♪ Welcome to this week in South Carolina.

I'm Gavin Jackson.

This week we're talking about our state's health care needs and developments amid continued growth in our state.

And we have two people who are at the forefront of that.

Doctor Cawley, Doctor Patrick Cawley is the CEO of MUSC Health.

And Doctor David Cole is the president of the Medical University of South Carolina.

Welcome to you both.

Welcome back.

<Thank you> I know it's been two years, but we got you back here in studio.

With that being said, we have some great news to talk about, Doctor Cawley, And that's this cancer center that's coming together.

The comprehensive cancer hospital that will advance MUSC toward a comprehensive cancer center designation.

This is a huge development, a long time, much needed, too.

What would such a designation mean and how does this build upon what y'all already have at the Hollings Cancer Center down there in Charleston?

Well, maybe the best question to start with is really what's driving all this?

And what's driving this is the amount of cancer that is, we're facing today and that we're seeing coming into the future.

20 percent increases in the amount of cancer cases diagnosed in South Carolina, in the coming year.

And, the other thing is, we have found when we're out in communities, if we, you know, you've watched the rise of MUSC and the growth of MUSC in the last 7 to 8 years, as we're out in communities, the number one thing that every single community wants help on is cancer.

Sometimes it's surgery, sometimes it's medicine, sometimes it's, research, but, you know, we took a step back and said, you know, what can we do to really help the entire state all at once, you know, rather than just, you know, one off these things constantly.

And so we took a step back and said, we need to develop a comprehensive cancer network anchored by two things in Charleston, a comprehensive cancer center that is NCI, National Cancer Center, designated.

We are NCI designated today.

This is a designation above that, called comprehensive.

And then the other thing would be to have a hospital, a dedicated cancer hospital in Charleston, not to treat everybody in South Carolina.

But, if you have a cancer that does need to be treated, that you don't need to leave South Carolina in order to get that taken care of.

And then that would be part of a network, that'd be the hub of a network across the state.

That network, some of that would be directly MUSC ourselves.

Some would be partners.

You know, we work with any health system, across the state to help deliver that cutting edge cancer care.

Just to add another view to what Doctor Cawley was saying, the Hollings Cancer Center has had NCI designation for 15 years, and that means we provide excellent, best in class quality care, largely within the Charleston area.

For us to get an NCI comprehensive cancer center designation, we, MUSC, actually have to prove that we are delivering for the citizens of the state of South Carolina, highest quality access to the state of the art care across the state.

That's a high hurdle, you know, but it's what our mission and purpose is.

And this isn't about MUSC only.

It's about with partners, with providers across the state.

How do we build that network and capability?

So, the Cancer Center hospital in Charleston is the epicenter of that.

But we're building an ecosystem.

We're building an ecosystem that will provide best in class for South Carolina.

Gavin Jackson> Especially since there's been so much expansion that we'll talk about as well.

But when we talk about, this designation, I mean, does that make us something like an MD Anderson, when people think of these cancer centers across the country?

Dr.

Patrick Cawley> Yes.

These are the places that can treat all kinds of cancer comprehensively.

Right.

So these would be rare cancers.

These would be cancers that's, maybe not rare, but maybe have special issues that need to be treated in a in a place like MUSC.

But then the other thing is, Doctor Cole pointed out, these are, this will be a place to facilitate cancer care close to home, because, you know, all of us have had family members who have had cancer and who have been going through treatment.

It's rough, right.

And you don't want to be traveling, you know, when you're going through chemo and radiation.

You want to be close to home, right.

So increasingly, you know, we feel that the technology is here.

The technology is getting much closer to be able to deliver this cutting edge care at home, facilitated by the epicenter in Charleston.

Dr.

David Cole> Sorry, just if you look at, you know, I'll speak as a surgical ecologist taking care of 30 years of cancer patients.

You know, when you say, we always talk about best care is local and we actually want, you know, if you, if you have cancer and you live in Columbia, your local oncologist should be able to take care of and be able to provide best local care.

But sometimes you fail treatment.

You're looking for what's next.

You want what would be clinical trials in terms of delivering the next capability.

And with our presence in the ecosystem I mentioned earlier that we're building that partnership and presence enables us to be in that community, partnering with those providers, saying, look, and here's a clinical trial that Ms.

Smith can have as an option in Columbia.

You know, so, so that's how we start providing access and in partnership to do something that's meaningful for the citizens per se.

