Saline Memorial Hospital's recently appointed CEO is utilizing her clinical perspective to improve staff development.
As the CEO of a hospital or health system, it's arguably never been more important to be able to see pain points through the eyes of your clinical and non-clinical staff.
With the workforce shortage continuing to plague organizations everywhere, having common ground with employees can allow leaders to approach areas like recruitment and retention through a valuable viewpoint.
That ability is giving Char Boulch a deeper understanding of how to guide Saline Memorial Hospital as CEO. Boulch took over the helm of the Benton, Arkansas-based hospital in February after serving as its CNO since 2023.
Her experience also includes other senior nursing leadership positions at various hospitals, as well as time spent as a patient access clerk, providing Boulch with a well-rounded perspective of what life is like across the hospital workforce.
"Starting at the ground level has given me a unique perspective into hospital operations and how decisions at the top affect the people who are directly impacted with the work," Boulch told HealthLeaders. "I’m passionate about driving positive change and making a difference in our patients and staff lives. The CEO position offers a perfect platform to do this."
Boulch believes that her tenure as a CNO specifically has set her up for success. The announcement of Boulch's appointment as CEO highlightedher impact as CNO on quality improvements like reducing preventable harm and increasing inpatient and acute rehabilitation admissions, along with her effect on furthering a culture of collaboration and innovation.
"As a CNO, I honed my ability to lead people and vision cast," Boulch said. "These skills are directly transferable to the CEO role, where strategic leadership and organizational efficiency are crucial. Moreover, my firsthand experience in clinical settings allows me to make informed decisions that prioritize both patient care and operational success."
Pictured: Char Boulch, CEO, Saline Memorial Hospital.
One of the areas that Boulch especially knows a thing or two about thanks to her nursing experience is how to attract and keep staff.
Though the workforce shortage in healthcare isn't at the heights it was during the pandemic, it remains a concern—for both now and the future. A report by Mercer consultancy found that the U.S. will have a shortage of over 100,000 critical workers by 2028, putting the onus on provider CEOs to be proactive in maintaining and strengthening their workforce.
Boulch wants to keep the focus on staff well-being and professional development opportunities to ensure her workers feel valued and supported. Some of the ways Saline is doing that is by providing a lavender room where employees can decompress and having 'Wellness Wednesdays' to designate a day for workers' welfare.
"Ultimately people want to feel valued and respected. That is key," Boulch said. "We have an employee engagement committee that addresses the question, 'how do we make sure our employees feel valued and respected,' and they come up with initiatives and ideas on how to ensure our staff receive recognition and understand how they contribute to the overall strategic vision for Saline."
Boulch may be settling into the CEO role, but her familiarity and understanding of the people she's leading is putting Saline in position to tackle essential challenges.
A new survey reveals how turnover in the workforce is trending and why executives are looking elsewhere.
Healthcare organizations aren't just contending with high levels of turnover with their clinical workers—they're also facing significant change among their leadership.
That level of change is expected to increase in the coming year with almost half of provider executives intending to leave their organizations, according to a survey by B.E. Smith, a division of staffing solutions company AMN Healthcare.
Responses were collected from 588 leaders, ranging from management to the C-suite, with 73% working in health systems and hospital, 10% in clinics/group practices, 3% in post-acute facilities, and 14% in urgent care centers, medical schools, and other care settings.
Forty-six percent of respondents said they plan to exit their organizations within the next 12 months, while 26% stated they would do so either immediately or within the next sixth months. Nearly three out of four leaders (74%) said they were approached with a job opportunity in the past six months, with 17% pursued it.
One of the reasons executives are having wandering eyes is the decline in job satisfaction. Seventy-nine percent said they were extremely or somewhat satisfied with their job, compared to 82% last year. Those identifying as extremely satisfied dropped from 38% to 32%.
Tenure is also a major factor in leaders' intention to leave. Respondents who had been with their current organization for more than 10 years were the least likely to consider exiting, while those with one to five years of tenure were the most likely to contemplate leaving.
To improve retention efforts and get executives to stay, organizations should target the factors that leaders value most, including organizational culture (44%), colleagues (39%), and compensation package (38%).
