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In this episode, David Alemian, Creator of the Alemian Retention System, is discussing how people stay where their future is the strongest.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back David Alemian. David is America’s foremost expert on retaining highly skilled professionals and the creator of the Alemian Retention System. His work defines a critical reality for healthcare leaders, People Stay Where Their Future Is Strongest. He is the author of People Stay Where Their Future Is Strongest: How Organizations Retain Highly Skilled Professionals and Build Lasting Advantage. A definitive framework that explains why highly skilled professionals leave and what determines whether they stay long-term. With over 30 years of experience in financial and workforce strategy, David reframes retention as a financial discipline. He shows how workforce instability erodes margin, disrupts operations, and weakens long-term performance. His work has been featured in Medical Economics, MD Magazine, and Physician’s Practice. He has authored more than 300 articles and produced over 400 educational videos on talent retention and organizational performance.

In this episode, we’re discussing People Stay Where Their Future Is Strongest. Welcome, and thank you for joining us again, David.

David Alemian: Well, hi, Kelly, and thank you for having me. It’s so good to be back.

Kelly: Yes, it’s great to have you back. Well, let’s go ahead and jump in. So, David, yeah, you focus on aligning an employee’s financial future with their tenure. How does that change long-term retention behavior?

David: Great question. People are wired for the future. From the time we are very young children, we quickly learn to think about the future. It becomes imprinted on our brain. We’re asked, “What do you want to be when you grow up? Where do you want to live? Who are you going to marry?” It’s always looking toward the future. Employment is the same thing. Highly skilled people don’t make career changes on a whim. They think about it, and they think hard. And here’s what they think, “Is my future better here where I am? Or is my future better if I move to another organization?” Most major decisions are based on the future. When an employee considers staying or leaving, they are literally comparing two possible futures. One future is built by staying with their current employer. The other future is built by leaving and going elsewhere for another opportunity. The future that appears stronger usually wins. It’s that simple. For those who are listening to this, think about your own life and the decisions surrounding your career. Did you think about your future? Chances are very high that you did because our brains are wired for the future.

What’s really kind of cool is it’s one of the things that we all have in common. Here’s the difference. Traditional retention strategies often focus on the present. They focus on culture, recognition, wellness programs, team-building activities, and workplace perks. Those things are good, and they matter, but they do not fundamentally strengthen an employee’s long-term financial future. When an organization helps employees build a stronger financial future by staying, retention becomes much more stable because the employee has a compelling reason to remain committed for the long term. People stay where their future is strongest. And that’s what I mean by that.

Kelly: I love that. I mean, and I wholeheartedly agree with it, and it makes a lot of sense that focus on the future. You’re right. We do all have that in common. So, what distinguishes a short-term incentive from a true long-term retention structure in financial terms?

David: Okay. Now, most retention strategies are expenses, higher salaries, bonuses, 401(k) contributions, retention payments, enhanced benefits, and similar programs all have one thing in common. Once the money is spent, it’s gone. The organization incurs the cost, whether your employee stays or leaves. A true long-term retention structure works differently. The employer funds and owns the plan. The employee never owns the asset. The asset remains on the organization’s balance sheet where it continues to grow and compound over time. The employee agrees to remain with the organization until a future date is established in the agreement. It could be 10 years from now. It could be all the way until retirement. It could be anything in between. If the employee fulfills that commitment, the employee receives a substantial financial benefit. If the employee does not fulfill their commitment and leaves early, the benefit is forfeited. The organization keeps the asset. That distinction changes everything. Instead of creating another expense, the organization creates a growing and compounding asset while simultaneously creating a powerful incentive for the employee to remain long-term. Traditional retention strategies spend money. This strategy builds an asset.

Kelly: That is truly just so interesting to me, David. Thank you for explaining that. So how do forfeiture-based structures influence decision making compared to traditional benefit plans?

David: Oh, but they do. This is where retention becomes truly powerful. Most traditional benefit plans provide value regardless of whether the employee stays for the long term. An employee may receive higher compensation, employee retirement contributions, bonuses, or other benefits, and still leave for another opportunity. There’s nothing holding them in place. And what happens is the organization absorbs the cost and loses the employee anyway. A forfeiture-based structure operates differently. The employer funds the plan. The employer owns the plan. The asset remains on the organization’s balance sheet where it continues to grow and compound. And the power of compound interest is amazing. The employee earns the right to receive the benefit only by fulfilling the long-term commitment established in the agreement. If the employee leaves before that date, the benefit is forfeited. The organization keeps the asset. The employee receives nothing. That creates a completely different decision-making process. Remember when I said that choosing between two futures, one if I stay and one if I leave?

Kelly: Right, yes.

David: The employee is no longer evaluating only what might they gain going elsewhere. They’re also evaluating what they will lose by leaving. As the asset grows and compounds, the financial consequence of leaving becomes increasingly significant.

Kelly: Oh, yeah.

David: Yeah. Absolutely. An employee may receive a recruiting call from a competitor offering a higher salary. The employee now has to compare that offer against a growing future benefit that could be worth substantially more. People become far less likely to leave when doing so requires walking away from something meaningful they have spent years building toward. In other words, you’re giving them something to lose by leaving. At the same time, the employer benefits because the asset continues to grow, regardless of whether the employee ultimately stays or leaves. That creates a powerful alignment of interests between the employee and the organization.

Kelly: I mean, it seems like a win-win, right? I mean–

David: Everybody wins.

Kelly: Everybody wins. Right. So, David, what financial modeling should hospitals use to project the long-term impact of retention strategies?

David: It’s actually relatively easy for a hospital, or any organization, for that matter, if they’re tracking [inaudible] turnover, to figure it out. The starting point is understanding the true cost of turnover. And most organizations underestimate turnover because they focus primarily on recruiting and hiring expenses. Those costs are only part of the picture. I mean, how do you deduct lost productivity? I mean, these are– okay, for a nonprofit hospital, that’s not a big deal. But if you’re a for-profit hospital, what you can deduct and not deduct is really important. But hospitals should also evaluate lost productivity, onboarding time, training costs, overtime, temporary staffing, management distraction, reduced continuity, and, this is key, the impact on patient care. And that’s another key issue here because, if patients have to wait too long, or if there isn’t a specialist to help that patient, or they can’t get the care they need, they go elsewhere. And the hospital loses that income that would be generated by that patient.

Kelly: True.

David: Those revenues. Once those costs are understood, leaders can compare them against the cost of a retention strategy. It costs somewhere between eight hundred thousand and a million on average to replace a physician, depending on your specialty and location. And for other skilled employees, the general rule of thumb is– it can cost more than double the salary to replace someone with skills. Now, you multiply that by the percentages of turnover that hospitals have– and the question is not simply, what does retention cost? The better question is, what does turnover cost? When organizations perform that analysis, they often discover that preventing turnover can generate a significant financial return. You see, turnover is not just an HR issue. Not anymore. It is a financial issue. It is an operations issue. And so many hospitals operate on such slim margins–

Kelly: Definitely. Yep.

David: –absolutely, that when you get rid of– when you mitigate turnover cost and literally take a portion of that cost and turn– or all of it, for that matter, and turn it into a growing and compounding asset on the balance sheet, it becomes amazing what it can do to the bottom line. And like any financial issue, it should be evaluated based on its impact on the organization’s performance and long-term profitability.

Kelly: Yeah, I mean, the true cost of turnover is key. I mean, I agree with everything that you’re saying here. So how can hospitals implement retention strategies without increasing net operating costs?

David: Oh, they so can because they already have a turnover cost. They know it. They track it. I’ve sat in on so many conversations where they talk about turnover cost percentages. And I’ve always heard them talk about, well, the turnover cost for this group, our nurses is X, and the turnover cost for this group is Y and so on. But I’ve never heard them talk about turnover in the cost of dollars. I actually, on my website, I have a free turnover cost calculator that people can go and visit and download. And they can adjust it to however they want it to work. But they will end up with right in the ballpark of what turnover is costing them. And that website is talentretentionplans.com. And it’s just so that they can get that if they would like to do that. Now, if you can take a portion of that turnover cost– and every financial professional will tell you, if you’re in business, whether you’re a for-profit or nonprofit, you have to know your costs. You take a portion of that and put that into this plan, and it mitigates the turnover cost. And remember, this is key. We’re not spending the money. We’re literally turning it into an asset on the organization’s books and the organization’s balance sheet.

