Tammie Jackson: I never wanted to make this my platform. This isn’t what I wanted to do. But I also think when my 26-year-old son is asking me questions about accountability and how do we explain broader context around behaviors and things like that, I almost felt there was no way to go through this year and pretend it wasn’t going on.
Erika Grotto: Parting words from outgoing Board of Directors Chair Tammie Jackson, today on HFMA’s Voices in Healthcare Finance podcast.
Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today’s interview is a first on the podcast: a conversation with a sitting Board Chair. Tammie Jackson was kind enough to sit down with me recently to reflect on her unique year. But before we get to that conversation, let’s check in on the latest healthcare finance news. Here’s HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack.
Nick Hut: Hello, everybody. A couple of episodes ago, Shawn and I talked about the proposed rule for the Inpatient Prospective Payment System for FY23 and how the general consensus is that it’s inadequate in terms of allowing hospitals to respond to the inflationary trends we’ve been seeing in recent months. Shawn, you talk to providers all the time. What are they up against here?
Shawn Stack: Yeah, Nick. So I think now that comment season is well underway and people are working on their comment letters back to CMS in regards to the IPPS proposals, the 3.2 market basket increase after taking out, as we talked last time, the payment cut of 8%, the outlier payment adjustment that people are exploring very heavily right now, that came out at 1.8%. A lot of those outlier payment adjustments, we believe, and we’re mining the data now, is mostly because of the public health emergency and those outliers were paid at such a high rate because of those extended stays. We’re still seeing day increases across our inpatient stays. So as we analyze those proposals and say hey, you know, this is true right now, but won’t this correct itself in the future, what’s that going to do to covering hospital costs long term. So there’s a lot that folks are really working diligently right now to unpack, to see if some of these proposals that CMS is making is due to temporary influxes in charges and lengths of stay and what that’s going to do if they implement all these changes all at once without gradually phasing them in as the data and as the claims stabilize. So that’s going to be very interesting. And I know you’ve been watching and reading about labor expenses and some supply expenses that hospitals are up against. What are you setting there, Nick?
Hut: No doubt. Yeah, there’s a lot of data that illustrates the impact of inflation over the last year or couple of years. And with respect to labor, Kaufman Hall just put out a special report showing a 37% spike in labor costs between the pre-pandemic era—in other words, 2019—and March of 2022. Now, a lot of that has to do with contractors and pay rates, which are starting to come down quite a bit just in the last month or so. But that obviously can’t negate all the expenses that hospitals have had to sell out during the pandemic to date, and plus it’s not hard to envision infection rates coming back up. The Biden Administration says 100 million people could be infected with COVID-19 this fall and winter and then it follows that hospitalizations could surge and then demand for nurses could once again far outpace the supply. So it’s a shaky situation for a lot of hospitals right now.
Stack: Yeah, I would agree, Nick, and some of the labor costs are really unbalanced. I mean, I’m hearing from providers, hospital systems in Indiana having to pay those San Francisco labor rates because they’re losing their folks because so many people that aren’t in clinical care can now work across the country in San Francisco and live in Indiana. Indiana hospitals are losing their finance staff to jobs in San Francisco because those folks can work remote and they can’t pay those rates that San Francisco providers are paying. So it’s almost like a global labor market rate rather than regional to reflect the cost of living in each area, right? That’s something else hospitals are battling—some hospitals are battling.
Hut: Absolutely, yes. Totally new world as far as recruitment and retention. What about in the area of drug costs? What are you seeing there?
Stack: Drug costs right now, it looks like, have gone up about 28% across the board as an average. So that, of course, is digging into hospitals’ inpatient rates, you know, higher costs there on those expenses. And the medical supply expenses are up a little over 20% in comparison to 2019. So hospitals are really seeing a lot of increases there in the stable supplies that are needed for inpatient and outpatient care and DRG payments or case rate payments are just not keeping up with this elevated expense.
Hut: Yes, so there’s so many pressures right now to such a challenging time. Well, thanks for the knowledge, Shawn, as always, and we’ll be keeping everybody up to date on all these really important trends at hfma.org/news.
