Dr. Aurora Pryor is the chief of surgery at Brown Surgical Associates and Brown University Health. She recently spoke with Providence Business News about her role, the evolution of surgical care and the challenges facing the field.
PBN: What are your long-term goals as chief of surgery at Brown Surgical Associates and Brown University Health?
PRYOR: The mission of the Brown University Health Department of Surgery is to provide exceptional surgical care to our community, delivered with integrity and compassion while instilling our values of excellence in the next generation of surgeons. Our vision is to shape the future of surgery through leadership, globally recognized patient care, groundbreaking research and transformative education. These goals align with the Brown Health values of compassion, accountability, respect and excellence.
Our department includes the following divisions within Brown Surgical Associates: Surgical Oncology (includes breast, endocrine and liver/pancreas sections); Trauma/Critical Care (includes Burn); Surgical Research; Pediatric Surgery; Vascular; Colorectal Surgery; General Surgery (including Bariatric Surgery); Thoracic Surgery; and Transplant Surgery. The department also includes Urology; Cardiac Surgery; Ophthalmology; Plastic Surgery; Head and Neck Surgery; and Oral Surgery.
We deliver amazing care with top-tier clinical outcomes compared to national benchmarks. The breadth and depth of what we offer across our system is phenomenal. We are currently working to enhance patient and provider access by building departmental call centers to make it easier for our patients and referring providers to get the excellent care delivered by our surgeons. Many of our surgeons are nationally recognized leaders across their specialties.
My vision for the future of the department is to elevate the visibility of the remarkable work already being done at Brown Surgical Associates and Brown University Health. We are doing this by building programs that not only benefit patients of Rhode Island and southeastern Massachusetts but that are nationally recognized. My goal is that we continue to provide the best care possible to our patients and shape the future of surgery.
PBN: How have you noticed innovation and access to surgical care evolve in recent years in Rhode Island?
PRYOR: Rhode Island is embracing innovation. We have a unique position where expertise in medical-device innovation, new techniques and new technologies is converging to create exciting opportunities for providers and patients. In the Brown University Health Department of Surgery, we are also embracing new technology and the latest innovations in clinical care as well, with several of our surgeons holding patents on medical devices and working with partners in the industry to bring these latest ideas to our patients.
Rhode Island resources that help us succeed include partnerships with the R.I. Life Science Hub and the New England Medical Innovation Center, both of which are working with surgeons in the department. One example is a new testing technology invented by Sean Monaghan and his team that can identify bacteria causing sepsis within hours of coming to the hospital and tell us which antibiotics will be most effective. This is days faster than current technology and can help us treat patients more effectively.
Our goal is to provide our patients with access to the best technologies available, and we are achieving that. In recent years, we have adopted robotic approaches to many surgical conditions and introduced endoscopic alternatives to many traditionally surgical diseases. We also have expanded our use of medical technologies that help us avoid surgery whenever possible. We are bringing in new devices such as clips and stents to manage GI [gastrointestinal] perforations that will allow us to provide less-invasive options for care, which help our patients recover faster and with fewer risks. Our surgical outcomes at Brown University Health reflect our commitment to providing excellent and innovative surgical care.
PBN: Are there any new educational tools or trends you’ve found effective for training surgeons?
PRYOR: We have developed a robust simulation experience within the Department of Surgery that allows our trainees to develop their skills before they participate in treating patients. In addition, our surgical robots give metrics to practicing surgeons and trainees about their technical performance. There are also new opportunities for feedback using video assessment that help enhance technical care, much like what is used for professional athletes.
We are also leveraging AI [artificial intelligence] algorithms to help with diagnosis, treatment and feedback for our trainees. Although many of these technologies are new at this point, our surgeons are leading these efforts on a national level, and we at Brown University Health will have early access to these opportunities to enhance our training.
Importantly, we at Brown University Health have a particular focus on the “softer” side of surgery, teaching skills beyond technical excellence such as communication and leadership. We also employ a wellness coach with a sports and business background to help our trainees and faculty maximize their performance and well-being. With these additions, we graduate highly skilled and compassionate clinicians.
PBN: How does the ongoing Medicaid reimbursement struggle affect surgical care? Do different specialties feel the effects differently?
PRYOR: Rhode Island cares for a higher percentage of Medicaid patients than any surrounding state. Our reimbursement for these patients is also the lowest in the region and is less than it actually costs us to care for these patients. In fact, Brown University Health alone lost over $138 million in the last two years caring for Medicaid patients. Currently, the federal government will fund back to Rhode Island $2 for every dollar we invest in Medicaid to help offset these expenses in patient care. This is money we are leaving on the table that can help us improve patient care and access. Our lawmakers are now considering changing funding to Medicaid. It is essential that we increase reimbursement to help our hospitals survive and to ensure our talented physicians, nurses and other providers remain in the state and we can continue to recruit talent at a high level.
For readers of this interview, reaching out to your legislators and expressing the importance of local high-quality surgical care will help us keep offering it in Rhode Island. Any support readers can give to these initiatives is appreciated and helps us give you excellent care here when it’s needed.
For surgery specifically, less reimbursement means that it is harder to recruit and retain surgeons, advanced-practice providers, nurses and team members that all contribute to surgical care. We are doing everything we can to cut expenses and compensate our providers fairly, but we are handicapped by reimbursement. If we want to keep our surgical expertise here in Rhode Island and our hospitals functioning at the top of our ability, our health care professionals must be paid fairly for their work. All our specialties are impacted and addressing reimbursement preserves our ability to deliver top specialty care here in Rhode Island.
PBN: What other challenges are surgeons facing in Rhode Island?
PRYOR: Reimbursement challenges have contributed to shortages of primary care physicians or limited access to primary care within Rhode Island. As a result, some patients are seeking primary care services out of state, which often leads to the fragmentation of care, to the detriment of patients, and referrals outside our health care system – particularly among those with the means to travel. Seeking care out of state, moreover, leads to higher costs for Rhode Islanders because out-of-state providers charge and receive more for their care. This trend will further weaken reimbursement rates in Rhode Island and restrict the care we are able to provide locally.
In addition, Brown Surgical Associates and Brown Physicians Inc., our affiliated group, are seeking to integrate with Brown University Health to make our patient care more efficient between Brown Physicians and Brown University Health. A key advantage of integration would be the unification of our electronic medical records, allowing clinic notes to be seamlessly accessible across both outpatient and hospital settings. For patients, this will result in a single portal for all test results and appointments, along with a centralized billing service.
It is imperative to recognize that higher reimbursement rates are directly tied to better clinical outcomes. Adequate funding allows for the recruitment and retention of top medical talent, investments in infrastructure and technology, and expanded access to high-quality, timely care for all Rhode Islanders. This transaction is currently being considered by the Federal Trade Commission and the R.I. attorney general and is, frankly, essential to help us constrain costs and improve our long-term ability to deliver outstanding surgical care for our patients in Rhode Island.
Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.
