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In this episode, Noah Breslow, CEO of Revecore, discusses the growing denials crisis and what healthcare leaders can do.

• Why denials are becoming such a significant challenge for health systems
• What the financial implications are on health systems
• Why so many organizations struggle to prevent denials before they happen
• What the biggest reasons denials continue to slip through the cracks
• How health systems can shift from reacting to denials to preventing them
• How AI and automation can help identify and address denial risks earlier
• What roles dedicated denial prevention processes play in improving outcomes
• What revenue cycle leaders should do now to strengthen their denial strategy

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Noah Breslow. As CEO of Revecore, Noah brings more than 20 years of executive leadership experience with a focus on driving growth, innovation, and transformation in complex, highly regulated industries. Most recently, Noah was a partner at Bain Capital Ventures, or BCV, where he led their portfolio support team, built out data-driven investment tooling, and helped incubate two startups at the forefront of applying AI in the insurance claims processing and wealth management industries. Prior to BCV, Noah served as chairman and CEO of OnDeck, a pioneering online small business lender where he built the business from its earliest stages, took it public, and ultimately facilitated its acquisition. Earlier in his career, Noah held leadership roles in product, engineering, and marketing.

He holds a Bachelor of Science in Computer Science and Engineering from MIT and an MBA from Harvard Business School.

In this episode, we’re discussing the growing denials crisis and what healthcare leaders can do. Welcome, and thank you for joining us, Noah.

Noah Breslow: Thanks so much, Kelly. It’s really great to be here.

Kelly: It’s great to have you. Well, let’s go ahead and jump in. So why are denials becoming such a significant challenge for health systems? And what are the financial implications on health systems?

Noah: Yeah, it’s a trend that’s obviously been there for a long time. But it’s getting worse and worse. So, denials have really moved from a back-office kind of nuisance to a real top-line, front and center margin issue. So, research from McKinsey shows that nearly 3% of net patient revenue is written off due to clinical denials alone. And then if you add in underpayments, the cost of appealing those denials, timely filing issues, you might get another percent or two as well, hitting hospitals. So, I think you have a big financial set of changes going on, and we can get more into that. And then you’ve also got the fact that payers have gotten a lot more sophisticated. So, they’re using AI to do AI-driven claims review, deny claims in a more automated way, in a more nuanced way, maybe than they did before. And we’re seeing just denial trends going up across the board.

Kelly: Yeah, I mean, I know denials are a huge issue with such significant financial implications. So, Noah, why do so many organizations struggle to prevent denials before they happen?

Noah: It’s got a variety of reasons here. I think organizations struggle to prevent denials, not because they don’t intend to stop denials. So, 47% of organizations cite improving clinical denials as a top priority, yet only around 36% have standardized processes to actually do it. So even though they want to make this an issue, actually implementing the process and the infrastructure to better manage denials is more of a challenge. The other thing about denials is you can obviously engage in that firefighting motion, right? You get a claim denied, you appeal the claim, you go back and forth to adjudicate that one claim. That’s a very different thing than fixing that root cause of the denial upstream. And I think most organizations are better positioned to do that firefighting on a claim-by-claim basis than really do that systemic analysis. “Why is this denial happening? What process do I have to fix on patient intake, or on clinical documentation, or on billing and coding to make sure that that denial doesn’t happen again in the future?” And that fragmentation is a huge challenge for hospitals.

Kelly: Yeah, it seems like doing that hard work is key there. So, what are the biggest reasons denials continue to slip through the cracks?

Noah: Yeah, I think it’s a multidisciplinary thing. So, you need kind of that combination of data intelligence, the reporting that says, “Hey, we’ve been submitting claims to this particular payer and these types used to get denied at this rate, but we’re seeing this uptrend in these particular types.” You have to connect that intelligence piece. What’s actually happening, and trend analysis, but then you need really human expertise to go, “Okay, why is this trend happening? What could I change upstream to maybe prevent this denial from happening in the future?” And that’s a very multidisciplinary thing. It could involve changing processes. It could involve retraining staff. It could involve system changes, collecting different pieces of information at different points in the process. So, I think it’s that multidisciplinary way to integrate the data on the back end and the intelligence gathering with the process engineering upfront to prevent those denials from happening in the future.

Kelly: Yeah, I love what you said there about the combination of data intelligence and human expertise. That totally makes sense to me. Probably to others as well. So, you know how can health systems shift from reacting to denials to preventing them?

Noah: Yeah. There’s a few different ways I think health systems can go from reactive mode to prevention mode. First is organizational. You have to set up processes and teams inside your revenue cycle organization that are dedicated, that make it someone’s full-time job to making those structural changes to prevent denials from happening in the future. So, organizations with those dedicated processes to prevent denials have a much higher appeal success rate than organizations who don’t have those dedicated teams. And then the other piece of it is around timing. If you imagine you go to the doctor’s office and they hit your knee with a hammer, and it takes you two months to kick, your reflexes are pretty slow, right? And so, two months later, that procedure happened a long time in the past. The patient has already gone home. The documentation may be locked down. And so working on your feedback loop, that rapid cycle from the moment that denied claim comes in to the trend analysis to going upstream and working to make those changes, it’s a governance question as much as it is a technology question, and denial trends should be front and center in revenue cycle leadership meetings, not something you check in on once a quarter.

Kelly: Completely agree. And I love what you said about the reaction mode to prevention mode. That makes a lot of sense in this specific example. So, AI is all the hype. How can AI and automation help identify and address denial risks earlier?

Noah: Yeah. So, AI is a tool that payers frankly have a head start on over providers. I think they’ve been implementing AI at scale now for a few years. Providers are starting to catch up, but it’s a little bit of an arms race, and providers really need to deploy AI, I think, to be the best position to handle increasing types of denials in the coming years. So, AI’s real value is pattern recognition at scale, right? Finding those connections across payers, service lines, procedure types that are driving recurring denials faster than someone could just reviewing claims one by one on their own. And so getting that AI deployed to find those patterns is critical. And the other piece, it is a moving target. So, the claims that are denied this year may not be the ones that are denied next year. There are always new types of denials coming in, and some of them can be addressed very basically, right? They could be administrative denials. They could be missing documentation. Those are more sort of straightforward process issues, but there are a lot more subtle ones in terms of the way procedures are coded and billed, the way procedures are bundled together. And that’s where, again, having that human expertise to complement the AI is so important.

Kelly: Completely agree. And I mean, it does really seem like providers really need to get on the AI trainer in a major way. So, what role do dedicated denial prevention processes play in improving outcomes?

Noah: It’s massive. They have that dedicated team focused on improving outcomes We see it all the time in our client base at Revecore. Some of our customers, maybe the smaller health systems that don’t have those dedicated teams focused on denials, they’re, again, more in that reactive mode, but our larger customers often do have specialized denial teams or executives focused on those. And we’ve seen some of our more sophisticated clients not only have dedicated teams, but have dedicated analytics. So, they’ll know to the analyst level on their team what their overturn rates are by procedure type, by payer, and then they start to actually optimize. So folks on the team who are better at getting certain types of denials overturned will focus there. And then other areas might be gaps that need to be addressed by training or hiring new skill sets. So dedicated team, specific measurement of payer-specific trends, procedure-specific trends, and training and upskilling are all a big part of this.

Kelly: I love what you said about the dedicated team. That really is key here. So, Noah, what should revenue cycle leaders do now to strengthen their denial strategy?

Noah: I think the first step is– forgive the phrase. The first step is admitting you have a problem. And you have to get honest about that infrastructure gap. 64% of organizations lack the infrastructure to prevent denials. You can’t do any of this without these processes, dedicated teams, workflow systems, tracking mechanisms. And so, you have to sort of assess what you really have to fight denials and then start to up-level it if you don’t have all of those pieces in place. I think the next thing is really making denial a frontline activity in your revenue cycle team. So, segmenting by payer, by service line, by root cause, making it a recurring executive topic. One healthcare revenue cycle leader I know has daily stand-ups with their team where they read out on the latest trends of denial. So, it’s not a weekly meeting, it’s not a monthly or quarterly meeting. It’s literally every day they’re talking about this. And then I think really looking at that delay between hitting your knee with the hammer and then having a kick, right? So when you see a new trend, measuring your time as an organization from detecting that trend to making that upstream fix, I think if you can do that and work on shrinking that time down, getting really agile and fast with your processes and with your changes, that is the ultimate weapon because denials are always going to be a moving target. It always impairs economic interest to deny some fraction of claims. And so, you have to be moving to where that puck is going every year, every month, every quarter.

Kelly: Wow. Yeah. I mean, I love what you said about the daily meetings. That is certainly an impressive dedication to this issue. Well, thank you so much, Noah, for sharing your insights with us on the growing denials crisis and what healthcare leaders can do. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Noah: Yeah, no, thanks, Kelly. It’s been great to be here. And if folks want to learn more about what Revecore does to help health systems manage denials and get them overturned and get hospitals the revenue they deserve, they can visit us at our website, https://www.revecore.com, R-E-V-E-C-O-R-E, dot com. Or they can reach out to me directly. I’m just noah.breslow@revecore.com.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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Princeton, New Jersey 08540

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The post The Growing Denials Crisis and What Healthcare Leaders Can Do [PODCAST] appeared first on Besler Holdings.

In this episode, Jake McCarley CEO and Co-Founder of Alluvium, discusses why patient access is the missing link in the revenue cycle.

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In this episode, Eric Englebretson, Besler Holdings’ VP of Information Technology, provides us with a glimpse into our next Hospital Finance Academy Webinar, the second in the Modern Identity Defense for Healthcare series, Passkeys in Practice, live on Wednesday, September 16, at 1 PM ET.

• What we can expect in this second installment in this series?
• Why passkeys specifically?
• How MFA isn’t solving the identity security problem
• What actually is a passkey?
• What makes passkeys phishing-resistant?
• HIPAA and compliance rules
• What’s next?

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Eric Englebretson, Besler Holdings’ Vice President of Information Technology. In this episode, Eric will provide us with a glimpse into our next Hospital Finance Academy Webinar, the second in its Modern Identity Defense for Healthcare series, Passkeys in Practice, live on Wednesday, September 16th, at 1 PM Eastern Time. Welcome back, and thank you for joining us, Eric.

Eric Englebretson: Thank you for having me yet again.

Kelly: All right. Let’s go ahead and jump in. So, Eric, the last time you talked about identity attacks in healthcare. What can we expect in this second installment in this series? And why passkeys specifically?

Eric: Well, Kelly, because if part one was about why attackers go after identities, part two is going to be about the single biggest fix we’ve seen in at least 15 years. Passwords are, and I can say this without hyperbole, one of the worst security tools we have for protecting a digital identity. And honestly, passkeys are the industry’s answer. Google, Microsoft, Apple, Amazon, PayPal, if you’ve logged into any of those lately, you’ve probably already been nudged to create one. And this session is going to take the mystery out of what’s actually happening when you do.

Kelly: Yeah, no, I’ve seen a lot more passkeys myself lately, so this will be interesting for me too. So, we already have MFA. Isn’t that solving the identity security problem already?

Eric: So, it does help, but it doesn’t solve it. SMS codes can get intercepted via either SIM swapping and just general insecurities in the protocols behind text messages. The one-time codes you get from apps like Google Authenticator, those can still be phished and replayed if someone tricks you into typing your password and code into a fake site. And then, of course, push-based MFA has what we call and what we identified in the last session as MFA fatigue where people just approve prompts to make them stop. That’s literally how Uber got breached, in fact. Passkeys sidestep all three because they’re inherently multi-factor: something you have, the device, plus something you are or know, like a biometric or a PIN. So, it’s one seamless step, nothing to fatigue approve and nothing to get intercepted and replayed.

Kelly: Very, very interesting. So, Eric, in plain English, what actually is a passkey?

Eric: And this is so fun because at its core, it’s really complicated, but it’s a pair of cryptographic keys. Don’t let your eyes glaze over when I say that. I’ll explain a little bit more in the session. And ultimately, of those keys, one lives on the website server and one lives on your device, and they never trade that secret part back and forth. So, think of it like a locked suggestion box. Anyone can drop a message in using the public key portion, but only the person holding the private key can open that message box and, in this case, sign something to prove that it’s really them. The signature is what gets checked, not a password, not your private key. So, the important bits don’t go back and forth where they could be intercepted.

Kelly: I mean, it sounds easy enough. So, what actually makes passkeys phishing-resistant? I mean, it sounds like a big claim given how easily we can be tricked into giving away passwords and authenticator codes.

Eric: It actually is a big claim, but I think it holds up. So, each passkey you create is bound to a specific domain, and that’s one of the important bits. So, if somebody builds a pixel-perfect clone of Microsoft.com at, let’s say, micronsoft.com and you don’t notice, your device actually won’t even offer the passkey. It actually simply won’t even respond. When implemented properly, there’s no password to type, so there’s nothing to divulge and put in the wrong place. And that one property right there basically neutralizes phishing and the adversary-in-the-middle attacks, which we talked about and were the star villains of our last session.

Kelly: Very interesting. So, healthcare has HIPAA and compliance rules around all of this. Do passkeys actually check that box?

Eric: So, this is great. They don’t actually just check it. They exceed it. So, HIPAA Security Rule requires verifying that a person accessing e-PHI is who they claim to be, but they don’t mandate a specific technology. So, passkeys deliver cryptographic proof of identity, and that eliminates the number one credential theft vector. And that also aligns with, and I’ll explain this as well in this session, something called NIST SP 800-63B. Again, don’t let your eyes glaze over. And basically, they have what are called authenticator levels. And these meet or even go up to the next level depending on whether or not you’re using hardware keys. And then for HHS’s own 405(d) program, they’ve been recommending FIDO2 and passkeys as a priority mitigation for healthcare specifically for quite a while now. So yes, definitely, this far exceeds the things that we need for HIPAA.

Kelly: Well, that is great news. And I’m looking forward to learning more about that. So, this all sounds almost too good. What’s the catch?

Eric: That’s a really fair question. I get it a lot. So, in this case, we’ve got– we’re building a front door that is genuinely rock solid, made out of metal. The catch is actually a backdoor here, account recovery. So as an example, let’s say you’re storing all your passkeys on your phone. If your phone dies and you lose your passkeys, what’s guarding your way back in? Because you’ve got to have one, right? Well, usually it’s a password reset email plus an SMS code. Well, that’s the absolute weakest link protecting the strongest lock we’ve ever built. We’ll dig into exactly how to close that gap in the full session, but that’s really the only downside.

Kelly: Okay. Good to know. So, if someone only takes one thing away from this episode before they join us for the live webinar, what should it be?

Eric: Ultimately, it’s that passkeys aren’t just a nice-to-have. For healthcare organizations, they’re one of the most practical wins available right now against phishing, credential stuffing, and the account takeover attacks that dominate breach reports. In the full session, we’ll walk through the different types of passkeys, where they actually live on your device, device-bound versus synced trade-offs for enterprise deployments, and really an overview of creating and using one. I think it’s going to be well worth your time.

Kelly: Yeah. I think so, too. I think this is going to be a great webinar. Well, thank you so much for joining us, Eric, and for giving us this glimpse into Hospital Finance Academy’s free webinar, Passkeys in Practice, that’s going to be live Wednesday, September 16th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Eric.

Eric: Absolutely.

Kelly: Wow, sounds like things are always changing in this space for sure. Well, thank you so–

Eric: Absolutely.

Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
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Medicare Appeals

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Modern Identity Defense for Healthcare Series—Passkeys in Practice [PODCAST] appeared first on Besler Holdings.

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In this episode, VerifyMedCodes Co-Founders Nathan Turock and Angelo Selitto, discuss why the money is in the clinical note, not the claim.

• What it means when they say “the money is in the note, not the claim”
• What problem VerifyMedCodes solves
• How the deterministic approach is different
• “You can’t defend a code you can’t reproduce.”
• How to catch issues before the claim goes out, missing modifiers, unsupported codes, and linkage problems
• How hospital finance leaders should be thinking about readiness
• How to process a clinical note without patient data ever leaving the building

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Nathan Turock and Angelo Selitto. Nathan is CEO and co-founder of VerifyMedCodes. He leads strategy, partnerships, and go-to market, focused on helping hospitals and RCM teams turn clinical documentation into defensible, denial-resistant revenue. He founded Verify Med Codes to close the gap between what clinicians document and what actually gets paid. We have Angelo, who’s co-founder and chief architect of VerifyMedCodes. He’s a healthcare integration architect with 13-plus years’ experience across Epic, FHIR, HL7, Identity, and Clinical AI. And he’s delivered production CDS hooks and FHIR for value – based care and led ambient AI documentation rollouts across 33, 000 providers. He designed the VerifyMedCodes deterministic PHI-safe coding engine.

In this episode, we’re discussing the money is in the note, not the claim. Welcome, and thank you both for joining us, Nathan and Angelo.

Nathan Turock: Thank you for having us.

Angelo Selitto: Thank you for having us. Thank you for the intro, and wonderful to be here.

Kelly: All right. Well, let’s go ahead and jump in. So, VerifyMedCodes started as a coding engine. What problem did you set out to solve, and why do you say the money is in the note, not the claim? And Nathan, I’m going to toss this one over to you.

Nathan: Okay, that’s great. The money is in the note. The way it all works, if we’re going to make it easier for the audience, the progress note that the doctor writes is actually what gets paid by the insurance companies. The way it’s set up in the United States healthcare system is the doctor writes the note, then it goes to a coding or billing agency, and they have to put in all the codes that have been created since the ’50s and ’60s by the insurance industry to make sure it’s accurate so they get paid. The problem with that is the insurance companies have made it so convoluted and so difficult to find all the proper codes.

And I won’t get too into the weeds, but you have your ICD-10 codes, your EM codes, your RAF scores, your HCCs, etc. And it gets very difficult for the physician, hospital, provider to get paid what they’re owed. We created this to make it transparent. So, it goes right from the doctor’s note, we code that the English language, then we code it into the medical nomenclature of actually the entire globe, and then we code it into the coding system that has been created by the insurance companies in the United States to maybe not pay exactly what they should. So, we’re going for clear transparency because I believe that the healthcare provider should get paid what they’re worth, and they shouldn’t be convoluted or changed up by the insurance company just because they want to put all this coding into play.

Kelly: Right. No, I love that y’all made that transparent. I know there’s a lot of complexities in the coding world. So, a lot of AI coding tools make compliance teams nervous because they can hallucinate a code. How is a deterministic approach different, and why does same note in, same codes out matter for revenue integrity? And Angelo, I’m going to toss this one to you.

Angelo: No, it’s a great question. And a probabilistic AI coder can read the same note twice and give you two different code sets. And for revenue integrity, that’s the whole problem. You can’t defend a claim you can’t reproduce. So, our deterministic core is same note in, same codes out every time. And that’s the type of defensibility that we want to offer, right? Is that we have the history, we have the evidence-based, we are giving you the information because of what the note stated. It’s not a hallucination. It’s there in the documents. So, we’re really just carrying it forward, and you’re going to reproduce the same information because the same defensibility and the same information always surfaces. So, it’s just the AI can do its suggestions. It could offer and flag, basically recover anything that was missed and offer options. But in the end, the AI doesn’t have the final say. And I think that’s the difference between fast and defensible.

Kelly: Yeah. No, I love what you said about, “You can’t defend a code you can’t reproduce.” I actually wrote that down because I really thought that that was very interesting that you said that. I love that. So, Nathan, where are hospitals leaving the most defensible money on the table today? Is it risk adjustment capture, denials, or is it somewhere else?

Nathan: It’s in all those, to be perfectly honest with you. The denials is your holy grail, capturing the right amount of money for the service that you provided. The reason being is the insurance companies like to deny a lot. I know everybody out there in podcast land has never heard of an insurance company denying anything.

Kelly: Right.

Nathan: Exactly. So, with that being said, I’m going to sort of piggyback off of what Angelo said and to make this very digestible. Angelo loves when I say it’s an incredibly complex tool that we’ve created, but it’s an A plus B equals C or A plus B plus C equals money. Coding system A is the progress note, which is written in the English language. B is the medical terminology that we’ve also coded into a large LLM. C is all the codes from the insurance companies that we utilize their language against them so they can’t deny. So, we have A plus B plus C equals the correct dollar amount. It’s deterministic. It’s accurate. It’s to the point. So, where they’re leaving money on the table is a couple of different sectors. The first one is first pass rate, which means that the note goes through cleanly and insurance says, “Yep, it’s good to go. We’re going to pay you for it.” The second one is– the big one is denials, which when an insurance company says, “Nope, you don’t have enough data on that. We are denying this for XYZ reason,” it costs money to reprocess that note again.

So, we decrease the first– or increase the first pass rate so it’s a better coding system that goes through insurance and they pay. We decrease the denials because we’re using their language, their wording, and their codings directly against them, directly correlated to the progress note. And there’s also a whole lot of other scores like RAF scores, which is risk adjustment factor, and HCC scores that get very, very complicated, that would drive most coding people nuts and gets lost a lot in the shuffle. With the technology that we have now and with how we coded this, it can’t miss. It’s A plus B plus C, LLM. It’s like a giant calculator. I know, Angelo, it’s a lot more complicated than that. But basically, it’s a giant calculator that makes sure the provider, the healthcare provider, the doctor, the hospital, what have you, gets paid what they’re owed by the insurance company. First pass rate is up, productivity for getting the claim through is increased, and denials go down. Simply put, it’s a giant calculator to make sure the doctors get paid what they’re owed.

Kelly: Yeah, no. I love that A plus B plus C equals the money that you’re owed. So that’s awesome that you guys came up with that. So, Angelo, you catch issues before the claim goes out, missing modifiers, unsupported codes, linkage problems. What does that look like on a real claim?

Angelo: That’s pretty much the bread and butter, right? We catch the missing modifiers, the unsupported codes, linkage problems before the claim goes out, just like you said. And it really looks like a straightforward office visit, 34-year-old, appendicitis. The engine builds the full claim, the diagnosis, six procedures, the levels, the EM. It then scrubs before submission and catches two things the payer would have bounced, one procedure, maybe a lab, an 82565 that needed a modifier 59. And without it, the payer bundles it, and you don’t get paid for it. The EM might have needed modifier 25 to sit alongside the procedure without the denial. There’s denial risk scores at 10 %. Both items flagged with the payer denial reasoning spells it out. And we basically are doing that double-check work. We’re doing that assessment before it goes out. And we also do it before an RCM tech might even see it. So the real capture is that we’re able to surface these as options as well. So, in the deterministic engine that we have, it’s not saying this is the end-all be-all. It’s a really nice system that allows you to see all of the options and see what is missing and what could have been created to build and bundle the exact claim that you guys were looking for or want to execute.

Kelly: Wow, I mean, that sounds pretty impressive there. With CMS interoperability and prior authorization requirements landing in 2027, how should hospital finance leaders be thinking about readiness? And Nathan, I’m going to let you take this one.

Nathan: Okay, pretty much this is the transparency, and CMS is your Medicare, Medicaid. And that goes out to all the insurance companies throughout the United States. So, they want to make sure that this is extremely transparent. It’s fire-based exchange. The clean data is moving between the payers and the providers. So, there is an awful lot of data, and we’re not going to go read all the CMS data points that they’re making up. With that being said, all the hospitals and all the providers and everyone else have to have cleaner capture across the board in 2027. So, the crunch time Angelo specializes in and the team specializes in is that we can help integrate all this into whatever system that they’re running now, either with Epic or any other EHR system that is on the market right now. Simply put, it’s got to be more transparent, easier to decipher, and cleaner data that flows through all this, or CMS isn’t going to pay you, which is going to be a bigger headache.

Kelly: Yeah, I mean, I know transparency is key here, especially. So, PHI safety is a real concern with AI. How do you process a clinical note without patient data ever leaving the building? Angelo, can you help us with this one?

Angelo: Yes, I sure can. So, the concern is real. Most AI coding tools ship the raw note to the cloud, and we don’t, or maybe it’s not to the cloud. It might be a homegrown LLM or AI that they built internal. The deterministic engine runs locally with full access to the note. So, before anything touches an outside model, we do a structural transformation. Every clinical concept is preserved, but the patient identifiers are replaced with typed placeholders. We also have a way of the– basically a backwards communication. So, if something, if they have a question about the local progress note, there could be a communication to say, “Is this a name, or is this–?” maybe it’s the name of a medication, which is another big issue that happens within PHI redaction is that it misses or it hides the name of a medication or anything, a building. And so, what leaves the building is the PHI-free representation, the medicine, not the patient. So, 99.5 % of the clinical content is preserved, and the identifiers don’t travel. That is probably the most impressive piece that we built because it uses a very interesting method to get that data and to transform it, and it’s fail-closed. So, if the gate is ever unsure whether something is safe, if it blocks it, uncertainty defaults to do not send. That’s to a 100 % onshore, and the AI helps us reason, but the medicine never sees who the patient is.

Kelly: Very interesting. I know PHI safety is a real concern across the board. Nathan, if a finance leader listening wants to start small, what is the first step?

Nathan: The first step is just to go on our website and check us out. So, it’s verifymedcodes.com. And the great thing that I designed the website is Angelo comes from the tech side. I’m still in healthcare, but I’m on more of the finance side. So, they can go onto our website and look at the slider scale that we have that can tell how much money that they’re losing on the first pass rate in productivity, in denials, and so on and so forth. They contact with us. We are actually doing right now a 100 notes for free. So, they can send us our 100 worst notes, and we can actually– Well, we’ll process it for them. It doesn’t cost them a dime. And we’ll show how our system is better, faster, more efficient, and will make them more money. So, as a finance person, and I designed this because that’s where I sit in the healthcare sector. I want to know why it’s going to make me more money, why it’s going to make my facility more productive, how much money am I leaving on the table, and how much I’m saving, but want a freebie of a 100 notes or so. So that’s what we offer. We offer the easiest process across the board. So once again, go to verifymedcodes.com, look at our finance calculator, contact us, send us the notes, and we will prove what will work.

Kelly: That sounds like a great offer. Well, thank you so much, Nathan and Angelo, for sharing your insights with us on the money is in the note, not the claim. And if a listener wants to learn more, contact you to discuss this topic further, how best can they do that?

Nathan: Well, they can contact me at nturock, that’s N as in Nathan, last name Turock, T as in Tom, U-R-O-C-K, at verifymedcodes.com. Or, once again, go to the website, verifymedcodes.com, and all our contact information is there. And, Angelo, you can tell them where your contact info is.

Angelo: Yes, thank you, Nathan. Contact info is same. It’s on the website as well. You could also contact me at Angelo, A-N-G-E-L-O, dot Selitto, S-E-L-I-T-T-O, at verifymedcodes.com.

Kelly: Awesome. Thank you both for writing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes our episode of The Hospital Finance Podcast. For show notes and additional resources, visit us online at besler.holdings. The Hospital Finance Podcast is a production of Besler Holdings; Built on partnership, Driven by success.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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Princeton, New Jersey 08540

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The post The Money is in the Note, Not the Claim [PODCAST] appeared first on Besler Holdings.

In this episode, Theresa Hush, CEO at Roji Health Intelligence, discusses the impact of value-based care's failure to progress in achieving the economic sustainability of the healthcare system and if or what can change the course.

In this episode, Kevin Torf, Co-Founder & Managing Partner at T2 Group discusses the revenue walking out your door, capturing wellness spend at the point of care.

In this episode, James Jacobi VP of Employee Benefits at Hilb Group discusses something that hits every CFO and finance leader in healthcare directly, the runaway cost of employee benefits.

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In this episode, Eric Englebretson, Besler Holdings’ Vice President of Information Technology, provides us with a glimpse into Webinar, the first in its Modern Identity Defense for Healthcare Series: Defending Against Identity Attacks – When MFA Isn’t Enough live on Wednesday, August 12, at 1 PM ET.

• What is this webinar about?
• MFA still effective?
• How the attacks are evolving
• What session tokens are and why you should care about them
• Why healthcare is a frequent target
• Warning signs that an account may be compromised
• Next evolution beyond traditional MFA

Kelly Wisness: Hi, this is Kelly Wisness.We’re pleased to welcome back Eric Englebretson, Besler Holdings’ Vice President of Information Technology. In this episode, Eric will provide us with a glimpse into Besler Holdings’ next Webinar, the first in its Modern Identity Defense for Healthcare Series–Defending Against Identity Attacks – When MFA Isn’t Enough live on Wednesday, August 12, at 1 PM Eastern Time. Welcome back and thank you for joining us, Eric.

Eric Englebretson: Thank you so much. I’m happy to be here.

Kelly: Well, great. Well, let’s go ahead and jump in. So can you provide a quick overview of what you’re going to be reviewing during this webinar?

Eric: Absolutely. So, the thing that I think is very important for us to cover is that identity has become one of the most targeted areas in all of cybersecurity right now. It used to be that attackers focused on servers or the corporation’s network, and once they’d gotten in from there, they would pivot to get at the thing they’re really after, which is often a company’s data. In the age of cloud computing and remote work, defenses have generally gotten better because traditional defensive methods of defending the network give way to security practices like something called Zero Trust, whereby any interaction with an organization’s resources must be authenticated no matter where a location request might come from. And so, the next logical step is identity attacks. And why is that? Like I said, since attackers focus used to be on breaking into networks and servers, the payoff might be limited. A compromised web server hosting a hospital website might not have any access to any data at all, really, but in today’s integrated environments, one compromised user account. Now that can give an attacker access to email, collaboration tools, patient systems, financial applications, and cloud services, depending on your role. In most organizations, your identity becomes the new perimeter, and that’s why attackers increasingly target people and accounts instead of infrastructure. This is going to be a two-part series covering modern identity security, why attackers have moved to trying to capture identities as a first attack rather than compromised servers, what we can do about it. And in part two, one of the biggest new advancements you’re probably already using in a few places, passkeys.

Kelly: Awesome. Sounds like you’re going to cover a lot during this webinar. I’m really looking forward to it. So, we hear a lot about MFA and how attackers try to bypass it. So is MFA still effective?