It’s one of the most important questions that hospital leaders can ask. Most retention strategies are treated as expenses. This is not an expense. Higher salaries, larger bonuses, increased 401(k) contributions, retention payments and benefits. They all require the organization to spend money today. Once that money is paid, it’s gone. And employees can still leave. A different approach is to create a retention strategy that is structured as an asset rather than an expense. Under this approach, the employer funds and owns the plan. And the employee never owns the asset. And the asset remains on the organization’s balance sheet where it continues to grow and compound over time. Now, imagine what that would do if for your key people, your doctors, your nurses, your technicians, your physician assistants, and all of the people that, shall we say, that we use to build the insurance companies, if they remained in place, and they didn’t leave, wow, look what that would do to your bottom line. And that’s where the money to fund the plan comes from. We’re simply taking a cost and turning it into an asset. And now the employee agrees to stay, and they have a serious, substantial reason to stay should they fulfill their end of the agreement. That alone creates a powerful retention incentive.

But there’s another feature that makes this approach particularly attractive from a financial standpoint. Because the asset compounds over time, it can grow to a point where the employee receives a significant financial benefit that they were promised, while the organization simultaneously recovers its investment in full. In many cases organization can recover more than it invested. That means the strategy can achieve something very unusual. The employee receives a meaningful long-term benefit, the organization recovers its investment in full and then some. The plan can actually generate additional value for the organization. From a balance sheet perspective, the net cost can approach zero while improving workforce stability. That stability changes the game. Instead of asking what will retention cost us, leaders can be asking, how can retention strengthen both our workforce and our financial performance? Most retention strategies, as I said, create an expense. This strategy creates a growing and compounding asset.

Kelly: Yeah, positively affecting the bottom line for sure.

David: Absolutely, it does.

Kelly: Yeah. So, if you were advising a hospital CEO preparing to retire in the next few years, how would you structure retention to protect their legacy?

David: Every CEO wants to leave an organization stronger than they found it. It’s just the way they’re built.

Kelly: Yeah, of course.

David: Yeah. One of the greatest threats to a CEO’s legacy is instability after they leave. Key people depart. Institutional knowledge disappears. Performance suffers. Momentum slows. I would focus on strengthening retention among the hospital’s most valuable professionals before the transition occurs. The objective would be to create continuity, preserve expertise, and maintain organizational stability. A strong leadership legacy is not measured only by today’s results. It is measured by how well the organization performs after the leader is gone. Retention plays a major role in making that possible. The most successful leaders don’t simply build organizations that perform well today. They build organizations that continue performing long after they leave.

Kelly: That’s their legacy, right? They’re part of it.

David: Legacy. Yeah.

Kelly: Right. So, what separates organizations that successfully retain top talent from those that just continue to struggle?

David: Organizations that continue to struggle with retention often focus primarily on current conditions. Organizations that succeed focus on the future. The best organizations understand that talented professionals are constantly evaluating where they can build the strongest future for themselves and their families. When employees believe their future is stronger somewhere else, they leave. They’re out of there. When employees believe their future is strongest right where they are, they stay. That is why I often say that people stay where their future is strongest. The most successful organizations create a future that employees do not want to walk away from. They understand that retention is not simply an HR issue. It’s a financial issue on both sides of the equation. It’s an operational issue. It’s a leadership issue. And increasingly, it is a competitive advantage. Organizations that understand that principle and build their reputation strategies around it consistently outperform those that do not. In today’s healthcare environment, retaining highly skilled professionals is one of the most effective ways to improve stability, strengthen performance, and protect the bottom line.

Kelly: Well, thank you so much, David, for sharing all these insights with us on people’s day where their future is strongest. And also, we’re going to link to that free turnover cost calculator that you mentioned. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

David: Oh, the best and fastest and easiest way is connect with me on LinkedIn. I’m the only David Alemian on LinkedIn, so I’m easy to find. And if they go to my profile, they’ll see my email address is there, my phone number is there, my websites are there, so they can find me. I’m really passionate about this. And if people have if your listeners have questions, I’m happy to spend time with them and answer any questions that they may have. Because good health starts with good healthcare, and nothing is more important than quality healthcare.

Kelly: Completely agree. Well, thank you so much. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: Best Practices, presented live on Wednesday, July 22, at 1 PM ET.

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ next and final webinar in its Medicare Cost Report Appeals and Reopening series. This one focused on Best Practices. This will be live on Wednesday, July 22nd at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Thank you for having me again.

Kelly: All right, well, let’s go ahead and jump in. So, this webinar will focus on best practices. Can you give us a quick review of what we can expect in the way of best practices?

Kristin: Yes. Navigating a Provider Reimbursement Review Board appeal requires rigorous adherence to strict rules and regulations. And because of that, there are some extremely valuable best practices that you need to think about when you’re filing these appeals. The portal and the deadlines are not just suggestions, they are requirements. So, navigating those in terms of best practices and setting forth how you remember when things are due and that kind of stuff in terms of an appeal is really important. But also important is the reopening process, ensuring that you adhere to the max deadlines, and that’s the Medicare Administrative Contractors deadlines and requirements. They are different. You do things a little bit differently. So, you need to think of how you handle that and getting those filed as well. And then just in general, CMS in general, there’s so many different parts and pieces that lead into appeals and reopenings. So just trying to set yourself up for success in terms of getting these filed and following the protocols, and basically trying not to irritate the board and the MAC are very important in this process.

Kelly: Yeah, that sounds like solid advice, Kristin. And we always love best practices, so this is going to be a really great webinar. So, what do you think is going to be some key takeaways from the webinar?

Kristin:Kind of what I just said about the being able to categorize or set up maybe calendaring or other avenues to ensure that you’re meeting the deadlines. And also cataloging, keeping your documentation together in a way that somebody else can understand. We all get caught in the, I’ve done it, I’ve looked at it so much, then we forget that people aren’t exactly like us and don’t read things exactly the same. So, cataloging that in a way that others can understand and appreciate, I think, will be the greatest takeaway.

Kelly: Yeah, that sounds like a great takeaway too. So, this is the last in our Medicare Cost Report Appeals and Reopening’s webinar series. Can you do a quick recap of the first two, and how does this one fit in?

Kristin: So, the first one was a deep dive into the PRRB and the rules and the deadlines, the timeliness, the amount of controversy. Those strict requirements and then we talked a little bit about the reopening requirements. And so, all of that together then led us to, well, what are the most common issues? That was the second webinar. And we did the deep dive into the most common issues, and we gave the status, kind of case law where they were sitting right now, and what we expect, or hope, maybe, is a better word, the outcome will be for those cases. So, the third one will definitely not hit the issues and the updates. So really, if you want to learn about the most common issues, updates, that one you’ll have to go watch if you didn’t join us for the second webinar. Hopefully, you’ll join us for the taped version, so to say. But I think this third one really will kick and tie to the first one where we kind of went through everything, but this will just be a little bit different approach. So maybe the lingo might be repeated, and I might forget to give the definition for my lingo. So, I will do my best. But I invite you to look at the whole series together, because I do think the whole thing together really makes sense.

Kelly: Yeah, creates that complete picture, right?

Kristin: That’s correct.

Kelly: Yeah. So, do you have to watch the first two or watch them in order for this webinar’s content to make sense? I mean, or are they standalones?

