In this Best of 2023 episode, Rodney Adams, Vice President of Research and Reimbursement at Tennessee Hospital Association, gives insights on what providers can do regarding payors and healthcare workforce shortages.Learn how to listen to The Hospital Finance Podcast® on your mobile device.
Highlights of this episode include:
- What can providers do to influence where things are heading
- How providers can collaborate more with payers
- How to improve denial rates
- The positive impact COVID-19 had on the healthcare workforce
- Workforce burnout
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Rodney Adams, vice president of research and reimbursement for the Tennessee Hospital Association. In this role, he works with hospitals across Tennessee in the areas of managed care, revenue cycle, case management and utilization review, and compliance. Prior to his current role, he was the associate administrator of finance for Williamson Medical Center in Franklin, Tennessee, where he oversaw patient access, health information management, coding, case management, patient financial services, and managed care. He was also with Maury Regional Health System for almost 12 years, holding various roles during his tenure there. Rodney is a past president of the HFMA Tennessee Chapter and has obtained both the CRCR and CHFP certifications from HFMA. He holds a bachelor’s degree in business administration from Warren National University and completed his graduate studies at Vanderbilt University’s Owen School of Management, where he obtained his master’s in the management of healthcare. Thank you for joining us today, Rodney.
Rodney Adams: Thanks for having me, Kelly. It’s great to be here.
Kelly: Well, let’s jump in, shall we? What can providers do to influence where things are heading?
Rodney: Kelly, that’s a great question. You see a lot of rule changes that are coming out. I mean, just recently– and public comments are due in March for a proposed rule from the CMS just released about authorizations. And I think one of the big things that I would encourage providers to do is really keep up with these CMS releases. These releases and these proposed rules that are out, CMS really focuses on those in their rulemaking process. And through some conversations that I’ve had with CMS Region 4 Office, which is the regional office for Tennessee and many other states in the southeast, they’ve told us that while they do accept feedback outside of the formal comment during the rulemaking process, the only comments that they can accept or use in the rulemaking process is through the formal comments. And so I encourage providers to enter comments any time that you believe something is going to have an impact on you or your organization.
Another thing that I would say is state lawmakers have a tremendous amount of influence on what goes on in the landscape and the day-to-today operations of hospitals and healthcare systems in their state. And so be engaged with the state process. Understand what’s being proposed and how that may impact your organization. The local hospital association, your state hospital association is likely very engaged in that. But even for revenue cycle and managed care professionals, understanding if bills are being proposed that would impact your operations, I think, is key and something that you should be paying attention to. And knowing now after having been on the hospital association side now for almost a year and a half, I certainly believe that I would have paid more attention to those rulemaking processes when I was in the hospital, actually. So those are a couple of things that I would suggest all providers do to maintain some contact and try to influence where rules and laws are headed.
Kelly: Those are great tips. Thank you. And can you talk more about how providers can collaborate more with payers?
Rodney: It’s become a very adversarial relationship, primarily with hospitals, health systems, and payers, especially in recent history. There is some reprieve from that during the heights of COVID. But as COVID has subsided, the old kind of mentality seems to be sneaking back in and moving towards this adversarial relationship, sometimes even enhancing that and pushing forward in that direction even faster. And I think there are ways where you can certainly collaborate with payers. I think there are common opportunities and win-win situations that exist for payers and providers. Some of those include the workforce challenges that we’re faced with today. I think given the workforce challenges, the payers are filling that crunch as well. And so how can you work with payers to promote entering the healthcare field? We found through some work with our hospital association that beginning to influence those decisions for people’s careers can start as early as middle school. And so we’re working with some junior high students with programs to continue to drum up interest in the healthcare field. And that’s clinical care and non-clinical care.
I mean, I know this is a healthcare finance podcast, obviously. And so there are nurses who work in our finance areas too, and we need them, but even just all the way through. We recently started a campaign that says It Happens in a Hospital. And with that campaign, it’s really focused on that the jobs in hospitals are not just nursing or clinical care, that there are jobs in hospitals for people who are marketing professionals, IT professionals, food and nutrition, environmental services, revenue cycle, finance, accounting. All of those, there are jobs in hospitals for that. And so I think you can collaborate with payers around campaigns like that. I think also, you see a lot of denials coming from payers these days. Some of those denials are obviously automated, and some of them, at least a large portion of them, are for additional information needed. When I was overseeing revenue cycle, you got a lot of denials for additional information needed. So, what does that mean?
