Keith Chew is a healthcare thought leader and subject matter expert with over 40 years of experience. He has developed a specialty consultancy focusing on hospital-based practices, especially medical imaging and radiology.

His invaluable experience has equipped him with in-depth understanding and expertise across various aspects of the healthcare domain. In this interview, Keith talks about his learnings in the field and his expectations for the future of healthcare.

Getting Started in Healthcare

Keith grew up on a farm in Illinois but was always drawn to science and education. After completing his medical studies, he planned on becoming a practicing physician but soon realized that he liked the science of medicine, not the practice of medicine.

Keith was working toward a Ph.D. in anatomical sciences. At the time, heading up research in a medical college, he was required to undertake certain coursework in finance and human resource management. He educated himself in other aspects outside of science such as accounting, human resources management, and financial management within healthcare organizations.

‘I found that I could apply that knowledge very well to medical practices because I understood the basic premise of the practice of medicine.’

From here, one thing led to another and Keith ended up getting a masters in health services administration after which he entered healthcare from the business side, not the clinical side.

‘Revenue cycle management is an extremely important component of every medical practice and I have come to understand it at a relatively deep level.  My entire consulting practice has been built out of the desire to try to help practices, provide high-quality service in the most effective and efficient manner possible.’

Talking about his first consulting account, Keith recalls was a consulting project to merge five radiology practices located between Chicago and Springfield, Illinois and help them continue to move forward as a group. Even though Keith didn’t have any prior experience in this aspect exactly, his work was already well-appreciated.

The client and Keith had worked together during his time at a for-profit hospital chain where he was the head of physician practices and off-campus ancillary services. During his time there, he had set up physician practices, imaging centers, outpatient labs, radiation oncology centers, and physical therapy centers.

After the success of his first consulting account and his prior work experience, Keith became well-recognized within the healthcare domain. He participates actively with professional societies including the Radiology Business Management Association and the American College of Radiology.

‘For the past 22 years, I have focused exclusively within radiology but through my career, I have managed primary care practices, ophthalmology practices, a large multispecialty group, and orthopedic groups. I have had a broad experience within the medical practice side of healthcare.’

Current Business Structure and Organization

Presently, at Consulting with Integrity, Keith focuses on the general class of strategic positioning. He looks at ways of how organizations can meet all of the legislative and regulatory compliance issues and still position themselves to be successful for upcoming things and ultimately provide the care for the patient in the most efficient and effective manner possible.

While Keith does not have a team directly reporting to him, he has 15-20 subcontractors with the required skill-set to bring the best to every project. As he is solely in charge of the projects he undertakes, Keith prefers not to exceed five or six clients at any one particular time.

Though he does say that during times of big changes the numbers go up to 15 or 20 clients at a time, he never drops down below four or five clients. Additionally, his clients keep varying as his goal is to help them get to a resolution for their problem and provide them the skill set they need to continue to manage that process moving forward.

For Keith, it is important to treat the patient as a person and ensure there is true contribution to the patient care continuum.  His primary work is within medical imaging, the radiology realm, and he works with radiology practices, hospitals and health systems across the country in that realm.

One of the biggest things Keith observed in radiology is that radiologists initially were seen as the doctor’s doctor and with the advent of the PACS that changed and radiologists started to be seen more and more as a commodity.

For Keith, this is concerning, as radiologists are physicians with valid diagnostic and patient care insight that need to be heard in the patient care continuum to properly meet the care needs of the patient.

He now works with practices to help radiologists, in particular, position themselves so that their medical judgment is not lost but is brought to bear ultimately as a component of the patient care continuum in the care needs of that patient.

With teleradiology becoming popular, a common perception is that radiologists are not needed on-site for their expertise. However, Keith believes that having a radiologist present at a facility allows the other physicians on the medical staff to interact with the radiologist and discuss the case personally.

The nature of interaction that occurs between the medical staff and the radiologist is important. If done remotely, it does have as large an impact on patient care and the lack of onsite presence can commoditize the radiologist.