Eric: Absolutely. So, MFA really remains one of the most important security controls that has come to us in the past 10 or so years, and it really does stop the vast majority of common attacks, including password reuse, credential stuffing, and other attacks similar to those. The key message here is that MFA is definitely not broken. The message is that attackers have evolved and they’re now looking for ways to get around it. It is just that effective. They’ve got to work around it now rather than just simply trying to use a username and password. And that means organizations need additional layers of protection alongside of MFA.

Kelly: Yeah, so we know that MFA is still effective. So how are attacks evolving to work around it?

Eric: Modern attackers often focus on stealing authenticated sessions rather than stealing passwords. In some phishing attacks, victims enter their credentials and complete MFA successfully, but the attacker captures the resulting session that’s created. Think about it this way. Is it easier for a thief to steal your hotel room key or to try to convince the front desk to issue a new one? In most cases, it’s easier for the thief to steal your room key. After that, they can just come and go as they please, usually without so much as a second glance. We’ve put so many guardrails around the authentication process that attackers are now moving on and looking at what’s behind that, something called sessions and tokens.

Kelly: So, what are session tokens and why should people care about them?

Eric: So, session tokens and they are kind of background… so this is kind of we enter that realm of nerdy a little bit, but stick with me. Session tokens are what keep you log in after you’ve authenticated. They’re the reason that you don’t have to enter your password and MFA code every single time you open an email or click a new page. They’re incredibly useful, but that makes them also incredibly valuable to attackers. If an attacker does steal a valid session token, they may be able to act as though they’re already authenticated without having to have your password again. And that is what makes them so important, and that is why people should care.

Kelly: Yeah, no, that makes a lot of sense. Why is healthcare such a frequent target for identity attacks? I mean, we’ve been hearing so much about this lately.

Eric: Absolutely. So, the main reason for that is that healthcare combines highly valuable data with extremely time-sensitive workflows. Clinicians and staff are constantly dealing with alerts, messages, urgent requests, and attackers understand that environment, and they design their hacking and phishing campaigns specifically to exploit human pressure and urgency. Healthcare isn’t targeted because it’s careless. That’s actually quite the opposite. It’s targeted because its mission creates very unique opportunities attackers can try to exploit.

Kelly: Yeah. I guess having that– always having that sense of urgency probably doesn’t help us in that way, right?

Eric: Absolutely.

Kelly: Yeah. So, what are some warning signs that an account may be compromised?

Eric: So, a few of the things that you should look out for some of those red flags include unexpected MFA prompts, alerts about sign-ins from unfamiliar locations. If you are looking at your inbox forwarding rules, which I recommend that everybody does every once in a while, if a forwarding rule you didn’t set up has appeared and it’s forwarding to some account you don’t know about, that is definitely a big red flag, or just anything that seems off to you that might signify unusual account activity. And one of the most important things you can do here is just to simply report those to your IT staff, help desk, or security staff, whatever your normal workflow is, immediately. Early reporting can often stop a small incident from becoming a major breach.

Kelly: Yeah, no, that makes a ton of sense. Just be more vigilant. So, what’s the next evolution beyond traditional MFA?

Eric: And that is an excellent question. This is something I’m going to cover in part two. The future is phishing resistant authentication. So, there are technologies, and I’m going to use another nerd word here like FIDO2 security keys, Windows Hello for Business, and Passkeys are designed to prevent attackers from stealing or reusing credentials and session information. In part two of the webinar series, we’re going to explore how passkeys work, why companies should adopt them, and how they can dramatically improve both security and user experience.

Kelly: Wow, sounds like things are always changing in this space for sure. Well, thank you so–

Eric: Absolutely.

Kelly: Yeah. Well, thank you so much for joining us, Eric, and for giving us this glimpse into our next free Webinar — Defending Against Identity Attacks – When MFA Isn’t Enough. Join us live on Wednesday, August 12th at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Eric.

Eric: Absolutely.

Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Modern Identity Defense for Healthcare Series–Defending Against Identity Attacks – When MFA Isn’t Enough Webinar [PODCAST] appeared first on Besler Holdings.

In this episode, Jack Risenhoover, healthcare attorney and chair of Velocity Health, discusses a modern CFO playbook for using “other people’s money” to support AI, 340B, and patient engagement initiatives.

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In this episode, Dr. Claudine Lott, Physician Executive for Commercial Transformation and Implementation at Elsevier, discusses building trust and clinical AI, what hospital leaders need to know about evidence-based decision support.

• What ClinicalKey AI is
• How AI enhanced clinical decision support tools can help organizations improve both clinical efficiency and financial performance
• How AI-powered tools can support clinicians in real time to reduce errors, avoid denials, and strengthen the overall revenue cycle
• ROI opportunities for health systems adopting AI-powered clinical intelligence
• How AI-powered tools remain evidence-based, transparent, and aligned with clinical best practices
• The most common misconceptions hospital leaders have about implementing AI and clinical workflows

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Dr. Claudine Lott. She is a board-certified family medicine physician who is passionate about developing and implementing tech-based clinical solutions that improve both patient outcomes and provider experience. As physician executive for commercial transformation and implementation at Elsevier, she supports the development and deployment of their reference products for healthcare providers, including ClinicalKey AI. Dr. Lott received her medical degree from the University of Massachusetts Medical School and completed her residency at White Memorial Medical Center. She served as a primary care physician at the federally qualified Santa Cruz Community Health Center, where she was promoted to site medical director. She then joined Healthcare Startup Crossover Health, where she contributed to the development and expansion of their virtual care model, as well as the creation and deployment of their Patient Engagement Technology Platform. Since joining Elsevier in July 2023, Dr. Lott works cross-functionally to support key initiatives, including customer implementations, product development, and change management.

In this episode, we’re discussing building trust and clinical AI, what hospital leaders need to know about evidence-based decision support. Welcome, and thank you for joining us, Claudine.

Dr. Claudine Lott: Thanks for having me on. Appreciate it.

Kelly: Well, it’s great to have you. And let’s go ahead and jump in. So, what is ClinicalKey AI, and how are its new capabilities designed to reduce clinician burden and improve documentation accuracy?

Claudine: So ClinicalKey AI is Elsevier’s flagship generative AI tool that’s designed for clinician use to quickly surface the latest evidence at the point of care to support clinical decision-making. And just to take a step back and provide some context, so here at Elsevier, we’re an almost 150-year-old publishing company. So, for almost 150 years, our role has been as a provider of scientific information and clinical evidence that clinicians can use in their decision-making and in their patient care. And as we’ve moved into more and more clinical solutions, that’s always been kind of our guiding North Star. And so with generative AI coming on the scene, we’ve really thought about, okay, how do we use this emerging technology in our role as a provider of clinical evidence, scientific information to really further that goal of getting clinicians what they need to make decisions and take the best possible care of patients as quickly, accurately, and effectively as possible. And rather than just sort of slapping generative AI on everything because that’s sort of the new thing to do, how do we really leverage this new tool to solve that problem? So ClinicalKey AI is a conversational search tool. The clinician’s able to ask a question in natural language, almost like they might ask a colleague. And then the system goes and searches a curated set of content that we’ve given to it. So that includes much of our Elsevier clinical content, but also some non-Elsevier sources as well, and searches for information and then surfaces that for the clinician. So, it’s not replacing their clinical knowledge or decision-making, but it’s really supporting them by getting the information that they need and we’ve been developing and iterating on this tool for several years now, constantly thinking about how do we make it better and more suited to this clinician use case. So constantly thinking about how we expand our handpicked content sources, thinking about making sure that we always have traceability so clinicians can see where the information is coming from, citation verification, and always thinking about technology upgrades. So, things like privacy, security, and supporting HIPAA compliant use.

Kelly: Wow, that ClinicalKey AI technology sounds really fascinating. So how can AI enhanced clinical decision support tools help organizations improve both clinical efficiency and financial performance?

Claudine: So clinically, the biggest win is what we might call speed to evidence. So, we’re in a situation now where patients are increasingly more complex. Medical knowledge is expanding exponentially. And so, getting that information that is really tailored to the clinical situation as quickly as possible is going to enhance clinical efficiency so that AI enhanced decision support can really surface the most relevant trusted information. In seconds, really supporting those consistent decisions under time pressure and given all those other complexities. In terms of how that clinical efficiency translates into financial performance, I think this is something that we’re going to see continuing to evolve as more and more organizations are integrating these types of tools. So certainly, it makes sense that improving clinical efficiency, improving the quality of care is going to translate into financial performance, but sometimes that ROI can be a little bit difficult to quantify. So, I think that we’re going to see those benchmarks continuing to evolve as more and more institutions are implementing these tools.

Kelly: Yeah, and I love what you said at the beginning, that speed to evidence. I love that. So, what should hospital healthcare system operation leaders look for in the first six to 12 months to know an AI tool is truly delivering clinical value?

Claudine: Yeah, I think this is a great question and something that a lot of both vendors and organizational leaders are really thinking about. Because again, these tools are still new. We’re still seeing how they affect healthcare and how they affect the clinical workflows. And so, we’re still really figuring out how we quantify this sort of clinical value. So, thinking about sort of what can you look for at that 6- or 12-month point to know if your tool is delivering that clinical value. For things like time-saving, improvement of quality of care, those things can be hard to really quantify. And also some of the benefits of generative AI tools, as we mentioned, is that helping clinicians provide faster and better care, it leads to a better experience for those clinicians, for that care team, really addressing that sort of fourth leg of the quadruple aim. But again, that’s something that can be hard to quantify. So, in thinking about, okay, what are some of the metrics that we can sort of look at those sort of checkpoints to see the value that these tools are providing? Certainly, usage metrics are one aspect in terms of just seeing how many providers are using the product, how often are they using it. But that’s only sort of one aspect of it.

Given that there’s more of a– there may be more of a qualitative improvement, some customers and organizations that we’ve seen have chosen to use surveys. So, for example, we had one customer who was utilizing ClinicalKey AI, who did a survey to ask their users after they had trialed it for a given period of time to rate the improvement in their ability to conduct patient care, their confidence in their clinical decision making, and their time saved. And so, they were able to, through that sort of surveying of the users, to sort of quantify the improvements they were seeing in all those areas in that way. And this is also a place where having a clinical champion really involved in the implementation process and in the adoption of these tools can help because checking in with those champions can really connect you to understand, again, some of those sort of improvements in experience that can be a little difficult to quantify. And I think it also comes down to for organizational leaders thinking about what is the problem that the generative AI tool was implemented to solve. So, as I kind of mentioned before, we don’t just want to throw a tool at clinicians just to give them something AI because AI is sort of new and exciting now. We really want to think about, “Okay, what problem are we solving with this?” And from there, then at those checkpoints, I think you have a place to go back and say, “Okay, here’s the problem we were trying to solve. What progress have we made on that?” And use that to kind of quantify the value?

Kelly: Yeah, I know it is difficult to quantify that value there, at least for now. So, it sounds like you guys are making progress with that. So how can AI-powered tools support clinicians in real time to reduce errors, avoid denials, and strengthen the overall revenue cycle?

Claudine: In real time, AI-powered decision support can reduce errors by helping clinicians quickly sort of cross-check their decisions against trusted evidence, or by getting them information that they need to make that decision quickly, especially in an environment that’s high-pressure and time-constrained. In thinking about aspects of revenue cycle management like coding integrity, managing denials, having that grounding in clinical evidence is so vital. Having that documentation that’s based in clear and trusted evidence that’s traceable is really going to provide that sort of grounding and foundation for the decisions that are being made and then the documentation that’s going into that. And that’s going to really support those aspects of the revenue cycle.

Kelly: Yeah, thank you. That makes a lot of sense. So where do you see the strongest ROI opportunities for health systems adopting AI-powered clinical intelligence?

Claudine: So, I think there’s three sort of big ROI opportunities that I see. So first of all, speed, as we’ve discussed, just making decisions more quickly frees up more time for patient care, can help with reduction of administrative burden, and just really free up clinician time. So that just speed is a huge part of it. And then I think the second part is the accuracy and that strong evidence base that I mentioned. So, making sure that decisions are based in strong clinical evidence and that that is really documented in a well-supported way, that’s going to not only support patient care but also those aspects of revenue cycle management that we mentioned. And then I think another opportunity is thinking about standardization. So, there’s definitely an art to the practice of healthcare. So, we may still see some variation in the way that different clinicians might approach the same problem. And having an evidence-based tool has the potential to support more sort of consistent practice patterns across settings. So, I think that standardization and ability to make sure that all care team members have access to evidence on which to base their decisions is another significant opportunity.

Kelly: Sure. Sounds like there are quite a few really strong opportunities there that you shared with us. So how is Elsevier ensuring that AI-powered tools remain evidence-based, transparent, and aligned with clinical best practices?

Claudine: So, as we mentioned, we really anchor clinical key AI in peer-reviewed, copyright-cleared medical evidence. So that includes full-text journal articles as well as journal abstracts, clinical practice guidelines from different organizations, full-text medical textbooks. And we’re constantly thinking about curating that content set, what we need to add, what we want to expand on, how we want to adjust it to make sure that it’s really providing what clinicians need. And we also keep the content current. So, we have a content pipeline that updates every 24 hours. So, the outputs are really reflecting the latest evidence and guidelines as much as possible.

And we’ve really tried to build in that transparency, that traceability, so that the clinician can really see down to the paragraph where that information is coming from. So, they can have that trust. They know that the citation is not being hallucinated or made up by the AI. They can have that trust in where the information is going from, and they can also do a deeper dive if there’s a topic that they want to explore further. So, it really gives them that ability as well. And we use a clinician in the loop approach with a rigorous evaluation framework to continually test the system, follow up on feedback that we get with users, and really just make sure that we’re maintaining and constantly improving the quality of the insights we’re providing.

Kelly: Well, it sounds like that trust is very important to your team there, and that’s appreciated. And you all take that responsibility very seriously.

Claudine: Definitely.

Kelly: Yeah. So, Claudine, from a physician executive’s perspective, what are the most common misconceptions hospital leaders have about implementing AI and clinical workflows? And what advice would you give them as they evaluate solutions?

Claudine: So, there’s three main points about successful adoption of clinical generative AI tools that we’ve seen from our teams and customers, as well as what we’ve been hearing from others in the industry. So, I think these are a great starting point for organizational leaders who are considering implementing a generative AI tool. So first and foremost, as we mentioned before, really knowing the problem that you’re solving with the generative AI tool. So, if you have a generative AI tool, but it’s not solving a problem for the clinician, it’s not making their experience and their care better in some way, nobody’s going to want to adopt that. Nobody’s going to take the time out of their schedule to learn and integrate something new. So really knowing the problem that you’re solving and making sure that you have a tool that fits that.

And so, for us at Elsevier, as I mentioned, we’re seeing this problem of increasing patient complexity, increasing medical knowledge beyond what anyone can sort of memorize. And so, thinking about, okay in our role as a provider of clinical content, how do we use this technology to really solve that problem? So that’s the first part. The second aspect is making sure that the tool is accessible and easy to use, that it’s really embedded in the workflow. Because even if you have a tool that does solve a problem for the clinician, if you’re going to implement something that they have to leave their workflow to try to utilize, that’s not something that they’re going to want to adopt. And certainly, if you’re implementing something because you want to increase their speed and efficiency, if it’s an inefficient process, that’s not going to be helpful at all. So, for us, that consideration goes into things like making sure that our product is integrated into the EHR, having an API option, and basically just making sure that the tool is really in the workflow where the clinician is making that decision.

And the last point is really coming back to this point about trust, because I think some of the misperceptions about clinical AI tools themselves are really related to a lack of understanding of how these tools work. So not understanding that a standalone general use large language model is going to answer clinical questions just based on its training. It’s not actually going to be going out and searching. Whereas a tool that pairs LLM capabilities with retrieval is going to actually be searching and surfacing information in that way. Knowing that some general use tools are drawing from perhaps the whole internet or from sources that are unclear as opposed to a tool that is really clear about where the content is coming from. Risks of using a tool that the privacy protections are not clear. So, all of this sort of lack of understanding contributes to lack of trust, and that’s going to make sure that, again, this is not something that is going to be widely adopted.

And I think that here this is a place where organizational leaders need to think about support from both internal clinical champions and strong vendor partnerships. Because those internal clinical champions, as I mentioned, they’re going to have that deep clinical expertise of the workflow. They’re going to know those problems that the clinicians are facing. And they’re able to be a voice to their peers to say, okay, here’s how this tool works, here’s why it’s trustworthy, and here’s how it’s going to solve the problems that you’re facing. And that’s going to really lead to more successful adoption.

Similarly, having a partnership with a vendor that’s trustworthy, that you’re able to work with them, you’re able to provide feedback and get support for your implementation and your adoption efforts are also very important. And we at Elsevier, as a vendor, really do try to be partners to our customers in that way in supporting them and helping them understand our tools, how they work, how they can benefit them. So those are kind of the three main points that I think are really helpful in thinking about implementing generative AI tools in the clinical setting.

Kelly: Right. It sounds like having those champions and partners are really key to success there. So, Claudine, looking ahead, how do you see AI shaping the future of hospital operations and financial sustainability? And what role will Elsevier play in supporting that transformation?

Claudine: Well, it seems like AI is here to stay, right? So, I think we’re going to, in the future, see AI continuing to lead to changes in really every aspect of healthcare. In terms of clinical decision support, I think we’re going to see these clinical generative AI tools increasingly becoming like a standard layer inside these clinical workflows, so helping clinicians find information, make those quicker decisions, supporting their documentation, but really just with an increasing integration and seamlessness as these tools become more integrated and more widely used. And I think Elsevier’s role is going to be to continue to build on what we’ve been doing all along. So again, constantly thinking about how do we deliver responsible AI solutions that clinicians can trust grounded in that evidence, not replacing their clinical judgment, but really getting them the information that they need in our role as this provider of trusted clinical content and just continuing to think about usability, what features are needed, what content is needed, and how do we continuously think about supporting the clinician with this new technology.

Kelly: Thank you, Claudine, for sharing your insights with us on building trust in clinical AI, what hospital leaders need to know about evidence-based decision support. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Claudine: They can definitely connect with me on LinkedIn.

Kelly: Awesome. I will do that as well, and thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

Podcasts
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Medicare Appeals

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Building Trust in Clinical AI–What Hospital Leaders Need to Know About Evidence‑Based Decision Support [PODCAST] appeared first on Besler Holdings.

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In this episode, David Alemian, Creator of the Alemian Retention System, is discussing how people stay where their future is the strongest.

• How aligning an employee’s financial future with their tenure can change long-term retention behavior
• What distinguishes a short-term incentive from a true long-term retention structure in financial terms
• How forfeiture-based structures influence decision making compared to traditional benefit plans
• What financial modeling should hospitals use to project the long-term impact of retention strategies
• How hospitals can implement retention strategies without increasing net operating costs
• What separates organizations that successfully retain top talent from those that just continue to struggle

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back David Alemian. David is America’s foremost expert on retaining highly skilled professionals and the creator of the Alemian Retention System. His work defines a critical reality for healthcare leaders, People Stay Where Their Future Is Strongest. He is the author of People Stay Where Their Future Is Strongest: How Organizations Retain Highly Skilled Professionals and Build Lasting Advantage. A definitive framework that explains why highly skilled professionals leave and what determines whether they stay long-term. With over 30 years of experience in financial and workforce strategy, David reframes retention as a financial discipline. He shows how workforce instability erodes margin, disrupts operations, and weakens long-term performance. His work has been featured in Medical Economics, MD Magazine, and Physician’s Practice. He has authored more than 300 articles and produced over 400 educational videos on talent retention and organizational performance.

In this episode, we’re discussing People Stay Where Their Future Is Strongest. Welcome, and thank you for joining us again, David.

David Alemian: Well, hi, Kelly, and thank you for having me. It’s so good to be back.

Kelly: Yes, it’s great to have you back. Well, let’s go ahead and jump in. So, David, yeah, you focus on aligning an employee’s financial future with their tenure. How does that change long-term retention behavior?

David: Great question. People are wired for the future. From the time we are very young children, we quickly learn to think about the future. It becomes imprinted on our brain. We’re asked, “What do you want to be when you grow up? Where do you want to live? Who are you going to marry?” It’s always looking toward the future. Employment is the same thing. Highly skilled people don’t make career changes on a whim. They think about it, and they think hard. And here’s what they think, “Is my future better here where I am? Or is my future better if I move to another organization?” Most major decisions are based on the future. When an employee considers staying or leaving, they are literally comparing two possible futures. One future is built by staying with their current employer. The other future is built by leaving and going elsewhere for another opportunity. The future that appears stronger usually wins. It’s that simple. For those who are listening to this, think about your own life and the decisions surrounding your career. Did you think about your future? Chances are very high that you did because our brains are wired for the future.

What’s really kind of cool is it’s one of the things that we all have in common. Here’s the difference. Traditional retention strategies often focus on the present. They focus on culture, recognition, wellness programs, team-building activities, and workplace perks. Those things are good, and they matter, but they do not fundamentally strengthen an employee’s long-term financial future. When an organization helps employees build a stronger financial future by staying, retention becomes much more stable because the employee has a compelling reason to remain committed for the long term. People stay where their future is strongest. And that’s what I mean by that.

Kelly: I love that. I mean, and I wholeheartedly agree with it, and it makes a lot of sense that focus on the future. You’re right. We do all have that in common. So, what distinguishes a short-term incentive from a true long-term retention structure in financial terms?

David: Okay. Now, most retention strategies are expenses, higher salaries, bonuses, 401(k) contributions, retention payments, enhanced benefits, and similar programs all have one thing in common. Once the money is spent, it’s gone. The organization incurs the cost, whether your employee stays or leaves. A true long-term retention structure works differently. The employer funds and owns the plan. The employee never owns the asset. The asset remains on the organization’s balance sheet where it continues to grow and compound over time. The employee agrees to remain with the organization until a future date is established in the agreement. It could be 10 years from now. It could be all the way until retirement. It could be anything in between. If the employee fulfills that commitment, the employee receives a substantial financial benefit. If the employee does not fulfill their commitment and leaves early, the benefit is forfeited. The organization keeps the asset. That distinction changes everything. Instead of creating another expense, the organization creates a growing and compounding asset while simultaneously creating a powerful incentive for the employee to remain long-term. Traditional retention strategies spend money. This strategy builds an asset.

Kelly: That is truly just so interesting to me, David. Thank you for explaining that. So how do forfeiture-based structures influence decision making compared to traditional benefit plans?

David: Oh, but they do. This is where retention becomes truly powerful. Most traditional benefit plans provide value regardless of whether the employee stays for the long term. An employee may receive higher compensation, employee retirement contributions, bonuses, or other benefits, and still leave for another opportunity. There’s nothing holding them in place. And what happens is the organization absorbs the cost and loses the employee anyway. A forfeiture-based structure operates differently. The employer funds the plan. The employer owns the plan. The asset remains on the organization’s balance sheet where it continues to grow and compound. And the power of compound interest is amazing. The employee earns the right to receive the benefit only by fulfilling the long-term commitment established in the agreement. If the employee leaves before that date, the benefit is forfeited. The organization keeps the asset. The employee receives nothing. That creates a completely different decision-making process. Remember when I said that choosing between two futures, one if I stay and one if I leave?

Kelly: Right, yes.

David: The employee is no longer evaluating only what might they gain going elsewhere. They’re also evaluating what they will lose by leaving. As the asset grows and compounds, the financial consequence of leaving becomes increasingly significant.

Kelly: Oh, yeah.

David: Yeah. Absolutely. An employee may receive a recruiting call from a competitor offering a higher salary. The employee now has to compare that offer against a growing future benefit that could be worth substantially more. People become far less likely to leave when doing so requires walking away from something meaningful they have spent years building toward. In other words, you’re giving them something to lose by leaving. At the same time, the employer benefits because the asset continues to grow, regardless of whether the employee ultimately stays or leaves. That creates a powerful alignment of interests between the employee and the organization.

Kelly: I mean, it seems like a win-win, right? I mean–

David: Everybody wins.

Kelly: Everybody wins. Right. So, David, what financial modeling should hospitals use to project the long-term impact of retention strategies?

David: It’s actually relatively easy for a hospital, or any organization, for that matter, if they’re tracking [inaudible] turnover, to figure it out. The starting point is understanding the true cost of turnover. And most organizations underestimate turnover because they focus primarily on recruiting and hiring expenses. Those costs are only part of the picture. I mean, how do you deduct lost productivity? I mean, these are– okay, for a nonprofit hospital, that’s not a big deal. But if you’re a for-profit hospital, what you can deduct and not deduct is really important. But hospitals should also evaluate lost productivity, onboarding time, training costs, overtime, temporary staffing, management distraction, reduced continuity, and, this is key, the impact on patient care. And that’s another key issue here because, if patients have to wait too long, or if there isn’t a specialist to help that patient, or they can’t get the care they need, they go elsewhere. And the hospital loses that income that would be generated by that patient.

Kelly: True.

David: Those revenues. Once those costs are understood, leaders can compare them against the cost of a retention strategy. It costs somewhere between eight hundred thousand and a million on average to replace a physician, depending on your specialty and location. And for other skilled employees, the general rule of thumb is– it can cost more than double the salary to replace someone with skills. Now, you multiply that by the percentages of turnover that hospitals have– and the question is not simply, what does retention cost? The better question is, what does turnover cost? When organizations perform that analysis, they often discover that preventing turnover can generate a significant financial return. You see, turnover is not just an HR issue. Not anymore. It is a financial issue. It is an operations issue. And so many hospitals operate on such slim margins–

Kelly: Definitely. Yep.

David: –absolutely, that when you get rid of– when you mitigate turnover cost and literally take a portion of that cost and turn– or all of it, for that matter, and turn it into a growing and compounding asset on the balance sheet, it becomes amazing what it can do to the bottom line. And like any financial issue, it should be evaluated based on its impact on the organization’s performance and long-term profitability.

Kelly: Yeah, I mean, the true cost of turnover is key. I mean, I agree with everything that you’re saying here. So how can hospitals implement retention strategies without increasing net operating costs?

David: Oh, they so can because they already have a turnover cost. They know it. They track it. I’ve sat in on so many conversations where they talk about turnover cost percentages. And I’ve always heard them talk about, well, the turnover cost for this group, our nurses is X, and the turnover cost for this group is Y and so on. But I’ve never heard them talk about turnover in the cost of dollars. I actually, on my website, I have a free turnover cost calculator that people can go and visit and download. And they can adjust it to however they want it to work. But they will end up with right in the ballpark of what turnover is costing them. And that website is talentretentionplans.com. And it’s just so that they can get that if they would like to do that. Now, if you can take a portion of that turnover cost– and every financial professional will tell you, if you’re in business, whether you’re a for-profit or nonprofit, you have to know your costs. You take a portion of that and put that into this plan, and it mitigates the turnover cost. And remember, this is key. We’re not spending the money. We’re literally turning it into an asset on the organization’s books and the organization’s balance sheet.

It’s one of the most important questions that hospital leaders can ask. Most retention strategies are treated as expenses. This is not an expense. Higher salaries, larger bonuses, increased 401(k) contributions, retention payments and benefits. They all require the organization to spend money today. Once that money is paid, it’s gone. And employees can still leave. A different approach is to create a retention strategy that is structured as an asset rather than an expense. Under this approach, the employer funds and owns the plan. And the employee never owns the asset. And the asset remains on the organization’s balance sheet where it continues to grow and compound over time. Now, imagine what that would do if for your key people, your doctors, your nurses, your technicians, your physician assistants, and all of the people that, shall we say, that we use to build the insurance companies, if they remained in place, and they didn’t leave, wow, look what that would do to your bottom line. And that’s where the money to fund the plan comes from. We’re simply taking a cost and turning it into an asset. And now the employee agrees to stay, and they have a serious, substantial reason to stay should they fulfill their end of the agreement. That alone creates a powerful retention incentive.

But there’s another feature that makes this approach particularly attractive from a financial standpoint. Because the asset compounds over time, it can grow to a point where the employee receives a significant financial benefit that they were promised, while the organization simultaneously recovers its investment in full. In many cases organization can recover more than it invested. That means the strategy can achieve something very unusual. The employee receives a meaningful long-term benefit, the organization recovers its investment in full and then some. The plan can actually generate additional value for the organization. From a balance sheet perspective, the net cost can approach zero while improving workforce stability. That stability changes the game. Instead of asking what will retention cost us, leaders can be asking, how can retention strengthen both our workforce and our financial performance? Most retention strategies, as I said, create an expense. This strategy creates a growing and compounding asset.

Kelly: Yeah, positively affecting the bottom line for sure.

David: Absolutely, it does.

Kelly: Yeah. So, if you were advising a hospital CEO preparing to retire in the next few years, how would you structure retention to protect their legacy?

David: Every CEO wants to leave an organization stronger than they found it. It’s just the way they’re built.

Kelly: Yeah, of course.

David: Yeah. One of the greatest threats to a CEO’s legacy is instability after they leave. Key people depart. Institutional knowledge disappears. Performance suffers. Momentum slows. I would focus on strengthening retention among the hospital’s most valuable professionals before the transition occurs. The objective would be to create continuity, preserve expertise, and maintain organizational stability. A strong leadership legacy is not measured only by today’s results. It is measured by how well the organization performs after the leader is gone. Retention plays a major role in making that possible. The most successful leaders don’t simply build organizations that perform well today. They build organizations that continue performing long after they leave.

Kelly: That’s their legacy, right? They’re part of it.

David: Legacy. Yeah.

Kelly: Right. So, what separates organizations that successfully retain top talent from those that just continue to struggle?