Kristin: I don’t know that they’re necessarily standalones completely. The first one did go through in detail what we’re going to talk about in best practices. And it gave a little overview of the issues. But really, that second webinar, the diving into those issues and really telling you what the status is, where they are right now, I think really is a standalone. But in order to get there, you had to meet all of the requirements. And you have to have the best practices to ensure that you’re really not irritating your audience. You want to make sure that you’ve complied and have done things showing not to be rude, right? When the board says you have 20 days to file this, don’t do it on the 21st day. It’s just as simple as that. Just following the rules and some best practices to help get you through. The other thing is appeals aren’t new, reopenings aren’t new. So, there is a lot. 30-plus years of going through the process has really, I think, laid out for us a nice, seamless transition from, “Here’s the rules,” to, “Here’s the issues, and here’s how you keep the goodwill going with your issues and your appeals, and even your reopenings.” So we’re going to talk a little bit more about reopenings, probably, in this third series, because I think the max concerns about how we approach issues and appeals, I think it’s something that we really need to take heed of because they are the ones that are going to help you settle your cases and help push these cases through. So, I think I want to do a little bit more focus there.

Kelly: Okay, that makes a lot of sense. Looking forward to that one. So, who do you recommend attend this webinar? Who is the target audience?

Kristin: Really, anyone in reimbursement. If you are filing a cost report or even thinking about an appeal, and you’re probably filing reopenings, so anyone doing those that has always wondered, “Well, I wonder why I did my reopening this way, and I didn’t get a really good response,” or, “Wow, I thought this would move faster. I’m not sure what I did wrong. I thought I compiled the evidence.” So, I think really focusing on that and moving through that process. And maybe that’s it. Maybe you’re someone new to reimbursement. This would be a great way to kind of experience, okay, so this is what I need to do. And it’s not all going to be about rule following. Some of it is just common courtesy.

Kelly: Yeah. That makes a lot of sense, yeah.

Kristin: Oh, I was just going to say I hope everyone can join the webinar. I’m really excited about this one. I think it kind of gives you more of a– let’s me put some personal flair on it and what I’ve experienced over the years.

Kelly: Yeah, love that. Well, thanks so much for joining us, Kristen, for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings Best Practices, that we’re going to do live on Wednesday, July 22nd, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristin.

Kristin: Thank you. Have a great day, Kelly.

Kelly: Thank you. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

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Medicare Appeals

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©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

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In this episode, Lauren Schafer, Founder of Lake House Digital Media, discusses LinkedIn Tips for healthcare finance leaders.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Lauren Schafer. Lauren is the founder of Lake House Digital Media, a boutique agency helping life sciences, tech companies, and growth-minded founders build authority that actually drives demand. Lauren blends SEO, thought leadership, LinkedIn strategy, and event marketing to help complex companies become the obvious choice in their category. You’ll walk away with practical ways to earn trust faster and turn visibility into real momentum. In this episode, we’re discussing LinkedIn Tips for Healthcare Finance Leaders. Welcome, and thank you for joining us, Lauren.

Lauren Schafer: Thanks for having me, Kelly.

Kelly: Well, let’s go ahead and jump in. So why is it important for hospital finance executives to have a strong LinkedIn profile or identity?

Lauren: Financial leaders are just like anybody else on the leadership team, and that means having a really strong professional presence on LinkedIn is critical for correct positioning. It’s both for their current role, to build their own network, and for future opportunities, but it also is letting you build the hospital’s network, that healthcare network and presence to build more brand awareness and trust.

Kelly: Most definitely. Agree with that. So how would a hospital finance leader start building a LinkedIn profile if they have limited experience on LinkedIn?

Lauren: So, the biggest thing there that a lot of people miss, or they skip because they’re like, “Oh, I’m not so sure yet,” is they skip putting their photo on there. It sounds so basic, but at the end of the day, people want to know who they’re doing business with. And so, the biggest thing is make sure that you’ve got a profile picture and that it’s a current picture, right? It’s not you, maybe 20 years ago, 15 years ago, a little bit thinner, a little bit different hairstyle, but it needs to have the current position that you hold, the company that you work for, and your name, and absolutely your full professional name. So, one of my biggest pet peeves is if people do like John S., and I’m like, if they’re trying to find you, there are millions of John S’s out there. So, you need to put that full name. But then some next steps that would just kind of ease you into doing things on LinkedIn is set a timer a couple days a week, maybe two or three times a week to just log on for even 15 minutes, turn those notifications on, so if someone sees that you’re getting active and reaches out, that you don’t miss it.

But also, a good next step to start expanding their network if they haven’t had a lot of experience is connect with your employees, connect with people that are on your board and your own networks. So, start leading by example. Your employees do more on LinkedIn, but also just start connecting with people and then slowly start commenting when you’re comfortable on other people’s posts. It’s going to help you get more views. It’s going to help where you’re working, get more brand awareness, and you’re going to develop relationships through that. You don’t have to have these long, drawn out thesis type of comments, but even just like, “Hey, congrats on the new role,” or, “This is a great resource for our community.” Something that is thoughtful, but it can be short and sweet to start building that relationship on LinkedIn.

Kelly: That’s all great advice. And I do agree that the photo is key. So how can finance leaders contribute to the overall marketing and social media efforts of the hospital?

Lauren: So, the biggest thing, especially when you’re looking at LinkedIn, it is a social media network, but it’s business-minded first and foremost. And a lot of people are looking for thought leadership. They’re looking for trust and who do I know there? If something comes up, whether they are looking potentially to apply for a job or to do business with you, to be in partnership with you. But when you start having posts on there from your brand– and even little things like the employees start to share the post. Employees’ share get two times the amount of clicks that a regular company brand page gets. So, it indicates to other people, “Hey, I like working here. I don’t mind telling people that I work here, and I’m trusting the content when I’m sharing it.” So that’s a big thing, is to get your overall marketing efforts to make sure that your healthcare institution is posting optimally at least twice a week. You don’t need to post every day. But getting that brand awareness out there and then enabling your employees to say, “Hey, we want the shares, let people know if we’re sharing some–” maybe a great new project at the hospital, some new cutting-edge technology, or just a feel-good post, maybe how you’re giving back to your community. All of that is adding more brand awareness, more trust signals, and keeping you top-of-mind, so then when people do have a choice and they need something that your healthcare institution provides, you will be top-of-mind.

Kelly: I completely agree that the employees getting involved is really key to getting out the word and helping with that brand awareness of the hospital. Lauren, other than LinkedIn, how can hospital finance leaders help their professional profile and the hospital’s professional profile?

Lauren: So, a couple of things on there. You’ve got LinkedIn as a great resource, sometimes to amplify the other efforts that you’re doing. So, if the hospital, for example, has put out a press release, or if they put out some new thought leadership on an experimental– anything that they’re trying, some new technology, sharing it on LinkedIn is great. If they’ve got those resources that are on the webpage from the hospital, if they’re on a podcast, something like this, where they’re sharing new developments and things, to share those both from your website, if they’re on podcasts, to make sure that you’ve got a presence where people are looking now. And people are looking so much at AI now. So, AI is indexing posts on LinkedIn now, and it’s one of the most cited LinkedIn places, when people are putting those questions in Google or in the search engines, and those AI answers are coming back. So, it’s making sure that your healthcare institution is where people are at. If there’s video, do you have a YouTube channel? They’re free to start. Or if there is something new, a ribbon cutting with you or one of your partners, share that. You want consistent signals, both on your website, for it to be up-to-date.

You want to reach people where they’re at, whether that is searching online, whether it’s on LinkedIn, or even simple things like having just a good community newsletter. As much as I would love for people to be on LinkedIn all the time on social media, because it’s what we do, the one place that they are sure to check almost every day is their work email. And it is, one, just sending a newsletter, sharing latest developments, any big staff changes, community involvement. People open their work emails, and it’s a great place and an easy place to make sure that your institution is staying top-of-mind.

Kelly: Yeah, those are such great ideas, Lauren. Thank you for sharing those with us. What are some of the biggest mistakes someone can make on LinkedIn?

