What a VP of Clinical Efficiency Needs HR to Understand

Featuring Katie Abebe, Vice President of Clinical Efficiency, Upstream Rehabilitation

If you have ever wondered what it feels like to run clinical operations across 800 clinics in 25 states — and what that VP actually needs from HR to make it work — this is the episode. Katie Abebe took an unconventional path from construction to community college to a doctorate in physical therapy from Chatham University, and now builds systems for clinical quality and efficiency at one of the top five largest outpatient rehab providers in the country.

⚙️ What Clinical Efficiency Actually Means Clinical efficiency is not just operational throughput. It is eliminating waste, aligning what payers require with what is best for the patient, and delivering high-quality care within insurance-constrained reimbursement models where margins are already thin. One missed clinician can eliminate an entire week's margin at a single clinic. The math is not forgiving.

🧑‍⚕️ What HR Can Do for a Clinical Workforce Right Now Katie's direct answer: flexibility and compensation. Clinical staff carry a unique burden — when they cannot show up, real patients go without care and real revenue disappears. Systems that have built flex clinician pools are absorbing that risk. For PT specifically, reimbursement has not kept pace with inflation, meaning highly credentialed clinicians are often financially stressed. Performance-based earning opportunities — not just productivity bonuses — are a meaningful retention lever.

🤖 AI in the PT Space: The Promise and the Guardrails Upstream is already using AI to reduce documentation burden — the number one reason Katie says she left the clinic. On the horizon: AI-assisted triage at the front of the funnel, helping route patients to providers most likely to deliver results. But Katie draws a clear line. AI for notes and scheduling? Embrace it. AI making the final clinical call without a human in the lead? Not yet.

🔎 The HR Takeaway Build the flex pool. Create performance-based earning paths. And when a clinician's attendance pattern shifts, don't go straight to corrective action — go to the conversation. It is almost never a work problem.

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HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

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April 27th, 2026. Three policy hits in the same week, all with direct workforce consequences. Bo, Luke, and ASHHRA Executive Director Jeremy Sadlier break down what HR leaders need to do before July 1st.

💉 RFK Jr. Defends $15.8B in HHS Cuts — His Own Word: Painful After seven congressional hearings, HHS Secretary Kennedy called the FY27 cuts painful and acknowledged his department does not want them: $5B in NIH funding, elimination of the National Institute on Minority Health, $923M in HIV/AIDS reductions, and deep cuts to the Agency for Healthcare Research and Quality. Bipartisan pushback was visible — Republican Senator Tom Tillis called the NIH cuts handing China our lunch. These are not Washington cuts. They flow directly to hospitals, universities, and health systems. Action: Identify every federal grant, research partnership, and workforce development program your organization depends on through NIH, HRSA, or HHS. Build that list this week. Contingency planning starts now, before FY27 makes the cuts real.

🩺 Nursing Was Excluded From the Definition of a Profession Effective July 1st, graduate nursing students lose access to $50,000/year in federal loans — capped instead at $20,500 — because nursing was excluded from the Department of Education's professional degree definition. Law, medicine, and dentistry made the list. Nursing, PT, OT, PA, and social work did not. 59% of nurses say they are now less likely to pursue a graduate degree. Action: Audit your advanced practice nursing vacancies. Evaluate whether your tuition assistance and loan repayment programs can close the new gap. Connect with academic partners now before fall enrollment is affected.

📋 Medicaid Work Requirements: 80 Hours a Month, Starting Late 2026 HR1 Medicaid work requirements are becoming operational — 80 hours per month of documented work, school, or community service or enrollees lose coverage. 65% of Medicaid recipients already work. Those most at risk are the low-wage frontline workers staffing your EVS, food service, PCA, and security roles. Action: Map your lowest-wage workforce against Medicaid thresholds in your state. Brief your CHRO on your exposure before a coverage gap destabilizes the frontline workforce you cannot afford to lose.

Every story this week lands on HR's desk. High five to every practitioner still standing.

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HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

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Featuring Ricky Price, Founder, Game Ready Skills & Development | McDonald's All-American | Duke University | NBA Veteran

Healthcare HR professionals spend their days building cultures where people can do their best work under extraordinary pressure. Ricky Price has lived that challenge at the highest level — growing up in Compton, earning a spot under Coach K at Duke, competing professionally for nearly a decade in the NBA, and now translating every lesson from that journey into leadership development for organizations that refuse to settle for average.

This one hits different.

