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Best of the 2021 Crowe Healthcare Summit

Simplify. Elevate. Transform. 

12/3/2021
Best of Summit 2021

More than 600 healthcare finance leaders from across the country gathered virtually and in person at the 2021 Crowe Healthcare Summit in Denver, Sept. 19-23. Two-thirds of the attendees joined Summit online, and one-third participated at the Grand Hyatt Denver. Eighty-eight healthcare organizations from 41 states were represented at Summit, the 11th annual hosted by Crowe.

The big turnout reflected the industry’s desire for a high-quality education event in healthcare finance, especially in the wake of the COVID-19 pandemic, which has shaken up almost everyone’s balance sheet.

This event roundup features the best of Summit, including educational session summaries, interesting numbers, and insights to remember. If you attended this year’s Summit, you can access all session recordings and materials through Dec. 31, 2021, through your virtual lobby. CPE credit is not available for recorded sessions. If you didn’t attend this year’s Summit and would like access to session recordings and materials, please email us at [email protected].

And don’t forget to save the date for the 12th annual Crowe Healthcare Summit, to be held Sept. 19-22, 2022, back at the Grand Hyatt Denver and virtually. We hope to see you there.

1. Keynote sessions

The 2021 Crowe Healthcare Summit featured three keynote sessions that collectively set the tone and introduced major themes throughout the event: capital access during an unprecedented public health emergency, innovation during an unprecedented public health emergency, and creativity – you guessed it – during an unprecedented public health emergency.

Keynote sessions
Opening keynote session: Access to – and cost of – capital: Insights to manage the healthcare business of tomorrow

The opening keynote session was a reality check on the financial impact of the COVID-19 pandemic on hospitals and health systems. In a panel discussion moderated by Derek Bang of Crowe, four specialists said the outlook for accessing capital was generally positive. Anne Cosgrove, an S&P Global Ratings analyst, said healthcare executives have effectively learned to coexist with COVID-19. David Morlock, managing director at Cain Brothers, said the cost of borrowing has never been cheaper. And Sarah Dawkins, managing director at Kaufman Hall, said balance sheets have never looked so good. But Matt Elsey, McLaren Health Care corporate controller, said the healthcare labor market is worsening with staff shortages disrupting services and wages going up. If expenses continue to rise faster than revenue, accessing capital could get more costly, he said.

Watch a preview of the keynote

A number to remember

85%

Percentage of S&P Global rated healthcare organizations that carried a stable or positive credit rating outlook, as of June 2021

Source: S&P Global Ratings

 

Insight

“Non-COVID inpatient volume and emergency department visits remain below pre-pandemic levels.”

– Matt Elsey, Vice President and Corporate Controller, McLaren Health Care, Grand Blanc, Michigan

Innovation keynote address: CFO spotlight: Innovative thinking to solve today’s healthcare financial challenges

Michael Allen, CFO of OSF Healthcare in Peoria, Illinois, led this keynote that featured three “what if” case studies. Allen asked attendees what they would do if they were the CFO in the following situations:

  • What would you do if a struggling community hospital approached you and wanted your bigger hospital or health system to buy it?
  • What would you do if a private equity firm bought one of your large medical specialty practices and began siphoning off your commercially insured patients?
  • What would you do if you were approached by a vendor to which you could outsource all your revenue cycle functions, most of your finance functions, and their related IT support services?

Watch a preview of the keynote

A number to remember

74%

Percentage of Summit attendees who cited financial projections and their budget as their top revenue concern at the beginning of the pandemic

Source: Crowe

 

Insight

“Strategy answers the question, ‘how will we win?’ not ‘what are the numbers?’ or ‘are we operating efficiently?’”

– Brian Sanderson, Principal, Healthcare Consulting, Crowe

Awards and closing keynote address: Think together better: Building innovation, collaboration, and creativity into every meeting

At Summit’s closing keynote address, Matt Homann, founder and CEO of Filament, addressed how to make the most of meetings. Before you send meeting invitations, Homann said, you must communicate the meeting’s purpose by completing the following three statements clearly:

  • We are gathering to accomplish …
  • We must do this together because …
  • By the end of this meeting, we will …

Homann also said you need to identify the elephants, zombies, squirrels, and porcupines in each of your meetings.