Grotto: Tammie Jackson has had a unique experience as Chair of HFMA’s Board of Directors since before her term even began. Originally slated to take the role in 2020, she’d chosen a theme, as all Chairs do, and she was gearing up to get started when the COVID-19 pandemic changed everything. The decision was made to retain 2019-2020 Chair Mike Allen for an additional year, and as that year passed, Jackson reflected on her message, ultimately deciding that what she’d planned didn’t fit anymore. So she chose a new theme: Bolder, Brighter, Better. And during her term, which began in June 2021, she’s been speaking on that theme at HFMA events across the country. I really wanted to know how that message had been received and what it’s really like to serve as HFMA Chair, so I was thrilled when Jackson, the Chief Growth Officer at nThrive, sat down with me to tell the story.
I want to talk about your theme a little bit: Bolder, Brighter, Better. Can you explain, for anyone who might not have gotten a chance to hear you speak—I don’t know that there’s too many people left in HFMA who haven’t—but what’s your sort of elevator pitch on that theme? What has your message been?
Jackson: My message has been that it is altogether an acknowledgement of the journey that we have been on, paying homage to that journey because it has been tough and we have persevered and excelled in many cases, while at the same time creating a call to action in light of what we have been learning about ourselves. And so as I talk about the theme, that’s the very abridged and short version. As I talk about the theme, we talk about these pivots in time, right, these periods of time that serve as qualifiers for everything else that happens as either before or after. And so when you think about—and I talk in what I deliver to the chapters—it’s World War II, the assassination of JFK, certainly 9/11—all of those events, they include not only the toll that was paid that culminates in the event itself but it also includes all of these positive things that happen afterward. So I think that was the call to action for our Association—how will we be made bolder, brighter and better as a result. And what we have been through as a result, what we have learned about ourselves, and it’s not only about who we were before as an industry, whether that be changes that we’ve made in the revenue cycle, in how we deliver care, all of that, but also who we are as a society. We learned a lot about ourselves in the last 24 months on how we behave and treat one another. And then who we are as an Association. And so that’s been the crux of it all and really challenging people to think about what will their “after” narrative look like. What are those things that they want to change, those things that we want to pull through to forge a brighter and better path forward.
Grotto: Initially, you had some pushback on your message from some members. What was that like? Did that surprise you? What was your response to that? And where are you now with it?
Jackson: First of all, I have had a ton, a ton of positive feedback. And I think the message has touched people in a way that did surprise me. I didn’t expect a lot of the positive stuff that I have gotten, and I don’t know why that is, but I think much like what I talk about in my speech around microagressions and implicit biases, it’s the negative stuff that kind of sits in the back of your mind, and that’s kind of the noise that sometimes speaks louder than all of the other positive stuff that I’ve heard. What I’ve learned is, not everybody was in a place where they were able to receive it. And my message was really about health equity and inclusion because inclusion helps to foster health equity, and it’s simply the right thing to do. But I think the packaging of the messenger, which is me, which is a person of color, prevented many people from hearing the entire message, and it disallowed them from being able to focus on the broader message, and they weren’t able to get past some of the pieces of my message. And so I was surprised by that. That surprised me.
Grotto: What do you want members to be left with when they look back on this year?
Jackson: What I’ve come to realize over these last several months, it’s interesting, when you reflect back on the summer of 2020, which was incredibly tumultuous relative to our society. I was thinking about that, and all of the social riots that we were seeing with all of that. I think that there was a really high interest and sensitivity around engaging in meaningful conversations about inclusion and so forth. And over the year, my short year, I’ve seen that interest wane. And I think that maybe there’s a bit of a fatigue there around the topic of diversity, equity and inclusion, which again, if we’re doing well in that, it will foster health equity. It’s important. It really, really is important. And I think that I would encourage people to do their best to remove the emotion and just look at the data, because data is not emotional. And the data is there that marginalized cohorts do experience health and healthcare differently. They have tremendously different outcomes. It’s also true, the data is there, that inclusive workplaces, inclusive environments produce better results. They have better ROIs, they have higher retention, all of that. So it’s not only a good business decision, but it’s also the right thing to do. And I would want people to reflect on, it’s not OK, it shouldn’t be OK that social determinants of health should produce such great social risk and that manifests itself, that risk does, in such inequitable ways. I don’t think we should be OK with that, and I don’t think we should pretend that we don’t know that this is happening.
