CFOs are getting creative when it comes to retaining talent, succession planning, and maintaining the overall financial health of their organizations.
Labor shortages, diminished margins, accelerating expenses, and leadership vacancies: A perfect storm of factors is pressing financial leaders to employ meticulous strategies to rein in costs while creatively thinking about building a sustainable workforce.
Meeting true staffing needs requires a steely focus on workforce governance basics. CFOs are relying more on data to forecast tomorrow's workload and plan for longer-term flexing staff-to-volume. Hiring for new positions is under greater scrutiny, while staff is being downsized when needed and technology investments are reducing the need for FTEs. But while current shortages are commanding attention, leaders must also plan for future viability by attracting, growing, and retaining talent.
The June 15, 2022, Healthcare Workforce of the Future virtual panel brought together three chief financial officers at leading healthcare systems to share their approaches for overcoming the fiscal demands of staffing in a post-pandemic world.
Prioritize labor management
To counteract diminishing margins, financial leaders are concentrating on streamlining labor costs through keener portfolio management, strong governance models, daily productivity monitoring, budgeting, and prioritizing nurse staffing.
"We're looking at all the overhead departments throughout the system, employing benchmarking standards and reassessing prior decisions," says Mike Browning, SVP and CFO at OhioHealth in Columbus, Ohio.
"We need a transformation team and an innovation team to answer the question, 'Do we need to be that large?' " he says. "We're double-checking decisions we've made in the past. When times are good, we keep adding things. Now we're asking, are we creating value for what we need in the future?"
To trim costs, Northwell Health is applying automation in the revenue cycle space to eliminate or avoid adding FTEs.
"A number of repetitive tasks have been automated and that has created the need for a new technical workforce to manage that work," says Michele Cusack, SVP and CFO at Northwell Health in New Hyde Park, New York. "Our largest area of success with RPA has been in revenue cycle, but we're trying to replicate the success in other functional areas as well using various technology platforms to further optimize workflow and putting tools in place to mitigate the need for manual work efforts"
"We're looking at clinical staffing models to figure out a way to predict staffing based on historical information—trying to understand the seasonality of some utilization patterns, whether it's the ED or certain medicine volumes or particular geographies. The goal is to put tools in schedulers' hands to help optimize scheduling for nurse staffing" says Cusack.
OhioHealth has established a singular committee, which has over each site and each business unit it monitors.
"We try to do it similarly in all areas to ensure there's consistency throughout the system and that helps us understand where vacancies are and which we need to fill, whether it's clinical or not," says Browning. "The team sets guidelines, and we try to adhere the best we can throughout the system. "
Mayo Clinic, headquartered in Rochester, Minnesota, is undergoing a major technology upgrade to provide managers and leaders with the best choices as to who's available next and managing to demand.
"We’re months away from deploying these tools but the build is focused on predictive modeling so we can get closer to staffing on-demand," says Dennis Dahlen, CFO at Mayo Clinic.
Finance teams are working hard to support the challenges presented by the nursing crisis that is distressing health systems.
"I agree with our nursing leadership that we have to find a different staffing model," says Dahlen. "It has to be something besides an all-RN model because the math on workforce availability just doesn't support that model.
"I give our nursing leadership colleagues high marks, as they are innovating and trying to figure out what the new model is from both the compensation and benefit standpoint and scheduling, and how to organize this by providing more choice," he says. "I think there's good work going on here, reinforced by the imperative that current circumstances have created."
Cultivate a pipeline for talent
Attrition within leadership across the industry has been pervasive, so CFOs are doubling down on succession planning to discourage talented staff from jumping to new opportunities outside the organization.
"Given our size and scale, succession planning has always been a focus," says Cusack. "So, we have developed several management and leadership development programs to create a pipeline of successors at any level to ensure successful leadership transitions. We also have designed a benefits package that incentivizes staff to stay."
As an academic medical system, Mayo Clinic offers lifelong learning and career advancement, in which succession planning plays a significant role.
"We have a well-defined succession model [which involves] a mandatory rotational leadership design element," says Dahlen. "Nobody stays in a leadership position for long periods of time, more likely moving every seven to 10 years to round out their experience and abilities. The premise is offering a career for a lifetime: Our core workforce design is to hire people young and keep them engaged by giving them responsibilities, continuing to increase their compensation, and providing an industry-leading retirement plan."
While current shortages are demanding short-term focus, senior leaders realize the need to create a pipeline of candidates to foster a continuous flow of talent for different positions. Organizations are investing in high school programs to expose students to the variety of careers within the industry, as well as supporting nursing education to increase the number entering the profession.
"We can't neglect the pipeline," says Dahlen, citing 92,000 nurse applicants unable to attend nursing schools last year due to a lack of faculty. "I've been on a bit of a crusade about this. We should never ignore the supply side and how to use nurses best.
"These are great jobs," he says. "A nursing license is a key to the middle class. The industry is very nearly recession-proof. We're a staple good for consumers, not a discretionary spend, so all those factors work in our favor. So why aren't [healthcare organizations] going into high schools, communities of color, or wherever there are qualified candidates? We've got to increase the width of the pipeline. That's going to require all of us as health systems to lean in on this."
Northwell is targeting underserved communities to help people navigate a path forward.
"We've been very thoughtful about confronting the roadblocks that are preventing individuals living in typically underserved communities from entering the marketplace," says Cusack. "We're targeting the high school level, partnering with 12 local high schools and helping their students navigate the barriers keeping them from furthering their education. The program offers them transportation, food, books, and scholarships.
"In addition, we've created our own nursing school, which creates a pipeline of new workers for the System," she says. "And we entice them to stay with us through loan forgiveness."
Growing talent is another way leaders are attracting workers to their organization.
"Healthcare is a great training ground," says Browning. "We're bringing people from other industries into lower-level positions, such as scheduling and call centers, and over time they take on other roles within the organization and tend to move up. We have a strong educational reimbursement program, so a lot of people come to our organization to get their degrees and often get promoted from within.
"It's a tremendous opportunity for people wanting to move up in their career and it doesn't have to be on the clinical side," he says. "I tell people to get into healthcare, see what you like, discover what you excel at, and develop that further."
Embrace a modern workforce
As younger and more diverse generations make up the workforce, employers are recognizing the different needs, wants, and expectations to attract and retain workers. Benefit packages must accommodate a new generation by being more family-oriented, more flexible, and meeting other priorities and desires.
Mayo Clinic is tapping an external firm to conduct internal and external surveys to determine trends and what would draw future employees to its system. Survey results will help them craft new designs with choices for benefits and fund the things that are most valuable to people.
"Can you repurpose some of the benefit load to meet the individuals' or cohorts' or professional strata's [preferences]?" says Dahlen. "We believe we can and we're working on that."
Northwell offers a 'returnship' program to bring back those who have left the workforce for a time to care for children or a parent. The organization provides resources to acclimate them to today's healthcare.
"We've had success in the finance areas," says Cusack. "They might not always have a two-year degree, but they often have the critical thinking skills, experience, background, and understanding to be a top performer."
"For those who have participated in [the program], the results have been positive. We recognize they may have another 10- to 15-year career within Northwell, so we give them the support and investment they need," she says.
