Becker’s Healthcare Podcast: Conversation with David Dunkle, CEO, Johnson Memorial Health
Date: January 6, 2026
Host: Will Riley (Becker's Healthcare)
Guest: David Dunkle (CEO, Johnson Memorial Health)
Episode Overview
This episode features Dr. David Dunkle, the CEO of Johnson Memorial Health, a single-hospital system just south of Indianapolis. The discussion focuses on the challenges and realities of running a small, community-focused, independent hospital amid difficult payer mixes, legislative pressure, and technology advancements like AI. Dr. Dunkle offers candid insights into financial concerns, the promise and limitations of technology, payer relationships, and the importance of keeping patients and staff at the center of healthcare work.
Key Discussion Points & Insights
1. Background and Hospital Overview
[00:56 - 02:09]
- Dr. Dunkle shares his journey from 18 years as a family physician in his hometown to CEO.
- Johnson Memorial Health is a one-hospital system with approximately 900 employees and $120 million net patient revenue.
- The hospital emphasizes patient safety and quality, striving to excel beyond the "band-aid station" stereotype often held against county hospitals.
- “We're CMS five star organization though it's embargoed...We always put, you know, we say everything we do is put the patient first. We mean it because when you're a community hospital, that's what you have to do.”
(Dunkle, 01:45)
- “We're CMS five star organization though it's embargoed...We always put, you know, we say everything we do is put the patient first. We mean it because when you're a community hospital, that's what you have to do.”
2. Community and Payer Mix Realities
[02:09 - 04:04]
- The hospital serves a mix of suburban and rural populations—some patients may only come to town annually, highlighting access issues.
- Payer mix is heavily tilted toward government programs: 70% of Johnson Memorial’s patients are Medicare/Medicaid.
- “70% of our business, we're losing money, you know, and, you know, and that puts more pressure on that 30%, the commercial payers.”
(Dunkle, 02:53)
- “70% of our business, we're losing money, you know, and, you know, and that puts more pressure on that 30%, the commercial payers.”
- Medicaid in Indiana covers only 57 cents on the dollar; Medicare is about 82 cents—making margins extremely tight.
3. Mounting Financial and Legislative Pressures
[04:04 - 05:03]
- With Medicaid enrollment restrictions tightening, more uninsured patients are showing up in the ER, resulting in increased charity care.
- Delayed care among uninsured patients often leads to more serious (and costly) conditions by the time they seek help.
4. AI and Technology Adoption in Healthcare
[05:03 - 07:37]
- Unlike past technology, AI draws more enthusiasm due to potential for cost savings and reducing errors—particularly in rev cycle and denials management.
- “AI works 24/7, it works on weekends, it doesn't take vacation, it doesn't get sick. And so long term that can pay off.”
(Dunkle, 05:58)
- “AI works 24/7, it works on weekends, it doesn't take vacation, it doesn't get sick. And so long term that can pay off.”
- Despite optimism, smaller hospitals like Johnson Memorial must carefully vet and trust technology partners, because every investment must pay off.
- “It's a lot of pressure when every hit has to be a home run...You have to trust your partners and trust that things have been properly vetted.”
(Dunkle, 07:50)
- “It's a lot of pressure when every hit has to be a home run...You have to trust your partners and trust that things have been properly vetted.”
- There’s enthusiasm for technologies like ambient listening, but implementation costs and user education are critical.
5. Challenges with Commercial Payers & Reimbursement
[09:02 - 12:44]
- Commercial contracts are hard to optimize, with Dr. Dunkle describing problematic denial practices by payers.
- “It's just egregious when you know, you have an inpatient stay and they ask for the same chart notes eight times...I just don't understand how we have to fight so hard to get paid for the care that we've already delivered.”
(Dunkle, 09:26)
- “It's just egregious when you know, you have an inpatient stay and they ask for the same chart notes eight times...I just don't understand how we have to fight so hard to get paid for the care that we've already delivered.”
