Latest / Becker’s Healthcare Podcast / Christopher E. Smith on Pediatric Growth, Financial Sustainability and Physician Workforce

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Christopher E. Smith on Pediatric Growth, Financial Sustainability and Physician Workforce · 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.
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  - 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 Laura Dirdo with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
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  - Christopher Smith, chief financial officer and senior director
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  - at UT Le Bonheur pediatric specialist
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  - in Le Bonheur Children's Hospital.
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  - Christopher, it's a pleasure to have you on
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  - the podcast today. Yep. Thank you for having
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  - me. I appreciate the opportunity.
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  - Absolutely.
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  - Now I'm excited for our conversation. I know
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  - we're gonna be talking about a lot of
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  - great things you're doing at the hospital as
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  - well as how you're looking at the future
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  - and in leadership too. But before we dive
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  - in, can you tell us a little bit
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  - more about yourself and your background?
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  - Sure. So I've been with Le Bonheur Children's
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  - Hospital for about seventeen years.
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  - My current role,
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  - only in the past two years as CFO
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  - for the practice plan.
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  - So ULPS itself,
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  - or UT Le Bonheur pediatric specialist is a
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  - pediatric academic,
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  - physician group. We're affiliated with Le Bonheur and
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  - the University of Tennessee Health Science Center.
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  - Our region that we kinda cover is a
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  - tristate region.
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  - So we're over West Tennessee,
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  - North Mississippi,
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  - and East Arkansas.
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  - So we have clinics kinda sprinkled out throughout
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  - that area,
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  - Downtown Memphis, East Memphis. Then we go out
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  - as far as Jackson, Tennessee, Jonesboro, Arkansas, and
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  - Tupelo, Mississippi.
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  - We've roughly got 350
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  - providers in our provider group. We cover 37
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  - pediatric specialists.
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  - That's before getting into subspecialties,
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  - within those areas.
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  - So this year, we're on track for roughly
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  - a 146,000
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  - patient visits. That's
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  - including 37,000
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  - new patients,
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  - that we'll be seeing seeing. So there's a
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  - lot of tremendous amount of both scale,
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  - clinical complexity,
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  - kinda across the organization that we have. I
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  - like to think of my role as a
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  - little bit broader than your traditional
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  - CFO role with just finance accounting.
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  - I'm overseeing revenue cycle, revenue integrity,
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  - provider enrollment,
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  - payer contracting,
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  - provider relations.
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  - But we do handle a line share
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  - of,
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  - provider productivity
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  - metrics,
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  - such as access,
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  - work RVU production
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  - to help kinda translate
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  - the clinical activities we're seeing to that financial
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  - performance.
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  - So
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  - the breadth is kinda one of the things
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  - that I enjoy the most, I would say,
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  - about the role,
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  - because it puts me at that intersection of
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  - finance operations and strategy.
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  - In a physician organization like ours, financial performance
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  - is always kinda the downstream result
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  - of operational performance. So I spend a lot
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  - of time looking at those
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  - access numbers, provider capacity,
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  - productivity,
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  - onboarding, workflow,
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  - rev cycle,
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  - just to make sure everything is kinda connecting
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  - and ticking and working together.
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  - Well, that's great to hear. And it it
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  - seems like a a fascinating role to be
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  - in in a space where you really have
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  - the opportunity to impact so many aspects of
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  - the organization
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  - and then support that delivery of really, really
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  - important clinical care. Now could you give us
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  - a a quick state of the union, for
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  - the hospital in general? What's gone well this
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  - year, and what what are you focused on
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  - for the rest of 2026?
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  - Yeah. So,
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  - for the
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  - hospital kinda provider group itself too, we,
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  - specifically my area on the provider group side,
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  - but the hospital as well, we're part of
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  - the larger Memphis Lebonner health care system. And
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  - in 2024,
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  - at the end of that year, we moved
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  - into Epic as our electronic medical record.
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  - Then then roughly a year after that, we
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  - partnered with Ensemble to handle revenue cycle space.
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  - So we transitioned specifically at,
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  - ULPS,
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  - our coding, and our back end of our
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  - revenue cycle functions to that partnership model.
