This episode of the MGMA Women in Healthcare podcast features Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, CGSC, CPEDC. Rhonda is a John Maxwell leadership coach and is also the president of the National Advisory Board for the AAPC. Rhonda’s current role is the chief compliance officer for Vision Innovation Partners.
MGMA Consultant Adrienne Lloyd, MHA, FACHE, met with Rhonda to discuss healthcare quality and innovation, including challenges such as quality of care issues and managing cultural changes post-COVID. Rhonda also emphasized the importance of understanding the full global picture regarding quality of care and patient experience.
Editor’s note: The following Q&A has been edited for length and clarity.
What are some of the challenges that you’re seeing in the compliance and regulatory space and how do you think about innovation?
Through compliance, there's a lot of things that we can drive and change culture, and I think that that's really important for us. I also like the aspect of being able to really help not only the doctors, but [also] our employees and ultimately the patients, because you're going to see a lot coming out in the next couple of years on quality of care.
We see a lot of the initiatives that are coming out from the government, and most often, those actually don't even cover quality of care. Since COVID, we've seen a huge increase in complaints against doctors that go straight to their medical licensing board and they're usually customer service-related things that don't belong there. Then, I'm in the position of having to defend and help my doctors. Because it goes on their license, they have to investigate every single one of them.
The culture in healthcare has changed a lot, especially since COVID. The increase of complaints — I read in one study — has been like 66% higher since 2020. From a compliance standpoint, if you can create a good culture, then you get people that will follow, you get people that can be compliant, and you get good work. In places where you feel comfortable, you can speak up, you can make changes and everybody feels comfortable and confident.
Early on in leadership, I was taught to just make the decisions and take your heart out of it — you leave everything at the door and you don't bring anything in with you. So you're taught to make those tough decisions without really thinking about the human factor. What I really discovered is it doesn't work; you need to have empathy and it doesn't make you a weak leader. As I grew into leadership and stopped questioning myself, I realized how much empathy played into who I was as a human being, and that I needed to be able to include that more in my leadership decisions.
When you have a lot of new team members or new physicians, getting them to that core alignment of what is most important — that the needs of the patient come first, this is how we take care, this is how we communicate with each other — it's so important to do that. We can as leaders bring our teams together and really have those conversations of “This went wrong. How do we keep this from happening?” or “This isn't really at the level we want it to be.” Are there any scenarios that you've had, where you've been going through those discussions with your teams or groups you've worked with?
A lot of times we teach to the technologies that we have to use and we don't teach the why. When you don't know the “why,” then you miss so much. Most practices that I work with, both at VIP, and when I do consulting, use online check in or kiosks because it does so many beneficial transactional items for us. But when people don't understand the why, you can get those prompts up on your screen. Let's say I was a patient this morning. I go to the kiosk at my doctor's office. Being the first of the year, you're going to get those prompts that come up. All of the systems give you a warning that comes up with an alert.
One example that I use is it'll give you a warning that says “Patient is managed care.” Employees just click through it because they don't even know what managed care is, and we're so busy teaching to the technologies that we forget to explain the “whys.” It's the same when you get back through to the clinical care. It's really [about] trying to teach those employees to take that step back — because everybody's still burned out in healthcare — and reminding them about the patient experience.
I think that's the vision and the “why.” The other piece I would add that I've seen is particularly related to technology — using outside services or even different types of roles of personnel. You've got to be very intentional about looking at the process — what role is this technology and this other solution going to serve, and how do the rest of our team members need to function around it. Some of it is like Lean Six Sigma standard work.
But overall, we're really trying to improve the process for the patient, we're trying to improve the quality of the data we're capturing or improve our billing. Help the team think through that before you go and buy something and add it on. Have a process of, “do we really need this and is this the right technology?” And then how do we fit the technology into what we want to have happen, versus just adding it on top and having to work around it. AI continues to impact our space.
We start to see a little bit of AI come into the rev cycle with different offerings. The problem with AI, at a clinic level, is that most of the vendors are in beta and they want to control the data. As a healthcare provider, you’ve got to be really careful with those beta agreements because they're doing recordings of patient experiences. There's so many laws around consent for recording of patients and each state varies. You have to do a lot, whether or not it's a two-party consent.
When we talk about technologies, where we try to streamline and try to make things run more efficient for clinics, is what I like to call “knowledge gap.” As soon as you standardize a process, and you take it off site, you consolidate it somehow. When that team stops doing that job, then they lose that knowledge.
