Sleepless in the C-suite: Workforce, Part 3

Erika Grotto: The path to better communication among healthcare staff and leaders, today on HFMA’s Voices in Healthcare Finance podcast, sponsored by Red Dot. Hello, and welcome to the podcast. I’m Erika Grotto. Today we wrap up our three-episode series on the healthcare workforce. I’m getting over a cold and my voice is a little off, which is unfortunate but maybe just the right thing for an episode about obstacles to communication. Today, we’re discussing issues honey and lemon tea can’t solve and finding ways for staff and leaders to work toward common goals. 

Stu Schaff is founder and principal of Intentionate Healthcare Advisors. His work is very physician-focused, so although there is some overlap with other types of work in healthcare, his comments are about physician work specifically. And there’s actually one pretty stark difference between physicians and other types of healthcare workers: The expectations put forward by their employers. 

Stu Schaff: This is a problem that goes both ways when you’re talking about physicians and employers of physicians. And it really starts all the way back at recruitment. What I mean is that the employer is generally not saying, “Here’s what you need to do in your job.” Like, we—average non-physician folks—would have job description, would have SOPs, standard operating procedures, other things like that. We don’t do that really for physicians in the same way. What we do instead is we say, “You’re a doctor. You know how to doctor. I’m not going to tell you how to doctor.” Right? And physicians, for their part, are not really saying, “This is what I expect out of my job. This is what I need out of my job.” A lot of them have medical debt or other things that they’re worried about coming into a new position, and they’re so worried that they’re going to lose the opportunity they’re afraid of speaking up. I’ve heard this from multiple physicians. So what we have is a situation where each of the parties is speaking different languages in their own heads.

Grotto: Another issue Schaff says is difficult to untangle is compensation. He says physician compensation can be hard to understand, even for physicians. 

Schaff: There isn’t really education around the topics around business and finance for physicians and finance in medical school or in training. And another thing is that as an industry, we’ve found that the easiest way to address a problem is to try and build a better mousetrap. In this case—and I’m doing air quotes—better compensation. But the reality is, we’re missing out on the more challenging but more meaningful way to address an issue, which are typically going to not be about handing more money to that physician. It’s going to be about adding better infrastructure, adding another MA to that clinic, finding more space for them to see patients, working with them to overcome whatever challenges that they’re facing. That’s more challenging, and so what we’ve done instead is said, “OK, well, I have this particular issue. How can I bolt something on to the compensation model to maybe address this particular issue?” And all these bolt-ons kind of stack up. There’s all these unintended consequences, and you have a situation, ultimately, for a lot of organizations, where you have a complicated model. Most of the physicians, if you sat down and asked them, “How do you get paid?” couldn’t give you a real, straight, correct answer about that. And the ones maybe who could are very few. You just have a lot of confusion and a lot of dissatisfaction around that.

Grotto: Todd Nelson, HFMA’s Chief Partnership Officer, who we heard from in the first two parts of this series, agrees. He says understanding job duties, compensation, and how what a person does fits into the organization is all critical. 

Todd Nelson: Having clarity of role and purpose and the duties that you need to perform your job successfully is, you know—I can’t underestimate the importance of that. So whether you’re a physician or a nurse or an accountant or a biller in revenue cycle, understanding your piece of the overall puzzle and how you fit in there is important. What are the duties that you need to perform to be successful? And then, when you perform them successfully, is there a reward for doing that? And if so, what is the clearly articulated reward for that? And I don’t know that many people understand the entire picture of that. They might understand, you know, the job duties and the job description. So they get that piece. But they don’t know, necessarily, how are they going to be compensated by doing those specific things. Or they may know very clearly what they get compensated for, but that might not align exactly with the duties they’ve been asked to do. And so I think that clarity of purpose and how it ties to compensation and how it fits in the bigger picture of the organization and what is needed is very important.

Grotto: Vicki Abelson is an executive coach with The Defined Leader and was previously a rev cycle leader in physician groups. She says departmental goals and how they fit in with the goals of the organization is another area that can be murky, especially in revenue cycle. 

Abelson: The organization might have, you know, one set of goals, but revenue cycle organizations oftentimes have different sets of goals. And revenue cycle employees don’t often know what it is they’re working toward. It can be really hard to show up every day and work really, really hard if you don’t know what your why is, if you don’t know what the organization is moving toward. Non-clinical employees, it’s really important for them to know, are we working toward a specific budget number, are we working toward a specific number of cases coded. Whatever it is, they need to understand what they’re working toward and why, just like anybody else.

Grotto: Schaff said untangling duties and compensation have to begin in the recruitment stage. 

