Latest / Becker’s Healthcare Podcast / Building Financial Strength Through Growth and Stewardship with Austin Jones

Transcript

Building Financial Strength Through Growth and Stewardship with Austin Jones · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Madeline with the Becker CFO and
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  - revenue cycle podcast, and I'm so excited to
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  - be joined by Austin Jones, senior vice president
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  - and CFO of NKC Health. Austin, thank you
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  - for joining me today.
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  - Hi, Madeline. Thanks for having me. So, Austin,
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  - before we kick things off, do you mind
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  - sharing with our listeners a bit about your
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  - background in health care and more on your
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  - time at NKC Health? Yeah. I'd be glad
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  - to. So I started in health care, I
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  - think, in about 2013.
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  - Before that, I was a CPA in a
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  - public accounting firm,
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  - and I've worked in for profit, private equity
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  - backed, and faith based. And I've been
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  - here at n k c health, on the
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  - North Side Of Kansas City, for the last
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  - five years roughly.
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  - Wonderful. Can you give us a little bit
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  - more background on n k c health?
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  - Yeah. So n k c health is an
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  - independent,
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  - not for profit health system. We serve the
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  - Greater Northland of Kansas City, which is everything
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  - north of the Missouri River
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  - it covers a population of about half a
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  - million people
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  - And, we're the second largest hospital
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  - in town in terms of total admissions
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  - we are the busiest emergency room in town,
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  - by far. We do about 83,000
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  - emergency room visits a year, and we have
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  - about 30 clinics spread throughout our service area.
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  - We've been growing since I got here in
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  - 2021.
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  - We've almost doubled in size, all of that
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  - organic.
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  - So we've,
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  - we've really continued to meet the needs of
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  - our community here in the Greater Northland.
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  - Oh, sounds like it. And to confirm, you've
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  - been CFO since 2021?
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  - That's correct.
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  - Wonderful. Yeah. I'd love to hear a little
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  - bit more about that organic growth.
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  - Maybe we could actually just kick off with
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  - that. So could you share just a little
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  - bit more behind the decision making processes that
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  - you've seen over the years and kinda how
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  - you got to where you are now?
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  - Personally,
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  - the decision making processes,
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  - you know, is really just understanding the needs
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  - of our community.
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  - And I think during that time, if you
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  - think back five years, there was a lot
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  - of
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  - scarcity mindset. We had scarcity of resources
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  - even with supplies, but also with labor. And
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  - so a lot of health systems were pulling
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  - back.
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  - Our board
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  - and our,
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  - leadership team here at MKC Health took a
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  - different approach, a little bit counter to the
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  - the common approach that we saw in the
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  - market.
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  - And we opened up the doors and we
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  - said, you know what? We know there's gonna
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  - be losses associated.
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  - Even some of this incremental volume may come
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  - at a loss in the short term.
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  - But it matters more to us to serve
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  - the community as the only remaining community
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  - hospital that's not funded by
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  - tax dollars
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  - in the whole city
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  - we knew that we had to stand up
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  - in that way and I think it really
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  - did pay dividends,
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  - over the course of the last five years
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  - Yeah, that's incredible to hear and as you
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  - kind of noted, you know, there are a
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  - lot of pressures and headwinds facing the industry
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  - over the last few years, always in health
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  - care, but especially right now. What would you
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  - say are the most pressing financial pressures that
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  - system CFOs are navigating, and how are you
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  - prioritizing these?
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  - Yeah. That's a good question. You know, the
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  - first that comes to mind is still the
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  - provider scarcity. So
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  - whether it be
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  - a medical doctor or a nurse
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  - or even our nursing assistants and medical assistants
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  - that work in our provider
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  - clinics, we're seeing just a continued shortage of
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  - those. And so the recruitment, you know, being
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  - a small health system, we we don't have
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  - as much of a reach or a brand,
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  - that can reach out to potential candidates for
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  - those roles,
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  - but also just the affordability.
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  - To be able to bring people in, you
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  - have to meet the market,
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  - rates. And the market rates are just
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  - increasingly competitive
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  - and,
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  - and kind of
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  - ever increasing, it seems, each year when we
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  - do market assessments to try to figure out
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  - where we stand.
