Speaker 1 0:00
A lot of groups that I come into say staffing is the highest cost. We need to get rid of staffing, and then we do an analysis and find out they're already vastly understaffed. And the reason that they don't have more revenue is because the staff is burnout and they're not able to get to all of the tasks.

Austin Littrell 0:23
Welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, Physicians Practice Management Editor Keith Reynolds sat down with Shantea Gordon, CEO of Atlas and Perpetua Healthcare, to talk about the money that practices are losing without ever noticing it's gone. Every line item is climbing: staffing, medical supplies, and a technology stack that Gordon says has grown at some organizations from two or three core systems to as many as 15. The problem, though, is that reimbursement has not moved with it. When the math gets that tight, the reflexes to start cutting, and that reflex is exactly where Gordon says most practices go wrong. A cut made without data behind it is a guess, and the wrong guess can cost more than it saves. So in today's episode, she and Keith get into the leaks that she finds the most often, how to tell which benchmarks are actually worth trusting, why staffing reductions so frequently backfire, and the recurring expense has been quietly billing practices since the paper era. With all that said, Chanteja Gordon, thank you for joining us. Let's get into the episode.

Keith A. Reynolds 1:30
Hey there, folks. Today we're talking to Taya Gordon, CEO Atlas and Perpetual Healthcare. How you doing today, Taya?

Speaker 1 1:36
Very good. How are you?

Keith A. Reynolds 1:37
I can't complain. So, don't want to take up too much of your time. Let's dig right in. So financial pressure on practices-that's not new. So what's different now, and why does this feel more urgent than it did a few years ago? I

Speaker 1 1:50
think it feels more urgent now because the disparity between the costs we're putting out and the reimbursement we're getting in has gotten so much larger. In addition, we have staff shortages. We have difficulty negotiating with payers for higher reimbursement. We have medical costs rising, and our technology costs-I mean-are just skyrocketed. I think the tech stacks with our organizations have gone from maybe two or three main software systems to upwards of 15. So we're just seeing a lot more demand on our practices.

Keith A. Reynolds 2:22
Okay, so when you walk into a practice and start digging around, you know, where do you usually find money that's leaking out that nobody's noticing?

Speaker 1 2:31
Oh man, do I need to just tell you

Keith A. Reynolds 2:33
one? Hit me with as many as you got.

Speaker 1 2:35
I think that there's front desk practices with entry that cause revenue leakage because we're not capturing coordination of benefits correctly, or we're not capturing patient responsibilities. We have missed services happening and documentation when maybe providers send patients for a test that can be done in the clinic, but they forget to document that. We have denials that aren't appealed. We have downcoding happening. There's there's kind of a ton of places where I find leakage typically.

Keith A. Reynolds 3:04
Okay, so what do you find most often? Would you say

Speaker 1 3:09
most often probably unmanaged denials. That would probably be the one I see the most, or things just sitting in AR.

Keith A. Reynolds 3:19
Okay, so for an administrator who's never benchmarked their expenses before, what's the very first step?

Speaker 1 3:26
Oh man, if you've never benchmarked it before, you need to go do some digging and some analytics. You need to understand where you're sitting right now before you can start making any type of change. So, for example, if you have never benchmarked your medical supply cost. Well, it's a time to pull out the invoices, see what you've been paying over the last 12 months, see what you've been ordering, see if that's optimized. Look at what your alternatives are. Try to look at different GPO contracts. But if you are not starting from an evidence-based perspective, you're at a high risk of going off into the wrong direction. So first and foremost, go dig into your own historical data.

Keith A. Reynolds 4:01
Okay, so MGMA, AAFP, CMS, commercial tools. How do you know which sources to trust, and whether you're actually comparing apples to apples?

Speaker 1 4:12
Ooh, great question. I think that the challenge with trying to make sure that it is a validated resource is that there's so many organizations online right now claiming to be a validated resource. I think when you're looking for organizations that genuinely have the data that you're looking for in terms of validation, you should look at those associations like MGMA and HFMA, AAFP, the specialty organizations as well, or your medical societies, groups that definitely have their nose to the ground, but have been established long enough to have the type of historical data that gives benchmarks that are actually worth their weight. But comparing apples to apples with your organization means being really thoughtful and being really transparent with yourself about what your organization is and looks like. Where is it located? What type of community? How big is it? What services do you provide? What does your payer mix look like? All of those things are going to contribute to what you look like as a whole, so that you can identify what kind of apple you are to compare to the other apples.

Keith A. Reynolds 5:12
Okay, so staffing is the biggest line item in most budgets, but it's also where cuts can do real damage. So how do you help leaders walk that you know fine line.

Speaker 1 5:23
I love this question because it it really comes into alignment for me with the data. So look at your staffing ratios. How many employees do you have? What does that look like from admin to provider ratios or clinical support staff? Pull down your validated resources and look at the numbers. Are you right sized? A lot of groups that I come into say staffing is the highest cost. We need to get rid of staffing, and then we do an analysis and find out they're already vastly understaffed. And the reason that they don't have more revenue is because the staff is burnout and they're not able to get to all of the tasks. So you have to dig into the data. You have to see if you're right sized for your organization, and you also need to evaluate if your processes and your technologies are supporting you in the way that you need them to before you just start eliminating people.