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  - So over kind of a relatively short period
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  - of time, we we've changed technology platforms,
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  - operating
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  - that we're operating on,
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  - and a significant portion of our revenue cycle,
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  - structure had been changed. So
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  - creating a lot of change,
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  - that's also created a lot of opportunity that
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  - we have kinda going on. And that opportunity
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  - really to me is to refine a lot
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  - of the workflows,
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  - improve some of the visibility we have, better
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  - connect with the operational and financial data together.
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  - And what I mean by that is really,
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  - getting a better look at patient access,
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  - provider productivity,
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  - charge capture, revenue cycle performance,
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  - and our financial results, kinda to connect them
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  - all together,
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  - rather as separate functions.
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  - So
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  - one of the things over the last,
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  - year that I've done that has been particularly
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  - helpful,
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  - that we're continuing to do is,
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  - partnering with the clinical operations. I host a,
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  - financial office hours is what I call them.
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  - Allows our clinic managers to come in,
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  - ask questions,
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  - work through financial information,
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  - work through dashboards,
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  - the p and l that we send out,
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  - all the data that we're pushing out so
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  - they can ask
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  - questions or something that they're seeing that they
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  - wanna check and make sure it makes sense
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  - fiscally on the other side of the business
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  - with us.
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  - And then I'll also post topics every now
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  - and then and talk to kinda help with
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  - our financial literacy that we have,
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  - to make sure that they understand
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  - our side of the street. We understand their
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  - side of the street because we're all, you
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  - know, interconnected and and working towards one goal
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  - there.
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  - I would say,
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  - also, from the remainder of the year,
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  - there's kind of
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  - three
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  - areas
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  - of focus. So,
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  - one of our biggest ones here within ULPS
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  - is improving patient access,
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  - and helping assist that with through provider productivity.
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  - Strengthening revenue integrity is an important piece of
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  - that puzzle,
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  - to myself, helping reduce
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  - whatever revenue leakage that we may have out
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  - there.
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  - And then working with Ensemble
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  - and ourselves partnering to make sure we optimize,
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  - our epic workflows for the clinical side
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  - as well as the business side of of
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  - how we do our billing and the revenue
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  - cycles aspects of that.
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  - So
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  - I would say
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  - a lot
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  - at the forefront, of course. Our financial results,
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  - like I usually like to say, our financial
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  - results tells you usually where to look,
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  - but they don't always tell you where,
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  - things need to be fixed.
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  - So we kind of have have went to
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  - optimization
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  - focusing on,
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  - what we can see under the hood with
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  - the root cause analysis is and partnering with
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  - our clinical managers and team,
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  - to nail down those processes.
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  - Got it. That makes a lot of sense.
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  - And, you know, it really is interesting to
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  - be able to have all of of that,
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  - in place. And I think to your point,
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  - you know, the office hours sound like a
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  - really great opportunity
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  - for different,
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  - department leaders to come in and align and
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  - understand better the financial side of things. And
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  - then
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  - thinking through the partners you have with Epic
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  - and then Ensemble
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  - and others,
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  - on the revenue cycle side and just overall
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  - operationally, it seems like technology is coming into
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  - play a good amount. And so, you know,
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  - when you look at everything that
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  - is,
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  - happening right now and and and all of
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  - those different partnerships,
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  - internally and externally,
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  - how do you keep it all in place
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  - and really make sure everybody is focused on
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  - and working towards the right things, especially coming
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  - into
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  - next year when I know there's going to
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  - be a good amount of changes, on the
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  - financial side?
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  - Yeah. So, for us, keeping organized,
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  - making sure that we have the touch points
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  - that we have with our leaders,
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  - making sure we're getting that,
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  - whatever
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  - reports for us. It's big,
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  - transparency wise. I've I've pushed that from from
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  - day one of being in this role, so
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  - making sure providers have access to their data.
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  - We do that through financial dashboards.
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  - We also,
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  - make ourselves available,
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  - have a big and open door policies, that
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  - kind of thing,
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  - to make sure that our providers are comfortable
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  - with the data they're seeing. A lot of
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  - times, they're coming to us and saying, hey.
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  - I'm seeing this, from the data that you
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  - sent. Help me kinda put this together, and
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  - then we can kinda work through a lot
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  - of the optimization,
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  - strategy that we have.
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  - That sounds like it it makes, a lot
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  - of sense, and it is really cool to
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  - have that in place,
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  - as a way to keep everybody aligned and
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  - moving in the right direction.
• 9:16
  - Now looking ahead to, what are some of
• 9:17
  - the big headwinds that you have your eye
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  - on and are preparing for?
