The Succession Gap: Protecting Revenue and Services in an Aging Medical Staff

Across rural America, a significant portion of the medical staff is nearing retirement. But replacing a 30-year veteran orthopedic surgeon, or primary care physician, is not a simple 1:1 financial swap. The clinical relationships, referral patterns, productivity levels, and service line contributions built over decades create revenue structures that are difficult to replicate overnight.

This session will examine the implications of the rural retirement cliff using state and congressional district data to illustrate the scope of the challenge. More importantly, it will shift succession planning from a reactive recruitment exercise to a proactive revenue protection strategy.

Kevin DeRonde, CEO of Mahaska Health, will share how his organization developed and implemented a 10-year provider strategy to anticipate retirement risk, preserve key service lines, and align recruitment with long-term financial sustainability. Attendees will hear how succession planning, implementing a healthy physician led culture, along with hosting medical students can be integrated into strategic planning, capital allocation, and board governance discussions.

Participants will leave with a practical framework for forecasting provider-driven revenue gaps, identifying high-risk service lines, and building a long-term provider development strategy tailored to rural realities.

By the end of this session, participants will be able to:

  • Understand the financial and service line impact of impending provider retirements using demographic and market data.
  • Develop a multi-year provider strategy that aligns recruitment, retention, and service line planning with long-term revenue protection.
  • Engage boards, medical staff leaders, and administration in proactive succession planning as a financial governance priority, not just a recruitment initiative.
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Q&A

How do people stay on top of all the payer newsletters to sort through everything to pull out applicable information for the facility/provider? Who typically is going through the newsletter to gather the information to share with other staff?

Our billing specialists are organized by payer, allowing them to develop deep expertise in their respective areas. Each specialist subscribes to their payer’s newsletters to stay informed about updates and changes. Additionally, our team leads, Supervisor, and Director of Patient Accounts—along with the Prior Authorization Team—collaborate to share key insights and ensure the entire team stays up to date. This collective approach enhances our ability to navigate payer policies efficiently and provide the best possible service. 

What leadership structure do you have in place for your revenue cycle and who or what do you use for training when billers or coders need it? Especially for new service lines or common denials?

Our billing specialists are supported by a structured leadership team, including two team leads, one Supervisor, and one Director. Training for billing specialists is conducted by our Supervisor and team leads to ensure consistency and expertise. Additionally, billing specialists meet weekly with leadership to review denials and identify payer-specific trends. For new coders, who are required to be certified, training is led by our Coding Lead to maintain high standards of accuracy and compliance.

Are the billers assigned based on an alphabetical split or by insurance type, such as Medicare and Medicaid specialists?

Billers are first assigned by insurance type and then further divided by alphabetical split. Since each insurance type has multiple billers, the alpha split helps distribute the workload efficiently.

Since we have union employees, how could we implement a similar incentive to Kindal’s while ensuring compliance with union regulations?

This would depend on the specifics of your union contract. Stroudwater can work with you to review the contract and develop a compliant incentive model.

Does your Coding/HIM department manage CPT coding, modifiers, and ICD-10, or do they focus solely on ICD-10?

Our Coding team handles all aspects of coding, including CPT, modifiers, and ICD-10. They thoroughly review all provider documentation to ensure accuracy and compliance.