Billing and Collections

Healthcare Blame Game, the podcast: First episode is here!

April 11, 2023 12:17 pm

The much-anticipated pilot episode of the “Healthcare Blame Game” podcast is now live and available to HFMA members. In this episode, HFMA Chief Content Executive Brad Dennison and Executive Producer Erika Grotto question the methodology and narrative of a recent Kaiser Health News investigation.

Erika Grotto: Are workforce issues keeping you up at night? Today on HFMA’s Voices in Healthcare Finance podcast, sponsored by Red Dot. 

Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today, we’re starting a three-part series on the healthcare workforce. In this episode we’re focusing on finance and revenue cycle staff, which, just like clinical workers, have been affected by pandemic-driven shortages and low morale, according to an October 2022 article in hfm magazine.  

Jonathan Wiik has been watching the healthcare workforce throughout the pandemic and last year prepared an extensive labor report, which he references in the interview you’re about to hear. He has a long background in healthcare and is a regular at HFMA events. The vice president of healthcare insights at FinThrive, Wiik is an affable guy and always up for a friendly conversation. When I asked him to talk with me about the healthcare workforce, his tone was cheerful, but he made it clear the stakes are high when you consider the skills, expertise, and sheer numbers of people it takes to run a hospital. He put it this way. 

Jonathan Wiik: Hospitals are hotels, restaurants and doctor clinics all rolled into one, and they never close.

Grotto: HFMA’s Chief Partnership Executive Todd Nelson had a long career in hospitals before joining the Association, and today works with professional groups across the industry. He says contributing factors of burnout aren’t limited to pandemic-related issues. 

Todd Nelson: Environment of care is really important so the physical environment that you’re in certainly leads to burnout. The just plain number of hours that you’re working and the amount of patients—or if you’re not in patient care, the amount of tasks that you’re doing—leads to burnout. And a lot of people take this home with them. So whether you’re clinical or non-clinical, when you’re in healthcare, it’s a 24/7 thing. I mean, you know that when you walk out the door, your patients are still there many times, trying to heal, and you form a bond with them. And frankly, when you’re in an office setting—whether you’re in a finance setting or a revenue cycle setting—you know when you walk out the door, it’s not done. There’s still things to do.

Wiik: About a third of the workforce has left since the pandemic, and that’s amplified in nursing.

Grotto: That’s Jonathan Wiik again.

Wiik:  When I’m talking to revenue management and revenue cycle, they’re saying that it’s up 10%, 10-20%, so they’re on the lower end of that. So what that means is if you were running a revenue cycle of 100 folks, you’re running with 90, and before that you probably were running with 95 and it just went even worse. You never had the amount of staffing. My run rate when I ran my revenue cycle was always right around 3-5% of what I actually had budgeted. We just had an open rate—which quickly became my budget. There’s an awful lot of discussions with my CFO and others—“No, no, no, I need those people. I just haven’t been able to hire them yet.” That’s been amplified. 47% for that labor report survey I referenced plan to leave in the next two to three years. That’s what somewhat more scary, Erika. Not only is it bad, it’s not going to get any better. Usually, these things kind of oscillate and come in waves kind of like Covid. This is very, very real. I’ve talked with the rating agencies and others, and they are starting to impact their outlook. Fitch changed negative to deteriorating for not-for-profits. That’s one of the first times in my career I’ve seen that. They cited labor shortages and organizations “ability to meet its operational needs.” They’ve stopped their staffing challenges, again primarily. Shifting over to revenue cycle, a third have said, per Kaiser Family Foundation survey, that they want out. They’re done. Mic drop. “I’m out. I did not sign up for this. I did not sign up for people yelling at me. I did not sign up for doing the jobs of three people and I’m the only one left.” They feel very isolated and on an island right now. Having to cover other people’s shifts, work longer into the night, weekends. The work-from-home atmosphere has helped kind of tender that to some extent, but still, a third are considering leaving, and that’s not good. I’ll finish with how it’s impacting them. A survey indicated that about half of hospitals are experiencing about 40% larger billing errors. And so what that means is that you have less people, they’re having to do more stuff, that’s with anything. If I have to make 12 sandwiches and tomorrow I have to make 24 sandwiches, my chances of making a sandwich wrong is higher.

Grotto: He’s quick to point out that healthcare isn’t sandwiches, but that only means the stakes are higher when it comes to patient experience. 