Fortifying the workforce and reducing turnover should improve the outlook of executives going forward. Currently, 34% of respondents expect the financial and operational conditions at their organizations to improve in 2024, with 48% expecting no change, and 18% anticipating conditions to worsen.
When it comes to the financial and operational conditions facing the industry, 30% expect conditions to be better, while 39% expect no change, and 30% expect them to be worse.
The nonprofit is changing up its management and administration positions, which could lead to some workers being laid off.
Yale New Haven Health is the latest health system to pursue restructuring with the aim of achieving greater efficiency.
The Connecticut-based hospital operator announced it will alter its management and administration roles as it works to "redefine and consolidate" its leadership team to "streamline decision-making and drive growth," a spokesperson for the organization said.
The changes will affect Yale New Haven Health's inpatient care and ambulatory operations, allowing it to be "nimble" in delivering care.
Though most impacted employees will have opportunities within the new structure, up to 38 people could be laid off in the process, according to the spokesperson for the health system, which operates five hospitals in Connecticut, New York and Rhode Island.
The health system also said in February that after three years of negotiations to close a deal with Prospect Medical Holdings for three Connecticut hospitals, the sale had become "impossible."
Prospect's alleged financial mismanagement derailed the $435 million transaction and is causing the bankrupt hospital operator to locate new buyers for the trio of facilities.
Meanwhile, Yale New Haven Health is joining several other health systems in restructuring, including Mass General Brigham and Providence.
Last month, Mass General Brigham announced it would conduct the largest layoffs in its history by cutting hundreds of management and administrative positions. The organization said it expects to save more than $200 million per year from the jobs cuts.
In the case of Providence, the Washington-based health system announced in January that it would restructure its executive team again under new CEO Erik Wexler. The streamlining included placing executive vice president Sara Vaezy in charge of AI strategy, digital health, innovation and sustainable partnerships.
As more health system grapple with the financial ramifications of rising expenses, trimming down leadership teams through restructuring can allow organizations to save on labor costs while realigning priorities.
Kaufman Hall's latest National Hospital Flash Report reveals that performance indicators are mostly holding steady.
As more patients received care to kick off the new year, expenses continued to rise, resulting in a balanced financial performance for hospitals in January, according to Kaufman Hall's National Hospital Flash Report.
The research, which draws on data from more than 1,300 hospitals nationwide, found that that the median monthly operating margin index for January was 8%, bringing the calendar-year-to-date figure up to 5.1%.
For the first time in one of its reports, Kaufman Hall included hospital margin performance with the inclusion of all allocations for the cost of shared services that they receive from their health system. Including all allocations, the median monthly and calendar-year-to-date operating margin index was 4.4%.
"January was a relatively stable month for hospitals, as more people received care due in part to seasonal challenges like flu and other respiratory diseases," Erik Swanson, senior vice president and data and analytics group leader with Kaufman Hall, said in a statement. "Hospitals are also experiencing more rapid revenue growth from inpatient than outpatient services. Expenses are also rising, driven primarily by drug costs, though the rate of cost growth has slowed."
In terms of volume, January saw month-over-month increases in discharges per calendar day (5%), adjusted discharges per calendar day (2%), equivalent patient days per calendar day (6%), adjusted patient days per calendar day (4%), average length of stay (2%), and operating room minutes per calendar day (2%).
More patients were treated in the hospital and emergency room, resulting in inpatient revenue growth outpacing outpatient revenue growth month-over-month on a per calendar day basis, 8% to 3%, respectively.
Net operating revenue per calendar day rose 1% from the previous month, while gross operating revenue per calendar day jumped 5% from December.
Expenses ticked up at a modest rate, with total expense per calendar day increasing 1% month-over-month, largely driven by 2% growth in labor expense per calendar day and 1% growth in drug expense per calendar day.
Medicare Advantage is exacerbating providers' financial and operational problems, making the current path almost untenable, say hospital CEOs.
In this week's HealthLeaders' The WInning Edge series, hospital CEOs Rachelle Schultz from Winona Health and Holly McCormack from Cottage Hospital share what strategies providers can use to hold their own against the challenges posed by Medicare Advantage plans.
Tune in to hear the panelists discuss the issues caused MA, as well as how leaders can approach contract negotiations with payers and advocate for reform.
