Leadership Development within the Revenue Cycle

Jonathan Wiik:
[00:00:30] [00:01:00]

Hello, everyone. I'm Jonathan Wiik, the vice president of Health Insights at FinThrive, and this is the Rethink podcast. I'm joined today by the illustrious Rory Boyd. He is the revenue cycle manager over at Scripps. Him and I are going to chat about quality in patient access and just what's going on there. That's one of my favorite subjects to talk about. I'm a patient access guy by heart. That's where I started in the hospital, as a transporter, and then moved my way into an MRI department, and then ultimately was an admissions rep, and then started to get into admissions, and billing, and all those things. But Rory, welcome to the show. We're very happy to have you here, and welcome to the podcast.

Rory Boyd:
Thanks for having me, man. I'm excited.

Jonathan Wiik:
You bet. Who were you voting for in football over the weekend? Did your team win or did they lose? Or do you follow a different sport?

Rory Boyd:
I don't like football, which is kind of weird to hear in America, right?

Jonathan Wiik:
Yeah, that's all right.

Rory Boyd:
I'm a big baseball fan.

Jonathan Wiik:
Okay, cool.

Rory Boyd:
Being from San Diego, it's a depressing time for us right now.

[00:01:30]
Jonathan Wiik:

[inaudible 00:01:29]. Yeah, they got close this year though, right? I don't follow baseball super close, but they made it to one of the playoffs?

Rory Boyd:
Yeah. So we won the wild card, and then we played the Dodgers again, and it's always hit-and-miss with them and-

Jonathan Wiik:
No pun intended.

Rory Boyd:
Right. Right, exactly.

Jonathan Wiik:
Well, give me your background at Scripps a little bit. How long have you been working there, and how did you come to that place, and what your role is? I think that'd be cool for the audience to kind of understand.

[00:02:00]
Rory Boyd:

Yeah. So I've been with Scripps, this will be my 13th year.

Jonathan Wiik:

Nice.

Rory Boyd:

I came out of construction, honestly.

Jonathan Wiik:
Oh, wow.

Rory Boyd:
[00:02:30]
We get laid off during the holiday months and things like that, and when it rained you don't get paid, and I was like, "This sucks." So I started thinking about, "Okay, what's recession proof, I can always count on a paycheck?" A lot of my family was in healthcare and they're like, "Dude, go to healthcare." "All right, fine." So I went and got my MA and-
 
Jonathan Wiik:
Nice.
 
Rory Boyd:
Joined Scripps as a part-time medical assistant in dermatology.
 
Jonathan Wiik:
Very cool. Very cool. That's-
 
Rory Boyd:
Worked derm for about, shoot, six months. Then I got a back office MA scheduling role in employee health. Did that for probably two or three years. Somehow somebody nominated me for Employee of the Year, and they gave it to me, which I don't know how that happened.
 
[00:03:00]
Jonathan Wiik:
Wow. That's a big deal at a big org, man. That's pretty awesome.

Rory Boyd:
[00:03:30]
I had to pay off a lot of people. So that was cool. From there, finally got myself into one of their first programs, which was Employee 100 with Chris Van Gorder. Super fun. Good intro into the organization as a whole, where we're going, what we're about. Took a OP supervisor role at a large clinic, and did that for about three and a half-ish years. It was cool. Went through some more leadership development programs with, we call him CVG, Chris Van Gorder, and landed this role in the Access Quality Program for the corporate side of patient access. It's been a blast, man. They've given me a lot of freedom to do a lot of cool stuff, and I think we're really making some waves.

[00:04:00]
Jonathan Wiik:

That sounds cool, man. I remember working construction when I was in college, but I never took it on as a career 'cause it was so weather-dependent, especially in Colorado with the snow and everything. We'd be out for a couple days sometimes, and that just didn't help pay the bills when you didn't have any money to pay the bills to make it [inaudible 00:04:19] typically not part of your career. That's awesome. Let's dive into Scripps a little bit. Let's talk about this Access Quality Program and training that you're doing there. Walk us through what that looks like.