David: Organizations that continue to struggle with retention often focus primarily on current conditions. Organizations that succeed focus on the future. The best organizations understand that talented professionals are constantly evaluating where they can build the strongest future for themselves and their families. When employees believe their future is stronger somewhere else, they leave. They’re out of there. When employees believe their future is strongest right where they are, they stay. That is why I often say that people stay where their future is strongest. The most successful organizations create a future that employees do not want to walk away from. They understand that retention is not simply an HR issue. It’s a financial issue on both sides of the equation. It’s an operational issue. It’s a leadership issue. And increasingly, it is a competitive advantage. Organizations that understand that principle and build their reputation strategies around it consistently outperform those that do not. In today’s healthcare environment, retaining highly skilled professionals is one of the most effective ways to improve stability, strengthen performance, and protect the bottom line.

Kelly: Well, thank you so much, David, for sharing all these insights with us on people’s day where their future is strongest. And also, we’re going to link to that free turnover cost calculator that you mentioned. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

David: Oh, the best and fastest and easiest way is connect with me on LinkedIn. I’m the only David Alemian on LinkedIn, so I’m easy to find. And if they go to my profile, they’ll see my email address is there, my phone number is there, my websites are there, so they can find me. I’m really passionate about this. And if people have if your listeners have questions, I’m happy to spend time with them and answer any questions that they may have. Because good health starts with good healthcare, and nothing is more important than quality healthcare.

Kelly: Completely agree. Well, thank you so much. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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Princeton, New Jersey 08540

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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: Best Practices, presented live on Wednesday, July 22, at 1 PM ET.

• What is this webinar about?
• Key takeaways
• Recap of the whole series
• Who can benefit from this webinar

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ next and final webinar in its Medicare Cost Report Appeals and Reopening series. This one focused on Best Practices. This will be live on Wednesday, July 22nd at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Thank you for having me again.

Kelly: All right, well, let’s go ahead and jump in. So, this webinar will focus on best practices. Can you give us a quick review of what we can expect in the way of best practices?

Kristin: Yes. Navigating a Provider Reimbursement Review Board appeal requires rigorous adherence to strict rules and regulations. And because of that, there are some extremely valuable best practices that you need to think about when you’re filing these appeals. The portal and the deadlines are not just suggestions, they are requirements. So, navigating those in terms of best practices and setting forth how you remember when things are due and that kind of stuff in terms of an appeal is really important. But also important is the reopening process, ensuring that you adhere to the max deadlines, and that’s the Medicare Administrative Contractors deadlines and requirements. They are different. You do things a little bit differently. So, you need to think of how you handle that and getting those filed as well. And then just in general, CMS in general, there’s so many different parts and pieces that lead into appeals and reopenings. So just trying to set yourself up for success in terms of getting these filed and following the protocols, and basically trying not to irritate the board and the MAC are very important in this process.

Kelly: Yeah, that sounds like solid advice, Kristin. And we always love best practices, so this is going to be a really great webinar. So, what do you think is going to be some key takeaways from the webinar?

Kristin:Kind of what I just said about the being able to categorize or set up maybe calendaring or other avenues to ensure that you’re meeting the deadlines. And also cataloging, keeping your documentation together in a way that somebody else can understand. We all get caught in the, I’ve done it, I’ve looked at it so much, then we forget that people aren’t exactly like us and don’t read things exactly the same. So, cataloging that in a way that others can understand and appreciate, I think, will be the greatest takeaway.

Kelly: Yeah, that sounds like a great takeaway too. So, this is the last in our Medicare Cost Report Appeals and Reopening’s webinar series. Can you do a quick recap of the first two, and how does this one fit in?

Kristin: So, the first one was a deep dive into the PRRB and the rules and the deadlines, the timeliness, the amount of controversy. Those strict requirements and then we talked a little bit about the reopening requirements. And so, all of that together then led us to, well, what are the most common issues? That was the second webinar. And we did the deep dive into the most common issues, and we gave the status, kind of case law where they were sitting right now, and what we expect, or hope, maybe, is a better word, the outcome will be for those cases. So, the third one will definitely not hit the issues and the updates. So really, if you want to learn about the most common issues, updates, that one you’ll have to go watch if you didn’t join us for the second webinar. Hopefully, you’ll join us for the taped version, so to say. But I think this third one really will kick and tie to the first one where we kind of went through everything, but this will just be a little bit different approach. So maybe the lingo might be repeated, and I might forget to give the definition for my lingo. So, I will do my best. But I invite you to look at the whole series together, because I do think the whole thing together really makes sense.

Kelly: Yeah, creates that complete picture, right?

Kristin: That’s correct.

Kelly: Yeah. So, do you have to watch the first two or watch them in order for this webinar’s content to make sense? I mean, or are they standalones?

Kristin: I don’t know that they’re necessarily standalones completely. The first one did go through in detail what we’re going to talk about in best practices. And it gave a little overview of the issues. But really, that second webinar, the diving into those issues and really telling you what the status is, where they are right now, I think really is a standalone. But in order to get there, you had to meet all of the requirements. And you have to have the best practices to ensure that you’re really not irritating your audience. You want to make sure that you’ve complied and have done things showing not to be rude, right? When the board says you have 20 days to file this, don’t do it on the 21st day. It’s just as simple as that. Just following the rules and some best practices to help get you through. The other thing is appeals aren’t new, reopenings aren’t new. So, there is a lot. 30-plus years of going through the process has really, I think, laid out for us a nice, seamless transition from, “Here’s the rules,” to, “Here’s the issues, and here’s how you keep the goodwill going with your issues and your appeals, and even your reopenings.” So we’re going to talk a little bit more about reopenings, probably, in this third series, because I think the max concerns about how we approach issues and appeals, I think it’s something that we really need to take heed of because they are the ones that are going to help you settle your cases and help push these cases through. So, I think I want to do a little bit more focus there.

Kelly: Okay, that makes a lot of sense. Looking forward to that one. So, who do you recommend attend this webinar? Who is the target audience?

Kristin: Really, anyone in reimbursement. If you are filing a cost report or even thinking about an appeal, and you’re probably filing reopenings, so anyone doing those that has always wondered, “Well, I wonder why I did my reopening this way, and I didn’t get a really good response,” or, “Wow, I thought this would move faster. I’m not sure what I did wrong. I thought I compiled the evidence.” So, I think really focusing on that and moving through that process. And maybe that’s it. Maybe you’re someone new to reimbursement. This would be a great way to kind of experience, okay, so this is what I need to do. And it’s not all going to be about rule following. Some of it is just common courtesy.

Kelly: Yeah. That makes a lot of sense, yeah.

Kristin: Oh, I was just going to say I hope everyone can join the webinar. I’m really excited about this one. I think it kind of gives you more of a– let’s me put some personal flair on it and what I’ve experienced over the years.

Kelly: Yeah, love that. Well, thanks so much for joining us, Kristen, for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings Best Practices, that we’re going to do live on Wednesday, July 22nd, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristin.

Kristin: Thank you. Have a great day, Kelly.

Kelly: Thank you. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

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Webinars

Medicare Appeals

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Medicare Cost Report Appeals and Reopenings—Best Practices Webinar [PODCAST] appeared first on Besler Holdings.

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In this episode, Lauren Schafer, Founder of Lake House Digital Media, discusses LinkedIn Tips for healthcare finance leaders.

• Why it is important for hospital finance executives to have a strong LinkedIn profile
• How a hospital finance leader can start building a LinkedIn profile
• How finance leaders can contribute to the overall marketing and social media efforts of the hospital
• Other than LinkedIn, how hospital finance leaders can help their professional profile
• The biggest mistakes someone can make on LinkedIn
• The best practices for LinkedIn

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Lauren Schafer. Lauren is the founder of Lake House Digital Media, a boutique agency helping life sciences, tech companies, and growth-minded founders build authority that actually drives demand. Lauren blends SEO, thought leadership, LinkedIn strategy, and event marketing to help complex companies become the obvious choice in their category. You’ll walk away with practical ways to earn trust faster and turn visibility into real momentum. In this episode, we’re discussing LinkedIn Tips for Healthcare Finance Leaders. Welcome, and thank you for joining us, Lauren.

Lauren Schafer: Thanks for having me, Kelly.

Kelly: Well, let’s go ahead and jump in. So why is it important for hospital finance executives to have a strong LinkedIn profile or identity?

Lauren: Financial leaders are just like anybody else on the leadership team, and that means having a really strong professional presence on LinkedIn is critical for correct positioning. It’s both for their current role, to build their own network, and for future opportunities, but it also is letting you build the hospital’s network, that healthcare network and presence to build more brand awareness and trust.

Kelly: Most definitely. Agree with that. So how would a hospital finance leader start building a LinkedIn profile if they have limited experience on LinkedIn?

Lauren: So, the biggest thing there that a lot of people miss, or they skip because they’re like, “Oh, I’m not so sure yet,” is they skip putting their photo on there. It sounds so basic, but at the end of the day, people want to know who they’re doing business with. And so, the biggest thing is make sure that you’ve got a profile picture and that it’s a current picture, right? It’s not you, maybe 20 years ago, 15 years ago, a little bit thinner, a little bit different hairstyle, but it needs to have the current position that you hold, the company that you work for, and your name, and absolutely your full professional name. So, one of my biggest pet peeves is if people do like John S., and I’m like, if they’re trying to find you, there are millions of John S’s out there. So, you need to put that full name. But then some next steps that would just kind of ease you into doing things on LinkedIn is set a timer a couple days a week, maybe two or three times a week to just log on for even 15 minutes, turn those notifications on, so if someone sees that you’re getting active and reaches out, that you don’t miss it.

But also, a good next step to start expanding their network if they haven’t had a lot of experience is connect with your employees, connect with people that are on your board and your own networks. So, start leading by example. Your employees do more on LinkedIn, but also just start connecting with people and then slowly start commenting when you’re comfortable on other people’s posts. It’s going to help you get more views. It’s going to help where you’re working, get more brand awareness, and you’re going to develop relationships through that. You don’t have to have these long, drawn out thesis type of comments, but even just like, “Hey, congrats on the new role,” or, “This is a great resource for our community.” Something that is thoughtful, but it can be short and sweet to start building that relationship on LinkedIn.

Kelly: That’s all great advice. And I do agree that the photo is key. So how can finance leaders contribute to the overall marketing and social media efforts of the hospital?

Lauren: So, the biggest thing, especially when you’re looking at LinkedIn, it is a social media network, but it’s business-minded first and foremost. And a lot of people are looking for thought leadership. They’re looking for trust and who do I know there? If something comes up, whether they are looking potentially to apply for a job or to do business with you, to be in partnership with you. But when you start having posts on there from your brand– and even little things like the employees start to share the post. Employees’ share get two times the amount of clicks that a regular company brand page gets. So, it indicates to other people, “Hey, I like working here. I don’t mind telling people that I work here, and I’m trusting the content when I’m sharing it.” So that’s a big thing, is to get your overall marketing efforts to make sure that your healthcare institution is posting optimally at least twice a week. You don’t need to post every day. But getting that brand awareness out there and then enabling your employees to say, “Hey, we want the shares, let people know if we’re sharing some–” maybe a great new project at the hospital, some new cutting-edge technology, or just a feel-good post, maybe how you’re giving back to your community. All of that is adding more brand awareness, more trust signals, and keeping you top-of-mind, so then when people do have a choice and they need something that your healthcare institution provides, you will be top-of-mind.

Kelly: I completely agree that the employees getting involved is really key to getting out the word and helping with that brand awareness of the hospital. Lauren, other than LinkedIn, how can hospital finance leaders help their professional profile and the hospital’s professional profile?

Lauren: So, a couple of things on there. You’ve got LinkedIn as a great resource, sometimes to amplify the other efforts that you’re doing. So, if the hospital, for example, has put out a press release, or if they put out some new thought leadership on an experimental– anything that they’re trying, some new technology, sharing it on LinkedIn is great. If they’ve got those resources that are on the webpage from the hospital, if they’re on a podcast, something like this, where they’re sharing new developments and things, to share those both from your website, if they’re on podcasts, to make sure that you’ve got a presence where people are looking now. And people are looking so much at AI now. So, AI is indexing posts on LinkedIn now, and it’s one of the most cited LinkedIn places, when people are putting those questions in Google or in the search engines, and those AI answers are coming back. So, it’s making sure that your healthcare institution is where people are at. If there’s video, do you have a YouTube channel? They’re free to start. Or if there is something new, a ribbon cutting with you or one of your partners, share that. You want consistent signals, both on your website, for it to be up-to-date.

You want to reach people where they’re at, whether that is searching online, whether it’s on LinkedIn, or even simple things like having just a good community newsletter. As much as I would love for people to be on LinkedIn all the time on social media, because it’s what we do, the one place that they are sure to check almost every day is their work email. And it is, one, just sending a newsletter, sharing latest developments, any big staff changes, community involvement. People open their work emails, and it’s a great place and an easy place to make sure that your institution is staying top-of-mind.

Kelly: Yeah, those are such great ideas, Lauren. Thank you for sharing those with us. What are some of the biggest mistakes someone can make on LinkedIn?

Lauren: Oh, that’s a great question, Kelly. I would say, first and foremost, having either no photo or an outdated one. So, let’s say that you have a photo that you really like, but it’s maybe 10 to 15 years old, and maybe you’ve got a little bit more gray hair, or maybe your weight is different, either way. But let’s say that someone connects with you, that maybe they want to do a new project and they’re interested and is your hospital a good partner for them? And you set a time to meet at a conference, or you set a time for coffee, and you show up and you look nothing like your picture, regardless of the integrity you have, the trust, all the things about your reputation, that first impression of you is going to make them hesitate because you don’t look like your picture. So that is my biggest pet peeve. But then a few other things is if people comment or ask you a question, if you have posted, but then you check out for a couple weeks, if you don’t respond to their comments, that’s a big mistake that people make, because then people will be less likely to comment on your post the next time. And then one other one, and then I’ll wrap this one up, is people forget that even though LinkedIn is a business platform, first and foremost, it’s a social media platform. And so, their algorithm still will reward social interactions and conversations. It’s a two-way street.

So, a lot of people go on, they’ll just post, “This is the great thing we’re doing. Look at what we’ve got new. These things are all great. Look at my promotion.” But then they post, and then they check out of LinkedIn. And other people that are congratulating them or asking questions feel ignored when you don’t respond back, or if they post something, you don’t reciprocate by commenting back. So, a big mistake that people do make is forgetting that it is a social network first and foremost, even though it’s a business platform. But to be able, it’s a two-way street.

Kelly: Definitely is. And those are some great mistakes that you pointed out. On the flip side, though, what are some of the best practices for LinkedIn that you can share with us?

Lauren: So, a lot of people that are on there are leaders in the business community. They are leaders in healthcare, and they are on there in a business mindset, right? So, some of the best practices is to make sure, are you posting thought leadership on there? Let’s say that your institution is growing, or if they’re investing in a certain area, and here’s why, and here’s either an unmet need in your community that it’s going to answer, or whatever the value is to your community and to those that you want to be in your network, the more that you can share thought leadership and show value is a great– this is a great place to do it, not only for those on LinkedIn, but again, it’s being indexed by Google. It’s being indexed and cited on AI. So, a lot of things, even if they’re just on LinkedIn, can suddenly show up in a quick excerpt that is back on an AI, an AI question that somebody asked. But it’s also another great practice is to highlight your staff. If you’ve got someone new coming in on your leadership team, it’s going to be great to announce that you guys are expanding or that this person has joined your team, if they have a new award, a new certificate. It’s great because it both is great from an HR perspective to welcome them and show that hospitality and recognition. But on the flip side, it’s also great doing other things. If you’re very involved in something that is philanthropic in your area, it’s showing your community that a place you work cares about where they’re doing business. They care about the people in the community. And all of those things just nod to your brand recognition, your brand awareness and reputation, and making sure that you have a positive association with where you’re working out in the community.

Kelly: Those are such great tips. Thanks for sharing those with us, Lauren. Any final thoughts for hospital finance leaders?

Lauren: I think here’s the thing is everybody really loves to work for a successful organization, right? But people have choices where they work for recruiting. And if something happens in their lives, a lot of communities, they have a choice of what hospital or healthcare institution that they’re going to go to. So, staying top of mind is so key in this situation. Having a good association with your brand, both for employees, for recruiting and everything, but also so that you get those patients, you get the customers and clients, in that when they have a choice and something happens, and they have to make a quick decision, there’s no choice other than where you are. So, I think that’s our final thing, is there’s a lot more to it than just posting on LinkedIn as a social media platform. It’s more about growing that brand awareness so that where you are always is top of mind for everybody.

Kelly: That’s wonderful. Thank you. Thank you so much, Lauren, for sharing your insights with us on LinkedIn tips for healthcare finance leaders. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Lauren: Well, obviously, LinkedIn is a great place. We’re on it all the time. So, we’re Lake House Digital. Lake House is two words on LinkedIn. I am on LinkedIn as Lauren Miller Schaefer. And also, if you wanted to go to our website and get in touch, we are thelakehousedigital.com, and we would love to hear from you.

Kelly: Awesome. Thanks for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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In this episode, David Beahm, President and CEO of Blanchard and Company, Inc., discusses the financial safety net for healthcare leaders.

• What the structural gap is that most healthcare CFOs and executives aren’t accounting for in their portfolios
• What diversification means in practice for a chief medical officer or a hospital executive
• The most common blind spots for high-income healthcare professionals
• ETFS and paperback gold vs. physical ownership
• What you need to know so that your wealth is both protected and accessible
• Industrial demand from AI infrastructure and green energy initiatives

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome David Beahm. David serves as the president and CEO of Blanchard and Company, Inc., the largest and oldest retail investment firm specializing in precious metals and rare coins in the United States. With over a decade of executive leadership at the firm, David stewards a legacy that began in 1975, shortly after his predecessor helped spearhead the grassroots movement to re-legalize gold ownership for private American citizens. Under his leadership, Blanchard has surpassed 800,000 clients and $1.3 billion in recent sales, maintaining a premier partnership with legendary numismatist John Albanese. David is known for his “Advisory-First” philosophy, moving the industry away from high-pressure sales toward sophisticated long-term wealth preservation and portfolio diversification.

In this episode, we’re discussing the financial safety net for healthcare leaders. Welcome, and thank you for joining us, David.

David Beahm: Thanks, Kelly. Thanks for having me.

Kelly: Yeah, well, let’s go ahead and jump in. So, hospital endowments and executive compensation packages are heavily tied to equities and bonds. And when markets correct, healthcare institutions feel it hard and fast. From your perspective, what’s the structural gap that most healthcare CFOs and executives aren’t accounting for in their portfolios?

David: So, I think the gap leads to risk in what most healthcare CFOs and the executives that work with the endowments, they underestimate the concentration of risk, and they kind of disguise it a little bit with what they call diversification. But really, on paper, if they own equities and bonds, when the day’s over with, that’s still tied to the same system. So, when you see liquidity tighten or confidence break, like we saw in 2008 and then again in 2020, that correlation that just is one. So those assets individually basically are tied to one another, and they move with one another. So, the gap right there is really the absence of a counterweight, such as gold. And because some of these portfolios lack assets that sit outside of that stock and bond financial system, what physical gold can do is actually provide them with a little bit of insurance to make sure that when those traditional types of portfolios come under pressure, it’s not as critical when you own something like gold in there. So as long as you are truly diversified and have exposure to something outside of the stocks embalmed realm, you can bridge that gap.

Kelly: Right. I know diversification is really key there. The word non-correlated gets used a lot in finance, but what does it actually mean in practice for a chief medical officer or a hospital executive sitting on a $50 million endowment committee?

David: So, when you start looking at non-correlated assets, you start thinking about a theory, and it’s really the behavior of certain assets under stress. And so, when you see an endowment or really just stocks in general drop 20% or so in a short window, some of these assets, they just move together because people are forced to sell, people are forced to raise money for margin calls, or they need liquidity. And so, everything is fair game. So, when you look at that type of movement and gold does behave that way, gold is a source of liquidity, but it’s a little bit different because it’s not dependent on earnings or credit markets such as stocks and bonds. So, for a hospital executive managing a $50 million endowment, non-correlating assets mean owning something that will hold value or even appreciate while some of the other assets are declining. So, gold’s not going to outperform assets every single year, but it provides that insurance policy and it’s there when you need it.

Kelly: Yeah, that makes a lot of sense. Thank you. So, healthcare leaders are often incredibly sophisticated when it comes to clinical risk management, but personal wealth planning is a different discipline entirely. What are the most common blind spots you see when high-income healthcare professionals come to Blanchard for the first time?

David: I think the blind spot that we see is, just in general, just the retail investor, is the overconfidence in that system we were talking about a little while ago. You spend your entire college in the finance world learning about stocks and bonds. And then, the last day you learn about gold. So, nobody really knows about it in the United States. It’s not all over the world, but in the United States, it’s not owned by as many as it should. So, healthcare leaders, because they’re trained to manage risk, they need to make sure that they have an asset that will perform or at least provide insurance. So, we consistently see a few things. One is people being overexposed to paper assets that, again, are all tied to that economic system we were talking about. And then almost more importantly is liquidity– the misunderstanding that gold is not liquid, and it is liquid, especially in a time of crisis. And then the third is, what do you really own? A lot of retail investors, a lot of managers, fund managers– that’s not really clear on what they own and what exposure it is through any sort of financial asset that they may have. So the ownership, clarity, the misunderstanding of liquidity, and then again, going back to being exposed to stocks and bonds, their traditional assets, those are the blind spots that we see.

Kelly: Yeah, I appreciate you sharing those blind spots with us. ETFs and paperback gold products are easy to buy inside a brokerage account. Many executives already hold them and think they’re covered. Why isn’t that the same thing as physical ownership? And why does that distinction matter, especially during systemic financial stress?

David: The gold market loves ETFs. When they came into the marketplace, they added a lot of demand that wasn’t there. And partly because of what you just explained, it’s easy to get in, it’s easy to get out. What our investors do is they’re looking for a long-term hold, and really the true proxy to owning gold or being exposed to gold is actually owning physical gold. So, ETF serves a great purpose, but you do have some expenses that you don’t have with owning gold. You have management fees. You have marketing fees. You have storage insurance, which you do have with owning physical gold. But those funds that are needed to actually run the ETF or taken off of the asset. So, in our mind, physical gold is really the only way to truly have a gold position. And again, you also have mining shares out there as well, exposed to the price of gold, but not– you have to worry about management, mining collapse, geopolitical risk in that area. We just feel that physical gold that we actually send to clients or arrange for storage for them is the true way of being exposed to gold.

Kelly: Very interesting take on that. So, there’s a liquidity question that comes up with physical assets. How quickly can I actually get out if I need to? How do you answer that for a healthcare executive who needs to know their wealth is both protected and accessible?

David: That’s one of the biggest things misunderstood about the physical gold market is liquidity. And physical gold and silver, for that matter, are really liquid assets. As a matter of fact, just a side note, our pilots carry gold with them when they’re overseas flying combat missions, because if they go down and they need to get from one place to another, they use gold to do it. So, for a healthcare executive, the key is structure. Really, if the metals are properly allocated, which we can help with, they’re properly stored, which we can help with and documented, they could be converted to cash fairly quickly. I mean, within a few business days, depending on where the assets are. So, what I would just emphasize is not just liquidity, but it’s the certainty of liquidity. And in a stressed market, the ability to access your gold or your capital without relying on market stability is certainly a significant advantage.

Kelly: Yeah, no, I totally agree with that. So silver is having a moment driven by industrial demand from AI infrastructure and green energy initiatives. How does that factor into the broader portfolio strategy?

David: Yeah, so silver has been on a tear because it’s uniquely positioned right now because it’s kind of in that intersection of the investment world, but also in the industrial complex. So, it’s more of an industrial commodity than gold is. The demand for the infrastructure for the AI and energy and all the electronics. We’re having emerging technologies seemingly every few months and silver is going to play a real big role with all of that. So, from a portfolio or investment standpoint, silver has just a little bit more dimension than gold, but we view silver as a complement to gold. And what we advise is to have both in your portfolio. You can say, well, why would I do that? You’re just talking about diversification. Well, that’s truly within the precious metals complex being diversified is having some exposure to gold and silver. While they do typically run together, there are certain times where one outperforms the other. So, it adds a– silver has an element of growth potential that’s really tied to real world demand. And having the right allocation of both of those working together strengthens your overall portfolio.

Kelly: Definitely. Well, thank you so much, David, for sharing your insights with us on the financial safety net for healthcare leaders. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

David: So first, our website, blanchardgold.com. And then also we have portfolio managers that help advise. So, we don’t just sell this product, we form relationships with people and we’ve been around for 50 years. So, we love talking to people on the phone to get a feel for what their goals are, what their drifters are, and that way we can put them into the right asset class. So, I would encourage anybody to call our 1-800 number. It’s 800-880-GOLD, 4653. So, it’s 800-880-4653. And we can help with any questions and hopefully help some of your listeners get involved in an asset that maybe they were a little unclear about before.

Kelly: Wonderful. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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In this episode, James Morgan, Founding Partner of Lanzone Morgan LLP, discusses how to identify nursing home abuse, prevent negligence, and evaluate care facilities.

• What is nursing home abuse and neglect?
• Most common types of nursing home abuse and neglect.
• Why are nursing home residents getting neglected?
• How are nursing homes usually paid for caring for its residents?
• The difference between nursing homes and assisted living facilities.
• What family members can do to prevent abuse from happening in a nursing home.
• How do people know if a nursing home is good or bad?
• If someone suspects that a family member is being abused in a nursing home, what should they do?

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome James Morgan. Jim is a highly respected nursing home abuse attorney, an elder abuse lawyer in California, and the founding partner of Lanzone Morgan LLP. For more than 25 years, Jim has dedicated his legal career to representing victims of elder abuse, nursing home neglect, and assisted living facility misconduct, helping families hold negligent care providers accountable. He has helped secure millions of dollars in settlements and verdicts for elderly victims and their families while pushing the long-term care industry to improve safety and accountability. He graduated cum laude from Jacksonville State University in 1991 and went on to graduate Magna cum laude from Washburn University School of Law in 1997. Jim is currently licensed to practice law in Arizona, California, and Nevada. He’s also licensed with the United States District Court, Southern District Court of California, the United States Ninth Circuit Court of Appeals, and the United States Supreme Court. Jim has also served as president of a national organization of attorneys dedicated to suing nursing homes for elder abuse.

In this episode, we’re discussing how to identify nursing home abuse, prevent negligence, and evaluate care facilities. Welcome, and thank you for joining us, Jim.

James Morgan: Thanks for having me.

Kelly: All right, well, let’s go ahead and jump in. So, let’s just start off with a pretty basic question. Jim, what is nursing home abuse and neglect?

James: Well, that’s a good starting point. Nursing home abuse and neglect can be anything from as minor– I shouldn’t say minor, but anything that doesn’t necessarily cause major injuries but is certainly concerned about somebody’s dignity, which is maybe not being showered timely, not getting changed in a timely manner if you’re sitting in your urine and feces and you can’t change yourself and make it to the restroom. Those are dignity issues, and that’s the result of neglect. If somebody is sitting in their urine and feces for hours not being changed, it may not lead to long-term problems, but it could. And then neglect can also lead to very serious injuries, such as infections from what I just described. Also, falls, fractures, falls with subdural hematomas or brain bleeds that may lead to death. And of course, probably the number one type of case we get, which is terrible bed sores from somebody sitting in the same position in bed for hours upon hours and not getting turned and repositioned. So, neglect ranges from everything from dignity issues to very serious injuries and death. But the bottom line is nursing home neglect is when nursing home residents are not getting proper care to meet their needs.

Kelly: Okay. Thank you for explaining that for us. So, what are the most common types of nursing home abuse and neglect that you see?

James: The two top cases that we take are the falls fractures or falls leading to other serious injuries and bed sores. Those are by far the most common types of injuries that lead to lawsuits. And when I say bed sores, what I’m talking about are wounds that happen at pressure points in the body when somebody’s sitting in bed. So, the most common type of pressure sore that we see is on the coccyx area where your tailbone is pushing down you’re not being turned and getting any pressure relief.

So, you get a terrible pressure sore on your coccyx or on your heels because those are also bony prominences where people can get bed sores if they’re laying in bed all the time. But other types of nursing home abuse and neglect cases are dehydration, malnutrition, especially if somebody’s on a feeding tube. Elopement cases. Elopement cases are when somebody wanders out of a facility. They might have Alzheimer’s or dementia, and they should be in a locked facility or somewhere where they’re kept safe, but they wander out of the facility and, unfortunately, can get injured. And then there’s probably fewer cases of, but certainly problematic, are the actual physical abuse of the residents, either just physical assaults or some type of sexual assault. So those are probably the most common types of neglect that we see here in our law firm.

Kelly: Wow. That’s very sad, but thank you for giving that information to us. So why are nursing home residents getting neglected?

James: Most of the neglect that we see in our cases stems from understaffing issues. Understaffing occurs when the nursing home tightens its budget to save costs and make more profit. Most nursing homes are privately owned. They’re for-profit enterprises, so people are trying to make money. And the way to make money in a nursing home is to fill every bed because that’s where you’re getting your revenue and to cut costs. And labor is by far the highest cost of running a nursing home.

So very simply put, the way to make money by owning a nursing home is to fill every bed so that you can make as much revenue as possible and to take care of those residents with as little labor as possible. When that happens, it could be a recipe for making money. But unfortunately, it’s also a recipe for neglect of the residents when there’s not enough staff to meet their needs.

Kelly: Yeah, labor does make sense to be the highest cost there. So how are nursing homes usually paid for caring for its residents?

James: Okay, so skilled nursing facilities are primarily paid by Medicare, Medicaid, private pay, or insurance. Private insurance, or maybe somebody has long-term care insurance. But the private pay and the private insurance are the lowest number of residents getting paid paying for the nursing home care that way. By far, most of the revenue in nursing homes comes from Medicare and Medicaid. Now, Medicare pays the highest amount of money to the nursing home to care for the residents. So nursing homes want Medicare patients. So, here’s what happens. An elderly person is living at home and they have a stroke or a heart attack or a fall with an injury, and they go to the hospital.

