Alright, we're going to get started. It is my distinct pleasure to introduce our first guest speaker, Dr. Frank Opelka. I could probably give his introduction and take up the entire amount of time with this talk to describe all of Dr. Opelka's contributions. To be brief, Dr. Opelka is trained as a colon and rectal surgeon who for many years served at the LSU School of Medicine in numerous positions, both as faculty and administration, was integral in the response of the medical school to Katrina, both in relocating the medical school, getting everybody housed, taking care of, keeping the school running, and has also a long and distinguished track record of advocacy working with the American College of Surgeons in D.C. Just to give you a short list of some of the things he's done with the American College of Surgeons, he founded the ACS Patient Safety and Advisory Committee. He co-chaired the Performance Measures Committee, was on the Health Policy Scholars Committee. He founded the Surgical Quality Forum in D.C., of which we are proud participants. He has worked with the ACS and specialty societies on things such as the CPT Editorial Panel, the RUC. He led the Practice Expense Advisory Committee at the RUC. He was on the National Quality Forum Measures Application Partnership, which came about as part of the ACA. He was chair of the AMA's PCPI, the Physician Consortium for Performance Improvement. He was chair of the National Voluntary Consensus Standards for Hospital Care Outcomes. We can go on and on and on. Suffice to say we are thrilled to have him here today to talk to us. And I'll turn the stage over to him now. Thanks for coming, Dr. Parker. Thank you so much, and it's really my pleasure to be here. I know we don't have a big crowd. I wish I was down there walking with a mic. It'd be more fun to get amongst you. But being that as it may, welcome to New Orleans. This is my hometown. And in my current role in advocacy, I actually leave New Orleans every Monday morning on the first flight, go to D.C. I spend wherever that week takes me for the college, and then I try to be home Friday for dinner. My wife thinks it's the best job I've ever had. So she gives me an allowance, too, and that's how it works. Thinking about service and how this rolls in for me for health policy and giving a little bit of the lay of the land for me and kind of some thoughts about what I learned along the way, because I had to learn a lot of different things about how to approach problem-solving in the policy world. I actually began in the military. I trained in the military and had a wonderful start in the military. And shortly after completing my residency, somebody came to me with an opportunity that had to do with the fact that I had, during medical school, I had done silly things like going to ranger school and learned to jump out of airplanes and stuff like that. So somebody came up to me after my residency and said, there's this mission, do you want to volunteer for it? And that was my, I think, my first effort for volunteerism. Now, the way that they hooked me, because when you're dealing with volunteers, you've got to set a hook and then pull them in. So the way they hooked me was, but we really can't tell you what it is. We're going to have to fly you to a discrete location. We're going to have to blindfold you to take you in this room so you won't know where you are. And then we're only going to partially brief you on the mission. And then you can tell us whether or not you want to do it. And basically they said, we want you to work with the best soldiers that there are in the world. And we want you to be their surgeon because they don't have anybody. And I was like, who's turning this down? And that was it. I'm in. I'm hooked. And then they really took us forward. And what was unique about it was these were the best, these are the best soldiers in the world. And they go to the most unbelievable places in the world. And they take risks that you wouldn't believe. And the doctrine that we had for caring for them dated all the way back to the same doctrine that was MASH. Stabilize them, put a splint on it, get them off the battlefield, take them back four or five miles maybe, and then get them back to somewhere else where they begin a care process that might take weeks before they really get the definitive care they need. It wasn't modern care by any means. So how could we actually redesign care? And that became my first step into the policy foray that I was now asking a policy question that we're going to redesign doctrine, and we did. And we moved care at that point in time to what it is today. They're called surgical fast teams. And they move very forward to get to the point of injury and try and get care interdicting within ten minutes. And that was always our goal, that we set that goal for ourselves. If I could get to one of my injured soldiers in ten minutes and begin real therapy, real curative efforts to stabilize them. So that was my first foray. And so I came out of the military, and as I did, I was actually stepping back from this unit. I was in this unit for six years. I was all over the world. We went on all kinds of missions, none of which none of you know anything much about at all. Most of it's the secret stuff that they don't talk about, and I still can't write about it. And as I came off of that, my wife was the one who said, You know, you've got four kids. You're getting old. You can't carry 80 pounds on your back and jump out of airplanes anymore. It's time that you went and started working like a regular surgeon in a hospital. So I