BUILDING THE FUTURE OF REVENUE CYCLE
SHEILA AUGUSTINE
CRISTIE SCHUMACHER
Director of HIM, Revenue Integrity & CDI Senior
Director of Revenue Cycle
Jena R. Eggert
CEO&FounderRCR|HUB
LayersofFall
Welcome to RCM Connections
This month, I found myself inspired by the layers that fall has to offer. So, I challenged my team to take a deeper look at all the elements that come together during this season We’ve revisited some classic fall traditions football being one of them And yes, as for that University of KY (UK) game, we should have never punted; we had our shot at Georgia!
Our team has been diligently focusing on the importance of education within Revenue Cycle Management (RCM). We've curated and spotlighted incredible resources, articles, and short clips, all of which are now live on our site and across all of our social media platforms.
In my search for rising stars, I’m thrilled to introduce you to Cristie and Sheila two absolute rockstars. Not only are they excelling at their respective organizations, but their volunteer hours exceed many of our full-time commitments. They’re making an impact, and I can’t wait for you to get to know them
Speaking of dedication, meet Sal, the CEO of Spark Change. His latest article embodies the spirit of entrepreneurship and showcases what it means to truly invest time and energy into making a difference This edition has it all, and if that weren't enough, two major announcements are in the following pages!
To my RCM CommUnity, thank you for your continued support. This issue is packed with content that reflects our passion for growth and leadership in RCM
Enjoy!
TABLE OF CONTENTS
CRISTIE SCHUMACHER
Senior Director of Revenue Cycle
Jena Eggert: Welcome to another edition of RCM Connections. I’m excited to be interviewing Cristie Schumacher from Northwell Health
Cristie Schumacher: Thank you! I’m Christie Schumacher. I am the senior director of Revenue Cycle for Northwell Health Enterprises, and I oversee bad debt partnerships and all of the enterprise's self-pay bad debt
Jena: Let's jump right in and discuss how you got to your role at Northwell. Could you walk us through the steps that led you to your current position?
Cristie: Before Northwell I was the Director of Revenue Cycle at Long Island Family Service League, a large nonprofit specializing in social services and mental health.
When I started, the organization’s revenue cycle operations were basic, using paper billing, and did not have electronic funds transfer (EFT) capabilities. I had to start from scratch to rebuild their entire revenue cycle process.
I grew up in healthcare, but I don't think I ever dreamed of being in revenue cycle when I got out of high school College was not something that my family really could afford. I got a job at a doctor's office checking people in and doing some minor billing. That grew into a role where I got a job in the billing department. So, revenue cycle was a very fancy-new word, right? When I came in, it was the billing department, and I got a job at Coram Healthcare, which is a national home infusion company, and they threw a HCPC book on my desk and a stack of denials and said, call on these
I worked my way up from collector to biller to team lead, supervisor, manager, and project manager. Ultimately, when CVS purchased Coram Healthcare in 2015, I was on the team that centralized all its 11 billing centers into one shared service center in Phoenix. I was a road warrior for about two years, flying into Phoenix from New York and working and then flying in on Sundays, out on Fridays, in on Sundays, out on Fridays And that became just way too much And I didn't want to relocate due to my parents.
So, I ended up at Family Service League and decided that I wanted to do something for my community, and my skillset was in revenue cycle
And I thought, can I give back to the world by making this organization have more money in the bank to provide more services? How can I help the world?
In 2020, I was approached by Corrie Quaranto from Northwell Health with an opportunity to oversee bad debt management a role that interested me because it was a departure from my previous experience, where bad debt was often overlooked.
Diving in headfirst, I accepted the job, and yes, crazy enough, it was during the global pandemic I managed bad debt and successfully improved collections year over year. My experience at Northwell has taught me that it’s possible to enhance both patient experience and collections simultaneously. Simply put, we can improve the patient experience and collections We can do both!
Jena: Let's discuss the individuals who have been part of your journey, your mentors.