And they’re in the hospital for a few days, recovering from whatever happened. And the doctor says, “We really don’t want to send you directly home. You need some physical therapy to gain some strength. You might need to be on an IV antibiotic for a little while. We want to send you to a nursing home for some rehab.” Okay? If that person has Medicare, Medicare is going to pay for that nursing home stay. Nursing homes love this because Medicare pays the highest rate of reimbursement. So if a nursing home had its way, every bed would be filled by a Medicare patient because that’s how they’re going to make money.

That’s how they’re going to make the most money. Now, the problem is that Medicare will only pay the nursing home for about 100 days of physical therapy. After that, the resident is going to have to go either on Medicaid or private pay or insurance. And so the nursing home will want to get rid of a resident right at that 100-day mark after they’ve gotten all the money they could possibly get out of Medicare. And then all of a sudden, they might tell the family, “Hey, you got to go. They’ve reached their peak. We need to discharge them by tomorrow.” They a lot of times will give you short notice. And the nursing home doesn’t– and even if the family says, “Hey, they’re not quite ready to go home. They need some more physical therapy. They need some more care.” The nursing home’s not going to want to keep them because if they end up being a Medicaid patient, then Medicaid reimbursement is quite a bit lower than the Medicare reimbursement. So, what the nursing home wants to do is get rid of that person who ran out of Medicare days, get them out of the facility, and fill that bed with another resident who’s on Medicare. So, they can keep getting the maximum reimbursement for that bed.

So, what you’ll see in nursing homes sometimes are called Medicare wings, so where everybody on a certain hallway is a Medicare patient. And those hallways are typically staffed well because the reimbursement is good on that wing. And then you’ll see other wings that are what’s called long-term wings for long-term care residents whose stay is being paid by Medicaid or private insurance or private pay. There is a drastic difference between the Medicare wing and the long-term care wing. And when I say drastic difference, what I’m talking about is staffing and care. So when somebody comes to me with a case, it’s typically somebody who is in that long-term care wing because that wing is staffed less than the Medicare wing. We do not get a lot of cases from people who are on the Medicare wing because those wings are typically staffed better because the reimbursement is higher. So that was a long answer to tell you that most of the nursing homes pay comes from Medicare, Medicaid, private pay, and private insurance.

Kelly: That makes a lot of sense. Thank you for sharing all that with us. So are nursing homes and assisted living facilities the same thing?

James: No, no, they are not. Skilled nursing facilities– or when I say nursing home, I’m talking about a skilled nursing facility. And that’s basically a step down from an acute hospital, okay? So, when somebody leaves an acute hospital, a lot of times they will go to a nursing home, also called a skilled nursing facility, for rehab because they need more care, right, coming right out of the hospital. And the skilled nursing facilities have just what that’s described as: the skilled nursing. So, they’re going to have nurses on staff, and they’re going to have people with more medical experience at the nursing home. An assisted living facility is a step down from that. It’s somebody who doesn’t need quite as much medical care and is fairly independent, can get up themselves, can wash themselves, take a shower themselves, usually, can dress themselves, feed themselves. Assisted living facility residents simply don’t need 24-hour nursing care. But one of the big differences also is that all of those ways I described how nursing homes get paid is completely different at an assisted living facility. Assisted living facilities are primarily reimbursed by private pay. Okay? That means the families pay for the stay at the assisted living facility or long-term care insurance. Medicare does not pay for care at assisted living facilities because they don’t pay for– they only pay for the skilled nursing care, not assisted living care. So primarily private pay and primarily people who are less in need of services are the ones who are living in assisted living facilities.

Kelly: Okay. Thanks for describing those differences for us. And so, what can family members do to prevent abuse from happening in a nursing home?

James: The best thing a family can do to prevent abuse and neglect in a nursing home is to be present and to visit as frequently as possible. And not only that, but to visit at different times of the day. So, for example, I’ve had clients say, “I come every day after work, so I get there at 5:30 every day, and they’re dressed, and they’re ready for dinner. And everything looks good. So, I had no idea anything bad was happening until one day I went at lunch, and I saw that their breakfast was still sitting there. Nobody helped them eat breakfast. They’re not dressed. They’re sitting in a soiled diaper.” And so, what happens is that the nursing home staff will learn the routine of the family. If the family comes at the same time every day, that’s when the patient’s going to look like they’ve been taken care of. So, the family is going to think, “Oh, this is what’s happening 24 hours a day. Everything is great,” but that’s not necessarily the case. So, the family, if at all possible, needs to visit frequently and at different times of the day to see what’s happening morning, afternoon, and evening. Not only that, but you have to be a squeaky wheel. When something’s not right, you got to speak up and you got to say something. And when I say, “You got to say something,” I’m not talking about just to the CNA or the certified nurse assistant who’s providing direct care, who’s maybe changing the sheets or changing the diapers. You’ve got to make complaints to the head nurse or the charge nurse or the director of nurses or even the administrator because a lot of times these CNAs are overworked, they’re working a shift or maybe a double, and they’re going to be out of there. They’re not going to make any changes to the care of a resident systematically. They may change what they do on a particular shift. But when you need a change made, like you need your mom or your grandma’s medication given on time every day and that’s not happening, you need a systemic change there not just a change with one CNA. So you’ve got to make those complaints to the director of nurses or the administrator in order to hope that any systemic change is made with respect to the care of your loved one. And if that doesn’t work, then you make a complaint to the state and you tell the state what’s– your complaint is, and you call the state and you ask for a formal complaint investigation. And the state will go in there and they will investigate what your complaint is, and they’ll either substantiate it or they won’t. But that’s a good way to get the attention of the nursing home.

Kelly: That’s really good advice. Thanks, Jim. So how do people know if a nursing home is good or bad?

James: Well, I tell people my two favorite online resources for finding information out about nursing homes. And these resources will give you information on what the patient’s rights are, what the state and federal regulations are that govern the care that’s supposed to be given in a nursing home. And they’ll give you some history on the nursing homes. So, you can look up what complaints have been made against nursing homes. What complaints have been substantiated against nursing homes? How many complaints does this nursing home get compared to other complaints? I’m going to give you three total things to look for, but I’m going to tell you two websites that are super helpful to me and that I always recommend people look at. One is a California website, but it’s useful for people all over the country because a lot of the information on there refers to federal regulations, and federal regulations will govern all nursing homes, not just the ones in the state of California. But that nursing home is– I’m going to say it, and then I’m going to describe it. It’s canhr.org. C-A-N-H-R, dot org, and that stands for California Advocates for Nursing Home Reform. That website is great for all kinds of information, not just California-specific information.

But the other website that’s fantastic, believe it or not, is medicare.gov. And if you go to Google and you just type– in Google, type in Nursing Home Compare or Medicare Nursing Home Compare, either one, and the first thing that’s going to pop up is Medicare’s website that talks about nursing homes. And you’re going to be able to look for nursing homes by zip code or city. When you find nursing homes, you’re going to be able to click on them, and you’re going to be able to find out who owns that nursing home, what complaints have been made against that nursing home, what the staffing is. Medicare has a star rating, one to five stars. I don’t always look at the star rating because the star rating is based on information that the nursing home provides to Medicare. But it’s helpful more for me to look at the complaints against the nursing home and see what complaints have been substantiated against the nursing home. But let me give you one more thing to look up because you asked, “How do you know if it’s a good or bad nursing home?” I’m going to tell you something to look up that’s going to tell you if a nursing home is bad, okay?

And what I mean by that is they have been put on notice by Medicare that they may lose their federal funding unless they straighten up their act. So, I always tell people to go to Google and type in, “Special focus facility.” The special focus facility list will come up, and that will be a list of nursing homes that are of special focus to Medicare because Medicare has warned them they’ve got to straighten up their act, they’ve got to take better care of residents, or they’re going to lose their federal funding. They’re going to lose their Medicare funding. If you see a facility on that special focus facility list, I would absolutely not let a loved one go to that facility. That is the best advice I can give as far as knowing whether a nursing home is good or bad. You can’t tell by the outside of the nursing home. If it looks nice, to me, that just means they’re spending all their money on gardening and making it look pretty. You got to go in there. You got to see, “Does this place smell? Does it smell bad because they’re not changing the residents timely? Is it hot because they don’t have air conditioning?” Because believe it or not, not all nursing homes have air conditioning. So, other than just walking in and using your best judgment, those are the websites that I would go to to get information on nursing homes.

Kelly: Wow. Thanks for providing those great resources, Jim. We appreciate that. And lastly, if someone suspects that a family member is being abused in a nursing home, what should they do?

James: So back to what I said earlier, make a complaint to the director of nurses and the administrator at the nursing home, not just a verbal complaint, put it in writing. Make sure you have a letter or an email that you send to them. Or sometimes they’ll give you their cell numbers. You can put it in a text. But I always ask clients who call me, “Did you complain to the director of nurses or the administrator? And when and what did you say?” Because you need a trail of documentation showing that you put them on notice that certain things weren’t being done and certain changes needed to be made. So, I always say, “Make a complaint and be able to trace that complaint.” If that’s not sufficient for taking care of the problem, then you go to the state, and you make a complaint to the state, and you ask the state to do a complaint investigation. In California, it’s called the Department of Public Health. It’s something similar in every state, but you can go online. And you can go to that Medicare website that I told you about, Nursing Home Compare at Medicare.gov. And there will be a link to how to make a complaint against a nursing home to the state.

And so, looking at those websites and getting that information and making complaints, and if the abuse is bad enough or not being addressed still or somebody’s been injured, then you can always look for an attorney and consult with an attorney to say, “Hey, is this right? Am I wrong? What can I do? Does this rise to the level of a lawsuit? Should we do something more?” But if you type in, “Nursing home abuse and neglect lawyer,” wherever you are, I’m sure you’re going to get a lot of attorneys’ offices popping up. And talk to a law firm that specializes in that type of litigation. My advice is don’t talk to just somebody who does all kinds of personal injury, auto accidents, and falls. Talk to some law firm that specializes in suing nursing homes and assisted living facilities.

Kelly: Thank you so much for providing that for us, Jim. And thank you for sharing your insights with us on how to identify nursing home abuse, prevent negligence, and evaluate care facilities. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

James: They can go to our website, number one, which is lanzonemorgan.com, L-A-N-Z-O-N-E M-O-R-G-A-N, Lanzone Morgan. Or they can call us 888-887-9777. But if you look up Lanzone Morgan in Google, you will certainly find us pretty easily. I think we’re the only firm in the country named Lanzone Morgan.

Kelly: All right. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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The post How to Identify Nursing Home Abuse, Prevent Negligence, and Evaluate Care Facilities [PODCAST] appeared first on Besler Holdings.

In this episode, Allen Cooper, Co-founder and CEO of ReadyList Inc., discusses the cost of operational blind spots in healthcare.

In this episode, Erin Rollenhagen, Founder and CEO of People Friendly Tech discusses balancing compliance and creativity in healthcare technology innovation.

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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, presented live on Wednesday, June 17, at 1 PM ET.

• What is this webinar about?
• Who will be joining Kristin on the webinar
• Key takeaways
• What this series about
• Who can benefit from this webinar

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ next webinar in its Medicare Cost Report Appeals & Reopenings Series, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, live on Wednesday, June 17, at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Thank you for having me again. I appreciate it.

Kelly: All right. Well, let’s go ahead and jump in. So would you please tell us a little bit about this webinar?

Kristin: Well, as you mentioned, it is the second webinar in the series on cost report appeals and reopenings. And we’re really going to focus on the appeals side and the commonly appealed issues before the Provider Reimbursement Review Board. So hopefully, we kind of gave a little bit of a glimpse into what we were going to talk about in the other webinar. So hopefully, everyone coming will be ready to take that deep dive.

Kelly: Awesome. Yeah. Sounds like it’s going to be a great webinar. And you have some guests joining you on this webinar. Can you tell us a little bit about the people that will be joining you?

Kristin: I do. I have Leslie Goldsmith and Page Smith from Bass, Berry & Sims joining me. And we have done some webinars in the past together. We complement each other really well. Both Page and Leslie have an extensive background in appeals, both at the Provider Reimbursement Review Board level, the administrative level, and the court level. So, they are ready to help me kind of dive into the issues. And where they have more expertise in the area, they’ll be able to lend you their thoughts as to the status of those issues and kind of where we approach it from a legal standpoint and more of a cost reporting standpoint. So, I think together, it’s going to be a great webinar.

Kelly: I agree. I’m really looking forward to hearing you all kind of come together and complementing one another. Please share what you think some of the key takeaways will be from this webinar.

Kristin: Greatest thing will be not only an insight into what exactly the issue is that’s been appealed and determining, “Well, is this something that would apply to me, to my hospital? Are there others out there with the same issue?” and then also where it is today. Where is the issue? Are we still waiting on a decision at the Provider Reimbursement Review Board, or are we waiting on a hearing decision? And where we are in court, are these issues there? Are we expanding the ideas behind these appeals? All those insights that a provider who may not have an outside consultant or an outside lawyer that’s privy to the ongoings– I think it’s going to be a great webinar to dive into that.

Kelly: Right. I totally agree. Can you tell us a little bit more about this webinar series? The first one that we had, last month. We’re going to have another one in July. Can you just tell us a little bit about why the series came about?

Kristin: The series is really focusing on the cost report and more an appeals focus, although a lot of the issues that we appeal can also be reopening issues. And kind of the goal is once we appeal it, if we get a favorable decision, it tends to lead to the issue being more of a reopening issue and getting providers that reimbursement a little bit quicker than the appeals process tends to take. But we’re looking at it high level. We started with, “Well, what is the board? And why do we appeal? And what are the processes behind filing those appeals? And how they differ from reopenings.” But then we’re now going to move into really the meat: not only the why, but here’s what we appeal. And the status of that leading to providers having a better understanding of what might be available to them out there that are– maybe there’s other groups, they’re not comfortable doing it on their own and they want to join a group. Well, then they can see, “Okay, well, where do I fall in that? Is there opportunities for me to join that?” I think that’s really the biggest thing. And then we’re going to end kind of on a best practices from all parts and parcels, not only from the board itself, but maybe how to file the issue. Maybe there’s ways to tailor it a little bit better. So, the best practices, I think, is a great way to end the webinar. And I’m hoping that all of them together, that the people attending will be able to avail themselves of all three together, because I just think it’s a great series to help figure out, again, what do I appeal and where am I at in this process?

Kelly: Right. No, I think it’s going to be a great webinar series. Looking forward to this one and the next one. And you mentioned the people who are going to be watching this. What is the target audience for this webinar series?

Kristin: So, it really is what I call on the front lines. Those people preparing the cost reports, attending the audits, and whether it be a desk review, and then there’s a final review, final review meeting, that’s probably the front line. But we also have to have those who make the decisions, who decide, “Okay, my reimbursement manager has told me, this is an issue I need to tackle, something I need to handle. Why?” So those decision makers, the CFOs, maybe even the corporate reimbursement directors, maybe even up to the CEO, whoever’s making those decisions and really needing to understand why we have the process. And then, of course, the what. So, I think at all aspects. And then maybe if there’s documentation required – which, quite frankly, there is – maybe getting the patient financial or accounting, or whoever does the data, who would handle the data requests and the data needed to pursue these appeals. So, I think it really spreads across the organization. And so, I think those people attending really would have the best full, complete picture of the process.

Kelly: Right. No, that makes a lot of sense. Well, thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues–A Deep Dive. Join us live on Wednesday, June 17, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristin.

Kristin: Thank you.

Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Medicare Cost Report Appeals and Reopenings—Commonly Appealed Issues–A Deep Dive Webinar [PODCAST] appeared first on Besler Holdings.

In this episode, Dr. William Padula, Health Economist and Professor at the University of Southern California, and Martin Burns, CEO at Bruin Biometrics discuss the financial burden of pressure injuries.

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In this episode, Scott Linthorst, Senior Vice President of Value-Based Care for TailorCare, discusses understanding the escalating costs of musculoskeletal care.

• Why musculoskeletal care is such a major financial challenge in healthcare
• Where costs escalate in MSK episodes
• What role early navigation plays in controlling costs
• What role data or predictive analytics play
• Predictive analytics results
• What metrics hospital/health plan leaders should track

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Scott Linthorst. Scott is the Senior Vice President of Value-Based Care for TailorCare, a leading provider of specialty value-based care solutions focused on improving patient outcomes for joint, back, and muscle conditions. Scott leads the organization’s efforts to optimize outcomes under value-based care arrangements. He oversees the actuary, medical economics, and analytics teams to drive a data-informed strategy that improves clinical, financial, and operational performance. Scott has a diverse background in finance, patient engagement, and healthcare services. In his previous role at Babylon, he led the Value-Based Care Finance Function, managing over $1 billion in deals from contracting to forecasting and ongoing performance management.

Prior to that, he spent eight years at CVS Aetna and also served as the CFO of an internal startup that empowered physician-led organizations to assume medical cost risk and led FP&A teams focusing on digital health, member engagement, and virtual care initiatives. Scott also has a decade of experience as a management consultant, enhancing his strategic and analytical capabilities.

He earned a Bachelor of Science in Engineering from Columbia University. In this episode, we’re discussing understanding the escalating costs of musculoskeletal care. Welcome, and thank you for joining us, Scott.

Scott Linthorst: Hey, Kelly, great to be here with you.

Kelly: Well, let’s go ahead and jump in. So why is musculoskeletal care such a major financial challenge in healthcare?

Scott: Well, I think there are a couple things. I mean, first, musculoskeletal conditions affect about half of all adults. And in the United States, it’s about $420 billion in annual spend, the single largest specialty, more than cardiology, cancer, kidney, and it’s really closely aligned with a lot of other comorbidities, cardiovascular health, metabolic health, behavioral health. I think one of the big challenges is that it’s a mix of both chronic, think degenerative arthritis and hip or knee, and episodic costs, think acute injuries from falls or lifting something too heavy. And for patients, often the biggest challenge is just knowing where to start. Patients begin their journeys in a variety of different places. It might be their PCP, it might be with a physical therapist, it might be with other downstream specialists. And so, it’s just really fragmented and hard to figure out where the costs start and where they escalate.

Kelly: Yeah, no, that makes sense. The chronic and episodic costs that you talked about, that makes sense with this particular care that we’re discussing. So where do you typically see costs escalate in MSK episodes?

Scott: Well, the anecdote I often hear from orthopedic specialists is that patients will suffer a functional decline in silence, think you’ll put your salt shaker on the counter instead of up on a shelf. But when they get to pain, that’s what really begins to motivate action. What we see in the data is there’s little consistency across different patients’ care journeys. There’s imaging. There are specialist visits. And especially when those come before conservative care treatment options are attempted, they predispose patients towards surgery at a much higher rate than if you start with some of those conservative care options. And if there isn’t some form of clinical triage that starts at the beginning, some guidance to those patients, they often end up on the most intensive care pathways as opposed to those that might work best for them.

Kelly: No, that makes a lot of sense. Thanks for explaining that for us, Scott. So, what role does early navigation play in controlling costs?

Scott: I think there’s several things that influence cost. I think the first is just educating patients about their conditions, spending time with them, really understanding not just what is the diagnosis, but what are the functional constraints? What is the impact? And then talking to them about what are their goals, what do you want to accomplish? Are you trying to walk your grandchild down the aisle? Do you want to get back to your gardening habit? What is the thing that you want to be empowered to do? And then really exploring what are the different treatment options and modalities, and what has worked for patients similar to you? Going through that kind of shared decision-making process and navigating patients to the best providers downstream can really help control costs. When patients go through that type of navigation, they’re more likely to start with physical therapy or exercise programs, and those may help them avoid those more invasive procedures downstream.

Kelly: Yeah, no, I love what you said about shared decision-making. That totally makes a lot of sense in this particular instance. So, Scott, what role does data or predictive analytics play here?

Scott: Because there are such a different variety of places that people will start in their care journeys, try to identify patients early and before they get to some of those escalated care modalities is really important. You can identify, using predictive analytics, those patients that are just more likely to have surgery. And if you can look at those patterns and engage those patients early, sometimes you can engage them even before they get to those places that they were likely to get to downstream.

Kelly: I’m always so fascinated by predictive analytics. And I think engaging patients early, that also makes a lot of sense to me. So, what results have you seen from this model?

Scott: When we see patients that begin with that kind of structured evaluation that I talked about, when it’s clear to those patients what are the pathways that they could choose, what we frequently see is that patients choose to start on conservative care pathways, conservative treatment options, exercise programs, physical therapy before they would then continue on to more invasive or more escalated options. And I think when they do that, what we typically see is a decent number of those patients stick to those pathways and report really meaningful improvements in pain and in their function. And they also report a lot higher satisfaction. When patients feel informed, they feel supported through the process, they generally just have a more warm, fuzzy feeling, right? They feel wrapped up by the– wrapped in the warmth of the healthcare system, as opposed to just being hustled through it. And this ultimately can lead to, on average, less imaging, fewer specialist visits, and better follow-through with those conservative care treatment options. For specialist providers, it also can be a better use of clinical resources because when patients do ultimately get to those more escalated pathways to– they get in front of an orthopedic surgeon, those surgeons generally actually convert those patients to surgeries at a much higher rate. So, it’s a better use of the healthcare system resources.

Kelly: Yeah, no, I love that. I was kind of taking some notes here while you were talking because it was just so interesting. The meaningful improvements and higher satisfaction are so key, and sometimes it’s so lacking in healthcare. And I also love the better use of clinical resources. I think that’s really important. So, Scott, what metrics should hospital or health plan leaders track?

Scott: I think some of the most helpful metrics tend to be really straightforward. I mean, if you just look at utilization rates of surgeries and of imaging, I think those are really good indicators of what’s going to happen from a cost perspective. I think we often want to look at how are patients tracking and following through on conservative care pathways with a conservative care pathway like physical therapy, that can be similar, that can be utilization-based metrics. But when you’re talking about exercise programs, then you need to see where you can get that data from. Is that a digital physical therapy platform? Can you get data out of that? And we find that really useful to talk about whether or not a patient is kind of activated in their care. Ultimately, patient satisfaction is both really valuable into itself as an indicator of whether or not you’re treating patients well, but it’s also a really good leading indicator on kind of what the total cost of episodes are going to be in an outcomes basis.

Kelly: Yeah, I know that tracking metrics can be challenging, especially in healthcare. So, what should healthcare leaders understand about MSK as value-based care evolves?

Scott: I think the big thing to understand is musculoskeletal care is impactable. The costs that are in the system today do not have to be the costs that are in the system tomorrow. Conservative care treatment options are accessible, pretty well understood. And when the system actually focuses on engaging members early and coordinating care between pairs, they can make really meaningful improvements in that in a relatively short timeframe. And what we see that’s super encouraging is when there is that collaboration, that coordination between healthcare providers and health plans and other navigation organizations that are focused on engaging and educating patients, we see real improvements in financial outcomes, in patient healthcare outcomes, and ultimately in the patient’s quality of life. And that’s what we want to see.

Kelly: So, collaboration is key, right?

Scott: Totally.

Kelly: Yes. Well, thank you so much, Scott, for sharing your insights with us on understanding the escalating costs of musculoskeletal care. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Scott: Well, they can get in touch with us at tailorcare.com or you can come follow us on LinkedIn and look for TailorCare. And that’s Tailor, T-A-I-L-O-R, in case you were confusing us with Taylor Swift.

Kelly: Thanks for making that distinction there, Scott. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes our episode of The Hospital Finance Podcast. For show notes and additional resources, visit us online at besler.holdings. The Hospital Finance Podcast is a production of Besler Holdings; Built on partnership, Driven by success.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Understanding the Escalating Costs of Musculoskeletal Care [PODCAST] appeared first on Besler Holdings.

In this episode, Dave Trier, CEO of ModelOp, discusses why AI ROI becomes guesswork once systems scale.

Fixing the Systems Professionals Depend On--The Hidden Operational Drivers of Hospital Financial Performance

In this episode, Tony Paquin, Co-founder, Chairman, and CEO at iRemedy Healthcare Companies, here to discuss the hidden costs of healthcare distribution, what hospital CFOs need to know.

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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, presented live on Wednesday, May 13, at 1 PM ET.

• What is this webinar about?
• Who would benefit most from this webinar and why?
• Key takeaways
• Best practices

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ first webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, live on Wednesday, May 13, at 1 PM Eastern Time. This is our first in our Medicare Cost Report Appeals and Reopenings Series.

Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Well, thank you for having me back.

Kelly: Well, let’s go ahead and jump in today. So can you tell us what’s this webinar about?

Kristin: So, we’re going to talk about the Provider Reimbursement Review Board, at least a background of that. And then we’re really going to focus on what you need to do to preserve your appeal rights as well as your reopening rights, which are different and are handled differently. And we’ll get into a little bit of the differences and provide some best practices.

Kelly: Awesome. Sounds like it’s going to be a great webinar. So, who would benefit most from this webinar and why?

Kristin: So, most people immediately think, “Oh, this is just for reimbursement people.” But actually, people in patient financial services, even executives that maybe don’t deal with the cost report and appeals and reopenings and really don’t get into the depth. But there are data elements that we need, which usually come from patient financial services. There are cost report elements needed. And again, you need the buy-in at the top so that they understand what it takes and maybe the costs associated with filing appeals and/or reopenings.

Kelly: Well, that makes a lot of sense. So, what will be some of the key takeaways from the webinar?

Kristin: So, the key takeaway, I think, really will be, “I can have an appeal that preserves my rights, and I can have a reopening at the same time.” Most people don’t realize that. And so, I think that’s beneficial where it’s an issue that can be settled. So, the problem we’ve got with the board, right, in filing appeals is that they often take a number of years. And so, the reopening may be the faster route, not always, but maybe the faster route to getting the dollars.

Kelly: That makes sense. And yeah, I didn’t know that you could do an appeal and a reopening at the same time, so I’m sure others don’t know that as well. So, what best practices do you have for those going through an appeal or reopening?

Kristin: So don’t take any chances. Don’t just assume you’re going to be able to appeal or reopen. You need to understand the specifics of those rules and how they apply to your cost report. Protest, protest, protest, protest, that is the key. And again, file your reopenings, even if you have an appeal.

Kelly: Those are some great best practices. Thanks for sharing those with us. So why is having an external partner important for this very complex and often long process?

Kristin: The change in rules between the cost report rules, the reopening rules, the board’s rules. There are many pitfalls. And if you don’t understand how they fit together, you could lose your right to appeal or reopen. So, you’ve got to understand how that comes together. And having an external partner that focuses on the rules, the changes, ensuring that everything is filed properly, that you have the right tools to ensure that your appeal rights are protected.

Kelly: No, that makes a lot of sense. Sounds like finding the right partner is important for this process. Well, thank you–

Kristin: Definitely.

Kelly: Yeah, so thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know.  Join us live on Wednesday, May 13th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristen.

Kristin: You’re welcome. Looking forward to seeing everyone Wednesday.

Kelly: Sounds great. And thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

Podcasts
Webinars

Medicare Appeals

Contact

©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Medicare Cost Report Appeals and Reopenings–What You Need to Know Webinar [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What is this webinar about?
• Who would benefit most from this webinar and why?
• Key takeaways
• Best practices

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ first webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, live on Wednesday, May 13, at 1 PM Eastern Time. This is our first in our Medicare Cost Report Appeals and Reopenings Series.

Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Well, thank you for having me back.

Kelly: Well, let’s go ahead and jump in today. So can you tell us what’s this webinar about?

Kristin: So, we’re going to talk about the Provider Reimbursement Review Board, at least a background of that. And then we’re really going to focus on what you need to do to preserve your appeal rights as well as your reopening rights, which are different and are handled differently. And we’ll get into a little bit of the differences and provide some best practices.

Kelly: Awesome. Sounds like it’s going to be a great webinar. So, who would benefit most from this webinar and why?

Kristin: So, most people immediately think, “Oh, this is just for reimbursement people.” But actually, people in patient financial services, even executives that maybe don’t deal with the cost report and appeals and reopenings and really don’t get into the depth. But there are data elements that we need, which usually come from patient financial services. There are cost report elements needed. And again, you need the buy-in at the top so that they understand what it takes and maybe the costs associated with filing appeals and/or reopenings.

Kelly: Well, that makes a lot of sense. So, what will be some of the key takeaways from the webinar?

Kristin: So, the key takeaway, I think, really will be, “I can have an appeal that preserves my rights, and I can have a reopening at the same time.” Most people don’t realize that. And so, I think that’s beneficial where it’s an issue that can be settled. So, the problem we’ve got with the board, right, in filing appeals is that they often take a number of years. And so, the reopening may be the faster route, not always, but maybe the faster route to getting the dollars.

Kelly: That makes sense. And yeah, I didn’t know that you could do an appeal and a reopening at the same time, so I’m sure others don’t know that as well. So, what best practices do you have for those going through an appeal or reopening?

Kristin: So don’t take any chances. Don’t just assume you’re going to be able to appeal or reopen. You need to understand the specifics of those rules and how they apply to your cost report. Protest, protest, protest, protest, that is the key. And again, file your reopenings, even if you have an appeal.

Kelly: Those are some great best practices. Thanks for sharing those with us. So why is having an external partner important for this very complex and often long process?

Kristin: The change in rules between the cost report rules, the reopening rules, the board’s rules. There are many pitfalls. And if you don’t understand how they fit together, you could lose your right to appeal or reopen. So, you’ve got to understand how that comes together. And having an external partner that focuses on the rules, the changes, ensuring that everything is filed properly, that you have the right tools to ensure that your appeal rights are protected.

Kelly: No, that makes a lot of sense. Sounds like finding the right partner is important for this process. Well, thank you–

Kristin: Definitely.

Kelly: Yeah, so thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know.  Join us live on Wednesday, May 13th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristen.

Kristin: You’re welcome. Looking forward to seeing everyone Wednesday.

Kelly: Sounds great. And thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post Medicare Cost Report Appeals and Reopenings–What You Need to Know Webinar [PODCAST] appeared first on Besler Holdings.

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In this episode, Beth Raboin, Founder & CEO of Global Medical Virtual Assistants, discusses using tech to boost patient care and streamline operations.