Grotto: I really want to talk about health equity, so you’ve provided a good transition here. In your column in hfm throughout the year—and I will post some links in the show notes for anyone who wants to go back and re-read, you’ve highlighted some challenges, you’ve talked about some wins, but we have a long, long, long history of inequity and a very long way to go. So realistically, what would you like to see happen in the next 5-10 years to get us on a better path to health equity and just maybe equity in general?
Jackson: I think that first, people have to be willing and vulnerable enough to be honest and have honest conversations about where they’re at. And I think the way to do that, again, going back to data, you have to collect the data. You have to be able to understand how your programs, how your processes—are your programs being consumed in equitable ways, do your processes, are they able to be experienced by different social demographics, socioeconomic classes in the same way, and you have to measure those results. And I think, you know, the next 5 or 10 years, we’ve gotta collect that data and then we have to be able to shift the dollars away. It has to go upstream. So we have to be able to shift the investment around health and healthcare, and we have to invest that further upstream. And this is not only of paramount concern to us as healthcare professionals. It’s of paramount concern to us as a society. We cannot sustain the kind of growth in healthcare spend that we’ve been experiencing over the last decades. So this is an ongoing problem, and as a citizen of this country, it should concern us that we’re spending 20% of our GDP on healthcare. And the more money we spend—and it’s growing—the less money we’re going to have for other things that are important to us all as a society—infrastructure, military, all of that. There’s only enough money to go around, and we have to think about what resources we need to be investing in. It’s a big problem, not only for us as healthcare finance professionals but also for us as citizens of these United States.
Grotto: As you were talking, I was thinking about a couple of things. I had an episode back in September with Dr. Rumay Alexander from UNC Chapel Hill. She’s a nurse leader, she’s a professor of nursing, but she’s also worked in DEI initiatives and things. So she had a really interesting perspective on healthcare and society in general. One of the things that Dr. Alexander talked about in our conversation—we talked about positions like director of diversity or, you know, Chief DEI Officer, or whatever the job title is, but just a DEI leader in an organization. And she was talking about choosing that person based on their experience and their qualifications and ensuring that this is something that this person is prepared to do. Being a woman of color, what has that been like for you? Were you ready for that experience?
Jackson: I’ve always been good at navigating different rooms. And being a woman of color, I’m quite comfortable and familiar with being the “only.” So I’m oftentimes the only. But what this process, what this last period of time has done is, I can’t just do that and be quiet about it. It has pushed me to acknowledge things that personally I was not ready to, so maybe that’s getting to your question. I didn’t want to, and I even said to the Chapters at leadership training last year, I never wanted to make this my platform. This isn’t what I wanted to do. But I also think when my 26-year-old son is asking me questions about accountability and having me explain broader context around behaviors and things like that, there was no way to go through this year and pretend it wasn’t going on. It’s going on. I couldn’t just make believe that that wasn’t going on and not talk about it. It was relevant to the times. I don’t know that I would have told you I was ready for that in 2019. I would have said no. But I sure got ready. And I think the health equity speaks to a lot of the work that I had done prior. I’m very passionate about value-based care. And even some of the data that I uncovered in my research, getting ready for the year was really stuff I didn’t even know, like decades-long research into inequities amongst American Indians and disabled and LBGTQ, so not only people of color, but so many other marginalized cohorts as well. So that’s been important for me to leave with the Chapters.
Grotto: This has been such a great conversation. You’re welcome back on the podcast anytime, whether you are Chair or not. But Tammie Jackson, thank you so much for joining me.
Jackson: And thank you. And I would say I am a huge fan. I think you do incredible work, so keep it up. I am your biggest campaigner on the road, so I always ask everyone to raise their hand, how many people listen to the podcast. So you should hopefully see huge increases in your subscribers because I see people on their phone when I mention it. I really do. I think you’re doing important work. So thank you for having me. It’s been a real pleasure, and I’ve enjoyed our conversation.
Grotto: Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is the director of content strategy. Our president and CEO is Joe Fifer. If you haven’t made your plans to attend our Annual Conference in Denver next month, you still can. Visit hfma.org for details. And if you’d like to talk with us, reach out to our podcast team. You can email us at firstname.lastname@example.org.
This is gonna be what gets me on Dateline.