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A
R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 US health systems, and handles over 270 million payer transactions annually. If you want to learn more about how you can transform your revenue cycle operations, Visit us at www. R1RCM.
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B
Hello and welcome to the Beckers Healthcare Podcast. I'm Will Riley from R1 and I'm joined today by Rob Rob Chestnut, who is the CFO at LMH Health in Lawrence, Kansas. Welcome to the podcast, Rob.
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C
It's great to be here, Will.
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B
Thank you. Thank you. Thanks for taking a few minutes to talk to us. To start off, Rob, can you tell us a little bit about you your role? Lawrence hands us the community you serv.
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C
Well, the community's wonderful. It's a university community of about 100,000 people. We're a sole community hospital, so we serve everyone in our community, 174 beds, but. But we also have about 160 providers that we employ. So we employ most everyone in our market and that includes specialists, primary care, internal medicine, really, really pretty much around, around the horn. So it's definitely a health system. We, you know, we sit about 45 minutes outside the greater Kansas City area. So we compete obviously with some of the systems in Kansas City, including Advent Health. HCA is in there. University of Kansas Health System is a very large system there. We have a strategic clinical relationship with them. So we share patients. When we need patients in our community, Douglas county, that need more help than we can offer, we send them to Kumed and they will diagnose them and then send them back to Lawrence for treatment because we think that's really important for our patients to get care at home. I was born and raised in Lawrence. I was born at Lawrence Memorial. So I am actually very much a Homer and will am proud to say that. So it's a great community and we really have a. What's really unique, I think about our system, it was founded by a person named Elizabeth Watkins. She founded the original hospital and she really had a insight into healthcare equity about 100 years ago. So we still try to stay true to that to that mission to this day.
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B
Got it. Brilliant. Thanks for that background. Just as you, as you think about where you are in the world, the community around you in Lawrence, what are a few of the things that are top of mind for you as you go into the next year?
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C
Well, it's certainly more Competitive. I mean, we lived in a. We lived probably up until about 10 years ago, not in a really competitive environment. We were. We were sort of a little bit of an island. And then as. As the greater Kansas City area started to expand and around it, it's kind of become a corridor. So that has really made us need to become more competitive. And it, It. It flows all the way down to becoming much more efficient in revenue cycle, much more efficient in the way we run our physician enterprise. Because when I started on the board of Trustees back in 2011, you know, we didn't have a lot of employed physicians, but over time, we've brought them into our system that gets really complex, and so we've had to learn how to. To become a much more complex organization. And that's. That's not always easy to do. You know, we've made a few mistakes along the way, but I think we've learned that we've got to. We've got to figure out how to become more efficient. And obviously, you know, reimbursement continues to be compressed. So you. You figure out how to do less with or more with Less. Yeah, essentially, yeah.
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B
Okay, great. That's a great setup for some of the things that I think we'll. We'll talk about. So I'd like to start with a bit of discussion on technology and innovation. It feels like healthcare's traditionally been quite conservative and cautious around technology adoption, but it feels like that might be changing a bit at the moment, largely because of AI, which feels like it's being adopted pretty widely and in a very committed way. Is that true for you?
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C
Absolutely. We're kind of committed, I would say, on both ends of the spectrum. We're doing a lot in AI with, you know, documentation for our providers, and we have some tools with that. You're right about the fact that the adoption has been sometimes uneven, but I think what you find is, in any particular specialty, when you have a physician that really is a champion, it sort of becomes infectious because everybody figures out, wow, this is great. You know, they'll say, I'll never use that again. And then, you know, six months later, they're doing all their notes, you know, using AI. And so we're moving through all of our practices to implement that. Then on the revenue cycle side, obviously, we've done some things in our coding to automate a lot of the codes, the DRGs and CPTs that are very standard and going through. So our revenue cycle, which I manage, has gotten a lot more efficient, and it's essential because obviously there's a lot more denials now you're dealing with because we have all the big carriers in the market, UnitedHealthcare, we have blue Cross of Kansas, which is more local, but we have Aetna, we have Humana, we have Medicare Advantage plans. And so we have to be. You know, I think one of the things about technology is it levels the playing field. So, so it really, I think creates an efficiency that, that you can replicate even as 174 bed, you know, community hospital versus a very large system. There's a lot of investment there, but the returns are fabulous. And so we've had great experience with AI implementation.
