COVID-19 Critical Challenges Told By Healthcare P2P Staff

Written By: Amanda Geelhoed Papach, Marketing Director at SpendMend

A few weeks ago, SpendMend created a COVID-19 Idea Exchange for Healthcare Finance, Internal Audit, Supply Chain, and Accounts Payable Departments. This Idea Exchange survey requested input about how the COVID-19 pandemic has impacted their work environment and processes. We received many thoughtful responses from healthcare professionals from over 31 major U.S. hospitals. The data gathered was eye-opening, meaningful, and thought provoking.

The pandemic has affected every facet of the healthcare industry, but the answers to one key open-ended question needed to be shared. The question “What are the critical challenges you faced throughout the COVID-19 outbreak?” I have broken the answers down into categories, and hope these responses show that we are in this together and other hospitals are experiencing the same concerns you are.


  1. Staffing Issues

    1. Limited Staff – “We had limited staff so the first thing we did is re-prioritize tasks within the department.  Essential tasks were prioritized highest.  We then set parameters around non-essential tasks and assigned targeted dates.  While we still have a backlog on some of the non-essential tasks – we are functioning at normal level on our essential tasks.”
    2. Furloughed Staff – “Until this past week this was not an issue for us but with the additional financial impact, we are being asked to furlough 20% of our team on a temporary basis.  We have decided rather than to completely shut down for a week or fully furlough an associate we would rotate one staff member each day which provides the same overall financial result yet provides us coverage for our internal customers and vendors.”
  2. Working Remotely

    1. Working from Home – “It took a while for us to get settled in with remote access but once we didwe are functioning at probably 75% of normal.  We froze all our automation projects and our system conversion timeline has been extended due to limited resources all around the hospital.”
    2. Staff Communication – “I would have said our staff communication was average before COVID.  I think we have improved our overall staff communication using video conferencing.   Our meetings are shorter with better participation.  Each participant adds to the agenda and we go around the Zoom room and address all the points.  We document the notes while we are on the call and it’s been a great way to stay connected.”
    3. Motivating Staff – “Working remote really makes this a challenge.  We made an effort to make it personal and gave everyone a chance to comment on what they liked and what they didn’t.  We took the positive responses and incorporated some of those recommendations into our overall process and the ones we were challenged with we discussed various ways to fix the issue.  The team was very open to discuss change and I think motivated them to openly communicate.”
    4. Remote Access – “This has been extremely challenging.  First, we could not get remote access for all the users.  Then we had connectivity issues.  After about 2 weeks of difficulty we were finally able to fully connect to our systems.”  
  3. Exception Processing – “Our non-match invoices created the biggest challenge for us.  Our workflow routes the match exceptions to procurement after AP has performed initial review.  With procurement focused on PPE we started to backlog exceptions.  Procurement and AP worked together to develop new exception limits and prioritized the larger exceptions which procurement agreed to turn within 3 days. Those transactions under the new match exception limit were paid and a variance account established.  We notified our vendors that due to COVID -19 we would be processing transactions and tracking exceptions.  When we get back to full staff, we will reconcile those vendor’s variance starting with the largest supplier balance.” 
  4. Invoice Approval – “Our invoice approval is automated for the most part, but we are finding delays in obtaining approval.  Because of this we have noticed the vendor call activity increasing and duplicate invoices being presented from suppliers.”
  5. Interacting With Suppliers – “At first we found it difficult to reach our normal vendor contacts but over time this improved.  We just tried to prioritize critical tasks and limited our outreach.”
  6. Third Party Invoice – “This was a real challenge.  We outsource certain functions that are performed offshore which was totally shut down.  We had to scramble to get resources in place to cover the gap in our process. One thing is for sure, we are looking at each of our processes to ensure there is a fall back option.”
  7. Pause Projects – “COVID paused all projects we have going on.”

We don’t know how COVID-19 will change healthcare, but we do know that as a healthcare community we must work together to support each other. As critical challenges continue to change and grow – know that you are not alone in your experiences #weareinthistogether.

Healthcare Finance & Accounts Payable Leadership Spotlight: Patty Carrel

Name: Patty Carrel

Area of Expertise: AP, Leadership, People Management, Automation, Process Optimization, Financial Technology Solutions

Patty Carrel has worked for some of the largest and most recognizable brands in healthcare for over 30 years.  In her tenure she has been responsible for accounts payable, payroll, accounting and financial reporting, recovery auditing and much more.  She has managed environments with many locations while overseeing staffs of over 75 people.  At her high-water mark, her teams processed over 170,000 invoices a month which is an enormous volume by any standard.

“It didn’t come easy and it didn’t happen overnight.” Patty assured us with full humility.

To construct a process that could manage such a volume, Patty has had to educate herself over the years and work tirelessly.  As she learned to optimize her process, she then began to place more emphasis and effort on building out her technology and automation.  This has been a specialty of hers for the last several decades.  But more than her accomplishments in process, operations and automation, Patty’s most impressive accomplishment, to date, seems to be her focus and dedication on supporting her team.

I caught up with Patty a couple weeks ago and she was gracious enough to join our spotlight and answer a couple questions

Q: Can you tell me a little about what drives you?  What are you passionate about?

A: I’m passionate about driving continual process improvement.  This has always been important to me. Early on when I drove the first initiative to consolidate accounts payable there were a lot of opportunities.  Eventually we got to a point where we had everything highly automated, but every year we still sit down and come up with quite a few ways to improve efficiency.

Q: In your 30-year career do you think you’ve done it all?

