In this episode, Rodney Adams, Senior Vice President of Finance and Reimbursement for the Tennessee Hospital Association, is discussing the intersection of healthcare finance.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- The challenges in revenue cycle
- How organizations are responding
- Which areas of the hospitals are impacted
- Innovation
- How hospitals view revenue management and how they manage strategies across the various financial areas
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Rodney Adams, Senior Vice President of Finance and Reimbursement for the Tennessee Hospital Association. In this role, he works with hospitals across Tennessee in the areas of Medicaid and Medicare policy, directed payments, supplemental pool programs, managed care, revenue cycle, case management, and utilization review and compliance. Prior to this 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 the CHFP certifications from HFMA. He holds a bachelor’s degree in business administration from Moore 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. In this episode, we’re discussing the intersection of healthcare finance. Welcome back and thank you for joining us, Rodney.
Rodney Adams: Hi, Kelly. It’s great to be back. Always appreciate the opportunity to connect with you guys.
Kelly: Yeah, we’re glad you’re here. So, let’s go ahead and jump in. So, we find ourselves in interesting times in healthcare finance with provider taxes and directed payments changing as a result of the One Big Beautiful Bill Act, or the OBBBA. Plus, changes in the payer landscape as more seniors move to MA and the boomers retire, decreasing the number of commercial patients. And then there are the challenges in revenue cycle, including claim denials, downcoding, off denials, payers redirecting patients to other providers, pricing transparency, and the list goes on and on. So, with all these headwinds and challenges, how are you seeing organizations respond?
Rodney: Yeah, there’s plenty of headwinds at the moment, and I will just start by saying anything that I share today is the opinion of Rodney Adams, not the opinion of the Tennessee Hospital Association. Obviously, I have exposure to a number of things in my role now, whether it be the impacts of federal law and regulation, and just trying to track and understand how that’s changing across the country. And I will say, I think that the impacts of the OBBBA are going to be different in different states. Expansion states have a different impact than non-expansion states, and states that were grandfathered on their directed payment programs have different impacts than states that did not have a directed payment program. Strategy for organizations is just not a one-size-fits-all. Each organization has to map their strategy according to the opportunities that they see in their market and how they view their future. And this is really a national trend that you’re seeing. And you can watch some of the strategies unfold at the national level, and there’s been plenty of articles in Becker’s and many sources around how some organizations are focusing on outpatient.
They’re potentially hedging against some of the site-neutral provisions that are even floating around in DC today. Other organizations are putting more of a strategy on inpatient services, which may work well for them in their market, but that doesn’t work for everyone. Others are finding unique partnerships and opportunities to collaborate with other providers. All of those things can be successful strategies, but they’re not necessarily successful for every organization. I mean, you’re seeing headlines around layoffs around the country. You’re seeing how payers, especially MA payers, are being forced to adapt as well. I mean, just in the last few weeks, there have been a number of articles around MA payers and how they’re adjusting their forecast. The enhanced premium tax credits that are set to expire at the end of the year, those EPTCs, as we in the industry call them, expiring, could have a major impact. There’s also potential for those to move in some federal legislation later this year. I think the industry is watching that very closely as we all try to understand what additional headwinds we may have to deal with. But I think organizations are responding in different ways based on what is the priority for them and how do they see their future.
Kelly: Well, there certainly are a lot of challenges right now. I do know that. With this level of complexity, which areas and hospitals are impacted?
Rodney: Yeah, I mean, obviously the financial areas, reimbursement in particular, with trying to understand the impacts of the OBBBA and what that looks like, revenue cycle, dealing with all the challenges with payers and off-coding and denials and the like of that. I think managed care, the impacts to managed care are really– contract negotiations are not getting easier in the market, particularly as payers experience pressures – financial pressures, in particular – those managed care negotiations are much more difficult. Accounting and finance are trying to figure out how to make sure that they have the appropriate reserves. You’ve got quality programs that are being rolled out by CMS. The new Teams model is rolling out effective 1/1/26, so that’s impacting your quality departments. But teams will have an impact not only on quality, as I see it, because they can’t manage this program on their own, there’ll be impacts to operations and clinical teams that’ll have to be worked through. And so as I see it, the changes and challenges are affecting the industry and are essentially going to touch all departments, not just– it can’t be viewed as just a financial issue or a financial challenge that the typical finance areas are going to be forced to work through. I think organizations are going to have to work through this at the executive level as they develop their strategy, but also working through some of those things with their mid-level management on what types of operational changes and implementations, and how are they going to be able to address those and work through those problems?