[00:04:30]
Rory Boyd:
We like the short version of everything. AQP is what everybody calls it.

Jonathan Wiik:
AQP. I like it.

Rory Boyd:
[00:05:00]
We're weird. I don't know how best else to describe it, we're just weird. We've got a little bit of everything. We've got estimates for the system, which is ran by five team members. I have two analysts and three patient service specialists, and they do estimates for the system. I've got two gals who are analysts, and they create all the access trainings for 3, 500 access staff. We have first pass denials in access.

[00:05:30]
We've got a lot of cool different things going right now. We just centralized our authorization department here, for in patient auth that is. So it's evolving, that's for sure. But I think the cool part that has us standing out and doing something different was the programs that we're doing for development for access. Everyone's doing a flavor of what I just told you, so that's not really anything fun or exciting. I met our chief experience officer who now is our chief medical officer, Dr. Ghazala Sharieff, amazing, amazing woman.

Jonathan Wiik:
Nice.

Rory Boyd:
[00:06:00]
If you guys don't know who she is, please look her up. Bumped into her randomly when I was a supervisor at the clinic. The lights were all off one morning and she was in the lobby, and I came in and said, "Oh, hi, let me check you in," and turned on the lights, talked to her. We had a great time, super, super awesome conversation. And later that day I get an email from Dr. Ghazala Sharieff, your CMO, and I was like, "What the hell? Oh, damn, that was that lady."

Jonathan Wiik:
Yeah, that was her.

Rory Boyd:
Thank God I checked her in, right?

Jonathan Wiik:
I'm glad you didn't mess it up, right? I love it.

[00:06:30]
Rory Boyd:
So her and I have been good friends since that day. With her blessing and CVG's blessing, they said, "Go start building access staff." So it's been crazy. We did a patient experience ambassador course, and that's really where it-

Jonathan Wiik:
Cool.

Rory Boyd:
[00:07:00]
Kicked off for access. We take the six best access staff for six months, so it's a small group of people. Usually we let in 12 or 15, but the requirements to graduate are so tough, we probably end up with about six to eight at the end. Because if they don't hit their deadlines, I kick them out. Because if you're going to hold the title, you got to earn it, right?

Jonathan Wiik:
Yeah, for sure.

Rory Boyd:
So we do that. We recently just launched a Revenue Cycle Leadership Development Program, so we've been really diving into that as well.

Jonathan Wiik:
Nice.

Rory Boyd:
It's cool, man.

[00:07:30]
Jonathan Wiik:

[00:08:00]

Yeah, that sounds cool. I remember we centralized our scheduling departments at my hospital across imaging, pre-surgery testing, if that's still a thing, and then cardiopulmonary, those three areas, and it was an undertaking. I couldn't imagine a behemoth like Scripps trying to do that, just even on the inpatient side. But, that's good. I like having the Ambassador Program too. I think that makes a lot of sense just in terms of having that career ladder.

[00:08:30]
We struggled with that at my hospital. These were hourly wage folks. We were competing with a lot of the fast food, and I would argue retail restaurants in town, just to keep them kind of happy without them defecting for 50 cents, a buck more an hour, which doesn't seem like a lot, but it was a lot to that group. We wanted to have programs like that to where they maybe learned scheduling. But we did not have an ambassador, so that's kind of cool. That sounds something that's aspirational too. Have you seen that help retain your staff also?

Rory Boyd:
Well, yeah. What's the biggest cost in any organization? It's labor. So you-

Jonathan Wiik:
Labor, baby. Yeah.

Rory Boyd:
[00:09:00]
Start having to train all these new people coming in because exactly what you're talking about. We've got the VA on our door, we've got UCSD, we got Kaiser, Sharp. It's a big competitive market out here, and if somebody gets 50 bucks a paycheck more, they're gone. It's like, "Wait, you've been here for 10 years and you're gone?" So we started investing in them, and showing them that we care.