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  - Yeah.
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  - So as it comes to headwinds, there's there's
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  - three things that I think most everybody in
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  - the the industry is kinda familiar with, a
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  - lot of them specifically in pediatrics. So the
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  - first being reimbursement pressure.
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  - So there's a cost and complexity of delivering
• 9:37
  - pediatric specialty care.
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  - That cost continues to rise.
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  - Reimbursements not always keeping pace with that rising
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  - cost.
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  - So it's putting a lot of pressure on
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  - us to think and be creative and making
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  - sure that we're using our resources and being
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  - the best stewards that we can
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  - to deliver the best care that we can
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  - for our patients.
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  - The second is workforce.
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  - So,
• 10:03
  - particularly,
• 10:04
  - we have a a shrinking provider pipeline,
• 10:08
  - in several pediatric specialties that we have, especially
• 10:10
  - with the breadth of specialties that we run
• 10:13
  - here. There's, of course, national shortages
• 10:16
  - of some of these pediatric providers, so we
• 10:19
  - can't just simply locally recruit.
• 10:22
  - That's a challenge.
• 10:23
  - So one of the advantages that we have
• 10:25
  - is our relationship with the University of Tennessee
• 10:27
  - Health Science Center. That kind of creates an
• 10:30
  - opportunity for us to be more intentional about
• 10:32
  - developing physicians,
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  - specific specifically in an academic environment.
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  - Helps create that pathway for them to ultimately
• 10:40
  - join UT,
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  - Le Bonheur pediatric specialist as a provider.
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  - So we we cannot simply create an increasingly
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  - limited pool of experienced physicians. So this is
• 10:52
  - kinda how we work to build our workforce,
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  - specifically for the future.
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  - The third
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  - is,
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  - continuing administrative complexity. So between credentialing, enrollment,
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  - prior authorization,
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  - documentation,
• 11:07
  - charge capture,
• 11:09
  - payer requirements,
• 11:11
  - all those can kinda create function friction. I'm
• 11:14
  - sorry. Those delays can impact,
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  - patient access,
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  - provider productivity,
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  - and ultimately reimbursement. So those are the kind
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  - of headwinds that we have. It really comes
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  - down to protecting access,
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  - strengthening
• 11:30
  - our provider pipeline,
• 11:31
  - and removing those,
• 11:33
  - operational friction,
• 11:35
  - that we have in those spaces so we
• 11:36
  - can operate,
• 11:38
  - as a as a well oiled machine.
• 11:40
  - All three seem like vitally crucial when you
• 11:43
  - think about the continuing operations and sustainability
• 11:46
  - for the next couple of years. And I
• 11:49
  - I think you know, appreciate you talking through
• 11:51
  - the reimbursement pressures. I know that's something top
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  - of mind for so many people. And then
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  - workforce too, strengthening that pipeline there, will make
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  - a big difference. Are you seeing any types
• 12:01
  - of
• 12:02
  - trends
• 12:03
  - or or or changes when you look at,
• 12:05
  - trying to bring in additional physicians, providers, or
• 12:08
  - or team members?
• 12:09
  - If you can't recruit locally, how are you
• 12:11
  - thinking through,
• 12:12
  - additionally,
• 12:14
  - bringing in more folks so that you can,
• 12:16
  - continue to provide access to care across the
• 12:18
  - board.
• 12:19
  - Sure. Well, Le Bonheur honestly makes it easy.
• 12:21
  - It's a amazing hospital.
• 12:24
  - If we can get,
• 12:25
  - a recruit provider into the door, it's easy
• 12:28
  - to showcase
• 12:29
  - how how incredible this place is and how
• 12:32
  - patient centered,
• 12:33
  - the facilities are that really drive the hospital
• 12:36
  - operations
• 12:38
  - for us to be able to recruit.
• 12:40
  - So we do,
• 12:42
  - just because of Lebonneur and the nature is
• 12:44
  - being ranked in US News and World Report
• 12:47
  - have a have a really good reputation.
• 12:49
  - So,
• 12:50
  - we do leverage that outside recruitment when we
• 12:53
  - can,
• 12:54
  - of course, to go out and get the
• 12:56
  - the
• 12:57
  - hottest, latest new provider talent that we have
• 12:59
  - out there.