🏀 Visualize First, Then Do the Work Ricky's number one pillar: visualize and imagine your success before it happens. He visualized game-winning shots, big-time college basketball, and a professional career — and when those moments arrived, they felt like deja vu. For healthcare leaders, the application is direct: if you cannot see where your team is going, you cannot build the culture to get there.

⏭️ The Next Play Mentality Coach K's most transferable lesson: when you make a mistake, you cannot wallow in it. Get to the next play. For clinicians who carry the weight of high-stakes errors, this is not a dismissal of accountability — it is the framework that makes continued high performance possible. The leaders who model this give their teams permission to recover and keep moving.

🏆 Assign Roles. Build the Team. When Ricky arrived at Duke, every player was the number one recruit in their state. Coach K's solution: assign clear roles and hold everyone accountable to theirs. High-performing healthcare teams fail the same way athletic teams do — when stars refuse to subordinate individual brilliance to collective purpose. Role clarity is not a limitation. It is the architecture of a championship culture.

🎉 Celebrate Your Wins — Strategically The goal is not the only moment worth celebrating. Daily discipline, weekly consistency, small process wins — these compound. Teams that only celebrate outcomes miss the habits that produce them.

📖 Resource Celebrate Your Wins by Ricky Price (Foreword by Coach K): https://amzn.to/4mCr874 Connect with Ricky: https://www.linkedin.com/in/ricky-price-1a242438

You do not need a wicked jump shot. You need the mindset behind it.

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HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

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Hospital M&A Hits a 6-Year High, a 42,000-Worker Strike Looms & a Rural Hospital Has 56 Days

April 20th, 2026. More than 1,000 hospital leaders are in Washington, DC for the AHA Annual Meeting. The urgency they are carrying into that building has never been higher. Bo, Luke, and ASHHRA Executive Director Jeremy Sadlier break down three stories hitting simultaneously.

📉 Hospital M&A Is Back — But It's a Survival Story Kaufman Hall's Q1 2026 report: 22 hospital transactions, highest Q1 total since 2020, $14.5B in transacted revenue. The marquee deal is Sutter Health's proposed acquisition of Allina Health, creating a $26B nonprofit spanning 39 hospitals. But 68% of Q1 deals were divestitures — systems shedding underperforming assets before distress makes them less attractive. HR 1 Medicaid cuts are explicitly driving independent hospitals to seek partners now. Action: Share the Kaufman Hall Q1 report with your CHRO. Know where your organization sits on the risk-to-resilient spectrum. Build your M&A integration playbook if one doesn't exist. If your board is in partnership discussions, HR should already be at the table.

🏠 UC's 42,000-Worker Strike Is About Housing, Not Wages Local 3299 representing 42,000 UC service and patient care technical workers announced an open-ended strike beginning May 14th. The central grievance: UC refused to bargain over housing aid and unilaterally imposed higher health premium rates during negotiations. Workers are being priced out of the communities they serve — many commuting two hours each way. This is not a California story. The affordability gap exists in every major market. Action: Assess your own affordability exposure. What your lowest-paid workers spend just to get to work is a labor risk hiding in plain sight.

🏚️ A Mississippi Rural Hospital Has 56 Days A rural Mississippi hospital announced possible closure by June 15th after laying off 86 employees and eliminating service lines. The driver: a Medicaid clawback — $2.5M already recouped, another $5M in dispute. This hospital is not one option for its community. It is the only option. And it is not alone. Action: If you operate or support rural or critical access facilities, conduct a billing documentation audit now — not after a clawback notice arrives.

When the whole system is under pressure simultaneously, HR leaders already at the table make the difference.

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HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

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90% of Healthcare Organizations Missed Their Hiring Goals Last Year. Here's Why.

Featuring Casey Marquette, Founder & CEO, Covenant HR, which is an active member of the ASHHRA Preferred Partner Program (AP3).

Hundreds of open reqs. Inboxes flooded with applicants. And somehow nine out of ten healthcare organizations still missed their hiring targets last year. Casey Marquette, founder of Covenant HR and creator of the AI recruiting platform Scout, joins Bo and Luke to talk about why the problem isn't the talent pool — and what an AI-native solution actually looks like in practice.