Jonathan Wiik:
That's cool.

Rory Boyd:
[00:09:30]
[00:10:00]
By doing this, things have come out of it that we didn't expect. It became a feeder program for our leadership. These folks are really the best of the best, but we're not focusing on skills. We're not focusing on, "Hey, here's how you do Excel." My goal in these programs is to focus on them as people because we're all broken, we're all jacked up in some way, and we bring that crap to work, and we bring our baggage and our issues into work, and then we're bad leaders because of it, we're bad staff because of it, because we're dealing with all of that noise in the background. But when we focus on, like what we do in the program, "What's your values? Who are you as a person? Do you even know?," once we find those core values, then we can start talking about, "Now, where are we going? Now you know who you are, now let's talk about where you want to go."

Jonathan Wiik:
For sure. For sure.

Rory Boyd:
Really, the foundation is in those first two classes. The second class, right as we start to end the first class, I tell them, "Your homework for next time is to show up with your eulogy."

Jonathan Wiik:
Awesome.

Rory Boyd:
And they're like, "What?"

Jonathan Wiik:
That's an odd request. I like it though.

[00:10:30]
[00:11:00]

Yeah, we like to get weird. But you think about it, "Now I know my values, I know who I am." And if you've been to a college course or anything like that, you get a syllabus at the beginning of the course. Well, your eulogy is now your syllabus for life, because you know what you want to accomplish, you know where you're going now, you know who you are. All right, now everyone get on the damn bus. Now we can do some stuff. Now that we know who we are and where we're going, let's go do it. So we use that as the foundation. But if any of you guys who are watching this haven't done that, have your staff write their eulogy, if you have a good connection with them. Build that bond and make sure you have that, because that takes a lot of trust and people are super vulnerable when they share those, and oftentimes there's tears and it gets deep. But I think I've seen probably some of the best outcomes come from what people didn't realize they wanted in life and reading that out aloud. 
[00:11:30]

Jonathan Wiik:
[00:12:00]
I really appreciate that, Rory. I think creating that value and belonging is a huge core thing you see when you're a leader in terms of your staff. I remember, I had 160 folks reporting to me through my directors at my hospital, and it wasn't until that connection was made, to your point, that folks stayed, and they probably gave you that extra 20 or 30% that they were either holding back or didn't know they had when they were there, and it showed. It showed they were happy about being at work, they didn't feel like they were doing meaningless things. They realized their connection to what was going on as ambassadors of the organization too, not to use your word. But, it matters.

[00:12:30]
I didn't use the eulogy thing. I think I just ended up asking people to tell me their life story, and what they were interested, and if they had family or not. Having a chief revenue officer walk around and have those types of conversation was interesting to them 'cause they were typically... If they ever got it from their supervisor, or director, or manager, it wasn't from someone like me. But I found that just walking around and asking people how their day was kind of shallow and trite, where doing something like that really kind of creates and grounds folks. So that's awesome. And kudos, it sounds like that's working out really well.

[00:13:00]
Rory Boyd:
I always heard people don't leave an organization just because. It's usually because of bad leaders or bad managers. I believe that if you can connect with your folks and make that interpersonal bond with them, that's I think what a lot of people are looking for, that sense of belonging and partnership.

Jonathan Wiik:
Right. Do you think that's what's been most impactful for you personally with that? Or has there been other things from the program that you're super proud of that you'd want to share?

[00:13:30]
Rory Boyd:
Yeah, I think so. Because it's crazy, we've had some folks from Ambassador Program and Leadership Development come out and say, "Hey, look, I've actually got a problem with drinking and I'm going to go to recovery now because [inaudible 00:13:46]-"

Jonathan Wiik:
Wow. Well, you guys are doing employee therapy stuff too. That's awesome.
Rory Boyd:
[00:14:00]
You know what? Honestly, that's kind of what it feels like, a therapy session. But dude, we need that. As people, we need that. A lot of us don't go to therapy, we just suck it all in and-
 
Jonathan Wiik:
Totally. Totally.

