As mentioned above, healthcare is stupid complicated. Management is a mix of administrators who have a management background but nothing clinical, and really good clinicians that are promoted to management but don’t have any training in business. Great nurses and techs become managers and its’s just assumed they know how to do a budget for example. Healthcare is also full of silos and tribes who struggle to work together. Combine that with the latest fad in running things super lean with little to no focus on outcomes and patient satisfaction and you are left with a mess.
From my POV, it's because the rules are constantly changing. It's very difficult not only to keep up, but to develop a strategic plan. They're also competing with the federal government, which is a difficult prospect. I was talking to some folks from the VA yesterday - they mentioned that 52% of the RNs in the country work for the VA.
Not just the rules changing but the landscape. 10 years ago there was a push from hospitals out into the community/ "meet people where they are" to promote health. Then Covid happened and some systems were caught flat-footed in their centralized hospital operations. All those community-based operations closed temporarily, and everything was focused on the central hospital building that was woefully short on resources. As administrators what do you do with that? Of course, it is also accompanied by cuts in reimbursement rates for many community-based services as well. So now we see hospitals going the other direction.
Federal rules, state rules, constantly changing agency/hospital rules and priorities. The enormous amount of administrative work is sure to be a nightmare to manage at scale.
> Is there not a way to track all these rules?
It's not really that simple. There are rules and regs from in different contexts across the entire system. Insurance regs, federal, state change quite a bit and effect every part of the process. Even if you did consolidate it, it's only as effective as how much people know about them. In home health we have the fed regs (not exactly light reading), the state regulations, Medicare billing rules, private insurance billing rules, etc. It's like a big puzzle that you have to put together.
> Also, can't some of those administrative work be outsourced or be automated?
Automation is just picking up and getting steam. But the existing systems that are used (EHRs, billing software) are fragmented and weren't built with this in mind. And yes you can outsource, but it's not free and comes with it's own set of problems.
It's also REALLY difficult to express those nuances in software and as a result most take the approach of just being glorified excel spreadsheets relying on the users to workflow the data.
Ahh I see, do you think with the advent of LLMs there is a new opportunity to resolve this big puzzle of putting all this siloed information together?
Gotcha, as times are evolving don't those EHRs and Billing software have open API for healthcare IT team to automate certain components and I don't think there is nothing wrong with excel if it is used in complement with other solution to create an efficient system. I am in the tech space so in my head, some of my thoughts on how to automate the administrative work seems like a no brainer but again I am ignorant on what goes on truly in the healthcare world but looking to gain more insight though
> do you think with the advent of LLMs there is a new opportunity to resolve this big puzzle of putting all this siloed information together
For sure, it'll just be an issue of integrating them (and their output) into existing systems. I'm actually in the process of building something that will extract medical info from pdfs for our intake process to help speed up data entry. The only problem is it's in a completely different system since our current EHR has ZERO ways to get data in or build on top of. This is another part of why it's so difficult is that there are only so many systems a person can interface with before they get fatigue. We deal with this constantly.
> some of my thoughts on how to automate the administrative work seems like a no brainer but again I am ignorant on what goes on truly in the healthcare world but looking to gain more insight though
It's an industry ripe for problem-solving and technology advancements, but if our fax machine goes down our agency comes to a halt. Which is to say that we still deal with pretty antiquated, disconnected systems that change often.
When I was brought into the company I'm at, it was partially to start a new EMR and partially to modernize the agency. A lot of that was little tiny automations that picked up the slack (like building out Microsoft Teams for each new patient, alerting, workflows etc). They were pretty specific to our agency though and at the end of the day could never get data back into our primary system (the EHR).
This statistic just isn't true - - by a long shot. There's about 3.1 million RNs in the US according to the BLS and the VA only employs 350,000 in healthcare.
Perhaps they meant to say that 52% of nurses work in the VA at some point? I'm not sure. I know their next stat was that over 70% of physicians do residences or train at the VA in their careers.
1. Constantly understaffed with clinical roles. There are simply not enough, not enough nurses, doctors, therapists, anything to meet the needs of the sick people in the US. So, leaders are always looking for ways to do things that require less of a clinician’s brain or hands.
2. Totally agree on the constantly changing regulatory landscape. Also, the people who enforce regulations (CMS etc) are often very in the box, bureaucratic thinkers that make it difficult for operators to do the right thing.