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B
You say a level playing field. So I'm just like by extension then you've mentioned Pay a Payer dynamics a couple of times as well. Do you see the technology helping you there significantly?
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C
Yeah, it helps us.
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B
Is it today?
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C
It helps us a lot to identify the patterns of, of denials and, and what's going on. You know, I would say that what's happening, and maybe this is slightly cynical is you have, you have AI on their end and AI in our end and they're fighting each other in the middle to try to figure out, you know, because we know, for instance, if, if we have a certain level of, of claims and everything's going through just swimmingly and then all of a sudden we start having denials. You know, our cynical side says somebody's figured out that, you know, it's just, there's the clean claims rates too high, so they start denying things. But, but I do think that, I really do think that it helps us be able to work with United Healthcare and some of the big players. Now clearly we don't have the resources they do. But, but we do feel like we have a fighting chance in there.
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B
Yeah, yeah, yeah, yeah, totally. Well, it seems to me that.
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C
You.
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B
Mentioned a sort of battle of, of bots and technology and so on, but that in the end it's quite productive.
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C
Yes.
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B
And we, what you're actually getting to is a more transparent system where, where both sides can see and understand what's happening much more quickly.
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C
Yeah. And I, and I do think this is my idealistic side, which is slightly rare for a cfo, but I will say that I do think that over time technology is, is going to create the kind of transparency where you don't have as much, you know, opacity, where you just have no idea what, what's happening with your, with your peer institutions around and what everybody's doing. It, it, it's fairly clear. You can see it, a pattern. So I do think that it does create, I hope in time sort of of getting away from the war of attrition that's being played right now in denials and everything else. And, you know, we, we have the same issue as a lot of other, a lot of provider hospitals. You know, Medicare Advantage has been a struggle for us.
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B
Yeah.
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C
Actually, last year we chose to not renew two Medicare Advantage plans and we have a few others that we work with and that was disruptive to our patient population. But, but I think I'm hoping over time that we kind of work through the, the issues we're working through and, and we get to a, a more subtle place.
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B
Yeah. Yeah. Makes sense. Makes sense. When you think about doing some new things with technology, who are the people, people around you, who are the partners around you that are supporting you in that? Is it, is it the, you know, your, your incumbent technology providers? Are you working with innovative new disruptive technology providers? And, and how are you, how do you think about that?
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C
Well, I think, you know, we, our platform is Oracle Cerner and, and it, it has its own issues just like Epic or any other. And, and I find that the solutions typically don't come from the big players. They come from some disruptor that has figured out. For instance, I just had a conversation. If you walk into the, you know, the, the big ballroom up there with all the vendors, you know, and you shout revenue cycle, you'll have 1700 people come running at you. Right? So, so they're really making, they're, they're, they're trying to create and innovate in those spaces, but a lot of times it'll be in small pieces like referrals or, you know, just different pieces that they work on that they've really honed in on, on, on best practices. So we're always looking for, for different people to come in and, and, and look and say, can we do stuff better? Because we have to get better. I mean, we just, and it's not that we're bad now, it's just continuous improvement is, is going to be the watchword and we'll do revenue cycle with less people. Going to be the future.
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B
Yeah.
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C
So I'm always looking for new solutions. Now we, we just implemented Workday, which is a big ERP system. And, and so we're trying to, you know, figure out how that thing works. And so sometimes you have to be cautious not to introduce too much change because if you don't get people adapting to it, if you don't get people that adopt it, then it becomes just a wasted investment. Yeah. And so we, we work a lot with our providers. We actually have a clinic enterprise board that's made up of providers and technology is a piece of that where we say, hey, we're thinking about some of these things and there are times when they say that's great, but maybe a little bit later, because we're trying to, you know, we're trying to digest all this other stuff that, that you're doing. So it has to be a collaborative effort because without it, you can have the best solution that just doesn't, doesn't get adopted. And then, and then nobody's happy.
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B
Right, right, right, right.
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C
I don't see the roi and they're frustrated that I'm trying to get them to use something they don't want to use.
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B
Yeah, yeah, yeah, yeah. Staying in the finance organization for a minute. It's a, it's a revenue cycle, I suppose it's a space that's always been very labor led with technology aids and technology playing a, probably a supporting role. But it does feel like that paradigm is changing.
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C
Right.
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B
And it's going to be a space that is technology led with labor playing a supporting role or an expert role or what, however you want to call it. I'm stating that as a truth.
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C
Yeah, it is a truth.
