- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Chris Bergman,
vice President and Chief Financial Officer
at Dayton Children's Hospital.
Chris, it's a pleasure to have you on the podcast today.
- Thanks, Laura. Thanks for having me.
- Now, I'm looking forward to our discussion
because I know there's so much happening in healthcare right
now, and particularly learning more about
what you're doing at Dayton Children's
and really tackling some
of the challenges in healthcare today
and in some, you know, for all healthcare institutions
and some particularly for, um, children's health.
But before we dive into that,
can you tell us a little bit more
about yourself and your background?
- Uh, sure, Laura, let me, I'll talk a little bit about, uh,
my professional background, just a little bit about, um,
me personally, but I have been in, uh, healthcare finance
for over 40 years, uh, with a,
a long public accounting background at Ernst
and Young, uh, when I left there.
And then, uh, 20 years in
what I would call medium-sized adult systems.
Uh, I spent a little time in Colorado, was in the first, um,
joint operating agreement out there when those were the big
deal in the mid nineties.
Um, uh, so journey with that organization for 10 years,
and then a little bit of time in Michigan and,
and now down in Ohio
and kind of spending a lot of that time in the adult,
adult hospital world.
And about eight, a little over eight years ago, um, jumped,
uh, into the pediatric scene at Dayton Children's.
And it's been, uh, you know, again, I, I felt like for me
that medium, smaller size organization is a really good fit
for kind of my personality and,
and my skillset, um, as opposed to the larger,
larger organization.
So that's kind of professionally, personally,
just one thing nugget about me is that, um, um, you know,
God willing, in about a year, I'll,
I'll be ordained in the Catholic church as a deacon.
So I've been on a, on a faith journey for a period of time
and about ready to, uh, take the next step.
So that's a little bit about me personally.
- Oh, wow. Congratulations. That's a huge accomplishment.
And certainly as you mentioned, something that, um, is
so important and really a pillar of the community as well.
Uh, I can imagine. Um, it's been, like you said, a journey,
but, um, such a, a rewarding one too.
- It hasn't, it hasn't been a great, uh, rewarding journey,
um, all the way along.
Got, uh, 16 other guys and journeying with,
and it's been just a phenomenal experience.
- Oh, that's amazing. Well, congratulations again,
and definitely, um, a lot to look forward
to in the next, this next year.
And, you know, too, um, from your vantage point as CFO
of Dayton Children's, what are some of the biggest issues
that you're following in healthcare right now?
- Well, there's, there's a couple.
There's the ones that are unique
to the, the, the kids' world.
And the one I'm gonna talk about a little bit is
pediatric mental health.
Um, you know, pre covid we're starting to see more
and more kids need, uh, behavioral health services,
and Covid kind of really took it into, like,
made it go orbital on us.
Um, we've had a, we've seen an explosive need
for mental health services for our kids.
And, uh, I like to say that, that if you,
if you know a kid in middle school,
if you know five kids in middle school,
you've probably known one kid who's put
together a suicide pact.
And, uh, our, our highest admitting diagnosis in
2023 was suicide ideation at the hospital.
And, and we're not unique
to the other hospitals in the country,
other children's hospitals in the country.
So that one's a very big issue for us.
And it's pretty underfunded in terms of, I mean,
Ohio's doing a yeoman's job to try to put money into it,
understanding the, the need and, and,
and the need to fund it.
But it's still largely an underfunded service.
So when you think about my biggest growth opportunity over
the next five years in a service
that pays me a lot less than most of my other services do.
So that's, that's a challenge for us uniquely with the, uh,
of the children's side of things.
And I think that we also track in, in general,
like most hospitals do,
the whole labor workforce challenges we have, um, just the,
um, the, the work, um, the work,
I don't know if I'd call it the work ethic.
The work code of people today are different.
Not saying that's right, wrong
or different, they're just different.
So trying to find that, that nice medium understanding
that people aren't in it
for the same reasons they were in it
before, uh, the, the, um,
that Gen Z is different than the baby boomers, et cetera.
