Episode 5: Healthcare - Behind the Scenes

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation, resources and hope. One episode at a time. Oh. Today on Nurse Dot podcast.

Millions of dollars a year does. Does someone really need to make that much money if the people in their organization are not getting proper health care benefits or they're not getting a livable wage and their safety concerns? Yeah. How much does an administrator need to make? Joining us today, Ben, poor Bennie. As an administrator at a hospital in Chicago, Illinois.

Ben gives us a behind the scenes tour of how the system of health care works and answers many of the questions we constantly ask ourselves. I'm your host, Kara Lunsford, registered nurse and VP of community at Nurse dot com.

So, Ben Carbone.

Ben Porbeni

Yes.

Cara Lunsford

Hey, I am so excited to have you on this podcast. One of the things that I want to point out to many of our listeners, and I'm sure you don't want to just be known as Abby's brother. However, you are Abby's brother. You are his oldest brother. And I would be remiss if I did not point that out right at the beginning and say it really has been such an honor and a privilege to be working with you and life and talking to you about all the great things that you are planning and doing to continue his legacy and having you on here today is just an added bonus to this relationship that Nurse dot

com has with you guys. And on our last call. I learned something about you that I did not know and I was like, Oh my gosh, please, please, please, will you be on this podcast? Because you are going to be able to shed some light on some stuff that I am sure nurses do not know enough about. So I'm going to start with Ben.

What do you do for a living?

Ben Porbeni

What self-care. Just want to say thank you for the opportunity to be a part of the podcast and to go straight into your question. Yes, for live and I'm a health care administrator with the focus primarily on revenue cycle. So my current position now as the director, as he wrote in the cycle for one of the hospitals in the Chicago area revenue cycle.

Cara Lunsford

First of all, I try not to gloss over when I immediately hear money and revenue. I try really hard to stay engaged because there's this part of me that just wants to check out.

Ben Porbeni

I guess that.

Cara Lunsford

Well, we are grateful for people like you because there's plenty of us, especially nurses. We just want to show up, provide the patient care. We don't want to really get into the why can't I have this or why isn't there enough of that? We just want to show up and like, do the work.

Ben Porbeni

You know, it doesn't give you this revenue cycle isn't all fine out. I guess the best way to describe it would be finance account. And Jason, we don't necessarily do all the number crunching for the hospitals, but what we do focus on is the reimbursements from the insurance companies and copayments or self-pay from the patients, making sure that the claims are submitted correctly to the insurance companies and we get the right reimbursement for whichever care was provided to the patient at the hospital.

So that's what revenue cycle entails.

Cara Lunsford

You're the guy that we say, Show me the money to show me the money ban. Well, it already paints you in a better light. You are the person bringing the beans in way.

Ben Porbeni

So we work closely with the accounting team to make sure we're balancing the books, whatever's allocated to be reimbursed back to the hospital. If we're over budget in terms of maximizing revenue, which is always a good thing to collect more than we projected for from that over allocated the forms correctly and, you know, applying it back to the hospital.

Cara Lunsford

So I have a I have a lot of questions because I they're all kind of flooding into my brain right now. And I'm like, Oh my God, which one do I want to ask first? I think the first question I want to ask you is, do you feel like the physicians, the nurses, the do you feel like they understand reimbursement and what goes in to reimbursement?

Ben Porbeni

It depends. You know, you have some physicians there to own their own private practice. So from their perspective, they may have an idea of the reimbursement process compared to individuals just working in the hospital. And in most cases, it is our job to educate the providers, clinicians on what needs to be done. Perfect example of what we see all the time is incomplete documentation providing notes as a as a good example so as to provide a notice and all you have portion notes that doesn't support the diagnosis or the treatment provided through to the patient.

That can create a denial when their claims submitted.

Cara Lunsford

When nurses do their documentation, I'm making an assumption here that doctors will go into notes and pull information that they then need to put into their physician document that then makes its way up to you.

Ben Porbeni

Yes.

Cara Lunsford

So nurses having really thorough, clear documentation of what was done when it was done and then that information being able to be seen and read by the ordering physician and then the physician being able to put it into their note, which then makes its way to you because you end up submitting that in order to get reimbursement.

Ben Porbeni

Yes.

Cara Lunsford

And then when you make this claim and you submit it with the notes in the coding, are we getting reimbursed as a hospital for diagnosis but also for procedures that were done, etc.? Like so for a variety of things. So for example, in one claim, how many codes could you see?

