Annual Conference Day 1: HFMA, AHA leaders hold forth on the state of the healthcare industry

HFMA’s 2024 Annual Conference began Monday afternoon with HFMA’s Ann Jordan and the American Hospital Association’s Rick Pollack rallying attendees to address the profound challenges and opportunities facing the industry.

To start, Jordan, HFMA’s president and CEO, highlighted the conference theme, “A New Frontier in Health.”

Frontier is “an exciting and unsettling word that really represents a dichotomy — the limit or boundary to what is known, and beyond, which is the unknown or the wild,” Jordan said.

That scenario brings trepidation but also the potential for paradigm-changing advances. The healthcare industry is in just such a situation.

“The U.S. healthcare industry faces perils,” Jordan said. “We can’t ignore it. Most of us here today know that the U.S. spends far more per capita on healthcare than any other developed country, and yet it lags in life expectancy and other vital outcomes. We are confronted with a challenge to optimize care delivery practices, prioritize prevention and purge administrative waste from within the system to improve affordability.”

Solutions seem elusive because the challenges are so complex, Jordan added, involving lagging reimbursement rates, pressures on the workforce, health inequity, and administrative hindrances such as prior authorization, among other issues.

“Despite these perils, fear not, for there are opportunities in the new frontier,” Jordan said, noting the potential for substantial advancement in cost effectiveness and revenue cycle efficiency through AI and other technology.

Technological applications also can fuel a transition to value-based payment, a greater focus on prevention and wellness, and improvements in health equity, she said.

A trusted guide

HFMA, having nearly tripled its membership to more than 120,000 over the past five years, will continue to help members navigate their journey into the new frontier, Jordan said. That starts with continued and expanded opportunities for learning and education.

“The challenging landscape and growing competition for talent from other industries creates a need to upskill and power-skill our professionals and meet today’s demands to plan for the future,” she said.

Upcoming initiatives at the Association include a faculty-led institute with a curated portfolio to provide thought leadership “that is reflective of these dynamic times and the new risks and opportunities facing financial management professionals,” Jordan said.

HFMA also is determined to expand its influence to the wider healthcare industry. A prime example is an ongoing task force comprised of a diverse cross-section of industry leaders representing providers and groups such as employers, health plans and venture capitalists. Questions under consideration include how to attain value transformation within payment model design, risk-based business practices and fund solvency among stakeholders.

In a survey of task force members, 94% said the system is financially unsustainable.

Said Jordan, “As the association dedicated to the mission of advancing financial management in healthcare, and coming from a position of strength, as we are today, what is our response to the reality that the current healthcare system very likely is not financially sustainable? Do we deny it, ignore it, play victim, blame others for it, admire [the problem]?

“Or do we aspire to better understand the situation and try to solve it? And if HFMA fails to address financial sustainability in healthcare, then what stakeholder will take on that responsibility — and who will the effort aim to benefit? Who will ensure that our communities receive the return?”

HFMA’s role in tackling such questions will be to serve as a trusted convener. Jordan posited that “true leadership in healthcare [is] not accomplished by who at the table wields the biggest sword, but rather through the art of purposeful and solve-based convening of partnerships and collaborations striving to do better.”

Massive implications

At stake is not simply the effort to make the healthcare system more sustainable, but also the critical task of defining and measuring sustainability.

“There is a remarkable opportunity — and to many of us, it will be viewed as an obligation — to assure that addressing financial sustainability inherently implies consideration of how well the healthcare system satisfies its intended purpose: the purpose of delivering improved outcomes and whether those outcomes apply equitably to all,” Jordan said.

The issues to be settled are societal and existential.

“When we talk about financial sustainability in healthcare, the stakes for failure are high, because failure literally impedes human life and well-being,” Jordan said. “The calling to advance financial sustainability in our system is about more than healthcare, more than health. It ultimately speaks to the entire essence of living, to the human vitality in our communities.”

Jordan concluded her remarks with a call to action to attendees and HFMA members.

“Own the crisis, champion the cure,” she said. “Courageously embrace the opportunity to evolve and to lead for financial management, for financial sustainability, for health, for equity and for vitality.”

AHA’s Pollack describes what’s on the line for healthcare finance professionals and the industry

Finance professionals play a crucial role in allowing hospitals and health systems to create outcomes that “are often referred to as miracles,” said Pollack, the president and CEO of the American Hospital Association (AHA).

Pollack made his remarks after receiving HFMA’s Richard L. Clarke Board of Directors Award. He received the 2023 award, which is bestowed annually to an industry leader who makes a significant, positive contribution to the profession of finance or the financing of healthcare services. His acceptance speech was delayed by one year after he was unable to attend the 2023 Annual Conference due to a family matter.