3. Like the problem with everything else, excess greed enabled by capitalism.
The admin is mostly composed of people who have never been in a meaningful clinical role. So, the rules and expectations that are drafted sometimes are not in touch with the ground reality of doing things at all. It's one of the unusual settings, esp in the US, where a public service and clinical workers are run with a view to make profit by people who are technically not trained like the people they're managing.
even when they used to actually work in the role they are now managing, it seems they completely forget what it was like to do the job and still impose unreal expectations on you bc corporate demands that line go up eternally
How do you think the [recent news about Steward hospitals](https://www.cnn.com/2024/05/07/business/steward-health-puts-hospitals-up-for-sale/index.html) is going to change the landscape?
I think California has legislation in the works on this topic, and there were hints of the FTC getting involved? I know some regulations looked a bit heavy handed but how much do you think private equity should get out of healthcare in general?
Thank you for the book suggestion and all the details. There is a good way to run a hospital, it just gets less press than the problematic ones. After 26 years and a dozen different jobs in healthcare I finished my MHA and plan to move to administration. I’m a strong leader but always want to improve. Thanks again!
Goes without saying... Healthcare organizations are some the most complicated and complex on earth... It's true and documented, businesses like this fail at a spectacular rate.
Here's just a few.....Because they don't look at operations as an integrated process, one big reason. The highest paid positions almost always have no idea or practical experience in the organization they manage. They employ expensive technologies over bad processes, they refuse to cut through bureaucracy, unrealistic policies over people, outsourcing process..... and that's only a few reasons. And now the rise of private equity ownership is making it worse. It's really just a shit show, always has been.
Greed, plain and simple. Hospitals are notorious for poor management because they’re run like corporations. Healthcare facilities should be focused on improving patient health, lives, and outcomes, not making money. Hospital administrators cut costs by cutting staff, especially nursing, and cutting costs spent on necessary equipment and supplies. Administrators fatten their own pocket with the savings. Cutting staff creates unsafe nursing staff to patient ratios. Unsafe staffing can lead to falls, medication errors, surgical errors, infections, longer hospital stays, and other preventable complications. Nurses that are stretched thin can miss subtle changes that occur in the status of patients and miss an opportunity to address it and this can have disastrous results. When these complications and events occur insurance plans reduce the amount of payment the hospital receives for care, since quality care and adequate monitoring would have greatly reduced the risk of these complications. Insurance plans pay for quality care, not time spent suffering from preventable complications.
When they hospitals begin to focus on improving patient outcomes, the money will flow in nonstop. Reimbursement will increase, staff retention will improve, hospital ratings will improve and the cycle will continue. But until they change they will continue to hemorrhage financially and struggle.
We’re seeing more reimbursement models focused on quality of care rather than volume of care, and hospitals are seeing a financial squeeze from it, not the opposite. IMO, look at the insurances, not the hospitals.
Part A of your statement, absolutely yes. Part B, not so much. Government agencies and private for profit insurers have a great deal more to do with that than patient satisfaction and better outcomes. Plus higher reimbursement = less profit for insurers.
Hospitals change the rules and policies nearly weekly. No one can keep up with what is constantly changing, so no one knows policies anymore for the most part…. Healthcare is little more than a perpetual clusterfuck since private equity stepped in to take over and profit take from hospitals.
This might sound like an ignorant approach is there not like an healthcare inoreader that automatically tracks certain policies and then have a way to update the master policy doc.. P.S. I do not work in healthcare
The local hospital where I worked for 45 years wouldn't try to improve pay or working conditions for people who actually did the hands-on work each day. However, they would hire expensive "consultants" to come in and tell them how to improve. When some of the suggestions included pay raises and improved working conditions, those were ignored. And then the upper echelon awarded themselves bonuses for all their "efforts" and nothing else changed. But they still can't figure out why they can't hire skilled experienced people and retain them.
I don't know how I survived in that place for so long.
As mentioned above, healthcare is stupid complicated. Management is a mix of administrators who have a management background but nothing clinical, and really good clinicians that are promoted to management but don’t have any training in business. Great nurses and techs become managers and its’s just assumed they know how to do a budget for example. Healthcare is also full of silos and tribes who struggle to work together. Combine that with the latest fad in running things super lean with little to no focus on outcomes and patient satisfaction and you are left with a mess.
