In this episode, we’re pleased to welcome Matt Rolfes, Chief Financial Officer at MedEvolve, to discuss effective intelligence, how healthcare leaders can mitigate labor shortages and gamify their staff.Learn how to listen to The Hospital Finance Podcast® on your mobile device.
Highlights of this episode include:
- Who is MedEvolve?
- Severe staffing shortages within RCM and billing teams
- What is effective intelligence?
- Advice for clients and healthcare leaders who are trying to maximize their revenue with a reduced staff
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Matt Rolfes. Matt leverages his 15 years of experience in technology and finance to drive and support MedEvolve’s growth and operational success. He brings to MedEvolve expertise in accounting and finance as well as corporate development and operations experience. Matt joined MedEvolve as Chief Financial Officer in August 2013 after serving as the Controller of Streamline Health. While at Streamline Health, Matt led the company’s accounting and reporting function through a time of significant growth, including the planning regarding two strategic acquisitions. Prior to Streamline Health, Matt spent five years with Grant Thornton, LLP, an audit and assurance services, working with private and public companies in the technology, service, banking, and consumer industrial product sectors. Matt holds a BS in Business Administration with major studies and Accounting and Management Information Systems from the University of Dayton. In this episode, we’re discussing Effective Intelligence, how healthcare leaders can mitigate labor shortages and gamify their staff. Thank you for joining us today, Matt.
Matt Rolfes: Thanks, Kelly. Thanks for having me today.
Kelly: Well, great. Well, let’s jump in. Can you take a few minutes and introduce yourself and MedEvolve?
Matt: Sure. I’ll start with MedEvolve first. MedEvolve is a leader in revenue cycle optimization technologies, focusing on reducing the cost to collect each dollar that is billed. We like to look at retaining key staff which is kind of one of the big topics here today, and overall, just maximizing profit margins for medical enterprises. Our EI Suite is our flagship technology. It provides back-office workflow automation and actual analytics which we’re referencing here as the Effective Intelligence, and this is specifically for RCM operations to help them focus on key operational points. So, my journey and technology started, I guess, I want to say almost 20 years ago now, I’m working with technology firms at Grant Thornton across many industries. And my first contact with healthcare, as you referenced, began with Streamline Health beginning in 2009. This was a time that the high-tech DAC was coming out and being implemented across the country. And more investment began into the data analytics side of technology to begin to help lower costs and get better actionable data to medical practices and hospitals alike. For me, I love healthcare because there’s so much opportunity to affect meaningful change in how we consume it, what it costs us as consumers, but also how much it costs the physicians and the hospital entities to provide care. And clearly, there’s a lot of systemic problems in many ways with regards to cost, a lot of things around sustainability for both patients and providers. And our aim is to be a meaningful player in correcting some of those deficiencies. So that’s kind of the overall mission of MedEvolve.
Kelly: Thank you. That’s great. Many healthcare leaders and organizations are experiencing severe staffing shortages within RCM and billing teams, especially post-pandemic. What do you think is driving this shift?
Matt: Yeah. I mean, we have an RCM business here at MedEvolve. We do outsource billing for many providers. So, we felt some of the pain that you’re describing as well. So, we’ve lived it. I think just like many other industries, people have found other careers, retired, moved out of the industry. And then there’s just a lot of job hopping going on because of wage competition. Along with that, I think there’s just a declining supply of people wanting to get into RCM-type jobs. Yeah. I think this also creates a lot of brain drain. So, the loss of a trained employee gets compounded by the knowledge that they walk out with. So, while maybe there’s a person following on that can be hired to replace that person, you sometimes lose a lot of the informational and institutional knowledge those people possess. So, I think that’s probably the biggest thing. I think kind of following that, it’s increasingly complex and burdensome reimbursement system. It’s difficult for people to get the skill set to learn it. And there’s, like I said, less availability of experienced staff with knowledge.
And then I think the last thing probably that we’re seeing more and more, especially coming out of the pandemic, is around misalignment and low staff morale. Many organizations are just not well-aligned from an ownership perspective all the way down to the frontline staff. And there is really a clear change in the dynamic of how people feel valued, how they recognize value, as maybe even a post of 5 or 10 years ago, pre-pandemic. The workforce is just demanding more, more recognition, more financial gain, and it’s obvious that employers have been willing to increase wages to compete and recruit for talent. But it makes you wonder kind of what has that done for the mission overall. Are we driving up wages and getting better work? Are people any more motivated today than they were five years ago? Or is it just employers that are seeking results, or are they just seeking bodies? I think we believe, and I think where I think things are headed, employers and employees should be more aligned. And if there is a higher wage or higher pay, there should be equally higher quality work.