• 13:01
  - And then it's also enticing just to have,
• 13:04
  - the the realm of pediatrics tends to lend
• 13:07
  - itself,
• 13:08
  - to that academic,
• 13:10
  - interest of those providers and the the brightest
• 13:13
  - out there that we can get,
• 13:15
  - always wanna continually
• 13:16
  - learn and grow,
• 13:18
  - which makes it easier to even recruit,
• 13:21
  - from outside.
• 13:22
  - So, really, we're working two ends of that,
• 13:24
  - not just
• 13:25
  - growing the workforce through,
• 13:28
  - UT Health, Science Center's
• 13:31
  - partnership that we have with ULPS and the
• 13:33
  - hospital,
• 13:34
  - but also just being able to to recruit
• 13:37
  - ourselves nationally there.
• 13:39
  - Helpful to understand. And, you know, it seems
• 13:41
  - like a really, really great position to be
• 13:43
  - in,
• 13:44
  - to try to solve some of these challenges.
• 13:46
  - Now how else are you thinking about growth
• 13:48
  - over the next two to three years? What's
• 13:50
  - really gonna be critical as you look at
• 13:51
  - continuing to grow and expand?
• 13:54
  - Yeah. So we definitely have some opportunity
• 13:57
  - within the next two to three years,
• 14:00
  - really aligning,
• 14:01
  - our clinical resources with where demand exists.
• 14:04
  - So I'm a I'm a big data guy,
• 14:06
  - big into analytics.
• 14:08
  - So,
• 14:09
  - of course, we're taking a look at work
• 14:11
  - our views that we're generating, but we don't
• 14:13
  - look at that siloed. We we really wanna
• 14:15
  - pair that with our scheduling data,
• 14:17
  - our access data, our wait list, and other
• 14:20
  - locations that we serve.
• 14:22
  - That helps us kinda really identify
• 14:24
  - where the demand is and where the demand's
• 14:27
  - outpacing,
• 14:28
  - where we have our resources,
• 14:30
  - so we can better align with the communities
• 14:32
  - that we serve.
• 14:34
  - So growth also for us doesn't necessarily mean
• 14:37
  - just hiring more providers.
• 14:39
  - It all is really for me a a
• 14:41
  - refinement.
• 14:42
  - So making sure we're effectively using the resources
• 14:45
  - that we have so everybody's
• 14:46
  - we got the right specialty in the right
• 14:48
  - place at the right time for our patients.
• 14:51
  - I would say another opportunity,
• 14:53
  - that we have is rural health.
• 14:55
  - So,
• 14:57
  - meeting the patients kind of where we are
• 14:59
  - is a lot of the culture.
• 15:00
  - Where they are is a lot of the
• 15:02
  - culture at Le Bonheur.
• 15:04
  - So looking at ways to expand,
• 15:06
  - that specialty care into communities where families have
• 15:09
  - limited access,
• 15:11
  - is a big initiative for us,
• 15:13
  - taking it there. And then, of course,
• 15:15
  - we're on a podcast, so we can't not
• 15:17
  - mention AI at some point in the conversation.
• 15:21
  - So I think there's an opportunity with AI.
• 15:24
  - Right now, we're
• 15:25
  - piloting an AMIA AI documentation technology,
• 15:29
  - so where we can
• 15:31
  - we'll listen to the conversation between the provider
• 15:34
  - and the patient, scrubs it, pulls in all
• 15:36
  - the clinical
• 15:37
  - necessary information from that conversation.
• 15:40
  - Of course, the physician still has to review
• 15:42
  - it, make any necessary edit edits, and then
• 15:45
  - ultimately sign and own that documentation.
• 15:48
  - But if that technology allows us to reduce
• 15:50
  - the burden,
• 15:52
  - specifically after hours,
• 15:54
  - as some people call it, pajama time from
• 15:56
  - our providers and give them some meaningful time
• 15:59
  - back,
• 16:00
  - create that capacity, help them with work life
• 16:02
  - balance,
• 16:04
  - then then we're doing the right thing for
• 16:06
  - the providers there. So
• 16:09
  - it's truly taken the the data and showing
• 16:13
  - where that additional capacity may be,
• 16:16
  - targeted,
• 16:17
  - recruitment and expansion,
• 16:20
  - where we have to. And and that kinda
• 16:23
  - gives us that threefold effect where it's the
• 16:25
  - alignment of capacity,
• 16:27
  - expanded access where the community needs us, and
• 16:30
  - technology to give our physicians more time, to
• 16:33
  - focus on patients and and themselves.
