University of Washington Medical Center in Seattle has made significant expansions in recent years, even as other facilities struggle. Even more impressive is the fact that UW continues to be a leading institution on a national level. HealthCare Business News spoke with Geoff Austin, executive director for the medical center, to learn what makes him tick and how UW has managed to stay on a track of success.

HCB News: How did you get involved in health care?
Geoff Austin: My undergraduate degree was in industrial engineering. When I was looking into careers, I wanted to make a difference in improving people’s health rather than designing factories for semiconductors or airplanes. My grandmother was a nurse, and a nurse educator, so I had a family background of wanting to help people. Meanwhile, a classmate of mine was doing a management engineering internship with Kaiser Permanente. I was fascinated by the role. I began conversations with Kaiser Permanente in southern California and that was my first job in health care. As a management engineer, I was focused on implementing improvements in hospital and clinic operations and quality. From there, I decided to attend the University of Washington for an MBA and MHA. After finishing my graduate studies, I went into health care consulting for ECG Management Consultants. That’s where I learned about academic medical centers and schools of medicine. I joined UW Medical Center as the oncology line administrator in 2005, stepped in to the interim executive director position in August of 2015 and was made permanent in January of this year.

HCB News: In the last five years, UW Medical Center has completed some significant additions including a new NICU, operating rooms, ICUs and a surgical unit. Are there any other plans in the works?
GA: Yes. In addition to those, we’ve also opened a new transfusion services lab or blood bank. We brought the product modification services in-house. We also opened a new brain tumor center, new oncology and infusion center, a 31,000-square-foot sports medicine center and another 33,000-square-foot medical and surgical specialties clinic.

We are currently wrapping up a number of significant projects, including four more operating rooms and 42 prep/hold/recovery bays, which are feeders and receivers of our operating rooms. We are also beginning an emergency department remodel with an entrance extension and a cardiac cath lab remodel.

HCB News: How can you afford it?
GA: It’s all been planned over a number of years. The work on the new tower and inpatient units began over 10 years ago. We’re in the second phase of that overall expansion and we’ll be completing the entire project in December, including the prep hold recovery bays and ORs.

We fund all our capital improvements off our own bottom line. The reason we’re expanding is because we continue to provide highly specialized services to people in our region and we have a strong demand for our services.

HCB News: What’s your patient mix?
GA: About a third of our patients have a cancer diagnosis, where we provide complex surgical and radiotherapy treatments as well as provide bone marrow transplants and immunotherapy trials. We perform over 350 organ transplants a year and manage the care for over 1,000 patients with end-stage organ failure. Our Regional Heart Center cares for patients with structural heart defects, congenital heart disease, or patients needing a mechanical circulatory device or heart transplant. We can care for up to 50 preemies in our NICU, and we have the second-most complex birthing mother mix in the country. We also provide comprehensive care for sports medicine, orthopedic and brain and spine patients.

We see more than our fair share of Medicaid and Medicare patients. Our proportion of charity patients now is small since most are covered by insurance expansion driven by the ACA. At the same time, we very much focus on patient experience and provide a great service that attracts the commercially insured patients.

HCB News: How many new positions are being created from the new expansions and how did you go about staffing up for those additions?
GA: It was roughly 120 positions to open all of the new units. We started about 18 months ahead of the openings of the new units to begin the planning. We reassigned bed capacity from other parts of the hospital and conjoining unit operations in a sense. We took staff from existing areas to help in starting up the new units and backfilled the existing units.

We forecasted the ramp-up of patient volumes and determined how many staff we would need to manage the workload. Working from that plan, we began hiring about nine months ahead, knowing our ICU staff would need at least six months of training to get up to speed. We also augmented with agency staff and per diem staff to smooth the bumps in the hiring and training cycle.

HCB News: What attracts staff to UW Medical Center?
GA: We’re in a competitive marketplace. While we have a national reputation, we still need to compete for talent against other excellent health care organizations locally. We pay at market level and have great benefits, but we’re not the top salary in the market. What brings people to us is the collaboration, the people they get to work with, and the commitment to the mission. Nurses and staff participate in the local practice councils. We’re also an innovation center. We are frequently initiating clinical trials where a new device or therapy first becomes available for patients. It makes it exciting and a fun place to work because we don’t do the routine.

HCB News: What challenges does your facility have either at the regional level and/or at the national level?
GA: Two things. In a macro sense, health care is economically very challenging between declining reimbursements and pharmaceutical and medical supply inflation. We have to do our best to grow and expand our services while lowering our costs. Regionally, Seattle is a boom town which is good and bad. Good because it brings in top talent, bad because it has meant rapid increases in housing prices and overall cost of living. It also means increased traffic congestion, which makes it more difficult to get to work. We continue to work with the city, county and university on affordable housing and transportation. The people of Puget Sound have invested in light rail, and the opening of a new station across from the medical center has helped. We need to continue working toward solutions to help people afford to live here and get to work.

HCB News: Any concern about the ACA repeal?
GA: Hospitals, like any other industry, prefer predictability. If we know the regulations, we can plan more effectively. The proposed repeal created a huge uncertainty in our business and the marketplace. It makes it difficult to financially plan for the future if people we were caring for will not have coverage in the future. For example, with the ACA coverage expansion, we know we can provide services that are more effective and timely for people with diabetes and obesity. If they’re not covered in the future, they will continue to struggle to manage their disease. If people are covered, predictably, we can help to ensure a healthy workforce to drive the economy.

Another important current event is implementation of MACRA – the Medicare Access and CHIP Reauthorization Act of 2015, which was not contentious and was overwhelmingly passed by Congress. It is driving improvements toward preventive care, screening and population care that will do a lot in keeping people healthy.

We know a lot about our patients and MACRA drives us to use that information to identify different patient populations, where risks lie, what services they receive, what services they should receive. The only way we’re going to effectively decrease overall health care spending is to connect those dots. Identifying patient populations, risk factors, and figuring out how to keep people from getting sick will do much more to reduce health care spending than managing costs on an incident level. There’s only so much you can do to reduce the unit cost of each care episode.

HCB News: How do you predict health care will evolve over the next decade?
GA: Health care will become much more digital, meaning communicating with our doctors and nurses via email or text, and our EMRs sending out reminders to patients to take their medication or to go out for a walk and exercise. There will be more virtual interactions. Many physician/patient interactions will not need to take place in an office anywhere. Vitals can be taken by a device and communications can take place via video chat. Health care facilities will continue to be more focused on diagnostics and treatment of sick patients.

While digital developments may seem to be driving people out of health care facilities, we’re also facing a continuing aging boomers population. We’re doing really well at taking care of people as they get older, but that also means that the number of people over age 65 will continue to grow as they live longer. For example, we can now replace a defective heart valve via catheter in an 85-year-old patient where previously they might not have been a candidate for open heart surgery. We’re going to continue to see more of these advances. Do we need to build more facilities? Or use the existing ones differently? There’s always going to need to be some expansion in facilities, but I think we will begin to use our existing facilities very differently.