Let's use Rev cycles as an example. You decide you're going to have to consolidate the rev cycle because it makes sense. But you pull those people out of that practice and now you have someone that can’t answer billing questions. Now you have someone that when the front desk has a question about an insurance company, they don't know. They don't have someone to explain managed care to them. They don't have someone to explain all of that. And then as you get generational from that, as people transition in and out of that clinic that used to run independently, you continue to lose that knowledge. That knowledge gap can really hurt the practice at the end of the day.
It's more than the transactional impact too! It's the pervasive impact to the team — those moments when they're doing things that aren't at the top of their licensure, they're having to ask those questions. They're just feeling lost and feeling like they're not helping the patient in that moment. I don't know if there's always a perfect solution for it, but it’s definitely something we have to watch out for.
It's so important to look at things from a patient perspective when you're thinking through those types of things. We'll use the call center as an example. It should not take you ten prompts to get to the department that you need. So you start to build these prompts and then when you're building the prompts, you're like, “Oh, wait, I want to sell these kinds of services; let me route this first,” and you forget about the patient experience and they're frustrated. So you have to look at it from a patient perception and it goes back to the kiosks. If you have a team that now has two monitors in front of them to monitor your practice management system and your kiosk information, how are they supposed to greet that patient when they come in? It's a bad experience for that patient from the second they walk through the door.
That's really key and it'll be an ongoing discussion. I'm excited about some of the innovations and how you've seen technology be very helpful. I think there's still so much potential, but how do we do it in a way that is making a better experience — safer and more efficient — without losing the personal touch and experience in healthcare.
I was actually working with one clinic. It was a large one and they had multiple specialties inside that clinic. They were using kiosks to check patients in, but then the biggest complaint that was coming through on their patient surveys was the wait times. And then the doctors are not here, they're late, or we can't find them. It looked communal, but they had different waiting areas for each of the patients. Patients didn't know where to go because the front desk staff used to tell them to go sit in this blue area or the red area. When they were doing that at the kiosk, they didn't know where to go sit. So they go sit wherever. We were actually able then to streamline the technology so that when they checked in based on the doctor, it would tell them where to get seated. You’ve just got to think through those types of things.
In innovation and healthcare, we often think about it being these huge scale changes. Often it doesn't have to be. It really can be just creating that culture of a positive questioning attitude.
When you only base decisions on revenue, you'll always make the wrong choices because your decisions can't just be revenue based. To keep our clinics going, we have to have that function. We have to look at things as, “How can we make more money,” but it has to be about the whole [picture], because otherwise you just lose in the end. It's that whole global piece of it. And so that's why I say let’s talk it through and let's look at it from all aspects. I'm all about money, don't get me wrong, but it cannot be the only driver and healthcare.
How did you get into the leadership training and coaching space? What really helps you throughout your career journey and what else would you advise current or new leaders to really consider as they're looking to enter this world that we know is very rewarding, but also can be somewhat taxing?
When I got into John Maxwell at the very beginning of COVID, I actually sat back and reflected and said, “What can I do to make a difference throughout my career?” That is what drives me — I like to make a difference. When I've left an organization, it honestly has always been down to that fact. So making a difference is extremely important to me and then just trying to make life better for people through my own struggles in life and even in early leadership. One of the things that I tried to always do is self-reflection. After a project or an event, [I ask], “what could I have done better,” and reflect back on that. Then I work with my team on where I messed up and what we could have done better. It started to really build leadership.
Whether it's MGMA, AAPC or your specialty specific association, I think a lot of times the practice administrator is like, “Don't try to go it alone.” This is where you can't possibly go it alone, nor can you even understand it on your own and try to process all the things that are happening. So reach out to whichever group is most helpful for you. I think that's just so important to not only see what's coming and ideally be part of the change, getting ahead of it and trying to adjust it if possible, but at least understanding with your physicians what that impact may be.
For me it's getting that following; it's getting the doctors to understand and really working with them. Quality is just so important in healthcare. We were just recently impacted by a quality of care issue with my father in law. And so, you know, it just really makes you take a step back and, and reassess and, and just think things through of what does need to change in healthcare.
What's one piece of advice, as you think about new and current leaders coming in, to help them navigate through it personally, while they're taking care of everyone else?
What I've learned in the past few years is to be better listeners and to slow down and not have a judgment in our brain already — to actually listen and hear what that other person is saying. I tell everyone active listening and data is your backup, because the data is the only thing at the end of the day that you can really rely on and make sure that you have, and you can get data a lot of ways. Some of it's through Lean Six Sigma and just timing things and looking at production and looking at those types of things. But there's also data that you can pull from your systems and reports and look at that whole global picture of it, because you need to lead with empathy. You need to always have the data; that's extremely important for us to be able to affect change.
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