Health systems have learned how to accommodate virtual workers as many employees shifted to a permanent work-from-home situation. To adopt this new structure, financial leaders are having to determine an equitable price point for all locations, address taxation issues per state, and work with human resources to find solutions.
"Our analysis shows that an out-of-state worker cost us $10,000 or more, so we looked at which states were 'friendly' and which ones we wanted to participate in," says Browning. "We've hired workers for special roles in six or seven states.
"Remote workers have opened doors as to where we can go and what we can do, and then we can outsource certain roles that are hard to find," says Browning. "We're even looking off-shore to find talent that's hard to source in the U.S. But going out of the country is not easy. There are a lot of restrictions and cybersecurity issues, so we're having to do this in a very thoughtful way."
Since Mayo conducts business in all 50 states, the organization has experience in working through special issues.
With taxation and other financial hurdles posing problems in some locations, Mayo decided to constrain where it hires remote workers, apart from highly sought-after tech employees and high-end data scientists.
Lastly, as poor management is often cited as the main reason for employees leaving, organizations are focusing on developing leaders to be able to guide more effectively, think creatively, and escalate problems quickly to address staff concerns.
"We've been providing our managers with communication tools and tips for managing and engaging remote team members, as well as giving them tips on best practices for onboarding team members in a remote environment. We also provide team-building ideas that foster collaboration and a positive experience, since we want to ensure leaders have the proper tools [to be successful managers]," says Cusack.
"You have to have metrics," says Dahlen. "We conduct annual and semi-annual staff surveys and look for trends, such as negative staff survey responses. Then we have coaches work with leaders to achieve an acceptable level of performance.
"In addition, we have a compliance hotline for employees to report HR issues," he says. "Like most hotlines, it is a portal used by employees to report leadership issues, which take active management to address."
OhioHealth has upped its management training by identifying underlying issues and providing enhanced leadership training.
"Historically, you could let poor performance slide for a while," says Browning. "But with the way staffing is today, no one can afford to do that. As leaders, we need to make sure we're giving our people all the tools and resources they need to manage."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Follow the community on LinkedIn. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.
Barbara Jacobs has played an instrumental role in HealthLeaders leadership events over the years.
HealthLeaders is sad to say goodbye to Barbara Jacobs, MSN, RN-BC, NEA-BC, who recently retired as vice president of Nursing and CNO at Luminis Health Anne Arundel Medical Center in Annapolis, Maryland. Barb has played an instrumental role in our leadership events over the years, and we’ve reached out to her, time after time, for her unique perspective and insight about nursing practice.
As a founding member of our HealthLeaders CNO Exchange, she has been instrumental in connecting professionals to this peer network, as well as championing new leaders. We talked to her before she left Luminis Health to hear her advice for executives as the pandemic has altered the profession in unprecedented ways.
HealthLeaders: We have seen an exodus of nurses after the pandemic and now most healthcare organizations have a nursing shortage. What should healthcare leaders understand about this profession to attract and maintain a stable workforce?
Barbara Jacobs: It is important for everyone to realize that nursing is not just a profession for nurses; rather, nursing is who we are—it is truly a part of our heart and soul. Nurses receive incredible positives and are motivated by the relationships they have with patients and families, and with each other, and these positives allow nurses to do this demanding work. Feeling like you have made a difference in the life of another person by using expert clinical skills—and also expert people skills—is something immensely powerful. These relationships are what matters to nurses, and healthcare institutions must create environments that allow nurses to leave work feeling like they have made a difference to their patients, families, and colleagues. If we do not create these environments, we will continue to see nurses leave the bedside.
I often like to stop, day or night, and think about how hundreds of patients and families are receiving care by a nurse in our system at that very moment. We must work hard as healthcare leaders to recognize what matters to nurses.
HL: What factors during the pandemic led to nurse burnout?
The pandemic created stresses in the workplace but, in addition, it created significant stresses in home environments which caused nurses to reconsider their work. These stresses, combined with the retirement of large numbers of highly experienced baby boomer nurses, all contributed to burnout.
HL: How has burnout impacted nursing?
Jacobs: The pandemic led to situations that made nurses consider life choices as they tried to balance home and work life. Most institutions needed to make dramatic changes in practice, often at an extremely fast pace, asking nurses to work in less comfortable situations. I believe the combination of stresses at home and in the workplace at this time it has affected the amount of energy and enthusiasm nurses can give their workplace.
It is a challenging time for leadership, as it is essential that the frontline staff feel that they are being considered and supported while undergoing the continued change required. It will take great leaders to guide people through these next years.
HL: What can leaders do to reverse the trend?
Jacobs: It is essential that healthcare leaders remember that the heart of healthcare is in the hands of the staff who touch the patient and family the most. This staff must feel supported and that they are personally achieving what matters most to them. With the extreme financial concerns affecting healthcare right now, every system is looking at how to alter models of care to provide patient care in a more cost-effective way.
We must proceed with caution as we recognize that there is a large number of less-experienced staff in the hospital workforce. As we work for efficiencies, the burdens of non-nursing activities cannot fall back on these less-experienced nursing teams. As new models emerge to keep nurses at the bedside, they must allow nurses to very concretely feel that they are making a difference in people’s lives. We are humans taking care of humans and we must care for people at both sides of this statement to succeed.
Barbara Jacobs, MSN, RN-BC, NEA-BC
HL: What does today’s nursing workforce look like?
Jacobs: The workforce of today is quite different than three years ago. With the large group of baby boomer nurses retiring and the loss of other experienced nurses, most systems are replacing these staff with newly graduated nurses. This experience gap requires us to support this staff in different ways, including providing strong nurse residencies and clinical resources for these staff. In addition, systems are experimenting with adding different members to the care team, like increased numbers of LPNs, additional foreign trained staff, paramedics, and others.
HL: Can you cite an example of a patient you particularly remember?
Jacobs: There are many patients to remember. One was a patient on my unit when I was a young “head nurse.” She was 57 years old with crippling rheumatoid arthritis, leaving her with limited use of her hands and requiring the use of a wheelchair. An experimental treatment had caused aplastic anemia, and in 1980, we just had to hope her bone marrow would start producing white cells and that we could keep her free from infections. She had a lot of near-death experiences and was hospitalized for many months.
As she finally was preparing to go home, she gave me two hand-crocheted clothes hangers that she had made with her crippled hands. I still have them, and every time I see them, I think of her hands and how we both touched each other’s lives. It was for patient experiences like this that I became a nurse.
HL: Given the chance to start out in the profession today, is there anything you would do differently?
Jacobs: I think if I came out of nursing school today, I might have put myself on the immediate track to become a nurse practitioner. But I wonder if that might have kept me from working in nursing management as much as I have done.
As nurse leaders, I think there are lots of opportunities to make the leadership roles more interesting and appealing to newer nurses. It is an incredible feeling to think you might have played a part as a leader in improving the care to many patients and had influence in the environment and lives of many nurses. We need to better portray the leadership role to excite more young staff to following this track for personal fulfillment.
With a management engineering background, Richard Rothberger brought a performance improvement mindset and financial discipline that helped turn Scripps into a financially solvent, growing health system.
HealthLeaders spoke with Richard Rothberger, retiring CFO from Scripps Health to hear his parting thoughts on leading the organization for 21 years.