⚡ Scout: From Application to Interview in Under Five Minutes Scout evaluates a candidate in 2.2 seconds and sends an interview invitation in under five minutes if they score high enough. All 500 applicants for a role are considered — not just the 50 a recruiter had time to open. The video interview format pressure-tests candidates technically, catches identity fraud, and eliminates the ghosting problem that has plagued candidates for years. Covenant's recruiters went from working 8 requisitions at a time to 20 — with better results and more time for the human conversations that matter.

🔐 Fraud Is Already Here — and Getting Worse 20% of Scout's candidates are currently flagged as suspicious. Gartner projects that by 2028, one in four candidates will be fraudulent. Casey's background in cybersecurity shaped Scout's architecture: video interviews, ID verification, and tab-tracking all work together to surface the candidates who won't engage with the platform because they know their resume won't hold up under questioning.

🤖 What a Bad AI Implementation Looks Like Not all AI recruiting tools are equal. Bolted-on AI from legacy platforms performs differently than purpose-built solutions. When evaluating vendors, ask to see the live environment — not a demo video. Ask how performance is measured at scale. And look for end-to-end solutions that reduce steps rather than add them.

🔎 The HR Takeaway AI is not going to eliminate the need for great recruiters. It is going to separate the ones who use it from the ones who don't. The organizations that put these tools in their people's hands — and hold them accountable for using them — will outperform those still running a 2026 problem on a 2010 playbook.

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Elevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital’s own pharmacies. Discover smarter strategies with RxBenefits.

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HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

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Luke Carignan and ASHHRA Executive Director Jeremy Sadlier take a deliberate step back from the doom and gloom to look at what is actually working in healthcare HR right now — and the data is genuinely encouraging.

🩺 Ambient AI Is Ending Pajama Time A randomized controlled trial published in the New England Journal of Medicine confirms what many have suspected: ambient AI scribe software that passively listens to patient visits and auto-drafts clinical notes is producing a highly significant decrease in work exhaustion. Clinicians are saving hours per week. Notes are grading out more thorough and accurate than manually entered ones. This is not a vendor claim — it is peer-reviewed evidence from one of the most trusted sources in medicine. Action: Pull the NEJM data and send it to your CMO this week. Frame ambient scribing not as a cost play but as your 2026 burnout and retention strategy. Software is cheaper than replacing a burned-out physician.

📱 Internal Gig Scheduling Is Collapsing Nursing Turnover The AHA's 2026 Healthcare Workforce Scan shows voluntary turnover is actively dropping at systems that have embraced mobile scheduling — letting nurses bid on shifts, swap days, and control their hours from their phones. Reliance on expensive last-minute incentive pay has dropped by millions at early adopters. Flexibility also reduces corrective action and intermittent FMLA dependency. Action: Ask your CNO what percentage of nursing staff currently self-schedule via mobile app. If the answer is zero, make it your Q3 HR tech priority.

🌱 The Apprenticeship Boom Is Building Pipelines From Within Health systems are no longer waiting for the market to solve their clinical pipeline problem. By fully funding zero-out-of-pocket apprenticeships for EVS staff, patient transporters, and admin assistants, organizations are graduating their own CNAs, MAs, and sterile processing techs. ASHHRA's apprenticeship program, built in partnership with Dallas College, is available nationally at low cost and is ready to implement. Action: Audit your tuition reimbursement data. If it is mostly benefiting management, flip a portion of those funds toward entry-level apprenticeships. Visit ashhra.org to access the Dallas College program — the wheel has already been built.

The organizations healing fastest are the ones investing in their people before the crisis forces it.

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Elevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital’s own pharmacies. Discover smarter strategies with RxBenefits.

Learn More here - https://rxbene.fit/3ZaurZN

HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

HealthCare Associates Credit Union — a healthier benefit for healthcare HR leaders and their teams.

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When the Real Problem Is Identity, Not Skill

Featuring Dr. Marcia Reynolds, Master Certified Coach, Former Global President, International Coaching Federation

What if the leader on your team who keeps struggling isn't missing a skill — they're missing a clear sense of who they are becoming? And what if the most powerful thing you could offer your workforce right now isn't another wellness app, but a thinking partner who helps them see themselves differently?

Dr. Marcia Reynolds brings 30 years of neuroscience-informed coaching practice and a perspective shaped by working in 47 countries to one of the most underutilized conversations in healthcare HR: the transformative difference between coaching and mentoring, and what it costs organizations that confuse the two.