Ben Porbeni

It varies depending on the level of care provided. So each diagnosis pretty much has local sense of the insurance companies and individuals and patients typically drove a variety of reasons as to why a patient could be admitted as inpatients. So those claims would have gone to this one for every care that was provided during that time.

Cara Lunsford

I'm kind of looking at this whole process. I'm seeing it through the lens of a nurse. The thing that just stood out to me is that you said supplies. And, you know, I went back to a time where, you know, we never scanned supplies at where I was. I mean, I've been a nurse for almost six years. And so there was definitely a time where we just kind of used as much gauze as we wanted to use.

We grabbed as many syringes. We sent stuff home with patients. When we knew that they didn't have stuff at home. We're like, Here, take some diapers, take some us. I'm sure you're like, Oh God, I can't tell you this. But, you know, I think because as caregivers, you know, we're just looking at the patients like, hey, this person is marginalized.

They don't have access to things. We're just like, here's a little goodie bag to go because you don't we know you don't have enough stuff at home to manage this massive wound that we're sending you home with. And there was a time when we were just able to do that. And I'm sure that it probably wasn't very good for the hospital.

I'm sure we were just like hemorrhaging money. And this caregivers were like, whatever, you know, we feel good about it. So now it goes back to, okay, now we're scanning things. We're checking it out of the supply room. We're saying, you know what? This person used this many supplies and you guys then take that and you actually bill the insurance company for it.

Ben Porbeni

Yes, I love that fine line of what needs to be billed and what doesn't. And that's where the coding department comes into play with. And the right codes are what can be billed and what's identified as not billable item, but also from a supplies perspective. Part of it, too, is just simply because of the increase in costs and trying to run a health care facility.

It's not always necessarily because we're trying to get reimbursements from the insurance companies part of it. Now, with hospitals having nurses scan every single supply that's simply just trying to manage cost as well.

Cara Lunsford

Yeah, it's tough, right? Because I can see from the side of a business and, you know, say what you will about it. But health care is a business, right?

Ben Porbeni

Yeah.

Cara Lunsford

And it is it's very hard when you're trying to run a business and you want that business to be profitable. Yes. There's always a big question, and I'm going to say it only because this is where sometimes there's like a bone of contention where they're like, Yeah, how much does an administrator need to make? It's kind of that line, right, where you guys say millions of dollars a year, Does does someone really need to make that much money if the people in their organization are not getting proper health care benefits or they're not getting a livable wage and their safety concerns where the nurses are like, I'm not practicing safely.

And yet I'm told there's not enough money. And then because of pay transparency and especially for nonprofits, you can see how much people are making. So I don't necessarily expect you to have an opinion on this, but how do you what would you say to nurses? You know, did you and Abby have these conversations?

Ben Porbeni

We did. We you know, and, you know, it's funny, we're having this conversation. I'm doing this podcast. This was actually a topic we wanted to discuss this podcast before this person, but we did have conversations like this about being a nurse, being a health care administrator. These are the type of conversations we just at a dinner table or just face time and or whatever the case may be, because sometimes we just about bounce ideas off of me be going back to to your question in terms of multi-million dollar salaries, I don't know if I have a concrete opinion on that, you know, because healthcare, like you mentioned, is so an industry just like any other

industry. And this is the typical structure you see with president and CEO CEOs making that type of money, but maybe a little more. Most hospitals being not for profit, they may not be making as much as part of the CEOs of presidents and the private sector in a different industry. But I do understand the sentiment. You know, you run and ask, why should you be making that type of money, especially if you are at a hospital where there's safety concerns under all the issues.

But I really can't speak to that. One thing I will say is most hospital leaders engage, at least I can speak from my experiences where I've worked, that when we have the engagement. So that is going out. You know, it's not something that was just sent out just for the fun of it and just to get feedback. But we actually take action.

We try to address the concerns that are being brought up. What I can say with that is dependent on a hospital, depending on location. For the most part, it's an issue of trying to close the gap and making sure we can deliver wages. All of those things that are being taken into consideration. Like I speak for my hospital.

We've done a lot of what I just mentioned. You know, there have been pay increases and different things have been done to address the concerns that you you alluded to and address and safety issues that are at our facilities as well.

Cara Lunsford

I think those are all such valid and really great points that you made. And I think that until our health care system isn't really for profit, right. Like until that changes and I don't know if I'll ever see it in my lifetime. I hope I do, because I do kind of think of I think of it more as like a public utility, right?

It's like this is something that as a human being, we should be taking care of each other and we should be providing a certain level of health care, actual health care, not sick care, but health care. Yes.