It can mean something different for a lot of payers, but I think really diving in with those payers and trying to get those rules up front is a way that you can collaborate because what we’ve seen out of COVID is some of the payers have gotten behind in processing their appeals. And so we’re seeing an increase in denials. We’re seeing delays in processing appeals. And part of that is that the payers are struggling with staffing just like everybody else. And so we’ve had some conversations with payers about, “How do we focus on decreasing the administrative burden for both sides?” And so that’s where I think there’s a win-win for the payers and the providers, so getting that information right, sending it up front, eliminating that denial, which eliminates the need for an appeal, which eliminates the need to process the appeal on the payer side. So, I think that’s a great opportunity in ways to collaborate with the payers, a couple of examples there. And I think it’s different in every market. Yeah, I mean, there may be other ways. And so if you have those, we’ll share some contact information at the end. But if you have ways that you’re collaborating with payers that are outside of the couple that I mentioned, please feel free to share those. All ideas are welcome.
Kelly: Right. And I know you already kind of talked about this. But what can we do as providers– given your experience with the HFMA, the hospital association, and your other healthcare experience, how can we improve denial rates?
Rodney: That’s a great question as well. I think improving denial rates can mean a lot of different things. I worked for a CFO when I was on the hospital side who said, “Our work with denials is not finished until we’re at zero,” which pretty much means our work with denials is never over because we’re not going to reach zero. And he knew that was not a realistic goal, but he also wanted to drive home his point that until we got there, this was going to be a focus. I think the best way that I have seen to address denials and denial rates is to understand and categorize denials and then really focus on root cause analysis and put processes in place to prevent denials. So, denial prevention is far more important than denial management. I used to hate having staff with titles of denial management. It just seemed like we were okay then with, “Let’s just manage denials. And as long as they’re not too bad, it’ll be okay.” And that was not the philosophy that we had as an organization at any of the organizations that I’ve been at and worked in revenue cycle or overseeing revenue cycle for. And so we would literally take an approach that said everyone owns denials. But there would be primary contacts.
And so some denials were related to the business office. Timely filing denials or denials in which we didn’t send additional information even though we’d gotten requests for it, those were owned by patient financial services. And so they would have to develop a corrective action plan that I would review and approve, and then we would monitor those denials on a continuing basis. Right. So, the next time we got that denial, I had a date for which– this process changed on February 1st. And so if that denial, data service, or occurrence was after February 1st, then our process wasn’t working. And so we needed to go back and look at our process and see, “Why did we have something that fell through the cracks?” If that denial was from December, “Okay. We’re going to move on. We’re not going to try to create another corrective action plan because we put one in place in February.” Right? But we did that with literally most every department in the organization. And it was time consuming. And it was painful. But we drove denials down by– I mean, we literally reduced denials by more than 50%…
Rodney: …just by focusing on them. And it’s the old, “What gets measured gets managed.” And so we were measuring denials. We were meeting with departments. We were having conversations with them at least monthly. Some departments that had some significant denial problems, we met with weekly. And we also found out about processes that needed to be updated, denials that, for instance, we were getting denied for a specific modifier that’s being placed on an account in and out of therapy, and the modifier didn’t need to be there. But they had an email from five or six years before that said that those modifiers needed to be on there. So, when we talked to billing, billing’s like, “Yeah, those modifiers needed to be on there five or six years ago, but those rules changed four years ago or three years ago.” But they didn’t communicate the change and that they were no longer needed. And so we had all this time spent putting modifiers on and then billing follow-up focusing on this denial and how to get it overturned and how to rebuild the claim and get all these processes, and literally, all we had to do was share with the folks up front that those were no longer needed. And so they were super happy. And we stopped seeing those denials come through. And so I think there’s not a lot of– there’s no magic bullet on improving denial rates, but I think that with some work and some collaboration with the other departments in your organizations, you can certainly do it, and you can decrease denials pretty dramatically. In today’s climate with the financial challenges that hospitals have going on and healthcare systems have right now, every dollar is important. And so I would encourage folks to be working on denials.
Kelly: Yeah, those are some great takeaways. Thank you. And we had some challenges with the healthcare workforce going into COVID-19. And now we have a new set of challenges, post-COVID-19. Can you talk about the positive impact that COVID-19 had on the healthcare workforce?