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B
You think it is?
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C
Yeah, yeah. And I think that, I mean, as. I'll give you a specific example. So I had a corporate controller who worked for me. She retired after 27 years. You know, obviously maybe not as embracing of technology as, as you would, maybe somebody new. And I have a new person coming in. She's brilliant, much more on the, has a lot more feel for the business intelligence side of the business. But she's managing now our accounting area. So we're really hoping to look at some of those solutions too. And again, those, those groups will be smaller. They will be over time. It's just, it's just the way of the world. I also have supply chain. We've seen it a lot in supply chain. So it, it is, it is important that we not try to keep it at bay because you're not going to win that battle.
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B
Yeah. And does your administrative team welcome it?
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C
I mean, I think they do.
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B
I've never, never met a revenue cycle team that says they've got like too much time on their hands.
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C
Yeah. For example, I would say a little bit uneven. You know, I wouldn't say everybody in my organization stands up today and says, I just can't wait for the next technology solution to come down, down the road. But I think for the most part, I have a good leadership team. I have a good team of directors. They understand what the, what, you know, the Runway is. And so they have to bring everybody in to say, this is, this is where, where we're going next.
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B
Yeah, okay, okay. What about if you step away from the administrative side, look at the provider side, what impact do some of these new technologies making on them and their work?
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C
Well, ultimately, much better, but getting there is the issue because you're making them change whatever internal processes they've had. I think one of the things we've been very fortunate in our community to be able to hire new physicians and younger physicians. And what we find is when we introduce a younger physician into a specialty, like we just hired a new urologist, we have two others, so we have a three person urology group. It really ups the game as far as technology because they come in with a lot of the training that maybe some of their older colleagues don't have. And if you get a physician leader in there, in a practice to go, it's going to happen fast because everybody says, wow, what have I been missing out on here? And so I do think that we've had some success with that, but it's always a little bit of a struggle because you get some folks that are just not as technology savvy, let's say we do have a lot of investment on our information technology group to have, you know, technology adapters that are dedicated to providers. But like I said, it's, it's coming. And I think the majority of providers know this is the future. Yeah.
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B
You mentioned the beginning of our conversation about your, your market, your environment being increasingly competitive. Does this technology help you as a, as a rural hospital going to keep a competitive edge?
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C
It's, it is, it's everything. Yeah, I mean, it really is everything. And, and you just can't hide from it anymore. And, and I think it's good too, because it is easier. I mean, when you really get AI working on, on physician notes. I mean, I have not met a provider yet that said, that has adopted it. That said, I wish I could go back to what I was doing before. Right. I'd say 99 of the time they're thinking, why didn't I, you know, jump into this before? Because this is great. And you know, for us, we want to have the right work life balance. We want to make sure that they can get their notes done within, let's say, 30 minutes after their last visit and be able to go home. Because right now there's so much pressure to have productivity and everything else. And the only way they're really going to achieve that and have the right work life balance is to adopt some of these technologies.
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B
How about maybe bringing us home? How about patients? What do you think will be the outcome for them?
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C
Well, I think that the other thing is that healthcare has also traditionally not been a patient centered environment. I mean, you know, come to the office when I have office hours and so on, and that's changing, obviously. I think the thing that we have to recognize in our community, and it's true in any community, is that generationally people interface with healthcare differently. Right. If you're under 40, you interface with it differently than if you're over 40. You know, our, our portal, the apps that we have, the, you know, doing everything online, that is becoming critical and that's the expectation. And if you don't have that, people ask why. I think it was sort of unique for a while, no more. That's their expectation. And you know, one of the things we explained to many of our providers and our schedulers and everything else saying if we don't make this easy, we'll lose these patients. And this is just the expectation and relationships are still important between patient and provider. But that interface as they come into the system has to be through technology. They aren't going to pick up the phone and call a physician office. They're going to look online and see what's available.
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B
Start there.
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C
Yeah.
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B
Rob, it's been great to hear about all this. From your perspective, is there anything, any other concluding thoughts that you want?
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C
No, I'd say the last thing is we also have the same challenge. Everybody else's workforce, you know, right. There's, we're competing for, for less people and you know, we want to create a great environment to work and we realize that it's not all about compensation or not all about benefits. Sometimes it's just about creating a great environment where people can flourish.
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B
Very good. Rob, thank you so much for sharing your perspective with us today.
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C
Appreciate it.
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B
Thanks.