Rory Boyd:
And if you can have that with your work... Dude, we spend more time with our folks at work than we do at home sometimes. So if we show them we care, and they belong, and we love them, then why would they go?

Jonathan Wiik:
[00:14:30]
That's awesome. I bet you're going to get a lot of applications to Scripps after this podcast. You guys have got a pretty cool work environment. How are the staff developing in this? What do you see? Have you lost folks to your own organization, I hope? And I mean that with love. Have you seen people promote out because they've gone through this, or are they telling their friends? What's the dynamic of shifting and growing, and where do you see it, and where would you like to see it as a program as it's been going on?

Rory Boyd:
[00:15:00]
[00:15:30]
I think early in my career, I was very aggressive to move up and to get the positions I wanted, and I really went after them. But there was points where I think I was put in a box, because it's like, "Oh, you're good at this, so stay doing this 'cause it really works for us." I think we all, at some point in our careers, find ourselves in that box. But I'm really big on, "Go out and get whatever it is you want. Because if you want it, and you're stuck here with me, well then you're not going to be happy and you're not going to be performing at your best. So go get what you want. And if you move on and you're successful, I did my job as a leader." So 40% of the folks who have gone through Ambassador Program have promoted after Ambassador Program.

Jonathan Wiik:
Wow. I love that you have the stats. That's great.

Rory Boyd:
[00:16:00]
I'm a nerd at heart. I like numbers. Data are the facts, those tell the stories. But a long time ago... Truthfully, when I first joined Scripps, it was a steady flow of surfboard money, and I could always count on that surfboard money coming in. I went to a town hall, and I went because there was free food. I was 20 when I joined Scripps, 21 when I joined Scripps. And I went to a town hall 'cause they said, "There's free barbecue." And I went, "Oh, hell yeah, I'm in." So I took my lunch and went down to the town hall, and Chris Van Gorder was speaking there.

[00:16:30]
I'm eating the food, I'm not really paying attention. Then I hear him start talking about how it's very important for our senior leaders to take care of the frontline staff, because if they take care of us and they show us that they care for us and that we matter, that we'll just take care of the patients because now we are committed to the organization, we love the organization, we have a belonging. I'm like, "What the... This is very different than anything I've heard before. This is kind of weird." And I feel like ever since that day, I've been wasted on the Kool-Aid, man.

[00:17:00]
Jonathan Wiik:
[00:17:30]
Yeah, that's cool. I remember one of my mantras was, "I want you to be happy, and sometimes that isn't here." So that totally falls into that. You want your folks to stay there, but we want them to be in the, not to be too much Collins, right bus, right seat, where we're going, and those types of things. To get good to great, you've got to create that culture. I used to say, "If you ended up graduating from our hospital and working somewhere else, and we had a step in your career that was beneficial, that's fine. We're going to lose people anyway, it's just the nature of any business."

[00:18:00]
I think it's arguably amplified in patient access and registration, EVS, those types of roles in a hospital too are that way also. There's just this revolving door. I used to joke with my supervisors, "We don't want to necessarily jam our foot in it, we can maybe slow it down a little bit. We don't want to speed it up either, but just live with it. And that door should revolve into our organization as well too, and hopefully they're going up." It's almost like a spiral staircase, if that makes sense. It sounds like your program has been helpful with that in developing your teams and getting them happy. Do you guys measure employee satisfaction too? Has that improved in this program?

Rory Boyd:
I don't know for the other areas, but I've put my staff through, and they've all gone through the program. I know at least for the areas that I oversee we have very, very good scores.

[00:18:30]
Jonathan Wiik:
That's cool.