After Homann spoke, Dan Gautschi, healthcare consulting leader at Crowe, handed out awards to the winners of a variety of networking and team-building activities held during Summit.

Watch a preview of the keynote

A number to remember

12

The number of attendees who successfully passed their certified net revenue analyst exam since the 2020 Summit and are now full-fledged CNRAs, bringing the total number of CNRAs to 88

Source: Crowe

 

Insight

“Think about how often we just invite people to meetings because we think they’ll be upset if we don’t.”

– Matt Homann, Founder and CEO, Filament

Breakout sessions

2. Breakout sessions

The 2021 Crowe Healthcare Summit featured 15 different breakout sessions that gave virtual and on-site attendees a wealth of practical information to take back to their own hospitals, health systems, and medical practices to help improve the performance of their finance and revenue cycle teams. Here are summaries of each of the breakout sessions.

Worksheet S-10 best practices

Knowing what goes where is an important competency in any profession, but it’s critical for hospital and health system financial leaders when they’re filling out their Worksheet S-10, which is part of hospitals’ annual Medicare cost reports to report reimbursable uncompensated care costs to the Centers for Medicare & Medicaid Services (CMS). In this breakout session, Matt Laird and Nick West of Crowe walked session attendees through the S-10 worksheet line by line and explained what expenses to include and what expenses not to include. One expense not to include this year is the cost of caring for uninsured patients with COVID-19. The government reimburses hospitals for those patients through the Provider Relief Fund, and CMS would consider reporting those costs as “double-dipping,” according to Laird and West.

A number to remember

$7.2B

Projected uncompensated care payments to hospitals in 2022 based on their previously reported uncompensated care costs

Source: CMS

 

Insight

“The charity care items reported on line 20 and line 25 [of the S-10 worksheet] should be represented in your financial assistance policy. If they’re not, you’re really opening yourself up to some scrutiny and some risk at the time of audit.”

– Nick West, Healthcare Consulting, Crowe

2021 area wage index update and strategies 

Hospitals’ labor costs are rising dramatically thanks to the pandemic. Staff shortages are forcing hospitals to hire high-priced temporary staff and pay higher wages to those who haven’t left. But there is a silver lining: Accurately reporting those rising labor costs to CMS could bump up hospitals’ Medicare payment rates, which CMS adjusts for variable labor costs around the U.S. That’s the big takeaway from this breakout session led by Dave Andrzejewski and Suzy Montecalvo of Crowe. The pair educated attendees on the different factors that affect Medicare’s area wage index, and, in turn, the rates Medicare pays to each hospital. Hospitals need to be exacting in how they capture and report those factors, they said.

A number to remember

$46.47

Projected hospital occupational mix-adjusted average hourly wage for 2022

Source: CMS

 

Insight

“A&G [administrative and general contract labor] is big for hospitals, if you can capture that consulting and legal cost. Those are usually higher paying jobs. That is going to help your hourly wage.”

—Dave Andrzejewski, Healthcare Consulting, Crowe

Top pain points in cash reconciliation

How hot is the topic of cash reconciliation in the finance departments of hospitals and health systems? It’s so hot that Crowe elevated this topic from a small roundtable discussion to a hybrid in-person and virtual breakout session when 160 attendees signed up for it. Led by Tracey Coyne, Eric Proctor, and Matt Swafford from Crowe and Julia Reinbold, director of finance at the BJC HealthCare system, this lively and interactive session identified three cash reconciliation best practices for hospitals and health systems: Create an interdisciplinary cash reconciliation steering committee comprising finance, revenue cycle, treasury, and information systems; continually assess gaps in current cash reconciliation processes and consider how they can be improved; and identify the roles that technology and automation can play in daily cash management.

A number to remember

42%

The percentage of session attendees who said the financial operations in their healthcare organization spend less than 20 hours per month reconciling cash accounts

Source: Crowe

 

Insight

“Historically, when you’ve operated in silos, often the overall objective of cash reconciliation could get overlooked, and there could be things missed.”