With a management engineering background, Rothberger brought a performance improvement mindset and financial discipline that helped turn Scripps from a poorly rated company with an unaffordable capital plan to a financially solvent, growing health system. He is also a founding member of the HealthLeaders CFO Exchange, a premier thought leadership and networking community for healthcare executives.
Richard Rothberger, retiring CFO from Scripps Health. Photo by Thomas Cronshaw.
Q: How did you enter the world of finance for a healthcare organization?
A: "I came up an unusual path for CFO. My background was industrial engineering which was focused on healthcare systems. I was an analytically inclined mathematician that could help reimagine healthcare and make a difference.
"During my time at [a healthcare organization] in Sacramento, the system went from three to seven hospitals, and I was also involved in acquisitions and got board exposure. As time went on, people I worked with saw an aptitude in me. More doors opened because I continued to take on more responsibility--more engineering consulting, productivity improvement, cost accounting and analytics. When the CFO vacated his position, he said it was my job to lose.
"The CFO of future is not a CPA but has operations knowledge of every area of the business."
Q: What advice do you have for healthcare CFOs?
A: "The industry has never been this volatile and uncertain, so we need to change expectations of revenue. There will continue to be increased costs for labor, supplies and services that will not be offset by revenue. Healthcare leaders will need to reduce or rethink capital plans and have a new way of thinking about how to provide value to customers and get paid for it.
"Demand for healthcare is going to be greater than supply, so healthcare organizations will need to set a new price point—increase prices, provide incentives for outcomes and service, and do whatever you can to get payers to work with you.
"CFOs will also need to focus on managing their capital spend, improving productivity, advocacy, and tighter budgets. [Financial leaders] have always relied on their investment portfolio, and with the cost of debt increasing, reassessing your debt portfolio is important. And leaders will need to keep ratings to the highest level to give them the ability to finance with lenders.
"CFOs will need to understand and [make wise investments in] technology: There may be opportunities with AI and technology to reduce labor costs and find opportunities for revenue improvement, but there will be increased spending to deal with cybersecurity risks."
Q: What skills sets have you found to be indispensable in your role?
A: "Most important is being transparent, thoughtful, ethically grounded, and keeping C-level executives and the board informed.
"I’ve been with the same CEO for 21 years and never expected to be in one place with same CEO for so long. Have a boss you trust and respect, and who is on the same page with integrity and desired outcomes.
"You need to have excellent working relationships with both internal and external customers. Foster confidence with others so there’s trust when there’s hard news to deliver. Having a sense of humor can help.
"It takes experience to build [others’ confidence in you] so that you don’t say something in the wrong setting or not know your audience. Make sure you can be a trusted part of the team, and then people are open to coming to you for guidance and you can even give unsolicited advice.
"You need your team’s support, as well as getting [others in the organization] to work with you. The CFO leads many initiatives and opportunities, but you must be able to execute. As long as you stay focused on opportunities to transform the organization and effectively execute, you can be successful.
"It’s essential to hire and motivate the best people who will go the extra mile. I lead by example and coaching, and I delegate but hold people accountable for their work. You need to understand detail, but never lose sight of the big picture.
"Healthcare is a difficult challenge for everybody, so it’s important to have fun. Over the many years I’ve been working I’ve never had a dull day, never been bored. Be open to new responsibilities—as long as you’re thoughtful about what you take on--but it’s okay to say no if you give a clear reason.
"It’s about commitment, compassion, hard work, being yourself, and having fun.
Scripps President and CEO Chris Van Gorder has high praise for Rothberger’s leadership and accomplishments and acknowledges him as a trusted colleague.
"I arrived at Scripps in 1999 as COO, and there was turmoil on the first day on the job. I took over as CEO [unexpectedly] just six months later and was dealing with an organization that was weak, losing money, had 55 days of cash on hand, and had no confidence from the physicians or staff. I needed someone who could rebuild the balance sheet and regain trust in the community and with donors
"I searched for someone like Rich for a year who had the qualities I was looking for: I needed more than a banker--someone who truly understood operations. Rich had been a management engineer who made operations more efficient. I didn’t need a CPA but a financial leader I could trust.
"Within the first 15 minutes of his job interview with me, I knew I had found my guy. He exhibited energy, drive, and excitement. We had a lot of work ahead of us and I needed a partner who possessed those qualities.
"During the interview, we talked about what we could do together to move the organization forward. That kind of two-way dialogue is rare in a job interview. I thought, ‘This is the guy that could fix the system.’
"I’m a retired cop, and one thing you have to know early on, as a police officer, is how to assess lots of nonverbal information--what you’re seeing, body language—and make a judgment call as to whether the person is credible or going to jail. You must assess quickly; in the field you have less than a second since lives are at stake.
"After he left his interview with me, Rich wrote up a plan, outlining what we should do and sent it to me. It was exactly what we needed to do.
"Rich and I have been aligned since Day 1. I told him, ‘The more you look worried, the more I don’t have to be.’ In 21 years, he’s never disappointed me or the organization.
"I also needed someone who could be transparent with the financials. A CEO needs people he or she can trust and tell how it really is and not what the CEO wants to hear. When there was a need for capital spending and we didn’t have the cash on hand, we needed to establish discipline in the organization. Physicians wanted cash for new equipment, and Rich told them, ‘I know what you want, but we don’t have any cash.’ He then opened the books and showed them. This is the type of leadership we needed to get us through a dark time. It took us four years—working smart together—to turn things around.
"We’re making Rich the first-ever Scripps’ CFO emeritus and the board has passed a resolution in recognition of his 21 years of service. He leaves us with a strong balance sheet, stronger operations, and a better platform than when he first arrived.
"He’s been a wonderful friend, partner, advisor, confidant—all the things a CEO must have with their CFO, so we’ve stayed together all these years. He’s retiring from Scripps but Rich and I are going to be lifelong friends."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
UNC REX Healthcare's CMO shares how the organization is planning for administering the COVID vaccine.
As the vaccine for COVID-19 is deployed to healthcare systems this week, HealthLeaders talked with Linda Butler, MD, vice president, medical affairs, and chief medical officer at UNC REX Healthcare in Raleigh, North Carolina, about their approach to the pandemic and what’s involved in vaccinating their workforce.
HealthLeaders: How has the community been responding to the pandemic?
Butler: It’s kind of interesting here. The state capital is in Wake County, so mass compliance is pretty good for the most part. In the more rural counties, you definitely see that mask use is optional. We’re at the point right now where it has impacted our numbers, in which we have more COVID patients in house and more staff either positive or quarantined because of community spread, than we did back during our previous peak. In July, we'd have maybe 45 COVID patients in house, and now we've got a little over 60, and our numbers of other procedures and patients have been really high. We hit an all-time high of 550 patients in the hospital last week and we're licensed to have 433 inpatient beds. So that tells you how full we are, and that people are just tired.
We’re continually asking people to wear a mask, social distance, wash your hands. Now, most of the media focus has been on the vaccine, and we're preparing for that. We're anticipating we'll get the vaccine on Dec. 17th, and will be getting 2,900 doses.
HL: What sort of planning has been required for administering the vaccine?