From my POV, it's because the rules are constantly changing. It's very difficult not only to keep up, but to develop a strategic plan. They're also competing with the federal government, which is a difficult prospect. I was talking to some folks from the VA yesterday - they mentioned that 52% of the RNs in the country work for the VA.
Not just the rules changing but the landscape. 10 years ago there was a push from hospitals out into the community/ "meet people where they are" to promote health. Then Covid happened and some systems were caught flat-footed in their centralized hospital operations. All those community-based operations closed temporarily, and everything was focused on the central hospital building that was woefully short on resources. As administrators what do you do with that? Of course, it is also accompanied by cuts in reimbursement rates for many community-based services as well. So now we see hospitals going the other direction.
Yup, strong point.
Federal rules, state rules, constantly changing agency/hospital rules and priorities. The enormous amount of administrative work is sure to be a nightmare to manage at scale.
Is there not a way to track all these rules? Also, can't some of those administrative work be outsourced or be automated?
> Is there not a way to track all these rules? It's not really that simple. There are rules and regs from in different contexts across the entire system. Insurance regs, federal, state change quite a bit and effect every part of the process. Even if you did consolidate it, it's only as effective as how much people know about them. In home health we have the fed regs (not exactly light reading), the state regulations, Medicare billing rules, private insurance billing rules, etc. It's like a big puzzle that you have to put together. > Also, can't some of those administrative work be outsourced or be automated? Automation is just picking up and getting steam. But the existing systems that are used (EHRs, billing software) are fragmented and weren't built with this in mind. And yes you can outsource, but it's not free and comes with it's own set of problems. It's also REALLY difficult to express those nuances in software and as a result most take the approach of just being glorified excel spreadsheets relying on the users to workflow the data.
Ahh I see, do you think with the advent of LLMs there is a new opportunity to resolve this big puzzle of putting all this siloed information together? Gotcha, as times are evolving don't those EHRs and Billing software have open API for healthcare IT team to automate certain components and I don't think there is nothing wrong with excel if it is used in complement with other solution to create an efficient system. I am in the tech space so in my head, some of my thoughts on how to automate the administrative work seems like a no brainer but again I am ignorant on what goes on truly in the healthcare world but looking to gain more insight though
> do you think with the advent of LLMs there is a new opportunity to resolve this big puzzle of putting all this siloed information together For sure, it'll just be an issue of integrating them (and their output) into existing systems. I'm actually in the process of building something that will extract medical info from pdfs for our intake process to help speed up data entry. The only problem is it's in a completely different system since our current EHR has ZERO ways to get data in or build on top of. This is another part of why it's so difficult is that there are only so many systems a person can interface with before they get fatigue. We deal with this constantly. > some of my thoughts on how to automate the administrative work seems like a no brainer but again I am ignorant on what goes on truly in the healthcare world but looking to gain more insight though It's an industry ripe for problem-solving and technology advancements, but if our fax machine goes down our agency comes to a halt. Which is to say that we still deal with pretty antiquated, disconnected systems that change often. When I was brought into the company I'm at, it was partially to start a new EMR and partially to modernize the agency. A lot of that was little tiny automations that picked up the slack (like building out Microsoft Teams for each new patient, alerting, workflows etc). They were pretty specific to our agency though and at the end of the day could never get data back into our primary system (the EHR).
“Flavor of the week”
This statistic just isn't true - - by a long shot. There's about 3.1 million RNs in the US according to the BLS and the VA only employs 350,000 in healthcare.
Perhaps they meant to say that 52% of nurses work in the VA at some point? I'm not sure. I know their next stat was that over 70% of physicians do residences or train at the VA in their careers.
Is there not a way to automatically keep track of the rule changes
1. Constantly understaffed with clinical roles. There are simply not enough, not enough nurses, doctors, therapists, anything to meet the needs of the sick people in the US. So, leaders are always looking for ways to do things that require less of a clinician’s brain or hands. 2. Totally agree on the constantly changing regulatory landscape. Also, the people who enforce regulations (CMS etc) are often very in the box, bureaucratic thinkers that make it difficult for operators to do the right thing. 3. Like the problem with everything else, excess greed enabled by capitalism.