Rory Boyd:
But what you said earlier kind of reminded me, as far as one of your sayings, my senior director, Alicia Kintzele... Don't try to recruit her. I like her. And if you do recruit her, I have to go with her. It's a package deal. Just so anyone knows that's listening.

Jonathan Wiik:
You guys come together.

Rory Boyd:
She's amazing. She's so good.

Jonathan Wiik:
Very cool.

Rory Boyd:
But she says, "You might be the right person for the organization, you're just in the wrong role." And I always thought that was super cool because-

Jonathan Wiik:
Oh, okay. I love that.

[00:19:00]
Rory Boyd:

You see that a lot, " You're good, but you're not good at this, but I think you might be better at this."

Jonathan Wiik:
[00:19:30]
Yeah, we saw that a lot with scheduling and registration. We had people that were just kick butt registrars that never made an error. You could have given them three insurance plans and six things to key in for visits, and they got them all right, and the name was some Norwegian name with 800 K's and L's in it and stuff, and they spelled it the same every single time. But the minute you put them on the phone with scheduling, they would misschedule six things. Then the other way around, we'd try to put schedulers and they would just get terrified with these face-to-face organizations. So I think you have to rotate people through, and then let them find their spots, and creating those spots and allowing for flexibility was huge.
[00:20:00]
[00:20:30]
I think you're right, I think that person you're speaking about, it is finding your spots and where people's strengths are. We didn't have too many uber registrars that you could just kind of put anywhere, like the utilitarian baseball shortstop, to use your example if you want, or the utilitarian football player that can run both ways. They're a diamond in the rough usually. If I can think in my 30 years of healthcare, I maybe ran across three or four of those people who wear pretty much any role you could put them in, and within a week they could change their spots and kind of chameleon into it.[00:21:00]
But most of them, it was good to kind of let them focus on their strengths, and if their strengths were having efficient phone calls, and they didn't have to necessarily be that personable on the phone, we'd keep them in scheduling and rotate them around through different departments, keeping things interesting. Healthcare could be somewhat tedious and mundane I think, to some extent. There's only so many mammograms or so many patient admissions you could do before you start driving yourself nuts. So we'd let them spend some time on insurance verification, or maybe doing some other tasks. How have you diversified things in this program to help people stay interested and engaged?

Rory Boyd:
[00:21:30]
It's really nice running these programs, but also having the ability to impact education and training with the team that I have. So one of the things that we really honed in on in the last few years is creating a culture of learning, and that's been our big thing, this culture of education learning. Because you can say, "Hey, we have this idea we want to try out, and it's a new initiative." Well, initiatives die. That's what Alicia always says, "Initiatives are meant to die." But if you create a culture, then it is what it is, and that's what you do. So we partnered with HBI, Health Care Business Insight.

Jonathan Wiik:
Nice, love them. Big fans.

[00:22:00]
Rory Boyd:
They're awesome. Love them. We jumped in. We've made a lot of LMS, learning management courses, on our own through our training team and through our subject matter experts. Two of my analysts together combined have been with the organization for 75 years, so they're lifers. We vet everything out. So we'll make January MSP Month, Medicare as a secondary payer. Well, we know January is a-

Jonathan Wiik:
Nice.
[00:22:30]

Rory Boyd:
Total mess, I don't care what organization you are.

Jonathan Wiik:
Absolutely, yep.

Rory Boyd:
So we created a Medicare as a secondary payer module, and we pushed that out to over 3000 staff, and it's a mandatory module that they take. So every month we have a different topic, and it's a mandatory module that every access staff member, from MA, to PSS, to PSR, supervisors, everybody takes it.

Jonathan Wiik:
Nice.

Rory Boyd:
[00:23:00]
I think that's really helped elevate everybody's knowledge base and their skill, and we're seeing a ton less registration errors, a ton less authorization-related denials. You got to get it right from the start or it's just crap, crap in, crap out.

