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This is Alan Condon back with the Becker's
CFO
and revenue cycle podcast,
And I'm thrilled to be joined today by
Kevin Baron, deputy vice president of payer relations
at University
Health in San Antonio, Texas.
Kevin, a pleasure to have you make your
debut appearance with us on the Becker's podcast.
For those of our listeners who mightn't be
as well acquainted with the work it is
that you do at University Health, do you
mind just, opening it up a little bit
and kind of share a little bit more
about your background at the at the health
system?
Sure.
My role is deputy vice president for payer
relations. So essentially, I'm responsible for all of
our managed care contracting,
on behalf of the health system facilities and
our about 800 member,
provider group.
I've been here for about nine years or
so. Been doing this one way or another
for probably, I hate to say it, over
thirty years,
and got started many years ago back in,
in New Orleans,
out of college working for a hospital there
doing number crunching, and,
it's led to where I am now. And
San Antonio is a great place. University Health
is is probably the most mission driven place
I've ever worked. So I'm happy to be
here and and happy to be on the
show.
Fantastic. So born in thirty years in the
health care finance, like you said, from number
crunching at a a hospital in the New
Orleans area and now to deputy vice president
of payer relations at University Health.
No doubt you've seen a lot of movement,
a lot of change, a lot of evolutions
in that time. But
what are you focusing on at the moment
in your current role? Certainly a lot happening,
at any one point in time. But what
are the two or three kinda key trends
that you're paying closest attention to today in
health care?
Well, the biggest one I guess is that
we've seen a lot of changes over the
years and it seems to be getting a
little bit more challenging to deal with our
payer partners.
They're much more aggressive on denials and their
work. And what, you know, has been known
to the industry is, terminate the contract or
contract,
by termination.
We've seen that happening in other parts of
Texas.
Thankfully, we haven't been there, but,
the whole environment is is much more difficult.
I kinda say that providers need to know
when to hold them and know when to
fold them, to quote the, the gambler,
because you just never know.
What we are as a governmental health system,
we're the Bexar County Hospital District, and,
we have one of the busiest ERs in
the state.
We're,
about we're staffing probably a little over 700
beds right now. We're about to open, within
the next year or so, two new hospitals
as well in the community.
There's a lot of things that we wanna
make sure that the community has access to.
And to me, what drives me generally is
making sure that people that need the care,
have access to the care regardless of their
ability to pay,
and regardless of, you know, of where they
are in our community. We try to bring
things to them.
So the whole payer situation is is challenging.
There's a lot of delay.
There's a lot of changes in staffing,
turnover, and contracting folks. At least we're seeing
that in Texas, and that makes it difficult
to build relationships, which is what it's all
about and what we do. So I guess
the second one is probably,
where we're going with rev cycle.
We're working actually right now with AI. We're
trying to get a system in that's gonna
help us with redlining documents, tracking contracts,
managing the the contents of them when we
need to do polls for specific information on
performance or anything else.
And then, I guess the
the piece of that that goes along with
the digitization
is the fact that,
we're part of the revenue cycle. We're the
way I put it is we're kind of
embedded.
When I started here years ago, we had
a news chief revenue officer who's still my
direct supervisor a while ago, and he's he's
fantastic.
His vision was to make sure that contracting
was smack in the middle of everything the
revenue cycle
cycle does. So I've grown quite a bit
even though I've been in this game for
a while. The last nine years or so,
I've grown a lot. I've learned a lot,
mostly due to his kind of mentorship and
the folks that I work with across the
rev cycle. So
that's something that I'm working on. We're still
trying to get a few new opportunities like
education set up, implementation of contracts to be
better.
And I guess the last thing is one
that we hear about a lot on the
clinical side, but I'll bring it up here,
And that's just making sure we have the
right people in the right jobs,
they call workforce sustainability.
My end of it,
is that we have a good bit of
turnover in some of the entry level positions
in the revenue cycle, and that's kind of
a challenge like patient access.
But if you give them opportunities and training
and all, I think that helps. When you
look different to more of the technical jobs,
we have three folks who are certified with
EPIC as contract analysts and that can build
our contracts in EPIC. They work in our
department instead of IT at this point,
and I love it because it helps us
translate what we negotiate into contracts in the
system a lot more quickly
and more accurately.
But keeping someone who's Epic certified, as folks
out there may know, is is not easy.
They're in high demand,
and they're very talented people. So, you know,
keeping making sure that we've got the right
folks,
in the right positions and can hold on
to them,
is a priority for me. So I guess
those would be the the big ones.
Yeah. No.
Great kind of bird's eye view with some
of those key trends, some of the things
that you're focusing on at university health. I
heard quite similar from other revenue cycle leaders
that are CFOs and other health systems across
the country in recent conversations.
But to kinda pick up on
the first trend that you'd that you'd noted,
Kevin, in terms of, you know, the health
systems taking a bit more of an aggressive
stance, to fight back on the equally or
probably a little bit more aggressive stance that
a lot of the commercial payers have have
talked in recent quarters, recent years when it
comes to no secret to you or myself
or any of our listeners here, but the
the alarming rate of denials,
slow payments, prioritization
burdens.