So you're just trying to find that balance to
how do I engage everybody across the spectrum and,
and also looking to see how do we, you know,
if there's a shortage out there, how do we change
how we do work so
that we make sure we have the right people in the right
place at the right time?
So that's the second one.
The third one kind, honestly, has been in the headlines.
The whole cyber thing has been big, um,
even pre covid we've been building, uh,
cyber capabilities at, at our place, uh, in terms of trying
to keep attacks out, ransomware, et cetera.
And just, you know, you got this whole change healthcare
that's impacting hundreds
or thousands of hospitals across the country right now.
And that's a challenge for us as well as, um, you know,
big ransomware attack at, uh, Laurie's Children's.
So in my own world, uh, one
of our own children's hospitals being attacked, uh,
in Chicago, and there's a lot of disruption, a lot of costs.
We have a lot of preventive costs in place.
We're only as good as the guy
that figures out how to get through our systems.
So the next person who gives away their credentials, right?
So those are, to me, the, the three big issues.
One that's generically healthcare labor, one
that's uniquely different in, in the kids' world,
pediatric mental health.
And the other one's kind of u kind
of ubiquitous across all companies is, is cyber issues.
And we just happen to have a lot of information
that people like to get.
So those are kind of three biggest things I I see us
tracking in, in 24.
And, and obviously beyond that too.
- Absolutely. I think all those aspects you mentioned are
so fascinating and certainly, um, top of mind
for many executives across the board today.
And in particular, as you were talking
through the cyber attack issues, I can imagine, you know,
for years, like you said, it's been something
that has loomed in,
in some organizations that have been hit.
But now with Change Healthcare, one of the largest
companies, um, connected with Optum
and United Health Group, uh, in the country
and associated with healthcare in particular too.
So, you know, in seeing that hit in, in the disruption from,
um, from that particular, um, side of things, how do you,
I guess, think about that?
Um, I, I know you mentioned obviously being able to, um,
have somewhat of a, um, ability to build capabilities
and think through what kind of financial, um, responsibility
that you have to, to put away, um, in
and put parts of the, um, budget
and hospital finances towards the cyber attack and,
and planning for a potential recovery if something happens.
But, um, from, you know, just kind
of like looking at the way you're thinking about it today
versus the way you thought about it five years ago.
You know, what's kind of different? How have things evolved?
- I think our education of our employees, uh,
and have, has evolved.
I always tell a funny story when we first started down this
path of trying to test people like you
send 'em a fake email, right?
And you, and you see if they respond
and then you use that as a training tool.
A training platform to say, okay, here's
what you should have noticed in this email
that why you shouldn't have responded to it, right?
So I'm teaching you to not respond to things
that are, that are coming in.
Um, the funny, the funny one was five years ago,
we sent one out and said, oh, Christmas time is usual.
We're going to, which isn't
as usual 'cause we don't do this.
We're gonna give you a free Turkey, so put all your info,
click on this link and put all your information in.
And of course, it was a fake thing,
and somebody actually responded to our messages saying,
well, you know, last place I worked
to actually offer you a Turkey or a ham.
I'm like, that guy's gonna be really
disappointed when he finds out.
We were just testing to see if he put his information in.
But that's how we've evolved to,
that's not an issue anymore.
We're still, we're testing people
with, you know, real things.
A lot of times during, um, during the, uh,
the January timeframe,
we'll put stuff out there about W2 information
because that's a real thing.
And I remember even five years ago, my CEO saying, well,
Chris, can you make it not seem so real?
I'm like, well, you know, bad guys make it look real.
We have to make our fake things look real
so we can test and we can educate.
We're not trying to hold anybody.
We're not, it's not punitive.
It's like, okay, we need to, we need to educate more here.
We need to tell people what this is like, et cetera.
So there's that piece that we've escalated our testing,
but that's only so good.
Then you've got 24 hour monitoring.
If things are, things are starting to ping us,
like what's our systems look like that says,
here's some walls up here that we're looking and training.
You know, you have to have software products that, that,
that look at those things and try to keep things out.
I mean, I guess we turn down thousands of emails a day
that are phishing emails and some get through, and CEOs
and CFOs and c-suite members are huge
targets for all those things.