• What is a medical virtual assistant?
• Where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?
• How GMVA ensures medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely
• How the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices
• Where’s the best place to start to ensure long-term ROI?
• What other hospital departments are a good fit for medical virtual assistance?

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Beth Raboin. Beth is leading GMVA in vision in the day-to-day business operations securing the functionality of the business to drive extensive and sustainable growth. Combining her strong leadership and determination with over 22 years of corporate experience in the private and public sector of surgical device, pharmaceutical, and specialty pharmacy industries, she keeps the company moving forward with high-level strategy while understanding the details of day-to-day execution to ensure steadfast success.

Prior to Beth’s corporate and entrepreneur experience, she competed as a full athletic scholarship athlete as a Division 1 gymnast at the University of Florida, where she graduated with a Bachelor of Science in Health Sciences.

In this episode, we’re discussing using tech to boost patient care and streamline operations. Welcome, and thank you for joining us, Beth.

Beth Raboin: Oh, thank you so much for having me, Kelly. I’m so excited to be here.

Kelly: We’re excited to have you. So, let’s go ahead and jump in. So, for listeners who may be newer to the concept, what exactly is a medical virtual assistant? And how do they differ from traditional outsourcing models?

Beth: Yeah, oh thank you so much. Starting with a big question there, Kelly. So, first of all, medical virtual assistants are additional staff that you can bring into your hospital or medical practice to help facilitate some of the back office work that needs to happen. So, we do not do clinical care. Medical virtual assistants do all of the clerical and/or administrative patient care that happens behind the scenes. So that’s the differentiator between your typical in-hospital setting versus bringing in a medical virtual assistant. And how we’re different from other models is you’re not outsourcing. You’re not sending and outsourcing all of the work elsewhere. That’s not how it works. We are actually more like an insource. We’re additional staffing that’s brought into your medical practice and/or hospital to do the work that needs to get done within your tools, within your systems, within your workflows. And so, we’re actually integrated as part of the team.

Kelly: I love that. It’s so intriguing. From a financial standpoint, where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?

Beth: Oh, gosh. Well, so we’re a fraction of the cost of what it would be to hire someone here in– within the hospital system within the United States. We are outside of the United States, so we’re mainly in the Philippines where the cost of living is lower. So therefore, the cost structure for our business model is also lower. And where they can utilize our services is just, it’s endless. Where we’re seeing where we’re a huge asset– for example, we just were onboarded this past year with a huge healthcare hospital system on the West Coast. They brought us just in to do patient access to fill in some open appointments, making sure patients are going to show up to their appointments, and then backfilling the appointments within the schedule that those patients were not going to show up to. And they saw an immediate, an immediate, I think it was like $2 or $3 million difference in their bottom line just within two quarters. So that’s just one simple example. We’ve also been brought in heavily within the hospital systems, within revenue cycle management. Collecting dollars is critical for hospital systems, making sure that denied claims are in fact paid. And so the resubmittal of claims, following up on denied claims, making sure that patient balances are paid, all of that. So that also is a really big– a really great place to be able to bring in our staff to help and augment the way things are being done within that hospital.

Kelly: Wow, I mean, so some significant savings there. That’s awesome. So how does GMVA ensure medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely?

Beth: Yeah, well, so there’s a few different ways we do that. Number one, we’re hiring professionals, right? We’re hiring people who have a bachelor’s degree, a bachelor’s degree, typically in nursing. They understand healthcare. They understand HIPAA and PHI. And so, they’re put through obviously a HIPAA certification class, so they’re HIPAA-certified, but that’s not enough. That’s just not enough to ensure patient information is– it’s just not enough to make sure patient information is protected, right? So, we put in additional safeguards and everyone works remotely, they’re not working within a call center, they’re working from their home. So, we’ve put additional software security on their computer systems to make sure that they’ve got a closed network that they’re working within. So, they’re logging directly into the client’s EMRs, directly into the client’s tools, and we need to make sure that there’s no nefarious actors or viruses are able to penetrate the system. So, we’ve got a pretty substantial, what we call a blue box on their computer, and they’re working within the safeguards of that system. It’s amazing. It’s been one of the things that we heavily invested in just to ensure that we’re protecting patient information. But beyond that, we’re also protecting the tools of our clients because we all know that viruses and/or nefarious actors are working consistently to try to break into hospital systems, break into hospitality, break into banks, and any possible way that they can try to penetrate a closed off system. So, we do everything within our power to make sure that we’re keeping patient information protected.

Kelly: Yeah, I know HIPAA compliance is so important. And for lack of a better term, it’s an epidemic that we’re just kind of hitting. We’re being hit with all these bad actors all the time. So, it’s just a constant issue, isn’t it?

Beth: Oh, constantly. So, I mean, we’re all getting them even into our private email addresses, work email addresses, people sending over what you think looks like a real invoice, but it’s not a real invoice. You click on it, before you know, you’re in trouble. So yeah, we’re trying to do the absolute best we can to keep up to date on protecting any and all software that we’re logging into.

Kelly: Definitely, yeah. So how does the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices?

Beth: Yeah, I mean, the scaling is one of the things that we’ve really become a specialist in. What we do is the onboarding of our services can be– that’s where you have more skin in the game, and there’s a good six to eight weeks of training us on your tools, your systems, your strategies, your service level agreements that we work out with you. That’s where really that’s some of the hurdles you need to get over in the beginning. Once we do that, we have all the training materials necessary to then scale with you, so your team is no longer having to do the training, right? So, scaling has really been one of the wonderful things that we can do really quickly and efficiently. And hospital systems for sure– like I said, I had mentioned one particular hospital system. We had another hospital system we also started with last year that just wanted to start with 10 medical virtual assistants. And within a month’s time, they were like, “Wow, this is really working out amazing.” And they’ve already scaled up over 75. And so we’re able to be able to do that for them and really kind of keep up with the pace of what’s necessary and intending to bring in really great talent to be able to do and meet the service level agreements that we’ve come up with along with our client to make sure that we’re bringing nothing but the best in terms of patient service. So yeah, it’s been an interesting, fun business model. I love the scaling piece of it. It’s one of the things that we’ve I’m really great at. And it is different for a large practice or a large medical system versus a smaller practice. Smaller practices, they just don’t see the huge patient volume that a large system would see. And so, but we can still manage and handhold them through bringing on one, two, three virtual assistants. But in a hospital system, we can bring in 25, 50, 75, 150 virtual assistants and scale and keep them and manage them.

Kelly: Yeah, that sounds pretty awesome. I mean, I love what you said about scaling with you. That seems like something that you got that is very valuable. So, for a CFO or revenue cycle leader considering medical virtual assistance for the first time, where’s the best place to start to ensure long-term ROI?

Beth: Yeah. I mean, of course, one of the first places you would want to start– any one of us would want to start is where we can make an immediate impact to the bottom line, so whether that’s patient balances, whether that’s following up on denied claims, whether it’s submittal of claims. As we become more and more infiltrated into some of the hospital systems, we’re learning that there’s large amounts of balances that are still not on the balance sheet, that just have not been paid to the bottom line yet. That’s where we can make an immediate impact. How we are different than other outsourced companies is we don’t take a fee for that. That’s not how we function. We don’t get a percentage of what is collected. That’s just not what we do. We are additional staffing. We are butts in seats to do the actual work. And so that also is a really great benefit to the hospital or medical system because then they’re not losing part of that revenue to an outside source. And so that also is an additional part of the way we function in terms of bringing an additional asset to the team without getting a part of what those payouts would look like or a percentage of those fees.

Kelly: That sounds pretty awesome. Beyond those revenue cycle teams, what other hospital departments are a good fit for medical virtual assistance?

Beth: Most definitely anything within specialties. Specialties are really where we shine. We have extensive training internally for particular specialties. So, our medical virtual assistants are very well versed in the types of procedures that they’re going through, whether it’s in neurology or it’s the cardiac unit or it’s in the fertility space. We become quite versed in being able to have those conversations with patients or internally with the existing staff, knowing the medical terminology is there. We understand the patient journey. We understand the procedures that are taking place. We understand the medications that the patients are being given. So, when it comes to be doing prior authorizations for patient medication or prior authorizations for getting diagnostic care or getting the procedures done, we can do all of that. So, we really fit really nicely in every piece of the model within revenue cycle management, if you include prior auths and insurance verification as part of that journey. We can do all of that. But patient facing, patient access is also something we’re really, really fantastic, and we have a great fit within models of the patient access.

Kelly: Yeah, that makes a lot of sense. Well, thank you so much, Beth, for sharing your insights with us on using tech to boost patient care and streamline operations. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Beth: Yeah, we’d love you. Just go right to our website. You can find so much information. So, it’s https://gmva.com/, and that’s Global Medical Virtual Assistants dot com. And we’ve got voice recordings there of what our virtual assistants sound like. We have podcasts like yours, Kelly, will be on there kind of listening to hear what we’ve done or what we do, as well as a whole host of other resources, and also a way to be able to quickly schedule a strategy session to have a meeting with us and have a Zoom call with us to get a better understanding of how we can fit into your model.

Kelly: Great. Well, thank you for providing that for us, Beth. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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The post Using Tech to Boost Patient Care and Streamline Operations [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What is a medical virtual assistant?
• Where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?
• How GMVA ensures medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely
• How the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices
• Where’s the best place to start to ensure long-term ROI?
• What other hospital departments are a good fit for medical virtual assistance?

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Beth Raboin. Beth is leading GMVA in vision in the day-to-day business operations securing the functionality of the business to drive extensive and sustainable growth. Combining her strong leadership and determination with over 22 years of corporate experience in the private and public sector of surgical device, pharmaceutical, and specialty pharmacy industries, she keeps the company moving forward with high-level strategy while understanding the details of day-to-day execution to ensure steadfast success.

Prior to Beth’s corporate and entrepreneur experience, she competed as a full athletic scholarship athlete as a Division 1 gymnast at the University of Florida, where she graduated with a Bachelor of Science in Health Sciences.

In this episode, we’re discussing using tech to boost patient care and streamline operations. Welcome, and thank you for joining us, Beth.

Beth Raboin: Oh, thank you so much for having me, Kelly. I’m so excited to be here.

Kelly: We’re excited to have you. So, let’s go ahead and jump in. So, for listeners who may be newer to the concept, what exactly is a medical virtual assistant? And how do they differ from traditional outsourcing models?

Beth: Yeah, oh thank you so much. Starting with a big question there, Kelly. So, first of all, medical virtual assistants are additional staff that you can bring into your hospital or medical practice to help facilitate some of the back office work that needs to happen. So, we do not do clinical care. Medical virtual assistants do all of the clerical and/or administrative patient care that happens behind the scenes. So that’s the differentiator between your typical in-hospital setting versus bringing in a medical virtual assistant. And how we’re different from other models is you’re not outsourcing. You’re not sending and outsourcing all of the work elsewhere. That’s not how it works. We are actually more like an insource. We’re additional staffing that’s brought into your medical practice and/or hospital to do the work that needs to get done within your tools, within your systems, within your workflows. And so, we’re actually integrated as part of the team.

Kelly: I love that. It’s so intriguing. From a financial standpoint, where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?

Beth: Oh, gosh. Well, so we’re a fraction of the cost of what it would be to hire someone here in– within the hospital system within the United States. We are outside of the United States, so we’re mainly in the Philippines where the cost of living is lower. So therefore, the cost structure for our business model is also lower. And where they can utilize our services is just, it’s endless. Where we’re seeing where we’re a huge asset– for example, we just were onboarded this past year with a huge healthcare hospital system on the West Coast. They brought us just in to do patient access to fill in some open appointments, making sure patients are going to show up to their appointments, and then backfilling the appointments within the schedule that those patients were not going to show up to. And they saw an immediate, an immediate, I think it was like $2 or $3 million difference in their bottom line just within two quarters. So that’s just one simple example. We’ve also been brought in heavily within the hospital systems, within revenue cycle management. Collecting dollars is critical for hospital systems, making sure that denied claims are in fact paid. And so the resubmittal of claims, following up on denied claims, making sure that patient balances are paid, all of that. So that also is a really big– a really great place to be able to bring in our staff to help and augment the way things are being done within that hospital.

Kelly: Wow, I mean, so some significant savings there. That’s awesome. So how does GMVA ensure medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely?

Beth: Yeah, well, so there’s a few different ways we do that. Number one, we’re hiring professionals, right? We’re hiring people who have a bachelor’s degree, a bachelor’s degree, typically in nursing. They understand healthcare. They understand HIPAA and PHI. And so, they’re put through obviously a HIPAA certification class, so they’re HIPAA-certified, but that’s not enough. That’s just not enough to ensure patient information is– it’s just not enough to make sure patient information is protected, right? So, we put in additional safeguards and everyone works remotely, they’re not working within a call center, they’re working from their home. So, we’ve put additional software security on their computer systems to make sure that they’ve got a closed network that they’re working within. So, they’re logging directly into the client’s EMRs, directly into the client’s tools, and we need to make sure that there’s no nefarious actors or viruses are able to penetrate the system. So, we’ve got a pretty substantial, what we call a blue box on their computer, and they’re working within the safeguards of that system. It’s amazing. It’s been one of the things that we heavily invested in just to ensure that we’re protecting patient information. But beyond that, we’re also protecting the tools of our clients because we all know that viruses and/or nefarious actors are working consistently to try to break into hospital systems, break into hospitality, break into banks, and any possible way that they can try to penetrate a closed off system. So, we do everything within our power to make sure that we’re keeping patient information protected.

Kelly: Yeah, I know HIPAA compliance is so important. And for lack of a better term, it’s an epidemic that we’re just kind of hitting. We’re being hit with all these bad actors all the time. So, it’s just a constant issue, isn’t it?

Beth: Oh, constantly. So, I mean, we’re all getting them even into our private email addresses, work email addresses, people sending over what you think looks like a real invoice, but it’s not a real invoice. You click on it, before you know, you’re in trouble. So yeah, we’re trying to do the absolute best we can to keep up to date on protecting any and all software that we’re logging into.

Kelly: Definitely, yeah. So how does the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices?

Beth: Yeah, I mean, the scaling is one of the things that we’ve really become a specialist in. What we do is the onboarding of our services can be– that’s where you have more skin in the game, and there’s a good six to eight weeks of training us on your tools, your systems, your strategies, your service level agreements that we work out with you. That’s where really that’s some of the hurdles you need to get over in the beginning. Once we do that, we have all the training materials necessary to then scale with you, so your team is no longer having to do the training, right? So, scaling has really been one of the wonderful things that we can do really quickly and efficiently. And hospital systems for sure– like I said, I had mentioned one particular hospital system. We had another hospital system we also started with last year that just wanted to start with 10 medical virtual assistants. And within a month’s time, they were like, “Wow, this is really working out amazing.” And they’ve already scaled up over 75. And so we’re able to be able to do that for them and really kind of keep up with the pace of what’s necessary and intending to bring in really great talent to be able to do and meet the service level agreements that we’ve come up with along with our client to make sure that we’re bringing nothing but the best in terms of patient service. So yeah, it’s been an interesting, fun business model. I love the scaling piece of it. It’s one of the things that we’ve I’m really great at. And it is different for a large practice or a large medical system versus a smaller practice. Smaller practices, they just don’t see the huge patient volume that a large system would see. And so, but we can still manage and handhold them through bringing on one, two, three virtual assistants. But in a hospital system, we can bring in 25, 50, 75, 150 virtual assistants and scale and keep them and manage them.

Kelly: Yeah, that sounds pretty awesome. I mean, I love what you said about scaling with you. That seems like something that you got that is very valuable. So, for a CFO or revenue cycle leader considering medical virtual assistance for the first time, where’s the best place to start to ensure long-term ROI?

Beth: Yeah. I mean, of course, one of the first places you would want to start– any one of us would want to start is where we can make an immediate impact to the bottom line, so whether that’s patient balances, whether that’s following up on denied claims, whether it’s submittal of claims. As we become more and more infiltrated into some of the hospital systems, we’re learning that there’s large amounts of balances that are still not on the balance sheet, that just have not been paid to the bottom line yet. That’s where we can make an immediate impact. How we are different than other outsourced companies is we don’t take a fee for that. That’s not how we function. We don’t get a percentage of what is collected. That’s just not what we do. We are additional staffing. We are butts in seats to do the actual work. And so that also is a really great benefit to the hospital or medical system because then they’re not losing part of that revenue to an outside source. And so that also is an additional part of the way we function in terms of bringing an additional asset to the team without getting a part of what those payouts would look like or a percentage of those fees.

Kelly: That sounds pretty awesome. Beyond those revenue cycle teams, what other hospital departments are a good fit for medical virtual assistance?

Beth: Most definitely anything within specialties. Specialties are really where we shine. We have extensive training internally for particular specialties. So, our medical virtual assistants are very well versed in the types of procedures that they’re going through, whether it’s in neurology or it’s the cardiac unit or it’s in the fertility space. We become quite versed in being able to have those conversations with patients or internally with the existing staff, knowing the medical terminology is there. We understand the patient journey. We understand the procedures that are taking place. We understand the medications that the patients are being given. So, when it comes to be doing prior authorizations for patient medication or prior authorizations for getting diagnostic care or getting the procedures done, we can do all of that. So, we really fit really nicely in every piece of the model within revenue cycle management, if you include prior auths and insurance verification as part of that journey. We can do all of that. But patient facing, patient access is also something we’re really, really fantastic, and we have a great fit within models of the patient access.

Kelly: Yeah, that makes a lot of sense. Well, thank you so much, Beth, for sharing your insights with us on using tech to boost patient care and streamline operations. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Beth: Yeah, we’d love you. Just go right to our website. You can find so much information. So, it’s https://gmva.com/, and that’s Global Medical Virtual Assistants dot com. And we’ve got voice recordings there of what our virtual assistants sound like. We have podcasts like yours, Kelly, will be on there kind of listening to hear what we’ve done or what we do, as well as a whole host of other resources, and also a way to be able to quickly schedule a strategy session to have a meeting with us and have a Zoom call with us to get a better understanding of how we can fit into your model.

Kelly: Great. Well, thank you for providing that for us, Beth. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post Using Tech to Boost Patient Care and Streamline Operations [PODCAST] appeared first on Besler Holdings.

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In this episode, Tom Furr, CEO and Founder of PatientPay, discusses how the Shift in ACA enrollment is driving more high deductible health plans.

• How the reduction in ACA enrollment numbers are affecting out-of-pocket payments
• How should providers prepare for this change in coverage
• Long-term projections

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Vrajesh Bhavsar. VJ is an engineer with a Master’s in Computer Science from USC and over 20 years of experience building hardware and software products. VJ built core technologies for iOS and Mac OS, including dynamic tracing, data protection, and secure enclave at Apple. He holds eight patents in distributed systems, data, and security. He is passionate about building technology-first businesses that drive positive human impact at scale.

In this episode, we’re discussing the AI security blind spot that healthcare can’t afford to ignore. Welcome, and thank you for joining us, VJ.

Vrajesh Bhavsar: Hey, thank you for having me.

Kelly: Well, let’s go ahead and jump in. So, AI is being deployed across healthcare at a remarkable pace. From a cybersecurity standpoint, what’s the risk that most hospital leaders still don’t fully appreciate?

VJ: That’s a great question. And it’s such an exciting time that we are living in. There are so many new innovations coming to the entire space. And the impact of AI in so many different areas gets really exciting for a lot of industries where this kind of innovation is needed. And, of course, healthcare has so many different areas where AI can be applied, but also there are a lot of risks that come in when you are exposing this kind of critical area of safety and care to this kind of new innovation. And so the big risks that we see in a lot of interactions we are having is how when you have a lot of kind of new innovation getting sprinkled across use cases and areas where you didn’t really understand the full scope and things are operating without a lot of visibility, especially in the deep areas where sensitive data is in question and you have patient information as well as ways that a lot of the third party systems are going to interface with these things. That’s where there are so many risks that it’s not fully understood and appreciated.

And the thing that really gets people is that we are used to kind of operating with these innovative systems in kind of traditional systematic ways, that A plus B results in something. But in the world of non-determinism, where there are a lot of new attacks coming in, the level of risk really, really goes to the roof. And the kind of attacks that have come through in terms of prompt injection or zero-click, and a lot of things that have been reported across the industry, and we have done some of the work ourselves. It really throws people back into like, “Oh, wow, I didn’t realize that this can really exfiltrate the data at such scale and such speed.” And the level of protections and defenses that people had through traditional tools are now out of question.

Kelly: Yeah, it’s definitely an interesting time in healthcare and AI, and there’s a lot to consider there. You recently discovered a zero-click vulnerability that can silently extract complete patient records without leaving a trace. What does that mean in plain terms, and why is it a signal of a much larger industry problem?

VJ: That’s a very interesting question. And I think as an industry, we have been trying to get everyone to kind of understand that, “Hey, don’t respond to random emails, don’t share credentials, don’t go chase random links and all that, right? But what’s happening in the world of AI is that without users taking any of such risky actions, now you can have a massive exposure and that’s what zero click refers to. And what we discovered is that a lot of these AI systems as they are interfacing with so many different data sources and all the records and all that, they can actually go take the credentials and access that you have given them and try to be helpful in ways that can actually result in data exfiltration and leakage at a massive scale. And so, what we are finding is there are the kind of attacks that come through in AI systems that are prompt injection or jailbreak attempts. And those things are getting embedded in documents, in ways that are invisible to the human eye, but those instructions mean a lot to what an AI system or an agent bot is going to do.

And that’s where, now, you are bringing– you have so many, so much intelligence baked into these AI stacks that they are trying to be super helpful and trying to kind of take all these instructions that are embedded and the users didn’t do anything wrong, but this is where some of the attacks that are coming through. Some of the ones that we have discovered and the industry has discovered, even Anthropic reported several different types of attacks. And there is a lot of education needed in the industry to really kind of understand the scale and scope of what these intelligent, non-deterministic systems bring in these critical environments.

Kelly: Completely agree. There’s definitely a lot of education required for us. VJ, HIPAA was built for predictable human-reviewed workflows. How does autonomous AI fundamentally challenge the compliance model healthcare has spent decades building?

VJ: I know. This is where we are really passionate about like there is so much to be done, and I know HIPAA is trying to catch up on a lot of the new innovation. But at the end of the day, there is kind of like an inert way in which HIPAA assumes there are human accountability layers behind all the different decisions that are getting made. And I think that’s the thing that gets thrown out the window when you bring in agentic AI. And in these environments where you are passing responsibility, you’re passing autonomy, you’re passing decision-making capabilities to agents and at a speed of machine speed at which you can access so many different systems all at once and try to be helpful. That’s where there is no mechanism in place to even understand what these systems are trying to do. And beyond understanding, you need to actually govern and bring controls into these environments, right? And I think that’s kind of the core to a lot of the challenges and what we refer to it as runtime visibility and runtime controls.

And when these agents are getting born and they are trying to figure out, like, “Okay, what are the instructions given to me?” And I’m going to try to make sense of that. I’m trying to access the systems that are available to me, and sometimes they overreach. And that’s when these breaches happen. That’s when, kind of, unexpected consequences happen. That’s when you end up with a non-compliant system. So, I think there is a lot to be done. I think the industry was still just catching up on what was happening in the world of microservices and all the API ecosystem. And now we have leaped directly into agentic environments. And I think that requires a full depth understanding of what all things are happening to stay compliant.

Kelly: Yeah, there’s definitely a lot of things happening right now, and I know HIPAA complicates things as well. So why do traditional security tools struggle to keep pace with the way AI actually moves data inside a health system?

VJ: Yeah, this is where we have gone through such massive waves in the last 30, 40, 50 years, right? And AI agents, and that’s a big, big one, that is going to completely change how security tooling and security requirements would work. But as you think about when cloud came about, there was a very bare bones kind of understanding of, okay, how am I protecting different network systems and databases? And this is very, very early on when you had your data centers, and firewalls came about to actually stop access to different parts of the data system, where different parts of the data center where you might have databases or critical data that you want to protect from different attacks. And over the years, we had usage of mobile and now usage of APIs, and there are so many different technologies have come into play, and you need a different approach for all these different technology adoptions that are going on.

And so, as you think about what is happening in the layers of APIs, in the layers of AI, in the layers of agent, you kind of need a very different AI layer firewall, right? The traditional things that used to be at the network layer, just trying to make sure that computer A doesn’t talk to computer B, it now needs to translate in the way that, hey, agent A cannot talk to agent B or agent A cannot talk to the patient record systems, or it needs to get permission from a human before it does that. And all those things are happening at such scale. We see so many stats about thousands of agents running and doing all these things every day in every enterprise. And so, when such speed and scale is at play, you’re going to need a different tool, a different system to tackle these systems, and it cannot be just a manual process. That’s kind of where a lot of the traditional tools fall apart because they relied on kind of checking the external boundaries, but they don’t know what is going on inside these environments. The tools used to be, oh, I’m going to scan code and try to make sure there is no threat lurking inside.

But when the code is being generated in real time by these agents, they’re coming up with new API endpoints on their own. They’re coming up with MCP servers on their own. And so, what do you do when this new code is getting generated on the fly? What do you do when intent and instructions can drift and can change over time? And that’s where you need something that is understanding what kind of actions are going on and make sure that you’re going to stay compliant as well as not bring more threats and risks into your system.

Kelly: Makes a lot of sense. Thanks for explaining all that for us. Beyond regulatory exposure, what’s the real financial and reputational cost when a healthcare AI deployment goes wrong? And is the industry pricing that risk correctly?

VJ: Look, there are a lot of people trying to understand a lot around pricing the risk and what to do in care of the benefits and kind of threats that come through. And I feel like we’ll learn a lot over the coming couple of years that how this translates in practical life, but definitely there’s a big shift needed, right? With the scale at which these agents can access the number of records, that’s really scary to be honest. There are different types of compliance rules and regulations around like, “Hey, XYZ number of records breached results in XYZ kind of fine.” Well, but also when you have the loss of trust, let’s say patients were trusting some EHR system or some hospitals and other systems with their private information that now suddenly when you have a massive scale breach, that trust is lost, there will be a lot of questions around like, well, do I want to be passing on all my data to the system that has a lot of security risks. But beyond that, there were a year or two ago, a couple of years ago now, where there was a massive outage at airports and airlines where some cybersecurity vendor was not able to deploy things properly.

And those type of operational risks that come in that can really bring down some of these systems and healthcare being such a critical infrastructure requires a level of kind of risk analysis before you put in AI into these environments where if something goes wrong, it can terribly, terribly bring down the entire infrastructure. And I mean, I think those things are obviously questions that a lot of the leaders are thinking through. A lot of the security teams that we talk to, the legal, financial teams that we interface with. And so those are things that are still kind of in flux and hopefully we’ll find ways to keep bringing innovation while also kind of bringing in the right guardrails and safety measures along the way.

Kelly: Yeah, no, definitely agree with all that. And what you were talking about, the lost trust really resonated with me because it seems like once that trust is lost, it’s hard to regain. VJ, for a CCO or Chief Compliance Officer who has already deployed AI across their organization, what are the first steps they should take to understand their actual exposure?

VJ: There’s a classic saying: You can’t secure what you can’t see, right? And I think in the world of AI and agents and APIs, I think a lot of leaders are realizing that discovery means a completely different thing at this point. A lot of teams have had engineering observability tools or some form of access visibility and all that. But I think what we are seeing is that as teams try to understand like, “What is going on? Okay. My teams have already deployed all this AI. They are using all these AI tools, or they have deployed agents in certain ways. Just getting visibility into what’s going on. That’s where everyone has to start.”

And being able to do that in all these different use cases and areas, so whether it’s employees using AI clients and talking to different AI systems and trying to, whether it’s private or public kind of exposure, there is a lot to be done in just understanding that exposure. When you have your EHR information or EHR systems as well as your other cloud environments, whether they are running on hybrid, private, there are a lot of different systems. People have to start with what are the AI models running? What are the agents running? And we’ve come across teams that feel like, “Oh, yeah, I have XYZ tool that gives me AI, SPM, and I know the five models that I’m running.” And when we actually go show them like, well, actually it’s not five. It’s like 97.

That really shocks people. And that type of sprawl has happened so fast in the last year or two that getting access to the telemetry that gives you that type of visibility, it’s something that is actually available, right? It’s such a daunting task to know what is going to come through. With kind of full visibility, we call it discovery. We talk about getting the right telemetry from the layers at which AI operates, layers at which agents talk to different agents and systems over APIs and MCPs. And if the leaders are uncomfortable kind of knowing like, “Do I really know how many things are running?” and that’s kind of the big gap that you have to start closing, and from there, you can set up the right processes around detecting the risks and then defending and controlling and governing all these different systems that are in your purview.

Kelly: Well, thank you so much for providing all that great information and for sharing your insights with us, VJ, on the AI security blind spot that healthcare can’t afford to ignore. If a listener wants to learn more, contact you to discuss this topic further, how best can they do that?

VJ: You can reach us on our website, operant.ai, and I’m also reachable on email directly, vrajesh@operant.ai. Thank you so much.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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The post The AI Security Blind Spot That Healthcare Can’t Afford to Ignore [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What’s the AI risk that most hospital leaders still don’t fully appreciate
• Zero-click vulnerability
• How autonomous AI fundamentally can challenge the compliance model healthcare
• Why traditional security tools struggle to keep pace with the way AI actually moves data inside a health system
• What the real financial and reputational costs are when a healthcare AI deployment goes wrong
• What the first steps are to take to understand their actual exposure

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Vrajesh Bhavsar. VJ is an engineer with a Master’s in Computer Science from USC and over 20 years of experience building hardware and software products. VJ built core technologies for iOS and Mac OS, including dynamic tracing, data protection, and secure enclave at Apple. He holds eight patents in distributed systems, data, and security. He is passionate about building technology-first businesses that drive positive human impact at scale.

In this episode, we’re discussing the AI security blind spot that healthcare can’t afford to ignore. Welcome, and thank you for joining us, VJ.