Pollack expressed his appreciation for HFMA and healthcare finance executives in general, saying they thrive despite “operating in the goofiest business model we could have ever dreamed up.”

“Frankly, I don’t know how you do it, but you always get it done, and you are the glue that holds it all together,” he said. “All of this occurs against a backdrop where our healthcare system is suffering from multiple chronic conditions.”

A few examples are massive government underpayment, workforce shortages and mounting patient-access issues, Pollack said.

The importance of wielding influence

Policymakers in the government struggle to address such issues, he noted, putting more of an impetus on organizations such as the AHA to use their voices as an advocate.

“We obviously have to reject funding cuts and preserve policies that preserve access to care,” Pollack said. “We have to support and strengthen the workforce. We have to hold commercial insurance companies accountable for their practices that delay, deny and disrupt care, and we have to have a reasonable approach to bolster support, to enhance cybersecurity for the entire healthcare system, not just hospitals.”

The AHA has an online initiative that includes questions for stakeholders to pose to congressional candidates, including about issues like site-neutral payment, the 340B Drug Pricing Program, workforce constraints and administrative impediments such as prior authorization.

“If the candidates don’t know the answers, we can help educate them,” Pollack said. “And just think about it: If all of you, not to mention your colleagues and our entire field, ask these questions, we could create an echo chamber to get our issues on the radar screen, and it can create a political environment that is more sympathetic to our concerns.”

In addition to political obstacles, the healthcare industry is coping with “motivated adversaries who are seeking to undermine public trust and confidence in hospitals and health systems to advance their own advocacy agenda and their position in the marketplace,” Pollack said. Those entities are pushing agenda items such as site-neutral payment, 340B reductions, staffing ratios and price restraints.

“Not only must we push back against these efforts of corporate insurance companies, drug companies and anti-hospital billionaires, we also have to focus on telling the positive story about all the heroic things you do day in and day out,” Pollack said.

Exciting times ahead

As Jordan did, Pollack focused on the word frontier, saying providers will chart different frontiers depending on their circumstances.

“Some of us will focus on forms of value-based payment or shared savings models that achieve better care at lower costs, no matter how you define those terms in terms of value-based payment,” he said. “Some of us will focus exclusively on treatment, with special attention to sophisticated diagnostics, therapies and surgeries, and developing centers of excellence. Some of us will focus on taking responsibility for managing the total cost of care for an attributed population and providing them with services across the continuum.

“Some of us may do all of the above. Some of us will chart new pathways where we’re only limited by our imagination.”

HFMA and the AHA will work to help providers succeed in the path they carve. The opportunity is particularly enticing — albeit daunting — with respect to taking on risk for the total cost of care for an attributed population because such an approach can solve many of the most frustrating financial and administrative aspects of the healthcare system, Pollack said.

“Working together, we could meet these challenges and make this vision a reality,” he said. “Working together, we can improve the patient care experience in a manner that can potentially benefit our children, our children’s children and many generations to come.”

17 organizations receive the 2024 MAP Award for revenue cycle performance

HFMA also began Annual Conference by honoring the 2024 winners of the MAP Award for High Performance in Revenue Cycle, including integrated delivery systems, hospital systems, individual hospitals, critical access hospitals and physician practices.

The award recognizes providers that have excelled in meeting industry-standard revenue cycle benchmarks (MAP Keys), implemented the patient-centered recommendations and best practices embodied in HFMA’s Healthcare Dollars & Sense initiative, focused their efforts on improving price transparency, and achieved outstanding patient satisfaction. Award recipients are acknowledged as industry leaders and share proven strategies with their colleagues.

“These organizations have demonstrated their commitment to putting patients first when it comes to their billing and payment practices,” Jordan said in a news release. “Congratulations to all of the 2024 MAP Award winners for serving as role models for the field.”

The winners are:

Integrated delivery systems (4): Baylor Scott & White Health, Dallas; Geisinger Health System, Danville, Pa.; Intermountain Health — Peaks Region, Broomfield, Colo.; University of Texas Medical Branch, Galveston, Texas.

Hospital systems (5): Ballad Health, Johnson City, Tenn.; Covenant Health, Andover, Mass.; Roper St. Francis Healthcare, Charleston, S.C.; ThedaCare, Inc., Neenah, Wis.; Union Health System, Terre Haute, Ind.

Individual hospitals (3): AnMed, Anderson, S.C.; Mercy Medical Center Merced (Calif.); The University of Texas MD Anderson Cancer Center, Houston.

Critical access hospitals (2): Mercy Medical Center-Mt. Shasta (Calif.); Ozark Health Medical Center, Clinton, Ark.

Physician practices (3): Alo/Avance Care, Durham, N.C.; ENT and Allergy Associates LLP, Tarrytown, N.Y.; Privia Medical Group, Arlington, Va.