Healthcare labor shortages are a significant concern and the problem isn't limited to clinical roles.
Front-end revenue cycle staff, back-office specialists, coders, accounts receivable, and denial management experts are all in short supply.
This is problematic for several reasons. The pandemic put immense financial and operational pressure on hospitals. In an environment of continued regulatory and technological uncertainty, health system leaders need their revenue cycle management teams to operate at peak performance. At the same time, many health systems are losing revenue cycle employees who have resigned or been terminated for refusing COVID-19 vaccinations. Staffing is now a primary concern for many health system CFOs.
In response, revenue cycle teams are turning to technology, automation, and outsourcing to reduce their cost-to-collect and to improve margins.
Becker's Hospital Review recently spoke with three revenue cycle leaders about the current healthcare labor shortage and recommended strategies for navigating this challenging environment:
- Elise Myers, Vice President, Revenue Cycle Clinical Revenue Integrity, Providence Health & Services in Renton, Washington
- Lynne Hildreth, Vice President, Workforce Automation, Cloudmed
- Kyle Hicok, President and General Manager, Cloudmed
Question: How is the labor shortage changing revenue cycle management?
Elise Myers: For Providence, it means keeping our teams remote so we aren’t limited by geography in our approach to filling positions. We have infrastructure in place to support this, including laptops for employees, cloud-based applications and automation tools. With technology, we can optimize our workforce wherever they are located - our revenue cycle department alone has 4,000 people across the U.S.
Lynne Hildreth: Due to the labor shortage, the cost of talent has risen. Clinical content knowledge expertise is at a premium. As a result, revenue cycle leaders' expectations have gone up commensurately. If you're paying premium salaries, you want to ensure that you're not underutilizing your staff. I’ve seen more of a push to automate tasks, incorporate machine learning and AI to ensure staff are not being underutilized.
Kyle Hicok: The impact to health systems that I'm seeing is threefold: 1) cash flow delays due to a lack of staff for core functions, 2) revenue left on the table due to capacity challenges in complex claim or denied populations, and 3) reductions in the audit and accuracy reviews to uncover additional revenue collection opportunities.
Q: What actions are leading to successful outcomes?
EM: At Providence, we've continued to explore and expand how we use technology to reduce manual efforts. As an organization, we've looked at where we are using large amounts of labor and where we have transactions that can be performed using technology. We've also been really thoughtful about the capabilities we want to keep in-house and what we want to outsource. We won't be the best at everything. We've relied on vendor partners to improve how we operate and to supplement our team when we can't hire as quickly as we need to. All of this has helped Providence with cash flow, which has been so essential during the pandemic. We've sped up payments, reduced denials and improved operations with analytics.
LH: Our clients that have managed the labor shortage best have used technology and automation to carve off routine, tedious revenue cycle tasks. This has increased employee engagement, reduced burnout and improved retention. For example, one client automated claims status. Once the team could stop checking insurance portals and making follow-up phone calls on claims that were already approved, there was significantly more time for them to invest in more satisfying revenue-generating tasks.
KH: Many healthcare organizations realize that they must reduce time-intensive or manual activities that consume internal capacity. The highest performing organizations work closely with vendor partners, whether it's to augment core revenue cycle functions, supplement specific specialties or collaborate on strategic issues. Strong partnerships with specialized partners can help to automate and optimize operations in meaningful ways.
Q: Do you have any words of advice for health systems struggling with this issue?
EM: The advice I have comes from the strategic work that Providence has done to optimize its workforce. I recommend going through every segment of your business and making decisions around what you want to have a core capability in. What functions can be done better via outsourcing? What can you automate or use technology to improve? The more you can automate low-level tasks, the more dollars you'll have available to hire people to handle more complex, strategic tasks. Then, work with your vendor partners to implement your plan. They can make your life so much easier.
LH: Accelerate the use of revenue cycle technology and tools that are available today so your employees can do more meaningful, high-value work. Once you've automated away the time-consuming and repetitive revenue cycle tasks, you can identify and retain problem solvers, critical thinkers and pattern recognizers. Health systems benefit from the critical thinking and problem solving that come out of teams working at the top of their abilities. Employees feel like they're really driving impact for the organization. They feel challenged and stay in their jobs.
KH: Take the time to establish a long-term revenue recovery strategy. COVID-19 showed us how important cash and resourcing capacity is to healthcare organizations. If you're leaving money on the table, you won't have enough when times get hard. Organizations must look for ways to accelerate cash, identify revenue leakage, and correct issues upstream to streamline processes. Proactive planning on how to handle staffing is critical to maintaining stable operations. The goal is to add capacity, which tools like automation and artificial intelligence can do, while the team members can take on other core work functions — there's never a shortage of work in revenue cycle!
Elise Myers
VP, Revenue Cycle Clinical Revenue Integrity
Providence
Elise Myers is VP, Revenue Cycle Clinical Revenue Integrity for Providence, a comprehensive healthcare organization with 120,000 caregivers who serve in 52 hospitals and 1,085 clinics nationally. She leads a department of 4,000 revenue cycle employees. Elise has nearly a decade of experience as a revenue cycle leader.
Lynne Hildreth
VP, Workforce Automation
Cloudmed
Lynne Hildreth is VP, Workforce Automation at Cloudmed. She provides subject matter expertise to support the development of RPA/AI/ML products for clients in the revenue cycle. Lynne spent nearly 18 years at Moffitt Cancer Center in various leadership roles including Patient Access Director and Women’s Oncology Administrator.
Kyle Hicok
President and General Manager
Cloudmed
Kyle Hicok is the President and General Manager of Cloudmed. He has over 20 years of healthcare industry and revenue cycle leadership experience. Prior to Cloudmed, Kyle was responsible for multi-state revenue cycle operations, national consulting and shared service operations, and general management of revenue cycle technology and services organization.