Butler: We have multiple calls each day across the system. Because we have a system central pharmacy, they're coordinating the supply chain. We have the ultra freezer here, so we don't have to worry about replenishing dry ice in storage containers.
We have a standing order that the system developed that we're getting approved at all of our entities. They’re helping us with adapting Epic, so that we have a standard workflow. We do a quick reg for our coworkers. We're a closed site; we're not immunizing people in the community, so that makes it a bit simpler. Before our interview, I was down in the auditorium where we're setting up our vaccination clinic, and we're going to try and have 10 stations to move people through. We’ll be immunizing on our very first day, taking it slowly and doing about 150 people, and then, ramping up pretty quickly to hit as many as 600 a day, so that we can get through our 2,900 doses. And then prepare for the second dose, which will happen in 21 days after the first one.
HL: That's an enormous effort. How are you going to do that and still conduct operations as usual with this added to your plate?
Butler: We have a great team and a lot of people have stepped up. We’ve asked people from our critical care transport--the EMTs and paramedics are able to vaccinate—and nurses from urgent care, so when they're off, they're going to be working a shift in the vaccine clinic. We’ve had to upload a lot of different files to the state because DHHS (Department of Health and Human Services) is having us log everything in through a portal. So we've all had to get portal access. It’s an amazing amount of work that's being done in a short amount of time, but it's going to be so worth it because this vaccine is really the light at the end of the tunnel. This is a way we can protect our coworkers, and eventually our patients, so that we don’t have to deal with COVID, since there's really no cure. If you can avoid the illness altogether, it's definitely the way to go.
HL: We’ve heard a lot about physician burnout. How are they holding up throughout the pandemic?
Butler: The physicians have been great. They've really stepped up and gone outside their traditional roles. When we first were dealing with COVID, there was a great sense of teamwork, everybody pulling together. We're looking to the physicians as leaders, as they get vaccinated to inspire their staff who may be worried about taking the vaccine. The docs also have had to cope with their own potential for exposure and make sure they're setting the example of wearing PPE appropriately. I can't say enough about how the team has pulled together. However, they are getting tired and don't have as much of a bench as the nursing staff. We're trying our best to make sure that we can get those at high risk vaccinated as quickly as possible.
COVID has really been sort of a burning platform. You have to adapt quickly. The standing joke was whatever we say today is probably going to change two weeks from now, and getting physicians comfortable with the fact that as the CDC guidance changes, that's how we change our process. One of our resilience webinars said that the waves are going to keep coming, so you might as well learn to surf, and our docs have definitely learned how to surf.
HL: What would you say to people who are afraid of getting vaccinated?
Butler: I will always take my chances with the vaccine--having a few side effects--rather than take my chances with the illness that can kill you. I have not heard of anything [severe side-effects]--a couple of allergic reactions, but I'll take my chances with that rather than dying.
HL: You started out in engineering and then shifted into medicine. Was that your intended goal or did something prompt you to move in the direction of healthcare?
Butler: I wasn’t one of those people growing up, thinking I am going to be a physician. My father had an illness while I was in college, and it interested me to help him go through that. I thought, I can probably do what the doctors are doing. So while I was in college, I did a lot of pre-med undergrad classes as my electives and finished off the engineering degree because I thought it might be useful. And I ended up completing that degree and then getting a master’s in medical physics. My undergrad was nuclear engineering.
It's really helped me more now being the CMO, because hospitals are very process-driven. The lessons learned in nuclear engineering, in which you want to be a high reliability organization, have made their way into healthcare. So I've come full circle. I started the performance improvement department at REX. We’re doing a lot of PI, and that department has helped with our quality objectives and goals. It’s been good to have been able to apply my engineering background to healthcare.
HL: What do you foresee for 2021?
Butler: I think getting back to a more normal state would be great. And making sure we take advantage of the lessons learned from this pandemic--that we need to have more things produced within the U.S., so we're not that depend on a foreign supply chain. And we don't forget that hand hygiene is good, no matter what infectious disease you're facing. Being able to accelerate certain processes to get a vaccine out in under a year is amazing. And hopefully we can accelerate other vaccines the same way.
Too often, healthcare leaders are caught by the idea of the bright, shiny object of innovation, without thinking through to the application. The industry today may be in the immature arc of the adoption curve, where the ability to create technology is outpacing the ability of providers to effectively deploy them.
Leaders need to ask: Do the people using a new tool or executing an innovative idea find it helpful or burdensome? What specific healthcare goal does a specific innovation improve? Is it achieving a desired outcome?
This intersection of innovation and adoption is the nexus of discussion at the HealthLeaders Innovation Exchangeheld July 17–19 in Ojai, California, where four dozen executives will come together to share best practices in identifying, funding, vetting, and applying healthcare innovation.
The two-day forum involves roundtable discussions as well as fast-paced executive presentations on how they are achieving results.
While innovation can seem appealing, leaders may be wise to avoid some common pitfalls by asking these five questions:
1. Can you see the healthcare value in the innovation?
Despite the push toward population health, Mouneer Odeh, vice president, enterprise analytics and chief data scientist at Thomas Jefferson University and Jefferson Health in Philadelphia, says the healthcare arena chiefly operates in two worlds.
"For most health systems, management focus is still on the fee-for-service world, but we have another world that we're working toward to achieve value," says Odeh.
"From a management perspective, how do we embed value thinking in everything we do? It's a shift in mindset that hasn't fully occurred yet; we're still bifocal," he says. "We need an integrated understanding about population health objectives that's fully integrated into everything we do, rather than a separate effort that is disconnected from our daily activities."
2. Is the innovation effective for the people using it?
Odeh encourages leaders to think carefully about how to achieve objectives.
"With clinical workflows, we have historically used bolt-on technologies. But now EHRs are guiding integrated pop health capabilities that give physicians triggers and alerts—so they are better informed and can take action as they see patients," he says. "It's a great innovation that is rapidly maturing, but we haven't fully understood how to make this technology truly work for our providers and ultimately for our patients."
"We're also dealing with physician burnout, so we need to make sure we're not just layering additional responsibilities on them," Odeh says. "We need to make sure technology works for everyone involved and is having the impact on patients that we're wanting to achieve. Innovation needs to be from the human-centric viewpoint, instead of being driven by technology. It needs to be tested to make sure we've got feedback mechanisms to ensure it's having the intended effect."
3. Is the data from the innovation measurable?
As a medical data analyst, Bradley Brimhall, MD, MPH, helps determine the effectiveness of population health programs led by Liem Du, MD, medical director at University Health System in San Antonio.
"I was asked to quantify the value and success of new approaches Dr. Du is taking in population health management in financial and quality terms. But getting data into one place so that it's easy to analyze is a challenge," says Brimhall, professor of pathology and laboratory medicine, and medical director of healthcare analytics & bioinformatics at University of Texas Health-San Antonio, University Health System.
"Data tends to be scattered because we're getting it from lots of outside sources, not just the EMR," he says.
"One barrier we encounter is getting data structured so that it's easy to organize and analyze—clinical data, cost information, health information exchange data, community resource information, etc. We have several large relational databases from multiple sources that need to be linked together. How do you tie all these disparate pieces together?"
