At Becker’s 11th Annual Health IT + Digital Health + RCM Conference on Sept. 14 in Chicago, three revenue cycle leaders discussed what reskilling a finance team looks like once the easy automation wins are gone.
Diana Allen, PhD, revenue cycle executive at Springhill Medical Center in Mobile, Ala., and CEO of healthcare finance technology company SSI Group, framed the stakes bluntly.
“We’re in a healthcare revenue cycle crisis,” Dr. Allen said on a panel moderated by Scott Becker, founder and chief content officer of Becker’s Healthcare. “I went down this rabbit hole of actually totaling up what the cost to collect is in our own hospital. It will astound you.”
Mr. Becker put a number behind that: The U.S. spends roughly $5.3 trillion a year on healthcare, and nearly 5% of it, $220 billion to $250 billion, goes to revenue cycle. Drew von Eschenbach, vice president of enterprise revenue cycle at UW Medicine in Seattle, put it in starker terms.
“Our job in revenue cycle is to convert the care that we deliver into cash, so that we can continue the investment and delivery of improving healthcare,” Mr. von Eschenbach said. Every dollar spent on revenue cycle, he added, is a dollar that does not reach patient care.
At UW Medicine, where Mr. von Eschenbach oversees more than 800 revenue cycle employees, that math has shaped a specific practice: not cutting headcount, but rebuilding it as people leave.
“I’m replacing, say, 12 positions with four, paying them close to equal amounts in terms of overall spend for those 12 into the four, so that we’re hiring a higher-caliber person who understands across the entire continuum of revenue cycle,” he said.
He compared the shift to how modern militaries fight. “No longer are we going to have to storm a beach with tens of thousands of soldiers,” he said. “We have drone technology, we have special forces, we have satellites. I see revenue cycle moving in a similar fashion.” The payoff, he said, is UW Medicine’s revenue cycle FTE count has stayed essentially flat even as the health system’s patient volume has grown.
Dr. Allen described a parallel shift in how her team works denials at Springhill. Rather than processing claims one at a time in a queue, her team now studies payer behavior across the entire system at once.
“I have taken it upon myself to champion ‘kill the queue,'” she said. In one case, that broader view surfaced a pattern that the old claim-by-claim process had missed entirely: a cluster of denials tied to National Drug Code errors, each one logged under a different stated reason so that no single claim ever looked like part of a larger problem.
“Once we saw it over 90 days, it was $10 million,” Dr. Allen said. “That got attention, and we put resources around it to mitigate it. That would not have happened in the old revenue model.”
Lindsay Myers Bennett, chief revenue officer at Nashville, Tenn.-based Centerstone, described a similar move away from manual, transactional work.
“Internal RPA has been working really well,” she said. “We’ve been taking the most painful manual processes and automating that so that our people can focus on more value-added work.”
That shift, she said, is changing what the job itself requires.
“We are shifting away from spending all of our time on compiling data, and we’re shifting forward to using that data,” Ms. Bennett said. “People need to have influence. They need to be able to go out and interact with the clinical teams and use data to tell a story in a way that’s relatable, so that we’re all aligned and to get the action that’s needed to actually move the numbers and not just report them.”
All three panelists agreed the harder problem is getting staff to actually change how they work. Mr. von Eschenbach described the challenge in terms borrowed from a well-known parable about change: “Getting people out of their comfort zone in their day-to-day life to think differently, to act differently, and to change the mindset of not asking the question, ‘who moved my cheese?’ but asking the question, ‘where is my cheese going next?'”
He also stressed the importance of identifying top performers early and protecting them. “You’ve got to know who your ‘A’ players are, the people who are high performers, you have high trust in them, and you take care of them,” he said. “That is your ‘A’ team, that is your SWAT team.” Neglecting underperformers, he warned, risks losing the best people on a team, who eventually tire of carrying the load.
Dr. Allen took a more structured approach at Springhill, building a framework she calls A4: agile, automation, AI, architecture.
“I made this up,” she said, but she pushed for every person in the organization to adopt it, backed by incentives and promotions tied to the change.
Full adoption took roughly six months, longer than she expected, but the result “has launched into something even bigger than I could have imagined.”
She credited part of that success to letting front-line staff decide how the framework applied to their own roles rather than dictating a single approach from the top.
“Not everyone’s role is the same,” she said. “Therefore, their adoption is different. How it solves their problem is different, and they know better than I do where they need to bring that change.”
Ms. Bennett closed on a similar note, arguing that leaders bear responsibility for making the urgency of the moment clear to their teams.
“Do all of our team members really realize the urgency and the degree of change across the industry?” she said. “It’s important for us to communicate that, and that inspires people too to keep moving up those levels as the lower levels disappear to technology.”
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