Keith A. Reynolds 6:16
Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds. We deliver proven, real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way-I want to feature it. Shoot me an email at k. Reynolds at mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. So everyone talks about supplies and IT, but you're also covering waste disposal, leases, and facility maintenance. What's a cost that's hiding in one of those categories that practices tend to miss?

Speaker 1 7:20
Man, I think the number one has to do with shredding services for me. As we shifted from paper to electronic, so many people kept their shredding services on the same rotation. And if you weren't paying by weight, or you're paying like a monthly minimum fee, and you're not really dumping a lot into the shredded bin or shredder bin anymore because you're putting everything online. That's one place that I see people just have these monthly contracts that they've had since '92, and we're not filling those bins up anymore. So you shouldn't be paying for that. So it's one of those kind of hides in the background. It's not a lot of money every month, but it adds up pretty quickly.

Keith A. Reynolds 7:58
That's honestly that is a an angle on this that I have never heard in the however many years I've been running physicians practice. That's yeah shredding. Jeez. So how do you make sure cost cutting strategies aren't creating compliance risks or hurting you know the patient experience?

Speaker 1 8:16
So you have to have a protocol in place for reviewing those things before you take that action. So, if you're making any large change that has systemic implications to your organization, you should always ask yourself: Is this going to create a risk of a compliance risk? Is this going to hurt the patient experience? Is this going to hurt our provider and our staff experience? Is this going to hurt our ability to collect revenue? That is something you should ask anytime you're making a big change. So, for example, I see a lot of groups go out and they think I need to go and just shift what our medical supply company is because this is costing us way too much money. Well, before you do that, have you done your research? Because I worked with a group last year; they made a huge change, shifted all of their medical supplies to go with a different group. That group actually had historically had a challenge procuring a very specific item they needed for surgery. It was always backordered, and now that they weren't under a special agreement with their previous supplier, that was now costing them more. And they used it so heavily that they actually just ended up doing a disservice to themselves in the long run, and you have to just have to dig into those things ahead of time. Really make sure you're looking holistically and not just making a decision based on your gut or based on a whim or based on a really cool salesperson.

Keith A. Reynolds 9:35
Okay, don't be don't don't get brought in by a flimflam man. I get it. Yeah. Yes. So a one-time audit is one thing, but you're talking about building a sustainable framework. What does that actually look like, and how do you keep the momentum going?

Speaker 1 9:52
This is really true because so many groups, particularly in healthcare, they're inundated. They're inundated with. Regulation and with constant need from patients and from staff and technology changes and all these cybersecurity risks and it's so overwhelming. If you don't build in something intentional, then you just end up reacting to everything that happens. I highly recommend doing a holistic review of the organization, develop a 90-day plan for improvement, and at the end of that, develop how you're going to continuously improve. So keep that strategy. If you've blocked off time every month to look at your 90-day plan, well, now that block of time becomes continuous improvement. What else can we change? Of what we changed, how did it do? That is something you have to do on an ongoing basis. It's not like okay, we looked once a year. Now we're done. We're good. Or we did that a few years ago, so I don't think we need to for a couple more years. This is something you look at every single month. How can we do better than we did last month? How can we improve, even if it's just by 1% every single month, so that we are so much further along a year from now than we are today?

Keith A. Reynolds 10:59
Alrighty, and this is physician practice. We love to give out tips. So you know, what's one tip you would give a practice leader that they can implement today? Well, I mean, it's almost noon on a Friday. Let's say one thing they can implement on Monday.

Speaker 1 11:12
Fair point. I would say run a report of what CPT codes you build out and what CPT codes were reimbursed. I would do that on a monthly basis because anytime there's a variance, that means you potentially are being subjected to downcoding by an insurance carrier.

Keith A. Reynolds 11:32
All right, awesome. Is there anything else that you think I might have overlooked or that I'm missing?

Speaker 1 11:38
No, you've been phenomenal. Oh

Keith A. Reynolds 11:39
no, no, you don't have to say that. The interview's already in the can. Thank you so much, Taya. It's been an absolute pleasure talking to you.

Speaker 1 11:46
Thank you. You too. I appreciate it.

Austin Littrell 12:01
Once again, that was Shantea Gordon, CEO of Atlas and Professional Healthcare, speaking with Physicians Practice Management Editor Keith Reynolds. For one action item for Monday morning, run a monthly report comparing the CPT codes you build against the codes that were actually reimbursed. Every variance is a possible down code. With that said, on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you subscribe so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. And if you'd like the best stories that medical economics and physicians' practice publish, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart, a business of medicine podcast is executive produced by Chris Masolini and Keith Reynolds, and produced by Austin Latrell. Medical Economics and Physicians Practice are both members of the MJH Life Sciences family. Thank you.

Transcribed by https://otter.ai