Latest / Becker’s Healthcare Podcast / Robert Chestnut, SVP & CFO, LMH Health

Transcript

Robert Chestnut, SVP & CFO, LMH Health · Becker’s Healthcare Podcast

• 0:02
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  cycle operations, visit us at wwwr1rcm.com.
• 0:30
  Hello, and welcome to the Becker's Healthcare Podcast.
• 0:34
  I'm Will Riley from r one, and I'm
• 0:36
  joined today by Rob, Rob Chestnut, who is
• 0:40
  the CFO at LMH Health in Lawrence, Kansas.
• 0:43
  Welcome to the podcast, Rob. It's great to
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  be here, Will. Thank you. Thank you. Thanks
• 0:47
  for taking a few minutes to talk to
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  us.
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  To start off, Rob, can you tell us
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  a little bit about you, your role,
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  Lawrence Hansus, the community you serve? Well, the
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  community's
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  wonderful. It's a university community of about a
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  100,000 people. We're a sole community hospital, so
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  we serve everyone in our community.
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  174
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  beds, but but we also have about a
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  160
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  providers that we employ. So we employ most
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  everyone in our market, and that includes
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  specialists, primary care, internal medicine,
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  really, really pretty much around around the horn.
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  So it's it's definitely a health system.
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  We,
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  you know, we sit about forty five minutes
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  outside the greater Kansas City area, so we
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  compete,
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  obviously, with, some of the systems in Kansas
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  City, including AdventHealth.
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  HCA is in there. University of Kansas Health
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  System is a very large system there.
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  We have a strategic clinical relationship with them,
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  so we share patients.
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  When we need patients in our,
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  community, Douglas County, that need more help than
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  we can offer, we send them to KU
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  Med, and they will diagnose them and then
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  send them back, to Lawrence for treatment because
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  we think that's really important for our patients
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  to get care at home. Mhmm.
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  I was born and raised in Lawrence. I
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  was born at Lawrence Memorial, so I am
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  actually very much a Homer,
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  and will am am proud to say that.
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  So, it's it's a great community, and we
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  really have a
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  what's really unique, I think, about
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  our system, it was founded by a person
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  named Elizabeth Watkins. She founded the original hospital,
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  and she really had a
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  insight into health care equity
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  about a 100 ago. Mhmm. So we still
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  try to trace stay true to that to
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  that mission,
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  to this day. Got it. Brilliant. Thanks for
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  that background.
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  Just as you as you think about where
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  you are,
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  in the world, the community around you, in
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  in Lawrence, like, what are a few of
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  the things that is top of mind for
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  you as you go into the next year?
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  Well, it's it's certainly more competitive. I mean,
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  we lived in a we lived probably up
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  until about ten years ago,
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  not in a really competitive environment.
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  We were we were sort of a little
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  bit of an island. And then as as
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  the greater Kansas City area started to expand
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  and and around, it's it's kinda become a
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  corridor. So
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  that has really made us,
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  need to become more competitive. And it it
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  it flows all the way down to becoming
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  much more efficient in revenue cycle,
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  much more efficient in the way we run
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  our physician enterprise because when I started on
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  the board of trustees back in 2011,
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  you know, we didn't have a lot of
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  employed physicians, but over time, we've brought them
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  into our system.
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  That gets really complex. And so we've had
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  to learn how to to become a much
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  more complex organization, and that's that's not always
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  easy to do. You know? We've made a
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  few mistakes along the way, but I think
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  we've learned that we've got to we've got
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  to figure out how to become more efficient.
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  And,
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  obviously,
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  you know, reimbursement continues to be compressed. So
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  you you figure out how to do less
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  with or more with less Yeah. Essentially. Yeah.
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  Okay. Mhmm. Great. That's a great setup for
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  some of the things that I think we'll
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  we'll talk about. So I'd like to start
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  with, a a bit of a discussion on
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  technology and innovation.
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  It feels like health care's traditionally
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  been quite
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  conservative and cautious around technology adoption,
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  but it feels like that might be changing
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  a bit at the moment
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  largely because of AI, which feels
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  like it's being adopted pretty widely and in
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  a very committed way.
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  Is that true for you? Absolutely.
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  We're kind of committed, I would say, on
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  both ends of the spectrum. We're we're doing
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  a lot in AI
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  with, you know, documentation
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  for our providers,
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  and we have some tools with that. You're
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  right about the fact that the adoption has
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  been sometimes uneven.
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  But I think what you find is,
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  in any particular specialty, when you have a
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  physician that really is a champion,
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  it sort of becomes infectious because everybody figures
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  out, wow. This is great. You know? They'll
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  say, I'll never use that again. And then,
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  you know, six months later, they're doing all
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  their notes, you know, using AI.
