Welcome to H&H Impact, uh, where we spend time with industry stakeholders across the United States. My name is Charles Hall. I’m one of the principals at H&H Leadership Solutions, and I’m really, really excited to spend a little bit of time with Dr. Jeremy Silver, who is not only an ER physician but also the Chief Operating Officer of Demi Healthcare Partners, correct? Hey, Charles, thanks for having me. Perfect, Jeremy.

Um, well, Dr. Silver, I know that we’ve spent quite a bit of time over the years together, so I want a little bit informal on you, but, uh, Dr. Silver, it’s great to have you on, uh, H&H Podcast, uh, today. My goodness, I think this is a moment that we’ve been waiting to spend some time with you all on our podcast, partially because you’re across the United States in delivering ER, inpatient, swing, and other services, but also because you’ve become a good partner and a good friend over the last years, a great confidant as we really try to make impact across the United States So thanks for joining me. Thanks for agreeing to doing this. I’m looking forward to our conversation. Well, listen, we love you guys and really appreciate the work that we’ve been able to do.

And I think when I think about the health systems that we work with, they’re really just people in primarily rural areas across the country. It’s just lovely to be able to bring in teams of experts to solve the difficult problems that we face every day in these settings. And we’ve been able to do that together, which feels really good to me. It’s good. You know, you and I have a shared passion.

For those who don’t know, I’m a paramedic, a medic, a hospital corpsman, a critical care nurse, an ER director, trauma, that whole world, a world that you’ve Dr. Silver, have dedicated your life to. And so when this opportunity came up, I’m like, I’m raising my hand like, oh my goodness, this is a big passion of mine. I spent quite a number of years doing this, so I’m excited to talk about your journey. But then when I think about your journey, you got like a lot of schools’ names attached to University of Vermont. You have the, the- I’m sorry, the George Washington University.

I hear Duke, I hear Yale. You have all of this education. I also understand you’re shifting in some of your focuses through the years. Why did you become a doctor? And then what was that journey?

Well, you make it sound very esteemed, but it really was mostly grinding. That’s, that’s how I’ve gotten to where I am. So not, not the smartest kid in the class. I was not school valedictorian. In fact, I graduated undergrad from Boston University and moved to New York City and took a job in sales.

And so my, my medical career actually started in sales. And the reason I say that is I was in Manhattan on 9/11 and watching all those events go down out the skyscraper window on 41st and, and 6th. And so from that moment, I realized that I thought that I needed something different in my life at that time. My father was an emergency physician for about 40 years in rural Maine, and I attended an airway conference with him in Montreal, and that was life-changing. It just kind of randomly happened that summer or fall after the, the events of 9/11.

And I was, you know, I was thinking I need to do something to, to feel like I can contribute to humanity. And so I decided to become a doctor. How old were you at that moment? I was 28. Wow.

So I- from sales in your 20s, and so now diving into the med school in your 30s. That is definitely a, a career change in mid-cycle. Yeah, it was, uh, maybe foolish, but, uh, but I think very well-intentioned. Uh, and so, you know, I ended up taking out, uh, quite a few loans to make that happen. I had to go back to school to take all the prerequisites.

So I did a post-baccalaureate, uh, and then, uh, got into the University of Vermont, uh, which was exciting to be close to home. And, and, uh, and I knew physicians that were friends of my dad that had gone there. And so very proud to be educated in Burlington, Vermont. It’s a beautiful town and a great medical school. And, uh, and following that, uh, training, I actually, uh, initially was, uh, heading towards a diagnostic radiology residency.

So that’s, that’s where the George Washington University comes in. I did my preliminary year there in internal medicine. Um, with, with a great group of people. I learned a ton and, uh, was really, uh, way more interested in the clinical than I thought I might be. You know, initially I was, I was, I loved radiology.

I love the, the visual part of it and, uh, the, the challenge. Uh, but when I got to Yale, I, I was, uh, I wasn’t happy. Was that to be a radiologist in a dark room in the corner? Is that- it was that the vision? Well, I think more interventional radiology was where I think I was heading, uh, so kind of marrying the, uh, the clinical bedside with the analytic evaluation.

