you get the MRI. And at that point, most of those people won't need the MRI. But the demand is so high that we cave in and we do it right away. is is America — we want everything now. Here's another example. My wife Liz and I were watching a Law & Order rerun marathon one day. It seemed like all of the commercials were for prescription drugs. One drug was for opi- oid-related constipation. First of all, there are far too many people consuming opioids in this country. ere are people who have pain, but our opioid consumption is too high. You can only get narcotics from a doctor. If they have constipation, their doctor should figure out what to do about it. ere are multiple over- the-counter solutions. Maybe the person doesn't even really need to be on the narcotic. Instead, because of these commercials, we have all of these patients demanding prescriptions for the consti- pation medicine. We are one of two countries to advertise pre- scription drugs, spending billions of dollars promoting them. We are pumping demand for unnecessary utilization.