• 16:36
  - I love it. And I think having that
• 16:38
  - ability to continue to grow and develop and
• 16:41
  - and with patients at the center, really,
• 16:43
  - it is the smartest way to develop that
• 16:46
  - strategy and and keep going on. Now I
• 16:49
  - wanted to ask you about leadership too. Could
• 16:51
  - you tell me about a leader who you
• 16:52
  - admire from really any industry and why?
• 16:56
  - Yeah. So,
• 16:57
  - that's a hard question for me. There's I
• 16:59
  - don't have,
• 17:00
  - specifically
• 17:01
  - one person I point to. I've had some
• 17:04
  - really great leaders throughout my time here.
• 17:07
  - I've had one leader who kinda showed me
• 17:10
  - that if you give a person an opportunity,
• 17:12
  - you give them some ownership,
• 17:14
  - trust them, give them room to grow, that
• 17:16
  - they're gonna kinda impress you
• 17:18
  - and and show you really what they're capable
• 17:21
  - of. Another leader,
• 17:22
  - that I've had through my time here,
• 17:25
  - the importance of data integrity was was very,
• 17:28
  - instilled into me. Information putting information in front
• 17:31
  - of someone
• 17:32
  - and asking someone to make a decision or
• 17:34
  - work towards a decision.
• 17:36
  - That data integrity, making sure the data is
• 17:39
  - right is extremely important.
• 17:41
  - And then
• 17:42
  - another leader
• 17:44
  - kinda instilled in standing behind the data. As
• 17:47
  - a finance leader, there's gonna be times where
• 17:49
  - numbers tell you something,
• 17:51
  - that you really don't wanna hear. And it
• 17:53
  - could be like a a tough conversation that
• 17:56
  - needs to be had,
• 17:57
  - but we have to be willing to explain
• 17:59
  - it, stand behind it, and ultimately do what's
• 18:02
  - right for the patients,
• 18:03
  - in the decisions that we make.
• 18:06
  - So
• 18:07
  - my probably my biggest influence is, honestly, has
• 18:10
  - to do with the culture here.
• 18:12
  - At Le Bonheur working in my my tenure
• 18:14
  - here,
• 18:15
  - a lot of that's doing what's right for
• 18:17
  - the patient.
• 18:19
  - Focusing on doing what's right for the patient
• 18:21
  - allows the financial results to follow that. It's
• 18:24
  - really a philosophy that we have here,
• 18:26
  - that we've always held on to,
• 18:29
  - making those right decisions for the patient, keeping
• 18:31
  - them,
• 18:32
  - patients and their families centered,
• 18:35
  - on the decisions that get made.
• 18:37
  - And then for me personally, I'd say my
• 18:40
  - parents probably have, of course, the most influence
• 18:42
  - on me,
• 18:44
  - as anyone else.
• 18:45
  - They were taught me the importance of hardworking,
• 18:47
  - staying humble,
• 18:49
  - putting family first, doing the right things,
• 18:52
  - even when no one's watching.
• 18:54
  - And and kinda those principles are have kinda
• 18:58
  - carried me through my career,
• 19:00
  - in the way I tend to lead people
• 19:02
  - today.
• 19:03
  - So
• 19:05
  - I can't really necessarily point to one person,
• 19:08
  - but my leadership style is really a collection
• 19:09
  - of lessons from people who have invested in
• 19:12
  - me over the years,
• 19:14
  - trusting your people,
• 19:16
  - protecting the integrity of your work, standing behind
• 19:19
  - what you believe is right,
• 19:21
  - staying humble in the decisions that you make,
• 19:23
  - and,
• 19:24
  - ultimately remembering,
• 19:26
  - the people that you're serving.
• 19:28
  - I love it. Christopher, thank you so much
• 19:30
  - for joining us on the podcast today. This
• 19:32
  - has been such a fascinating discussion, and I
• 19:34
  - look forward to seeing you as well at
• 19:36
  - our CEO and CFO roundtable coming up. I
• 19:38
  - know,
• 19:39
  - you'll be speaking there, so it'll be a
• 19:40
  - great opportunity to connect.
• 19:42
  - Yep. I'm very excited about it, and thank
• 19:44
  - you for taking the time.