Yeah, but, uh, but there’s quite a bit of dark room, as it turns out. Yeah, a true statement there for those of us that, that date back to the, uh, the analog age of photography. I mean, it truly is, uh, you know, it can be quite isolating in there. So, uh, but I also just- I think I realized that, uh, that maybe I was better suited to the bedside. And, and, uh, so I had a, had a very, uh, difficult heart-to-heart with the chairman of, of radiology there, a great gentleman, Jamal Bukhari, uh, who basically said, I’m not going to hold you back, man.

Go, go do what you want to do. And, uh, you know, I think as painful as it is to let a resident go- and there were two of us Actually, a fellow resident went, uh, went down the orthopedic surgery route, so we both left. But they were very accommodating, extremely kind, and so I really appreciated that. But that’s how I ended up at Duke. I went back into the match, matched at Duke, and headed south, down, uh, down towards Durham, North Carolina.

That’s awesome. That’s a great story as well. Um, Did you say something about internal medicine? Did I hear that story too? Right.

Well, so radiology requires a preliminary year, a clinical year to kind of get your feet wet and understand, you know, how all of this stuff plays together. And you could do surgery or internal medicine. And I thought, what, what would be the least painful of the two? I don’t know that I chose wisely. Internal medicine was pretty tough there.

We would do 13 out of 14. And then rinse and repeat. So that was, that was brutal. But man, I got to see a lot of really interesting stuff. They, they have a red phone that, that connects directly to the White House.

And the first day of residency, you learn that you never touch that phone on pain of, of I don’t know what, but I never touched it and it never rang. So, but that’s, that’s where Ronald Reagan was treated when he was, when he was shot. I think in ’81. And, uh, and one of our, uh, critical care attendings was, uh, the attending who took care of him in the unit. So that was pretty interesting.

That’s huge. That’s huge. I love your story. You ticked and tacked purpose together. 9/11 is a major moment in many of our lives, and you got to be there during all of that in New York City and that impactful side.

And then it led to Purpose Driven Life, where we started thinking about what you wanted to do, and your dad was a big role model. I mean, ER provider. And, and so you’ve made that journey. Was being an ER provider that first year everything you thought it was going to be? It was, and it still is.

Uh, even today going in on a shift, I was, I was working last weekend and, uh, had some very interesting pathology to sort through. And really more than that, it’s just the humanity. You really get to very quickly bond with somebody on probably their worst day, and if not their worst day, definitely not their best day. And, you know, help guide them through that and help ease some of that suffering, which feels morally quite good. So, yeah, I love I love what I do on the clinical side, and I also love what I get to do on the administrative side to further this, um, disability for others.

Hi, I work in a good number of hospitals, and, you know, I, I’ve left the bedside a good number of years ago, more into the administrative side of hospitals and now into advisory, working with multiple hospitals. Um, Because I lived for so many years in the ER, the beeps and the sounds has now become therapeutic when I’m in there. Um, the camaraderie, the voices, the personalities, and so forth, it’s, it’s, it’s always heartwarming. It’s the more- my most favorite place to be in the hospital, period. And, and the care that’s been delivered there I guess there was a leader that I worked a number of years ago that said it correctly, that always has resonated.

In that day, you can have the highest of highs where you’re saving somebody’s life and it works out, and then the next moment, the lowest of lows where unfortunately the hard responsibility of notifying somebody that their child, their parent, their loved one has passed. I mean, it carries all of that fulfillment a little bit of the burden as well. But it’s- it is a magical place to be.

It is. And, and I think maybe exemplifies the team-based approach that modern medicine really thrives upon.

The ER is, is one big team, and it really does require every team member to contribute in order to have a successful outcome. I can’t do it alone. I have to have not just nurses, but techs and the, you know, the bedside medical tech who maybe starts the IV or applies the leads for the cardiac monitor. The radiology technicians who come with the portable machine to take pictures when a trauma patient first arrives. The lab technician who carries the blood upstairs for somebody who’s bleeding to death.

The charge nurse who’s kind of organizing and marshaling all the forces and players accordingly. And the inpatient nurse coordinators who are coming downstairs to understand where this person might need a bed upstairs. And maybe even most importantly, the person working the phones for me, who just gives me a look and I nod, and I know that helicopter’s gonna be on the way. I mean, not even, nothing even needs to be said. So it is a, it’s a beautifully choreographed symphony, if you wanna think of it that way.