– Eric Proctor, Healthcare Consulting, Crowe

Maximizing the benefit from Crowe RCA for physicians

As hospitals and health systems continue to buy up physician medical practices and get bigger through mergers and acquisitions, their ability to measure and monitor the financial performance of individual practices and physicians can get diluted and more challenging. Hospitals and health systems need more sophisticated analytic tools for physician practices. During this hybrid breakout session, on-site and virtual attendees learned about the reporting capabilities of Crowe RCA for physicians from Eric Busch and Tom Alwine of Crowe. Crowe RCA for physicians collects nine different charge data points and feeds them into the reporting module along with transaction and aged trial balance data to generate seven different reports, including net revenue and productivity by individual physicians.

A number to remember

75

Number of health systems using Crowe RCA for physicians in 2021, up from 30 in 2018

Source: Crowe

 

Insight

“A big reason behind that [more health systems using Crowe RCA for physicians] is the consolidation of physician practices and just how difficult it is to do a lot of those things that we could do five to 10 years ago in [spreadsheets].”

– Eric Busch, Healthcare Consulting, Crowe

Emerging healthcare technologies: ROI and improving the customer experience with RPA

A single episode of care really is an amalgam of touch points between the patient and the provider, most of which could benefit from intelligent automation. For example, the automatic and consistent use of digital assistants to handle routine patient inquiries can free up staff time to provide more personal services to patients. Automation can improve both the patient and employee experience. And it can harness data at each touch point that the provider can use to improve the performance of its operations, from scheduling an appointment to billing for the medical care provided. That’s the big takeaway from this breakout session led by A.J. Hanna, vice president of client advocacy at SYKES Digital Services, one of Summit’s sponsors this year.

A number to remember

700%

Return on investment enjoyed by a U.S. health insurance company that automated its front-office operations, including its contact center

Source: SYKES Digital Services case study

 

Insight

“Most organizations, including the health systems that we work with, are really trying to drive growth and loyalty. I think we all know the impact of just one patient to our revenue and what the loss of that revenue can mean long term over the course of their life span.”

– A.J. Hanna, Vice President of Client Advocacy, SYKES Digital Services

Crowe RCA Next showcase: What’s in it for you?

Crowe Revenue Cycle Analytics software is moving to the cloud as Crowe RCA Next to become the single source of truth for net revenue for hospitals and health systems. This informative breakout session, led by Bryan Rector, Andrew Obaseki, and Andrew Holloway of Crowe, walked attendees through the why and how of the evolution of Crowe RCA into Crowe RCA Next. Moving Crowe RCA capabilities to a shared platform will simultaneously give all users access to the latest technologies that plug into the platform as well as new features and functionalities. The benefits are fewer administrative tasks, a better user experience, and more flexibility and customization in measuring, monitoring, and improving net revenue performance. The presenters demonstrated how to use Crowe RCA Next to improve month-end close management.

A number to remember

125

Number of Crowe client health systems, representing about 1,500 individual hospitals, currently using a version of Crowe RCA, with about half using Crowe RCA as an on-site application

Source: Crowe

 

Insight

“We had gotten to the point where there were new features and new functionalities that we wanted to add for our clients, but we were really hindered by the existing technology. We knew we had to make a change.”

– Bryan Rector, Partner, Healthcare Consulting, Crowe

Developing a strategic partnership between revenue cycle and finance

The finance department sets the budget and keeps the books. The revenue cycle department bills and collects the money. The performance of one largely depends on the performance of the other. At many hospitals across the country, though, the two departments are not on the same page – and might be worlds apart – in how they go about their own business. Led by Peter O’Neill and Chad Peters of Crowe, joined by Ann Bond, a finance manager with Hospital Sisters Health System, and Gary Simkus, division director of financial analytics and planning for Universal Health Services, this hybrid in-person and virtual breakout session offered practical guidance and real-world examples of how developing a strategic partnership between the two departments can improve the performance of each party.