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  - There's always a little bit of a sticker
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  - shock. So that that's probably the most pressing
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  - financial issue. At the same time, there's this
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  - decremental reimbursement that we're dealing with,
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  - both with the government,
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  - but also with the commercial payers.
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  - And with the government, you know, we see
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  - there's there's a little give and take. Certain
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  - years, they'll move things around.
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  - But really in the provider side, we've seen
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  - just
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  - reimbursements go down overall, and that's also pushing
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  - more providers from independent practice where they could
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  - sustain on their own Yeah. To employment.
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  - So part of our growth in revenue is
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  - simply just meeting that need where we've had
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  - these independent
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  - partners for decades at times,
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  - and now they're saying, hey. I can't make
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  - it on my own.
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  - I'm working as hard as I've ever worked,
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  - and I'm actually not even making ends meet
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  - as a doctor.
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  - And so we've had to bring some of
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  - those in, specialists in particular. But, you know,
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  - primary care's
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  - also, you know, one that we continue to
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  - to employ that used to be independent.
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  - So the decremental reimbursement on the provider side
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  - is a serious issue that we're having to
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  - face.
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  - But even on the commercial side, you know,
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  - as we try to negotiate contracts that keep
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  - up with inflation to the best of our
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  - ability,
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  - number one, being a small health system, that's
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  - very challenging.
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  - But what we're also seeing is that even
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  - when we get those increases,
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  - to realize the increase that you think you're
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  - going to get is becoming
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  - more and more difficult.
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  - That forces pressure into the revenue cycle to
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  - say, okay, we thought we would realize
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  - an X percentage increase, but we're actually not
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  - seeing it.
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  - Where is it going, or what are we
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  - missing?
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  - No. These are all such very valid points,
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  - and I'm sure many of our listeners are
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  - resonating with you here.
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  - Sticking with revenue cycle, obviously, revenue cycle is
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  - often where margin is won or lost.
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  - What area other areas even has KC Health
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  - focused on just to tighten up performance there,
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  - and what's making a big difference for you
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  - guys?
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  - Yeah. That's a really good question, and I
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  - I think any CFO you asked, this would
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  - be top of mind.
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  - For us,
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  - as with other health systems and other revenue
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  - cycles, we focus on really four categories.
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  - I think most focus on the first three,
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  - that is people, processes, and technology.
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  - The fourth one that we've really dug into
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  - is culture.
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  - You can have good people that want to
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  - do good work.
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  - You can have decent processes and you can
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  - have the technology to support it. But I
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  - feel like the culture
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  - is what brings all of that together,
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  - and that culture is met with strong leadership.
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  - So one of the areas that we focused
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  - on is strategic leadership.
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  - Not just the leadership that has the traditional
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  - background of being a biller or a collector,
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  - but a leader that understands how people
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  - are motivated,
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  - how teams are,
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  - brought together around a common purpose,
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  - and also leaders that can think outside the
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  - box. So even in our organization,
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  - over the last year or two, we've made
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  - some changes.
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  - My head of revenue cycle
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  - is not a revenue cycle leader by background.
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  - She's also a CPA.
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  - She started out in a CPA firm doing
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  - cost report type things and then reimbursement
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  - work,
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  - and then came in as my controller.
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  - But
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  - what we really focus on, especially as a
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  - small independent health system, we have to look
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  - at people's strengths. Right? So we don't have
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  - the the luxury to hire
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  - people for all different kinds of roles. A
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  - lot of times we have to wear multiple
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  - hats. Right. And so when we look at,
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  - a certain need that we have, we then
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  - look within our organization
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  - and find those special strengths and skills and
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  - abilities
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  - that certain people have, and we play to
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  - those strengths. And and that's been kind of
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  - a theme in our culture is we all
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  - have weaknesses. We can't try to work around
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  - or manage around weaknesses because they're all always
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  - gonna be there. But if we lean into
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  - people's strengths and pull them out of maybe
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  - a role that is
• 8:57
  - too heavily weighted on their weakness
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  - and push them into something that they're going
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  - to be able to lean into their strengths,
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  - we found a lot of success with that.
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  - And then after that, you know, just increasing
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  - our level of collaboration with IT,
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  - managed care,
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  - HIM,
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  - all of those
• 9:14
  - are such critical
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  - components of the process and the technology,
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  - that we've had to increase the level of
• 9:22
  - collaboration there.