And it’s a team. So, you know, you’re running a code and somebody says, hey, you know, should we be doing a pulse check here? You know, great, good point, let’s do it. We got, we got too into putting in the airway and now we got to go back to, uh, to the timing. So it really is, um, it’s a team sport and I love that part of it.

I, I couldn’t agree with you more. It, um, it’s fulfilling. It’s more than just the care, it’s the people, it’s how we work together. And as I kind of have gotten to know you and seeing your style at the bedside and working with hospitals and as a provider and as administrator, what I find very unique about your story, um, as well is you’ve not been stuck in just one ER. Um, you’ve actually worked across the country in multiple ERs.

And I’m going to say something that I know that you’re too humble to say, but I’ll label that. In many ways you’ve become a subject matter expert in emergency care because not only do you deliver the care, but you actually lead the care more on a national scale, as well as, um, um, raise new docs out of residency and putting them together in multiple hospitals. Do you want to talk about that journey of where your fingerprints have been? In multiple hospitals and working with administrations and providing care. Yeah, and I think that’s all emblematic of, of what an ER physician is.

They are the ultimate problem solver because there’s, there’s no situation that we can’t figure out how to make better, whether it’s a mass casualty event, whether it’s a scheduling snafu, whether it’s an employee whose, whose family member has just passed away, whatever the challenge is, um, we, we are capable of rising to that and, and addressing it. And that’s part of what I love about the, the specialty. And, uh, and it translates nicely into, uh, helping grow the specialty for others. Uh, so, uh, yeah, I’ve worked in a lot of ERs, uh, busy level 1 trauma centers, and austere, the most austere conditions on the border of Canada in the middle of nowhere, Maine. So it’s- and there’s certainly different challenges to each type of situation.

And I think you learn a lot from those experiences, from having to cobble together solutions that match the need. But yeah, we, you know, I started out training residents in the Duke system. I worked for a Duke affiliate hospital Duke Regional, uh, back in, you know, when I graduated from residency in 2016. And then I kind of went out and worked in the, in the contract management, uh, industry, uh, working for a couple of large, uh, players in the field for a few years as a medical director, um, still doing residency training, uh, in Southern Virginia and then Eastern North Carolina. Uh, and that’s when I met, uh, Andrew Oleksin, who’s the founder, and CEO of Demi Healthcare Partners, uh, who was looking for somebody to help, uh, take over one of his clinical sites of Illinois- in Illinois- so that he could start really focusing on growing, uh, the business.

Uh, so, you know, Demi, uh, started out as, uh, a group of ER docs, uh, in, uh, you know, the greater Chicagoland area, a couple of hospitals, and in the starting to become very rural parts of Illinois, out in DeKalb and Sandwich, Illinois. Those hospitals were eventually purchased by a large health system in, in the Chicagoland area. And, and Andrew grew that from ER medicine to internal medicine. We, we added the hospitalists and then he was asked to help with starting up a critical care intensivist group, which he did. Had that up and running within 6 months.

Uh, and, uh, so, you know, he had had a lot of hands-on experience working on the administrative side and growing a group, and I had a lot of experience kind of managing people, managing ER quality, and, uh, and residency instruction. So we really kind of saw mirror images in each other. Uh, maybe I think some, some mutual admiration for what each other had accomplished and then wanting to kind of do that together and combine forces. And so kind of that’s, that’s what we’ve done throughout the last 5 years. We’ve, we’ve 5x the group and we’re now in multiple states in the Midwest and outside of the Midwest and continuing to grow.

So, so, you know, and a lot of it has to do with, you know, meeting health systems where they’re at. A lot of our growth has come from either introductions from one CEO to another, or certainly through, through H&H. We’ve had some great introductions and developed some programs through that relationship, which we appreciate. But it just comes down to listening and trying to understand what- where are the challenges and, and then kind of building from there.

I, I love the story because as we start talking about Demi, I’ve had an opportunity to work with you and your groups in a number of different facilities. Me being a little bit of a past hospital administrator, some of the things I look for is that partnership, right? From an administrator point of view, that we’re all in there for the right reasons, that we have the right providers providing high top quality care. You know, the attributes that I have is I know that background, but many of the administrators don’t have that background. So I’ve seen you be a tool to them, a mentor, a coach on what good quality care in hospitals needs to look like.