Granted, there there's no silver bullet to these
epidemic of challenges here on the payer side.
But is there one or two things that
University Health is doing or has done to
fight back against denials, fight for those dollars,
maybe see a little bit more success in
terms of protecting your financial performance?
Well, I don't know that any of these
are really, super innovative apart from the fact
that our our contracting team that I, I
manage
is part of the rev cycle directly.
But in terms of just the operational side,
we've built within the managed care team, that
may be a little different, but we built
within our team a contract performance audit function.
So we have, three positions there. We have
a senior manager who's over that and then
two contract auditors and essentially what they do
is go through all of the trends and
payment issues,
make sure that they're identified, that we get
the scope and depth as we say of
what the problems are,
get those to the payers and try to
fix them.
That's something that, you know, happens a lot
of times in the business offices of different
health systems.
We've pulled some of that over on our
end to help with what the business office
has to manage because they have a lot
to say grace over.
But on our end, it's been successful.
One of the specific programs that we have
with them is that we pull everything that's
a high dollar claim. At a certain time,
it hits one of our epic work queues,
and they go through and do that.
Over the last
I think it was last fiscal year when
we did the report, we were able to
assist in collecting an additional $12,000,000,
on high dollar claims. And, basically, every claim
that we were able to assist the business
office with,
we're able to collect about another $150,000
on those services. So we we focus on
the high dollar ones. We look at when
they hit a certain age in the AR
where we know that it's gonna be hard
to collect.
Our opportunity to do that, you know, maybe
has passed a bit. But we go back
at them hard and we try to go
to the payers themselves,
and explain what's going on with the claim,
make sure that they have the records they
need. Records they need. All the rest of
that stuff, we kinda do from our team
as well
as, you know, it gets done in the
business office for other times.
But working on that, I think, has been
very helpful. Just being part of the rev
cycle generally, as I said, is helpful because,
I meet with our business office folks, our
reimbursement folks, our revenue integrity folks, and our
CRO every Friday morning. We have an AR
meeting,
and having the contracting folks in the AR
meeting, at least from what I've seen, is
not not always common,
but it helps.
It gives me an opportunity to hear where
the pain points are,
try to follow-up immediately,
when I'm sitting there, with whoever I need
to at the payers to try to address
a problem or get something kicked off anyway.
So a few of those things. I guess
the most recent thing that we started and
we've hired a dedicated manager for this,
and that's to we were building a contract
implementation
process.
You know, every time you do a contract,
it seems like, you know, it takes forever.
Like we talked about, it's challenging now more
than ever. But once you have the contract
done, sometimes, at least in my career years
ago, we would just move on. We'd send
a copy of it to legal. We send
it to the business office and whoever else
needed it.
Then we go on to the next negotiation.
We haven't done that in a very long
time where I am now, but what we're
trying to do is really focus on it.
So the goal is to build,
what we call our packed program,
and it's essentially just
making sure that we have the right education
for the revenue cycle teams, identifying where the
the knowledge gaps are, the access gaps,
to portals and that kind of thing,
getting the payers on-site or through some type
of, teams or Webex or something to do
in services for the staff and the leaders
of the revenue cycle.
We've, we've had good success with it. We've
only done a couple so far because it's
pretty new,
but I'm excited about what it's gonna bring.
And that person that's managing that is also
gonna manage our our joint operating committee meetings
or JOCs with our payers.
So we're gonna make sure that we're bird
dogging whatever is out there that needs to
be followed up on.
And the person we have in it is,
is a new grad, undergrad,
but she is really excited about the job,
and, she's helped us build it when she
was with us as an intern.
So that's one of my pet projects,
and I'm I'm excited about it because I
think it's gonna help us do things we
haven't been able to in the past,
by just making sure that the contracts get
rolled out appropriately.
Yeah. Yeah. And that's maybe so you might
be able to expand on that maybe just
one bit more. But but one, one quick
follow-up, Kevin. You'd mentioned the the the high
dollar the high dollar claims that you'd mentioned.
Are they are they,
higher acuity procedures
or longer inpatient stays in the hospital
or spine orthopedic surgeries, cardiology. What what what
specifically are those high dollar claims that you're
referring to?
Well, they could be pretty much anything.
We're the only the region's only level one
trauma center for adults and peds.
We're the level four NICU.
We're the only level four maternity care center,
and we also do solid organ transplants.
So it could be a lot of different
things.
The way we have it set up right
now, is that we have a specific work
queue in Epic,
where the claims will hit that if they're
in the AR for over seven months, which,
you know, you could arguably say it's gonna
be hard to collect after that.
They hit seven months and they have a
balance of 50,000 or more. So even if
we've gotten some version of payment, if we're
not adequately paid the way we think we
should be through our epic calculations,
it hits the queue and we follow-up on
So it's a partnership between us and the
billing team. We make sure that we do
everything we can to help when they get
that old. And a lot of times, it's
nothing to do with, you know, a lack
of collections effort on the billing team's part.
