IT and RCM must work hand in hand, says Luminis leader.
Sheldon Pink, vice president of revenue cycle at Annapolis, Md.-based Luminis Health, spoke with Becker's to explain what challenges he foresees.
Mr. Pink will serve on the panel "Healthcare in Crisis: Revenue Cycle Lessons for the Future From the C-Suite" at Becker's 7th Annual Health IT + Digital Health + RCM Annual Meeting: The Future of Business and Clinical Technologies. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place Oct. 4-7 in Chicago.
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Question: What are you most excited about right now?
Sheldon Pink: I'm most excited about my team. I spent the last year building up a diverse, multitalented and strategic team, and we had to move some parts, get new hires and align existing roles differently. Right now, I think we have a very cohesive unit, so I'm looking forward to our revenue cycle optimization efforts in the future. Another thing I'm excited about is our revenue cycle strategic plan. One of the challenges I faced once we joined the organization is that we didn't truly function as a revenue cycle, and now we are. So just getting that team together and helping drive revenue cycle performance within the organization is what I'm most excited about over the coming years.
Q: What challenges do you anticipate over the next two years?
SP: One of our biggest challenges will be regulatory changes. We consistently face different rules, regulations and policies from the state and federal governments. So that's going to be a challenge because those decision makers, we have noticed, don't come from healthcare and don't understand how moving healthcare in specific directions is like moving a battleship. The intentions are good, but sometimes they're not thought out. Also, technology doesn't truly exist in healthcare as in other industries where we can adapt quickly. So regulatory is going to be a challenge.
Expenses are another challenge. Inflation rose ridiculously over the last 18 months in salaries, the medical field and nursing; in turn, we need to be more creative and try to reduce expenses in an environment where they're asking us to build more technology to support regulation and productivity.
Lastly, another issue we will have is employee retention. I believe we have to be better leaders because retention is a universal challenge. Retention will be a statistic that leaders will be judged by in the future. It's not only going to be revenue cycle performance. As a vice president of RCM, I will not keep hiring a director every three or four months. Based on our market dynamics, people are not leaving for the dollar. They're going because they don't like their leader. After all, other jobs are available, so as leaders, we must focus on developing our team and being better managers.
Q: Where are the best opportunities for disruption in healthcare today?
SP: The mid-cycle is where we can find a lot of disruption. In clinical documentation improvement … there are a lot of tools out there that people are using. Still, I don't think there's a tool that has touched working with physicians, coders, clinical documentation integrity (CDI), and bringing it all together. And the reason is that there's an EHR involved, and sometimes they don't integrate well with the EHR. There's cultural adoption by the physicians. There are challenges with coding. Many variables serve as barriers to achieving what we would call optimal clinical documentation integrity. CDI technology is disruptive in our industry and can bring all the clinical pieces together with minimal risk.
Another disrupting item would be self-registration. At the Healthcare Financial Management Association conference, someone compared healthcare to the Walmart model at a roundtable. I thought that was very intuitive on his part from seeing it that way because it's the truth. You used to go to a supermarket and can go to a cashier. Correlating that to us, the patient walking into a physician's office or any hospital ancillary department does not exist anymore. You have to check out your groceries, and the direction of healthcare is moving toward a patient checking themselves in, scanning their ID card and registering themselves. So self-service registration will be another disrupting item in healthcare where individuals and patients have to get familiarized with interacting with a computer or a machine to receive healthcare services from the provider.
Then, digital communications are on the back end as we all attempt to optimize and reach our patients in many different ways. There are several generations we must consider, and the challenge we face in healthcare is generational gaps. We want to move toward more digital communications, i.e., whatever we can automate. However, some generations still say, "I want my paper statement, and I want to speak to somebody on the phone." So we're challenged to build a program that supports both populations, because we have a significant amount of both subsets.
Q: How is your role as a RCM leader evolving? How are IT teams changing?
SP: For us, what's evolving from an RCM standpoint is that we're much more involved in IT. Because of the evolution of machine learning and robotic process automation, the IT and revenue cycle will be hand-in-hand to the point where we might have integrated departments. The reason is that we're moving toward automation, and … you need to understand the business. Typically, the marriage between us is twofold. First, IT has the technical skill set to speak the language of scripting and writing code, whereas operations know what we want the code to say. So we must marry the parts together to make an optimal solution for our organization.
The other piece is that we will have to be project managers. I noticed within the revenue cycle that our team members have a solid skill set for the defined root cause, and we're very good at pointing out where different areas in operation are having issues. However, the evolutionary change will consist of partnering with operations and helping them solve problems. In all fairness, we don't expect case managers to be project managers. We can tell them what's wrong, but they may need revenue cycle's help to turn around and say, "All right, how do we operationalize this for us but still be able to do our job?" I think that's where the evolution of the revenue cycle is going.
Furthermore, I think IT focuses a lot more on revenue cycle operations, understanding what we do from a business standpoint, how we do it and what we're trying to achieve. So I've seen that piece of IT grow over the last several years. I see IT as a partner at the table when we select vendors and build strategy because everybody focuses on technology. Still, technology is no good if your organization can't support it. So IT needs to be at that table because there's been several instances in my career, not even here at Luminis but even in the past, where you have this great idea, and you bring in all these solutions, and IT's response is, "Our infrastructure can't manage this. We're not able to do this." So technically speaking, we're not truly aligned. You don't get what you pay for. So therefore, having IT at the table and understanding those parameters are paramount to executing strategy.
Here at Luminis, that strategy is in place. I embrace it because I hate to bring a vendor or a partner into the organization that cannot be implemented. Our IT team goes, "Sheldon, you didn't vet this out. We don't even have the infrastructure for this project. We can't do this," and at that point, you're stuck in all these contractual issues and trying to figure out how to get something out of what you thought you purchased. That's where the change has revolutionized over the last several years.