Kelly: Wow, I mean, it really does sound like it’s a challenging time for a lot of our hospitals. Are there any innovative things you’re seeing that hospitals are doing to manage some of these risks?
Rodney: Yeah, I do think that there are some innovative things I’ve seen. Here in Tennessee, there’s a payer scorecard implementation underway. Many organizations have payer scorecards that they are using internally, but we at THA are implementing a statewide type of payer scorecard where organizations can opt in to participate. And then we’re trying to understand how payer behavior is changing and comparing across multiple payer types. And I think that’s relatively innovative. There’s also a trend about outsourcing revenue cycle functions. You have Ensemble. There was an announcement in Becker’s, I think last week, but around five organizations, sizable organizations that are outsourcing revenue cycle functions. Three of those were moving, I think, to Ensemble. Either two or three. Conifer offers that service. I think Medmetrics is getting into that. Now you’ve got R1. So many organizations are considering these revenue cycle outsource functions. And I think it can be a successful strategy. I don’t know if it’s a strategy that is right for every organization, and each organization has to review that, determine on their own if that’s the right strategy for them. But I do think it’s innovative. I do think that there are some economies of scale that are being employed there.
Finally, I work more on the financial side, so I’m probably biased to some of the things that I know, but managed care strategies. The attention that is now given to language and not just rates is incredibly important. You can negotiate new rates, but if the language in the contract does not allow those– is such that it doesn’t allow the rates to be actually operationalized, the rates are just on a rate sheet and they’re not actually put into play. And so I’m seeing a lot of more innovative organizations or more forward-thinking organizations across the country who are spending a lot of time really diving into that language very closely. Finally, I think there are some changes that are occurring on the clinical side. There’s value-based care, shared savings, and things that have been around for quite a while. But those continue to roll out differently in different parts of the country. Some parts of the country are further down that road than others. And I do think that there are some potentials for wins from organizations there, but it’s something that they have to weigh the risks and benefits of as they consider what’s the right strategy for them.
Kelly: Certainly. Thanks for sharing those innovative solutions that you’re seeing. So how do hospitals view revenue management, and how do they manage strategies across the various financial areas?
Rodney: Yeah, I think healthcare has become, within healthcare finance, more interconnected than ever. So, state-directed payments and how that ties to revenue cycle performance and how that ties into managed care strategy and capital and operational planning. One of the things I’ve seen that some organizations are implementing nationally is the implementation of a chief revenue officer. I think that really complements the CFO role and other senior leaders well. Essentially, this Chief Revenue Officer or CRO is responsible for revenue management across the entity. And that includes many of the areas that I mentioned in healthcare finance from rev cycle and managed care and state-directed– or reimbursement, which typically handles more of the directed payments as well as cost reporting in the Medicare cost report. Having all of that roll up to a Chief Revenue Officer that’s focused on the interconnected nature of those functions can be rather successful. In the past, I think that reported up to the CFO, who’s also responsible for a number of other activities and really can be a challenge to get into the level of detail that a CRO can help with.
And so, I think for some organizations, that’s been a good opportunity and a good change and a good complement to that CFO as they kind of understand what the future of revenue looks like for their system and how that plays into their strategy. I think I’ll go a little bit further and say, I do think there’s a need for organizations to consider and adapt their work structure to make sure that revenue management and the strategy of that is a priority and taking those things into consideration as they develop their strategic plans. Understanding what the future of revenue looks like, whether that’s in your managed care negotiations, revenue cycle functions, how some of these supplemental payment programs that have been in place for quite some time impact your revenue opportunities, both in the short term and the long term, certainly plays into a role around your strategic plan and what your organization will be able to accomplish in the future.
Kelly: Wow. Well, thank you so much for sharing these insights with us, Rodney, on the intersection of healthcare finance. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Rodney: LinkedIn is a great way. If you’re not already connected with me on LinkedIn, you can find me there. I’m pretty easy to spot, but you can also email me. My email radams@tha.com. I’d be happy to connect with anyone. I’m always looking to learn and understand more about what others are seeing in the industry as well, but happy to also share what I’m seeing as I work both at the state level and with other states as well as at the national level.
Kelly: Great. Well, thank you for providing 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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