Rodney: Yeah. It’s hard to think about COVID being a positive impact just because there are so many negative things that have come from this, workforce shortages, all the things that we’re dealing with, where rates have gone up and in order to retain staff, you’ve had to increase rates. And so I understand all of that. And it’s certainly a very real thing. And we also know that when wages increase, they likely don’t decrease. Right? You’re not going to go back and say, “Yeah. We gave you these retention increases to keep up with the market.” But the market’s not going to slot back. And so those calls are likely here to stay. But I do think there are some silver linings, and I think it’s important to understand what those are. Many folks who are listening to this probably had some employees that worked from home but probably not nearly as many as you do today, at least on some hybrid schedule or fully remote. And so I think that was a huge win for the workforce in general. Those people who could work from home found out that they could work from home, and leadership approved for them to work at home because there were no other choices. Right?
Kelly: Right, right.
Rodney: And so there were no options to say, “Well, let’s look at the data. Well, we’ll follow this.” I mean, I’ve been in healthcare for a long time, as you mentioned in the introduction, and I was guilty of that too. It’s like, “Well, we need to see how this goes. We’ll pilot it. We’ll do a pilot for 90 days,” or whatever, “see how it goes.” And then you extend the pilots, and that’s how these things typically get rolled out. But I think we move forward from a remote workforce standpoint and technology around meetings and how to collaborate without being in the same room. I think we move forward five years in the first five months of COVID. I mean, if you go from February, March of 2020 to late summer, early fall of 2020, it would have taken us five years plus to get to that point under normal circumstances.
Kelly: Oh, yeah, completely agree.
Rodney: And so I think that’s one of the big positives that’s come from this. And now for positions that are fully remote, so some IT positions, maybe even some rev cycle positions, especially back-end, recruiting pool has grown pretty dramatically. And I’ve got friends in both of those industries that are recruiting people from all over the country now, and they wouldn’t have been able to do that before. And you’ve got some employees who have moved that you would have lost otherwise. They were good employee, but they decided to relocate. Maybe the spouse took another job or whatever that case may be. But they’ve been able to remain employees in the organization because of the remote capabilities. And so I think that’s a positive that’s come out of this, one of the few, I guess, that I could say. There haven’t been a ton, but that’s one for sure. It’s been a good thing.
Kelly: Yeah, wholeheartedly agree. There’s not much positive that came out of it, but that certainly did. And what more do you think we can do to improve healthcare workforce burnout and the subsequent healthcare workforce shortages that we’re facing?
Rodney: Yeah, there’s a lot to unpack in that question. Workforce burnout–
Kelly: It’s a little loaded. Right? [laughter]
Rodney: Yeah, that’s a loaded question for sure. Workforce burnout is real. And it was an issue in healthcare before COVID. COVID accelerated that. And I think I had a lot of team members that experienced just fatigue of what they were doing. I mean, went from– I mean, I literally remember being in the hospital in 2020 and seeing people aligning [at the drive?] as we entered the hospital campus, and they’re holding up these signs about heroes. Right? And I still get chills just thinking about all the support that existed. And we had volunteers who were making masks and delivering them to the hospital so staff could have a mask because of the mask shortages. And we obviously know a lot more now, roughly three years into this, than we did at the time, but all of those things that were occurring, and then came the mask requirements and the vaccine requirements and all of the controversy that ensued as a result of those. And so literally, heroes, 2020, move into early ’21 as the vaccine becomes more widely available, and there start to be these requirements and mandates that are placed and put out and then just complete division. And then there were masking requirements that were required by the federal government and the CMS and the OSHA and so on in the hospital. And patients and even employees for that matter, just very frustrated by that.
And obviously, I’m from Tennessee. And so other parts of the country may have experienced this differently, and I understand that. But I remember staff just being exhausted by the way that went, like, “We were heroes six months ago, boss. What happened?” And it’s like you’re still heroes and trying to build that staff up. And so addressing workforce burnout has always been important, but it’s never been more important than it is today. So, a couple of strategies that I would share that I felt like worked with my teams when I was in the hospital–and that’s been fairly recent. I’ve been at the hospital association, like I said, about a year and a half. Make sure the staff know they’re appreciated. And that can be done in a lot of ways. But it is not simply buying donuts on Fridays. It is having real face-to-face conversations with staff. So, if you’re a leader in healthcare, whether you’re in finance or you’re in some other group or division of the organization, seeing your staff and having conversations with them, understanding what their concerns are, and having those conversations in their work areas, I think, is very important because you can say, “My door is open.” I mean, my door stayed open for the most part unless I was in a meeting. But they won’t come to your door. By the time the problems get to your door, they’re big. By the time somebody decides to come interrupt you, problems have grown, and it’s probably much different than it would have been if you’d found it earlier.