Wiik: People are on hold. I don’t know if you’ve had to call a hospital lately. If it were bad, it’s gone worse now. You’re hearing the elevator music and how valuable you are and how important you are as a patient and someone will be right with you, but it’s much more than what you heard when you called before Covid. So it’s awful, and that’s happening 45% of the time, hospitals are reporting. 44% of hospitals are reporting they have to cancel things, and that’s because of some of the operational things clinically that I mentioned. So we can’t keep our nurse to patient ratios on our inpatient acute deck. So the telemetry unit can only do 40 casts instead of 20 casts a day, which means that people have to cancel. Or I can’t wait anymore, things are getting booked out. I found another place to get it done quicker because everyone’s vying for this kind of backlog of patients that didn’t get done during the pandemic. And trust me, consumers are voting with their wallets and their legs right now, and they’re trying to get into places that have the least amount of friction.

Grotto: Listening to Wiik talk about all of these challenges—plus a few more there just wasn’t room to include in this episode, made it stand out to me just how critical the workforce issue is, because solving all of these problems takes the right people. We’ll talk about some tactics when we come back. 

Let’s take a moment now to get a word from our sponsor, Red Dot. Here to speak with me is Michael Bumann, Red Dot CEO. Welcome, Michael.

Michael Bumann: Thank you, Erika. Nice to be here.

Grotto: The revenue cycle workforce is facing many challenges, but one particular challenge that I think leaves a lot of people spinning their wheels is the motor vehicle accident claims. How does working with Red Dot help with employee morale when it comes to these claims?

Bumann: Erika, great question, and something we see with all of our clients is an uptick in their morale. The reason for that takes some understanding of what these claims are like to deal with. They’re 100% manual. There’s no standardization. And the revenue cycle team has to interface with claims adjusters, attorneys, paralegals. It’s what we refer to as “people touches.” They have to talk to them. They have to send them emails. It takes a lot of touches to monitor and resolve these accounts, and they’re not always the friendliest people to deal with. And so, put yourself in the team member’s shoes, and they have to call again on this particular account. They’ve gotta deal with claims adjusters. They’ve gotta deal with attorneys. It takes a lot, and they last for years. And so from a morale standpoint, it doesn’t feel like you’re accomplishing much, and you’ve got all this work piling up. So from a morale standpoint, it doesn’t feel like you’re accomplishing much, and you’ve got all this work piling up and it takes 15, 20, 30 minutes to get to an answer on a particular MVA account. That takes a lot out of them day after day after day, and these accounts, again, they’ll take years to resolve.

Grotto: So it sounds like working with Red Dot, taking these claims off the shoulders of the rev cycle people actually makes them more efficient. They’re able to focus on other things.

Bumann: That’s true, Erika. It’s a good point. Look at what they must deal with in a typical day. Self-pay motor vehicle accident claims—super complex, super time consuming, take years to resolve—or they can focus on standardized claims that pay quicker and with higher margins. And so in today’s environment, having an option like Red Dot to convert those to immediate revenue really have an impact in today’s market.

Grotto: Alright. Well, thank you for sharing these thoughts. Michael Bumann, thanks for joining me today.

Bumann: It was my pleasure.

Grotto: Red Dot is the best technology-enabled acquisition solution for hospital self-pay motor vehicle accident accounts. Hospitals can now leverage Red Dot’s solution to improve their bottom-line revenue while dramatically improving their patient relationships by avoiding debt collection activities. Red Dot: Good for hospitals, good for patients. To learn more, visit

Recruitment and retention—always important areas of focus in the workplace—are more critical today than ever, according to Jonathan Wiik. 