Ben Porbeni

With our health care, we tend to be reactive with health care in our country, with the way it's set up, like you said, is for profit. So, you know, the industry makes money off of individuals being sick. So until that changes, that's pretty much anything else that's being done. It's just put on a Band-Aid on the bigger issue that really needs to be addressed.

Cara Lunsford

Coming up in our next segment, we can always work towards change. We can always try to make it better. We can advocate for a different type of health care. But this is the system we work within right now.

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I guess my hope is that too what you were saying is that if we could just at some point focus more on preventative medicine and health care and then when somebody gets sick. That being the exception and not the rule, it would be really great for that to be the case. I know that that's not the case right now.

So we we kind of just have to operate within the system that we're in. We can hope and dream all day long, but this is the system we work within right now. We can always work towards change. We can always try to make it better. We can advocate for a different type of health care in the meantime, we have to make sure that the institution that we're working for is profitable, you know, or is generating revenue so that when we go and ask for things directly, we can say, Hey, I did my part, I've done my charting, I've I'm really good about scanning all my supplies.

I'm not giving goody bags away when they're going to leadership and they're saying, look, what can I do differently? What can me and my team do differently? Because we need better benefits. We need like wellness here. We need a resiliency room. I need mental health support. We actually need to have a psychologist that comes and works here and that we can go see that person in the middle of our shift if we need to.

And what can I do to help make that happen for this hospital?

Ben Porbeni

I think it's a hospital with very. But what you just indicated is the nurses are advocating for themselves, like I mentioned with the hospital that I work for and the ones that I've worked with in the past, we had the engagement surveys. So taking the time to actually fill out this survey and provide feedback and not just looking at it as some exercise that wouldn't bear any fruit just communicated with the leadership at the hospitals.

What nurses would like to see.

Cara Lunsford

Those are perfect examples. And it's funny, when you bring up about surveys, they kind of cringe a little bit. I'm always like, Oh God, the surveys, you know, it's you're like, Who wrote these? I think we often times are like, I don't know who wrote this, but I don't think it was a nurse.

Ben Porbeni

The the questions are geared towards nursing.

Cara Lunsford

I do think that there's something to having nurses write those survey questions. I think it would be a great exercise if you compiled questions that you received and you said, look, the next time you guys do a survey, they're all going to be written by you and your peers. I kind of wonder if you would get a different response.

Ben Porbeni

You could you could trigger more engagements from the clinical team, from nurses. I'll just keep it in mind when those stories are done. It's for the entirety of the hospital and not just for one particular group. Just from my experience with my team, I always take it upon myself to implement change and I know where my service lives.

We've always done that as well. I don't know if I mentioned this earlier, but prior to working in an organization, I'm working and now I worked at the V.A. Hospital and we had services like this as well. And the leadership took the initiative and made changes at that particular hospital. We all saw the direct impact from that survey.

Cara Lunsford

That's really good to hear. Sometimes it's really hard to be vulnerable and put stuff out there. Sometimes you need to take advantage of those common sections. And we get busy and we get tired of doing surveys, especially if we don't see a lot of change. So I think it is on us. It's also on the administration to be receptive to that.

It's on them to take steps to be responsive. I know that we don't always get what we want. The answer is not always yes, but how we respond to people matters and giving them timelines for things or reasons why something can't happen right now. But what are some steps we could do to solve their problem? What are some solutions?

Cara Lunsford

Yesterday I was talking to a CEO and a CNO for a hospital in the Midwest, and one of their recommendations was come with solutions as well.

Ben Porbeni

Yes. Be prepared to have that discussion of what you think the solutions should be. Very just have recommendations as suggestions that really helpful.

Cara Lunsford

I think this has all been so, so rich with information and resources.

Welcome to a segment we call the DOD Spot, where you will hear more of your voice and a little less of mine. You can visit nurse dot com forward slash podcast to share stories, feedback and requests as a valued listener. You will also receive discounts on News.com courses and see use by using code nurse dot at the checkout.

I've been incredibly inspired and I know that so many in the nurse community have also been inspired hard by the work that Benny did during his all too short life. He was the founder and curator of the much loved nurse Life r n on Instagram, boasting 1.2 million followers and also the host of an incredible podcast with two seasons called Nurse Speak.

Today on the dot spot, we will be featuring a clip from Nurse Speak. Enjoy.

Dot Spot Segment

What's up? And welcome to the Nurse podcast. I am your host, Abby, and I am here with Emily.

Hay.