Cristie: My first mentor was at Coram Healthcare. His name was Sean Blosser. Over the years, he mentored me, especially because I didn't have a professional background. Working from the ground up, I was completely unaware of things in the professional world
He helped me navigate the professional corporate environment, such as participating in meetings, speaking effectively, and conducting myself at business dinners and lunches
Family Photo: Erik, Cristie, Luke and Drew.
He also helped me understand how different parts of the company fit together. I think that is something we don't teach in leadership – how all these parts fit together to make a cohesive financial statement for the company we work for and why it all matters He was able to put it all together to explain the puzzle to me. At that point, I understood how each role within not just the revenue cycle but also the provider itself affects the finances, which, in turn, affects the provider
My next mentor would be Corrie, my current boss I think she just took what Sean had and built upon it Such as an understanding of how to present to key leaders the information they needed in a presentation that they needed, not getting into the granular weeds, and understanding what they were looking for instead of, I think sometimes I over presented, I gave way too much information. She has taught me how to glean that down and tell the story instead of, well, here's the numbers. That has probably been one of the most valuable things I've learned
Jena: Let's quickly discuss the structure of your team at Northwell Health How many people are in your department and the overall healthcare revenue cycle department at Northwell?
Cristie: Northwell's revenue cycle is large, with approximately 2,500 staff members in the core hospital revenue cycle and additional personnel in ancillary departments. About 3,000 individuals are involved in revenue cycle and supporting functions at Northwell. My department is responsible for managing the bad debt of the core hospitals and some of the physician's practices. I have four direct reports and about 20 indirect reports. Additionally, I oversee all the vendors and their staff members.
Jena: In 2020, I was approached by Corrie, a close friend in our RCM Community said, "Jena, you have to interview her! She is so interesting." I enjoy following you on LinkedIn your voice, energy, and trying to discern the truth
Cristie and her husband Drew on their most recent vacation
Cristie helping to raise overdose awareness
On LinkedIn, you discuss regulations and the fear of losing our rural community hospitals. Let's take a minute for you to share your views.
Cristie: Recently, several states, including Oregon, Minnesota, North Carolina, and New York, have been examining the financial aid and charity care provided by hospitals in line with the 501 C3 regulations from the IRS. This scrutiny extends to both nonprofit and for-profit healthcare providers The goal is to ensure that individuals without the financial means to cover their medical expenses are not burdened by medical debt. The issue of medical debt and its impact on American society has been the subject of multiple Senate hearings However, the regulations can sometimes hinder healthcare providers, as a significant portion of medical debt stems not from self-pay patients but from individuals with insurance who must contend with deductibles, copays, and coinsurance
The charity care policies enforced by some regulators seem to lack clarity and a comprehensive understanding of the big picture. North Carolina is looking to introduce presumptive charity before billing patients, while in New York, the regulations are more realistic, acknowledging that many can afford their bills but choose not to pay. Some genuinely need the hospital's charity care assistance
I am concerned about the gaps in the tools available for presumptive charity, especially in densely populated urban areas. I have discussed this with service providers and my revenue cycle peers We need to come together and find better solutions.
We must ensure that those unable to afford healthcare receive the assistance they need without being burdened by debt while also ensuring that hospitals receive the revenue essential to keep their doors open
I think it is important to understand that one of hospitals’ primary revenue resource is patient revenue. Without this income, hospitals aren't able to stay open When hospitals operate at a loss, they might have to shut down, which has a widespread impact on communities and limits access to healthcare. It also leads to job losses for healthcare professionals and support staff The closure of hospitals affects not only healthcare access but also the local job market. This is an issue that I've been highlighting on LinkedIn in relation to the Steward Healthcare situation.
It's crucial to find ways to maintain financial stability in the healthcare industry to ensure that hospitals can continue to serve their communities.
Jena: Last question: Is there anything we haven't covered that you'd like to ensure gets included in our September issue?