Lauren: Oh, that’s a great question, Kelly. I would say, first and foremost, having either no photo or an outdated one. So, let’s say that you have a photo that you really like, but it’s maybe 10 to 15 years old, and maybe you’ve got a little bit more gray hair, or maybe your weight is different, either way. But let’s say that someone connects with you, that maybe they want to do a new project and they’re interested and is your hospital a good partner for them? And you set a time to meet at a conference, or you set a time for coffee, and you show up and you look nothing like your picture, regardless of the integrity you have, the trust, all the things about your reputation, that first impression of you is going to make them hesitate because you don’t look like your picture. So that is my biggest pet peeve. But then a few other things is if people comment or ask you a question, if you have posted, but then you check out for a couple weeks, if you don’t respond to their comments, that’s a big mistake that people make, because then people will be less likely to comment on your post the next time. And then one other one, and then I’ll wrap this one up, is people forget that even though LinkedIn is a business platform, first and foremost, it’s a social media platform. And so, their algorithm still will reward social interactions and conversations. It’s a two-way street.

So, a lot of people go on, they’ll just post, “This is the great thing we’re doing. Look at what we’ve got new. These things are all great. Look at my promotion.” But then they post, and then they check out of LinkedIn. And other people that are congratulating them or asking questions feel ignored when you don’t respond back, or if they post something, you don’t reciprocate by commenting back. So, a big mistake that people do make is forgetting that it is a social network first and foremost, even though it’s a business platform. But to be able, it’s a two-way street.

Kelly: Definitely is. And those are some great mistakes that you pointed out. On the flip side, though, what are some of the best practices for LinkedIn that you can share with us?

Lauren: So, a lot of people that are on there are leaders in the business community. They are leaders in healthcare, and they are on there in a business mindset, right? So, some of the best practices is to make sure, are you posting thought leadership on there? Let’s say that your institution is growing, or if they’re investing in a certain area, and here’s why, and here’s either an unmet need in your community that it’s going to answer, or whatever the value is to your community and to those that you want to be in your network, the more that you can share thought leadership and show value is a great– this is a great place to do it, not only for those on LinkedIn, but again, it’s being indexed by Google. It’s being indexed and cited on AI. So, a lot of things, even if they’re just on LinkedIn, can suddenly show up in a quick excerpt that is back on an AI, an AI question that somebody asked. But it’s also another great practice is to highlight your staff. If you’ve got someone new coming in on your leadership team, it’s going to be great to announce that you guys are expanding or that this person has joined your team, if they have a new award, a new certificate. It’s great because it both is great from an HR perspective to welcome them and show that hospitality and recognition. But on the flip side, it’s also great doing other things. If you’re very involved in something that is philanthropic in your area, it’s showing your community that a place you work cares about where they’re doing business. They care about the people in the community. And all of those things just nod to your brand recognition, your brand awareness and reputation, and making sure that you have a positive association with where you’re working out in the community.

Kelly: Those are such great tips. Thanks for sharing those with us, Lauren. Any final thoughts for hospital finance leaders?

Lauren: I think here’s the thing is everybody really loves to work for a successful organization, right? But people have choices where they work for recruiting. And if something happens in their lives, a lot of communities, they have a choice of what hospital or healthcare institution that they’re going to go to. So, staying top of mind is so key in this situation. Having a good association with your brand, both for employees, for recruiting and everything, but also so that you get those patients, you get the customers and clients, in that when they have a choice and something happens, and they have to make a quick decision, there’s no choice other than where you are. So, I think that’s our final thing, is there’s a lot more to it than just posting on LinkedIn as a social media platform. It’s more about growing that brand awareness so that where you are always is top of mind for everybody.

Kelly: That’s wonderful. Thank you. Thank you so much, Lauren, for sharing your insights with us on LinkedIn tips for healthcare finance leaders. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Lauren: Well, obviously, LinkedIn is a great place. We’re on it all the time. So, we’re Lake House Digital. Lake House is two words on LinkedIn. I am on LinkedIn as Lauren Miller Schaefer. And also, if you wanted to go to our website and get in touch, we are thelakehousedigital.com, and we would love to hear from you.

Kelly: Awesome. Thanks for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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In this episode, David Beahm, President and CEO of Blanchard and Company, Inc., discusses the financial safety net for healthcare leaders.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome David Beahm. David serves as the president and CEO of Blanchard and Company, Inc., the largest and oldest retail investment firm specializing in precious metals and rare coins in the United States. With over a decade of executive leadership at the firm, David stewards a legacy that began in 1975, shortly after his predecessor helped spearhead the grassroots movement to re-legalize gold ownership for private American citizens. Under his leadership, Blanchard has surpassed 800,000 clients and $1.3 billion in recent sales, maintaining a premier partnership with legendary numismatist John Albanese. David is known for his “Advisory-First” philosophy, moving the industry away from high-pressure sales toward sophisticated long-term wealth preservation and portfolio diversification.

In this episode, we’re discussing the financial safety net for healthcare leaders. Welcome, and thank you for joining us, David.

David Beahm: Thanks, Kelly. Thanks for having me.

Kelly: Yeah, well, let’s go ahead and jump in. So, hospital endowments and executive compensation packages are heavily tied to equities and bonds. And when markets correct, healthcare institutions feel it hard and fast. From your perspective, what’s the structural gap that most healthcare CFOs and executives aren’t accounting for in their portfolios?

David: So, I think the gap leads to risk in what most healthcare CFOs and the executives that work with the endowments, they underestimate the concentration of risk, and they kind of disguise it a little bit with what they call diversification. But really, on paper, if they own equities and bonds, when the day’s over with, that’s still tied to the same system. So, when you see liquidity tighten or confidence break, like we saw in 2008 and then again in 2020, that correlation that just is one. So those assets individually basically are tied to one another, and they move with one another. So, the gap right there is really the absence of a counterweight, such as gold. And because some of these portfolios lack assets that sit outside of that stock and bond financial system, what physical gold can do is actually provide them with a little bit of insurance to make sure that when those traditional types of portfolios come under pressure, it’s not as critical when you own something like gold in there. So as long as you are truly diversified and have exposure to something outside of the stocks embalmed realm, you can bridge that gap.

Kelly: Right. I know diversification is really key there. The word non-correlated gets used a lot in finance, but what does it actually mean in practice for a chief medical officer or a hospital executive sitting on a $50 million endowment committee?

David: So, when you start looking at non-correlated assets, you start thinking about a theory, and it’s really the behavior of certain assets under stress. And so, when you see an endowment or really just stocks in general drop 20% or so in a short window, some of these assets, they just move together because people are forced to sell, people are forced to raise money for margin calls, or they need liquidity. And so, everything is fair game. So, when you look at that type of movement and gold does behave that way, gold is a source of liquidity, but it’s a little bit different because it’s not dependent on earnings or credit markets such as stocks and bonds. So, for a hospital executive managing a $50 million endowment, non-correlating assets mean owning something that will hold value or even appreciate while some of the other assets are declining. So, gold’s not going to outperform assets every single year, but it provides that insurance policy and it’s there when you need it.

Kelly: Yeah, that makes a lot of sense. Thank you. So, healthcare leaders are often incredibly sophisticated when it comes to clinical risk management, but personal wealth planning is a different discipline entirely. What are the most common blind spots you see when high-income healthcare professionals come to Blanchard for the first time?

David: I think the blind spot that we see is, just in general, just the retail investor, is the overconfidence in that system we were talking about a little while ago. You spend your entire college in the finance world learning about stocks and bonds. And then, the last day you learn about gold. So, nobody really knows about it in the United States. It’s not all over the world, but in the United States, it’s not owned by as many as it should. So, healthcare leaders, because they’re trained to manage risk, they need to make sure that they have an asset that will perform or at least provide insurance. So, we consistently see a few things. One is people being overexposed to paper assets that, again, are all tied to that economic system we were talking about. And then almost more importantly is liquidity– the misunderstanding that gold is not liquid, and it is liquid, especially in a time of crisis. And then the third is, what do you really own? A lot of retail investors, a lot of managers, fund managers– that’s not really clear on what they own and what exposure it is through any sort of financial asset that they may have. So the ownership, clarity, the misunderstanding of liquidity, and then again, going back to being exposed to stocks and bonds, their traditional assets, those are the blind spots that we see.

Kelly: Yeah, I appreciate you sharing those blind spots with us. ETFs and paperback gold products are easy to buy inside a brokerage account. Many executives already hold them and think they’re covered. Why isn’t that the same thing as physical ownership? And why does that distinction matter, especially during systemic financial stress?

