Becker's Hospital Review

37 RCM LEADER Recruitment and retention In rural areas, recruitment and retention can be challenging no matter what, but Ms. Gale said that Landmann-Jungman has filled several open positions since the conversion and currently has just one open role. She said that multiple employees are happier now in their roles than they used to be. Many of the multiple hats they used to have to wear are gone. e change is especially noticeable from a business office perspective. "e arduous preauthorizations, denial managements on inpatients and swing beds — which were a real problem here with some payers — those just went away, so [those employees] were able to deploy in some different areas, which they really enjoyed, have strengths in." Ms. Sorrell said the conversion decreased Clion-Fine's FTE cap from about 80 to 55, but the hospital just had the most stabilized staffing year in the seven years she's been at the helm of the hospital. "I think everybody knows their role and we're doing the services that make sense," she said. "It's staffed appropriately and I've seen no turnover this year. Nursing is stabilized. We're not using any agency staff at all this year. So that's been an unpredicted trickle down effect." Policy gaps remain Among the policy changes leaders would like to see, one issue came up repeatedly: eligibility for the 340B drug discount program. Rural emergency hospitals are currently ineligible to participate. "at program was set forth for safety net hospitals and you can't get any more safety net than rural emergency hospitals," Ms. Gale said. Mr. Bright said he would like to see loan forgiveness for rural emergency hospitals regardless of their tax status. Crittenden is a for- profit hospital, which makes them ineligible for some loan forgiveness programs. A change would help for physician recruitment. Ms. Gale said that the outpatient payment add-on of 5% should apply to all outpatient services provided and added that there are some state and federal policy alignment issues that could be addressed. No regrets on conversion All four leaders told Becker's they are happy with their decision to convert and would make the choice again. Mr. Bright said conversion to a rural emergency hospital isn't a "magical solution" to rural hospitals' challenges, but it has been proven to be a significant tool to stabilize and even build at his hospital. Importantly, Mr. Bright added, the conversion can be reversed if needed. "If we have some drastic growth in the community and it becomes sustainable to go back to a 49-bed acute care hospital that we were before, that is doable." Ms. Sorrell said the designation provides a structural reset, but is not the finish line. e first year of the Clion-Fine's conversion had a learning curve, but they now have a strong strategic mindset on how to make the designation work. "We would be going out of business if we didn't convert," Ms. Sorrell said. "I don't think there was another option for us." n 2 revenue cycle leaders on strategies that reduced denials By Kristin Kuchno A sk a Revenue Cycle Leader is a new series featuring insights from health system and hospital revenue cycle executives nationwide. Becker's poses questions on the most pressing issues in healthcare finance — from payer relations and automation to workforce and patient experience. This week, Becker's asked leaders how they are reducing payer denials. Question: What is the most effective strategy you've implemented in the last year to reduce denials? Editor's note: Responses were lightly edited for clarity and length. Paul LePage. Vice President of Revenue Cycle at UC Davis Health (Sacramento, Calif.): The most effective strategy we implemented this year was a comprehensive denial mapping initiative that focused on identifying true root causes and eliminating non–value added work. We built a denial taxonomy that tied payer codes to operational ownership and stratified denials by preventability, financial impact, and overturn probability. By stopping low-yield appeals and redirecting resources toward upstream prevention — such as authorization accuracy, eligibility verification, and documentation improvement — we reduced rework and improved clean claim performance. This worked because we treated denials as process defects to eliminate rather than inventory to manage, creating shared accountability across the revenue cycle and clinical operations. Cindy Otero. Senior Director of Revenue Cycle at NCH Medical Group (Naples, Fla.): Meeting with each specialty/ practice leader on a monthly basis to review and decrease denials by category. Holding the front-end responsible truly helps. Next question: What is one issue in revenue cycle that you think is underappreciated or not discussed enough? n

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