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  And so we're moving through all of our
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  practices to implement that. Then on the revenue
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  cycle side,
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  obviously, we've done some things
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  in in our coding to to automate a
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  lot of the a lot of the codes,
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  the DRGs and CPTs that are very, you
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  know, standard and and and going through. So
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  our revenue cycle, which I manage,
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  has gotten a lot more efficient. And it's
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  essential because, obviously,
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  there's a lot more denials now. You're you're
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  dealing with because we have all the big
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  carriers in the market, UnitedHealthcare.
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  We have Blue Cross of Kansas, which is
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  more local, but we have Aetna. We have
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  Humana. We have Medicare Advantage Plans.
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  And so we have to be
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  you know, I think one of the things
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  about technology is it levels the playing field.
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  So
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  so it really, I think, creates,
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  an efficiency
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  that that you can replicate even as a
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  174
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  bed, you know, community hospital versus a very
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  large system. There's a lot of investment
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  there, but the returns are fabulous. And so
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  we've had great experience with,
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  AI implementation.
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  You say a level playing field. So,
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  just like by extension then, you've mentioned payer
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  payer dynamics a couple of times as well.
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  Do you see the technology helping you there
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  significantly? It it helps us Is it today?
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  It helps us a lot to identify the
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  patterns of
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  of denials and and what's going on. You
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  know, I would say that what's happening, and
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  maybe this is slightly cynical, is you have
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  you have AI on their end and AI
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  on our end, and they're fighting each other
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  in the middle of trying to figure out.
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  Sure. You know? Because we know, for instance,
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  if if we have a certain level of
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  of claims and everything's going through just swimmingly
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  and then all of a sudden we start
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  having denials,
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  you know, our cynical side says somebody's figured
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  out that, you know, it's just there's the
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  clean claims rate's too high, so they start
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  denying things. But but I do think that,
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  I really do think that it helps us
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  be able to
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  work, with UnitedHealthcare
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  and some of the big players.
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  Now, clearly, we don't have the resources they
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  do, but but we do feel like we
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  have a fighting chance in there. Yeah. Yeah.
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  Yeah. Yeah. Totally. Well, it seems to me
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  that
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  you you mentioned a sort of battle of
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  of bots and technology Yeah. And so on.
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  But that's
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  in the end, it's quite productive.
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  Yes. And what you're actually getting to is
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  a more transparent
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  Mhmm. System
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  Exactly. Where where both sides can see and
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  understand what's happening much more quickly.
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  Yeah. And I and I do think this
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  is my
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  idealistic side, which is slightly rare for a
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  CFO. But I will say that I do
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  think that
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  over time, technology
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  is is gonna create the kind of transparency
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  where
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  you don't have as much, you know, opacity
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  where you just have no idea
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  what's happening with your with your peer, institutions
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  around and what everybody's doing. It it it's
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  fairly clear. You can see it, a pattern.
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  So I do think that it does create,
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  I hope in time
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  sort of of,
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  getting away from the war of attrition that's
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  being played right now and denials and everything
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  else. And, you know, we we have the
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  same issue as a lot of other a
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  a lot of provider hospitals. You know, Medicare
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  Advantage has been a struggle for us. Yeah.
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  Actually, last year, we
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  chose to not renew two Medicare Advantage plans,
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  and we have an a few others that
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  we work with.
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  And that was disruptive to our patient population,
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  but but I think I'm hoping over time
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  that we kinda work through
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  the the issues we're working through, and and
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  we get to a a a more settled
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  place. Yeah. Yeah. Makes sense. Makes sense. When
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  you think about doing some new things with
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  technology,
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  who who are the people around you? Who
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  are the partners around you that are were
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  are supporting you in that? Is it is
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  it the, you know, your your incumbent,
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  technology
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  providers?
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  Mhmm. Are you working with innovative, new,
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  disruptive technology providers?
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  And and how are you how do you
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  think about that? Well, I think,
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  you know, we our platform is Oracle Cerner,
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  and and it it has its own issues
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  just like Epic or any other. Sure. And
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  and I find that the solutions typically don't
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  come from the big players. They come from
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  some disruptor
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  that has figured out,
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  for instance, I just had a conversation. If
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  you walk into the, you know, the the
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  big,
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  ballroom up there with all the vendors, you
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  know, and you shout revenue cycle, you'll have
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  1,700 people come running at you. Right? So
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  so they're really making they're they're they're trying
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  to create and,
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  innovate
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  in those spaces. But a lot of times,
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  it'll be in small pieces, like referrals or,
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  you know, just different pieces that they work
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  on that they've really honed
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  in on, on on best practices.