"For example, the cost of care (supplies, services) must be integrated with quality and other performance data to understand the financial and service impacts of clinical decisions," he says. "Some solutions to the cost of healthcare are likely to be simpler steps but measuring the quality and financial impacts are more complicated."
Brimhall cites the lack of integration hindering predictive modeling as well. "Understanding the data can save money and hassle for high-risk patients who don't have to be hospitalized and can be treated more proactively. But integrated data is much better for predictive model development."
"To design a project, I need to analyze the data, and it takes longer than it should," he says. "If we could design better data structures and my team could access the data better, then we could be cranking out projects faster."
Another challenge is having people with the skills and proficiencies to understand information and arrive at solutions, says Brimhall. "We need to train a subgroup of physicians in clinical informatics to focus on analytics. We also need to train some nurses, technologists, and medical laboratory scientists."
To help further this goal, Brimhall has established a clinical informatics fellowship for physicians to be trained in data analytics.
"Incremental improvements can yield high savings and value improvement if you can overcome the barrier of data integration and measurement."
4. Does the innovation need to span the care continuum?
Hospitals are dinged for readmission penalties, but often providers are sending patients to other settings, such as physical therapy rehab, home health, or skilled nursing facilities (SNF), in which they have no control over patients' continued care.
"We face a lot of challenges with smooth transitions from inpatient to what comes next," says Peter Charvat, MD, vice president and chief medical officer at Johnston UNC Health Care in Smithfield, North Carolina.
To improve coordinated care, Charvat is piloting a program with one of the system's SNFs. "Rather than sending a patient immediately back to the hospital when something goes wrong, as often happens, we have conversations with the SNF to help avoid readmission."
Helping the effort are UNC Health Care's preferred-provider SNFs to ensure the system is partnering with facilities with quality and outcomes, says Charvat.
"More than anything, providers need to set clear expectations when patients are discharged—which means a provider-to-provider call that details what they saw and what they anticipate the stay will be," he says. "We're training physicians and our hospitalists group to have the calls."
"In addition, we have a secure messaging app that we give to the SNFs to text each other," he says. "They also have access to our EMR and can pull up reports for any patient encounter to get more complete information."
Johnston Health is also piloting a program that gives community paramedics access to the SNF.
"Medicare pays for a short-term stay for up to 21 days, and we know that on day 19, if the patient is not ready to go home [but is discharged], then the paramedics will visit the patient's home on day 22," he says.
"Hospitals need to work on communication with home health, case management, transition calls, [and] community paramedics to call patients and ask if they are taking their meds and following up with a doctor's appointment. It's keeping a patient well at home."
5. Will real people be able to use the innovation?
Another quality improvement hindrance is providers' capacity to motivate patients regarding their lifestyle practices.
"Health systems have an important, but limited role in improving the health of patients," says Odeh. "When a patient visits a provider or is in one of our hospitals, we have the ability to influence, but when they go home our influence is limited. And while we have care coordinators to help with that, the needs are much greater.
"Our CEO, Dr. Steven Klasko, calls this ‘healthcare without an address,' " he says. "How do you take the things that promote better health and push that out to where people live—at work, or home, or in the community?"
"Addressing real-life experiences is a challenge requiring a high degree of technological innovation," says Odeh. "But it's not an area that health systems can naturally affect, so how do we work with the community—religious institutions, nonprofits, public health entities, respected leaders, and other influencers—to remove barriers and make it easy to practice the right, healthy behaviors?"
One of the ways Jefferson Health is working to foster a healthier community is through establishing the Philadelphia Collaborative for Health Equity (P-CHE).
"While Jefferson Health is currently leading it, our goal is to be a facilitator of dialogue, to develop an institutional framework and collaborate with other institutions and community organizations regarding what is needed."
Odeh emphasizes, "The key message is that innovation has got to work for people in order to achieve our goals and objectives."
The theme of Monday's sessions highlight an industry rife with upheaval and disruption and how successful executives can navigate the stormy waters.
CHICAGO – The overriding messages at the American College of Healthcare Executives 2019 Congress on Healthcare Leadership on Monday centered on how healthcare leaders can welcome new thinking and action in the face of change and disruption.
Platypus Labs Chairman and Cofounder Josh Linkner kicked off the Congress, where thousands of healthcare executives have gathered to learn strategies to thrive in a mercurial environment rife with challenges.
Every barrier can be broken. Think outside the box for solutions to complex problems.
Video killed the radio star. Defy tradition to generate new revenue streams.
Break the rules to get the jewels. When resources are scarce, leverage human creativity.
Seek the unexpected. Instead of expected approaches, embrace bold and unorthodox ideas.
Fall seven times; stand eight. Rise back from adversity with grit and determination.
This focus on inventive thinking and fresh ways of operating carried into Monday's sessions as well, covering a healthcare environment undergoing rapid technological advancement, an aging and diverse population, major disruptors, payment and reimbursement restructuring, mergers and acquisitions, health policy shifts, cost increases, and more.
To survive in this atmosphere, executives must be prepared to lead in the midst of upheaval and build a team who can function effectively in this new and changing reality, attendees were told.
Thriving in VUCA Environments
Volatility, uncertainty, complexity and ambiguity (VUCA) are the new norms for healthcare, said Gail Marcus, assistant dean and assistant professor at the Massachusetts College of Pharmacy and Health Sciences University School of Healthcare Business in Boston.
"Having to solve problems without complete information requires individuals to think outside the box and break the rules," Marcus said in a session she co-led with William Goodman, MD, FCCP, chief medical officer and vice president of medical affairs for Catholic Medical Center in Manchester, New Hampshire.
That problem-solving approach means leaders who aim to inspire transformation need to refrain from reflexively saying, "That's not our job; that's not the way we're doing it," Marcus added.
As an example, Marcus and Goodman cited a New Hampshire firefighter's inventive approach to handling a drug addict. The idea ultimately had a positive impact on addressing the state's opioid crisis, but it took his supervisor to embrace the idea to enable its success.
Goodman said a drug-addicted person presented at a fire station. When the case was deemed medically stable, the firefighter took the patient to a primary care service provider, rather than to a hospital emergency department. The simple change was later adopted throughout New Hampshire as part of the "Safe Station" initiative that has reduced both overdose deaths and unnecessary ED utilization.
"If the firefighter had worked for someone who said, 'That's not the way we do it,' then that program would have gone away," Goodman said.
Leaders need to bring their staff along in the process. The session shared these considerations for building nonclinical talent that can thrive in the midst of VUCA:
Drive and manage innovation and transformation by empowering staff. Catholic Medical Center established a self-directed interdisciplinary team—an "Imaginovation Committee"—that engages both clinical and nonclinical staff to generate new solutions and improvements. Goodman said the committee didn't conceive any ideas for major improvements, but the significance of their work sent a message to the organization that this kind of thinking works, is valued and can be fostered.
E-health and the "Internet of Things" demand new roles and skills to leverage technology to improve care delivery and the patient experience. New health system roles have emerged in recent years, including data scientists to synthesize volumes of data into meaningful insights for decision-makers, and data "visualizers," who can make fashion the data into convincing arguments. Chief experience officers are also popping up at hospitals and health systems in response to consumerism. Marcus suggests considering hiring staff with a retail background, or those with strong customer service skills.