A number to remember

13

The number of final claim denial “reason” codes in the revenue cycle management system of one prominent electronic health record vendor

Source: Crowe

 

Insight

“Revenue is now proactive in working with finance like including us in discussions before changes, and they notify us of changes or adjustments that may have an impact on net revenue.”

– Ann Bond, Finance Manager, Hospital Sisters Health System

Hot topics in regulatory reimbursement

This breakout session covered a lot of compliance ground related to Medicare and Medicaid reimbursement, including the latest information on the area wage index, Worksheet S-10, Medicare bad debt payments, the 340B Program, and more. But likely the most hallowed compliance ground covered by Dave Andrzejewski and Nick West of Crowe and Liz Elias, attorney with Summit sponsor Hall Render, were provisions in the final inpatient prospective payment system (IPPS) rule that took effect Oct. 1. An inpatient quality reporting (IQR) provision requires hospitals to report employee COVID-19 vaccination rates. Hospitals must submit one week of COVID-19 vaccination data each month for October, November, and December. Hospitals that fail to comply with IQR reporting requirements may have their annual Medicare payment update cut by 25%.

A number to remember

$521M

Estimated total reduction in Medicare payments to about 2,500 hospitals in fiscal year 2022 for excess readmissions

Source: 2022 IPPS final rule

 

Insight

“If there’s no other takeaway from my remarks today, it is to please go home and call your quality people and make sure that they’re aware of this requirement [reporting hospital employee COVID-19 vaccination rates] that’s in the 2022 IPPS final rule. It’s not getting as much publicity as I think it probably deserves. It is a significant additional reporting requirement for these quality folks.”

– Liz Elias, Attorney, Hall Render

Digging into operations using Crowe healthcare suite data analytics and visualization

Big-ticket capital assets at a hospital or health system (such as medical imaging equipment) require a lot of, well, capital. As a finance leader, how do you know that you’re spending that capital wisely? This on-site-only breakout session led by Tom Alwine and Fred Lewis of Crowe demonstrated how to use the Crowe Asset Optimizer technology platform to create a real-time repository of all capital asset data. The data generated by that platform can help inform equipment purchasing and leasing decisions. For example, the platform tracks medical equipment use by a host of variables, including day, time, and clinician, to help you understand how that equipment is being used and whether it’s being used productively. If productivity is lacking, maybe it would be smart to pass on buying another machine.

A number to remember

0

Additional facility reimbursement for performing a laparoscopic surgical procedure with robotic assistance compared with no robotic assistance

Source: Crowe

 

Insight

“A lot of your service line leaders are geniuses, but they’re making anecdotal requests for various capital assets. Here we’re empowering you to have that data.”

– Tom Alwine, Healthcare Consulting, Crowe

Crowe RCA Next: Advancing month-end close and net revenue reporting

This breakout session elicited feedback from on-site and virtual attendees on Crowe RCA as it evolves into the cloud-based platform Crowe RCA Next. Bryan Rector, Andrew Obaseki, and Matt Frank of Crowe facilitated the interactive session, which featured three small-group discussions among on-site attendees on such topics as variance analysis themes, month-end close data elements, and net revenue reporting modules. Rector, Obaseki, and Frank fielded questions on those topics and recorded both on-site and virtual attendees’ feedback in order to formalize, review, and prioritize actionable insights from that feedback to continue to improve Crowe RCA.

A number to remember

15

Number of variance analysis themes in Crowe RCA that attempt to capture the drivers of changes in prior budget estimates

Source: Crowe

 

Insight

“As we try to bring Crowe RCA Next to market, we don’t want to change too many things about it because we want to make sure adoption is quick as well.”

– Bryan Rector, Partner, Healthcare Consulting, Crowe

Net revenue analytics for executives 

This hybrid in-person and online breakout session could be renamed “How to explain to your boss what you do and why it’s important.” Brett Butts, Brad Heaton, and Ryan Herr of Crowe walked attendees through what works and what doesn’t when explaining net revenue data to the senior leaders at a hospital or health system, most notably the CFO. Typically, most senior leaders want the big picture: What happened and why? But most finance leaders fail to communicate the what and the why because they get bogged down explaining each and every net revenue metric. The Crowe team recommended giving senior leaders digestible presentations with key drivers and associated action items to keep focus on the topic at hand.