David: The gold market loves ETFs. When they came into the marketplace, they added a lot of demand that wasn’t there. And partly because of what you just explained, it’s easy to get in, it’s easy to get out. What our investors do is they’re looking for a long-term hold, and really the true proxy to owning gold or being exposed to gold is actually owning physical gold. So, ETF serves a great purpose, but you do have some expenses that you don’t have with owning gold. You have management fees. You have marketing fees. You have storage insurance, which you do have with owning physical gold. But those funds that are needed to actually run the ETF or taken off of the asset. So, in our mind, physical gold is really the only way to truly have a gold position. And again, you also have mining shares out there as well, exposed to the price of gold, but not– you have to worry about management, mining collapse, geopolitical risk in that area. We just feel that physical gold that we actually send to clients or arrange for storage for them is the true way of being exposed to gold.

Kelly: Very interesting take on that. So, there’s a liquidity question that comes up with physical assets. How quickly can I actually get out if I need to? How do you answer that for a healthcare executive who needs to know their wealth is both protected and accessible?

David: That’s one of the biggest things misunderstood about the physical gold market is liquidity. And physical gold and silver, for that matter, are really liquid assets. As a matter of fact, just a side note, our pilots carry gold with them when they’re overseas flying combat missions, because if they go down and they need to get from one place to another, they use gold to do it. So, for a healthcare executive, the key is structure. Really, if the metals are properly allocated, which we can help with, they’re properly stored, which we can help with and documented, they could be converted to cash fairly quickly. I mean, within a few business days, depending on where the assets are. So, what I would just emphasize is not just liquidity, but it’s the certainty of liquidity. And in a stressed market, the ability to access your gold or your capital without relying on market stability is certainly a significant advantage.

Kelly: Yeah, no, I totally agree with that. So silver is having a moment driven by industrial demand from AI infrastructure and green energy initiatives. How does that factor into the broader portfolio strategy?

David: Yeah, so silver has been on a tear because it’s uniquely positioned right now because it’s kind of in that intersection of the investment world, but also in the industrial complex. So, it’s more of an industrial commodity than gold is. The demand for the infrastructure for the AI and energy and all the electronics. We’re having emerging technologies seemingly every few months and silver is going to play a real big role with all of that. So, from a portfolio or investment standpoint, silver has just a little bit more dimension than gold, but we view silver as a complement to gold. And what we advise is to have both in your portfolio. You can say, well, why would I do that? You’re just talking about diversification. Well, that’s truly within the precious metals complex being diversified is having some exposure to gold and silver. While they do typically run together, there are certain times where one outperforms the other. So, it adds a– silver has an element of growth potential that’s really tied to real world demand. And having the right allocation of both of those working together strengthens your overall portfolio.

Kelly: Definitely. Well, thank you so much, David, for sharing your insights with us on the financial safety net for healthcare leaders. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

David: So first, our website, blanchardgold.com. And then also we have portfolio managers that help advise. So, we don’t just sell this product, we form relationships with people and we’ve been around for 50 years. So, we love talking to people on the phone to get a feel for what their goals are, what their drifters are, and that way we can put them into the right asset class. So, I would encourage anybody to call our 1-800 number. It’s 800-880-GOLD, 4653. So, it’s 800-880-4653. And we can help with any questions and hopefully help some of your listeners get involved in an asset that maybe they were a little unclear about before.

Kelly: Wonderful. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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In this episode, James Morgan, Founding Partner of Lanzone Morgan LLP, discusses how to identify nursing home abuse, prevent negligence, and evaluate care facilities.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome James Morgan. Jim is a highly respected nursing home abuse attorney, an elder abuse lawyer in California, and the founding partner of Lanzone Morgan LLP. For more than 25 years, Jim has dedicated his legal career to representing victims of elder abuse, nursing home neglect, and assisted living facility misconduct, helping families hold negligent care providers accountable. He has helped secure millions of dollars in settlements and verdicts for elderly victims and their families while pushing the long-term care industry to improve safety and accountability. He graduated cum laude from Jacksonville State University in 1991 and went on to graduate Magna cum laude from Washburn University School of Law in 1997. Jim is currently licensed to practice law in Arizona, California, and Nevada. He’s also licensed with the United States District Court, Southern District Court of California, the United States Ninth Circuit Court of Appeals, and the United States Supreme Court. Jim has also served as president of a national organization of attorneys dedicated to suing nursing homes for elder abuse.

In this episode, we’re discussing how to identify nursing home abuse, prevent negligence, and evaluate care facilities. Welcome, and thank you for joining us, Jim.

James Morgan: Thanks for having me.

Kelly: All right, well, let’s go ahead and jump in. So, let’s just start off with a pretty basic question. Jim, what is nursing home abuse and neglect?

James: Well, that’s a good starting point. Nursing home abuse and neglect can be anything from as minor– I shouldn’t say minor, but anything that doesn’t necessarily cause major injuries but is certainly concerned about somebody’s dignity, which is maybe not being showered timely, not getting changed in a timely manner if you’re sitting in your urine and feces and you can’t change yourself and make it to the restroom. Those are dignity issues, and that’s the result of neglect. If somebody is sitting in their urine and feces for hours not being changed, it may not lead to long-term problems, but it could. And then neglect can also lead to very serious injuries, such as infections from what I just described. Also, falls, fractures, falls with subdural hematomas or brain bleeds that may lead to death. And of course, probably the number one type of case we get, which is terrible bed sores from somebody sitting in the same position in bed for hours upon hours and not getting turned and repositioned. So, neglect ranges from everything from dignity issues to very serious injuries and death. But the bottom line is nursing home neglect is when nursing home residents are not getting proper care to meet their needs.

Kelly: Okay. Thank you for explaining that for us. So, what are the most common types of nursing home abuse and neglect that you see?

James: The two top cases that we take are the falls fractures or falls leading to other serious injuries and bed sores. Those are by far the most common types of injuries that lead to lawsuits. And when I say bed sores, what I’m talking about are wounds that happen at pressure points in the body when somebody’s sitting in bed. So, the most common type of pressure sore that we see is on the coccyx area where your tailbone is pushing down you’re not being turned and getting any pressure relief.

So, you get a terrible pressure sore on your coccyx or on your heels because those are also bony prominences where people can get bed sores if they’re laying in bed all the time. But other types of nursing home abuse and neglect cases are dehydration, malnutrition, especially if somebody’s on a feeding tube. Elopement cases. Elopement cases are when somebody wanders out of a facility. They might have Alzheimer’s or dementia, and they should be in a locked facility or somewhere where they’re kept safe, but they wander out of the facility and, unfortunately, can get injured. And then there’s probably fewer cases of, but certainly problematic, are the actual physical abuse of the residents, either just physical assaults or some type of sexual assault. So those are probably the most common types of neglect that we see here in our law firm.

Kelly: Wow. That’s very sad, but thank you for giving that information to us. So why are nursing home residents getting neglected?

James: Most of the neglect that we see in our cases stems from understaffing issues. Understaffing occurs when the nursing home tightens its budget to save costs and make more profit. Most nursing homes are privately owned. They’re for-profit enterprises, so people are trying to make money. And the way to make money in a nursing home is to fill every bed because that’s where you’re getting your revenue and to cut costs. And labor is by far the highest cost of running a nursing home.

So very simply put, the way to make money by owning a nursing home is to fill every bed so that you can make as much revenue as possible and to take care of those residents with as little labor as possible. When that happens, it could be a recipe for making money. But unfortunately, it’s also a recipe for neglect of the residents when there’s not enough staff to meet their needs.

Kelly: Yeah, labor does make sense to be the highest cost there. So how are nursing homes usually paid for caring for its residents?

James: Okay, so skilled nursing facilities are primarily paid by Medicare, Medicaid, private pay, or insurance. Private insurance, or maybe somebody has long-term care insurance. But the private pay and the private insurance are the lowest number of residents getting paid paying for the nursing home care that way. By far, most of the revenue in nursing homes comes from Medicare and Medicaid. Now, Medicare pays the highest amount of money to the nursing home to care for the residents. So nursing homes want Medicare patients. So, here’s what happens. An elderly person is living at home and they have a stroke or a heart attack or a fall with an injury, and they go to the hospital.