Cristie: Yes, I’d like to say how proud I am to work for Northwell. We do a fantastic job of fulfilling our commitment to the community and are creative. I believe that many healthcare systems have this, but we, as a community, don't highlight it enough For example, Northwell has partnered with public school systems to develop high school programs where students graduate with their high school diploma and earn a CNA certificate or radiology certificate We are looking into RCM to get them billing-certified and coding-certified. So, when students graduate, especially in these urban areas, they come out with some job prospects, a career path as well as their high school diploma, and then also a job market because in the next five to six years, the healthcare industry, especially in revenue cycle, is going to be struggling to find just labor.
Another thing I love about Northwell We do a lot to support our local communities We partner with food banks and other services to ensure that the community has access to important screenings such as women's and men's annual check-ups We provide transportation and other resources for those in need
My last comment, which I think is the most important, is that at Northwell, we recognize that we're not just a hospital system but a member of the community and that all our employees are members of that community.
Northwell employs 85,000 people; it's a large community Northwell does an excellent job balancing the finance and revenue cycle with being a productive member of society!
Stay connected with Cristie and Sheila
Cristie Schumacher
Sheila Augustine
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SHEILA AUGUSTINE
Director of HIM, Revenue Integrity & CDI
Sheila: I'm Sheila Augustine. I'm the Director of HIM and Revenue Integrity here at Nebraska Medicine, and I have been in this role for two and a half months now.
Jena: As always, welcome. Let's dive right in How did you end up where you are? Take us through your journey
Sheila: Let's start at the beginning. I didn't know what I wanted to do when I started college, but I knew I wanted to be in healthcare I initially planned to become a nurse but quickly realized I couldn't handle blood.
I still wanted to be in healthcare and knew I had accounting skills, but I wasn’t sure exactly what I wanted to do I applied to be the secretary of Patient Financial Services at Nebraska Medicine. I finished my bachelor’s degree in business administration for Healthcare and left PFS for a short time to go to Decision Support at Nebraska Medicine
I soon realized I missed Patient Financial Services After I left, the position of Education Coordinator became available again, so I returned to take on that role. Then, in 2010, I wasn’t sure about taking on a manager role. At that time, one of my kids was about five months old, and the other was 18 months old Honestly, I wasn’t sure I could handle it, but it was a once-in-a-lifetime opportunity.
That position didn't open often. I applied and got the position. In 2014, our two hospitals and our physicians' group came together to form Nebraska Medicine We combined two revenue cycles, and the Director of PFS position became available. Again, another crucial moment, and yes, my thoughts were, "My kids are young. Are you sure you can take this on?" But I decided to apply and got the role, which I held for seven years.
As part of succession planning, our vice president decided to rotate her directors through the revenue cycle to give them exposure to the front end This involved moving them through Access Services, the middle HIM, and then PFS. I spent three years in Patient Access, and now I've been in Health Information Management for two months
Jena: I love the rotation model! Its impact on individuals and organizations is phenomenal! Did any family members influence your decision to be a part of healthcare?
Sheila: Yes, two of my uncles are physicians. One, in particular, I credit a lot for helping me get to where I am today. He started buying ambulatory surgery centers in the 1990s, believing it was the way of the future And indeed, it turned out to be just that. I loved his dedication, not only to the clinical aspect but also to the business side of healthcare. I also had the opportunity to do my student study in the Student Health Department at the University of Montana for two years, where I found filing records surprisingly enjoyable, although I didn’t expect it to be as fun as it turned out to be!
I laid out the map for you. you chose to follow it. I aspire to be that kind of leader!
Jena: Who have been your mentors on your journey?
Sheila: First would be my boss, Jana Danielson, Vice President of Revenue Cycle. She actually hired me as her secretary. Jana had been with Nebraska Medicine for eight to ten months before I started. I have always reported directly to her She’s the one who inspired me to go back and finish my bachelor's degree I had started it in Montana but never finished. She has shown me where I have potential and where I need to grow. I’ve always wanted to report directly to her. I owe a lot to her; she's the one who has helped me get to where I am today One thing she always said that stuck with me is, "I didn’t do it. I laid out the map for you. You chose to follow it." I aspire to be that kind of leader!