A number to remember

38%

Percentage of session attendees who said one of their CFO’s main questions, on a regular basis, is, “What drove the current month’s net revenue results?”

Source: Crowe

 

Insight

“As we all likely know, net revenue is complicated. It’s technical, and it’s detailed. Those are like the two words that executives hate, right?”

– Ryan Herr, Healthcare Consulting, Crowe

Uncompensated care reporting and the importance of single-source data 

Accurately capturing and reporting all allowable uncompensated care costs is more important than ever as the size of the Medicare pool of available uncompensated care payments back to hospitals is shrinking. That’s the big lesson from this breakout session led by Nick West of Crowe and Amy Duncan, president of Collaborative Data Inc. based in Clarkson, Michigan, a firm that works with Crowe and its hospital and health system clients. CMS’ uncompensated care pool will shrink to about $7.2 billion in 2022 from about $8.3 billion in 2021. West and Duncan recommended hospitals and health systems should use a single data source for their costs to accurately capture and report uncompensated care costs and obtain their fair share of the pool. They said this will minimize risk and errors and maximize reimbursement.

A number to remember

$41.6B

Uncompensated care costs incurred by U.S. community hospitals in 2019, according to the latest available data from the American Hospital Association

Source: American Hospital Association

 

Insight

“We have to ensure that we’re capturing all our uncompensated care costs so that we can secure our piece of the pie. It’s a zero-sum game.”

– Nick West, Healthcare Consulting, Crowe

Techniques in net revenue performance measurement and revenue cycle monitoring

This hybrid in-person and online breakout session drew a straight line between revenue cycle performance and net revenue performance. Led by Chad Peters and Matt Szaflarski of Crowe, joined by Charlie Graham, vice president of revenue cycle for Riverside Health of Newport News, Virginia, this tactical session outlined best practices for measuring and monitoring net revenue and revenue cycle performance with the goal of flagging and fixing small problems early – before they become big problems later. The three foundational pillars to that effort are access and transparency, with all the appropriate resources having access to data they need and using the same data sources; integrity, with all quality assurance checks completed and all processes standardized; and context, with historic trends and industry peer performance benchmarks.

A number to remember

2.2%

The national average percentage of net patient service revenue that was subject to final denials from payers in 2020

Source: Crowe

 

Insight

“Do all of the required stakeholders have access to the appropriate data sets? For example, is everybody looking at the same thing when they’re talking about denials? This is a key area of disconnect between the revenue cycle operators and finance.”

– Matt Szaflarski, Healthcare Consulting, Crowe

Credit ratings and access to capital: What healthcare leaders should know today

What do the three largest healthcare credit rating agencies think about your financial outlook and your subsequent ability to pay back the money that you borrowed for a large capital investment? If you don’t know how credit rating agencies think, this virtual-only breakout session at the Summit was for you. Jay Sutton from Crowe moderated a no-holds-barred panel discussion featuring three healthcare credit rating luminaries: Suzie Desai, senior director at S&P Global Ratings; Lisa Goldstein, associate managing director at Moody’s Investors Service; and Kevin Holloran, senior director and U.S. public finance sector leader of not-for-profit healthcare at Fitch Ratings. They revealed many of the factors they consider when rating hospital and health system debt, including the performance of the management team.

A number to remember

8,000+

Decline in number of hospital and health system jobs in September 2021, according to the American Hospital Association, citing data from the U.S. Bureau of Labor Statistics

Source: American Hospital Association

 

Insight

“There still are fundamental [financial] challenges that we view happening now and over the near term, and the biggest one appears to be labor from our perspective.”

– Lisa Goldstein, Associated Managing Director, Moody’s Investors Service

COVID net revenue impact: Where have we been and where are we going? 

Winston Churchill said, “Those that fail to learn from history are doomed to repeat it.” Churchill’s sentiment permeated this virtual breakout session led by Brad Heaton and Abby Susko of Crowe. The duo shared responses by healthcare finance leaders in the spring of 2020 when the first surge of the pandemic drove patient volume and net revenue down. They talked about how volume and revenue have since rebounded, with finance leaders keeping things afloat until then. More importantly, they recommended actions finance leaders should take now in the event of another pandemic-related shutdown. Key to that preparation is learning from your 2020 financial data and knowing how to use it to deflect the impact.

