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Becker’s Healthcare Podcast
Driving Growth and Financial Sustainability in Hospice Care with Lindsay Myers of Chapters Health System
00:14:58
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier at athenahealth.com.
- [00:44]
B
This is Laura Dirdo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Lindsay Myers, Vice President of Revenue Cycle and him at Chapters Health System. Lindsay, it's a pleasure to have you on the podcast today.
- [00:56]
C
Thank you so much for allowing me to be here today.
- [00:59]
B
Absolutely. Now I'm looking forward to our conversation because I know there's so much happening in healthcare and particularly important right now is the revenue cycle and how things are changing, digitally transforming, and really an engine to making sure the health system is successful in the future. But before we dive into that, can you introduce yourself and tell us a little bit about your background?
- [01:19]
C
Definitely. As you mentioned, I'm Lindsey Myers, the Vice President of Revenue Cycle and Health Information Management for Chapters Health System. I've been in the industry for 25 years now, with 20 years of leadership experience and finance and operations, and I've worked in a number of healthcare settings over the years including hospital systems, multi specialty medical practices, and hospice. I started my career in 2001 as a budget accountant for a large hospital system and then I moved into management roles in financial planning and decision support, and my first exposure to Revenue Cycle was as a consultant 15 years ago. I've also been a CFO for a statewide nonprofit and a COO for a 340B consulting firm. And I've worked with Chapters Health System in various capacities over the last 11 years, first as a consultant and then as Director of Financial Planning and Analysis, and now for the last three years as Vice President of Revenue Cycle. And him I also want to introduce Chapters. We're known as the largest nonprofit hospice in the country, but Chapters Health System is actually a portfolio of 30 different companies serving patients with advanced illness throughout the United States. We have PACE Centers, our Care New division, participates in Value Based Care, we have a Medicare Advantage plan, and we've provided MSO and consulting services. We're in Florida, Georgia, D.C. virginia, Maryland California, Oregon and Nevada. And I work in the hospice division, which is where we serve more than 36,000 hospice patients annually.
- [02:56]
B
That's amazing to hear. And you know what a huge accountability that is to be serving patients at that level of care. In particular, given that position that you are in the marketplace, what are some of the opportunities and headwinds that you have on your ION right now?
- [03:12]
C
Value based care would be the first one. As a hospice provider we receive fixed per diem payments. So we already have decades of experience delivering high quality, high patient satisfaction, cost effective care in the home setting. We've also mastered interdisciplinary team coordination and hospice has always been about individualized care and meeting the holistic needs of each unique person. We're able to deliver care in the patient's home, whether it's in an urban setting or in rural settings throughout the country. And I think that all of these attributes come together well in align with value based care arrangements. For example, some of these features make us an ideal partner for acos or for health plans because we have extensive experience avoiding unnecessary hospitalizations, readmissions and other costs while still achieving high patient satisfaction and quality. We have opportunities to collaborate with other stakeholders outside of the traditional Medicare and Medicaid reimbursement structures and to expand the role of our care model beyond just the final months of life. Chapters and its Care new company have been really proactive in this space and we plan to continue growing in the value based care space with an emphasis on chronic illness and end of life care even beyond hospice. And we want to be innovative in shaping what those arrangements look like. Taking care of patients earlier on Upstream is also an opportunity for less fragmentation of care and smoother and sooner transitions to hospice. And when ultimately when you get patients into hospice earlier, it's a win win for everybody because it gives patients and their families more time to get the full benefit that Hospice has to offer. The patients get to maximize their quality of life and their relationships with their families. And it also helps us improve our length of stay in margins. And of course as a nonprofit, we're fortunate to be able to put that back into the organization to further its mission. The other area of opportunity is affiliations and in the last several years Chapters has been strategically affiliating with community hospices all over the country. For example, Cornerstone in Florida, Capital Caring Health in the D.C. area. More recently Willamette Vital Health in Oregon, Nathan Adelson Hospice in Las Vegas and Hospice of Santa Cruz and Hospice East Bay in California. And it's been a little Bit of a whirlwind, but as our CEO has said, our pace is really determined by market forces. So in addition to the economies of scale that come from a shared services model for revenue cycle finance, IT and compliance, another benefit of that consolidation is that Chapters has been able to amass a lot of intellectual capital through these affiliations, and that's put us in a position to be able to offer consultative and MSO type services to other providers. As far as headwinds, some of the challenges that we're actively managing are an anticipated increase in unfunded patients. So as a nationwide health system, especially in revenue cycle, we deal with the nuances of multiple different state Medicaid programs. And as a nonprofit, we serve patients regardless of their ability to pay. And we all know that the one Big Beautiful Bill act is ultimately going to impact Medicaid coverage for a lot of people. It's difficult to quantify the exact impact that these changes are going to have in each of our various markets. But the bottom line for us is that Medicaid changes mean that the number of unfunded patients is likely to increase and these people are still going to need care, and that's likely to take a toll on our operating margin. My team in revenue cycle is going to continue to collaborate with other departments upstream to make sure that we're optimizing our workflows to maximize revenue. And we're also implementing new technology to increase collections to help offset the impact of increasing charity care and bad debt. For example, our IT department has helped develop timely reporting that allows us to identify trends and take action more quickly. And we're also exploring more automation in the area of eligibility, which is going to be important with frequent Medicaid changes. Another headwind that we're dealing with is workforce shortages, labor price inflation, and the mass retirement of healthcare staff at a time when population trends are driving an increase in demand for hospice services. So across the hospice industry, we have labor shortages, and we also compete with hospitals, staffing agencies, home health and other providers for the same staff. So even though this is a major challenge and a headwind, we do have an advantage in that the incoming workforce wants to feel a sense of purpose and a connection to mission. And as a nonprofit that's well established in the communities that we serve, we're able to offer that sense of purpose. Plus, we have a culture that's earned numerous awards and recognition. I have over 130 FTEs on my team and we have a very diverse workforce that's spread out across the country. We've also just gone through multiple mergers. So it's a testament to the great culture that we've developed that everyone is so aligned with our mission and that we have such cohesive teams. We're able to attract and retain top talent and minimize turnover costs.