And they’re in the hospital for a few days, recovering from whatever happened. And the doctor says, “We really don’t want to send you directly home. You need some physical therapy to gain some strength. You might need to be on an IV antibiotic for a little while. We want to send you to a nursing home for some rehab.” Okay? If that person has Medicare, Medicare is going to pay for that nursing home stay. Nursing homes love this because Medicare pays the highest rate of reimbursement. So if a nursing home had its way, every bed would be filled by a Medicare patient because that’s how they’re going to make money.

That’s how they’re going to make the most money. Now, the problem is that Medicare will only pay the nursing home for about 100 days of physical therapy. After that, the resident is going to have to go either on Medicaid or private pay or insurance. And so the nursing home will want to get rid of a resident right at that 100-day mark after they’ve gotten all the money they could possibly get out of Medicare. And then all of a sudden, they might tell the family, “Hey, you got to go. They’ve reached their peak. We need to discharge them by tomorrow.” They a lot of times will give you short notice. And the nursing home doesn’t– and even if the family says, “Hey, they’re not quite ready to go home. They need some more physical therapy. They need some more care.” The nursing home’s not going to want to keep them because if they end up being a Medicaid patient, then Medicaid reimbursement is quite a bit lower than the Medicare reimbursement. So, what the nursing home wants to do is get rid of that person who ran out of Medicare days, get them out of the facility, and fill that bed with another resident who’s on Medicare. So, they can keep getting the maximum reimbursement for that bed.

So, what you’ll see in nursing homes sometimes are called Medicare wings, so where everybody on a certain hallway is a Medicare patient. And those hallways are typically staffed well because the reimbursement is good on that wing. And then you’ll see other wings that are what’s called long-term wings for long-term care residents whose stay is being paid by Medicaid or private insurance or private pay. There is a drastic difference between the Medicare wing and the long-term care wing. And when I say drastic difference, what I’m talking about is staffing and care. So when somebody comes to me with a case, it’s typically somebody who is in that long-term care wing because that wing is staffed less than the Medicare wing. We do not get a lot of cases from people who are on the Medicare wing because those wings are typically staffed better because the reimbursement is higher. So that was a long answer to tell you that most of the nursing homes pay comes from Medicare, Medicaid, private pay, and private insurance.

Kelly: That makes a lot of sense. Thank you for sharing all that with us. So are nursing homes and assisted living facilities the same thing?

James: No, no, they are not. Skilled nursing facilities– or when I say nursing home, I’m talking about a skilled nursing facility. And that’s basically a step down from an acute hospital, okay? So, when somebody leaves an acute hospital, a lot of times they will go to a nursing home, also called a skilled nursing facility, for rehab because they need more care, right, coming right out of the hospital. And the skilled nursing facilities have just what that’s described as: the skilled nursing. So, they’re going to have nurses on staff, and they’re going to have people with more medical experience at the nursing home. An assisted living facility is a step down from that. It’s somebody who doesn’t need quite as much medical care and is fairly independent, can get up themselves, can wash themselves, take a shower themselves, usually, can dress themselves, feed themselves. Assisted living facility residents simply don’t need 24-hour nursing care. But one of the big differences also is that all of those ways I described how nursing homes get paid is completely different at an assisted living facility. Assisted living facilities are primarily reimbursed by private pay. Okay? That means the families pay for the stay at the assisted living facility or long-term care insurance. Medicare does not pay for care at assisted living facilities because they don’t pay for– they only pay for the skilled nursing care, not assisted living care. So primarily private pay and primarily people who are less in need of services are the ones who are living in assisted living facilities.

Kelly: Okay. Thanks for describing those differences for us. And so, what can family members do to prevent abuse from happening in a nursing home?

James: The best thing a family can do to prevent abuse and neglect in a nursing home is to be present and to visit as frequently as possible. And not only that, but to visit at different times of the day. So, for example, I’ve had clients say, “I come every day after work, so I get there at 5:30 every day, and they’re dressed, and they’re ready for dinner. And everything looks good. So, I had no idea anything bad was happening until one day I went at lunch, and I saw that their breakfast was still sitting there. Nobody helped them eat breakfast. They’re not dressed. They’re sitting in a soiled diaper.” And so, what happens is that the nursing home staff will learn the routine of the family. If the family comes at the same time every day, that’s when the patient’s going to look like they’ve been taken care of. So, the family is going to think, “Oh, this is what’s happening 24 hours a day. Everything is great,” but that’s not necessarily the case. So, the family, if at all possible, needs to visit frequently and at different times of the day to see what’s happening morning, afternoon, and evening. Not only that, but you have to be a squeaky wheel. When something’s not right, you got to speak up and you got to say something. And when I say, “You got to say something,” I’m not talking about just to the CNA or the certified nurse assistant who’s providing direct care, who’s maybe changing the sheets or changing the diapers. You’ve got to make complaints to the head nurse or the charge nurse or the director of nurses or even the administrator because a lot of times these CNAs are overworked, they’re working a shift or maybe a double, and they’re going to be out of there. They’re not going to make any changes to the care of a resident systematically. They may change what they do on a particular shift. But when you need a change made, like you need your mom or your grandma’s medication given on time every day and that’s not happening, you need a systemic change there not just a change with one CNA. So you’ve got to make those complaints to the director of nurses or the administrator in order to hope that any systemic change is made with respect to the care of your loved one. And if that doesn’t work, then you make a complaint to the state and you tell the state what’s– your complaint is, and you call the state and you ask for a formal complaint investigation. And the state will go in there and they will investigate what your complaint is, and they’ll either substantiate it or they won’t. But that’s a good way to get the attention of the nursing home.

Kelly: That’s really good advice. Thanks, Jim. So how do people know if a nursing home is good or bad?

James: Well, I tell people my two favorite online resources for finding information out about nursing homes. And these resources will give you information on what the patient’s rights are, what the state and federal regulations are that govern the care that’s supposed to be given in a nursing home. And they’ll give you some history on the nursing homes. So, you can look up what complaints have been made against nursing homes. What complaints have been substantiated against nursing homes? How many complaints does this nursing home get compared to other complaints? I’m going to give you three total things to look for, but I’m going to tell you two websites that are super helpful to me and that I always recommend people look at. One is a California website, but it’s useful for people all over the country because a lot of the information on there refers to federal regulations, and federal regulations will govern all nursing homes, not just the ones in the state of California. But that nursing home is– I’m going to say it, and then I’m going to describe it. It’s canhr.org. C-A-N-H-R, dot org, and that stands for California Advocates for Nursing Home Reform. That website is great for all kinds of information, not just California-specific information.

But the other website that’s fantastic, believe it or not, is medicare.gov. And if you go to Google and you just type– in Google, type in Nursing Home Compare or Medicare Nursing Home Compare, either one, and the first thing that’s going to pop up is Medicare’s website that talks about nursing homes. And you’re going to be able to look for nursing homes by zip code or city. When you find nursing homes, you’re going to be able to click on them, and you’re going to be able to find out who owns that nursing home, what complaints have been made against that nursing home, what the staffing is. Medicare has a star rating, one to five stars. I don’t always look at the star rating because the star rating is based on information that the nursing home provides to Medicare. But it’s helpful more for me to look at the complaints against the nursing home and see what complaints have been substantiated against the nursing home. But let me give you one more thing to look up because you asked, “How do you know if it’s a good or bad nursing home?” I’m going to tell you something to look up that’s going to tell you if a nursing home is bad, okay?

And what I mean by that is they have been put on notice by Medicare that they may lose their federal funding unless they straighten up their act. So, I always tell people to go to Google and type in, “Special focus facility.” The special focus facility list will come up, and that will be a list of nursing homes that are of special focus to Medicare because Medicare has warned them they’ve got to straighten up their act, they’ve got to take better care of residents, or they’re going to lose their federal funding. They’re going to lose their Medicare funding. If you see a facility on that special focus facility list, I would absolutely not let a loved one go to that facility. That is the best advice I can give as far as knowing whether a nursing home is good or bad. You can’t tell by the outside of the nursing home. If it looks nice, to me, that just means they’re spending all their money on gardening and making it look pretty. You got to go in there. You got to see, “Does this place smell? Does it smell bad because they’re not changing the residents timely? Is it hot because they don’t have air conditioning?” Because believe it or not, not all nursing homes have air conditioning. So, other than just walking in and using your best judgment, those are the websites that I would go to to get information on nursing homes.