Kelly: Completely agree. We are seeing a lot of that in healthcare specifically these days. What is Effective Intelligence? And does that inform finance leaders’ approach to RCM and staffing challenges?
Matt: Yeah. So having been a CFO and being kind of groomed in the finance world and accounting world, you kind of learn that data without context is not valuable. But when you add context in, which is kind of how we characterize Effective Intelligence, you’re providing that context to standard RCM data which can tell you the people and the processes that are effective or not effective and where you may need to make changes. For example, one of the things that we kind of point to and really kind of our one-of-one in Effective Intelligence is zero touch rate. So, meaning how many of your claims are processing to insurance and receive a payment without human intervention at all? For us, this is kind of the Holy Grail of efficiency for us and what really makes Effective Intelligence valuable. From a staffing perspective, one of the biggest challenges we see and, in particular, prior to us having the EI Suite and Effective Intelligence at our disposal, not even knowing what fully staffed even looks like for the organization. Many organizations can’t tell you what their AR inventory looks like, let alone really understand how many people they may actually need to address their current AR portfolios. Also, who are the people that should be paid more, or who are consistently doing the best work, and how do we retain those people? And then lastly, from a cost perspective, how much time and effort could be saved by correcting ineffective process, for instance, in pre-service, where you’re likely generating the majority of work? So again, this kind of goes back to how Effective Intelligence, you can determine that maybe cash flow is not where it should be, but this can really give you context to kind of that feeling you have or just that kind of anecdotal understanding and really drive you towards where you can make change.
Kelly: Makes a lot of sense. And how can healthcare finance leaders properly gamify their staff using Effective Intelligence?
Matt: Yeah. So, I think there’s kind of five different ways to go about this. I’m trying to do these kind of in a prescribed order. So first of all, I think you need to really obtain a deep understanding of your operational workflows and where they need to show improvement. One of the things that we do here is do value-stream mapping of processes and analyze those using Effective Intelligence to guide us to where the opportunity is to gamify. I think just as a general rule, throwing tech or things like gamification at something without really fully understanding it will just waste your time. So, I think, again, starting with just a deep understanding of operational workflows is key. So, if you do understand your processes, don’t gamify broken process. Sure, you’ve optimized where you can and where you see a need before gamifying. Next, I think defining what is a “gold standard, high-value work,” and what do we do to replicate it. So, let’s just say zero touch to payment is your metric. And you identify a bulk of denials are coming from registration errors. How do you incentivize those people through gamification or create those game medication programs to build around a better process and further a better process?
Next, I would say not everybody is built the same or has the same motivations. So, providing different options for reward systems, I think, is key. So, some people are motivated by cash, maybe not others. So if it’s non-monetary or maybe your organization is on a smaller budget to where you can’t be paying out large bonuses or things like that, are there ways to provide a catered lunch for achievement or extra PTO days, company swag, things like that, that may be a smaller dollar amount, but may give people an equal amount of recognition for the work that they’re doing. And then I think lastly, have that measurable result in mind. We want to make sure we see an improvement to X, whatever X is, and measure towards that. We want to have a measurable result in mind is our last thing. We want to see improvement to X and measure towards that. So whatever X is, we need to know that X is working, and we can repeat it, or if it’s not working, we adjust. So again, those are my kind of five things that I would consider in terms of gamification is deep understanding, don’t gamify broken process, understand what your gold standards are, and what your high-value work is, provide different reward systems that are tailored to the people that is your audience, and make sure you have a measurable result in mind.
Kelly: Matt, those are some great ideas. Thank you. And do you have any advice for clients and healthcare leaders who are trying to maximize their revenue with a reduced staff? How can they adapt to the current labor market?