‘Teleradiology brings the ultimate impact down to a very small portion of what radiologists really do and that is why I don’t think that a total teleradiology approach contributes to a high-quality service.’

Standout Moments as a Business Leader in Healthcare

Healthcare is a business about caring for people but in Keith’s experience, often the federal government gets in the way.  The increase in administrative cost, administrative time, and additional burdens along with the changing demands of insurance companies can be problematic.

For Keith, the things that have stood out have been the times when even with all the regulatory environment, prior authorization requirements, and other administrative burdens that are placed on practices, he still finds a way to assist the practice meet the patient’s healthcare need. He finds a way for the practice to do what has to be done and to do what is right for the patient.

While he understands that the payers and the government are trying to do the right thing from a regulatory perspective, those administrative or legislative actions burden healthcare with having to figure out how to live by these rules.

‘For me it has always been the fact that no matter what, we find a way to meet the patient needs, to care for the patient.’

Over the years, Keith has set up various practices that instill a sense of pride in his work. Among the top of the list are times when he was able to work with a practice and a patient to get the service that they needed in a manner that did not bankrupt the patient.

Also, being able to make certain that some of the small practices in rural areas with which he works, are able to meet the care demands of the patient populations and ensuring that the patients in those areas don’t lose that service.

‘If somebody has got to get in a car and drive an hour just to get their mammogram they are not going to do it.  Something is going to have to really be wrong to make them take that drive.  It is no longer going to be a preventive service.’ 

 Overcoming Challenges in Healthcare

A growing challenge is being able to continually maintain insight into what is going on in the industry and trying to contribute to that industry.  The industry is continually facing challenges. There are certain issues right now with artificial intelligence that are starting to play heavily within the field. Five years ago or so people were talking about artificial intelligence replacing radiologists entirely.

Everybody is rightly looking at artificial intelligence as augmented intelligence where it can contribute to the knowledge of the radiologist in a very positive manner. But Keith doesn’t believe there is sufficient understanding yet where AI can be deployed in a manner where it impacts the diagnostic workflow effectively.

At this early stage of the deployment of AI, it is more of a quality tool than a diagnostic tool and as the industry continues to build, the algorithms continue to improve and people begin to truly understand artificial/augmented intelligence as a whole, it can start moving into the diagnostic realm.

Most people right now are not aware of how to evaluate, install and deploy artificial intelligence. Just because a manufacturer says that it works does not mean it is going to work at the manufacturers claimed accuracy or specificity at a facility, on the facility’s specific imaging equipment, or the PACS system, or the current patient population.

‘The first big goal is to understand that AI is best deployed currently as a quality tool before it is being utilized as a tool that directly impacts the actual care being provided.’

Business Plans for the Future

The focus for Keith, as he gets older, is wondering how to slow it down rather than build the business. Even without any marketing or sales activities, he gets enough calls from people to stay busy. Over the last few months, Keith has found himself turning down a few projects.

Having developed such expertise through personal learning and in-depth experience, Keith is doubtful of being able to teach his skillset to somebody else so that they can take over the business.

Now the focus is on figuring out how to become more constrained in who he works with as he looks at continuing to try to get down to a point where he can start to enjoy retirement even if it is a partial retirement.

‘I am probably never going to stop working but I would like to get to a point where I am not working 70 plus hours a week just to make certain that everything the client needs to be done is done timely.’

Top Philosophies and Core Values in Business

A major philosophy for Keith stems from the Hippocratic Oath to do no harm.  He believes that healthcare should be here to help the patient first and foremost and his biggest concern is that the prime focus seems to be lost owing to the corporatization of healthcare, and other factors.

Another core belief for Keith is identifying the cause for people providing healthcare. For some, it is about doing the right thing, while for others the motivation is money. That for Keith is a very distinctive question between an infinite game approach and a finite game approach.

If people are doing something because it is the right thing to do, then ultimately it will work out financially for everybody.  If is it monetary-inspired, it is going to be a short-term splash and it could be detrimental in the overall confines of healthcare moving forward.