And so I would suggest, book some time on your calendar to get out and see your staff and understand what’s going on in their day and ask them questions about them, understand what their likes and dislikes are, but ask them questions about how their work is going. And if you ask, “Is there anything you can do?” the answer is probably no. But if you ask, “What has frustrated you at work lately?” I’ve always found that that frustration question enlists more of a response than just, “How are things going?” because you’re going to get a one-word sentence, “It’s good,” or, “It’s fine.” So, I think that rounding with your staff is important in addressing burnout and then just making sure that you’re listening to them. If they’re reporting that they’re overloaded and if they can’t get the work done, understand that that can be a one-time issue and they can just be having a bad day. But if you’re constantly hearing that reported, try to figure out what can you do– and I kind of go back to the denial conversation that we just had. Some of that is, “What work are we doing that’s not adding value?” because we are great at adding additional responsibilities. Right? “Oh, pick this up. We need to do this now. We’re adding that.” But we never take inventory and say, “What can we stop doing?” And so if you can give your staff one or two things that they can stop doing– that report that they’ve pulled since 1994 that you literally look at for about five seconds, do you really need it, or have you just always had it? If you’re not using it to make a decision– somebody’s putting that together, and they’re trying to do it to the best of their abilities. So, allow them to stop doing something.
The second part of your question about the workforce shortage is incredibly complex. And it’s something that the industry is grappling with, but I think I mentioned earlier about having these campaigns to let people know hospitals do more than just nursing. Right? We don’t just need nurses. We don’t just need clinical staff. We need all kinds of staff, [inaudible] staff, clinical staff, physicians, administration. All of that’s needed to run an effective hospital health system. And quite honestly even, it’s needed in the payer community. Those things are needed in post-acute care. I mean, they’re needed in every sector of the healthcare market. And so I think engaging with people– I even mentor students that are transitioning from high school to college, formally through a program that Tennessee has, partly so they will understand that there are other opportunities in healthcare. Right? I’m not trying to convince all of these eight students that I’m mentoring to go into healthcare. And quite honestly, I’m not sure that any of them will this year, but so that they know there are options in hospitals other than being a doctor or a nurse. And I think on the finance side, we have a big opportunity to recruit and retain people into healthcare finance because if you’re in finance, you could be in finance in most any industry. Healthcare finance has its own unique opportunities and challenges. But I think it’s our duty to make sure that those staff know and understand what the opportunities ahead of them are. And so I would encourage those who are listening that are seasoned and experienced people in healthcare finance to mentor some of these young folks. And you can do that.
I’ve been involved with HFMA for a really long time, served as president of the chapter, and I’m still involved. Even as a past president, I’m still involved with the chapter partly just so I can mentor some of these younger professionals who are entering this field and help them understand and help connect them with people that can help them grow their career like people did for me as I was growing up in healthcare finance. And so I think those are some of the things that we can do to try to address burnout, to try to address shortages, but again, if other people have feedback on any of these topics, I’d certainly love to connect because I believe in continuing to learn, continuing to try to understand more and more about the landscape both in the state and what other states are doing to address some of these things because until you listen with an intent to understand and not listen with an intent to respond, I think that’s when you can really start to learn. And so that’s the other thing I would say is, “Stay curious. Listen with an intent to understand.”
Kelly: That’s great advice. Thank you. And thank you so much for joining us today, Rodney, and for these really outstanding insights.
Rodney: Kelly, it’s been a pleasure. I certainly appreciate you having me on the podcast. And it’s been a lot of fun.
Kelly: Yes. And if listeners want to learn more, what’s the best way to reach you?
Rodney: Yeah, I would love to connect with others. You can look me up on LinkedIn. It’s Rodney Adams in the Greater Nashville area on LinkedIn, or you can email me directly. My email is email@example.com. So that’s firstname.lastname@example.org.
Kelly: Thank you very much for that. And thank you all for joining us for this episode of The Hospital Finance podcast. Until next time.
[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER, SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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