And yes, there's things that can only be provided in Charleston, you know, as the highest complexity, care facility essentially that would be an equivalent of an MD Anderson and so forth.

Gavin Jackson> And along those lines, too, when we're talking about wanting to keep people closer to home for that treatment.

But even within the state, if you're traveling to Charleston for some of those more complex procedures, sometimes it's difficult to find lodging or it's kind of an unaffordable area for a lot of people when they come to Charleston, whether that's for, you know, emergent care, and there's the needs to stay long term down there.

And will there be any component to that for families that are maybe, in need to be there longer, but don't maybe have the means to stay?

Dr.

Patrick Cawley> Well, two things I would would say to that.

First of all, right, across the street from where we're, building this new hospital downtown is the Hope Lodge.

The Hope Lodge, you know, helps and does that exact thing that you're talking about.

We are big advocates of the Hope Lodge.

We help the Hope Lodge.

They plan to expand.

That's right across the street, particularly for those that can't afford it.

But then right next to the cancer hospital is going to be a hotel or some kind of lodging, right.

We're not exactly sure, but it's going to be lodging of some sort.

There's a building there today called Rutledge Tower, which we use for predominately ambulatory needs.

We're going to decant that completely and that'll be up for redevelopment.

And then the best use we would see is exactly what you're talking about.

Some kind of lodging, maybe hotel, maybe some short term, stay type place.

And you're right next to the hospital.

If you look across the United States, cancer centers that have that, that's a big plus, for those patients in those, in those places.

Gavin Jackson> Who would you be competing with in the region for that cancer center?

I mean, Emory?

Dr.

Patrick Cawley> I mean, we've looked at Emory, Duke, Mayo down in Florida would be the big ones that we're talking about.

Gavin Jackson> Gotcha.

And then along those lines, Doctor Cole, tell me how this such a facility would fit in to the academic aspect of this.

I mean, you're going to have students rotating through or it's gonna be more residents and fellows coming through.

How does that fit into what's going on right now?

Dr.

David Cole> So, I think we've had a lot of discussions over the years of the Innovation District and what that innovation sort of corridor looks like.

This, I keep referring to ecosystem.

It's not merely a building which will be state of the art, it's the people that are part of that, the education that occurs there, the research that supports it to provide that standard of care and the patient experience.

We've been talking about and verbalizing that we're going to make two commitments to the citizens of South Carolina.

We're committing to actually creating cures in cancer, and we're committing to best patient cancer experience for South Carolinians, period.

And that doesn't happen with the building.

It's it's having a facility.

If you talk about, you know, the hotel right next door where as a patient family, once you're being discharged from the hospital earlier, you can stay in the location that's supported by the facility.

Think, Cleveland Clinic, you know, think MD Anderson.

Those are the type of patient experiences that give you best in class.

You know, going to your question, the academic side, we have outstanding research capability that we're just starting to apply as we speak.

And some of that is actually to redefining the standard of care in cancer in terms of cutting edge clinical trials.

We have clinical trials coming from CAR-T Therapy that we have been developing that will likely enable that complex care that's starting to lead to cures, to have a broader base of application likely to be providers in out patients.

Now, maybe you can actually get it in downtown Charleston.

You know, that's the things that we're excited about.

So, it's important to understand that this is a part of a whole.

It's a critical part the hospital, but it's also part of something that we envision to be, transformative in terms of what South Carolina is going to have as a resource.

And we feel very strongly that South Carolina should take care of South Carolinians, you know, as much as humanly possible.

Gavin Jackson> And to that end, we were talking about, and we'll talk about this further, but the need for doctors and nurses and such, I mean, this could be a big recruitment tool to assume as well, to have such a hospital.

Dr.

Patrick Cawley> We're committed to, expanding the number of physicians, the number of trainees for all different kinds of cancer residencies and fellowships, nurses, etc.. So we see, you know, we're going to expand because it's going to be part of what we need to do to build this ecosystem As Doctor Cole is pointing out.

And then at the same time, yeah, it will be a magnet for people wanting to come.

Gavin Jackson> Doctor Cawley, to that end, we're talking about how much is it going to cost to you're asking the General Assembly I think, for 350 million dollars in the funding.

Big investment, but at the same time, we've seen years of big investment in academic and health research.

I'm thinking about, I know this is different, but Clemson University's vet school obviously was a big one for Clemson.

They won that 285 million-dollar vet school.