Schaff: I heard a recruitment expert talk about this in a way recently that I think is really helpful to keep in mind. So there are primarily four things that are going to draw a physician to a particular practice, whether it’s a hospital practice, an independent practice, or whatever. There’s the quality of the practice. There is the quality of life that that physician is going to have while they’re working in that job. There’s where the practice is located, and there’s the financial aspects, compensation. And you can’t change where you are. You can’t change your geography. You can’t change what life is going to be like living there. That’s just bigger than any practice manager or hospital CEO even is going to be able to take on, unfortunately. The ones you really can control is the quality of the practice and the financial aspects. So it’s what it’s going to be like to work there and what we’re going to get out of it. So what it’s going to be like to work there is those things that I was talking about earlier. It’s the level of support that they’re going to get from other staff. It’s the IT systems that they’re going to have to work with and how much those are roadblock versus a helpful tool. There’s things around throughput, whether it’s exam rooms or ORs or tests. Relationships with other providers, how that’s facilitated. Reducing administrative burden. And so on.

Grotto: As for physician compensation, Schaff said there are three words to keep in mind: clear, competitive and fair. 

Schaff: I didn’t say sophisticated. I didn’t say complicated. And I didn’t say, like, absolutely the highest paid in the market. That’s not always the most important thing to folks. It’s really, again, that pay is clear, that pay is competitive, and that it’s fair.

Grotto: Again, Schaff was talking about physicians specifically, but according to Abelson, all of that can apply to other areas of healthcare.  

Abelson: When I talk to people in lots of different industries, oftentimes money is the last factor that they consider when evaluating jobs. They’re considering things like work-life balance, advancement opportunity, education, PTO, other kinds of benefits. And so I really like to challenge employers to think about, what are some of those other things? Is there an opportunity to be flexible with employees in terms of where and when they work? Are there opportunities to provide them extra training, whether it is in hard skills—systems, coding, processes—or perhaps soft skills in leadership, in resilience, in communication, in change management. That’s a really big one recently as well. Are there ways to provide maybe advancement opportunities or special projects? Are there ways to offer more PTO or other kinds of incentives that will allow people to feel valued, heard, understood?

Grotto: We’ll talk about how to make people feel valued, heard and understood in a minute, after a brief sponsor break. 

Let’s take a minute now to get a word from our sponsor. Welcome back, Michael Bumann, CEO of Red Dot.

Michael Bumann: Thank you, Erika.

Grotto: We’ve been talking a lot about workforce efficiency and job satisfaction. But I know what the leaders are going to be asking about working with Red Dot. They’re going to ask, “What does that mean for my bottom line?”

Bumann: Erika, you’re right. That’s one of the key components to our platform. The answer we provide is, day one, the first acquisition that we do, is to clean up two and a half years of these aged accounts. And remember, they take years to resolve, so every hospital has significant amount of revenue locked into these really old accounts. So we come in. We clean up the first two and a half years, and then as we move forward into forward flow, dealing with new accounts daily, what I like to tell CFOs is this: You’re going to see the largest amount of bottom-line revenue working with Red Dot in your first year, because during that first year, we’re actually resolving about three years worth of accounts.

Grotto: And as we talked about in a previous segment, what you’re doing is taking these very complex claims away from the rev cycle staff, giving them an opportunity to work other claims, making them more efficient. So what does that do to the bottom line?

Bumann: Well, naturally, it’s going to improve it. Not only are they receiving a bolus of cash from us in the acquisition, but then they’re able to focus more efforts on their higher margin accounts. So it’s really a double win. One, you’ve got immediate cash from us, and two, you’re improving your overall collections because they’re not spending all the time necessary to resolve the complex motor vehicle accident claims. So they become more efficient with the time they’re spending, and that results in higher account resolutions, which of course flows directly down to bottom-line revenue.

Grotto: Thank you for joining me once again, Michael.

Bumann: It’s always a pleasure, Erika. I really appreciate your time.

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 reddotmgmt.com.

FinThrive vice president Jonathan Wiik mentioned in the first episode of this series that stay interviews are important in addressing staff retention. With physicians in particular, Schaff recommends those stay interviews start right away. 

Schaff: The best thing you could do is ask them what will help them. Ask them regularly, show them that they’re being heard. You’re not making promises. You’re not saying we’re going to do exactly what you tell us to do. But you’re listening to them. You’re showing them that they’re being heard. And you’re continually having this dialog. An open and honest dialog, although it’s challenging for a lot of people, ends up creating a better work environment that physicians are going to want to be in, and it needs to start at the very beginning. Within, say, 30 days of a physician starting, they should have a stay interview. It should be a structured way of continually checking in with them and making the time and space to sit down together and talk about what’s going well and maybe what needs to be improved. That’s the best way to find out what they need, the most direct.

Grotto: Workload balance can be an important piece of the puzzle, and Abelson said good leaders will be looking for imbalances and ways to correct them. 