In the new environment, "soft skills" are as important as content knowledge. Leaders need to hire people who think this way, as well as create a safe space for effective communication, cultural sensitivity, collaboration and negotiation, self-awareness and feedback, curiosity, agility, risk-taking, and resilience.
Hire the necessary talent and train for the critical skills to move your organization forward. Recruit the right people, including those from other industries. Use existing staff with the appropriate skills to help recruit. Be a destination employer. In addition, develop internal talent by providing high-potential individuals with training and experience to build these skills; and utilize simulations to help staff and managers build agility. Also important: Retain employees by providing development opportunities via involvement in industry forums, training, and virtual communities.
Marcus closes with this advice: "Match volatility with vision; match uncertainty with understanding; match complexity with clarity; match ambiguity with agility … and establish an environment where people are comfortable."
The session gave Ruth Bash some thoughts for her role as vice president and chief culture officer of Children's Specialized Hospital/RWJBarnabas Health in New Brunswick, New Jersey: "This is a refreshing look at the skills and competencies we should be looking at in our new hires and next generation of leaders," she said.
Editor's note: This piece was edited by HealthLeaders' Steven Porter.
The event's agenda covers a wide range of topics, highlighting some of the most consequential issues for the industry at present.
CHICAGO — If you want to quickly learn about the healthcare industry's current hot-button issues, try reviewing the agenda of leading conferences, such as this week's American College of Healthcare Executives (ACHE) Congress on Healthcare Leadership.
Thousands of senior executives are gathering here for the annual event, where they will hear how they can address these critical issues and challenges effectively.
"This year's Congress sessions will not disappoint, with over 4,000 people registered to attend," says Kurt Barwis, FACHE, president and CEO of Bristol Hospital in Bristol, Connecticut.
Barwis, a member of HealthLeaders CEO Exchange, is finishing his term as ACHE Regent for Connecticut and is now an ACHE Governor.
"I'm excited about my new role and the opportunity to once again network and learn from our [industry's] thought leaders over the next week," he says, adding that participating with ACHE has helped to advance his career.
This year's event, to be held Monday through Thursday, will cover a lot of terrain, including the following noteworthy topics:
1. Fostering enterprise innovation and emerging technology adoption of emerging technologies in care delivery. Telehealth, mobile solutions, and other technologies are increasingly the primary drivers of healthcare delivery transformation.
2. Improving population and community health through internal and external collaboration. Health systems cannot solve community health issues alone. Collaboration with other organizations is necessary to address tough issues like chronic care management, behavioral health service gaps and the opioid crisis.
3. Aligning stakeholders around quality, safety, and patient satisfaction goals. Achieving healthcare value is a team effort. Healthcare leaders need effective alignment and commitment from physicians, nurses and other service providers.
4. Developing a resilient corporate culture. Leaders must acknowledge and mitigate physician and staff burnout by addressing culture and other causal factors.
5. Employing advanced analytics to improve quality, costs, and service performance. To create high reliability organizations, leaders must invest in people and systems that leverage clinical and financial data to better support decision-making.
6. Staying focused on personal career development. In the midst of industry turbulence, organizational mergers and other disruptions, leaders must remain agile and adaptive to change while continuing to invest in their knowledge, skills and careers.
7. Leading increasingly diverse workforces. Executives must foster and lead teams that are increasingly multi-generation multiethnic, and LGTBQ inclusive.
8. Building organizational brand and customer loyalty. To win in the age of medical consumerism, leaders must hardwire systems and staff capabilities to engage patients and build a lasting bond to the organization.
9. Improving case management and throughput competencies. Patient throughput continues to a primary operational challenge for healthcare systems. ED boarders, short-stay admissions, and improved access are some of the myriad factors that must be addressed by caregivers.
10. Transformation and margin improvement- Many healthcare organizations continue to struggle with low or negative operating margins. In these instances and others, a comprehensive organizational transformation is warranted.
Editor's note: This article was edited by HealthLeaders editor Steven Porter.
Hospitals and health systems are facing an increasingly intense payment environment from all directions. Payers are creating more roadblocks to either limit or slow the pace of reimbursement, while patients strive to cover their costs and staff turnover subverts process improvement.
To learn how their peers are battling payment woes, revenue cycle leaders will join other health system executives to discuss best practices at the HealthLeaders Revenue Cycle Exchange. The 2019 program will offer two options to ensure a personable small group environment at each: March 27–29 in Ojai, California, and December 9–11 in Palm Beach, Florida.
Leaders recently shared their views about the state of the industry, which will be addressed in moderated roundtables at the Exchanges. The following are some of the concerns expressed.
1. More adverse payer strategies
As new technologies and pharmaceuticals are entering the market for better patient care, there is a tug-of-war between payers and providers as to who will assume the risk of accelerating costs. Since payers are well-capitalized with systems, processes, and expertise, any deficiency in a revenue cycle is an advantage to a payer. Health systems need to be well-organized, aligned, and capitalized with information systems to level the playing field.
"The cost to provide care to patients goes up year after year, but we're not seeing an increase in reimbursement. Instead, we're fighting daily to get the reimbursement we are due," says Abby Abongwa, vice president of revenue cycle at UW Health in Madison, Wisconsin. "The payers are looking for opportunities to change the policy or find mistakes, but ultimately are trying to pay at a lesser amount than we would expect to be reimbursed."
Abongwa also notes that most payers are issuing more denials accompanied with requests for medical records, itemized patient billing statements, and pre-bill audits.
"Payers are using a plethora of strategies to manage their costs, so we are developing contractual language to protect ourselves from denials, as well as standardizing how we operate, such as creating standard processes to make sure referrals and prior authorizations are always populated in the same place in our billing system, as well as implementing workflow changes. We have also developed workflows to better communicate with and keep patients engaged when we get specific types of denials where we believe engaging the patient could be beneficial in overturning the denial," she says.
Maribeth Keeven, regional director of revenue integrity/CDM/HIM coding at SSM in St. Louis, Missouri, concurs. "While we've always tried to manage and be proactive with our claim submission, we are seeing the number of denials increase. As we continuously work toward getting our internal denials processes intact, payers are doing everything they can to not pay for servicing their beneficiaries. The volume of initial denials is increasing, and payers are overturning fewer appeals and placing more at risk. So how do we win back the dollars we are due?"
Securing proper reimbursement is an even greater worry for research institutions involved in costly care.
"An academic medical center provides high-acuity, high-complexity services, so there are higher costs associated with that," says Abongwa. "There's an immense amount of work that goes into these cases to make sure the clinical team is aligned with patient access to get prior authorization. A lot of discipline is required to manage the entire revenue cycle as well as the clinical piece so that we don't lose anything on these claims."
Another factor causing angst is although new-to-market therapies are FDA-approved, many payers are still considering these drugs and therapies experimental and don't know how to appropriately reimburse for the associated charges, according to Garland Goins, director of revenue and documentation integrity, patient revenue management organization for Duke University Health System in Durham, North Carolina.
"Payers haven't necessarily had sufficient time to review/revise their medical policy to determine if the new treatment is going to be fiscally consistent and best for their beneficiaries," he says.