It really was that dyad team model that many hospitals strive for because that partnership that Demi provides with with hospitals and, and, and, and care teams, you’re in it for the right reason. It isn’t about hedge funds or bottom lines and big profits. It’s really about care and making that experience with that patient and that administration, that facility, um, smooth as possible. Well, that’s a good point. You know, we have, we have been approached many times by big money to try and, you know, level us up or turn this into something different.

And, and I think we’ve resisted those attempts because of kind of what you speak of, because that, that approach, I think, gets severely diluted and maybe disappears with these large big box groups there. They’re- they are in it. Medicine is a business to them and they’re in it to make money. And I think if you asked a lot of folks that work in those environments, that the care does suffer and the patient gets lost in all of this, not to mention the provider at the bedside. Yeah.

And so what we’ve tried to do is reverse that, is to put the patient and the provider at the center of the universe. And then by doing that, you really are able to focus on outcomes because you have the two pieces of the puzzle that you need. You need the patient and you need the person who’s caring for the patient and of course, all the ancillary services. But that comes down to the DIAD approach. And that approach is simply assigning a clinical person on the facility side.

Usually it’s a nurse manager to be an advocate and a, an accountability holder. And then we assign somebody on the Demi side. Usually that’s the medical director for that facility to work in tandem with the nurse manager to drive clinical outcomes, quality outcomes. And that could be door-to-doc, that could be total time to disposition, it could be patient engagement, it could be sepsis, CMS sepsis outcome measures. It could be stroke metrics, STEMI.

It can be any, anything in the world that’s important to that institution. In the case of critical access hospital, maybe they want to monitor transfers and look at trends. And so we’ve been able to do that and, and work on keeping patients closer to home by circumventing those transfers through things like DemiConnect, which is our multi-specialty telehealth platform. So, so the dyad is- the dyad is- it starts with the clinical leaders, but it expands to other members of the hospital. And usually what we try to do is drape those C-suite members that are interested in stakeholders.

That is usually the CNO. If there’s a quality manager in the hospital, if it’s large enough to have a quality manager, that person would be involved. We always invite the CEO, COO, CMO, and even finance likes to be involved sometimes because what you’re doing is you’re creating momentum around a, a quality outcome and you put that into a dashboard and you follow, you set goals, achieve those goals, and then move on to the next. And so in some cases, like in the instance of the pandemic, we were meeting on a daily basis. In other cases where we were looking at measures over time, we’d meet on a monthly cadence, but it’s always a cadence.

It’s never quarterly or semi-yearly, semi-annually. That’s just that you lose momentum that way. And, and I think momentum is a big piece of this business because things change so dramatically quickly in the healthcare environment, whether it’s legislation coming down from Washington, whether it’s local trends. During a viral season that’s heavy, whatever the case may be, we’re always adjusting to something. And the best way to adjust is to communicate.

And that dyad team allows for that rapid-fire, consistent, strong communication. And that’s the foundation for change and clinical excellence. And we’ve, you know, we’ve seen that in spades across the board, whether it’s patient engagement or throughput or any number of variables that we look at. You know, I wanna dive into a little bit about your outcomes, but let me touch a little bit about your primary clinical services that Demi offers, but also some of your Demi Connect platforms, some of the virtual stuff that you all also offer. Let’s just do a little bit of an overview on those services where it’s boots on the ground in the hospital providing care, anywhere from what we’ve already talked about all the way to EMS.

We’ve not touched base on that part, but definitely fingerprints in EMS and leadership in care as well. Can you give a kind of an overview of all those services you do provide today? Sure. So, so Demi Healthcare Partners is a physician-owned private company with no external funding, no private equity, that’s, that’s owned and operated by physicians. We are a contract management group, so we manage the day-to-day of the acute care service lines that should be very familiar to us in hospitalist medicine, critical care medicine, urgent care clinics.

And then we have this lovely platform called DemiConnect, which offers access to 9+ medical specialties through a virtual platform that utilizes AI technology to map the right provider to the right patient at the right time. And that platform is in 40+ hospitals across the United States. And one of the things that I think the, the patients and the health systems love about DemiConnect is that once you kind of accrue your cadre of specialists, those are your docs. So it’s not a revolving door of some Dr. X who’s on today, and then Dr. Y’s on tomorrow, and nobody knows who anybody else is. These are consistent providers that just become a part of the community, albeit virtually.