Jonathan Wiik:
[00:23:30]
Total. Garbage in, garbage out. The keeping up with those things was always tough. I used to walk around with a coffee can, you can take this one if you want, and it had our top 10 or 15 denials for can't ID insurance, and I had the cards in there. I'd de-identify them of course. Then I'd walk around and I'd shake that can. The staff would kind of cringe when I was walking around. I'd go, "Hey, pick a card," and they'd pick one. I'm like, "All right, jump into the system and pick the mnemonic from insurance."

[00:24:00]
If they got it right, I'd give them a coffee card. They could go... If they got it wrong, I'd make them pick another card. Sometimes I'd have to three go four. But after a while, they liked that game. They found it kind of fun. They're like, "I'll bet you're not going to get me today," and I'm like, "Ooh, I got new cards in here though today. The billing office called me [inaudible 00:23:59]." But making things fun like that are cool. So have you had things that don't work? Are there things you've learned in the program that you wish you would've gone back and done differently?

Rory Boyd:
[00:24:30]
[00:25:00]
Yes. I think it's me, things that I've done don't work. Not necessarily the program, but it's structure of it. I think, especially with the leaders, you can't ask, "Hey, when are you guys free? Does this date work? Does this date work?" It's like, "Hey, this is when we're having the class, clear your schedule." Then for the frontline staff, it's hard because they're still frontline hourly employees. They still have to be a part of the business. So we've made it all virtual, and that's been a game changer. So we used to try to come together and have this hour session together. Well, they got to drive, and we've got clinics who are 35 miles that way and 40 miles that way, and it's just-

Jonathan Wiik:
California traffic's awesome too.

Rory Boyd:
[00:25:30]
We're turning into LA. But I just think making it virtual is a game changer. So if anyone's thinking about doing something similar, make it virtual. They can join from their desk, they can join from a conference room, and they're right back to work right afterwards. That was the buy-in we needed from the access leaders, from all of the frontline leaders, they're like, "Well, yeah, if they don't have to go anywhere..." It's really, what's an hour? That's a lunch. And if you have to, as a supervisor, it's easy to cover.

Jonathan Wiik:
Totally. Totally. Well, we're coming up on time, Rory. Is there something you'd like to kind of just have folks end on a closing thought for creating a reg QA or Ambassador Program at their hospital? What are some things you'd like folks to take from today?

[00:26:00]
Rory Boyd:
I think out of my career and the time that I spent building this program, I'd say put 15, 20 minutes in your schedule every day to reflect. CVG says-

Jonathan Wiik:
Cool.

Rory Boyd:
[00:26:30]
[00:27:00]
He takes 10 minutes at the end of every day, and he asks himself, "Would Mary Michael Cummings and Ellen Browning Scripps be proud of what I did today?" I think it's a hard question to ask yourself, and I think some days I've got to no, some days I am not sure, and I think a lot of days I get a yes. But knowing that that question's coming at the end of every day, and I've stayed consistent in asking myself that, has held me accountable to work harder and hit those metrics, hit those goals. But reflect on your life, reflect on home, is everything in order? Is everything kumbaya everywhere? And if not, make those changes, man, because you can't lead a program if you still haven't dealt with the things that you're going to ask them to deal with. So I think they've helped me more than I've helped them.

Jonathan Wiik:
Well, Rory, I think Scripps is very lucky to have you. I think your team is lucky to have you. I wish I would've had you at my hospital as well-

Rory Boyd:
Thanks, man.

Jonathan Wiik:
[00:27:30]
Just in terms of leading a group that is tough to keep happy, and you've managed to do that and create some love, I'll call it, at the organization as well that allows folks to reflect, as you mentioned. I can't thank you enough for coming on the podcast. I'd love to have you back as you come up with your next project or something as we're going. But, I'll close out. This is again, Jonathan Wiik, the VP of Health Insights at FinThrive with the Rethink podcast. And Rory, pleasure, man. Thanks for coming on.

Rory Boyd:
Thanks, Jonathan.