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  So we're always looking for for different people
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  to come in and and and look and
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  say, can we do stuff better? Because
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  we have to get better. But, I mean,
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  we just and it's not that we're bad
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  now. It's just
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  continuous improvement is is gonna be the watchword,
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  and we'll do revenue cycle with less people
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  over time. That's just going to be the
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  future. Yeah. So I'm always looking for new
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  solutions now. We we just implemented
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  Workday, which is a big ERP system.
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  And and so we're trying to, you know,
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  figure out how that thing works. And so
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  sometimes you have to be cautious not to
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  introduce too much change
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  because if you don't get people adapting to
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  it, if you don't get people that adopt
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  it, then it becomes just a wasted investment.
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  Yeah. And so we we work a lot
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  with our providers. We actually have a a
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  a clinic enterprise board that's made up of
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  providers, and technology is a piece of that
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  where we say, hey. We're thinking about some
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  of these things. And there are times when
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  they say, that's great, but maybe a little
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  bit later because we're trying to, you know,
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  we're trying to digest all this other stuff
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  that that you're doing.
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  So it has to be a collaborative effort
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  because without it, you can have the best
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  solution
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  that just doesn't doesn't get adopted. Sure. And
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  then and then nobody's happy. Right. Right. Right?
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  Right. I don't see the ROI. Yeah. You
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  have And they're frustrated that I'm trying to
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  get them to use something they don't wanna
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  use. Yeah. Yeah. Yeah. Yeah.
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  Staying in the finance organization
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  for a minute,
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  it's a it's a and revenue cycle, I
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  suppose. It's a space that's always been, very
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  labor led Mhmm. With technology
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  aids and technology playing a probably a supporting
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  role, but it does feel like that paradigm
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  is Changing. Changing. Right? And it's going to
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  be a space that is technology led
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  with labor playing a supporting role or an
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  expert role or what however you wanna call
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  it. Mhmm.
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  I'm stating that as a truth. Yeah. I
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  think it is a truth. You think it
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  is. Yeah. Yeah. And I think that,
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  I mean, as
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  I'll give you a specific example. So I
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  had a corporate controller who worked for me.
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  She retired after twenty seven years.
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  You know, obviously
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  Yeah. Maybe not as embracing of technology as
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  as you would, maybe somebody new, and I
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  have a a new person coming in.
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  She's brilliant. Much more on the has a
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  a lot more feel for the business intelligence
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  side of the business, but she's managing now
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  our accounting area. So we're really hoping to
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  look at some of those solutions to and
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  and, again, those those groups will be smaller.
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  They will be over time.
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  It's just it's just the way of the
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  world. I also have supply chain. We've seen
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  it a lot in supply chain.
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  So it it is, it is important that
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  we not try to keep it at bay
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  because,
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  you're not gonna win that battle. Yeah. And
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  does your administrative team welcome it? I mean
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  I think they do. I've never never met
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  a revenue cycle team that says they've got,
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  like, too much time on their hands, for
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  example. I would say,
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  a little bit uneven. Mhmm. You know?
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  I wouldn't say everybody in my organization
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  stands up today and says, I just can't
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  wait for the next technology solution to come
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  down,
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  down the road. Okay. But I think for
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  the most part, I have a good leadership
• 13:19
  team. I have a good team of directors.
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  They understand what the what, you know, the
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  runway is, and so they have to bring
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  everybody in to say this is this is
• 13:28
  where where where we're going next. Yeah. Okay.
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  Okay. What about,
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  if you step away from the administrative side,
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  look at the provider
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  side Mhmm. What impact are some of these
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  new technologies making on them and their work?
• 13:42
  Well,
• 13:43
  ultimately,
• 13:44
  much better. Mhmm. But getting there is is
• 13:47
  the issue because,
• 13:48
  you're you're making them change whatever internal processes
• 13:51
  they've had. I think one of the things,
• 13:54
  we've been very fortunate in our community to
• 13:56
  be able to hire new physicians
• 13:59
  and younger physicians. And what we find is
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  when we introduce a younger physician into,
• 14:04
  a specialty, like, we just hired a new
• 14:06
  urologist. We have, two others, so we have
• 14:09
  a three person urology group.
• 14:11
  It really ups the game as far as
• 14:13
  technology because they come in with a lot
• 14:15
  of the training that maybe some of their
• 14:17
  older colleagues don't have.