went back to the regular medical corps, and I found out I couldn't do it. It was too boring. It just didn't work for me. And I was like, I've got to go get out into the real world and try things. So I actually left the military, and I entered. I came here. I entered practice at the Oxnard Clinic. And as I got started in there, almost the year I started, the RUC started. And somebody in my department was appointed to represent the colorectal surgeons at the RUC. And he came back from this, and he said, I can't take this. You're trained in government. You know how to deal with it. You've been in the military. You need to go to this. And I volunteered again. So I went into this new environment called the RUC, and I was in the RUC for 15 years. I liked it for about five. And then it became social, and it was fun for about the next five. But it wasn't performing any great function, and it was actually pitting all of medicine against all of medicine. You never saw us rip apart each other more than inside the RUC. You go home, we're working together on the same patient. You go to the RUC, and we're fighting over the money on the same patient. And it was just, it actually was appalling to me. It wasn't in who I am as a person, and I just said, I've got to get out of this. So I moved away from being in the RUC, which was really to me nothing other than horse trading. And I told the College of Surgeons at the time, who had appointed me to serve on the RUC, that I was done. I was going home. And it was about five months before Katrina hit. And then Katrina hit. And at that point in time, I was the associate dean here in the school, and that was an exercise that reactivated all my special operations medicine training. I had to know about logistics. I had to know about cutting deals and getting this and that. We had to move the dental school, the nursing school, the medical school, the School of Public Health, 80 miles up the road, have it functionally in place and ready for reaccreditation in 30 days. And that's all we had. There was no more time than that. And we had to find a place for all those residents and students to live and for the faculty. And I was really getting quite desperate. So now I'm starting to learn a whole new set of skills, because as surgeons, we're trained to come in, understand the science of a situation, take control of it, be accountable for it, and get the job done. And it's got to be done in a finite period of time. That's not true in this other world. There's lots of negotiations and relationships and other things you have to develop. Where do you develop most of these? Well, during Katrina, at night, late, trying to figure out how I was going to find housing for the residents and students, because FEMA occupied every available apartment for 150 miles. They were everywhere. There was no place to rent to put the students. So you solve these problems in a bar under a bridge that's next to a dark alley in Baton Rouge. And I was sitting there with a friend of mine, and it was really a dive, and it looked like a place you'd never go to. And across the way were five very elegantly dressed women. I was like, what is – something's wrong with this picture. Who are these people over here? And they somehow could hear us and our frustration, and they passed over a cocktail. They sent us a couple cocktails, and they then invited themselves to our table, and they asked us what our problem was. And I said, I need a place for the faculty, I need a place for the students, et cetera, et cetera. These were five of the most powerful women in the state. They were the lobbyists to the governor. They immediately said, we've got some ideas. Let me call my dad. So one of them calls her dad. He's a maritime lawyer. He said, you know, one of my clients is about to mothball their ferry for the winter. What if we got the ferry to come over? It's got housing. The residents and students could all live on it. It'll house 1,000. And that's exactly what happened. We made a phone call the next day. We got a ship from Europe that came over. The ship came in. Now I needed to put it somewhere. We put it in the port of Baton Rouge because the port of New Orleans was closed. It had really been severely damaged, and there wasn't anything that was open yet. So we went to the port up in Baton Rouge. It's called Port Allen. Said I need a place to put a ship for the residents, blah, blah, blah. And they told me, no, we're going to make a fortune off of everything coming up river from New Orleans. Now, this is the busiest port in the world. So you can imagine what they were thinking they were going to make. Well, at this point in time, I went back, tail between my legs, and someone in the governor's office said, what's the problem? And it was one of those lobbyists again. It was five most powerful women in Louisiana. And I said, this is the problem. I can't get the port. I said, why don't we just seize it? And I was like, wait a minute. Let me open up my surgical book, Seizing a Port. I don't have the instructions. How do I seize the port? You have the LSU lawyer write the seizure letter, and the governor will sign it. OK, easy enough. Called the lawyer. He said, you write it. Give it to me. I'll put it on my stationery. We'll give it to the governor. She'll put a cover letter on it. It happened in 30 minutes. I went back over to the port. I said, I really need a place on the port. And they said, no, not going to happen. I said, could you read this? I really need a place on the port. It's not going to happen. I am activating that letter. You are in my port. I will now