Vrajesh Bhavsar: Hey, thank you for having me.

Kelly: Well, let’s go ahead and jump in. So, AI is being deployed across healthcare at a remarkable pace. From a cybersecurity standpoint, what’s the risk that most hospital leaders still don’t fully appreciate?

VJ: That’s a great question. And it’s such an exciting time that we are living in. There are so many new innovations coming to the entire space. And the impact of AI in so many different areas gets really exciting for a lot of industries where this kind of innovation is needed. And, of course, healthcare has so many different areas where AI can be applied, but also there are a lot of risks that come in when you are exposing this kind of critical area of safety and care to this kind of new innovation. And so the big risks that we see in a lot of interactions we are having is how when you have a lot of kind of new innovation getting sprinkled across use cases and areas where you didn’t really understand the full scope and things are operating without a lot of visibility, especially in the deep areas where sensitive data is in question and you have patient information as well as ways that a lot of the third party systems are going to interface with these things. That’s where there are so many risks that it’s not fully understood and appreciated.

And the thing that really gets people is that we are used to kind of operating with these innovative systems in kind of traditional systematic ways, that A plus B results in something. But in the world of non-determinism, where there are a lot of new attacks coming in, the level of risk really, really goes to the roof. And the kind of attacks that have come through in terms of prompt injection or zero-click, and a lot of things that have been reported across the industry, and we have done some of the work ourselves. It really throws people back into like, “Oh, wow, I didn’t realize that this can really exfiltrate the data at such scale and such speed.” And the level of protections and defenses that people had through traditional tools are now out of question.

Kelly: Yeah, it’s definitely an interesting time in healthcare and AI, and there’s a lot to consider there. You recently discovered a zero-click vulnerability that can silently extract complete patient records without leaving a trace. What does that mean in plain terms, and why is it a signal of a much larger industry problem?

VJ: That’s a very interesting question. And I think as an industry, we have been trying to get everyone to kind of understand that, “Hey, don’t respond to random emails, don’t share credentials, don’t go chase random links and all that, right? But what’s happening in the world of AI is that without users taking any of such risky actions, now you can have a massive exposure and that’s what zero click refers to. And what we discovered is that a lot of these AI systems as they are interfacing with so many different data sources and all the records and all that, they can actually go take the credentials and access that you have given them and try to be helpful in ways that can actually result in data exfiltration and leakage at a massive scale. And so, what we are finding is there are the kind of attacks that come through in AI systems that are prompt injection or jailbreak attempts. And those things are getting embedded in documents, in ways that are invisible to the human eye, but those instructions mean a lot to what an AI system or an agent bot is going to do.

And that’s where, now, you are bringing– you have so many, so much intelligence baked into these AI stacks that they are trying to be super helpful and trying to kind of take all these instructions that are embedded and the users didn’t do anything wrong, but this is where some of the attacks that are coming through. Some of the ones that we have discovered and the industry has discovered, even Anthropic reported several different types of attacks. And there is a lot of education needed in the industry to really kind of understand the scale and scope of what these intelligent, non-deterministic systems bring in these critical environments.

Kelly: Completely agree. There’s definitely a lot of education required for us. VJ, HIPAA was built for predictable human-reviewed workflows. How does autonomous AI fundamentally challenge the compliance model healthcare has spent decades building?

VJ: I know. This is where we are really passionate about like there is so much to be done, and I know HIPAA is trying to catch up on a lot of the new innovation. But at the end of the day, there is kind of like an inert way in which HIPAA assumes there are human accountability layers behind all the different decisions that are getting made. And I think that’s the thing that gets thrown out the window when you bring in agentic AI. And in these environments where you are passing responsibility, you’re passing autonomy, you’re passing decision-making capabilities to agents and at a speed of machine speed at which you can access so many different systems all at once and try to be helpful. That’s where there is no mechanism in place to even understand what these systems are trying to do. And beyond understanding, you need to actually govern and bring controls into these environments, right? And I think that’s kind of the core to a lot of the challenges and what we refer to it as runtime visibility and runtime controls.

And when these agents are getting born and they are trying to figure out, like, “Okay, what are the instructions given to me?” And I’m going to try to make sense of that. I’m trying to access the systems that are available to me, and sometimes they overreach. And that’s when these breaches happen. That’s when, kind of, unexpected consequences happen. That’s when you end up with a non-compliant system. So, I think there is a lot to be done. I think the industry was still just catching up on what was happening in the world of microservices and all the API ecosystem. And now we have leaped directly into agentic environments. And I think that requires a full depth understanding of what all things are happening to stay compliant.

Kelly: Yeah, there’s definitely a lot of things happening right now, and I know HIPAA complicates things as well. So why do traditional security tools struggle to keep pace with the way AI actually moves data inside a health system?

VJ: Yeah, this is where we have gone through such massive waves in the last 30, 40, 50 years, right? And AI agents, and that’s a big, big one, that is going to completely change how security tooling and security requirements would work. But as you think about when cloud came about, there was a very bare bones kind of understanding of, okay, how am I protecting different network systems and databases? And this is very, very early on when you had your data centers, and firewalls came about to actually stop access to different parts of the data system, where different parts of the data center where you might have databases or critical data that you want to protect from different attacks. And over the years, we had usage of mobile and now usage of APIs, and there are so many different technologies have come into play, and you need a different approach for all these different technology adoptions that are going on.

And so, as you think about what is happening in the layers of APIs, in the layers of AI, in the layers of agent, you kind of need a very different AI layer firewall, right? The traditional things that used to be at the network layer, just trying to make sure that computer A doesn’t talk to computer B, it now needs to translate in the way that, hey, agent A cannot talk to agent B or agent A cannot talk to the patient record systems, or it needs to get permission from a human before it does that. And all those things are happening at such scale. We see so many stats about thousands of agents running and doing all these things every day in every enterprise. And so, when such speed and scale is at play, you’re going to need a different tool, a different system to tackle these systems, and it cannot be just a manual process. That’s kind of where a lot of the traditional tools fall apart because they relied on kind of checking the external boundaries, but they don’t know what is going on inside these environments. The tools used to be, oh, I’m going to scan code and try to make sure there is no threat lurking inside.

But when the code is being generated in real time by these agents, they’re coming up with new API endpoints on their own. They’re coming up with MCP servers on their own. And so, what do you do when this new code is getting generated on the fly? What do you do when intent and instructions can drift and can change over time? And that’s where you need something that is understanding what kind of actions are going on and make sure that you’re going to stay compliant as well as not bring more threats and risks into your system.

Kelly: Makes a lot of sense. Thanks for explaining all that for us. Beyond regulatory exposure, what’s the real financial and reputational cost when a healthcare AI deployment goes wrong? And is the industry pricing that risk correctly?

VJ: Look, there are a lot of people trying to understand a lot around pricing the risk and what to do in care of the benefits and kind of threats that come through. And I feel like we’ll learn a lot over the coming couple of years that how this translates in practical life, but definitely there’s a big shift needed, right? With the scale at which these agents can access the number of records, that’s really scary to be honest. There are different types of compliance rules and regulations around like, “Hey, XYZ number of records breached results in XYZ kind of fine.” Well, but also when you have the loss of trust, let’s say patients were trusting some EHR system or some hospitals and other systems with their private information that now suddenly when you have a massive scale breach, that trust is lost, there will be a lot of questions around like, well, do I want to be passing on all my data to the system that has a lot of security risks. But beyond that, there were a year or two ago, a couple of years ago now, where there was a massive outage at airports and airlines where some cybersecurity vendor was not able to deploy things properly.

And those type of operational risks that come in that can really bring down some of these systems and healthcare being such a critical infrastructure requires a level of kind of risk analysis before you put in AI into these environments where if something goes wrong, it can terribly, terribly bring down the entire infrastructure. And I mean, I think those things are obviously questions that a lot of the leaders are thinking through. A lot of the security teams that we talk to, the legal, financial teams that we interface with. And so those are things that are still kind of in flux and hopefully we’ll find ways to keep bringing innovation while also kind of bringing in the right guardrails and safety measures along the way.

Kelly: Yeah, no, definitely agree with all that. And what you were talking about, the lost trust really resonated with me because it seems like once that trust is lost, it’s hard to regain. VJ, for a CCO or Chief Compliance Officer who has already deployed AI across their organization, what are the first steps they should take to understand their actual exposure?

VJ: There’s a classic saying: You can’t secure what you can’t see, right? And I think in the world of AI and agents and APIs, I think a lot of leaders are realizing that discovery means a completely different thing at this point. A lot of teams have had engineering observability tools or some form of access visibility and all that. But I think what we are seeing is that as teams try to understand like, “What is going on? Okay. My teams have already deployed all this AI. They are using all these AI tools, or they have deployed agents in certain ways. Just getting visibility into what’s going on. That’s where everyone has to start.”

And being able to do that in all these different use cases and areas, so whether it’s employees using AI clients and talking to different AI systems and trying to, whether it’s private or public kind of exposure, there is a lot to be done in just understanding that exposure. When you have your EHR information or EHR systems as well as your other cloud environments, whether they are running on hybrid, private, there are a lot of different systems. People have to start with what are the AI models running? What are the agents running? And we’ve come across teams that feel like, “Oh, yeah, I have XYZ tool that gives me AI, SPM, and I know the five models that I’m running.” And when we actually go show them like, well, actually it’s not five. It’s like 97.

That really shocks people. And that type of sprawl has happened so fast in the last year or two that getting access to the telemetry that gives you that type of visibility, it’s something that is actually available, right? It’s such a daunting task to know what is going to come through. With kind of full visibility, we call it discovery. We talk about getting the right telemetry from the layers at which AI operates, layers at which agents talk to different agents and systems over APIs and MCPs. And if the leaders are uncomfortable kind of knowing like, “Do I really know how many things are running?” and that’s kind of the big gap that you have to start closing, and from there, you can set up the right processes around detecting the risks and then defending and controlling and governing all these different systems that are in your purview.

Kelly: Well, thank you so much for providing all that great information and for sharing your insights with us, VJ, on the AI security blind spot that healthcare can’t afford to ignore. If a listener wants to learn more, contact you to discuss this topic further, how best can they do that?

VJ: You can reach us on our website, operant.ai, and I’m also reachable on email directly, vrajesh@operant.ai. Thank you so much.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post The AI Security Blind Spot That Healthcare Can’t Afford to Ignore [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What RevSpring does and the difference it makes for healthcare organizations
• Biggest challenges healthcare organizations face when trying to protect their finances while also helping patients
• Personalization and how it impacts patients and providers
• Practical strategies for meeting patients where they are financially
• RevSpring’s approach
• What trends or innovations that will shape healthcare communications and finance

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Casey Williams. Casey leads solution consulting and sales efforts for new direct healthcare customers at RevSpring. He has 20 years of experience in developing customized patient engagement and payment solutions for over 100 healthcare revenue cycle clients. His knowledge of patient engagement strategies, including self-service optimization, has made him an advocate for change for RevSpring clients and the wide healthcare revenue cycle market.

In this episode, we’re discussing personalizing healthcare, strategies to drive patient engagement, and financial impact. Welcome, and thank you for joining us, Casey.

Casey Williams: Kelly, thanks for having us. We appreciate it.

Kelly: Yeah, we’re glad to have you here. So, let’s go ahead and jump in. So, Casey, can you tell us about your background? And how did you end up in your position at RevSpring?

Casey: Yeah, it’s a great question, Kelly. I think by default is probably the most honest answer. Coming out of Bowling Green State University, studying interpersonal communication, there was nothing that screamed healthcare finance from that background. But actually, I think kind of started as most people start their jobs or their careers where I had a friend working in a company, a smaller company, at that time called Data Image. And they had just had some transition in their sales environment. And the owner, founder had asked me to join. And that kind of began the path into communication, payments, and engagement overall. And really started at that smaller company involved in the hospitals in and around central Ohio and then expanded into the greater Midwest. But really got a great appreciation for when you’re a small company at that time, you not only position what the value is, but when you do that successfully, then you actually do the setup or the implementation, and then you service it. And then when there’s a billing question, you’re actually the finance arm as well. So, I was very blessed to be able to have such exposure at such a young time in my career to where I got a lot of different experiences within that and have just enjoyed it ever since. And we at RevSpring, which Data Image then sold into what then became RevSpring in 2010– and we’ve continued to acquire value across the market in how we are trying to build our technology stack today. So, by happenstance, I got into it, but I have been fully immersed and fully engaged ever since.

Kelly: That’s awesome. It’s great how those things happen. For someone who isn’t– for someone who isn’t familiar, how would you describe what RevSpring does and the difference it makes for healthcare organizations?

Casey: Yeah, Kelly, it’s a great question. I think the most simplistic answer to that question and one that I get from my kids all the time is they see me going into hospitals and thought for many years that I was a doctor. And then at one time, we had an office inside a bank, and then they thought I was a banker. So, I practiced this answer a lot over the years. But primarily, we are a patient engagement and communication company with an emphasis on payments. And the sense of this is that when patients need services, we handle everything from the intake to the scheduling to the registration at time of service to estimating the balance that that patient would owe, do our absolute very best in terms of trying to capture payment at that time or a method of payment so that autopay could be performed. Once that individual service, if not collected in full at time of service, goes to be billed from an insurance standpoint and that amount is adjudicated, then there’s a self-pay after insurance balance. We are then engaging within that patient population to let them know that there is a balance to meet them where they are, meaning that if they are unable to pay that balance in full, we have predictive analytics that address how much that patient can afford to pay on a monthly basis.

And so, whether that engagement is print, we produce about a billion and a half communications a year from that standpoint, or we engage digitally within that to be able to facilitate payment and those outcomes. And so, I think that’s probably the simplistic answer to that question. And I think why that matters is…is you look at healthcare in terms of the ecosystem in which everything is operating today, there’s a great strain in healthcare. As high-deductible healthcare plans continue to progress, patients continue to pay more for the health insurance, continue to be pushed off from their employers of having to pay more themselves within that. That then puts a strain within healthcare, is that 20, 25% now of the receivables that are within the total revenues of healthcare are now to the patient, meaning self-pay/self-pay after insurance. And so, without our technologies, without our sophistication, without our intelligence, it becomes very tough to engage, as well as getting patients to respond to what they owe.

Kelly: Wow, that’s very fascinating. Thanks for sharing that with us, Casey. Yeah. So, what are some of the biggest challenges healthcare organizations face when trying to protect their finances while also helping patients?

Casey: Yeah, that’s another great follow-up to that, Kelly. And I think probably the number one answer you would get within a healthcare finance type of roundtable would be insurance denials. And so when you, when you look at the ecosystem and the landscape of healthcare, about 75, 80 percent of all revenue that comes into an IDN/hospital provider is generally on the commercial Medicare and Medicaid side. And then about 20 to 25 percent of that revenue comes in on the patient responsibility. And what that means is, is after their insurance is paid, what is their responsibility? Or if they’re uninsured, what is their responsibility? And so, denials continue to play a large part in that 80% of the revenue stream. But if we’re looking at the 20, 25% of revenue, it is around the patients continue to owe more, but yet the wages have not continued to go up at the same levels in which they’re either paying for their healthcare or their healthcare insurance. And so that creates kind of that massive strain that I was mentioning in terms of how do they collect? How do they give pathways for those individual patients to be able to engage in order to pay their balances? And if that doesn’t happen, we look at rural healthcare as an example, continued consolidation, even closures within that environment, when that doesn’t happen.

Kelly: Well, yeah, there are quite a few challenges in healthcare right now, that’s for sure. We hear a lot about personalization these days, but how does it actually impact patients and providers in terms of engagement and financial outcomes?

Casey: I oftentimes give bad examples or metaphors. And for those of you that are old enough listening to this, know the old TV show Cheers is that kind of the opening song is, “Everybody wants to know your name.” I think it’s a…I think it’s a really good illustration in the sense of what personalization means to any commercial engagement that we have as a patient, as a human, from a commerce perspective. And the more that the business knows about me and can perfect that engagement, can perfect that pathway, to where I don’t have to continue to repeat myself. Once I’ve answered a question, I don’t have to answer it again, or meeting me where I am, meaning that if I if I don’t have $1,000 in my bank or if I’m like 50% of Americans that do not have $500 in their account to pay for a surprise bill, that you’re not just sticking a $2,500 bill in my face and saying, “Pay me.” So, the personalization really gets down to meeting the patient where they are. To give you a couple of practical examples of that is if I am a patient, let’s even say I’m a millennial to where I do not like to receive paper and all I receive is paper. But if you send me a text, I’m going to pay within 15 seconds as long as I can afford that. That’s a good example of meeting the patient where they are, as well as personalizing that.

If you have, let’s say a person like me that is midlife, I think 47 is midlife. Maybe that’s on the older side of the life. I’m not sure. But I actually still like paper. Now maybe that’s because we print and mail a billion and a half communications. But let’s say I’m one of those individual patients that cannot afford $2,500. So am I receiving a communication in printed form to where I can touch, feel, and interact with that, but yet see a pathway to where I can potentially hit a QR code taken into a payment application where it’s giving me the option of 10 payments of $250. That is where the dynamic of patient engagement is massively changing and it has been massively changing over the last two to three years to where we can utilize intelligence and technology to meet patients where they are and then give them pathways to engage and respond.

Kelly: Yeah, I mean, personalization is key. I think in all industries now, as a marketer, it’s important for me too. And I really loved what you said about meeting the patient where they are, because that is so true. When it comes to meeting patients where they are financially, what are some practical strategies or tools that you see work really well?

Casey: It’s a great question, and this is probably a little bit challenging, hopefully, for the audience that you have. So, if you’re a healthcare executive within the revenue cycle or in finance as a whole, I think the number one thing to understand is what is the affordability of your demographic? So I give you a great example of this is that when we look to healthcare is as healthcare is continuing to go from the towers out to the strip malls in terms of urgent cares, pop up health clinics and all of these pieces, you’re starting to see kind of the retail experience happening within healthcare. And what retail does better than anybody else does is that they truly understand their customer. And so, when we look at standalone IDNs, large health systems, is there an understanding of the affordability within their customer market? The answer to that generally is no. If you were to say, what is the affordability of our patients or my patients within my individual demographic? I don’t think there’s an understanding of that, nor is there any kind of view into that?

And here’s the example that I’ll give in terms of explaining that. If you are a not-for-profit, large IDN or health system or even rule, for that matter, and you have a financial assistance policy, is that meeting your needs of your community? Furthermore, if you have a payment or collections policy that says we do not accept payment plans greater than 12 months, but yet your patient population with their accounts receivable, meaning the AR that is actually outstanding, many times we get into these data studies. And the answer to that question is that greater than 60% of all their patient AR, meaning accounts receivables or balances do, cannot engage within their collections policy. So just stop and think about that for a second. Greater than 60% of your customer base cannot afford to pay you. Now, if you’re a retail environment, if you’re a dollars and cents type of business, maybe even brick and mortar, I don’t think you would go into business for that. And so, the opportunity that you have by understanding what your actual demographic is, what your affordability is, and what your reality is, is now our policies or their policies can actually bend themselves to actually meeting the needs of that demographic.

So whether that is, hey, we’re going from a 6-month policy to a 36-month policy, whether that is we’re going to create intelligence to be able to meet patients where they are, or whether that is we’re going to offer up additional relief valves to patients that are not necessarily qualifying for financial assistance, but yet we’re not just pushing them into bad debt because our policies do not meet them where they are. So I think that is something that I highly encourage in terms of any healthcare executive that is sitting in a position of authority or power, actually having that data to be able to guide decisions versus just what our gut opinion is or what our experience has been over the last 20 years because our experiences over the last 20 years are not indicative of what today’s market is.

Kelly: Definitely not. Thanks for sharing all of those strategies and tools. Those were great. Can you share a story or example of a healthcare organization that saw results using RevSpring’s approach?

Casey: Yeah, I think from just, again, vast experiences within our client base, a little bit nuanced in terms of demographic. If you’re a safety net hospital, it’s not like somebody’s going to wave a magic wand and suddenly change the demographic in terms of the ability to pay, but I can tell you countless times when technology is utilized, when intelligence is utilized. And what I mean by that is, is going back to understanding how do we know as much as we possibly can about an individual patient, a guarantor, and then utilizing technology to then convey what we know and then a pathway around that. You are talking about increases in the patient pay rate, or better stated maybe as yield, of no less than 3%. We’ve had individual customers that have modified their pay rate in the low teens. And you start to think about that as people might be listening to this podcast and saying, “Well, what does that mean?” It’s a very simple math equation. If you were to take your amount billed, meaning the total dollars that you billed out to your patient population on an annual basis, and then multiply that by 3%, that is the worst-case lift that we have seen within the market when intelligence and technology have been deployed. And then, if you want to get really excited, go to the small teams and then multiply that by 11, 12, 13, 14%, then become art of the possible, right, in terms of what those response rates have been.

And then, kind of the icing on the cake or the cherry on top is that you then have these different value levers, maybe otherwise defined as cost. Postage is number two when it comes to cost centers within a revenue cycle. Labor is generally number one. Another large cost center within finance is merchant processing and that cost. Those are three mechanisms that potentially you can pull to not only increase the outcome from a yield, but also decrease your cost to collect so that maybe your two largest KPIs, you can have dramatic impacts on. And not to say that you can get rid of labor. Nobody wants to do that. But if you can increase patient self-service by utilizing intelligence and technology, then you can bring down the inbound call center. If you can allow pre-check in and take care of the intake process and the forms environment before a patient ever walks in your door, then you’re taking down the labor needs and those experiences. If you can convert to digital, not necessarily just to reduce cost, but actually reduce cost and increase yield and eliminate some postage. You’re never going to eliminate postage. Anybody tells you that you want to do a digital-only environment doesn’t understand yield. But if you can have a 40, 50, 60% reduction within postage, it’s a great outcome.

Kelly: Definitely. I think my key takeaways there were the labor, the postage, and the merchant processing are the biggest kind of expenses there. And thank you for sharing that story. That was a great one. So, Casey, what trends or innovations do you think will shape healthcare communications and finance over the next few years?

Casey: Yeah, I think that just fear is the mother of all innovation. And right now, there’s a lot of fear. There’s a lot of fear in rural healthcare, which I grew up in rural America in eastern Ohio. And so, to see hospitals on the edge of closing, to see mass consolidation where someone having a child has to drive an hour and a half to receive services, none of that is good. And then you stack whatever your political views are, not to get into any of that. But with the big, beautiful bill, there is some fear out there, right, in terms of what reimbursements are going to look like going into 2027. And so that fear is perpetuating cost reductions within healthcare today that everybody’s experiencing. If there’s any partners or vendors on the phone, whether a web or radio listening to the podcast, they know this, they’re getting calls every single day from their clients saying, “We need you to reduce cost.” And that fear is perpetuating that need for cost reduction in allowing these systems to kind of prepare for the unknown. I think that that is driving innovation. And that’s the exciting part out of any type of market change, is that it’s exciting to sit back and see the innovation work, because not all the time can you cost your way out of situations. And so, where we’re seeing the market is, how do you utilize? And again, just back to technology and intelligence, how do you utilize those two value levers to be able to increase the outcomes while pulling the other three cost levers, such as merchant labor and postage within that.

And that’s where we’re seeing breakthrough innovation and how you’re looking at how do we gain as much information in terms of a patient to truly know me, create this know-me based experience, and then to be able to guide patients through the process from a self-service perspective to where they’re not having to interact with individual labor as much as they possibly can. I know going through COVID, based on a retail experience dealing with Kroger in the Little Clinic, I had a complete check-in experience at the Little Clinic and saw a salesperson who actually had to be the or was the healthcare provider. I didn’t see a receptionist. I didn’t see a registrar. I didn’t see a customer service rep. I simply interacted in a kiosk. I sat down and a clinician came and got me. I received the testing needed to go to a conference. And I walked out, and I paid my bill. The learnings from retail, as it is extending itself into the brick-and-mortar type of healthcare, along with the fear of reimbursements and what that cash crunch is going to be in the future, is creating mass change. And it’s exciting to be in the middle of it.

Kelly: Yeah, definitely exciting times. Lots of innovation happening, too. Well, thank you, Casey, for sharing your insights with us on personalizing healthcare, strategies to drive patient engagement and financial impact. So, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Casey: Yeah, our website is always a plethora of information in terms of revspringinc.com. Certainly able to reach out on our socials, whether that’s LinkedIn, Facebook, Instagram, within that environment in terms of Rev Spring. And as always, happy to find any associate that is willing to help and engage.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post Personalizing Healthcare: Strategies to Drive Patient Engagement and Financial Impact [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• How to reduce costs within medication management
• How system wide visibility can change decision making for health system leaders
• Centralized medication distribution and automation
• AI-driven analytics
• Efficiency and caregiver support
• How to drive enterprise-wide cost optimization

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Randall Lipps. Randy is the founder, chairman, president, and CEO of Omnicell, a company transforming pharmacy care delivery with a comprehensive portfolio of medication management solutions. Inspired by inefficiencies he observed during his daughter’s birth and his experience in airline operations, he founded Omnicell in 1992, growing it into a publicly traded company in 2001 that now serves healthcare systems worldwide. Recognized for his industry leadership, he was elected to the Bellwether League Hall of Fame in 2014 and has served on the American Nurses Foundation Board of Trustees. Randy and his wife, Kathy, actively support a range of charitable endeavors, while Omnicell fosters volunteerism and charitable initiatives through its Omnicell Cares program. He holds bachelor’s degrees in economics and business administration from Southern Methodist University.

In this episode, we’re discussing, from inventory to insight, rethinking medication management for clinical and operational performance.

Welcome, and thank you for joining us, Randy.

Randall Lipps: Well, Kelly, thank you so much for having me here today. It’s always fun to talk about the numbers, especially with folks who are thinking about the numbers all the time.

Kelly: Yeah, exactly. Well, let’s go ahead and jump in. So, Randy, as I read your bio, you don’t have a healthcare background initially, so what drove you into healthcare from the airline industry? It must be an interesting story there. [laughter]

Randy: Yeah, when I got out of school, I went to work for the airlines, and the airlines had a ton of numbers, kind of like healthcare, I guess. And it had some of the same profile: it had a lot of employees in order to run an airline, a lot of capital, and a lot of regulation, things you will also find in healthcare. And in order for us to survive in the airline industry – at that time, it was American Airlines – we had to lower our cost. There was no other mandate other than to lower our cost, and we had to do that by eliminating work that we didn’t really have to do, minimizing the necessary work, centralizing it so that we could then really get a good perspective on it, and then eventually automating it. As I experienced healthcare through my own daughter’s long-term stay in a hospital, I realized there were some of the same opportunities that existed in the airline that there is in healthcare, so some Stanford students and I launched a venture to go find out ways to make things more efficient and easier, particularly for nurses and pharmacies to do their jobs with less cost. I mean, what was ingrained with that thought process when I entered the airline is it’s great to think about soft costs, but you’ve got to save hard dollars when you come up with new technology and new automation, and so that’s always been on the front of my mind in the way I think and we move the company forward.

Kelly: I love that story. I mean, it’s just so interesting that you’re kind of sharing those commonalities between two industries that we wouldn’t think have anything in common but seemingly do. With U.S. healthcare spending nearing $5 trillion, where do hospitals have the biggest untapped opportunity to reduce costs within medication management?

Randy: Well, that is a great question, and medication management is really the– it’s a tale of two cities, right? One, it’s the cost side, particularly on inpatient, and the other side, of course, is the revenue opportunity or the earnings opportunity that you have with the outpatient side. And so, a good organization must take advantage of both of those, so let me just cover those. On the inpatient side where everything is a cost, it’s really important to eliminate unnecessary work. And this is clearly seen as you see the consolidation of providers and hospitals and sites, that there’s duplicate work done at these sites. So, first step, eliminate unnecessary work, and then minimize the necessary work. The things that you have to do, be sure that you don’t do– that you do them, but that you don’t exaggerate them. And here’s the key. And many of these organizations have already figured this out. You then centralize it. You bring that critical work that you’ve minimized into a central location. There you have the expertise, you have the enterprise mindset, and you can make better decisions because you’re not looking at an individual basis, but as an enterprise, and then you create standards and roll those out. And then of course, the final step is after you centralize, you automate. Then now you’re automating the processes that you centralize and really understand well. And we begin to see this happen with these consolidated service centers where hospitals with 20, 30, 40, 50 hospitals move their medication management process to a central site that’s automated, reducing headcount and processes at individual locations so that the deliveries can be done once a day at these sites through technology like ours, automated dispensing, and really reduce the burden and the need to run full out pharmacies at every location.

This is a huge savings in terms of inventory cost, huge savings in terms of people cost, and probably more importantly, it allows you to execute to a standard. Everybody’s running the same way and reducing the variance by which you run, and it can be measured. And so that opportunity is there. We’re starting to see the industry take more steps on that side, and it’s a game changer. The amount of savings we’ve seen in some cases has been a third of the total cost of onsite inventory, reduction in over half of wasted products, the reduction of shortages, which takes people and time to cover are reduced because you’re now managing those shortages from a central location. It’s just been a beautiful thing to watch and makes a lot of sense. But it’s a strategic move. It’s an investment, but it has very hard returns. And it is a scalable way to grow as well as you acquire more assets, whether they’re inpatient or outpatient. Servicing them from a centrally consolidated service center makes a lot of sense, and makes the scaling and tracking of those costs, and understanding what those costs will be as you scale, easy to understand.

Now the same thing is somewhat true on specialty. Today, we have crossed the threshold. Over half the drug spend in the United States now is specialty pharmacy. And 25% of that drug spend– as we go into ’26 and ’27, 25% of that specialty drug spend will be spent on outpatient infusion centers. In other words, a provider has to execute the delivery of that medication management. And if that’s true, then that’s an opportunity for these hospital and providers to gain and garner lots of revenue. You have to be an expert in those types of infusion outpatient situations. They’re new drugs, new protocols. They’re not easy to ontake. You have to get alignment with the manufacturer and the payer to do those, but those represent significant revenue and earnings opportunities for all systems and optimizing that. A lot of systems do have those, but the amount of influx of new opportunities in the next even 24 months is significant, and you don’t want to miss out on those because it’s revenue that should be in your P&L because they’re your patients, they’re passing through your hands, and it just makes sense for you to manage those specialty drugs.