Another colleague I’d like to mention is Stacie Adcock. She was a manager of RevCycle Administration, and during this rotation, someone left in the middle of it. At that point, we talked to her about becoming a director, and we were easily having conversations about how we’ve always worked so well together. I wanted to get back to being that close and being peers. As a director, I want to see her grow. She’s helped me grow so much. So, I attribute a lot of my success to the people I work with every day
Jena: Regarding the university, how many folks work in revenue cycle management?
Sheila: Around 450 people
Jena: Are you all working remotely or in person? What's your team dynamic like?
Sheila: Regarding HIM, where I am now, everybody is remote except for 18 people. Patient access, medical records, and documentation most of the team is onsite I would say about 75% of patient financial services are remote.
Jena: Are needs growing?
Sheila: Yes, we are growing and automating We are on Epic for our electronic health records and always look for ways to improve things without having people do manual processes. We must automate. As we look across any industry, people are not staying at jobs like they once did We do not see tenure As we lose expertise, we will have to leverage technology, business partners, and resources to help augment those things.
Jena: Do you offer any summer internship programs?
Sheila: We do. We offer year-round internships. In the past, we’ve brought several interns into patient financial services It’s great! It gives team members the chance to see how candidates fit and decide if they want to hire them. We hired 13 interns four years ago.
Jena: I speak for many when I say we love hearing your voice and being around your positive energy You're a major player in HFMA. Let’s talk a little bit about your affiliations and your plans for the future.
Sheila:I am currently the President of HFMA, Nebraska Chapter I want to stay vocal and a part of the industry After my time as president, I'm considering becoming a regional executive. I've just finished my third term as programming co-chair for Region Eight.
Raegan & Sheila Augustine
Brynn & Sheila Augustine
Raegan Augustine & Vinnie Armstrong (homecoming proposal)
Now, as I take on the HIM role, I'm also looking into becoming more active in AHMA Previously, HFMA had been my main focus due to its financial aspect
SheilaAugustine,JenHirschbrunner (DirectorofPFS),NatalieSelf,NicholeCase, JillWood,CarrieCarper
Jena: A lot of volunteer hours - thank you. Is there anything else you want to include in this edition? Did I miss asking you anything?
Sheila: Yes, one of the things I’ve focused on over the last three years, and I think we touched on this a little earlier, is mentoring other staff members and having candid conversations with them I ask, "Where do you want to go? What is your ultimate goal, if you have one right now?" Sometimes, we talk to someone about being a high-potential candidate or performer, but where do they ultimately want to go? We might assume someone should become a manager, but they may not want that. They might not want anything to do with HR accountabilities. I encourage people to talk to their employees on that level and ask, "Where do you want to be?" And make sure it’s not just a one-time conversation For example, I had an employee who told me three years ago, "I don’t want to be a leader. I don’t ever want to do that." A couple of years later, we had a different conversation, and she had changed her mindset Without that second conversation, I wouldn’t have known. You have to invest in people to ensure success not only for your revenue cycle but for your hospital as well.
Brenda DiGiacomo, Kim Shanks & Sheila Augustine
butwhoiscounting...
WrittenbySalLoPorto
Very few things last longer than 5 years The things that do often come with hard work and determination.
For context, 5 years is 60 months, 1,825 Days, or 2,628,000 minutes. Think about your life and name something you have done consistently for 5 years or longer.
Education?
Marriage?
Parenthood?
Friendships?
Last week marked SparkChange’s fifth anniversary I know that good things take time, but these 5 years have been truly impactful, not only for me, but for our teammates and clients. Over the past five years, I could have never imagined how many incredible people I would have had the opportunity to meet. Our team, our clients, and our future clients all have made each of these 1,825 days better and better.