Wiik: I think when I was at the hospital, recruitment and retention efforts were always something that we looked very closely at, and more importantly, our employee satisfaction and doing that and you’re like, yeah, those are important, let’s measure those, let’s see what’s our turnover rate, where are we at. Well, now it’s kind of become nuclear. I have to go focus on workforce now. And so what I’ve seen in hospitals are some pretty innovative things. They’re conducting what’s called stay interviews, and it’s not a performance eval Erika. It’s more like hey, Erika, how’s it going? How’s the family? How’s your daughter? How are things? Are you enjoying your work here? What kinds of things are driving you nuts? Are there things I can do less of or more of to help with that? And they’re doing that quite frequently, and I think those matter. I remember when I was a hospital transporter, I liked hearing that. Hey, the boss cares about what the heck I’m doing here and whether or not I’m enjoying myself and is actually asking my opinion, the lowly transporter, about how we can more efficiently deliver people in a wheelchair from point A to B. And that matters. That sounds pretty silly, but it’s actually a pretty effective way of keeping folks engaged because they value…people don’t leave the organization because of pay, they really don’t. You can look at statistics. They leave their managers, and they leave the environment that they’re in. And it’s important that as leaders in the organization—and HFMA is a big proponent of this—that you’re connecting on a different level that doesn’t have anything to do with the statistics that you’ve been tracking. Just, “How you doing? Hey, did you see the game?” Get tickets to the game. Do those things. Have an environment where folks feel like they’re valued. Everybody that’s in healthcare did not go there for the money. I guarantee it. Not even the docs these days. They went there from a service culture, service attitude, and I’m seeing that. From a monetary standpoint, I’ve seen some pretty innovative things too. I heard from a hospital out in Virginia. They looked at their career ladder and said, “Look, we’ve got all these vacancies. Hey, administration, could we take some of that money from the vacancies and put it in the pockets of the people that are staying here and carrying the load, those ones we’ve talked about?” So let’s offer a bonus incentive program where folks pick up overtime or another shift or maybe make the shifts 10 hour long instead of 8 and try to scatter that. Or ask the staff what type of staffing they want. I know—I’m gonna raise my hand—I’d love to work three days a week instead of five.

Grotto: Remote work has been a huge topic of discussion throughout the pandemic, in the healthcare industry and elsewhere. And whether any one organization embraces it almost doesn’t matter because so many others are willing to offer flexibility to job candidates. Not only that, according to Todd Nelson, healthcare workers now have the ability to jump to an industry not typically found in their geographic area. Hence, hospitals are competing for staff not only with each other but with all sorts of companies all over the world. 

Nelson: We’ve started to see a lot more competition as wages have gone up, which is a great thing, for wages to increase across the board. But if you have a choice between taking a higher paying job and staying at home, that maybe works for a company cross country or can be done remotely versus your commute, versus being in an office, all of those things we’ve started to see what were traditional office positions, many of them in the revenue cycle space or healthcare, move to other areas even outside of healthcare. And, you know, I haven’t even mentioned shortages of IT staff. We have a tremendous amount of demand for analytics and technical skills in healthcare with all of the information both clinical and business information—folks preparing, designing, implementing and analyzing all of that data and keeping it going. Well, again, we’re competing in healthcare with every IT company across the world. And so whether you have the ability to keep someone located at your health system or physician practice or hospital, to do that IT work has been very difficult. You could be living in the middle of Iowa but working for a company in California making California wages and living with the Iowa cost of living. And you know, that makes it hard for different organizations to compete.

Wiik: The remote workforce has been kind of a double-edged sword. It’s been wonderful to provide job flexibility and actually, studies show that people are more productive without having to come to kind of a brick-and-mortar place. You save commute time. You work when you’re available. You’re actually more productive at home because there’s already distractions and things, provided your teenager’s not bothering you. But it also became very, very competitive from a job market standpoint. So when you’re interviewing—and I’ve heard this from several revenue cycle leaders—you’re not interviewing for Boulder County or the state of Colorado or the state of Nebraska. Your job pool is now national, which is awesome. You’ve got way more candidates. But you’re also competing for that same pool. And many, many hospitals I’ve talked to, Erika, have said, “I am getting calls back saying, ‘What are your benefits? What type of shift would I have? What is my career path there?’” The employer is getting interviewed more than the employee about fit because they’ve got choices on where they want to work nationally in terms of shifts and things. So you’ve gotta be really creative as an organization to look at how you’re hiring, your relationship with your hiring managers and HR, what requirements are there. I’ve heard, you know, if you have a requirement saying you have to have a high school diploma—which is probably good for most things—but like a bachelor’s or a master’s degree, do they really have to have a bachelor’s or a master’s degree? Who are you excluding because of that? And then think about your equity and diversity efforts as well. Are you not hiring folks in different populations that may help more holisitically represent the workforce of your community because of those requirements? It’s a great time to kind of reevaluate all those things and hire and retain differently.

Grotto: Next week in Part 2 of our special series:

Nelson: Clinical people are a special, wonderful breed of folks that I’m always impressed with what they do and the level of compassion and care that they have to do it.

Grotto: Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Audio editing is by Linda Chandler. Brad Dennison is chief content executive. Our president and CEO is Joe Fifer. Thanks to our sponsor, Red Dot. Learn more about them at  


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