"We have to balance the fiscal obligation to the institution with what is clinically best for our patients by ensuring they understand the entire procedure—both clinical indications and associated cost/charges," says Goins. "Often the timing of FDA-approved drugs leaves the institution and our patients in a precarious position because the payer might not revise their medical policy for months. For these situations, we've frequently had to rely on entering into single-case agreements to ensure appropriate cost are covered."
"We've been extremely methodical in orchestrating massive coordination—from procurement, finance, compliance, government relations, payer contracting, revenue cycle, charge capture, coding, billing, pharmacy, and clinical care," he says. "It is truly a considerable amount of manpower to coordinate, but this approach has yielded significant efficiency gains in the timeliness of patients receiving these treatments and aided in capturing an abundant amount of data for analysis and improvement opportunities. Ultimately, the subject matter experts' commitment to this approach has been instrumental in allowing the creation of a reliable and repeatable framework that we are replicating for other drugs and therapies."
2. New rules for 2019 from Centers for Medicare & Medicaid Services
CMS continues to place more demands on health systems to perform and produce value. New requirements are being issued that contain layers of complexity to reduce or slow payment.
"The amount of information coming out of CMS which requires providers to analyze and provide comment back to them is increasing," says John Settlemyer, assistant vice president of corporate revenue management and CDM support at Charlotte, North Carolina–based Atrium Health. "Not only do we have the traditional proposed and final rules for various payment programs, but now imbedded within those rules are requests for additional information. It's difficult to provide substantive comment to CMS due to the sheer volume of
requests coming out."
Settlemyer cites the scrutiny and political sensitivity around pharmaceutical expenses as one example.
"There are multiple initiatives coming from CMS that are in some way related to drug pricing, which requires providers to read and understand what's contained within to determine whether the proposal directly impacts them fiscally or operationally. It's almost impossible to stay on top of this and provide meaningful feedback to CMS as to why we do or don't support the proposals," he says.
"Another issue is with outright payment reductions that seemingly exceed CMS' authority. An example is with the Medicare outpatient prospective payment system and ambulatory surgical center payment system final rule changes for 2019. CMS has implemented a non-budget-neutral payment reduction for clinic visits for hospitals. Consequently, the ‘grandfathered' off-campus departments that were protected by section 603 language will now be seeing a reduction in payment."
Revenue cycle leaders are also concerned that CMS' pricing transparency initiative requiring providers to list standard charges on their website by January 1, 2019, may cause additional confusion for patients.
"While providers have an obligation to work with patients for accurate price estimates, the chargemaster itself is not going to be very helpful because of the multiple facets to a hospital bill," says Settlemyer.
Keeven adds, "The challenge is to be in compliance of the regulation versus assisting patients in their personal responsibility. Our process has been to be specific to the patient and help them on their financial journey, and meeting the regulation isn't assisting the patient but I believe causing confusion."
3. Administrative work contributing to physician burnout
Clinical documentation demands are accumulating with new CMS regulations and escalating denials—and consequently, enmeshing physicians in more administrative details than before.
"Our ability to get reimbursed rests on providers having to correctly document, but we have to be careful as to engaging doctors so that we're not part of the problem with burnout," says Abongwa.
"There are instances with documentation deficiencies in which we will have HIM, our hospital clinical documentation integrity team, our facility coding team, and various professional (specialist and ancillary) coders all requesting information from physicians separately," she says. "That's four and even sometimes up to five well-intentioned groups reaching out regarding the same inpatient stay. So how do we align our workflows that allow all of us to get everything we need in a more coordinated manner?"
4. Ensuring a high-performing workforce
Retaining an underpaid front-end staff, who are responsible for scheduling patients, overseeing pre-authorizations, and capturing correct patient and payer information is a constant struggle. Another vacuum occurs with the rising turnover in nursing, requiring frequent training for new staff on documenting properly.
"Having front-end staff who make minimum wage tasked with important work is a challenge," says Abongwa. "There's value to their role, but the market data we receive from human resources hasn't caught up with paying them appropriately. Their ability to do their very demanding jobs well is critical, but unfortunately, we have a revolving door in some of these roles."
Turnover of clinical staff also impacts documentation.
"We often have problems obtaining clinical documentation for start and stop times related to infusions," says Tina Rosier, director of revenue integrity, acute care services at Community Health Network in Indianapolis. "While we recently implemented IV pumps that communicate event times with Epic, we still have situations where staff do not take the steps necessary to validate the times and resulting in them not interfacing to the legal medical record. We have found that new technology is only as effective as the training and workflows created to support its use."
"Because of this, we track the number of missed stop times and the potential impact on revenue per month. In a collaborative effort, this information is shared with nursing leadership at our six hospitals," she says. "And as a result of the data, we have begun to focus on units and/or staff with a high error rate for retraining on proper use of the new pumps. Time will tell, but we hope that this new focus on reeducation will facilitate the times being available in the chart for optimal charge capture."
Another issue that impacts optimal documentation and charge capture involves turnover of clinical staff and the continual need to educate them on documentation standards, says Rosier.
"We meet with new ED nurses 30 days after they onboard and focus on the top 10 high-intensity services that drive the ED acuity, the importance of service capture, and infusion start/stop times," she says. "But with baby boomers retiring and younger generations not always staying long with one employer, it is a continuous challenge to meet the educational needs for new staff."
An upcoming CFO roundtable provides a peer-sharing platform to learn best practices for advancing a healthcare organization's financial health.
Today's healthcare financial leaders face escalating costs, quality improvement issues, difficult reimbursement environments, an increasingly complex service portfolio, and risk management associated with performance contracting.
Pressure mounts on CFOs to ensure their organizations remain viable as they deal with these issues, which makes gleaning proven strategies from colleagues imperative.
Four dozen executives will convene at a private roundtable forum during the 2018 HealthLeaders Media CFO Exchange, August 8–10 in Santa Barbara, California, to
address top-of-mind concerns.
In pre-event planning calls, Exchange participants—representing integrated health systems, academic medical centers, community hospitals, and safety net providers from across the U.S.—want to know how others are taking on risk, improving costs, addressing consumerism, and capturing additional reimbursement.
During the two-day event, a series of moderated roundtables will explore areas of special interest expressed by CFOs, including the following:
1. Cost improvement
Since costs are increasing at rates higher than reimbursement, how does a CFO drive cost performance to maintain sufficient operating margins? How are systems successfully leveraging scale to rationalize administrative and support services?
2. Proliferation of mergers and acquisitions
How can an independent organization survive in this environment? Should it consider other affiliations? For those involved in new entities, how are leaders achieving value?
3. Taking on risk
How does an organization prepare to take on and reduce risk, and when does an organization know that it is ready? How can CFOs build reserves to offset unexpected outlays?
4. Enhancing revenue cycle performance
How can financial leaders improve payer terms, reduce denials, ensure payer compliance, and improve clinical documentation? What are effective ways to deploy new workflow technologies in patient accounts?
5. Performance-based contracts
How are organizations engaging medical staff to reduce the cost of care and improve outcomes?
6. Medical group employment
How does a health system minimize provider subsidies for employed physicians and improve practice performance?
7. Medical consumerism
How can healthcare organizations compete against disruptors in the growing environment of consumer choice? What are creative ideas for meeting consumer demand without adding cost?