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  - Then the last couple of things,
• 9:26
  - internal education and training. I think it's something
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  - we take for granted.
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  - People just
• 9:31
  - learn things as they go, but
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  - we have revamped our education processes. We've put
• 9:38
  - more resources into education and that ongoing education.
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  - So we've incorporated that into
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  - a monthly education platform,
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  - the quality assurance behind it that really does
• 9:49
  - provide that circular feedback and reference.
• 9:52
  - And then lastly, the technological partnerships,
• 9:55
  - there's a lot of buzz right now with
• 9:57
  - AI,
• 9:58
  - with
• 9:59
  - these scaled up technology platforms.
• 10:02
  - We operate on Oracle Health. We were the
• 10:04
  - second Cerner client to ever go live,
• 10:07
  - world headquarters across street, or used to be.
• 10:11
  - And so
• 10:12
  - we don't have maybe some of the
• 10:15
  - internal built
• 10:17
  - ins with maybe an Epic
• 10:19
  - shop. So we've really had to look at
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  - partnerships.
• 10:21
  - And that's actually one of our bigger challenges
• 10:24
  - is vetting those partnerships,
• 10:27
  - understanding who's
• 10:29
  - you know, great at sales but not great
• 10:31
  - at delivering,
• 10:32
  - and, who actually can deliver on a product
• 10:34
  - that'll help us,
• 10:36
  - to achieve efficiencies.
• 10:38
  - Yeah. All such good points there. I mean,
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  - the leadership piece that you touched on at
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  - the beginning is is so important. It's great
• 10:44
  - to hear that, you know, you're you're tapping
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  - these leaders that, you know, might not historically
• 10:48
  - have the background that one would think always,
• 10:50
  - but, hey, sometimes that brings skills that are
• 10:52
  - are even more needed. So that's that's great
• 10:54
  - to hear.
• 10:56
  - And and to your point, just in terms
• 10:58
  - of leadership, CFOs really are taking on a
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  - broader strategic role beyond the finance numbers crunching.
• 11:03
  - I just recently did a piece on where
• 11:06
  - how we're seeing CFOs becoming COOs and CEOs
• 11:09
  - more frequently. So how would you say you're
• 11:11
  - balancing that long term investment decision with day
• 11:14
  - to day pressures to hit your targets?
• 11:17
  - Yeah. That's a great question as well. You
• 11:19
  - know, when I think about
• 11:20
  - one of the bigger challenges with a small
• 11:23
  - health system is, again, you have to wear
• 11:26
  - numerous hats
• 11:27
  - and that causes you to bounce back and
• 11:29
  - forth between the
• 11:31
  - the kind of day to day problem solving
• 11:34
  - and the long term strategy.
• 11:37
  - My value is is best represented in that
• 11:40
  - three to five year time frame. But at
• 11:42
  - the same time,
• 11:44
  - we have to focus on
• 11:46
  - two things, you know, what we're doing day
• 11:47
  - to day,
• 11:49
  - and the goals that we've set for the
• 11:50
  - year and how we cascade those down into
• 11:52
  - tactics and then the level of accountability that
• 11:55
  - we have on a monthly basis,
• 11:57
  - a lot of that work is done and
• 11:59
  - a lot of that accountability
• 12:00
  - is held kind of from the front line
• 12:02
  - to the director level.
• 12:05
  - My role is to make sure that they
• 12:06
  - have the support they need from a visual.
• 12:09
  - So are we providing the
• 12:12
  - information support through business intelligence, through our, you
• 12:15
  - know, monthly reporting processes
• 12:17
  - to help them understand what's going on?
• 12:20
  - And then secondly, just making sure that they
• 12:23
  - know there is executive focus on it and
• 12:25
  - that it is important. So whether it's celebrating
• 12:28
  - the wins
• 12:29
  - or
• 12:30
  - applying resources and pressure to those areas where
• 12:33
  - we're struggling,
• 12:34
  - that's that's how I focus on that one
• 12:36
  - to two year kind of
• 12:38
  - blocking and tackling. But the three to five
• 12:40
  - year initiatives,
• 12:42
  - you know, I I try to spend a
• 12:43
  - lot of my time in that area. And
• 12:45
  - it's it's actually difficult because you don't get
• 12:48
  - a lot of
• 12:49
  - reward
• 12:51
  - when something is three to five years out.