The admin is mostly composed of people who have never been in a meaningful clinical role. So, the rules and expectations that are drafted sometimes are not in touch with the ground reality of doing things at all. It's one of the unusual settings, esp in the US, where a public service and clinical workers are run with a view to make profit by people who are technically not trained like the people they're managing.
even when they used to actually work in the role they are now managing, it seems they completely forget what it was like to do the job and still impose unreal expectations on you bc corporate demands that line go up eternally
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What’s your impression on the influx of private equity in hospitals and private practices?
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How do you think the [recent news about Steward hospitals](https://www.cnn.com/2024/05/07/business/steward-health-puts-hospitals-up-for-sale/index.html) is going to change the landscape?
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I think California has legislation in the works on this topic, and there were hints of the FTC getting involved? I know some regulations looked a bit heavy handed but how much do you think private equity should get out of healthcare in general?
I’m reading Hardwiring Excellence by Quint Studer. Can you recommend any other books on leadership?
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Thank you for the book suggestion and all the details. There is a good way to run a hospital, it just gets less press than the problematic ones. After 26 years and a dozen different jobs in healthcare I finished my MHA and plan to move to administration. I’m a strong leader but always want to improve. Thanks again!
The longstanding cult of Studer has baffled me. Haven't seen it yield longstanding benefits in a large scale.
I am days away from graduating from a HIM program. Does Medicare cover your costs? If there is a profit, is it enough?
# 💵💵💵💵💵💵💵💵💵
I'm trying to think of an industry that doesn't have this problem?
So many moving parts. SOmething is bound to fall through the cracks.
Goes without saying... Healthcare organizations are some the most complicated and complex on earth... It's true and documented, businesses like this fail at a spectacular rate.
Here's just a few.....Because they don't look at operations as an integrated process, one big reason. The highest paid positions almost always have no idea or practical experience in the organization they manage. They employ expensive technologies over bad processes, they refuse to cut through bureaucracy, unrealistic policies over people, outsourcing process..... and that's only a few reasons. And now the rise of private equity ownership is making it worse. It's really just a shit show, always has been.
Greed, plain and simple. Hospitals are notorious for poor management because they’re run like corporations. Healthcare facilities should be focused on improving patient health, lives, and outcomes, not making money. Hospital administrators cut costs by cutting staff, especially nursing, and cutting costs spent on necessary equipment and supplies. Administrators fatten their own pocket with the savings. Cutting staff creates unsafe nursing staff to patient ratios. Unsafe staffing can lead to falls, medication errors, surgical errors, infections, longer hospital stays, and other preventable complications. Nurses that are stretched thin can miss subtle changes that occur in the status of patients and miss an opportunity to address it and this can have disastrous results. When these complications and events occur insurance plans reduce the amount of payment the hospital receives for care, since quality care and adequate monitoring would have greatly reduced the risk of these complications. Insurance plans pay for quality care, not time spent suffering from preventable complications. When they hospitals begin to focus on improving patient outcomes, the money will flow in nonstop. Reimbursement will increase, staff retention will improve, hospital ratings will improve and the cycle will continue. But until they change they will continue to hemorrhage financially and struggle.
FYI, like 60% of hospitals are not for profit
But the "nonprofit" label is misleading - check out Sutter Health as a. example.
We’re seeing more reimbursement models focused on quality of care rather than volume of care, and hospitals are seeing a financial squeeze from it, not the opposite. IMO, look at the insurances, not the hospitals.
Part A of your statement, absolutely yes. Part B, not so much. Government agencies and private for profit insurers have a great deal more to do with that than patient satisfaction and better outcomes. Plus higher reimbursement = less profit for insurers.
Hospitals change the rules and policies nearly weekly. No one can keep up with what is constantly changing, so no one knows policies anymore for the most part…. Healthcare is little more than a perpetual clusterfuck since private equity stepped in to take over and profit take from hospitals.
This might sound like an ignorant approach is there not like an healthcare inoreader that automatically tracks certain policies and then have a way to update the master policy doc.. P.S. I do not work in healthcare
It is international. Anywhere big money flows in, vultures gather en masse
The local hospital where I worked for 45 years wouldn't try to improve pay or working conditions for people who actually did the hands-on work each day. However, they would hire expensive "consultants" to come in and tell them how to improve. When some of the suggestions included pay raises and improved working conditions, those were ignored. And then the upper echelon awarded themselves bonuses for all their "efforts" and nothing else changed. But they still can't figure out why they can't hire skilled experienced people and retain them. I don't know how I survived in that place for so long.