And this week we are talking superstitions. If you've been a nurse for any amount of time, I'm sure you have heard tons of superstitions. And today we're going to be talking about some of the more popular ones. Emily Yeah. What are some of the superstitions that you've heard?

And the East Coast. I heard about tying the knot on the bed to keep the patient through your shift. We've all heard the full moon. Like it's going to be a crazy shift that there's a full moon. All right, you got that?

That comes in threes.

Oh, yeah.

I've also heard the one that, if you like, talk about a frequent flier. If you say their name too much, you almost like, summon them.

Yeah. Speaking of saying, don't say the key word.

Don't say the Q word.

Cara Lunsford

You've given some really incredible recommendations to the listeners. I think a lot of what you have said today does provide validation because we're validating the fact that this is the system that we work in. It's not perfect. Far from it, but it's where we are at the moment and the frustrations that they're experiencing. They're real. These are real frustrations.

Cara Lunsford

The short staffing, the lack of supplies, the lack of bladder scanners being really clear about the things you need to be able to do your job effectively. I remember a time when I was at the hospital and it's kind of ridiculous that I look back on it and I'm like, I don't understand how this was the case. We had six cardiac monitors.

Cara Lunsford

Well, we had 17 rooms and we would have to basically fight over the cardiac monitors. And I was on an oncology floor for pediatrics and it was like, well, my my kid is getting chemo. Well, so is mine. And, well, my kid just had surgery. Well, so did mine. I was like, I went to my manager once and I was like, I don't really understand the math here.

Cara Lunsford

Six monitors, 17 beds. This math doesn't add up for me because this should be an every room thing. It's not like you. What if you said that about beds? What if you didn't give them a bed? We were like, Well, in this room, you just have a room and a cot. They're like, Yeah, right. That would be ridiculous.

Cara Lunsford

It's like, what are the what's the bare minimum? Right? Like, what are the basics that we need to be able to do our job safely? And that does come down to equipment supplies and staff. Yes, right.

Ben Porbeni

But, yes, these are things that should be elevated and brought to the attention of the hospital leaders. Absolutely no reason why you have 17 beds and just fix what it is.

Cara Lunsford

That's exactly right. So it shouldn't be the norm. Right. So we have to take a second. Why are there only three blood pressure carts? And I'm watching people roll them around from room to room. First of all, that's not sanitary. Second of all, just have a blood pressure machine in the room that's hooked up to a monitor. Well, I found one in a bathroom once.

Cara Lunsford

I found a blood pressure machine in the bathroom. I know that the Sienna hid it here. Not that I blamed her, but it was like, why are we chasing this stuff down? I feel like one of the very, very first things hospitals could do is just. Let's break this stuff down. Do you guys all have the basics to do the job that you you need to do?

Ben Porbeni

I think some of it was just having the hospital that is, you know, where it is, the president or whatever. Just really take a good look of what's happening at their respective hospitals, walk around, get familiar with people. You know, it helps them make it better informed decisions.

Cara Lunsford

Yeah. Yeah, absolutely. And I think definitely something that nurses can take away from this episode today is that this is something that is a responsibility that you have to take a look at where your frustrations lie and not just get used to living with it. Sometimes we get used to not taking breaks. We get used to running around and looking for equipment, even if it comes to like scanning in to things or the processes that you have to do that are frustrating, that are needlessly frustrating because maybe when we can eliminate some of those things, people are going to be a little happier.

Cara Lunsford

They're going to be able to spend more time with their patients because they're not trying to track things down. And I guarantee you, nurses are going to be happier when they feel like they have all the equipment they need and they can provide safe, patient care.

Ben Porbeni

Yes. Being a nurse and being on the clinical side of this is already stressful as it is. So you have to care for patients. And so that alone is already stressful and having to add the additional stresses over there to write down supplies and equipment is really not something that should be the norm for nurses.

Cara Lunsford

This has been better than I ever could have imagined this interview being. I feel like Abby was with us during this helping to guide this conversation. Oh, like I. Tell me what I should ask. We miss him. He was a bright light in the nursing community, and I love that you and your family in life are carrying on his memory, his legacy, the things that he cared about, and that you're going to be doing some exciting stuff in the future.

Cara Lunsford

And it was just an honor and privilege to have you here on this podcast. And I think it was a wealth of knowledge for people. So with that, we will chat with you soon. I have no doubt.

Ben Porbeni

Courage. Thank you.

Cara Lunsford

If you enjoyed this episode and want more information about revenue cycle and coding, Reliance has provided our listeners with a pretty cool resource revenue cycle and coding, education and training available at News.com. Forward slash Podcast.