🧠 How Coaching Actually Changes Behavior Coaching works differently than training because it triggers genuine discovery. When someone sees something new about themselves — not because they were told, but because they arrived there — the brain literally encodes the change differently. Dr. Reynolds calls this identity-level coaching: helping people move toward who they are becoming, not just what they need to do. Behavior follows identity. That is the sequence leaders keep getting backwards.

🔄 Coaching vs. Mentoring — Know the Difference Mentors navigate the organization. Coaches belong to the person, not the company. The most effective leadership development programs use both — internal mentors for organizational context, external coaches for the conversations people will not have with anyone inside. If your organization calls mentoring coaching, you are getting half the result.

🏥 The Healthcare Application Middle managers in healthcare are carrying 80–200 direct reports in some systems. The answer is not more performance reviews. It is identifying the 10% who want to lead, developing them without needing a title or a promotion, and delegating meaningful work to them. That is how you multiply your capacity and build loyalty simultaneously — and it costs far less than hiring new leaders.

📖 Resource Coach the Person, Not the Problem by Dr. Marcia Reynolds: https://amzn.to/3Q3FFwq

Your organization's leadership pipeline is only as strong as the identity your current leaders are building in the people behind them.

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Elevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital’s own pharmacies. Discover smarter strategies with RxBenefits.

Learn More here - https://rxbene.fit/3ZaurZN

HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

HealthCare Associates Credit Union — a healthier benefit for healthcare HR leaders and their teams.

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April 6th, 2026. Three separate policy shocks, all landing at the same time. Bo, Luke, and ASHHRA Executive Director Jeremy Sadlier break down what may be the most consequential week of news healthcare HR has faced all year.

🏥 446 Hospitals at High Risk of Closure A Public Citizen analysis of CMS data identified 446 hospitals at high risk of closing or cutting services due to roughly $1 trillion in Medicaid cuts under HR 1. Criteria: at least 20% Medicaid revenue and currently operating at a loss. Trinity Health has already cut 10.5% of its billing staff. St. Mary's Sacred Heart in Georgia has closed its maternity unit. The deepest HR 1 cuts don't land until 2027 and 2028 — making 446 the floor, not the ceiling. Action: Pull your Medicaid revenue percentage. If you're at or above 20% with thin margins, model workforce implications of 10%, 20%, and 30% revenue reductions and bring that to your CFO this week.

🩺 The $100,000 Visa Fee Is Hollowing Your Physician Pipeline The AHA surveyed more than 1,000 health systems on the new $100,000 H-1B visa petition fee — up from $3,500. 64% of hospitals have already paused or limited recruitment. More than 70% expect direct patient care impact. 57% of H-1B roles in healthcare are clinical. Pain is sharpest in rural and underserved markets where foreign-trained physicians fill gaps domestic pipelines cannot reach. Action: Audit your H-1B-dependent clinical roles by specialty and geography. For each, identify your contingency — J-1 waiver programs, GME partnerships, rural scholarships, grow-your-own pipelines. Lawsuits are pending. The pipeline gap is not waiting.

📦 Tariffs Hit the Supply Chain — Hospitals Can't Pass the Cost Along A 10% baseline tariff took effect April 5th. China supplies 94% of US hospital plastic gloves, most N95s, and the majority of anesthesia instruments. 82% of healthcare experts expect costs to spike 15% within six months. Medicare and Medicaid reimbursement is fixed. Hospitals at 3-4% margins have no room. Action: Meet with your CFO and supply chain leadership. Know your tariff exposure by category. Model what a one- and two-point margin compression does to your workforce budget before Q3 forces that conversation.

When revenue is cut, the physician pipeline narrows, and supply costs spike simultaneously — HR leaders not at the table will find out about the decisions in a memo.

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Elevate your employee benefits while managing costs. Did you know hospital employees fill 25% more prescriptions annually than other industries? Ensure cost-effective, high-quality pharmacy plans by leveraging your hospital’s own pharmacies. Discover smarter strategies with RxBenefits.

Learn More here - https://rxbene.fit/3ZaurZN

HealthCare Associates Credit Union partners with healthcare organizations to offer a no-cost financial wellness benefit for employees. Built specifically for healthcare professionals, HACU provides everyday banking, loans, mortgages, and financial education - all with no added administrative burden for HR teams.

Learn more at HACU's Human Resource Benefit or email directly at busdev@hacu.org and we are happy to take you through the process whether it's opening a membership for yourself or bringing us on as your employee benefits partner.

HealthCare Associates Credit Union — a healthier benefit for healthcare HR leaders and their teams.

Support the show