Two hospital leaders share how providers can improve their standing in negotiations with Medicare Advantage payers.
Medicare Advantage payers may have most of the power in the dynamic with providers, but there are strategies the latter can utilize to create leverage.
In HealthLeaders' The Winning Edge for Battling Medicare Advantage, Cottage Hospital president and CEO Holly McCormack and Winona Health president and CEO Rachelle Schultz highlighted ways providers can improve the conditions of their Medicare Advantage contracts.
Providers' frustration with the private program is palpable, but there are actions they can take to alleviate its consequences.
There's truth is that there's no silver bullet for winning the fight against Medicare Advantage (MA) as a provider.
However, even though hospitals and health systems are at the whims of payers in this struggle, they're also not without recourse to soften MA's negative effects.
It takes, in one part, working on the margins, and in another part, attacking the problem head-on in talks with payers, but there's enough reason for providers to not feel helpless with MA.
In HealthLeaders' The Winning Edge for Battling Medicare Advantage this week, Winona Health president and CEO Rachelle Schultz and Cottage Hospital president and CEO Holly McCormack dove into strategies, both direct and indirect, to help even the playing field versus MA plans.
Here are three ways provider leaders can mitigate the impact of the private program on their organizations:
Reduce administrative burden
One of the biggest issues with MA is the amount of administrative strain it places on providers.
Prior authorizations, delays, and denials are weighing down a workforce that is already stretched to its limits in a post-COVID environment. Hiring more workers to throw at the problem is easier said than done when labor costs are rising and many organizations are opting to trim down.
So, how can CEOs respond?
Leveraging technology, specifically automation, allows providers to fight fire with fire against payers' own fleet of AI, according to Schultz.
Still, the fight is far from a fair one because when it comes to knowing the criteria and algorithm payers use to accept or deny prior authorizations, "there is no visibility to that," Schultz said. "There's no transparency."
Providers are essentially going in blind with their automation, but it's necessary nonetheless to minimize the load on staff.
Getting completely away from the human component right now is impossible though. That's why Cottage Hospital has formed a prior authorization team rather than having that work done by each department, "in the hopes that there can be some recognition of commonality as you prior authorize one procedure versus another," McCormack said.
Work with—or against—payers
The most direct way for providers to truly make up ground in the battle against MA will always be to bring payers to the negotiating table.
Whether it's working to improve reimbursement rates or decrease prior authorizations, hospital and health system CEOs must get insurers to play ball—willingly or unwillingly.
For Schultz, Winona Health found success in opening a dialogue with its main MA plan in the area by letting them know they were open to innovating and realigning on things like new payment models and care delivery to create a more mutually beneficial relationship.
Having that conversation also allows providers to get more insight about payers' decision-making, thought process, and assumptions, creating a fuller picture of what you're negotiating with.
To gain more leverage, hospitals and health systems, especially of the independent rural variety, should also consider forming a clinically integrated network, Schultz said. Doing so will give organizations the scope and scale for payers to be interested in the number of lives that are covered by their MA plans.
There's also the extreme action of threatening and following through with the termination of MA contracts that some providers can utilize to put the heat back on payers.
If you're a big enough system and can survive the loss of patients, it may be an effective method to rid yourself of the headaches that MA can bring. However, Schultz views it as more of a "short-term strategy," while McCormack noted that in small communities, it won't have the impact that a provider would want.
Advocate for reform and educate
At the end of the day, much of the power in how MA is structured is in the hands of policymakers, which is why providers need to be vocal about changes they want to see made.
Advocating for cost-based reimbursement and streamlined prior authorization processes is of the utmost importance, McCormack highlighted.
Schultz also wants to see greater transparency and accountability by payers around access, quality, and outcomes.
"It's making sure that our policymakers are aware of these things that are wrapped up into this and they don't know unless you tell them," McCormack said. "It's making sure that you're involved with reaching out, however that is, with your representatives, whether it's by e-mail or whether it's a phone call or whether it's hosting a legislative breakfast within your organization, because these folks don't know unless we tell them."
At the same time, providers must educate their patients to help them understand what plan is right for them.