Um, and my CEO's super savvy at all.
This actually fell to one not too long ago, and it just,
because it looked super real
and, uh, it so it, it, it's, it's so, it's so easy.
I mean, I worry about it all the time and
because I get so many of these things,
I know sometimes I don't respond when I should have
because I, I think they're fake.
And, um, so it's just, it, it's a disruptor.
But we're, I mean, you never say you're in good shape
because you know, as good as the,
the guy tomorrow that does something.
But a lot of times what we found is it's people freely
giving up their, their, their credentials.
That is what is what how people, the bad guys get in.
And so it's just a matter of trying to, you're trying
to train people for that, you know,
now they're intercepting, you know, you have the, the, uh,
the, you know, the, the authenticator thing that comes in
and texts you and says, you know, put in this number.
Well, they're faking those things now too.
So now they've infiltrated that piece.
So it's just constantly trying to stay ahead of 'em.
And you end up having an infrastructure, you have a team
that monitors the traffic, you got software tools,
and now all of a sudden you have a caution in your system
to try to do something you really,
that adds zero patient care, uh, to
what you're doing in your organization.
It's just some way to try
to keep the bad guys from getting all your stuff
and locking down your systems.
And so it's unfortunate.
Uh, now it's the cost of business, um, uh, to do it.
But that's how it's changed over.
I mean, I would say five years ago we had very few
of those tools, um,
but that we've really escalated our training and education
and, and the tools we had to try to monitor that stuff.
And we continue to look at that
and our guys are dialed into all the cyber networks out
there, and they talk to the feds, you know,
'cause the feds host different things as
to what's going on in terms of the threat,
uh, alerts that are out there.
So they stay on top of that to try to do the best they can
to keep us, keep us safe.
- Absolutely. That's so helpful to hear and think through.
And, you know, um, definitely is something
that I can imagine, just like you said,
continues to evolve and change.
And so staying on top of it is a challenge. Mm-Hmm.
, when you look ahead,
what are you most excited about and what makes you nervous?
- Well, I think there's some really cool things going on.
Y you, so the cyber side, the, the, the digital things
that we're, that we're communicating with our patients
and families, et cetera.
So for us, our, our, um,
we're a little bit different in the pediatric world in
that most of the people we communicate with are millennials,
you know, 'cause they're in that 30 to 40 year range
as the parent that we're dealing with.
Whereas the adult hospitals have different, um, age groups
and generations they're talking to.
But we have a lot of people in that group.
They, they like to be kind communicated
with digitally, right?
So they don't, they don't want a
phone call, they don't want an email.
I mean, they're, they're digital.
Uh, a lot of times they're digital natives
'cause that's, they grew up with it all.
And so, but it's exciting there to start figuring out how
to get away from paper processes and old things, et cetera,
and move into that, that era.
So that's, that's exciting.
It's scary at the same time
because there's a little bit
of impersonal piece of that too, right?
When you, when when you do that,
you're disconnecting the personal touch into a,
a digital touch, which has, it loses something,
uh, from that perspective.
But it's exciting because we can build those tools.
We have it probably,
and maybe a little bit easier on the
pediatric side to do it.
'cause most of our patients families
and the people we communicate with are in that, in
that small group versus the adults that have the,
the seniors and the 30 year olds
and everybody in between
that all have different communication, uh, methods.
That's not to say we don't, but by
and large we have a large group of people
that can be communicated with in one fashion.
So I think that's exciting.
The other piece that we're seeing in the pediatric front is
the pediatricians are,
have largely been independent in the pediatric world.
Uh, usually in the pediatric world,
the hospitals will employ the specialist
and sub-specialists, but the pediatricians
have tended to be independent.
They're starting to, um, come into employment with us,
which gives us a great opportunity to integrate all
that information so that we can really tie in, um, you know,
all your wealth checks and all those things into ed visits
and, and costly healthcare and things like that.
So there's, there's, um, to me that's exciting
because that's, that's integration, that's integration
of healthcare at, at kind of, its at, its at its best.