And of course, the- where the rubber meets the road is that those, those patients now who might have once left in an ambulance to go seek care at a larger tertiary facility because the small critical access hospital doesn’t have pulmonary or cardiology or nephrology or or even psych- psychiatry now can keep those patients in-house and collect those technical fees for the visit, which is huge. That’s a huge revenue generator for, for health systems. But it’s also better outcomes for patients when they- now the family doesn’t have to drive 2.5 hours to a big city, get a hotel and all the costs associated with that, not to mention the stress. Then the patient comes home. Now they’ve got a problem.

They go back to the small ER, which still doesn’t have those services, and they have to go back to the tertiary care center if there’s a complication. And you break that, you’ve got a circuit breaker in that process, which keeps that cycle of care close to home. And I think that’s so important. So that’s, I think, what you were referencing. Yeah, you know what I’m pretty excited about?

Some of my clinical philosophies are care close to home and That’s a beautiful tagline, but the reality is care close to home equals compliance to care. It means there’s a larger likelihood that I will go to a doctor’s appointment if it’s within my own community versus scheduling something 2, 3 hours away, a specialty that maybe is not available in the rural market. I often say, you know, I’m a dad, I’m a husband, I’m a family man. I have a choice on where I go, but that choice is really based off off of convenience and making sure that, and even today I live in the rural environment, that I have access, whether it’s in person or virtually, to that care. And if I do have efficient access, that kind of says, listen, I’m actually going to seek care because I have proper access to it.

You all provide that access. You provide it not only boots on the ground in the facilities, but for those specialties that, maybe some of these rural environments don’t have, you provide that as well where they can just log on and make that connection with a specialist. Is that what I’m also hearing? That’s correct. But I think it doesn’t stop there because we can go beyond that, you know, into helping craft bylaws that are up to date, you know, working on anything from MTALA updates and training to We have a training platform for E&M coding for the emergency department to help increase the collections that emergency departments are able to take on the professional billing side.

We do emergency department preparedness for pediatrics. We do stroke recertification. I mean, as far as the, you know, quality education, maintenance of certification, we’re all about that as well. That really doesn’t require a ton of funding. It’s more just spending the time and having the experts at the elbow who can help usher you through that process.

And we have that experience in spades.

So what’s exciting to hear, and we’ve not talked about kind of the scope of it all, but I’ll allude to this in the regional side. You’re in metropolitan areas, large healthcare systems, you’re in the rural environment, Many times in the rural environment, all of these types of services that you provide, these platforms, this administrative partnership, this know-how to run a program and a business, you are that partner with that hospital in all these expertise areas. Is that correct? Yeah, I think that’s accurate. Certainly our experience shades to the rural markets.

But we have had a longstanding partnership with a U.S. News and World Report top 10 hospital, and that’s been an education. I mean, it’s truly been a fellowship in, in how to manage a quality program, that’s for sure. And some of that stuff then gets translated out to some of our smaller partners who I think have appreciated that. But even when that relationship runs its course, as many relationships do, you take that with you and apply it to the next scenario. So, for instance, EMS, we offer fractional EMS medical directorship.

So, you know, many small rural programs just simply can’t afford or don’t have the expert in their midst to run their EMS. And so we can come in either working with the county or with the hospital to basically provide medical direction to EMS. To do training and recertification for those folks in terms of the education and the CME that they need, as well as, you know, virtual training and hands-on simulation. And we’re working on building a paramedic training program with a community college in partnership with one of our Wisconsin hospitals. Not only that, we have a leading, a nationwide EMS expert who’s on our team who kind of helps manage all those initiatives.

So again, it comes down to having real, real experts with real-world experience who can apply those skills to, to solve these kinds of problems.

I love your company. I love working with you. I love what you all represent in this journey. I’ve worked with a good number of physician and physician groups and Um, not only that you’re great to work with, let’s really talk about outcomes. And outcomes is like the key reason why we’re there.