Matt: Yeah. So, what we see a lot of is really understanding and analyzing front-end processes can help. And what this naturally does is if you can correct issues on the registration side of things, you can prevent accounts receivable work from even happening. So again, we want to make sure that we are staffing appropriately and leanly as much as we can because clearly, we’re trying to solve for higher costs and lower reimbursement. And then when it does hit AR, so let’s just say you do eventually get it now, which I think is going to happen. Nobody disputes that. But how are we stratifying and distributing our accounts receivable work with a clear strategy in mind? So again, I think looking at the front-end process to make sure that our patients are financially cleared reduces workload, and then prioritizing those claims that do hit AR that have a higher probability of cash payment for the least amount of work done, I think is where most organizations are going to want to improve. Unfortunately, most of your EMRPM systems don’t do this for you. They don’t typically have these types of technologies that can really create better work drivers. So, you’ll need to either get advanced Excel skills, SQL skills to do things like this yourself through analysis. Or you can leverage solutions similar to MedEvolve’s and our EI Suite which automates a lot of these processes.
I would say other strategies that we’ve used, I think, that have been effective, and I think just in the survey data we get back from our employees, remote work opportunities are a huge benefit to folks. Obviously, that comes with responsibility and then also ways to monitor activity and outcomes of people. So again, this kind of goes back to the infective intelligence, not only are we getting information around claims data or denial data, but we’re getting the context around what it’s taking to actually adjudicate those claims and how efficient people are acting. Next, I would say incentive programs, as we talked about with gamification or incentive-based revenue cycle achievement plans, I think having those things in place to reward your winners and effectively allow those folks that aren’t going to do the best quality work to effectively not get paid as much. So, I think there’s monetary incentive programs you can put in place. I’m not a proponent of outsourcing, but there’s certainly an opportunity to outsource transactional work to gain scale. I would say with one kind of buyer beware there make sure you have a good understanding of quality around that work if you’re not going to control it. And then I think the kind of last thing here from adapting to labor market, I think the workforce have more discretion around what technologies that their employers purchase and use to do their jobs. I mean, I’m of the belief, if you have the best technologies, the best tools, you’re going to find good people to work for you. So, what technologies can they invest in that automate process and drive work to the right areas?
And in many ways, once these things are implemented, it can actually make people’s jobs more predictable and easier to manage. And we find that when people do implement, for instance, our EI Suite and our Workflow Automation Tools that it does give people more clarity and more predictability in terms of their day and what they can expect, and especially in that remote work-from-home type environment. So, I think there’s many ways that we can go about affecting change and assuring that we are kind of meeting the market where it’s at. We know labor spending is going up, and I don’t think that’s going to stop. But there’s just ways that organizations can leverage technology, better process, and better understanding to really drive results.
Kelly: Those are some great insights. Thank you. Is there anything else you want to add to today’s conversation?
Matt: Yeah. I mean, I think we just got notice of another reimbursement cut from CMS. I think there’s going to be continued downward pressure on reimbursement. There’s going to be increasing competition for people and resources since we know that those are becoming more and more scarce from an RCM perspective. Wages and supply costs are not going to decrease any time soon. So, I think it’s important that we embrace new ways of thinking and talking to prospects. There’s a strong pull to remain kind of fixated on denial management after the fact where we’re just managing the AR better and things will somehow improve. I think what we’re seeing working with clients of ours is that the pre-service processes really dictate the amount of work and staffing you’ll need in the whole. So, I would highly encourage folks to focus on, not forget about denial management, it’s important, but really focus on denial prevention. And what do we do to support what may be a poor functioning frontend process?
And as a whole, I think we need to rethink what revenue cycle metrics are really driving costs down in our organizations. Zero touch and really understanding how often you get paid without a human intervening in that process I think is to us, again, is really the gold standard of really understanding how well and how cost-efficient a revenue cycle may be functioning. And I think, again, lessons learned in this world, once you make a decision and you see early results, so in terms of making a decision of implementing Effective Intelligence or really any type of workflow automation software, if you see some early results, I think it’s important that you really rally the troops, you burn the boats, and you charge forward. So, I think these are all things that I think are good having learned lessons over the last several years. But I think really committing to something and really driving home results will do really well.
Kelly: Yeah, completely agree with that. Well, thank you so much for joining us today, Matt, for sharing all of this valuable information with us.
Matt: Yeah, you’re welcome.
Kelly: And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Matt: Yeah, so LinkedIn is probably an easy avenue for everybody. So, you can look me up on there. MedEvolve.com is our website address. If you want to log on there, you can find contact information for the company as well.
Kelly: Wonderful. Thank you. And thank you all for joining us for this episode of the Hospital Finance Podcast, until next time…
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