Kelly: Wow. Thanks for providing those great resources, Jim. We appreciate that. And lastly, if someone suspects that a family member is being abused in a nursing home, what should they do?

James: So back to what I said earlier, make a complaint to the director of nurses and the administrator at the nursing home, not just a verbal complaint, put it in writing. Make sure you have a letter or an email that you send to them. Or sometimes they’ll give you their cell numbers. You can put it in a text. But I always ask clients who call me, “Did you complain to the director of nurses or the administrator? And when and what did you say?” Because you need a trail of documentation showing that you put them on notice that certain things weren’t being done and certain changes needed to be made. So, I always say, “Make a complaint and be able to trace that complaint.” If that’s not sufficient for taking care of the problem, then you go to the state, and you make a complaint to the state, and you ask the state to do a complaint investigation. In California, it’s called the Department of Public Health. It’s something similar in every state, but you can go online. And you can go to that Medicare website that I told you about, Nursing Home Compare at Medicare.gov. And there will be a link to how to make a complaint against a nursing home to the state.

And so, looking at those websites and getting that information and making complaints, and if the abuse is bad enough or not being addressed still or somebody’s been injured, then you can always look for an attorney and consult with an attorney to say, “Hey, is this right? Am I wrong? What can I do? Does this rise to the level of a lawsuit? Should we do something more?” But if you type in, “Nursing home abuse and neglect lawyer,” wherever you are, I’m sure you’re going to get a lot of attorneys’ offices popping up. And talk to a law firm that specializes in that type of litigation. My advice is don’t talk to just somebody who does all kinds of personal injury, auto accidents, and falls. Talk to some law firm that specializes in suing nursing homes and assisted living facilities.

Kelly: Thank you so much for providing that for us, Jim. And thank you for sharing your insights with us on how to identify nursing home abuse, prevent negligence, and evaluate care facilities. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

James: They can go to our website, number one, which is lanzonemorgan.com, L-A-N-Z-O-N-E M-O-R-G-A-N, Lanzone Morgan. Or they can call us 888-887-9777. But if you look up Lanzone Morgan in Google, you will certainly find us pretty easily. I think we’re the only firm in the country named Lanzone Morgan.

Kelly: All right. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

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The post How to Identify Nursing Home Abuse, Prevent Negligence, and Evaluate Care Facilities [PODCAST] appeared first on Besler Holdings.

In this episode, Allen Cooper, Co-founder and CEO of ReadyList Inc., discusses the cost of operational blind spots in healthcare.

In this episode, Erin Rollenhagen, Founder and CEO of People Friendly Tech discusses balancing compliance and creativity in healthcare technology innovation.

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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, presented live on Wednesday, June 17, at 1 PM ET.

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ next webinar in its Medicare Cost Report Appeals & Reopenings Series, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, live on Wednesday, June 17, at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Thank you for having me again. I appreciate it.

Kelly: All right. Well, let’s go ahead and jump in. So would you please tell us a little bit about this webinar?

Kristin: Well, as you mentioned, it is the second webinar in the series on cost report appeals and reopenings. And we’re really going to focus on the appeals side and the commonly appealed issues before the Provider Reimbursement Review Board. So hopefully, we kind of gave a little bit of a glimpse into what we were going to talk about in the other webinar. So hopefully, everyone coming will be ready to take that deep dive.

Kelly: Awesome. Yeah. Sounds like it’s going to be a great webinar. And you have some guests joining you on this webinar. Can you tell us a little bit about the people that will be joining you?

Kristin: I do. I have Leslie Goldsmith and Page Smith from Bass, Berry & Sims joining me. And we have done some webinars in the past together. We complement each other really well. Both Page and Leslie have an extensive background in appeals, both at the Provider Reimbursement Review Board level, the administrative level, and the court level. So, they are ready to help me kind of dive into the issues. And where they have more expertise in the area, they’ll be able to lend you their thoughts as to the status of those issues and kind of where we approach it from a legal standpoint and more of a cost reporting standpoint. So, I think together, it’s going to be a great webinar.

Kelly: I agree. I’m really looking forward to hearing you all kind of come together and complementing one another. Please share what you think some of the key takeaways will be from this webinar.

Kristin: Greatest thing will be not only an insight into what exactly the issue is that’s been appealed and determining, “Well, is this something that would apply to me, to my hospital? Are there others out there with the same issue?” and then also where it is today. Where is the issue? Are we still waiting on a decision at the Provider Reimbursement Review Board, or are we waiting on a hearing decision? And where we are in court, are these issues there? Are we expanding the ideas behind these appeals? All those insights that a provider who may not have an outside consultant or an outside lawyer that’s privy to the ongoings– I think it’s going to be a great webinar to dive into that.

Kelly: Right. I totally agree. Can you tell us a little bit more about this webinar series? The first one that we had, last month. We’re going to have another one in July. Can you just tell us a little bit about why the series came about?

Kristin: The series is really focusing on the cost report and more an appeals focus, although a lot of the issues that we appeal can also be reopening issues. And kind of the goal is once we appeal it, if we get a favorable decision, it tends to lead to the issue being more of a reopening issue and getting providers that reimbursement a little bit quicker than the appeals process tends to take. But we’re looking at it high level. We started with, “Well, what is the board? And why do we appeal? And what are the processes behind filing those appeals? And how they differ from reopenings.” But then we’re now going to move into really the meat: not only the why, but here’s what we appeal. And the status of that leading to providers having a better understanding of what might be available to them out there that are– maybe there’s other groups, they’re not comfortable doing it on their own and they want to join a group. Well, then they can see, “Okay, well, where do I fall in that? Is there opportunities for me to join that?” I think that’s really the biggest thing. And then we’re going to end kind of on a best practices from all parts and parcels, not only from the board itself, but maybe how to file the issue. Maybe there’s ways to tailor it a little bit better. So, the best practices, I think, is a great way to end the webinar. And I’m hoping that all of them together, that the people attending will be able to avail themselves of all three together, because I just think it’s a great series to help figure out, again, what do I appeal and where am I at in this process?

Kelly: Right. No, I think it’s going to be a great webinar series. Looking forward to this one and the next one. And you mentioned the people who are going to be watching this. What is the target audience for this webinar series?

Kristin: So, it really is what I call on the front lines. Those people preparing the cost reports, attending the audits, and whether it be a desk review, and then there’s a final review, final review meeting, that’s probably the front line. But we also have to have those who make the decisions, who decide, “Okay, my reimbursement manager has told me, this is an issue I need to tackle, something I need to handle. Why?” So those decision makers, the CFOs, maybe even the corporate reimbursement directors, maybe even up to the CEO, whoever’s making those decisions and really needing to understand why we have the process. And then, of course, the what. So, I think at all aspects. And then maybe if there’s documentation required – which, quite frankly, there is – maybe getting the patient financial or accounting, or whoever does the data, who would handle the data requests and the data needed to pursue these appeals. So, I think it really spreads across the organization. And so, I think those people attending really would have the best full, complete picture of the process.

Kelly: Right. No, that makes a lot of sense. Well, thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues–A Deep Dive. Join us live on Wednesday, June 17, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristin.

Kristin: Thank you.

Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

Podcasts
Webinars

Medicare Appeals

Contact

©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Medicare Cost Report Appeals and Reopenings—Commonly Appealed Issues–A Deep Dive Webinar [PODCAST] appeared first on Besler Holdings.

In this episode, Dr. William Padula, Health Economist and Professor at the University of Southern California, and Martin Burns, CEO at Bruin Biometrics discuss the financial burden of pressure injuries.