A:  No! There is always something more to do.  When I approach a job function or an internal procedure, I am always committed to finding new efficiencies through process and automation. I am passionate about driving this level of continued improvement.

Q: Can you think of something, a project, that you are most proud of? 

A: Well, actually…  when you ask me the question like that, that probably has nothing to do with process or automation.  I’m happy with the work I’ve done, but I’m most proud of the relationships I build and the teams I have been a part of.  I’m always interested in promoting the perception of accounts payable throughout the larger organization and I always want to make sure all of my teams are fulfilled and happy and that they are proud to come to work.

Q: That’s excellent, I’m sure they appreciate it.  

A: It’s just something that’s always been very important to me, and something I’ve worked a lot on.

Q: Those were all the questions I had Patty.  Thanks for giving us a quick glimpse and for joining our Leadership Spotlight!

A: My pleasure.

The Fear That May Be Holding Some AP Professionals Back

Written By: Jill Ulliman, System Director, Accounts Payable at OhioHealth Corporation

I recently shared a story with a long-time colleague from the Recovery Audit firm, SpendMend, about a session I attended this past year at the annual IOFM conference.  After recounting the story for my friend, he asked me if I would be willing to write a guest blog for their website.  He is in sales and he insisted that my story hit directly on the single biggest obstacle he faces when working with prospects and potential clients.

Here’s what happened…  The Procure-to-Pay session was covering Post-Payment Audit and in an effort to engage a room of about 50 AP professionals, the speaker asked us to raise our hands if we were using a Recovery Audit firm or had experience with post-payment audits.  To my surprise only about 10 hands went up.  The speaker was a little surprised by this too; she quickly followed up with a couple of informal questions trying to understand why the vast majority of the room was avoiding a Recovery Audit.

After a few minutes of lively conversation, an AP manager boldly stated what was on their mind:

“I’m concerned my CFO would think I’m not doing my job if there happens to be a high volume of findings.”

As the others nodded in agreement, it was obvious that the AP professionals in the room had a fear that they might be exposed by the findings of a Recovery Audit, and they worried it could reflect poorly on their team’s quality of work.

My first thought was “WOW!” as I considered all of that lost revenue for their organizations.  I then thought ignoring the issues that could cause overpayments doesn’t make them go away and it certainly doesn’t put preventive measures in place to stop the bleeding.

I’ve engaged various firms in post-payment recovery audits over the years. I admit my ego may have been a bit bruised when I saw the executive summary after that first audit and how easily some of the overpayments seemed to occur.  I wanted to think my department’s processes were bulletproof.  Well guess what? All AP departments are vulnerable (typical recovery audits can yield 1.5% of spend in potential recoveries) and many things are outside our immediate control.  However, based on what we discovered, many things are within our control.   It was my call-to-action to close some process gaps in our operations.

I also have a tendency to be slightly (ok, maybe considerably) competitive.  So I shared the results with my team and put many of the recommendations into place.  I then challenged the team to help ensure that overall recovery findings would be less than the previous year.  Year over year audit findings declined until our organization was less than half in percentage of recoveries based on spend from the 1.5% industry average.

That’s the story our financial leaders want to hear!

I know that the need for post-payment audit recovery can create a certain perception from associates not as familiar with the process and why it is necessary.  I wanted to help dispel some of those beliefs by presenting our experience to our organization’s finance team (about 300 associates) at a recent retreat.

This is how I led into the presentation:

Post-payment audit ensures that terms and conditions of all purchases negotiated with suppliers are captured appropriately. The review provides an independent third-party evaluation of our procurement cycle, validates departmental controls and recaptures lost revenue.

If we do not review supplier payments on a regular basis, we are at risk of not recovering funds owed back to us as well as not having good data to hold suppliers accountable for contract compliance.

Many of those seasoned finance professionals were surprised to learn that ‘payment errors’ represented only 0.022% of our audit sample and the majority of claims were from pricing, rebates, and RTV credits.  Imagine if those claims were never recovered!  We just don’t have direct visibility into those transactions from the AP standpoint.

We have gotten so much value from recovery audits, both financially and operationally, that we decided to step up the timing.  In the past we would engage in audits every 2 to 3 years but the drawback was that we were always working with latent findings and credits that were from previous budget periods.  A solution was presented that performs continuous monitoring of more current activity (beyond 90 days versus 2-3 years) that helps us uncover erroneous payments and unidentified credits in the current budget period.  It also provides the visibility into process issues or supplier behavior that we can react to more timely for prevention.

While I don’t endorse any firm in particular, (much like this blog) I have a high regard for the practice itself.  I make sure I leverage the data from the executive summaries as well as ask the audit firm for industry benchmarking so that we continue our march toward best in class. (Did I mention I’m a tad bit competitive?)

I know many of you feel my pain when I lament that accounts payable tends to get a rap for being the ‘spenders’ and the transactions fall on the spectrum of being non-value add.  Imagine informing your CFO that you can happily bring lost revenue back into the financial statements.  Trust me, he/she won’t think you aren’t doing your job well; instead you may make an impression for identifying opportunities to control expense and leveraging additional process improvements.

Take my advice, get over your fear, and reap the benefits of a Recovery Audit.  You’ll quickly realize you had nothing to fear in the first place and can leverage audit findings to bring value back to your organization.


About the Author

In 33 years at OhioHealth, I have grown with the organization as an agent of change.  During my tenure, I’ve held various Finance positions that led to my current role as accounts payable director.  I have a passion for operational strategy, and I have led my team through Lean transformation with dramatic results.  I strongly believe in developing and empowering my associates so they can be experts at problem-solving and efficiency