It's huge.

Then 175 million dollars for the MUSC College of Medicine, as well.

And then we're also talking about what's going on here in Columbia, at USC School of Medicine, with their 300 million-dollar health sciences campus at Bull Street.

And of course, we've also seen some partnerships with the Nursing College of USC and Lexington Medical.

So now this is coming online.

What do you see when you see all that investment and that need and this working together to kind of create and address these, these concerns about nursing shortages and doctor shortages and even tech shortages when we talk about technical colleges?

Dr.

Patrick Cawley> Well, you know, when I look at that, I see, that's growth.

That's South Carolina growing.

And there's just a lot of needs and a lot of infrastructure to support the growth that is already here and, and is going to continue to come for the next 10 or 15 years.

Right.

So, you know, I think that investment has to occur.

It's also incumbent upon us to make sure we're doing this together.

And so we use those dollars together.

So, you know, we've said repeatedly this is not just about MUSC.

This is about an ecosystem for the state.

And it's not just about MUSC health system providing care.

We're going to link up with anyone who wants to be part of this.

So, you know, we're going to do that and work on that together.

Health care, manpower, it's a whole nother issue that we've been working on for a number of years.

You know, I was talking about this long before Covid.

Covid came along, and all of a sudden everybody began to understand and made the problem worse.

And everybody began to really understand what the issues are.

We've had great partnerships between particular hospitals in the state and in the universities in the state.

And, and, elected officials and the legislature around all kinds of... Gavin Jackson> Because they see the vision and they see it coming to fruition.

Dr.

Patrick Cawley> And these are things we need to work with, with the technical schools.

But you even need to work down at the middle school level to help students understand.

You know, people know about doctors, they know about nurses.

But that's actually the biggest problem we have is what we call the tech level.

You know, these are pharmacy tech, radiology tech, surgery tech, anesthesia tech.

This is a, this is a really good paying level of job that a lot of people just don't know much about.

So we have to train, you know, people at the middle school level to say these are options to think about.

So we really want to get our arms around the health care manpower problem we've really got to work on together.

Dr.

David Cole> I would echo everything Doctor Cawley is saying that through me, through my eyes, workforce currently is in shortage and will be in crisis, across the nation and certainly in South Carolina.

And we're working hard.

Part of our responsibility, you know, as a organization which is responsible for, as a state organization is to help address.

We educate.

We have six colleges.

We educate every dimension of health care provider.

We need to educate the heck out of everybody that is high quality and can deliver and be a part of this community in this state.

We partner creatively and I would say in a future leading sense, we need to redefine the model of care delivery, because as much as we work to create more training opportunities and, you know, pipelines and so forth, the need is going to outstrip anything that we can accomplish in the current way that we are delivering care.

You know, so we need to go to communities.

We need to provide, keep people out of hospitals.

We need to keep them healthy within their communities, which is part of why our footprint across the state has been intentionally part of and within in those communities that are, rural and underserved so we can start to affect what that looks like health wise.

You'd asked earlier about, you know, recruitment in the cancer hospital.

You know, Ray DuBois, our head of our cancer center has a whole strategic map.

And, you know, as an example and with support from the state, which we're very appreciative of over the last several years, that provide recurring dollars to help us to get to comprehensive, you know, he's recruited and will recruit by next year, 40 new, PhD investigators that the number of physicians that are required in the cancer space alone has been a focus of attention.

You know, the great news is that, you know, again, we can train, we can retain, we can recruit, and we're doing that, I would say with, purpose.

Gotcha.

Well, we're talking about a footprint here and MUSC Health under your purview Doctor Cawley has expanded, especially its investment.

And, one hospital system I will talk about Tidelands Health and its four facility, eventually five facility system centered on the Grand Strand.

MUSC health has a 51 percent stake in Tidelands Health right now.

Y'all got that approval last year by the JBRC.

This system, like other systems, y'all have taken over, require, I should say, is facing some financial difficulties.

So walk us through how that process works and the concerns that people have, but also the track record that MUSC Health has of taking over places like in Orangeburg and other locations across the state.

Well, the consolidation is occurring in health care.

And why is consolidation occurring?

It's because the cost of health care and there's just incredible pressure across the entire nation to, you know, get the cost of health care down.

You know, one of the ways to try to get it down is to consolidate.

Just for, you know, small hospitals to join bigger systems in order to deliver care less expensively.