• 12:53
  - You can put a ton of work into
• 12:54
  - it, and it's like, you know, the difference
• 12:56
  - between
• 12:57
  - raising a crop of corn or, you know,
• 13:00
  - raising an orchard of of teak wood. Teak
• 13:03
  - wood's a fifteen year harvest cycle, and corn
• 13:06
  - comes and goes pretty quick. Mhmm.
• 13:08
  - The other one, you know, the latter is
• 13:10
  - is just you have to be patient and
• 13:12
  - you have to be persistent
• 13:14
  - and disciplined.
• 13:15
  - And so I I try to build in
• 13:18
  - those disciplines
• 13:19
  - into my kinda daily work schedule so that
• 13:22
  - I can maintain progress on those three to
• 13:24
  - five year goals.
• 13:26
  - Yeah. And my final question for you here
• 13:28
  - today, when you think about advice that you've
• 13:30
  - been given over your time in health care,
• 13:32
  - what would you say is the best piece
• 13:33
  - of advice that you were given or maybe
• 13:36
  - a piece of advice that you wish more
• 13:38
  - health system leaders,
• 13:39
  - clinical operation,
• 13:41
  - what have you, they truly understood?
• 13:45
  - Yeah. I've been given a lot of good
• 13:46
  - advice over the years.
• 13:49
  - The things that stick out to me,
• 13:51
  - you know, to answer that question,
• 13:54
  - what what do I wish clinical or operational
• 13:56
  - truly understood? It is Yeah. Finance is here
• 13:58
  - to help. We're not here to to, you
• 14:00
  - know, call you out or or or, point
• 14:03
  - fingers. We're here to help. We're here to
• 14:05
  - provide insight.
• 14:06
  - The other thing is accountability is good.
• 14:09
  - I think a lot of times people kind
• 14:11
  - of
• 14:12
  - pull back at accountability. They it brings them
• 14:15
  - a little bit of heartburn.
• 14:17
  - The reality is the accountability that comes from
• 14:20
  - objective
• 14:21
  - data that we can provide,
• 14:23
  - it helps people to
• 14:25
  - be rewarded when they're doing great work. It
• 14:27
  - helps us to understand if someone's not in
• 14:29
  - the right spot as a leader, if we're
• 14:31
  - not getting results but we think we're doing
• 14:33
  - well.
• 14:34
  - All of that data driven insight
• 14:37
  - is great, and that level of accountability that
• 14:39
  - we can bring around it is good for
• 14:41
  - everybody.
• 14:42
  - Then lastly, one thing that I always
• 14:45
  - make mention of and really try to drive
• 14:48
  - home with our new employee orientation class
• 14:52
  - is that we're all stewards and we're all
• 14:53
  - leaders of stewardship.
• 14:56
  - I have a mentor that's
• 14:58
  - really taught this to me. He was CFO
• 15:00
  - of a large bank.
• 15:02
  - And,
• 15:04
  - you know, he's really
• 15:06
  - driven this home with me. And it's it's
• 15:08
  - resonated
• 15:09
  - in in that
• 15:10
  - stewardship goes beyond just, you know, little decisions
• 15:13
  - here and there, but it is a culture.
• 15:15
  - And so what I try to
• 15:18
  - impart on our new employees is,
• 15:20
  - and it we we we go about it
• 15:22
  - through a long presentation and a game and
• 15:24
  - all these things. But it is we all
• 15:26
  - have a role in stewardship regardless of of
• 15:29
  - what we do for the health system,
• 15:31
  - and that ultimately drives good patient care and
• 15:35
  - and the mission of our health system.
• 15:37
  - That's great advice there. Austin, it's been such
• 15:40
  - a pleasure getting to chat with you. I
• 15:42
  - think our, listeners will really take home a
• 15:44
  - lot of great insights from you. So, again,
• 15:47
  - thank you for being on the podcast with
• 15:48
  - me, and I'm excited to chat with you
• 15:50
  - again down the line. Yeah. It was my
• 15:52
  - pleasure. Thanks, Madeline. Thank you.