take a place on the port, and I will lease back the rest of the port to you for $1 a year, but I'm getting what I want out of the port. And we suddenly had a port. So now I was actually the Commodore of a port. I'd never had that title before. But this just showed some of the activities that went into or in and around this. We built a faculty trailer camp with in-ground plumbing, electric, cable, and housed the faculty in 30 days. And we built it in Baton Rouge. We took plumbing and restored potable water to the community because the community was outraged that we were doing all this. But all of this happened in 30 days. It was phenomenal. The schools all survived. And the moment they were back in school, certified, and everyone was doing well, they were at a place called the Pennington Biomedical Center. And they actually called it the Pennington Medical School. And they had all these t-shirts and hats that said PMS on it. That was the character of that class. The interesting thing for me, and I'm proud to say this, my daughter was in that class. And that's a special class of students that year, really cool kids, even to this day. Amazing, amazing kids. So then at this point in time, we had to come back to New Orleans and recover New Orleans because they're all now back in school. And we had to then prepare to return here in a year. So you can imagine the work we had to do to recover here. And that was, in itself, amazing. All that work was finished. We're heading back to school. And as we're going along here in the state, I'm witnessing, year after year after year after year, LSU, the state of Louisiana, is the last state that had a statewide hospital system. We had 10 hospitals funded by the state to take care of the poor people. Only state left in the union who does that. And we were losing. The way the state budget worked was they balanced the budget on the backs of the hospitals So when they didn't make budget, they cut the hospital budget. When they didn't make budget, they cut the hospital budget. So when I went into this job, we were budgeted at $1.5 billion. Now, almost 10 years later, we're down to $800 million. Now, you know what health care inflation has done. Everywhere else, it's going up. So we're cutting services back further, deeper, deeper, deeper, deeper. We also took care of all the prison health. I barely had enough money now to just do prison health. And that's federally mandated. We were under investigation by the Justice Department because we weren't giving prisoners timely health. And yet, we couldn't give any care to honest, hardworking, poor people. And yet, we were the safety net system. And we had a governor who wasn't going to do expansion under any means. So what could we do? This is my policy challenge. I was leaving LSU. The college was saying, please come to Washington and become part of Washington full time. So one of my good buddies in the Jindal administration said, before you go, let's just play around the golf one more time. So I went to Baton Rouge. And we were playing golf. And he said, well, before you leave, what would you do? I said, I'd get the hell out of the hospital business. We're a university. We train. We don't run hospitals very well. In fact, we run them poorly. We're budgeted on an operating budget. We don't have capital resources. We can't keep up with technology. We're not handling depreciation. Let's get out of this business. He said, how would you do it? I said, I'd close them. The private hospitals in this state will go crazy. And they will figure it out. But we'll just pay them to deliver care. So I left, finished the golf. I got a call that night from him. And he said, yeah, I just had dinner with the governor. And he wants to talk to you about this. I said, oh, well, that's great. So I'll meet you guys tomorrow morning. I'll come by the mansion. No, he's on the phone. So Governor Jindal and I talked. And he asked me what I needed. And I said, I'm leaving. I'm out of here. I've submitted my resignation. I'm going to Washington. And he said, no, seriously. You've got to give me two years. So I talked to the college and the governor and gave me two years and gave me everything I asked for. I told him I would take all the assets, all 10 hospitals, and I would lease them to the private hospitals. I'd let real hospital management come in and take them over. If the governor would allow me to take the lease money, match it for federal match, pull in more money for the poor, and use it for poor people anywhere they were. We took our budget from $800 million back up to $1.3 billion by that move. And it's still there today. So that was a policy move. And at that point in time, my whole life was consumed by lawyers. How do we write these deals? 10 separate deals had to be written. 