Now, on the other side of, of course, the specialty drug management is the 340B. We continue to see a lot of changes, or small changes, in 340B and reimbursement, and you’ve got to keep up with those 340B changes are, but it is still a profitable program that you need to be executing in your institutions. And many of the institutions we see are doing a great job executing the 340B program, but there’s still another 10 or 20% they’re missing out on just because of the changes and the dynamic nature of these 340B reimbursements. So, you’ve got to be able to take advantage of the outpatient specialty pharmacy and outpatient mail order pharmacy opportunities, and you’ve got to be able to consolidate in the inpatient area in order to automate and centralize and minimize and eliminate the workload so that it turns out to be a beautiful picture.

Now, what we’re starting to see is that in some situations, institutions are putting their outpatient pharmacy and their inpatient pharmacy in the consolidation center together. In other words, they’re utilizing the space to both manage inpatient and outpatient. And one area that has been sort of poorly managed is clinics or ambulatory care sites, which are under the responsibility of the provider pharmacy in many cases, but there hasn’t been the tools or the technology to manage medication management out at these distant spaces that use a few drugs, maybe expensive, but don’t use a lot of drugs. And with the new technologies that we have and that are in the marketplace, suddenly these become part of the equation, to manage these fringe sites in order to get closer to perfection. One of the big things that’s hard to manage in these sites is vaccines. Vaccines have expiration dates. You need to sometimes have a lot in different locations. They’re expensive. How do you manage vaccines in these clinics in order to not have too many there, not have too few there? It’s important to understand the best approach on those.

So those are the strategic areas that you as a provider have the opportunity to manage. And the challenges I know that you have today are about the shortage of techs. And what happens when you have a shortage of techs? You say, “Well, I’m saving money. I don’t have as many techs,” but then the processes get very inefficient and the costs go up other places. And so having a shortage of techs is costing you money, more than a little overtime here and there. It’s costing you money because then the process is people over-order because there’s not enough people to process the orders that they should be processing. And the same thing is true as in any part of your institution where you don’t have enough labor. Inefficiencies and costs are pushed up higher in other locations.

Kelly: A lot there to take in and to kind of think through all of that. What’s the financial risk of managing medications and silos? And how does system wide visibility change decision making for health system leaders?

Randy: Well, I always say, if you can’t manage the medication in the healthcare process, you can’t manage the risk. You can’t determine the outcome with understanding that leads to the best outcome and at the lowest cost. So the medication piece of the curative part of the healthcare experience is costly enough in getting it right not just in the cost of the med, but in the ability to get it right for these patients because it’s going to save you money because you’re not going to have the patient returning back to your institution because they were in the hospital and returned less than 30 days, and it costs you money to take care of them that you don’t get reimbursed for. So, managing medication is extremely important and the right medication. It’s harder to get than you think. And so, I think if we look at medication management as a chief goal of the curative outcome process, it really lends itself to the right outcome in terms of both cost and quality and best health for the patient.

Kelly: Wow. Thanks for sharing that with us. So, drug shortages are widespread. How can centralized medication distribution and automation help hospitals protect access to critical drugs without increasing spend?

Randy: Yeah. One of the things that’s really critical when you have shortages is visibility. Visibility starts with understanding what your demand is, but also understanding, “How much drugs do I have on hand?” And so, when you look at the demand and the drugs I have on hand, I really don’t have a shortage. I have enough drugs for the demand, but I don’t have those drugs in the right location so that it doesn’t create a shortage. When you centralize in a central location, you get that visibility both to the demand and to what you have available, and that availability when you put it in a central site usually is 6 to 12 hours. You can move it around to whoever needs it as quickly as possible, allowing for you to really eliminate that shortage. Even though that drug might be on short, per se, you may not have a shortage enterprise wide. You probably have shortages in certain locations. Eliminate that through a consolidated service center.

Kelly: Yeah. It makes sense that visibility is key there. How are hospitals using AI-driven analytics today to better forecast medication demand and reduce waste or inefficiencies?

Randy: Yeah. AI is a great tool. And one of the best tools that AI is helpful for is administration. We see a heavy burden in pharmacy for administrative tasks, and many of these administrative tasks are helpful in managing pharmacy better. But today, in our last study that I’ve seen, it’s about 76% of activities done in pharmacy are for administrative tasks versus only 24% for clinical work. So, AI being applied to this administrative workload, delivering the reports that you need, being able to manage regulatory compliance that you need, and being able to just use AI to query where I am I on these compliance issues, where am I on these reporting issues? And then being able to actually, in some cases, deliver those reports with the AI with supervision, obviously. And so today we have people totally dedicated to many of these functions and we can really minimize the amount of time and workload it takes to probably even get a better answer. Now, we do have a tall task in medication management, particularly on big providers. And that is the task of managing many, many discrete inventory locations. So even if we take one of the top 300 largest providers in the United States, each of those has over a million discrete locations where they’re managing inventory. That’s on every floor, and that could be at remote pharmacies that could be in OR rooms, that could be in doctor’s offices. That’s everywhere. That’s a million locations of discrete inventory. How do you manage that so that you don’t have too much in any of these 1 million locations, or you don’t have too little? And so today we do that with spreadsheets and pieces that really give us suboptimal results. And now with the advent of AI, how do we really consume all that data to get us this, I would say, perfect answer for each one location? AI is the engine that’s delivering much, much better results. We have a great new inventory management process that’s driven by AI that we’re doing with King’s College in the UK. And it’s just delivering phenomenal results. And so, we’re going to see more of that in the marketplace where the expectation is that we can do a lot more with a lot less inventory, but have it in the right places.

Kelly: Yeah, it does seem that AI-driven analytics is a game changer for sure. From a finance lens, medication inventory ties up significant capital. What does modern inventory management unlock for hospital balance sheets?

Randy: Well, that’s a great question. I hope that many of your listeners will see a significant drop in inventory. I don’t mean 10%. I mean a third or more drop in inventory because many of the legacy processes and systems that are in place are really creating these inefficient buckets for additional inventory. And it adds up. It adds up in cost not only in capital toward these inventories, but because the meds tend to expire on the shelf. They’re perishable. They can’t last forever. And so, one of the key indicators that I’m sure many of these institutions are following is understanding what their expiration of on-shelf products and drugs are and what those costs are. So that’s a key indicator of how well you’re managing your inventories and what the opportunities are to really eliminate those. And I believe these consolidated centers, this approach to automation, which gives you much more visibility on exactly where you have it and what you have leads to the confidence, right? Because it takes confidence to lower your inventory to know that you’re going to have the right things where you need them. But you need to lean into the systems to give you that confidence to do that.

Kelly: That makes a lot of sense, Randy. Your personal experience as a founder shaped on [Micelle’s?] mission. How does that perspective influence the way you approach efficiency and caregiver support today?

Randy: Well, I had been on the nursing foundation board as well as on the pharmacy foundation board. And it’s these clinicians that are on the front line. These clinicians have the healing hands, if you will. If you look at inpatient, nursing is doing all the palliative care, and then pharmacy is delivering all of the drugs that mostly are used in the curative session of those hospital stays. So if you look at the function that they’re providing, you give them the right tools to allow them to administer effectively and clearly, they’re going to enjoy their jobs more because they know they’re providing those good outcomes for those patients, and they can see it, seeing the impact of automation and technology and the outcome of your job, not just making it easier, but making it better for others. And I think that’s kind of how we think these days, right? I certainly think that if I can do something for others, it’s more satisfying to me than just doing something for myself. And so, these tools, these solution sets, we believe, really empower these clinical folks to give more to patients that deliver better outcomes.

Kelly: I love that, Randy. I mean, caregivers are key in our healthcare system, for sure. So, what’s one question that CFOs should be asking their pharmacy teams right now if they want to drive enterprise-wide cost optimization?

Randy: Well, I’d ask first, do you have a consolidated service center strategy or not? That should be on your strategic plan for pharmacy. And secondly, how do we know what our specialty in 340B is? Are they optimized? Can we optimize them more? What are our opportunities over the next two years to get positioned to fundamentally make a big impact on our P&L? Those are the two biggest impacts on the P&L is consolidated service center strategy, secondly, on the specialty pharmacy, how can we get prepared to do more outpatient infusions with a specialty drug lineup that’s coming out in the next two years?

Kelly: Yep. That makes a lot of sense. Well, thank you, Randy, for sharing your insights with us on from inventory to insight, rethinking medication management for clinical and operational performance. Randy, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Randy: Oh, just send me an email, randyl@omnicell.com. Just do it. And I’d love to hear from you.

Kelly: Great. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post From Inventory to Insight–Rethinking Medication Management for Clinical and Operational Performance [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What operational intelligence is
• How it changes the way hospitals function day-to-day
• How AI can be applied in hospitals
• Examples where operational improvements directly impacted patient care

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Chris McShanag. Chris is the founder and CEO of Virtual Teammate, which has helped more than 2,500 talented virtual professionals find their place in organizations worldwide, supporting over 600 clients along the way. His mission is simple but bold to reshape the virtual assistant industry by creating an experience that feels seamless, supportive, and genuinely valuable for both clients and assistants. At Virtual Teammate, culture comes first. Chris makes sure every assistant blends effortlessly into client teams, delivering immediate impact and dependable support. Many of these professionals are registered nurses and HIPAA certified, a testament to the company’s dedication to excellence in healthcare and beyond. Chris is passionate about building real relationships. His drive to help clients succeed and streamline operations is setting fresh standards in the world of virtual staffing.

In this episode, we’re discussing the role of remote work in healthcare and its impact on patient care.

Welcome, and thank you for joining us, Chris.

Chris McShanag: Thank you, Kelly. It’s a pleasure to spend some time with you today and excited to kind of share some important information about this topic and ever-evolving capabilities it provides for healthcare providers to really buy back their time.

Kelly: Great. Well, let’s go ahead and jump in. So, what shifted in the industry that made remote work not just possible, but necessary?

Chris: Well, what’s really shifted really in the last 10 years, we’ve gone from a workforce that 5% of the time was remote to well over 50%. And of course, we had a bump through COVID, but what we realized very quickly, particularly in the healthcare space, is there’s so many tasks that don’t involve touching a patient that can really be leveraged at a better pace and a better capacity and the right resources. And so, what we focus on at Virtual Teammate is really helping our customers and our clients and the clinic owners focus on the highest and best use of their time, which is patient care, and really delegating those tasks that don’t require their technical expertise or the technical expertise and capability of those in the office. And so, for us, it’s really been a game changer to have healthcare providers catch up with the insurance industry that for the longest period of time has been leveraging remote team members to really support their ongoing operations.

Kelly: Yeah, I know remote work is just so prevalent right now in healthcare and in other industries. Which healthcare roles are truly optimized for remote work, like medical scribes, billers, or admin support, and why?

Chris: Really, I mean, they’re optimized because they’re very much consistent, what I would like to refer to as kind of rinse, repeat the same process, the same task over and over. And that’s where our team accelerates is, as you mentioned, 80 to 90 percent of our folks are RNs healthcare trained. They’re all HIPAA certified, and a lot of them have come from the insurance industry. And so they have that deep experience from insurance verification, eligibility, precerts, billing claims. And so really, it’s about buying the clinics’ time back of the providers, but also getting reimbursed in a timely fashion for the work they do, and I know that’s what your company specializes in as well. And that’s where we really come alongside to support that and be intentional to really optimize the workflows for our clinics. And we leverage technology to really support that. So, it’s not just about a person or virtual assistants, a virtual assistant that’s enabled by technology to really improve and optimize the productivity. And because of that, we can confidently say that our team is about 47% more productive than having somebody in the office and allows for, yeah, exceptional revenue growth.

Kelly: Wow, no, that makes a lot of sense. So, I know some practice owners worried that remote staff might reduce the quality of care. What would you say to those who fear that outsourcing admin work affects the patient experience?

Chris: I would really challenge them to think about the patient experience starts when they come to the office, right? But it starts well before that. It’s when they interact with somebody. So many of my doctors and clients will say, “I love you, doctor, but I can never get in touch with you.” And so, by leveraging our teammates handling phone calls, handling scheduling, that really starts to enhance that patient experience well before they come in to the clinic. And so being able to connect with your doctor, being able to interact with them, that’s where our team takes a lot of that administrative support, phone calls, scheduling, off the doctor’s hands and those in the office so they can enhance the patient experience when they’re in front of them. And they can enhance that experience of feeling like they’re being heard and they’re connected and they have the necessary information, thereby allowing the doctors to spend more time with their patients. And what’s driven a lot of this is reimbursement has really declined, but costs have grown. And so, our team can really allow that opportunity for doctors to be intentionally spending time with their patients, particularly on the medical scribe side, where we’re real-time updating documentation while the doctor is spending time with the patient, instead of spending time in front of a computer.

Kelly: No, definitely. So how does removing administrative burden from doctors and clinicians directly impact patient outcomes and satisfaction?

Chris: So, I mean, I think it buys back their time. So, they spend more time doing what they do best and are educated to do is interact with the patient, get to understand the patient’s needs, where their struggles are, and really be able to respond in an empathetic manner, where they’re not overburdened. And we’re seeing such a burnout in the healthcare industry of doctors, dentists, veterinary folks really burning out because they’re spending the majority of their time, whether during the office hours or after hours, doing unnecessary paperwork that’s not the best for them. And then that has direct impact on the customer satisfaction in regards to their mood and how they feel and how they present themselves to work. And then, of course, the outcomes, they’re not getting that one-on-one interaction with the doctor because the doctor’s too distracted by making sure they update the notes, making sure they do all that information, or they’re following up on billing and things like that. And it also improves the satisfaction outcomes by streamlining the scheduling process and making sure that your patients can get in touch with the doctor’s office and get the care that they need and deserve.

Kelly: No, I love that. It’s so important to keep those doctors focused on what they really should be spending their time on. So, Chris, what measurable improvements have you seen in practices that embraced remote healthcare support, financially, operationally, or clinically?

Chris: So financially, and really clinically, on the financial side, we’ve seen huge bumps. And so a number of our clients have reported 40-50% increase in the number of claims and precerts that can get completed in a day, thereby really accelerating their reimbursement. And so being paid for the services. If you think about it, healthcare is one of the only industry that extends credit with the hope of payment, right? We deliver the services, but we don’t get paid at that exact time for the services. We have to go kind of chase that down. And so, for us, it’s really about enhancing that experience so the doctors can get the money that they’re paid or owed. Follow up with the insurance company, work through denials, and really reduce the AR days, which is such a burden for practices because they’re incurring all this cost with the hope of payment down the line. And so, for me, I’m really passionate about the little bit I can do to give back to doctors so they feel like they’re getting compensated for the work they’re doing, but also not spending all their time on paperwork, but being able to really invest in nurturing the relationships with their patients.

Kelly: No, I love that so much. Chris, looking ahead, 5 to 10 years, do you see remote staffing becoming the norm in private practices? And what happens to clinics that resist this shift?

Chris: Yeah, I definitely do see this continually being embraced because, on the provider side, we’re probably 5 to 10 years behind the insurance companies and other areas. I really see it embraced because, as we move more to technology and more to kind of some of these online visits, particularly we’re seeing a lot of growth in the behavioral health, mental health space with our clients. I think that’s definitely the trend is going to continue. But I think on top of that is not just having remote team members. It’s having remote team members like what we’ve put in place with Virtual Teammate, because the focus of Virtual Teammate isn’t just giving you an assistant. It’s a teammate. And because the definition of a team is a group of individuals that’s working together to a common goal.

And our teams have changed. As I mentioned previously, our teams were all in the office. Now our teams are what I like to refer to as here, near, and far. Here, physically in your office. Near, working remotely, maybe in the same geographical space within the US, for example. And then far, leveraging folks like myself, my team that’s in the Philippines, Latin America, across the globe, forming one team and really coming together and driving engagement. Because that’s where the workforce is going. And that’s where the optimization and efficiency is going because of the continued growth in technology. A lot of my clients will come to me and say, “Hey, but won’t AI replace all of that?” Well, healthcare is such unstructured data that AI is not going to really embrace that completely in the next 5 to 10 years. But instead, I see technology and AI enabling our remote team members to be more efficient and effective, thereby allowing doctors more time to spend with their patients and less time having to deal with unnecessary paperwork because with an executive assistant, you’re not just getting the work done, but it’s also monitored to make sure it’s accuracy. And that’s hugely important, of course, when you’re working in the healthcare space, data accuracy and data privacy.

Kelly: Oh, definitely, that data accuracy and data privacy is certainly key. If a healthcare practice owner is still overwhelmed, burned out, and buried in admin work today, what’s the real cost of not embracing remote support for both their business and their patients?

Chris: I mean, I think the cost really is mental burnout for our physicians. And so, we’re seeing about a 40% burnout of physicians. Rather get out of this business that they’re so passionate and loved and did education and spent so much time in their life into because it’s just overwhelming, right? The reimbursements are coming down. So, I think for those that don’t embrace it are going to kind of get swept over because costs continue to rise. Obviously, minimum wage and other things continue to rise. And really what we come alongside is, we take care of that heavy lifting to give you highly capable folks that can perform the work administratively in the back office. So, it allows to free you up time to do what you do best, take care of patients, but also buy back some of your time so you get to spend time with loved ones and others to really refresh. And if you don’t do that, then I think that those kind of physicians and practices are going to get rolled over because it’s just too much work, and they’ll get sucked up into some of these larger corporations.

And so, for me, I’m just passionate about how do I keep those one to two, three physician doctor offices sustaining? Because I think that’s a legacy they have to leave to future generations. And so, 95% to 97% of my clients are all one to five practitioners. I don’t do a lot of work with the hospitals because I think the uncapped capability and ability within this country is really those small to medium sized healthcare practices that have that opportunity to do personal care. And if they don’t embrace remote team members like the larger hospitals and insurance companies, they’re just going to get burnt out and rolled over.

Kelly: Well, Chris, I love all your passion for this topic. And we really appreciate you sharing your insights with us on the role of remote work and healthcare and its impact on patient care. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Chris: The best way is via LinkedIn. I love getting messages via LinkedIn. Also, you can go to our website, virtualteammate.com and book a call to kind of schedule to meet with me. I love sitting down with our clients and just kind of strategizing on how we can help them because my main focus in building this organization and really is to have an impact in the healthcare space. As I like to say, kind of I’ve been in the healthcare for about 30 years. And my focus has always been on delivering technology, whether it be meaningful use or large technology systems. But I realized really quickly that I could deliver all the technology, but that’s taking doctors away from their patients. And so, for me, I’m very passionate about Virtual Teammate and what we can do to make a difference to enhance clients leveraging remote team members, which is super important. And that’s creating that opportunity, but also the opportunity to enhance the virtual teammate experience working for fantastic doctors and clients and allowing them the opportunity to earn a living wage and really making that connection and then leveraging technology for frictionless growth and automation so that doctors can do the best they can do and we can really optimize their operations and segments. And so, the best way would be reach out via LinkedIn or reach out via our website, where I’m always happy to take your emails from our folks at cmcshaneick@virtualteammate.com. And I always love talking to doctors and learning more about how we can really help them be more successful because they go to work each and every day taking care of us. And I want to do our best to take care of them because I recently became a grandparent. I’m now a grandparent of three. And I want to have a legacy where I can at least contribute to having healthy, successful doctors and clinics when I pass on.

Kelly: Well, love that. Well, thank you so much, Chris, for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post The Role of Remote Work in Healthcare and Its Impact on Patient Care [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• How attendance was this year
• Reimbursement-related content
• Medicare Advantage changes

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome back Kristin DeGroat, Besler Holding’s Chief Legal Officer. In this episode, Kristin will provide us with a recap from the recent AHLA event in Baltimore. Welcome back, and thank you for joining us, Kristin.

Kristin DeGroat: Well, thank you for having me.

Kelly: Well, let’s go ahead and jump in. So how was attendance this year at the recent AHLA Institute on Medicare and Medicaid payment issues event in Baltimore?

Kristin: I think it was well attended. Last year, we weren’t able to hear from the Centers for Medicare and Medicaid Services or the Department of Health and Human Services, as they were unable to attend. However, this year they attended. I thought the attendance in terms of providers as well as government, and of course, the lawyers, but the consulting firms as well, I thought the attendance was great.

Kelly: That’s always a good thing to have everybody there. So, I know you’ve attended this event for more than 20 years now. How does this year’s AHLA event stack up to previous years’ events, you know, especially in regards to content?

Kristin: The content they provided was very helpful, especially in terms of reimbursement-related issues. And the speakers were amazing. We had the Office of General Counsel, the Office of the Inspector General, and, CMS all speak. And in fact, they were all female leaders. Beth Kelly, in particular, who’s the Deputy General Counsel in the Office of OGC, who also serves as the Chief Legal Officer, she said that the U.S. spends $4 trillion. That’s T, trillion, a year on healthcare.

Kelly: Wow.

Kristin: Yes, that’s the entire GDP of some countries. And by far, the U.S., the government spends more money on healthcare than it does in anything else. But I think we’ve seen that too. What we spend as individuals and for our family on healthcare is by far the largest spend as well. So, there is so much money flowing through this and so much going on with it because you need healthcare. And it’s just amazing. I didn’t realize that it was that much of an impact. So, I think that really set the tone and put things in perspective, because a lot of what was talked about was dealing with deciphering dollars and how the payment system works and the decrease in payments. Even though there’s a lot of spend, there’s a lot of issues for providers in the provider community that really impacts how they deliver that healthcare. And I think that focus kind of set the tone for how the content impacted me. As I attended the sessions, I really kept kind of that focus about this is a lot. And how we as consultants and even me as a lawyer in the industry can shape and mold the future of how that healthcare is delivered is what this conference brings to fruition every year.

Kelly: Wow. I mean, it does sound like it was pretty impressive, and I love that there were so many female speakers there. This conference, like you said, it offers a lot of sessions and content impacting both reimbursement and revenue cycle. So, what sessions did you attend?

Kristin: So, I focused on the reimbursement sessions, but being a lawyer, I also focused on the legal side of it. So, there’s some topics in fraud and abuse. There’s legal ethics and the use of AI. Of course, this conference wasn’t solely focused on the use of AI, but there was a lot of discussion about AI and how it can shape the future of healthcare, and maybe next year at this conference, there will be more on AI. But overall, the topics really were, I think, geared, again, as I mentioned, more towards the payment side of healthcare and the cost of that delivery.

Kelly: Right. And I think it’s a guarantee there’ll be more on AI next year, right?

Kristin: I would think so.

Kelly: Yeah. AI sessions and all the marketing sessions I attend are lately too. So yeah, I think it’s here to stay for a while.

Kristin: It is. It is. And from my perspective, and this wasn’t really talked about there, because it’s not really a conference on cybersecurity and data-driven. But my thought, and I mentioned this while I was there, to the AHLA members or the leadership. I mentioned that really, the focus, I think– I understand with AI and molding it to deliver healthcare, but my thought is, especially again, being a lawyer, is that the AI and the data, the PHI that is required to deliver the healthcare, you have to have– again, it’s all about your insurance, right, and purchasing your healthcare. So, your date of birth, your healthcare ID, all of that. And I said, really, what we should also be looking at is AI and its uses in cybersecurity and protecting the data and reducing those costs to the hospitals for, again, delivering that care. So, I do think we’ll see a lot of that, or maybe that should be a topic for next year.

Kelly: Right, yeah. Sounds like it. So, I know we’ve talked a lot about content already here, Kristen, but can you tell us about some of the things you heard at the conference from speakers and/or your peers?

Kristin: So, a lot of what we heard about were the changes coming for Medicare Advantage. So, I would say the biggest topic was around Medicare Advantage providers and, of course, the beneficiaries. Because it is a Medicare and Medicaid conference, the focus is more on Medicare, but those supplemental payments that do flow in as well from Medicaid for helping with the delivery of healthcare. But again, I do think it’s the Medicare advantage and how that is shaping the future of, especially, Medicare enrollees.

Kelly: Yeah, definitely. So, Kristin, what makes this one of the few conferences that you attend every year? What keeps you coming back?

Kristin: Partially, it’s the amount of continuing education I get for it, but it’s good content. Something I look forward to and want to listen to. The topics are very relevant to what I do, as well as what Besler Holdings does and what our clients– the topics that they need to know about.

Kelly: Right. Makes total sense. Well, thank you so much for joining us, Kristen, and for giving us this recap of the recent AHLA event. We really appreciate it.

Kristin: Well, I appreciate you as well. Looking forward to next year already.

Kelly: Awesome. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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The post AHLA 2026 Recap [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What operational intelligence is
• How it changes the way hospitals function day-to-day
• How AI can be applied in hospitals
• Examples where operational improvements directly impacted patient care

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Sam Yeruva. Sam is the founder and CEO of Pycube, Inc., a company transforming the way hospitals operate behind the scenes. With a background in electrical and computer engineering and training from Harvard Business School, his decade working inside hospitals revealed a systemic problem. While clinical care is world-class, operations are often unpredictable. Motivated by a personal experience where critical biopsy samples were lost for 10 days, Sam launched Pycube to bring true operational intelligence to healthcare. Today, Pycube helps hospitals track assets and supplies in real time, saving caregivers hours and unlocking millions in recovered efficiency. In this episode, we’re discussing the hidden cost of hospital inefficiency. Welcome, and thank you for joining us, Sam.

Sam Yeruva: Well, thank you, Kelly. Thanks for having me.

Kelly: All right. Well, let’s go ahead and jump in. So, what is operational intelligence, and how does it change the way hospitals function day-to-day?

Sam: Well, operational efficiency is a day-to-day operations that hospitals have. They’re like a well-oiled machine that actually runs millions of people who come in and get into the hospital. I call hospitals as nothing but– some people call them mechanic shops, which they actually– if you look at a repair shop where you take your cars, they actually make them better and send them back. The same way we all get sick and we go there and get taken care of, and then they fix us and they send us back into the productivity mode. I was talking to some doctors and they call it expensive hotel rooms. They’re providing a specific service. It’s just they’re full all the time, but they’re very complicated, run by very smart people, and they save our lives. So, it’s a well-oiled machine. It has a lot of components to it. There are very complicated things that they do to save our things.

While doing that, they have to work with different disciplines to make sure that a particular patient is taken care of. While doing that, they have a lot of inefficiencies that pop up. It’s a process thing, right? People with good intentions come together who are well-trained in certain things. They do the job as well as they can. But you and I both know that recently the new technologies have come in. Now we are actually writing– when you go in patient registration, you have an iPad where you’re actually putting the information in. But when you go inside the hospital, there are a lot of places where there are still manual processes, they’re writing it on paper. There are good people, good nurses, and good people working in the health systems. They are doing the best they can to make sure they cater the patients. But what happens is things get lost. Things don’t appear. [laughter] It’s chaos inside that machine, and that is what we’re trying to fix to make sure it’s clean, it’s neat, the process flows are known so that the patient is taken care of properly in that area. So that affects us, you, me, and everyone who’s going into hospitals, and that’s what we are trying to fix.

Kelly: That’s a great goal. I most definitely agree with all that. So how can AI be applied in hospitals in a way that is practical, safe, and measurable, not just hype?

Sam: Well, [laughter] yeah, I’m very bullish about AI, and that’s a very good question that you asked. How do we do that? That’s a quick question. I was talking to one of the CFOs of a big health system and he would call me, and said, “Sam, is it true that I will have to change all my processes to make sure AI works in my environment?” I’m like, “No, no, no. AI should be used as a layer on top of what we’re doing. It should help us do things better. It should not change the way we are doing things drastically, but they should definitely help us do things better.” So, it’s a challenge to actually put AI in everywhere because it’s a common folklore right now that people think that, “Hey, this is not working. Maybe I’ll throw AI at it. Let’s see if it works.” No, it doesn’t work that way. I always go with a statement saying, “AI without PI is not going to work out.” Artificial intelligence is not working out– it will not work out without your practical intelligence. If you can’t fix it, if you don’t know how to fix it, then you can’t tell artificial intelligence to fix it for you, because it might give you something that you don’t like.

So, there are definitely different ways. So, I think, first, there are different ways of implementing AI. The first, you have to understand, what is happening in the environment? What is going to happen in a particular workflow? A patient who’s giving you the sample, the sample is taken to the lab, which might be in that hospital or the hospital next door, or a couple of miles away. It’s been diagnosed, and then the report is given back to the provider, or in this case, the doctor. The doctor reviews it and gives you right diagnosis. In this entire process, there are many parameters that can go wrong, and you could be misdiagnosed or mistreated. So how do you ensure these things? If this is tightly coupled and if it’s tightly maintained, the data, if you’re collecting it, then you’re able to apply AI to make it better. But if anything in this entire thing is not properly working, then applying AI might give you wrong information. Garbage in, garbage out. So, it’s very important for you to have a digitized workflow which is properly maintained so that you can apply AI in a proper way and you can have a measurable outcome significantly improving the entire workflow efficiency and helping patients and helping providers to take care of their patients.

Kelly: No, I love that. And I actually took down– when you said PI, the practical intelligence, I really loved when you said that. So, Sam, can you share a real example where operational improvements directly impacted patient care or reduced burnout?

Sam: Oh, yes. So, I’ll give you an example in one of the hospitals, that healthcare we were actually working on. So, I’ll give you anecdotal– I shouldn’t say anecdotal, but without naming names here. One of the health systems where we are working, we showed them our tools where– it’s a big health system. It’s a big hospital that we’re working at. About a 700-bed hospital when they’re coming in. What happens is they collected the sample from one of the patients in the OR room, operating room, when they collected some samples. Millions of samples, thousands of samples that are collected every day, and one of the hospitals was actually doing the same thing. So, whenever you collect a urine sample or a blood sample, they’re supposed to go– based on their diagnosis or what they’re supposed to do, they’re supposed to go to A-lab, any lab, cyto lab, or a molecular lab, etc. It’s a clinical sample. And whenever you have a cancerous or a tumorous sample that they actually have a procedure on you, by giving you anesthesia or collecting them, they actually have to go to certain labs.