So I don't think that is going to stop.

Right?

I think that trend is going to continue because the cost pressures coming from health care remain extremely high and are going to remain very high for the next 10 or 15 years.

Right.

The number of people coming into health care, mainly driven by the baby boomers who are hitting an age, you know, when they have the most need for health care is going to drive health care costs, you know, sky high.

And so we're going to be really pressured as a nation.

So that's what's, that's what's driving it all.

We started years ago, working with communities.

And over time, Tidelands is a good example.

We started working with what was there originally, the Georgetown Health System.

We started working with them in the mid 90s to help them with cardiology care, in the Georgetown area.

And that has morphed and changed, over time until MUSC took a small minority stake in Tidelands back in 2020, took a 30 percent minority stake at that time.

We help them develop, different services.

We help them grow.

We help them do things a little differently.

But even still, even with us having a minority stake, it still wasn't enough.

And so us taking a majority stake at this point in time, which really puts us on, you know, under responsibility to make sure that this goes and goes well.

Right.

And I got to give my team a lot of credit.

I mean, we have really focused on doing things well from a financial perspective, turning around hospitals that are struggling.

And I got a fantastic team that does this and really, really focus on it.

We do have size, which does help us when it comes to, scaling things.

But, you know, we feel pretty good about Tidelands.

Turning these hospitals around is often a two, sometimes three years.

I don't think Tidelands will be more than, more than two years, but, we know them well, and we feel pretty good that, we'll be able to provide more services in the area.

At the same time getting them in a better place financially.

Gavin Jackson> Are you going to go to 100 percent stake at some point, or how does that, what's the progression there?

Dr.

Patrick Cawley> We're at when we went before JBRC, we talked about taking an initial going up to 51 percent, but there was a lot of, assessment and fair market value being done.

We technically have 85 percent today.

So that was when the, when the deal was finally actually closed on October 1st, it came to 85 percent.

So that's what we have today.

Gavin Jackson> And it's also in a very high growth area too.

I mean, we're talking at the low country, but up in the Grand Strand, Horry County, Georgetown County.

I mean, they're showing explosive growth as well.

I mean, and that's what we're talking about.

And even, you know, McLeod Health has been expanding that area, too.

When you see that expansion, both sides, both companies, both organizations, we're talking about this coming wave.

I mean, is it still, is that even enough still, what you've been talking about?

Dr.

Patrick Cawley> I don't know when when you start to look at the numbers, when you start to look at exactly how many cancers we're talking about, how many, you know, heart attacks are we talking about and then convert those into how many we see in the hospital and in our ERs and things like that?

It is mind blowing.

Sometimes I can hardly even believe it.

But it's significant.

Right.

You know, we tend to, we tend to not fully understand the, <magnitude> just the magnitude of this population surge that came after, after World War Two.

We kind of know it from the economics, but now health care is experiencing exactly what this means.

So it's pretty big.

And almost every health system in South Carolina is in full on recruit mode, just to recruit more doctors, more nurses, more tax, more everything.

You know, paradoxically, one thing that may help us is telehealth.

So very early on MUSC has been a big proponent of telehealth, aided heavily by dollars from the legislature and that allows us to deliver care in more areas than probably if we didn't have telehealth we've been able to do.

Gavin Jackson> Yeah, a lot of times it's for smaller things instead of to go to, you know, a doc on the box or to doctor yourself or I just pop on your phone and do that.

But Doctor Cole do you want to jump in here, too?

So a lot of really important topics I would say you'd asked earlier about our system.

How's the system doing?

And I'm going to ignore Tidelands for the moment.

You know, the rural hospitals that we took, control over.

If you look at the national basis, the general paradigm is that they're going under <you hear a lot about> of course, because inability to recruit and retain providers, loss of confidence by the local community, migration is the term, increasing overhead, and you get into a spiral, Right?

You know, I think as an academic health system, we are uniquely positioned to, weigh in a manner that's very positive with those hospitals to stop those dynamics.

And as I mentioned earlier, we can recruit and retain.

I mean, every one of our hospitals, we have brought in significant number of new doctors, physicians, providers, you know, the confidence and quality within the community has been, I think substantive.

The impact where we've been able to have locally is important.

And as a specific example, Orangeburg, within 18 months, we brought them from years in the red to positive.

In fact, every one of our divisions is in the positive.

We don't want them to be anything more than high quality, highly trusted, care facilities within those communities.