We, we want a good bedside experience, we want a good partnership, but the clinical outcomes matter. And you had tremendous amount of success in outcomes. Let’s talk about patient satisfaction, one of the things that are a little bit more poppy, more of you know, that resonates with most people. You recently been able to achieve some really high marks. Dr. Silver, where have you taken your group and what do those outcomes look like?

Well, let’s talk about patient engagement. This is something that I think has been in the past anathema to many physicians, including myself, before I truly understood what it was, and, uh, and what it means for clinical outcomes. Uh, so this is not, uh, welcome to McDonald’s, may I take your order? Uh, this is something, uh, what I think is, is deeper and more meaningful than that. Not to take away from the fast food experience, but, um, there’s a little bit of a difference between the satisfaction from having fries and a shake to the satisfaction of shaking a patient’s hand after they’ve kind of made it through the hurdles of a significant medical event.

And so, you know, our approach to patient engagement, without giving away the whole playbook, and we do have a playbook, is anxiety reduction in the emergency department. Because this is- it’s an imbalanced equation, right? You have patients who come into this sometimes wild setting. There might be 20 or 30 people sitting in the waiting room in various stages of distress. Inevitably, there’s a baby crying.

Inevitably, there’s somebody in the corner with a vomit bag. I mean, it’s a chaotic environment. You might have somebody running in the front with a woman who’s giving birth or somebody bleeding. And it’s- it can be frightening and, and, and make you feel frightened on the inside because you don’t know what to expect and you don’t feel safe. Then you get ushered into the triage room and the next thing you know, you’re being told, well, we’ll get to you when we can.

And then 4 hours later, a physician rolls in and says, hey, everything looks fine. Follow up with your primary care doctor. But I don’t have a- and the door shuts. And that’s, I think, unfortunately, the average experience for people coming into the ER. And so I think just having a basic understanding of how frightening that must be, combined with the fact that some of us, some of us on this side have been patients and so we’ve experienced some of that ourselves.

And it’s uncomfortable. So number one is communication and having a clear communication style that can be disseminated amongst the team. But it starts with anxiety reduction. And that starts with communication. You know, hi, I’m so-and-so, I’ll be your nurse today, and your care starts here.

And so really letting the patient know from the first touch that we’re here to take care of you. And it might be less than ideal. You might be in a stretcher in a hallway, unfortunately, if things are busting at the seams, but we’re paying attention to you. We’ve read your chart. We’re looking at your vital signs.

We’re looking at your labs. We’re looking at your imaging, and we’re updating you all along the way. We know from research in this area that Patient outcomes are actually better when they feel that the communication is strong, when they trust their care team, and when they feel their care team is working together. So there’s ways to hack that system that doesn’t make you feel like you’re, you know, faking it like a customer service representative, you know, simply saying, hey, the nurse told me that you were having some pain in your back. Is that right?

‘Can you tell me more about that?’ As opposed to, ‘So why are you here today?’ And I’m the fifth person to ask you that, and you’re like, ‘Does, does nobody talk to each other in here? Have you not looked in the chart?’ Um, you know, so, so these little details, it makes a huge difference. Uh, sitting at the bedside with the patient whenever possible, uh, is really important. Being eyeball to eyeball and not standing over someone creating this power dynamic, but sitting down eye to eye and saying, you know, “Hey, I’m Dr. Silver, and I understand you’ve been waiting a long time. I’m sorry for that, but you’ve got my undivided attention now.

How can I help you?” Makes a huge difference. And it doesn’t- you don’t have to fake a smile. You can still be, you know, doing your work thing and going from room to room and be busy., but to take that moment with that person, it, it means so much to folks. So those are some of the elements of that. But, um, to kind of, to then take it out to a, a sort of a macro level, we’ve spent collectively thousands of hours doing time motion analysis and looking at this process from the second the patient leaves their car in the parking lot to the point where they get dispositioned from the emergency room.

Either they’re either going home or they’re going upstairs, or they’re being transferred, or unfortunately they’re deceased. But that those are the 4 destinations out of the ER. And looking at the pathway from point A to point destination, and how do we help reduce anxiety, increase communication, and seed control and autonomy to the patients through that process where they really have none, where they feel like they have none. And so frequently updating, sharing the results, communicating in a, in a style that is appropriate to that person’s education level, and involving their caregivers, not kicking people out of the room when you’re doing critical procedures, particularly in the, in the instance of pediatrics, but really with everybody, allowing folks to be involved in the care and, and communicating all along the way, even if it’s just saying, hey, listen, I don’t have anything new. But how are you doing?