And um, so those are, those are two I think
that are, that are exciting.
There's obviously costs
and, you know, when you start employing physicians,
do you lose money, et cetera, et cetera.
So those are all your things you worry about.
But see, if you look at it as this ability to really
transform how we deliver care, uh, I find
that really, really exciting.
The other piece we've been working on from a clinical side
and, and, uh, I got involved
'cause we're looking at, you know, cost, how do we,
how do we improve cost outcomes, et cetera,
is just this whole notion of once a person comes in
and admitted, are we managing their discharge?
Are we discharging them when we, when we think we're ready
to send 'em home, are we manage 'em up front
and educating 'em, et cetera, et cetera,
which yields a whole bunch of great outcomes.
I mean, one, from the finance guy's perspective,
it's probably better cost because I'm not gonna have all
those variation in my patient pathways
because we're gonna be talking
to patients the day they come in the door
when they should be going home.
We're gonna be managing to an expected discharge date
that may change, but at least from
managing to a date we think about.
So that helps manage costs.
But I think from the patient communication,
patient expectation perspective,
I think has got tremendous upside to help them understand
and be more transparent with them on how they, their care,
uh, journeys through while they're at, at the hospital.
So to me that's exciting.
That's, that's, that's transforming how we deliver care.
It isn't just the standard, you know, standard finance stuff
of trying to, to do something
for a little bit less money than we spent the year
before, which we have to do too.
I mean, we have to figure out all those pieces as well.
But trying to transform it
where you really get some different, uh, change to me is,
is is exciting.
And the final thing for us is we're starting to, uh,
in the pediatric world, we've got some areas of town
that are largely underserved with very little access to,
you know, um, uh, primary care sorts of services.
And so we're starting
to venture out into those, those areas.
We, uh, we take risk on a Medicaid contract
and so we're able to reinvest those dollars into, um,
you know, going out to, uh, you know, into these communities
and bringing healthcare out to them.
So it's more convenient for them to do, which should,
should be transformative for them as well.
Uh, 'cause all, they won't be always being
seen in the emergency room.
So have a lot of, a lot of kids
who are seen in the emergency room simply
'cause they don't have access to anything else.
So that's, to me, that's exciting too, to try to change
how we, how we take care of our, our, our community better.
- That's amazing to hear. And definitely so important,
as you said, just to, um, have that access to care
and really cool to see some of those trends, whether it's
with kind of the, the digital access
and being able to connect easily in, in, in, in a way
that is, um, convenient for patients.
And then too, having the pediatric physicians now
coming into employment.
I think that's such an interesting trend.
Uh, what do you think is driving them into the employment
space and, um, versus being independent
as they had been for so many years?
- Well, it's interesting, but you know,
it's some of us, the impact of covid.
So even though we're, how many years are we past Covid,
who's, who could say, right, who,
who knows when covid actually ended,
but as they came out of covid
and some of the recovery dollars went away,
they found some people had changed patterns.
So, you know, when you have young kids
and they get sick, you, you want them seen right away,
but sometimes they get better in 72 hours.
Well, during Covid, you actually found that out
because you didn't go, you didn't go take him out.
You just kind of wrote it out sometimes.
So, so some things changed from that perspective.
And then as a parent, maybe I thought, I don't need
to take my kid to the doctor as quickly
as I, as I did in the past.
Right? That's one. All these are little pieces,
but they all impacted their volume.
Uh, people found alternative ways to do it.
They did, they did, uh, virtual televisit,
um, they went to urgent cares or,
or we have a series of these, uh,
pediatric minute clinics we've opened.
So people started going to those.
So they, they didn't go to the pediatrician,
so you had another little piece of the business
that went away, you know, from that perspective.
And then their cost of running their business went way up
because when inflation went high, uh, here 18 months ago,
whenever it was, they had a, you know, an 8% cost
of their labor workforce
and the same labor challenges we have,
but we're a large organization,
we can figure a lot of those things out.
They can't. And so they've, they've had, you know,
they've had a loss of volume and an increase in cost.