‘I try to keep an infinite game strategy in all of the activities with which I am involved within healthcare.  To me, it is the delivery of the care to the people that is the important component of this.  If you do it and you do it well, you should financially be rewarded but if you do it just for the money I see that as a problem.’

 Advice for Newcomers starting a Career in Healthcare

Newcomers tend to be full of drive with a belief that they know it all. Keith believes a certain amount of drive is necessary. But there is also a certain level of humility that needs to be brought in at the start of one’s career and to pay attention to the elders in the field.

‘Don’t ever get too full of yourself and remember everybody has a valid input.’

Healthcare is an extremely complicated business and people need to pay attention to everything.  If someone is headed down a path of learning one thing only, there is nothing wrong with that. They can be an expert in that area, such as revenue cycle management, healthcare marketing, coding, or something similar.

However, if someone wants to be a generalist and understand how it all fits together and works together, they need to pay very close attention to all the little bits and pieces, be willing to step in, and get a little dirty doing the jobs of everybody in a practice.

It is not important to get a degree in every aspect of healthcare, but learn by shadowing people in practices, talk to them and understand them as people. Bring that information to play and involve them in the discussions which are focused on creating solutions.

‘You want to make certain that you have got a solid team that is diverse not only in terms of gender, but age and ethnicity and insight. The solution you are going to come up with through that team is going to be so much stronger than anything you as an individual can come up with alone.’

Key Benefits of Services at Consulting with Integrity

The key benefits vary with the nature of the project. Keith recounts that during the last year under the pandemic, a lot of organizations were concerned about the appropriate staffing level by subspecialty level within radiology for their facility.

One of Keith’s expertise is in being able to take volumetric data of all services by hour of day, by date for a facility and delineate the radiology subspecialties that would be interpreting those studies by month, week, day or hour of day. This helps establish the appropriate level of staffing to meet the demand.

The focus is on getting to a right-sized, objective staffing level so that the institution can provide the quality of services that their patient population would expect at those types of institutions whether they are academic institutions or corporate or free-standing practices. Another advantage of appropriate staffing is decreased stress and burnout coming from a balanced workload.

Other projects include finding approaches for practices to work jointly or collaboratively.  There are some subspecialties within radiology that are difficult to maintain sufficient volumes to support the subspecialty at a location, pediatrics is a perfect example.

Operational improvements for better efficiency is another key benefit of Keith’s services. Being able to come in, research what a practice is doing, what their ultimate output or the goal is for performance, being able to look at their operations and figure out whether they can streamline things, is highly beneficial.

Another is strategic positioning which involves trying to understand that based upon the information currently available, what is going on in the industry with health systems, what is it that this practice needs to be doing, and being able to start building with the practice the business plans for either the advancement of particular services, expansion of particular services, the recruiting and all of the other things that contribute to those possibilities.

Vision for Future of the Industry

Keith believes healthcare is going to continue to evolve.  Part of the problem for this sector is that as administrations change within the federal and state government, healthcare visions also change.

There is a market-driven piece of the segment out there that is highly profit-focused. This is one of the reasons why healthcare is going to continue to have that problem.

Also, it is important to realize that healthcare is a complex industry that so many people do not understand. There are macroeconomic implications in healthcare that are very frequently overlooked.

Healthcare contributes to a large percentage of the national GDP. Any decrease in the size of this industry will decrease the national GDP and that will have a domino effect on a number of other economic factors.

‘If we develop a healthcare policy with a more universal perspective and less of the individualistic perspective, I think we will be a lot better off.’

Leadership Lessons Learned over the Years

Remember that no matter how good someone thinks they are, there is always more to learn, especially as a newcomer. Also, it is important to understand that diversity is your friend and doing the right thing will ultimately be rewarding, whether financially, emotionally or both.

‘Try to understand the different perspectives that exist, because your single vision perspective is not the only one of value. That is the big leadership lesson I have learned.’

Follow Keith Chew On : LinkedIn