• 14:19
  And if you get a physician leader in
• 14:21
  there in in a diff in a practice
• 14:24
  to go, it it's gonna happen fast because
• 14:27
  everybody
• 14:28
  says, wow. What have I been missing out
• 14:29
  on here? Mhmm. And so I I do
• 14:32
  think that that we've had some success with
• 14:34
  that, but it's it's always a little bit
• 14:37
  of a struggle because,
• 14:39
  that you'd get some folks that are just
• 14:41
  not
• 14:42
  as technology savvy, let's say. We do have
• 14:44
  a lot of investment on our, our,
• 14:47
  information technology group to to have,
• 14:50
  you know, technology adapters that are dedicated to
• 14:53
  providers.
• 14:54
  But,
• 14:55
  like I said, it's it's coming, and I
• 14:57
  I think the majority
• 14:59
  of providers know
• 15:01
  this is the future. Mhmm. Mhmm. Yeah. Mhmm.
• 15:04
  You mentioned at the beginning of our conversation
• 15:06
  about your your market, your environment being increasingly
• 15:09
  competitive. Mhmm. Does this technology help you as
• 15:12
  a as a rural hospital gonna keep a
• 15:14
  competitive edge? It it's it is. It it's
• 15:17
  everything. Yeah. I mean, it really is everything,
• 15:20
  and and you just can't hide from it
• 15:22
  anymore. And and I think it's good too
• 15:24
  because it is easier. I mean, when you
• 15:26
  really get AI working on on physician notes
• 15:30
  I mean, I have not met a provider
• 15:32
  yet that said that has adopted it, that
• 15:35
  said, I wish I could go back to
• 15:37
  what I was doing before. Right. I'd say
• 15:39
  99%
• 15:40
  of the time, they're thinking, why didn't I,
• 15:43
  you know, jump into this before because this
• 15:45
  is great? Yeah. And, you know, for us,
• 15:47
  we wanna have the right work life balance.
• 15:49
  We wanna make sure that they can get
• 15:51
  their notes done within, let's say, thirty minutes
• 15:53
  after their last visit and be able to
• 15:55
  go home. Because right now, there's so much
• 15:58
  pressure to have productivity and everything else, and
• 16:00
  the only way they're really gonna achieve that
• 16:02
  and have the right work life balance is
• 16:04
  to adopt some of these technologies.
• 16:06
  How about maybe bringing us home?
• 16:09
  How about patients?
• 16:11
  What what do you think will be the
• 16:12
  outcome for for them? Well, I think that
• 16:15
  the other thing is that health care has
• 16:17
  also traditionally not been a patient centered
• 16:20
  environment. I mean, you know, come to the
• 16:22
  office when I have office hours and so
• 16:24
  on.
• 16:25
  And that's changing, obviously. I think the thing
• 16:28
  that we have to recognize in our community,
• 16:30
  and it's true in any community, is that
• 16:33
  generationally,
• 16:34
  people interface with health care differently. Right? If
• 16:37
  you're 40, you interface with it differently than
• 16:40
  if you're 40.
• 16:41
  You know, our our portal,
• 16:44
  the apps that we have, the, you know,
• 16:46
  doing everything online, that is becoming critical. And
• 16:49
  that's the expectation.
• 16:51
  And if you don't have that, people ask
• 16:52
  why. I think it was sort of unique
• 16:54
  for a while. No more. That's their expectation.
• 16:58
  And, you know, one of the things we
• 16:59
  explained to many of of of our,
• 17:03
  providers and our schedulers and everything else saying,
• 17:06
  if we don't make this easy, we'll we'll
• 17:08
  lose these patients. Yeah. And this is just
• 17:10
  the expectation, and and relationships are still important
• 17:14
  between patient and provider,
• 17:16
  but that interface as they come into the
• 17:18
  system has to be,
• 17:21
  through technology. Mhmm. You know? They're they they
• 17:23
  are gonna pick up the phone and call
• 17:25
  at a physician office. They're gonna look online
• 17:27
  and see what's available. Don't they? Yeah. Mhmm.
• 17:30
  Rob, it's been great to hear hear about
• 17:32
  all this from your perspective. Is there any
• 17:34
  other
• 17:35
  concluding thoughts that you wanna No. I I
• 17:37
  I'd say the the last thing is,
• 17:39
  we also have the same challenge everybody else's
• 17:41
  workforce. You know? Right. There's we're competing for
• 17:45
  for less people, and, you know, we we
• 17:47
  wanna create a great environment to work, and
• 17:50
  we realize that it's not all about compensation
• 17:52
  or not all about benefits. Sometimes it's just
• 17:55
  about creating a great environment where people can
• 17:57
  flourish.
• 17:58
  Very good. Rob, thank you so much for
• 18:00
  sharing your perspective with us today. Appreciate it,
• 18:02
  Wilkes. Thanks.