We were just standing there and the nurse comes in– not a nurse, but a person who actually picks it up. He put them in the wrong spot. He picked up a sample which was supposed to go to A-lab, he put it in a B-lab, and the B-lab, he put it in A-lab and wrote it down and signed off and left. We were just watching there [inaudible] and I could figure that out. I’m like, “Oh, God, this might be in the wrong space.” It happened. And next day when we went back, and I was curious, and I asked the nurse, “Did you notice that?” And she was like, “Wow, would that happen? I didn’t know that.” She went back and started looking at it, and she caught it. And she tells me that these kind of things do happen. It goes to the wrong place. They don’t know where it is. Well-intentioned, but they’re all stressed out. They’re in a hurry. They write it down in the wrong space. That was one of the things that intrigued me because the intention of the person was not to go wrong, but when they’re writing it down, putting in the wrong bin, it just got routed to a different place.

I’ll give you an example. We were standing in an ER room as well, and there was a patient coming in, and the nurse was actually looking for the tools. There are different kinds of tools that are required to take care of a patient. They couldn’t find it. They were running around. They were actually calling people to see– “Go find me some tools. I don’t have it.” They’re called PAMs. They’re different kinds of tools that they use for this ER. They were not able to find it. So, we showed them how to actually go and look for using the right tools with our technology, and they found it in five minutes. And they were very thankful to us because normally it takes– in a chaotic environment, imagine it takes about three months. Imagine you’re losing keys in your house, if it’s a big house or in your office, and you’re not able to find it. That’s the kind of chaos they have.

So, we provide some technologies around it, which immediately they can go back and look for them. Having these tools, having this right technology to improve the workflow in the hands of the clinicians definitely saves the day and improves efficiency. It reduces the stress that the people have while they’re already in a stressful scenario. It actually de-stresses people a little bit, gives them back time, gives them time to think, gives them time to eat. You’ll be surprised, these clinicians and people, they don’t have their lunch sometimes. And when we were actually showing these technologies and solutions to make their life easier, yeah, the first thing they said is, “Wow, thank God. I had, at least, 15 minutes to have a lunch break here.” So that was very satisfying to me so that we could actually have some effect on the patient care in the U.S.

Kelly: Well, those are some great examples. Thank you for sharing those with us. You often say hospitals are clinically world-class, but operationally held together with duct tape. I love that. What inspired this insight? And how real is this problem? [laughter]

Sam: I’m an engineer by trade, Kelly. So, my life has always been complicated technology, right? My background was a data center architect. My job was to move things from New York to LA within milliseconds, and how do you design them and stuff? So, I come from that environment where nothing can go wrong. So, I go to a hospital and one of the niche players in New York– I was amazed to see this. I’m like, “Wow, this is like a 7-star hotel.” You go in, you have these LCD displays. You go to the cafeteria, and they have these AI machines that actually see what kind of change they are collecting, and is there any fraud? And they have so much technology in the patient room as well. But I go back to the administrative side of that hospital, and, wow, everything is hanky-panky. So, [laughter] I should put it that way. Because the main thing is they take care of the patients. They have these processes. They are figuring out how to do the best care that they can.

Ultimately, it’s a business, right? It’s a business in a good intent environment. It’s a nonprofit business environment that they’re trying to take care of their patients as best as they can. And what happens is they are not able– because it’s a nonprofit, a bulky environment, it’s a very huge ship that it has its red tape and it has regulations, they’re able to bring in technology on the consumer side or the patient side very fast, but adoption of technology in the administrative side is quite lagging. That was surprising to me because a person who goes into a 7-star hotel kind of a scenario, you would expect everything to be together. But when you go to the other side, it’s a different world altogether. And they do apply technology, but they are behind the curve on adopting new technologies compared to any other vertical in the market. So that made me think. It’s like, wow, this looks like everything is good, but imagine a latest and greatest LCD display, but on the backside, when you look at it, you have all these duct tapes put together. And that’s how they are making it run, and that made me feel like, “No, we have to actually fix these things from the backside as well.” And I do my part of it. Obviously, I can’t fix the entire part of it, but it’s a very complicated environment. But everyone has to do– who or can should solve these problems so that we have better running healthcare in our country?

Kelly: Wow. Well, thank you for sharing that with us. And thank you so much for sharing your insights with us on the hidden costs of hospital inefficiency. And, Sam, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Sam: We have a lot of information on our website, https://www.pycube.com/. You can go there. We keep hosting, putting more information and latest information that we are gathering from our customers. You can also connect with me on LinkedIn. I’m more than happy to chat with anyone you have. If you are curious about, how are we doing this? Any curiosity about what we’re doing and what kind of technology we are using, and if it’s going to help you for any professionals, more than happy to connect with you and chat with you.

Kelly: Sounds great. Thanks for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post The Hidden Cost of Hospital Inefficiency [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• What data stewardship means in the context of revenue cycle and compliance risk.
• How organizations think about the strategic value of internal and external data.
• What proactive monitoring looks like in practice.
• How strong data practices make a difference in a high-risk situation.
• How finance teams can use data to objectively evaluate issues.
• Practical steps toward building a more proactive, data-driven risk monitoring approach.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Konstantin Gorelik. Konstantin is an HFMA certified healthcare analytics and operations consultant with over 10 years of experience advising hospitals and provider organizations on reimbursement strategy, compliance risk, and revenue cycle performance. He previously served as a managing consultant at BRG, where he led complex claims analysis, payor provider dispute engagements, regulatory assessments, and multi-hospital monitoring initiatives. Konstantin focuses on data stewardship as a strategic tool, helping healthcare leaders translate internal and public data into structured, proactive risk monitoring frameworks that protect revenue in an increasingly transparent and regulated healthcare market.

In this episode, we discuss how healthcare finance and revenue cycle leaders can use data stewardship and external benchmarking to proactively reduce compliance, reimbursement, and regulatory risk.

Welcome, and thank you for joining us, Konstantin.

Konstantin Gorelik: Thanks so much, Kelly. It’s great to be here.

Kelly: It’s great to have you. Well, let’s go ahead and jump in. So, when healthcare finance leaders hear data stewardship, it can sound abstract. So, what does it actually mean in the context of revenue cycle and compliance risk?

Konstantin: That’s an excellent question, and it’s not the first time or the last time that I get that when I start pitching on what exactly the importance of all of this is. Data stewardship is synonymous in my mind and hopefully in the industry as well with intentional management of how data is collected, validated, stored, and used across the organization. So, to that light, it would allow you to connect your finance, compliance, your operations team, and even your clinical documentation team. It’s not just your IT and their analytics team anymore. In our day and age where everything is becoming more interconnected and interoperable and able to be assessed by not only yourselves internally, if you’re a hospital organization, but externally by any type of group that’s taking a look at you, it’s important to have strong stewardship. It ensures that your reports are defensible and not just informative because honestly, many times you’re going to want to get to the beef of why things are happening at an organization. Numbers work, but numbers also need to tell a good story. And poor stewardship office services during audits, litigation, investigations, which you touched upon when you introduced me, and that’s when it’s the most expensive to fix. A lot of organizations will balk at the fact that they might want to invest a little bit more than they probably should upfront. But then once one of those investigations does come down the line, it’s better that they have done this proactively.

Kelly: Interesting. I really like what you said about intentional management of that. That was something I took down because it just kind of stuck with me. You talk about internal and external data. How should organizations think about the strategic value of each when it comes to mitigating financial and regulatory risk?

Konstantin: So when you hear internal and external data, regardless of what type of organizational vertical you’re in within the healthcare space, so if you’re an RCM, if you are a hospital, if you’re a provider, if you’re a biller or a payer, internal data typically will mean what you have in-house and what you have at your fingertips. So that comes in to you and your organization based on your standard course of business. So hospitals have a little bit of a different flow than maybe a payer would, but the bread and butter of this for hospital finance leaders would be like your revenue cycle data, your claims analytics, all of your metrics that have to do with your dollars and your cents and your bed counts and all the utilization that you have there. It allows you, when you’re internally investigating, to contrast your claims and billing data with past trends and essentially live in a closed container. External data is everything that’s out there in today’s world that wasn’t something that was mainstream maybe 10, 15 years ago, but is now. That includes implementing CMS’s public data sets, which include cost report data. We now have transparency in coverage, which is the payer side of price transparency, which this administration has really flaunted as a way to get transparency for patients. You have hospital transparency data, which is the other side of that type of data, which is the hospitals posting their charges and how much things cost.

And so you have these two juxtapositions of internal and external data, and risk emerges in the gap between your internal performance, which is that closed container of how am I doing this month? How am I doing this year? How many claims did I see this year versus last year? That internal performance, in comparison to external benchmarks is, like I just said, where the risk emerges because you might have a very good view of your own world and your own realm, but if you’re not conscious of everything around you and how you sit relative to peers in the market, you’ll end up in that risky pool, as I like to call it. And external data is particularly powerful for benchmarking, like I mentioned. So, figuring out where you sit as an organization, whether you’re a hospital, a provider, a smaller entity, a health center, whatever it is, versus peers in the market, whether that’s in your area or abroad, also helps you identify outliers. So, if you guys have some sort of– there’s so many outliers that I could probably name off. But for example, you’re identifying conditions that have higher complications than maybe others do in the market for the same one. Like your knee replacements for some reason are 10 times more likely to be complicated.

Those are types of things that maybe internally you, as your organization, can contextualize and understand, but when an auditor or the government is looking at that, they’re going to have questions and those are going to come down the line for you. And when they start asking questions, you got to know how to defend yourself there. And the last piece that external data is very powerful for is, like I said, so it supports or defends your reimbursement position. So context is everything in today’s world, and data is amazing, and there’s so much of it, and it’s beautiful to be able to access all of it, but contextualizing it and marrying it up so that there’s a story to tell will be incredibly beneficial in the years to come as other organizations, namely the government, become more tech-savvy and more proactive with their monitoring and strategy into finding fraud, waste, and abuse.

Kelly: That makes a lot of sense. Thank you for that explanation. Many organizations are still reactive, responding when an audit lawsuit or denial trend appears. What does proactive monitoring look like in practice?

Konstantin: That’s a good question. So, to understand proactive monitoring, you have to also understand reactive monitoring, and reactive in the context of these investigations and things that I’ve been a part of are responding after your denials, for example. So, you have a way that you’ve been billing as an organization for five years, the policies change, you don’t change anything, and then all of your money is hung up in a denial pool. And then now you have to figure out, well, what’s going on here? That’s one way where the reaction comes in. You also have a whistleblower claim that could come in. So that’s your qui tams, for anyone listening who’s in the compliance side of hospital finance, as well as payer disputes that come in. So those are ones that we’ve seen publicly. I live in Massachusetts. We had a public article posted about a dispute between Blue Cross Blue Shield and UMass Memorial Hospital. And those disputes are something that could have been solved privately out of the view of the public if proactive monitoring took place, which sets me up nicely to tell you what proactive monitoring really is.

So that involves routine monitoring of patterns that regulators and payers already analyze. So, I want to let that sink in for anyone listening here. Examples of that would be length-of-stay outliers, unusually high units or charges for certain services, services that frequently trigger outlier payments for anyone in the revenue cycle space. A lot of your contracts will be paid– or, sorry, excuse me, not a lot of your contracts, but generally, there are going to be contingencies in there where, if you have an outlier case, you get paid a certain different rate. We’re seeing in the market and over the past few years, at least in my work with other clients as well, that that triggering of an outlier payment is subject to review and analysis now by payers. So, you might be having your revenue held up because they’re doing that type of investigation these days.

And to get ahead of this type of work, so what does proactive monitoring really look like? There are various aspects that you can take on this. And frankly, I don’t think there’s enough time, even in a podcast, to cover everything that you could do to be proactive, because I believe in the essence of proactivity here. But you can use tools like the PEPPER, which is a report that’s submitted by– or released by CMS and something that hospitals comply with. They flag you for your outlier rating on certain metrics. It’s important to be aware of that type of monitoring. You have cost report trending. So those are publicly available reports that any hospital can download, and you can segment that market so that it fits you as an organization. So, if you are an RCM, a hospital, or a payer, you can take your clients, or yourself, if you’re a hospital, and you can figure out who has a similar bed count, a Medicare percentage, rates of certain type of codes and procedures. There’s all of this data that’s available, and not just the cost support data, but you also have these Medicare fee-for-service data files that are out there and are used extensively by all kinds of litigation firms and investigation firms as well.

So that’s one aspect of it. There are also these very cool new data sets being released that I’m a very big fan of and love playing with. Those are your transparency and coverage files and the hospital price transparency files. So those have ticked in and now are getting more standardized by the government. But now, for the patient side of things, you now have the opportunity to see all of the rates for all of the services that are agreed upon between a payer and a hospital. And so, understanding how you’re pricing and charging for things in disputes with payers and disputes with the government is going to be key because you have to start valuing your services and juxtaposing your value proposition with whether or not the quality is there or whether or not the outcomes are there for what you’re doing. And underneath all of this, so to reiterate, reactive, like I said earlier, is an expensive, expensive process to go in when something hits the fan, and you have to go back for it. It’s a much more expensive process to go in and try to plug all the holes in it when the ship is already sinking, versus going in proactively, which is usually cheaper and less disruptive than those post-event reviews.

Kelly: Wow, so there’s a lot to proactive monitoring, and it looks like it’s pretty important, though. Can you share an example of how strong data practices made a difference in a high-risk situation?

Konstantin: Sure. So, I mean, like I mentioned, there’s many examples of this that we could pull upon from work and maybe even in public news sources. But one that comes to mind is an investigation where I worked. It was a False Claims Act investigation that was triggered by the government. And this was important because it actually came based on the documentation requirements for a hospice. And this case study was important because of the billing and medical record validation that needed to happen. You end up having the government come in for a False Claim Act, essentially saying that you fraudulently have billed Medicare. And so, when that happens, they have their own formula. They have their own extrapolations. They take a small sample. Maybe they found a few things in there. You never know. I’ll never be able to know for certain how they get to it because I’m not ever a part of their investigations at the beginning.

But you end up having an extrapolation, they come to you with a damages model, and then that’s when kind of all the bees in the hive activate, and you have to start reactively looking at this. And so, when you have an allegation of overbilling for an organization like a hospice, for example, they’re not a data-driven entity outright. In today’s world, more organizations are becoming data-driven entities. But here, because it’s something that came to them out of the blue, they were not ready for this. And it required a claim-level validation of all of the visits that they had had with patients over numerous years that the government was looking for audit trails on. And you end up in this situation where this one organization just simply doesn’t have the infrastructure to support this type of investigation because they never thought that this could happen to them. Most people don’t think that something like that could happen to them until the government comes knocking.

And to look and actually look through everything that the government was seeking, we had to combine the billing and the claims data with scanned medical records that were hundreds and hundreds of pages long, admin reports that were generated during the standard course of business. You have to combine that with CMS hospice rate data to figure out about the rates and what they’re charging versus others. And you end up with this project that starts ballooning in effort, scope, and price, frankly, trying to centralize and validate legacy data that are critical because, for the False Claims Act, the only way you can defend against that type of situation as an entity is to actually prove that every single claim is not, in fact, a false claim. So, you have to evaluate each alleged false claim to come back at the government and kind of whittle down that number for them when you’re strategically trying to position yourself. And so, the key lesson that you have there for how strong data practice could have made a difference is that the integrity and the strength of the integrity in your data would determine the legal and financial exposure that you have down the line. So, for a smaller price, by centralizing everything, having everything ready to be analyzed, this wouldn’t have taken hours and hours of consultants, lawyers, deposition hours. All of that adds up a lot for an organization that’s pretty much being reimbursed on a day-to-day basis, right? So that’s just one example.

Kelly: That was a great example. Thanks for sharing it with us. Payer-provider disputes are becoming more common. How can finance teams use data to objectively evaluate issues like charge master increases or reimbursement disagreements?

Konstantin: Yeah, that’s another great angle. So just like I mentioned at the top, with my own home state dispute that was going on between the insurer and the hospital, essentially, the claims data will need to be reviewed internally and externally, and policies will need to be reviewed historically, and contracts will need to be reviewed outright. So those three aspects of it are time-intensive, but proactively doing that will help identify and avoid situations where you end up in a dispute because of contract terms, policies, or actual claim behavior, changes, and anomalies. So, to do that, it’s important for you as an organization to proactively identify your outlier services that are driving disproportionate financial impact, perhaps. You’ll also want to start benchmarking against similar hospitals using cost reports and claims data. So those are publicly available external data sets that you can set to realize and see how things are going. And so, for example, I can touch upon another example. So not exactly what happened in Massachusetts, but in another state that I saw a client and a provider. I was put right in the middle of them trying to figure out what would be an objectively good reimbursement rate. And the finance teams were not quite ready to evaluate the data. So, while the claims data that’s internal to that hospital and that payer were not utilized due to the presence of payer data, it was still used to validate.

So, in these cases, as an organization, like a healthcare organization, like a hospital, that data that you have internally is the gold standard of what you should be relying on. If your data is not as good as what the payer is using, you end up putting yourself at a disadvantage when those things come knocking. You also have the opportunity to investigate the claims data from the payer. So anytime that a claim is adjudicated, the payer will send back those files and those data sets that tell you about what was paid, what was adjusted, and it’s important to have the infrastructure internally to track that type of information, because you have to know why your dollars and why your cents are what they are versus your chargemaster. And the cost report data and the fee-for-service data that I was referencing and alluding to, as well as the transparency data that I talked about, are also key aspects nowadays because the data will bring objectivity where narratives often conflict. So, you’ll have a payer saying one thing, you as a hospital organization will say another, or vice versa, depending on who you are in this disagreement. And so, like I mentioned, again, the context and the quality of your data is going to be incredibly important.

Kelly: Sure, of course. That makes a ton of sense. You know Konstantin, if a CFO or a revenue cycle leader wants to get started, what are some first practical steps toward building a more proactive, data-driven risk monitoring approach?

Konstantin: So typically, when you’re trying to set up a more proactive way to manage all of your risk at an organization, there’s three main pillars that I like to focus on. So, the first is to define your goals. So, is it for compliance purposes? Are you trying to protect your reimbursements, or are you trying to make sure that your bottom line is above a certain level or threshold? Is it an operational insight that you’re trying to glean from this information in terms of blind spots? Once you define your goals, the next set of those pillars I’m going to go into is to set your scope. So, whether or not there are certain service lines that need to be evaluated, if facilities in particular need to be monitored or set up. So, hospitals and health systems are becoming incredibly complex, and they are acquiring and merging and becoming larger and larger entities. And that, by proxy, puts a lot more risk and onus on the organizations that are taking charge of some of these facilities. So being more strategic with which ones you’re monitoring is also incredibly effective because you don’t just want to throw a net over everything when really it could just be a few problem children, we’ll call them for this set. Or outside of facilities if there are risk areas.

So if you have a lot of surgeries or if you as a finance leader are reading the news in healthcare and you see that there are certain investigations that the government are targeting, it’s a good idea to go back and read that and then come back to your data team or your analytics team and be like, “Can I run some of this stuff? Can I figure out how many patients are suffering from major complications in my surgeries that the government considers to be routine.” That type of information. And then once you have your goal and scope, the stakeholders are also the next key piece because those are going to be your legs that make the machine kind of roll. While we are becoming more technologically advanced, I still like the Flintstones analogy where you have a group of people inside of a kind of a wagon and it matters what feet are in there pushing because that’s going to be the quality of your ride, right? So, whether finance, compliance, your RCM leaders internally, externally need to be involved, if the clinical team needs to be involved to help contextualize some of those abnormalities, right? If you have codes that are far and above and you’re in the top percentile in your state for a certain line of [Latin?] procedures or business, you’re going to want your clinical team to come in there and be like, well, this is why X, Y, and Z versus reacting to that later.

And once you have those kind of three pieces, so you have your goals defined, your scope set, and your stakeholders who are going to be helping you, you’ll want to start moving into centralizing and validating the core data sources that you’ll be relying on. So, as I mentioned at the top, you have your internal data sets, right? So that’s what you as your organization steward, manage, and have at your whim, essentially, since it’s your data, versus that external data that you might be purchasing. So, if that’s a CMS data set, something from a commercial vendor, right, like your Komodo Health, your Definitive Healthcares out there, your Kytheras, those types of– IQVIA is a good example of one too. Merging all of that in and combining it into one spot is incredibly important as you start your data-driven risk monitoring.

And the last few things that I want to say on this are pretty straightforward and hopefully no-brainers for a lot of folks who are dealing with this on a day-to-day basis, but it’s important to align your monitoring with CMS and regulatory focus areas. So, if CMS is releasing their information on what they found, what they’ve targeted in years past, that should be on your radar as a finance leader too. It’s not just on your compliance team to be ahead of the curve on all of this, because finance, data, compliance, all of that is emerging in today’s world, and they’re going to be even more intertwined as the years go on. And finally, building processes that are repeatable and refreshed regularly. So not one-off analyses that are siphoned off in Excel workbooks or in someone else’s local drive, but something that is refreshed regularly and repeatable, because you want to be able to have insight and stories to tell as often as you really need it, especially when the judge comes knocking.

Kelly: Most definitely. Well, thanks for providing those practical steps for us. And thank you, Konstantin, for sharing your insights with us on data stewardship as a risk strategy, protecting revenue in a transparent healthcare market. And if a listener wants to learn more, contact you to discuss this topic further, how best can they do that?

Konstantin: So, if anyone wants to reach out and talk about more of what we covered here today, you can reach me via email. So, it’s gorelikadvisory@gmail.com or via LinkedIn. I’m always ready for conversations and love to talk about this information. I think this is such an interesting age that we’re entering in and would be happy to connect with colleagues or anyone else.

Kelly: Wonderful. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post Data Stewardship as a Risk Strategy–Protecting Revenue in a Transparent Healthcare Market [PODCAST] appeared first on Besler Holdings.

Highlights of this episode include:

• How the reduction in ACA enrollment numbers are affecting out-of-pocket payments
• How should providers prepare for this change in coverage
• Long-term projections

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Tom Furr. Tom is the CEO and founder of PatientPay, the leading patient payments partner for acute, ambulatory, and specialty care organizations. Prior to founding Patient Pay, Tom was the CSO and COO and board member at MobileSmith Health. He was also a co-founder and president of Kinetics Inc., an early online commerce provider for small businesses with partners such as Wells Fargo, First Union, and Netscape. In this episode, we’re discussing the shift in ACA enrollment and how it’s driving more high-deductible health plans. Welcome, and thank you for joining us, Tom.

Tom Furr: Hey, thanks for having me, Kelly.

Kelly: All right, well, let’s go ahead and jump in today. So how is the reduction in ACA enrollment numbers affecting out-of-pocket payments for providers?

Tom: Yeah, obviously, the Affordable Care Act was in the media a lot back in December. And so, it kind of got me thinking of, well, if these people leave the ACA, does that mean they’ll be uninsured, or do they move back to the employer insurance? And so, I started looking at the data out there and it’s quite interesting. It’s obviously, as of, I think, a week or so ago– and these are all numbers from Google Gemini. So, if they’ve changed, blame it on Google. But there was about 1.4 million people that had– or 1.2, 1.4 million that had left the ACA. And the ACA has kind of grouped within the private insurance market. And so, the private insurance market had been growing from ‘24 to ‘25. It was up about 1.4 million folks that were subscribing to insurance and are paying for insurance. And so, the question is, if they’re uninsured, there’s a different way to approach it if you’re a hospital or you’re an ambulatory group or what have you. If it’s insurance, what is that insurance going to look like? And so, what the numbers, the stats are looking at right now is, at least according to Google Gemini, so don’t blame me, the folks that are dropping off of the affordable moving over back to business insurance. Now, not all of them, obviously, but a vast majority of them. So, then the question is, okay, if all of these people are moving over to back to their employer-sponsored insurance plans, and are they all jumping into a fully high-end insurance plan? Is it a high-deductible plan? And because dealing with that versus uninsured, now you got to deal with claims and adjudication, and then you can only start billing at that point, or trying to do estimations on the front end of any services that are rendered.

And it was the numbers…I found them very interesting, at least on the high-deductible plans that are out there. And in 2024, there was give or take 27 to 29% of covered lives were using a high-deductible plan. That number grew to 33% in 2025. So, it was up, call it, 4 or 5%. And the estimation is now with more people moving over to their employer-sponsored insurance, that the companies now are having to find a way to help control costs in healthcare. And right now, it’s estimated it’s going to grow at least 20% in 2026. So, you could have upwards of 40% of people in employer-sponsored health plans now using high-deductible plans. And the other interesting stat was that 59% of employers out there are trying to find ways to control costs, unfortunately. And this is one of the ways to do it. So, it has been kind of an eye-opening experience because PatientPay obviously helps medical groups, hospitals, other folks in healthcare collect more dollars. And if you’re doing it on an uninsured patient, you want to catch them before they come in, you want to offer discounts, you want to incent them to do it. But if they’re moving to high-deductible plans, there’s a different strategy more on the back end, some on the front end with estimation. So, we’ve been digging into the numbers, and it’s been, to be honest, really quite eye-opening compared to the narrative that was kind of given back in December of last year on the potential that could happen with the shift in the Affordable Care Act. A lot of numbers, so I’m sorry to bore you with all the stats and everything.

Kelly: No, no, I mean, those are great numbers. I mean, it is very eye-opening. I have a high-deductible plan, so I can totally understand what you’re saying. But how should providers prepare for this change in coverage?

Tom: Well, that’s the next thing is, as we know, deductibles are becoming more and more a larger part of the dollars that are paid to providers out there. And the individuals now as a standalone, the largest payer into the system of healthcare, assuming you look at individual versus UnitedHealthcare versus Blue Cross and so forth and so on. So, there are lots of areas that need to be addressed in healthcare that, to be honest with you, haven’t been because they didn’t need to, but it’s continuing to become a material part of healthcare. And there’s a couple things that are necessary when it comes to the patient. And one, front and center is clinical care, and to have the best clinical care is priority number one. But priority number two is having a good experience with this portion of it. And for younger folks out there, you see that they are very interested in being able to pay things easily, understand bills, all the different components of what they live in outside of healthcare, right? They are able to go to Shopify to buy stuff. They’re able to do Instagram and buy stuff. I mean, it’s just a part of their day in life that allows them to, if they want to buy something, they can buy it. They can buy it easily. They don’t have to get checks out or get paper statements in the mail. And so, it’s important that medical groups and hospitals allow for patients, one, to understand going in with their eyes wide open on sort of what’s going to be expected of them. It’s kind of like when you take your car in to get fixed. You don’t know exactly what it’s going to be, but at least you have an idea of what it’s going to look like.

And then have an easy way for patients to pay these bills that can be through payment plans, electronically, all the different areas that help them to handle, quite frankly, some big bills. And it’s not that people don’t want to pay, not everyone, of course, but most people want to pay their healthcare bills. There are challenges when it comes to understanding those bills. There are challenges when it comes to paying those bills. There are all kinds of challenges. So, to make it as frictionless as possible for them to understand the bill and to make it as frictionless as possible for them to pay the bill in whatever manner they have. And as you know, Kelly, if you have a high-deductible plan, you most likely have an HSA account with it, hopefully, because it’s tax-free. And you also know that you have limited dollars that are put onto that by hopefully you and your company. So even though they want to pay $1,000 bill, they might only have $200 a month on that card that they can pay towards that. So, they might need a six-month payment plan to accommodate that. And so, to be able to help the patient, one, understand the bill. And one of the things that one of our groups uses, they allow us to integrate the EOB into the patient bill. So now you’re looking at your insurance EOB, you’re looking at your bill, you go, “Okay, these match up, check.” I understand I owe it. Number two, I have an HSA card. Do I even know how much is on this HSA card? So, to give them the ability to understand the total dollars on that card is important. And then three, to give them the ability to pay it based on the limited dollars that are put onto that card each month.

All of these things sound simple, but in healthcare today, it’s pretty challenging. And to be honest with you, I have the HSA card. I have a high-deductible plan. And inevitably, my wife will call me and say, “Can I use this card? Because I don’t want it to, quote-unquote, ‘bounce’?” It’s just you don’t have enough money on it. Right. So I have to log in, look it up. Then I call her back and I say, “Yeah, it’s only a $500 bill. We have it in there.” But if it’s a much larger bill than that, we might not. So, it’s a complex world out there in healthcare and to try and make it as easy to understand and easy to pay is kind of, we feel, mission critical.

Kelly: Completely agree. And I love what you said about making it as frictionless as possible. I can totally support that. So, what are the long-term projections for patients signing up for these high-deductible health plans?

Tom: Yeah, the assumption is that they could be at 50% of the total market within the next three years or so, at least from what I’m seeing. And the expectation is it’ll continue to grow from there. So, it’s a material part of the medical group’s dollars that they collect. And as you know, if you’re a primary care group, you’re now having to collect these dollars because the patient potentially hasn’t hit their deductible yet earlier in the year. And later in the year, you don’t have as much challenging in some instances. But it’s definitely an area that is growing and will continue to be challenging based on the complexities of healthcare. But there are ways to simplify it.

Kelly: Great. Well, having it simplified is always a good thing. Well, thank you, Tom, for sharing your insights with us on the shift in ACA enrollment and how it’s driving more high-deductible health plans. You know, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Tom: Yeah, so our website is https://www.patientpay.com/, P-A-T-I-E-N-T, P-A-Y dot com. My email is tf@patientpay.com. And then our telephone numbers on our website if you’d like to call, but I’d be happy to talk more and learn more about this from others out there.

Kelly: Awesome. Well, thank you so much for joining us, and thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

The post The Shift in ACA Enrollment is Driving More High-Deductible Health Plans [PODCAST] appeared first on Besler Holdings.