Wellstar Cobb Hospital prez talks COVID, labor shortage, Medicaid expansion

Jun. 23—AUSTELL — The president of Wellstar Health System's second-largest hospital recently shared insights about COVID-19, his personal philosophy toward health care, Medicaid expansion, and the challenges and upgrades his staff are facing.

Speaking at the South Cobb Area Council of the Cobb Chamber of Commerce this month was John Kueven, who has led Wellstar Cobb Hospital for a little more than a year, and previously led Wellstar Paulding Hospital for more than four years.

COVID-19

Kueven agreed that it feels like society is moving toward a more "endemic" period, transitioning away from a pandemic.

Expect the virus to continue evolving into new variants, Kueven said, and for new vaccines to be rolled out, not unlike an annual flu shot.

Kueven said that two months ago, less than 5% of COVID-19 tests in the community were coming back positive. Now, the positivity rate is near 15%.

"I'd say the positivity rate, right now, I think there's actually more people with COVID in this community than ever before," Kueven said.

Wellstar's Dr. Danny Branstetter told the MDJ this month that people who are experiencing allergies or "summer colds" likely have COVID and do not realize it.

Wellstar Cobb hasn't seen a proportional increase in hospitalizations, however, and cases seem to be mostly mild, Kueven said.

As of June 15, Wellstar had 107 hospitalized COVID patients across its system. During the pandemic's worst surges, Kueven said, the system has had 800-900 hospitalized COVID patients.

Promoting vaccines, Kueven pointed out that 62% of those 107 are unvaccinated, and 78% of COVID patients in the ICU are unvaccinated.

New drugs for treatment, prioritizing early diagnosis and the widespread accessibility of testing have all made fighting the virus easier, Kueven said.

"So we really want to continue to encourage the vaccine, boosters, certainly have a conversation with your physician about it," Kueven said, adding later, "We are hopeful that between the vaccine, and just kind of that herd immunity, the virus is moving into a phase where it's just less deadly."

The Centers for Disease Control and Prevention recommends everyone five and older receive a booster shot. The CDC recommends a second booster shot for people 50 and over, and people 12 and over who are immunocompromised.

While Keuven went to great pains to clarify he's not a biologist, he cited experts who say it's in the virus' interest to infect as many people as possible. It makes sense, then, that new variants will be highly contagious, but may have cause less severe symptoms.

Labor shortage woes

Companies across industries are having trouble hiring and retaining workers, and health care is no different.

"We are having, across the U.S., I've never in my career seen the level of staffing challenges that we're having," Kueven said. "There's a critical shortage, certainly in our clinical team, with our nurses, respiratory therapists ... People don't think about hospitals — we have to have cooks, and we have to have food, nutrition workers ... IT, and really across the board, we're experiencing challenges."

Staffing levels for physicians are mostly stable, though, Kueven said. For other positions, the hospital is trying to focus on reducing turnover first, with the idea that lower turnover can be marketed to improve recruitment.

"We are stressed from lack of staff. And that's not an excuse, it's a reality. We're working to mitigate that. But be patient with your healthcare provider. They've been through a lot," Kueven said.

Jake Lonas, a vice president at Puckett EMS who attended the talk, also said his industry was at "critical levels" nationwide due to workforce problems.

Changes to Wellstar Cobb

Located at the south Cobb intersection of Austell Road and East-West Connecter, Wellstar Cobb has 382 beds. It employs 2,700 staff, 1,200 of whom are medical staff. Of Wellstar's 11 hospitals, Cobb is the second-largest, after Wellstar Kennestone in Marietta.

"They are a critical piece of our community," said Ray Thomas, president of the Mableton Improvement Coalition, who attended the talk. "And especially down on the south side where, you know, we have folks who are in desperate need for healthy food options, healthcare options, so they play a critical role."

The hospital has 22,000 inpatient visits per year, 90,000 emergency room visits, and 12,000 surgeries. It serves 124,000 people a year for outpatient services, he said.

Kueven said Wellstar Cobb has one of the busiest surgical robotics programs in the country, and one of the largest comprehensive cancer programs.

It also boasts one of the only burn programs in Georgia, the others being Grady Hospital in Atlanta and Doctors Hospital in Augusta.

Security is "top of mind" right now for the hospital, Kueven said. Behavioral health patients have increased by 30% year over year during the pandemic.

Current projects at Wellstar Cobb include a new operating room for neurosurgery, new flooring in the emergency department, a facelift for the pediatric emergency room, new equipment for catheterization labs, new signage, upgrades to the neonatal intensive care unit, and a refresh of the women's area.

'Healthcare is not very safe'

A personal priority for Kueven is making health care safer by reducing harm to patients. He cited a 2013 study in the Journal of Patient Safety that projected between 210,000 and 440,000 patients die due to bad medical care per year, which, pre-pandemic, would make bad medical care the third-leading cause of death in the U.S., after heart disease and cancer.

"Healthcare is not very safe. I'm not talking about Cobb, I'm talking about across the U.S.," he said.

Kueven said he gives a similar talk about making health care safer to his staff. It's a reality the industry doesn't acknowledge enough, he believes, and must confront.

In an ideal world, Kueven would like to see health care become a "high reliability" field. An example is airlines, where commercial plane crashes are extremely rare.

"If healthcare were the airline industry, take that same plane that landed short, and fill it with people — we'd crash it every seven hours, all year," Kueven said. "Does anybody want to buy a ticket on our airline?"

The goal should be a push toward zero preventable harm. At Wellstar, Kueven said they're trying to create new, systematic processes to eliminate human error.

Over the last year, he said, "we've seen 50% reductions in things like hospital acquired infections, falls and injury, hospital acquired pressure injuries. We've seen a significant improvement in our patient experience scores."

Medicaid expansion

Taking questions from the audience, Kueven was asked about Medicaid expansion. A provision of the Affordable Care Act allows states to expand Medicaid eligibility, and the federal government covers 90% of the cost for the expanded group.

Georgia is one of 12 states that has opted not to expand Medicaid, which for years has been a hot-button political issue in the state.

Kueven said that he personally, and Wellstar as a company, support expanding Medicaid.

"Everyone in this country should get high quality health care, regardless of their ability to pay," he said.

Preventative health care is easier and cheaper for providers, Kueven said. When people get a flu shot, they're less likely to need flu treatment, for instance.

Hospitals are legally required to treat everyone that shows up at their emergency room. But often, for the uninsured, it's too late.

"And it's really tragic, because instead of getting that mammogram, they come to the hospital with stage IV breast cancer," Kueven said. "We're gonna spend $1 million trying to treat them, and unsuccessfully."

On the subject of preventative care, Kueven also called on the men in the room to get seen — June is men's health month.

"My fellow men out there, you are generally the most stubborn to actually go to a doctor and get checked out," he said. "Please do. ... There are a lot of preventative tests that can be done to ensure that you don't end up with something much worse."

Attendee Tara Hill Hanover thought the discussion on preventative care was particularly important.

"I really thought he was incredible, he gave me faith in Cobb Hospital," she said. "And I feel like he was right when he said preventative is the way to go. Everyone should be entitled to have preventative care, because I think it helps in the long run. ... If that's the vision of Cobb Hospital, I'm with him."