Additional information will be shared during the two-day gathering. The CFO Exchange is one of six annual HealthLeaders Media events for healthcare thought leadership and networking.
Revenue cycle and patient financial experience
Recently, HealthLeaders Media hosted a Revenue Cycle Exchange, which brought together 50 executives to discuss improving the patient financial experience; maximizing reimbursement; managing claims denials; technology adoption and data analytics; revenue cycle optimization; and creating a leaner, more effective team.
Noting how consumerism is influencing bill payment and giving rise to the patient voice, leaders are seeking ways to make paying easier. Consumer feedback suggested easy-to-understand and consolidated statements.
"We have a single business office with Epic, so regardless of where a patient gets their services, they get one bill from our organization," says Cassi Birnbaum, director of health information management and revenue integrity at UC San Diego Health.
"We've also created a position for a patient experience director, so any complaint goes through that unit and they'll contact one of my supervisors to ensure the patient gets the answers they need. That's helped a lot and provides a one-stop, concierge, patient-facing experience to help ensure the patient's balance is paid," Birnbaum says.
Providing estimates and leveraging technology are also helpful for fostering patient payments. More health systems are promoting MyChart, an online tool for patients to manage their health information, as well as kiosks in key locations.
"We have a patient portal in which you can see any outstanding balance at a hospital or clinic and decide what you want to pay today," says Mary Wickersham, vice president of central business office services at Avera in Sioux Falls, South Dakota.
"Patients can also extend their payments since we have a hyperlink that goes to the extended loan program if needed. With kiosks at our clinics, patients pull out their credit card and complete their copay. Nobody asks; they just automatically do it," she says.
Staffing
Front- and back-end staff play an integral role in calculating payment estimates, collecting dollars in advance of procedures and tests, and communicating the often-puzzling connection between hospital charges for physician practice and provider-based department patients.
"One of our big challenges now is we're bringing a lot of that back-end work to the front," says Terri Etnier, director of system patient access at Indiana University Health in Bloomington, Indiana.
Centralizing processes
As facilities move toward centralized scheduling systems to manage reimbursement, some facilities are centralizing coding and billing processes.
"We don't have a full comprehensive preregistration function for our clinics mainly due to volume. We're piloting a preregistration group for our clinic visits to work accounts ahead of time since we are continuing to work toward automation," says Katherine Cardwell, assistant vice president at Ochsner Health System in New Orleans.
"We have kiosks in some of our clinics. Epic has an e-precheck function where we can now do forms. You can sign forms on your phone, and make your payment and your copayment ahead of time. And you can actually get a barcode that you can just scan when you get to the clinic," Cardwell says.
By applying data, testing new approaches, and establishing community partnerships, you can bolster patient outcomes.
This article first appeared in the March/April 2018 issue of HealthLeaders magazine.
The dilemma of keeping patients healthy beyond the hospital walls often means that healthcare leaders must shift their organizations into a vulnerable and uncomfortable space that involves taking risk, partnering with outside organizations, experimenting with new ideas, and being willing to fail in order to learn.
Fifty healthcare executives in executive, clinical, and information technology arenas gathered in Colorado Springs, Colorado, last summer at the HealthLeaders Media Population Health Exchange to discuss their approaches for delivering comprehensive care to diverse populations.
Ideas that surfaced during the discussion to drive quality, reduce cost, and improve the overall health of the community included the following:
Base measurement on a source of truth
Achieving measurable improvement requires aligning disparate sectors within a healthcare system and with external partners via data.
"[Finding common ground] depends on getting agreement in terms of my data, our data, and their data—and what we're viewing as a source of truth," says Mac McClurkan, chief strategy officer at Oaklawn Hospital, a regional healthcare organization in Marshall, Michigan. "What is the data telling us, and how do we make those insights actionable?"
Determining and prioritizing the metrics by which an organization measures itself is how Allegheny Health Network (AHN), an integrated healthcare system based in Pittsburgh enhances patient care, such as lowering readmission rates.
"We had a readmissions summit, in which we brought key stakeholders from across our network—including payers—to the table, presented our data, and created groups to work on [improvement] projects related to readmissions," says Sam Reynolds, MD, chief quality officer. "But you need to have a metric (e.g., readmission rate) by which you can measure your success. A cross-cutting metric is needed to gain general consensus across all sites of care."
Through its homecare and skilled nursing facility (SNF) entities, Charlotte, North Carolina–based Carolinas HealthCare System, an integrated network in North and South Carolina, initiated a postacute collaborative with data submission requirements for its organization as well as community partners.
"Finding common ground depends on getting agreement in terms of my data, our data, and their data—and what we're viewing as a source of truth."
Mac McClurkan, chief strategy officer at Oaklawn Hospital, Marshall, Michigan
"We're moving all of our entities to the same care management platform in rehab, behavioral health, and the postacute space, so everyone can communicate across those systems," says Ruth Krystopolski, senior vice president of population health.
Establish beneficial partnerships with community organizations
A healthcare system can only go so far with population health endeavors without help from social service and community organizations.
Sutter Health, a nonprofit network of hospitals and physicians, serving more than 100 communities in Northern California, partners with the City of Sacramento to deliver first aid and referrals to social services for the homeless.
"Our nurses are out in the community providing care—supplying people with such things as needles and diabetic kits, and connecting them with free community resources," says Sameer Badlani, MD, vice president and chief health information officer for Sutter Health.
Houston Methodist, which includes a leading academic medical center and seven community hospitals serving the Greater Houston area, awards grants to federally qualified health centers and other community partners to collaborate on building healthy communities.
"We've also seen results in our collaboration with Meals on Wheels, in which drivers ask transitions-in-care questions of recipients and relay the information to our nursing care navigator team, so we're on top of the curve," says Julia Andrieni, MD, vice president, population health and primary care, Houston Methodist; and president and CEO, Houston Methodist Physicians' Alliance for Quality. "As a result, we've learned about medication errors, food insecurity, and other social determinants."
Understand that true innovation is risky, experimental, and can be messy and painful—but leads to great rewards
With change being a constant in healthcare, nurturing and introducing innovation into the workflow can meet resistance among those weary and wary of the next new idea. Yet leaders know that innovation equals fiscal survival, and it's imperative to create a risk-tolerant environment.
"You need to have a metric by which you can measure your success. A cross-cutting metric is needed to gain general consensus across all sites of care."
Sam Reynolds, MD, chief quality officer, Allegheny Health Network, Pittsburgh
"If the leadership is not willing to force the business portion of the organization to adapt to the various innovations, it won't move forward," says David Battinelli, MD, chief medical officer for Northwell Health in New York state. Northwell Health is a nonprofit healthcare network with 22 hospitals.
Changing risk-tolerance of an organization isn't automatic, points out David Stowers, RN, PhD, vice president, enterprise care management, at four-hospital Covenant Health
Partners in Lubbock, Texas.
"Everybody likes their own comfortable way of doing things," says Stowers. "So, the first thing we did at Covenant was to set up a pilot for four different processes, each with relatively low risk, understanding that some may fail. Some did, and others—like care navigators in primary care—did not. But the medical staff at Covenant and the administration could see that by putting in small processes, we were impacting little things, and that would grow to bigger things."
