Hello, and welcome to the Becker's Healthcare Podcast. My name is Will Riley from r one. I'm joined today by Amy Lee. Amy is president of the Nantucket Cottage Hospital, which is part of, Mass General Brigham out in Massachusetts. Welcome to the podcast, Amy. Thank you for having me. So you're on an island, which is fascinating to start with. So so tell us a bit about the hospital and the community you serve. So Nantucket Cottage Hospital is on an island that's thirty miles out to sea. It's a forty nine square mile island, and we have a population that swells by over one hundred thousand during season. So we are the second our island is the second busiest. The airport is the second busiest in the state of Massachusetts in the summer, so our population just explodes. But it's the hospital itself and the community are just so embedded with each other, and the hospital is so supported by the community because they know that in order to be on island, you have to have those health care services. So it's a really nice place to live and work, because it just has the support of a community where a lot of places don't. It it must create some unique pressures for you. Let's talk about that a little bit, because I can imagine as well, and I'm totally speculating, that the folks who live year round are different from the folks who come and visit over the summer demographically. Is that true? There's a very dynamic population in that, you know, we have the year rounders who are generally you know, they've been there a long time. They are working really hard to be able to stay there, those kinds of things. We have our seasonal visitors that you know, we have the workers that are coming on island, but we also have our very rich people that are coming on, and that's the typical person that someone thinks of when they think of standard. Right. Right. But our schools are sixty one percent minority. So Got it's a huge variation in population. We have over twenty one languages that we need to be able to communicate in because there's just such a dynamic population. Okay. So islands are more expensive. Yes. So you've got a cost challenge, probably. Tell us about that, and maybe tell us a little bit about attracting and and maintaining a workforce in that sense. Average home price is four million dollars. Good grief. That's unattainable for most people. So we have to really be yeah. Good that's the best understatement of the podcast so far. Yeah. Yeah. So we have to be really creative about how we house people, how we attract people. And, usually, we're really lucky because people want to be in that environment. They come to the hospital, and you can feel. When you walk through our halls, the the culture is really amazing because it's so incredibly supportive. So one of the biggest challenges that we have is workforce housing. The the hospital themselves, we own thirty eight properties, And then we work in the community to lease other properties and the community itself because it's not just the hospital that has challenges. There's lots of programs, and we just continuously are working with our our partners to see what else we can do to help provide housing. We have a full time position. His it's called a housing coordinator, and he literally works with people. He worked with a hundred and twenty of our employees last year to figure out housing solutions. So it really is one of our biggest challenges. We have a a very large capital campaign going on right now to build both clinical space, but also housing that are one bedroom. Because on Nantucket, we just don't have one bedroom. And a lot of people, especially young professionals, they want their own space. They don't wanna share space. And so that's one of those solutions that we've come up with, and we're now fundraising so that we will be able to build it and attract people. But of our current team, you know, we've this last year, we've hired quite a few physicians, nurse practitioners, nursing, I mean, whole gambit. And it's because we do offer a full package, and we work really, really closely so that the people are comfortable, and they understand what it's gonna be like living on an island because it's hard. You know, there's the beautiful time in the summer, and then there's the January through March where it is you know, the great lady gets her name for a reason, and it's very isolating. So you have to really be able to encompass the whole thing and and embrace that type of lifestyle. How about workforce on the administrative side? Because I could imagine in a community with a with a strong tourism component, you're you're competing with other places for for people in jobs like revenue cycle scheduling and so on. How how does all that We have a very, very small administrative team. We also because we're part of Mass General, we have the ability to centralize some of those services. So, you know, rev cycle, some of the the patient accounts, billing, those kinds of things are off island for the most part. We still have to have boots on the ground, though. We still have to have people that understand that so that they can meet with patients, so they can do the counseling for the finances, all those pieces. So it's not completely centralized, but it is that it allows for not only remote work and that kind of thing, but also support from a main hub because we have so few people. We joke that everybody wears at least eight hats. You know, it's there's just so many jobs, but because we're so small, you know, one person can cover multiple areas. So just how does technology help you with that? I can I can imagine it probably does in some ways, but then maybe if one person's wearing eight hats, then maybe that's tricky as well to to automate? Right? So You know, it's we we use technology in very creative ways. For example, we would never be able to support an infectious disease physician on island. There's just not enough patient volume. It's only about a hundred