And I think, and they,
and they have the same similar challenge like I talked about
before with the workforce, is
that people coming outta medical school don't necessarily
want to go entrepreneurial
and go run their own practice anymore.
They kind of want to go be,
they semi kind of want to just be employed.
They don't want to have to run it,
worry about running their own business.
And so I think these guys have been in it for a long time.
They can't recruit guys
to come in and do what they used to do.
You know, they, they, they have a, it's a different piece.
I think that there's kind of a three,
three three-pronged piece to that is I think there's loss
of volume, there's higher costs,
and I think it's hard for them to find replacement guys
to come in and, and, and it's hard to fund them.
If I got a little bit loss of volume
and higher cost, I don't have as much money to try
to subsidize a new guy coming into my practice.
And so I think all those things put together is really hard,
uh, for them to continue to manage through.
So you seeing more of 'em come to the door
and saying, you know, we've been working,
we've been working with 'em for years.
'cause they largely work with us.
It's just they have been working with us as a independent,
as an independent organization,
but now that they're have a tighter relationship with us,
we can incorporate them into our electronic medical record,
which happens to be epic,
but we can incorporate it in there.
Now all a sudden you've got this full patient record, right?
And so it's really got some great
benefits from that perspective.
- Absolutely. Well, thank you so much for, uh, going through
that with us and going one big deeper.
It is really just helpful and informative.
Um, before we wrap up our conversation here,
we've talked a lot about some
of the ways healthcare is changing, whether it's
through technology, um, obviously a lot of workforce changes
and then certainly, you know, different, um,
patterns from patients as well as what communities want
and, and need from healthcare.
So what do you think the most effective healthcare leaders
will need to be successful over the next
two to three years or so?
- I, I think you get the approach to everything that, um,
so first talk about the broader healthcare leader
and a little bit about the finance guy,
but I think you have to approach it
that the way I did it isn't always the right way going
forward and that we really have to think differently.
And it's hard. It's really,
and I'm not saying you're always stuck in the past,
but it's just hard to make transformative change
and really change what you're doing.
And you really have to think about it.
If workforce is gonna get tighter,
costs are gonna be higher.
It's just, and there's gonna be continued pressure on rates,
uh, in terms of what, how we're paid.
I think you just have to keep, um, you have
to keep constantly looking at
how you transform your business.
And, and as a healthcare leader, she, one of the things we,
we found with some of our, um, healthcare leaders is they,
they think they know what the consumer wants,
but they really need to listen to the consumer.
Like in our world is that, that, that,
because we have this millennial group, you have
to understand what I call 'em,
the Amazon prime generation, right?
Oh, it's 10 o'clock tonight and I need something tomorrow.
So I go online and I order it and I get it right?
That want, they want healthcare the same way and,
and we have to figure out
how we can't deliver the same way Amazon Prime can,
but we have to figure out how to deliver something
that they want and meet them somewhere versus thinking
that we've had people who said,
we had some pediatricians in our community
that thought consumerism was a disease
that was gonna go away.
and I, we can't wait till they come back to come in
and visiting us when we want to be here.
And it's like, well that's, that's, that's not gonna happen.
So as a healthcare leader, you gotta understand like,
what's the consumer, what's going on,
and how do I meet them where they need to be so
that they're, that, that I'm meeting their needs within
obviously a reasonable, uh, um,
cost perspective, et cetera, et cetera.
But I think that that's a big piece on a broad basis.
And as a finance guy, I always say,
you gotta keep your finger on the revenue cycle
because I, I would say I have a,
I have a really good revenue cycle leader.
I have a pretty good revenue cycle.
But you know, we, if we don't stay focused on it,
we wake up one day and we've lost a percent
and a half of our revenue through a variety of things,
the payers aren't looking to pay us more.
And we have to kind of think that
and say they're not looking to pay us more.
So they're always changing subtle things like things.
And if we don't stay on top of it,
it's really easy to lose a percent.
And that's a lot of money. Um, so he is just,
I think the finance guy sometimes it's like, yeah,
revenue cycles kind of ho-hum 'cause of the same thing,
but it doesn't take long to lose a percent or two
or 3% of that,
and all of a sudden that's a big, that's a big margin.