As I think about the past five years, it’s hard not to reflect on the early days The mission of those early days hasn’t changed and our attitude toward the end goal stays the same.
Here is a story that
has shaped us to this day.
It was just Monty, Craig, Dung, and me early in our tenure. As budding entrepreneurs, we did what we thought you were supposed to do, made Dung’s basement our headquarters (basements are where all businesses start, right?), bought a whiteboard and markers for our big ideas, updated LinkedIn profiles.
Oh yeah, we needed great headshots. Since we didn’t have money or a budget, we figured we could take these ourselves… It was these headshots that created an anticipated culture and approach for SparkChange. You can still see this same picture on my LinkedIn today
Our First Genuine Lead
Fast forward, and we are now a couple of months into our new business with no clients and few prospects. The reality is, we were the people behind the curtain at our previous employer. We didn’t have a network of people to call on We didn’t know any executives or CXO’s to share our story. All we knew was we had to tell our story, even if it wasn’t a perfect story. So, each day, we would send out LinkedIn connections, reach out to former colleagues, and attend every meeting possible I would "meet, seat, or eat” as we called it, with just about anyone who would listen.
Finally, it happened. I had coffee with someone who would change our business trajectory for good
He inquired about SparkChange assisting with some revenue cycle work and solving some critical issues for a former client. We were happy to do anything, but first, we needed to be vetted – a call was arranged.
On the day of the call, we were all anxious This client was perfect for us We knew we could help, but would that come through via a Zoom call? As the call started, I was the first person on the SparkChange side to share.
Client: This is good, but I have two questions for you One, have any of you worked at a hospital?
Blankly, we stared at each other. We had all certainly worked at a hospital, but not FOR a hospital, which is what was implied. As the silence seemed like it took forever, Monty spoke up
SparkChange: Yes, I worked for Danbury Hospital. I was in the IT department doing data analysis. Also, my mom and brother are both providers, as OBGYNs and ED Physicians, respectively
Shocked, Dung, Craig, and I stared at Monty with that look of “What the hell?” None of us knew that; honestly,
Monty rarely shared much about his personal side. On the other hand, we silently high-fived as we cleared the first question hurdle
Client: Second question, why don’t you have suits in your LinkedIn pictures?
Uhhhhhh… How do you answer that question? Tick, tick, tick, tick… we were stumped I had no answer
The reality is that we had just come from a workplace where talking suits were a real thing. We didn’t want to give off that perception, but you can’t say that, can you?
Tick, tick, tick, tick… As I prepared to explain, I was interrupted again.
Client: “Geniuses don’t wear suits. I will see you all on-site to provide a proposal.
As I stated at the outset, very few things last for five years, and of those things that do, I would argue they are some of the most meaningful aspects of our lives
We have carried this client’s lesson, and others, along the way, and they have helped shape our identity and goals. When we work with clients, we don’t show up in suits. We are there to roll up our sleeves and get to work That is who we are That is how we have made it this far.
We make sure that the work we are doing leads to sustainable change within our client organization We make sure that our mantra “ThinkDoWin” is at the heart of every decision and encounter. With our approach, we leverage insights, identify opportunities, and consistently deliver high-quality results for success in the revenue cycle We embrace continuous improvement, allow our clients to stay agile, and achieve impactful growth.
We want to spark a change in this industry that leads to better lives for everyone involved Yes, our mission is to make the Revenue Cycle less complex, but we know that this impacts more than just the bottom line – it impacts employees, patients, everyone.
Thank You!
There are so many people to thank, from families to colleagues to teammates to clients. And while they all deserve a shoutout, I would be doing them a disservice and ultimately missing someone by listing them all However, I have encouraged my teammates to seek these people out and tell them how impactful they have been to SparkChange and our careers. THANK YOU!
We are grateful for this opportunity to look back at our foundation and most importantly, excited about what’s to come. The next 5 years will continue to be filled with people (not in suits) rolling up their sleeves, tackling the healthcare crisis, and sparking real change
RFP, Yes it’s for me! X