Abelson: It’s so easy for our top employees to get, you know, all of the work and for our employees that are struggling maybe to not get as much work. And so it’s really easy in a group of people to have some people that are not working quite as much while another person is completely, completely drowning. And to think about, how do we better balance the work within our teams, within our organizations. Revenue cycle shops tend to be incredibly siloed, so if you’re a surgical coder, if you’re a surgical pre-cert person, you’re only going to do this one thing, and it’s going to be really hard for you to go do oncology or do primary care or whatever. So how can we think about cross training. How can we think about workload balance in such a way that allows everybody to be able to learn something new and also carry the weight.

Grotto: Another thing to remember is that nothing we’re discussing happens in a vacuum. Leaders, too, are experiencing stress and burnout. Trying to balance a growing workload with a shrinking staff can be difficult, so finding time for real conversations can be a big challenge. But the alternative isn’t always the best path, according to Schaff. 

Schaff: It’s not easy to have an open conversation with someone when you’re not used to doing it. What I’ve found in talking with hundreds of hospital administrators, medical group administrators and hundreds of physicians in the last several years, is that everybody has the things that they’re worried about, and those weigh on them, whether it’s in work that they’re doing from a day-to-day basis, the things that are happening outside of work, families, friends or whatever it may be. Everybody has a lot on their shoulders, and they’re trying to do the best work that they possibly can with the resources they have in the time that they have available. And that’s a lot for anybody to take on. Now, add on the complexity of the healthcare industry in general. It just creates a situation where it becomes extremely difficult to imagine reaching deeper, finding more time, more space for these important conversations and as a result of that, we just go for what’s easy, for what feels easy. And that’s the thing like, OK, well, let’s give another bonus for doing X. Let’s give a retention check of $X. Instead of going in and solving the underlying problem. I think that’s why it’s just human nature to look for the path of least resistance, even if that path is going to drive the most meaningful long-term change. And look, there’s nothing wrong with a quick win, but you can’t stop there.

Grotto: For Abelson, it kind of comes down to the old adage about eating an elephant one bite at a time. 

Abelson: It becomes incumbent upon our leaders to really understand they’re the domino that needs to fall first in order for the employees to feel supported, in order for their employees to feel like they’re understood or appreciated. So if it’s unclear expectations, great, what can we do today to help them clear up their expectations, help them understand what they’re going for. So the first thing I would recommend is to understand what is your team member’s overall—and everybody might have slightly different things—but overall, what is their primary driver, what is the thing that makes them the most frustrated on Monday morning when they wake up in order to go to work, and start chipping away at that answer. The other thing too is, we put a lot of focus on the leader to solve the problem, but I would really encourage for us to think about this as a co-creation. So the leader, the team members, the employees, and the organizations to come together and come up with a solution together. None of us is perfect. None of us is going to have like the one perfect idea that’s going to solve all the problems. But I can guarantee you that when those three groups of people come together, they’re going to be able to come up with a solution that’s going to be better than what they have today.

Grotto: Stu Schaff recommends that leaders become more deliberate in their communications strategies. 

Schaff: I have a challenge for every healthcare finance leader and every healthcare operations leader, and that’s to carve some time—half an hour, 45 minutes, maybe an hour if you can afford it—out of every day and say, “This is the time that I get out and I talk with my people and I figure out what is going well, what could be improved, not making any particular promises, but I’m going to be accountable to them because I’m asking them to be accountable to me as well.” And I would be willing to bet that organizations that take me up on that challenge will find that finding their short-term wins when something is pointed out to them that somebody was too afraid to say for one reason or another, didn’t feel like it was appropriate or they didn’t think to because nobody asked, but they’re also going to find opportunities for meaningful long-term change. And yes, sometimes it involves investment of money, and sometimes that can be significant. But I find that there is an ROI in word dealing with this at a time when the labor market is really just in a crazy place. I don’t have a better way to put it than that. And I’ve been told by healthcare leaders that they don’t know what to do. They just don’t know what other solutions that they have. And the most valuable asset that you have is your time, so why don’t we use that asset to protect our organization’s ability to recruit and retain great people, which ultimately are really the lifeblood of our organizations.

Abelson: Don’t be afraid to be wrong. If you try one thing, if you try, perhaps, a daily huddle that tells people what their daily goals are, but people, “I don’t know. This is not really working for me,” then throw it out and try something new. But communicate proactively and say, “This is what we’re doing to try and solve this problem. If it’s working, great, we’re going to keep doing it. If it’s not working, we’re going to try something else. We’re going to try doing something else.” And at the same time, we have to stay accountable to what our organizational goals are, what our deliverables are, so we can keep moving in the right direction.

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 reddotmgmt.com.