You're not getting paid for what you, what you're doing,
uh, in the organization.
So that's a, that's a big piece.
Um, and I just think that that,
the other thing I'd say on the finance side, you, you, you,
you gotta be like the, you may not be the COO,
but you gotta be like the COO,
you gotta really understand what's going on so you can try
to help make some of those changes.
And a lot of CFOs have gone down that path.
So I'm not trying to say they don't,
but I think that you've gotta always think about the fact
that it's not just financial.
And I always say that sometimes I have
to invest in something to get the return later.
And you gotta really think about that.
You gotta look at long term.
Um, one of the things we've tried really hard
to do is on the finding size, not get, you have
to look at the monthly results,
but you can't just be myopic on the monthly results.
You gotta look long-term and say,
are we going where we need to be going?
And I'm looking at the long-term health of the organization,
not what happened yesterday or today or tomorrow
or next week or this month or whatever.
So I think some of those pieces to say,
how do I look at, look forward?
How do I continue to work on transforming care and my,
and looking at my consumers?
And then just kind of keeping your fingers on
that revenue cycle and making sure that you're constantly,
uh, collecting everything, billing
and collecting, coding, capturing,
whatever you wanna call it, everything you can, I might
as well get paid for everything I do in the organization.
So,
- Yeah.
Yeah, I think all those are such a great point
and definitely interesting, um, from the CFO perspective
as you were talking about how to really get out of having
that myopic finance, uh, focus and really think broadly
and look broadly, think ahead
and, um, look at, you know,
where healthcare is transforming.
And I think it goes back to so much of
what we've talked about already,
whether it's looking at workforce
or where healthcare is taking place inside of the hospital
or outside of the hospital and
technology and all of these things.
Um, I can imagine, you know, having that open mind
and being able to, uh, transition along with healthcare, um,
is not always easy, but definitely, uh, one way that,
you know, you can really, um,
put yourself in the best position
to be successful in the future.
- Yeah. Say, well, the, the, the challenges is, is, uh,
we're all trained in the finance world.
We're trained to our skillset a lot
of times our personalities that we go into that profession,
we're, we're trained and, and kind of formed into.
That's how I think it's harder
to think differently sometimes.
That's is how we're trained to,
and you have to have some of that.
I can't let today get away from me either,
but can't just be focused on today.
I can't worry about how many fts I had today
or whatever the case may be.
I, I do, but I also gotta look ahead
and say, am I moving in the right direction?
Do I have the tools in place, uh,
to help people do their their things?
And maybe one of the last thing I'd say,
because we're still, we'd have no idea how
to figure this out, is the whole AI thing
and even defining what AI means.
Like what, what is ai? Is it machine learning?
Is it truly, is it the chat GPT stuff? Is it broad?
I mean, we're, we're still
trying to get our hands around that.
It's, um, but that's something that I even listed any
of the things we talked about, which that's still out there
as a big thing, but I don't, I couldn't tell you what I,
what I even think about at this point in time.
I think you gotta get your arms around it
and define it first so you can figure out where you're,
where you want to go with it.
- Yeah, definitely. That's such a great point.
So many of these conversations, AI comes up
and, um, you know, definitely, um, in a space
where it's still very much evolving and,
and understanding exactly what, um, that means and,
and what it entails for healthcare and health systems.
So it'll just be interesting, uh,
to see over the next few months here, um, where things go
and, and how, um, health systems can really, uh,
produce some of these, um, great use cases for it
and then, um, continue to evolve.
- Absolutely. - Well, Chris, thank you so much
for joining us on the podcast today.
This has been such a fascinating discussion.
I wish we had two or three more hours here to talk about it,
but, uh, you know, hopefully we'll be able
to catch up again soon and looking forward as well
to have you speaking at our fall events, um,
here in Chicago, our Health IT Digital Health
and Revenue Cycle event, as well as C-E-O-C-F-O Roundtable.
So it'll be great to have you here in person.
- Yeah, I'd like to meet you, Laura, when I,
when I get there.