- Small hospitals face unfair payment disparities even when quality is superior:
- “You can come to me and say you need procedure X...You can go to another hospital...Cms, two star bad safety scores, same procedure, same everything. They get X plus something. They're getting paid more.”
(Dunkle, 11:08)
- “You can come to me and say you need procedure X...You can go to another hospital...Cms, two star bad safety scores, same procedure, same everything. They get X plus something. They're getting paid more.”
- Dr. Dunkle critiques the monopoly power of large payers and systems, highlighting systemic misalignment between patient care and shareholder profits.
- “If you are a leader at a payer, you're fiduciary responsible responsibilities to maximize profit for your shareholders. My responsibilities take care of patients. That is misalignment.”
(Dunkle, 12:26)
- “If you are a leader at a payer, you're fiduciary responsible responsibilities to maximize profit for your shareholders. My responsibilities take care of patients. That is misalignment.”
6. The Real Promise—and Limitations—of Technology in Revenue Cycle
[12:57 - 14:47]
- Technology enables “perfect” insurance claims, but payers change rules and can still deny reimbursements arbitrarily.
- “You can get a perfect claim. It doesn't mean the perfect claim is going to be reimbursed. That is the issue.”
(Dunkle, 13:19)
- “You can get a perfect claim. It doesn't mean the perfect claim is going to be reimbursed. That is the issue.”
- Dr. Dunkle argues payers should be penalized for wrongly denying perfect claims—suggesting technology can help, but regulatory fixes are needed to change incentives.
7. Leadership & Team Culture in Challenging Times
[14:47 - 15:42]
- Staying patient-focused and fostering a strong culture helps staff persevere, even when external conditions are tough.
- “When you stay focused on the patient and the rest is noise, right? That's why are we in healthcare... As long as you keep that the forefront...the culture will be there.”
(Dunkle, 15:21)
- “When you stay focused on the patient and the rest is noise, right? That's why are we in healthcare... As long as you keep that the forefront...the culture will be there.”
Notable Quotes & Memorable Moments
-
On Quality and Community Mission:
“We always put, you know, we say everything we do is put the patient first. We mean it because when you're a community hospital, that's what you have to do.”
(Dunkle, 01:45) -
On Financial Pressures:
“70% of our business, we're losing money, you know...that puts more pressure on that 30%, the commercial payers.”
(Dunkle, 02:53) -
On AI’s Potential and Limitations:
“AI works 24/7, it works on weekends, it doesn't take vacation, it doesn't get sick.”
(Dunkle, 05:58) -
On the Impossibility of Mistakes:
“It's a lot of pressure when every hit has to be a home run.”
(Dunkle, 07:52) -
On Misaligned Incentives:
“If you are a leader at a payer, you're fiduciary responsible responsibilities to maximize profit for your shareholders. My responsibilities take care of patients. That is misalignment.”
(Dunkle, 12:26) -
On Leadership and Motivation:
“When you stay focused on the patient and the rest is noise...As long as you keep that the forefront...the culture will be there.”
(Dunkle, 15:21)
Timestamps for Important Segments
- 00:56 – Dr. Dunkle’s background and Johnson Memorial Health overview
- 02:15 – Community profile and payer mix details
- 04:04 – Effects of Medicaid changes and exposure to uninsured care
- 05:46 – AI adoption, costs, and clinical uses
- 07:50 – Decision-making on technology investments in a small hospital
- 09:19 – Revenue cycle hurdles and payer frustrations
- 11:08 – Payment disparities unrelated to quality
- 12:26 – Insight on payer/hospital misalignments
- 13:19 – Limits of technology for overcoming payer denials
- 15:00 – Keeping teams motivated in a tough environment
Summary
Dr. David Dunkle’s conversation sheds light on the complexity and adversity small community hospitals face—from razor-thin margins to systemic inequities with payers. Yet, his optimism for technology—when responsibly adopted—and belief in a patient-centered culture stand out. Hopes for legislative remedies and balanced payer relationships underscore the unresolved challenges ahead. Dr. Dunkle’s voice is one of realism paired with resolve, rooted in years of clinical and administrative service to his community.