"We have just heard so much feedback from patients who felt like they got blindsided by what was covered, what was not covered," Schultz said.
It's not about steering patients to one plan versus another, but about combatting some of the deceptive MA marketing that is out there and giving them all the information possible for them to make the best choice.
Ultimately, providers have to do what they can with what they have until the landscape shifts.
"There's so much dissonance that's happening, but Medicare Advantage is here to stay," Schultz said. "For us, we just have to sort of bide our time and continue to find openings to get in there and you provide care to the people who are under those plans in our community."
Living with Medicare Advantage can be draining for your organization, but it doesn't have to feel hopeless.
The unfortunate reality for providers is that Medicare Advantage (MA) is as popular as ever, meaning the hurdles that come with accepting the plan are here to stay.
Providers have little choice but to consider how they can alleviate the effects of low reimbursement, high denial rates, and increased administrative burden associated with MA to maintain the financial and operational health of their organization.
How MA can be crippling
Unlike traditional Medicare, MA plans are run by private payers, which have their own set of reimbursement rates and schedules, as well as claims processes.
Even when providers are reimbursed, payments can feel inadequate due to payers exerting power in contract negotiations to keep rates down. However, providers often face delayed payments or denials that place more strain on staff and administrative costs.
MA is particularly known for its prior authorization requirements for services, which force providers to submit additional documentation and wait before administering care.
The results can be devastating to organizations, like in the case of Bristol Hospital. Last year, CEO Kurt Barwis said the operator would eliminate 60 jobs, including 21 layoffs, to offset the costs stemming from MA delays and denials.
"The Medicare Advantage abuse is outrageous," Barwis told the Hartford Courant.
In many other cases, hospitals and health systems are going to the extent of dropping MA contracts to avoid the headache altogether.
Sanford Health, one of the Midwest's largest health systems, made the decision to do just that last August, when it announced it would end its participation with Humana's MA plan.
"We have attempted to work with Humana for several years, but unfortunately, we have continued to experience delays in patient care, barriers to scheduling and denials of coverage causing financial burden and undue stress to our patients," said Martha Leclerc, vice president of corporate contracting for Sanford Health.
The downside of the move is losing MA beneficiaries as patients, which is why not every provider will have the luxury of severing ties with MA payers.
Still, the strategy is one more and more leaders are considering. In last year's survey by the Healthcare Financial Management Association, 16% of health systems said they plan to stop accepting one or more MA plan in the next two years, while 45% reported considering the same without having made a final decision.
What's clear is that the toll MA is taking on providers everywhere can't be ignored.
Reclaim your ground
MA isn't going anywhere anytime soon, so leaders must rethink how they approach payer contract negotiations and improve efficiency within their own organization to withstand the negative impact from the private program.
The next webinar in our The Winning Edge series will dive into ways leaders can mitigate the financial and operational challenges stemming from Medicare Advantage, featuring insight from hospital CEOs.
Our distinguished panel includes:
Holly McCormack, president and CEO of Cottage Hospital, and HealthLeaders Exchange member
Rachelle Schultz, president and CEO of Winona Health, and HealthLeaders Exchange member
Jay Asser, event moderator and HealthLeaders CEO editor
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately.
Join us as we address problems, share solutions, and help you in the battle against Medicare Advantage.
Register here to reserve your spot and see what other topics we have in store this month.
Our Summer 2025 CEO Exchange is being held on June 4-6 at the Park Hyatt Aviara in Carlsbad, CA.
Are you a CEO interested in attending our event and strategizing with other attendees? To inquire about attending the HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
"The biggest waste that exists in the system is administrative expense related to how payers and providers work together," says one heath system CEO.
In this episode of HL Shorts, UMass Memorial Health president and CEO Eric Dickson shares what changes he would like to see made to the healthcare system to help avoid hospital bankruptcies and closures.
Be mindful of the people that will use AI just as much as the technology itself, says UMass Memorial Health's Eric Dickson.
Hospital leaders have little choice but to explore the ways AI can lessen the burden on clinical and non-clinical staff, according to UMass Memorial Health president and CEO Eric Dickson.
However, there's more to implementing AI than just picking the right technology. Here are three steps Dickson outlined for CEOs to get the most out of AI at their organization.