- [08:40]
B
That's amazing to hear and, you know, really valuable information. When you're thinking about how to head into the future and see what, where, where you can provide the most value to patients as well as the organization. Now, how are you thinking about growth and really adding more of that value? What does the future look like for you and how are you providing that strategy to your teams?
- [09:03]
C
In my role, we've had to scale rapidly. We have doubled in size in just a few years. So when I think about growth in my role, I'm primarily occupied with making sure that the revenue cycle and the HIM infrastructure are in place to expand rapidly while not having cash flow delays or falling out of compliance. So my focus has been primarily on systems, processes and automation. And there's so much that impacts collections that happens upstream from revenue cycle. So our success depends a lot on our collaboration with other areas like intake and admissions and clinical teams and medical services. Also in hospice, we have sequential billing requirements, which means that if we have one claim that's held up, the subsequent claims are held up too. So one bottleneck and process can hold up huge amounts of money. And also with growth comes additional complexity. So as we continue to merge and integrate with new affiliates, there's a lot of process mapping and evaluation and standardization that takes place, as well as learning new state regulations and new service lines. So we are constantly expanding our capacity in terms of both volume and expertise as well in order to handle all the growth. As far as value, the value that the revenue cycle brings is financial stability and sustainability so that we can continue to deliver care to chronically ill and end of life populations. And I think that value comes from continuing to innovate and automate processes, to upskill our people and to collaborate with all the stakeholders who can impact the revenue cycle.
- [10:45]
B
That's fascinating to hear. You know, I know revenue cycle is such an important engine for health system right now and has a lot of importance there. But you know, many hospitals and systems across the country and providers in any aspect of the continuum are looking at some financial challenges in the next year. So from your perspective, what do you see as being one risk or investment that's still worth making even though, you know, potentially purses are tightening across the board?
- [11:14]
C
We're investing in our people and because we are the biggest nonprofit hospice and because of our aggressive growth over the last few years, we are constantly needing to identify and implement scalable process improvements. So being so large, there's often not really a template to follow. We tend to be fairly unique. Therefore, we're relying on the agility and the innovation of our team members to design new ways of doing things. And the risk is that if you underinvest in people, turnover rises, morale drops, the quality of care suffers, and ultimately the financial performance is going to deteriorate. And that's why our mission has been taking care of patients and taking care of those who do. We've earned the Great Places to Work designation for eight consecutive years now. We've been recognized by Forbes and by USA Today, and we've received numerous other awards and recognition for our culture. And one of the aspects of investing in people is also investing in technology. So I know a lot of people would respond to that question about investment with AI. So I would just add that AI has tremendous potential to streamline workflows, especially in revenue cycle and him. But when we look at AI, the idea is to liberate our teams from the mundane, repetitive and administratively burdensome tasks so that they can focus on connecting with patients and connecting with families, which is something that AI can't do, and redeploying them to higher value tasks.
- [12:51]
B
Got it. That makes a lot of sense and it's really interesting to think about how you can leverage technology and really become more efficient there. Before we wrap up, I am curious, anything else you wanted to mention? Looking at some of the best opportunities for yourself professionally when you're looking at growth in the future.
- [13:09]
C
We're going to continue to grow and innovate in the value based care space with the emphasis on chronic illness and end of life care and also our collaborations and affiliations with other providers continue to transform the organization and bring in new talent and ideas as well as the economies of scale. So I think the opportunities are new payment models that are well aligned with the delivery models that we've developed and continued strategic affiliations with other organizations that have similar values in revenue cycle. That's a double digit growth industry and I would say that our opportunities are to enhance our analytical capacity and our processes to support those things.
- [13:55]
B
Absolutely. I know double digit growth is a huge, huge goal and so it'll be great to see how you tackle that in the next year and truly come out, you know, on top. Lindsay, thank you so much for joining us on the podcast today. This has been a really great conversation and I look forward to connecting with you again soon.
- [14:13]
C
Thanks so much, Laura.
- [14:16]
A
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.