And oh, by the way, going back to the discussion earlier about South Carolina should take care of South Carolinians, what do we want to say in downtown Charleston?

We want to have the relationship and the trust with those communities so that the patient who needs a heart transplant actually has the ability to get to Charleston in a timely manner.

<Sure> You know, so it's a systemness, right, and we are succeeding.

You know, we always hear about, oh, you know, they're underwater or this and so forth and you know, it's just not true.

You know, and it's not that we know everything about the future, but I am very proud of the success that we've had on behalf of and with the communities in South Carolina.

Gavin Jackson> And Doctor Cole, we've previously talked about your ways of retaining and keeping more folks in those communities, too, including, paying back medical school debt to keep those folks in those areas.

And we talked last May about this.

Have you seen, has that really been implemented yet?

Are you still starting that program?

Dr.

David Cole> Yes.

And again, so thank you to the state legislature and the leadership, you know, because we've been saying we need to be creative.

How do we do things that can do, specifically in this topic to, let me back up a step.

I think my firm belief is that if you have a heart for health care in South Carolina, you want to help in your career, take care of people in whatever form that might be, as a tech, a nurse, or whatever, you should have the ability to to be raised, educated and deliver for those who care in your communities.

I mean, as a basic thought, you know.

So it's another reason why we're excited to be a part of this community is because we can help create, residency programs in which physicians can go to highly underserved areas in which there's high needs for critical needs physicians.

And we're setting up training programs in which once the medical student graduates, they have to match for further training to be able to practice.

Those areas did not exist before in Florence, in Catawba divisions.

Soon in Columbia.

We're going to be 100, 150 new critical needs physician training programs in those communities.

The statistic which I believe is an Ahex statistic is that the best predictor of a physician practicing in South Carolina, 50 50 if you go to medical school, greater than 75 percent if you go to medical school and finish your training in South Carolina.

So the legislature has given us money to basically say, if a medical student matches in a high needs rural residency in South Carolina, they'll get half their student debt paid off.

And if they practice in that community for four years, the rest of their debt is paid off.

I think in our medical school, I'm making up a little bit, I think we had probably 20 percent of our class, was able to by matching in that mechanism to start into that pipeline.

So stay tuned because we're very excited.

We're trying to have the levers to incentivize where the need is, and to have an impact that's long standing in those communities.

Gavin Jackson> We only have two minutes left and I hate that because there's so much more to talk about.

But, that's great though, Doctor Cole.

But you've also been expanding, in your neck of the woods, too, at the West Ashley Pavilion and we're going to see some new hospitals coming online, too.

So a lot of growth, not just acquiring, but also growing.

But, to that end, I want to ask you a little bit about federal funding and any concerns you guys might have about Medicaid cuts, through that one big, beautiful bill that we saw and how that might affect MUSC Health going forward.

Dr.

Patrick Cawley> Well, we're always worried about any time Medicaid is being affected either at the state level or the federal level, because, you know, we're the biggest provider of Medicaid services, in the state.

So we always get worried.

That being said, the one big beautiful bill does have cuts in it.

We do know what the impact is going to be.

But the impact is over time.

You know, those cuts are coming in over 10 to 12 years, right?

And, you know, as long as we know, if those cuts were coming in next year, that's a whole different story.

Right.

But, you know, we have time to react.

So we're actually, we've looked at and said, you know, let's let's all calm down and let's just continue to march forward and do great things.

Doctor Cawley really quick with a minute left, AI and it's implementation.

Y'all are looking at applications for AI There's a fact that I saw that on a daily basis, 40 billion people are asking ChatGPT health care questions.

What does that say to you and is that somewhat like, web MD on steroids?

Is this a good thing?

What are we getting out of this, in about 30 seconds?

Dr.

David Cole> Well, brave new world, but I would say that most I think most people consider the health care sector the most in need of and most likely to be transformed by AI.

And so we're looking towards how do we actually enable that tool to provide more cost effective care, better predictive care to prevent and so forth.

And right now, honestly, it's a little wild west.

But we're working hard as an enterprise to be coherent and to be leaders in that space as much as possible as it gets applied.

Gavin Jackson> A lot of promise.

<Yes> All right.

That's MUSC President Doctor David Cole, and MUSC Health President Doctor Patrick Cawley.

Thank you to you both.

And thank you for tuning in.

for South County ETV I'm Gavin Jackson.

Be well South Carolina.

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