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In this episode, Scott Linthorst, Senior Vice President of Value-Based Care for TailorCare, discusses understanding the escalating costs of musculoskeletal care.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Scott Linthorst. Scott is the Senior Vice President of Value-Based Care for TailorCare, a leading provider of specialty value-based care solutions focused on improving patient outcomes for joint, back, and muscle conditions. Scott leads the organization’s efforts to optimize outcomes under value-based care arrangements. He oversees the actuary, medical economics, and analytics teams to drive a data-informed strategy that improves clinical, financial, and operational performance. Scott has a diverse background in finance, patient engagement, and healthcare services. In his previous role at Babylon, he led the Value-Based Care Finance Function, managing over $1 billion in deals from contracting to forecasting and ongoing performance management.

Prior to that, he spent eight years at CVS Aetna and also served as the CFO of an internal startup that empowered physician-led organizations to assume medical cost risk and led FP&A teams focusing on digital health, member engagement, and virtual care initiatives. Scott also has a decade of experience as a management consultant, enhancing his strategic and analytical capabilities.

He earned a Bachelor of Science in Engineering from Columbia University. In this episode, we’re discussing understanding the escalating costs of musculoskeletal care. Welcome, and thank you for joining us, Scott.

Scott Linthorst: Hey, Kelly, great to be here with you.

Kelly: Well, let’s go ahead and jump in. So why is musculoskeletal care such a major financial challenge in healthcare?

Scott: Well, I think there are a couple things. I mean, first, musculoskeletal conditions affect about half of all adults. And in the United States, it’s about $420 billion in annual spend, the single largest specialty, more than cardiology, cancer, kidney, and it’s really closely aligned with a lot of other comorbidities, cardiovascular health, metabolic health, behavioral health. I think one of the big challenges is that it’s a mix of both chronic, think degenerative arthritis and hip or knee, and episodic costs, think acute injuries from falls or lifting something too heavy. And for patients, often the biggest challenge is just knowing where to start. Patients begin their journeys in a variety of different places. It might be their PCP, it might be with a physical therapist, it might be with other downstream specialists. And so, it’s just really fragmented and hard to figure out where the costs start and where they escalate.

Kelly: Yeah, no, that makes sense. The chronic and episodic costs that you talked about, that makes sense with this particular care that we’re discussing. So where do you typically see costs escalate in MSK episodes?

Scott: Well, the anecdote I often hear from orthopedic specialists is that patients will suffer a functional decline in silence, think you’ll put your salt shaker on the counter instead of up on a shelf. But when they get to pain, that’s what really begins to motivate action. What we see in the data is there’s little consistency across different patients’ care journeys. There’s imaging. There are specialist visits. And especially when those come before conservative care treatment options are attempted, they predispose patients towards surgery at a much higher rate than if you start with some of those conservative care options. And if there isn’t some form of clinical triage that starts at the beginning, some guidance to those patients, they often end up on the most intensive care pathways as opposed to those that might work best for them.

Kelly: No, that makes a lot of sense. Thanks for explaining that for us, Scott. So, what role does early navigation play in controlling costs?

Scott: I think there’s several things that influence cost. I think the first is just educating patients about their conditions, spending time with them, really understanding not just what is the diagnosis, but what are the functional constraints? What is the impact? And then talking to them about what are their goals, what do you want to accomplish? Are you trying to walk your grandchild down the aisle? Do you want to get back to your gardening habit? What is the thing that you want to be empowered to do? And then really exploring what are the different treatment options and modalities, and what has worked for patients similar to you? Going through that kind of shared decision-making process and navigating patients to the best providers downstream can really help control costs. When patients go through that type of navigation, they’re more likely to start with physical therapy or exercise programs, and those may help them avoid those more invasive procedures downstream.

Kelly: Yeah, no, I love what you said about shared decision-making. That totally makes a lot of sense in this particular instance. So, Scott, what role does data or predictive analytics play here?

Scott: Because there are such a different variety of places that people will start in their care journeys, try to identify patients early and before they get to some of those escalated care modalities is really important. You can identify, using predictive analytics, those patients that are just more likely to have surgery. And if you can look at those patterns and engage those patients early, sometimes you can engage them even before they get to those places that they were likely to get to downstream.

Kelly: I’m always so fascinated by predictive analytics. And I think engaging patients early, that also makes a lot of sense to me. So, what results have you seen from this model?

Scott: When we see patients that begin with that kind of structured evaluation that I talked about, when it’s clear to those patients what are the pathways that they could choose, what we frequently see is that patients choose to start on conservative care pathways, conservative treatment options, exercise programs, physical therapy before they would then continue on to more invasive or more escalated options. And I think when they do that, what we typically see is a decent number of those patients stick to those pathways and report really meaningful improvements in pain and in their function. And they also report a lot higher satisfaction. When patients feel informed, they feel supported through the process, they generally just have a more warm, fuzzy feeling, right? They feel wrapped up by the– wrapped in the warmth of the healthcare system, as opposed to just being hustled through it. And this ultimately can lead to, on average, less imaging, fewer specialist visits, and better follow-through with those conservative care treatment options. For specialist providers, it also can be a better use of clinical resources because when patients do ultimately get to those more escalated pathways to– they get in front of an orthopedic surgeon, those surgeons generally actually convert those patients to surgeries at a much higher rate. So, it’s a better use of the healthcare system resources.

Kelly: Yeah, no, I love that. I was kind of taking some notes here while you were talking because it was just so interesting. The meaningful improvements and higher satisfaction are so key, and sometimes it’s so lacking in healthcare. And I also love the better use of clinical resources. I think that’s really important. So, Scott, what metrics should hospital or health plan leaders track?

Scott: I think some of the most helpful metrics tend to be really straightforward. I mean, if you just look at utilization rates of surgeries and of imaging, I think those are really good indicators of what’s going to happen from a cost perspective. I think we often want to look at how are patients tracking and following through on conservative care pathways with a conservative care pathway like physical therapy, that can be similar, that can be utilization-based metrics. But when you’re talking about exercise programs, then you need to see where you can get that data from. Is that a digital physical therapy platform? Can you get data out of that? And we find that really useful to talk about whether or not a patient is kind of activated in their care. Ultimately, patient satisfaction is both really valuable into itself as an indicator of whether or not you’re treating patients well, but it’s also a really good leading indicator on kind of what the total cost of episodes are going to be in an outcomes basis.

Kelly: Yeah, I know that tracking metrics can be challenging, especially in healthcare. So, what should healthcare leaders understand about MSK as value-based care evolves?

Scott: I think the big thing to understand is musculoskeletal care is impactable. The costs that are in the system today do not have to be the costs that are in the system tomorrow. Conservative care treatment options are accessible, pretty well understood. And when the system actually focuses on engaging members early and coordinating care between pairs, they can make really meaningful improvements in that in a relatively short timeframe. And what we see that’s super encouraging is when there is that collaboration, that coordination between healthcare providers and health plans and other navigation organizations that are focused on engaging and educating patients, we see real improvements in financial outcomes, in patient healthcare outcomes, and ultimately in the patient’s quality of life. And that’s what we want to see.

Kelly: So, collaboration is key, right?

Scott: Totally.

Kelly: Yes. Well, thank you so much, Scott, for sharing your insights with us on understanding the escalating costs of musculoskeletal care. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Scott: Well, they can get in touch with us at tailorcare.com or you can come follow us on LinkedIn and look for TailorCare. And that’s Tailor, T-A-I-L-O-R, in case you were confusing us with Taylor Swift.

Kelly: Thanks for making that distinction there, Scott. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes our episode of The Hospital Finance Podcast. For show notes and additional resources, visit us online at besler.holdings. The Hospital Finance Podcast is a production of Besler Holdings; Built on partnership, Driven by success.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected].

945.237.1009

116 Village Blvd., Suite 200

Princeton, New Jersey 08540

About
Team

Podcasts
Webinars

Medicare Appeals

Contact

©2026  Besler Holdings Terms of Use | Privacy Policy | Corporate Compliance

The post Understanding the Escalating Costs of Musculoskeletal Care [PODCAST] appeared first on Besler Holdings.