10 separate communities leased the hospitals and took them over. They now have capital budgets run by real CEOs who know how to make a hospital home. They can't deliver care. They still have to have the LSU teams in there delivering the care. But we got hospitals who are actually clean, working, and they've got the kind of money they need to sustain care for now. It's not a long-term strategy, but it's bridged them probably close to 10 years that they didn't have. Those were health policy moves. I'll finish by telling you that moving inside the college and what we're doing in DC, when I got there, we probably had a team of about four on the health policy team. We're up to 20. I think, and biased as this is, I think it's the best team in Washington. We look at every issue and attack every issue. We can't handle all that we have. We have 40 burning platforms every year. We tell our board we can handle 10. We tell the board to pick eight, because the hill's going to pick two that we didn't think about. So we didn't think about opioids, but there it is. And now we have to figure out a policy solution for this. The other mantra that we have that's really built for us the strength of who we are, we take issues on not to complain about them, but to solve them. If we are going to take on an issue, it's to go to the hill with a solution. If not, we're wasting our time. The hill has plenty of people who know how to come in and complain. That's not the problem. What they need are people who are going to come in with real, actionable answers, things to really consider. So we spend a lot of time and effort, and we partner with other policy institutes like Hopkins, or Stanford, or Harvard, or Brandeis. And we work with real, established policy scientists and economists to come up with the kinds of solutions that when we go to the hill, or go to one of the agencies, we're sitting down and looking at a real solution on a real problem. We rarely talk about money, because almost always everywhere inside the Beltway knows it's always about money. But if I can solve the problem, we'll figure the money out. If all we do is just complain about the money, nobody's focused on the problem, and nobody does anything to help anybody get anywhere. We're looking at things like burnout, interoperability, getting away from emphasizing the EHR, and emphasizing digital information that's meaningful and actionable to the providers and patients at the point of care. We're looking at alternative payment systems that create a sustainable workforce, that don't dilute one for the other and take from one for the other. Those are the kinds of issues that we work at. So we've come together as a team around all of those, and we reach out first to the circle of surgery every time. Where are all of our subsurgical units under the surgical umbrella? And they're all in different places. They all do different things. And we let certain ones carry certain water, because it's good. Let them carry that water. It's a strong position for them to take. Neurosurgery is an interesting one. It's probably one of the more interesting ones from my perspective. You're very small. You fly under the radar for the most part. You don't need to make a lot of noise, and you'll still be successful. And yet there are others, like ophthalmology, 40% of the surgical dollars coming out of Medicare go to ophthalmology. 40%. The next highest is less than 10%. It's orthopedic surgery. You're not even in the top 10. So stay down there. Don't be noticed. You're better off, because once they put a target on you, they zone in on it to take an action. And it's sometimes not an action that's rational or reasonable. But that's the world we live in. The observations I've had to make for myself is I had to diffuse the DNA of being a surgeon. Walking in the room and saying, but that's not right, doesn't get it. Although sometimes I still do that, and I have to go home and say, OK, I got to need a detox out of my surgical DNA again. It's more of, I'm interested in your position. It's hard for me to find that. I struggle to get where you are. Please help me. Help me understand. Walk me through to where we are, because I'm tripping up. Those kinds of alerts inside your emotional intelligence, those are the kinds of things that work inside the Beltway. The last thing I'll share with you that I find fascinating inside the Beltway is they make coalitions and tear coalitions down every week. For every issue that's out there, there's now a new opioid coalition of the surgical group. There's another opioid coalition of the anesthesia group. And there's going to be a patient opioid coalition. And then if the issue that they're dealing with doesn't get answered by the coalition, they'll say the coalition was ineffective. Let's get rid of that one, and we'll form a new one. And they just rejigger the cards. It's the same people in the room on a new coalition. And it's how the Beltway works. It's fascinating to watch. We don't play too many of the coalitions, because our focus is always to say, be patient-centered first, solve the problem for the surgical patient and the surgeon, and we'll solve the problem. We're also of the mind where we have gone to them with their position, where they are, and I mean the payers or the purchasers, not so much the patients. And we found that is not working. It's not helping the patients or the surgeons. So our position as we've gone forward this last year and coming into this year is, we're not going to meet you where you are anymore. We're going to meet you where the patient is and where the surgeon is and where you need to be. And if you really want to take better care of patients, come with us, because that's what we do for a living. So those are become what I say are the principal points of leadership. And that's a different way of thinking than how we think in our day-to-day practice, initiating and caring for the science of the moment in this patient. It's a much more broader framework, but it's how the policy world works. So for me, it's taken me on a journey through my career to this point in time. And I can only tell you, I'm working with some of the smartest people in Washington. Every day is a new day. Who knows what that man is going to tweet today? It's always different and new and exciting.

Dr. Frank Opelka

colon and rectal surgeon

patient safety

health policy

budget cuts

patient-centered care