consults per year. But because we can use technology and telehealth and teleconsults, we can for those about one hundred patients, we can work with Mass General or others, and that brings that resource. And about seventy five percent of those patients are allowed they're able to stay on island, which is huge, you know, because care close to home, their support systems are there. It is really hard to seek care off island, you know, between the ferry and everything else. It just takes a lot of time and effort and money. And so the more that we can provide care on island from a clinical perspective, but also from an operational perspective, the better. Yeah. Right. Right. Makes sense. Tell us about the I'm curious about the payer dynamic and how that plays out for you. Obviously, there aren't payers for Nantucket. So are you and what's your Medicare Medicaid population like? It's significantly high. Yeah. It is quite a bit of it. You know, it's interesting, though, because we have such a unique setting, things like we don't have a VA hospital or anything like that close to us or even for pharmacy. So we have special contracts so that that, you know, VA can fill prescriptions on island. We have we just have to be very creative about the way that we contract with payers so that they understand our dynamic because, you know, we have a large ambulatory population, but we only have a small area for surgeries, for example. So some things like a colonoscopy, which might be in an ambulatory surgery center off island, it's actually in our ORs on island because that is the environment that it is. But patients aren't gonna do it if they have to go off and seek care. Most of them won't. And so, you know, we have to really work with the payers so that they understand that, and they'll pay for something like that. And does that work? Most of the time. Yeah. Yeah. There's a few things. You know, we're we are a rural health center, and there's some there's some hiccups every once in a while. And it takes a lot of negotiating so people understand. You know, you can't just jump on a boat and go you know, they think it's very easy, but it really isn't. We have twelve hundred canceled ferries a year. It is very difficult, and you have to have a plan a and a plan b when you travel. So it's just one of those things. Presumably, you coordinate care with the main Mass General facilities in Boston. Yep. We have so we have Boston Med Flight, which provides a lot of the transport off island for our critical patients. We only transport three percent off island. We are able to take care of ninety seven percent of the patients. But when those three percent, when they need to go, they need to go. And so, yes, we work with Mass General, but we also work with others. Right? If we know a patient is not going to go to Boston for care, and we really need to figure out how to be creative, they might go to the Cape. They might go someplace else where they have a support system. So we're not completely locked in because we really have to consider what the patient needs. Right. Right. Right. Yeah. Okay. Okay. Tell us a bit a bit about community partnerships and community involvement because I'm sure it takes a a lot of relationships to sustain a health system like yours, a hospital like yours. There are zero degrees of separation on island. So there's a you know, everyone's related, or there's always a connection. We talk about a lot of times that health care is so much more than the four walls of the hospital. We really have to work with our community partners for behavioral health, for the support services with the town, everyone. The our nursing home is the only town owned nursing home in the state of Massachusetts. So, again, it's another there's kind of a quirk that you have to figure out. So we spend more time probably working in the community on our health care initiatives, especially on the operational side, than anything because we have to make sure that if the hospital can't do it, there is someone who can do it, and that we're supporting those that group. What's on your mind as you look to next year, Amy, and you think about twenty twenty six? It's really so we have we bring in thirty eight specialties on island and to really help support the patient population. It's looking to expand that in areas where we know where we are leaking patients off island, and we can take care of them on island. It's just trying to figure out those creative partnerships. A great example is, you know, for example, we have an OBGYN who does robotic surgeries and whatnot off island. So she's on island for several weeks, and then she goes off island to keep up her skill set so that she can come back and take care of her patients on island. But she has both. So we really think about how we can expand those services and really provide care. I mean, we have an interventional radiologist, which is unheard of in a hospital our size, but it's because they want to be on island. And so the more that we can help support their practice, it's better for our patients. He does about two hundred procedures that those patients, again, would have to go off island. We have a simulation lab for training, and we do a significant amount of training on the mannequins and everything else because island medicine is it's you know, you're resource poor, so you've gotta figure out how to take care of patients in bad weather and all those other things. We do a significant amount of training, especially for people who are new to the hospital so that way they understand and they're prepared when something does happen. So it's really it's workforce, it's housing, and it's innovation. It's really figuring out how, even as a small hospital, we can really expand our scope and make sure we're taking care of our community. Got it. Amy, it's absolutely fascinating. Thank you so much for for talking to us about it today. Thank you. I'm happy to talk about it. Thank you. Thank you.