A number to remember

44.1%

Percentage of session attendees who said they would use historic financial data from 2020 to estimate their net revenues and financial projections if the COVID-19 pandemic were to force another industry shutdown like what happened in the spring of 2020

Source: Crowe

 

Insight

“There are only so many times you can tell a CFO that volumes are down and that’s why net revenues are down. ‘Well, yeah, I know. Talk to me about yield. Talk to me about payer mix. Talk to me about service mix. Tell me about where we can start to enhance some of our offerings in these areas where we can actually keep some people at work and bring in some revenues for the organization.’”

– Brad Heaton, Healthcare Consulting, Crowe

3. Roundtables

The 2021 Crowe Healthcare Summit featured five different roundtable discussions with on-site attendees in Denver. The roundtables were closed-door sessions and not recorded, giving participants a venue to be as candid as they wanted to be in discussing their unique challenges, solutions, and ideas. The topics discussed this year at the roundtables were:

  • Converting to Crowe RCA Next and beyond
  • Crowe RCA net revenue for academic and children’s hospitals
  • Crowe RCA net revenue: Summarizing results to leadership
  • Reimbursement
  • Crowe RCA net revenue for physicians

If you’d like to learn more about our roundtables at which you can let your hair down with your peers and Crowe, please visit our Healthcare Summit page. The success of our solutions depends on our partnerships with our clients.

Roundtables
Boot camps

4. Boot camps

The 2021 Crowe Healthcare Summit featured 16 different boot camp opportunities for attendees to get intensive, two-hour training (from introductory to advanced levels) on a variety of healthcare finance topics, ranging from month-end close to variance analysis. If you’re interested in participating in a CPE-eligible boot camp in the future, please visit our Healthcare Summit page or contact us at [email protected].

5. Philanthropic activities

The 2021 Crowe Healthcare Summit gave attendees numerous opportunities to give back to those in need via a series of philanthropic activities in Denver. Click through this brief slide show to see what we accomplished together.

Philanthropic activities
Social, networking, and team-building events

6. Social, networking, and team-building events

The 2021 Crowe Healthcare Summit gave attendees numerous opportunities to see each other in person through networking and social events in Denver. Click through this brief slide show to see how we reconnected after being separated by the pandemic.

7. Video highlights

If you attended the 2021 Crowe Healthcare Summit in person this year, you no doubt noticed cameras and camera crews everywhere. We photographed and video recorded almost everything in order to capture the sights and sounds of this unique industry event to share with our entire Crowe healthcare community.

Please enjoy these eight short videos to relive your experience or see what you missed.

Video highlights
Welcome to Summit
Watch video
A behind-the-scenes look at putting on a hybrid in-person and virtual event
Watch video
Accessing capital during a pandemic
Watch video
Innovation as a healthcare business imperative
Watch video
Giving back at Summit
Watch video
Summit highlights from day one
Watch video
Summit highlights from day two
Watch video
Summit highlights from day three
Watch video
Welcome to Summit
Watch video
A behind-the-scenes look at putting on a hybrid in-person and virtual event
Watch video
Accessing capital during a pandemic
Watch video
Innovation as a healthcare business imperative
Watch video
Giving back at Summit
Watch video
Summit highlights from day one
Watch video
Summit highlights from day two
Watch video
Summit highlights from day three
Watch video

Thank you.

We hope you enjoyed this special Best of the 2021 Crowe Healthcare Summit page. How was your Summit experience? Let us know at [email protected]. We also hope to see you at the 12th annual Crowe Healthcare Summit, Sept. 19-22, 2022, in Denver or virtually. For more information on next year’s event, please visit our webpage.

The Crowe Revenue Cycle Analytics (Crowe RCA) solution was invented by Derek Bang of Crowe. The Crowe RCA solution is covered by U.S. Patent number 8,301,519.

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