Do you need anything? Do you need a blanket? Can I get you a glass of water? As if they were a guest in your house, which for all practical purposes, they are in that moment in time. So some of the outcomes that we’ve achieved have been pretty dramatic.

In fact, one of our critical access hospitals in Wisconsin just achieved a 99.5 percentile 99.5 percentile, uh, Press Ganey ranking for an ER, which I think is kind of unheard of. Unheard of. Um, Dr. Sura, I love the playbook philosophy that leads to those. I know that perception and care may not always be reality, and the perception of care is something that we can manage. We can manage when they come on site and then our interactions.

We can manage the sitting next to them and the hand on their shoulder, “Are you okay?” and the heart-to-heart connections. We can manage delays by articulating where they are in the journey. It really comes down to including the patient and the family members as the care team and keeping them informed. Even though maybe the diagnosis isn’t the greatest sometimes that you have to give, that genuineness, that heart-to-heart connection creates that trust. And, and you guys carry that.

And that to me is the secret sauce. Yeah. Well, I think it goes a long way, you know, even for folks. I’ll tell you, we have a lot of young people now who are deferring health insurance due to rising costs, and the ER becomes their primary care doctor. It’s not just young people, but, but it is- there are a lot of young people that we see that don’t get- that don’t have primary care.

It’s just not a thing anymore. People aren’t growing up with a family doctor the way that they did maybe 30 years ago. And so they’re coming to us with, you know, there’s a lot of anxiety and uncertainty and maybe they’ve Googled, you know, that, that a sore throat means that they’ve got cancer. And so sometimes it’s a matter of just saying, you know, hey, look, really reassured to know this is a virus, but let’s get you set up with a primary care doctor who can follow up with you. And so taking that extra step to connect them to resources once they leave, I think, is also an important piece of this.

But look, it’s just human nature. You know, you wouldn’t turn on a baseball game and have zero announcing for 7 innings, and then suddenly the announcer comes on and goes, and now it’s a 6-5 game and there’s a run. Runner on second. Well, what, what’s been going on for the last 2 and a half hours? Nobody’s telling me.

So it really is, it’s pretty straightforward. You just, just need to communicate with people. And, uh, and even though it’s busy in the department, you can work as a team. It doesn’t necessarily have to be the physician. It can be the, um, the secretary or the nurse or the nurse manager, uh, or sometimes even just the, uh, the house- I’ve had someone, I’ve had a housekeeper come up to me and say, hey, the, uh, The guy in room 2 asked me for a warm blanket.

I gave him one. I hope that’s okay. God bless him. I am so busy and I couldn’t get in there. Thank you for doing that.

But that, that’s- it comes back to that team ethos. And so if you can get the, the whole unit working together as a team, a lot of this stuff just happens. But you have to be intentional about it and you have to keep, keep at it because you can fall off that horse in no time if you’re not paying attention. I love it. Well, I, I know that I want to respect your time, and I love the journey that you personally have been on, what gives testament to your purpose, but also the work that you’ve been able to help lead, uh, with Demi.

You’re the Chief Operating Officer, is that correct? That’s correct. And also a practicing provider. That is also correct. Great.

So that goes a long ways in practicing what we preach and so forth. Dr. Silver, I very much enjoyed our time together. I’m looking forward to learning more from you about the services you have, but also as a partner within healthcare. I lean on you, you all lean on us in brainstorming ideas as a thought partner and It’s been a great- I think we’ve been together about 2.5, almost 3 years as we’ve got to know each other’s team and we have shared teams in different facilities. I just want to thank you for your time, and I’ve enjoyed being able to hear your story and the philosophy of your providers and Demi.

Well, we love and appreciate you guys. Thank you for your service, ex-Navy officer that you are. And just looking forward to what we’ve got down the road, what’s to come, a lot of exciting stuff. And we’re going to see you in Denver in a few weeks and looking forward to that. Awesome.

Well, thank you so much, Dr. Silver. We’re concluding the H&H Impact with Demi Healthcare Partners Chief Operating Officer and practicing provider, Dr. Jeremy Silver. Thank you so much for your time and thank you for listening.