It comes down to either payer response,
turnover with the folks on the payer side.
We've seen that a lot,
or just getting to the right person at
the payer to pay attention.
We've had some issues recently. I won't say
who it was with,
but we had a payer,
that we sent 2,000 pages of records to,
for a given one single claim.
They couldn't locate them. They wanted them hard
copy. We sent them hard copy certified, and
they couldn't find them.
And when we tried it again, they still
couldn't find them. So we essentially I just
reached out to the person and said, look.
We got an issue here with a potential
HIPAA violation because these records are out there
someplace, guys. Help us with this.
So I just got on the phone, talked
to him. We also sent him an email,
documenting this. And lo and behold, they found
the records within, like, three days,
and the claim got paid. So, you know,
you just you gotta be aggressive, but you
gotta be nice about it. You gotta find
new angles.
And the high dollar process has led us
to learn a lot about, you know, what
payers sometimes do as well as what we
may not do so great ourselves. It it's
not always a payer problem. Sometimes it's something
to do with our own processes, and we
we try to feed that back to the
rep cycle folks as well where we can.
Yeah. I mean, I certainly don't envy about
trying to strike that balance in that scenario
of being aggressive in terms of chasing down
those high dollar claims, but also in some
way, shape, or form, trying to be nice
about it. Must be challenging. But,
Kevin, that that's a lot of the challenges
we talked about there. You talked about one
or two things you're quite excited about now.
But maybe, if you could elaborate, what what
are you most excited about, when you think
about the future of university health, the future
rev cycle? What what kinda comes to mind
for you?
I think the the piece that I wouldn't
have had in as to perspective many years
ago before coming here and and working with
the wall,
is the fact that we are, you know,
part of the rev cycle. The fact that
we get to see it from a lot
of different angles.
Literally every place I've ever worked, I've worked
in five states, had the privilege to work
for a lot of governmental not for profit
health systems,
and I've never had that vantage point before.
It's created some challenges for me. It's created
some growth opportunities for me, some frustrations. But,
what it's allowed me to do is to
see how what we do in contracting and
payer relations really matters,
how it connects directly to the patients that
we're trying to see, especially
as the type of organization we are.
We try to reach patients, as I said,
wherever they may be and regardless of their
financial situation.
I have personally, I have my wife and
I have a daughter
with special needs who's had a lot of
challenges when she was born. She was born
very early, so I also have a personal
perspective of seeing how challenging it can be
to get the care you need, especially for
a child or even an, you know, an
adult with different types of disabilities.
And I want this place,
I want university health as good as it
is and as mission driven as it is
to be here fifty years from now. I
I want them to be here for my
daughter when I'm not.
So there needs to be organizations like ours
that care about the mission,
and the mission to me is always forefront.
We talk about it in our team all
the time,
because it's it's rare that when you're in
rev cycle, you you have an opportunity to
see how what you do affects a given
patient.
But we had an example recently that, our
director of managed care analytics did.
We had a
outreach from our pharmacy folks who said we
had a patient,
that was really in need of a certain
drug. There was a problem in terms of
coverage.
What could we do to set up a
single case agreement?
And
we did, essentially. It took a little bit
of doing, but, between him and our, senior
coordinator, the person that handles all of our
single case agreements,
they got together. They found a way to
make it work. They found a way to
make sure we got our cost coverage that
we needed to, and put it in place.
And through that, the two of them got
to know who this patient was, what their
circumstances were, how what they did actually mattered,
directly to that patient. Because the patient was
in house at the time,
it really it really hits home. I had
a similar situation years ago with a pediatric
patient with cancer,
and was working with his father to make
sure that because they were out of network,
they were still able to come to our
service, to come get service at our facility.
And it was extremely rewarding. That little boy
was actually put on, one of our, health
system commercials years ago,
as a success story, and I can't tell
you how good that made me feel. So
I think, you know, what I'm excited about
is making sure that we somehow get the
rubber, onto the road. The rev cycle does
what it's supposed to do. It's efficient as
it can be. We work together as a
team.
And before it's all said and done, the
patients out there, you know, they don't need
to worry about all the back end stuff.
Stuff. They just get the care they need,
and we can move on.
So I I can ramble about this stuff
forever, but that's, that's what gets me excited.
Now the the day to day,
of the work that we do, I love
also. I'm a bit of a nerd in
a lot of ways.
But the big picture, I guess, it's it's,
you know, affecting the community that we have
out there and meeting the needs that they
have.
Yeah. Well well, I love those specific examples
of those those patients and how rewarding it
is for for you and the rev cycle
team. No doubt your care team, your hospital
health system being able to take care of
patients in similar troubling challenging situations like that
as well.
I guess one one last question on that
before we move on to our last question,
Kevin, because it's something that no doubt a
lot of,
hospitals, nonprofit systems really struggling with grappling with
today. That's something you brought up in terms
of that mission versus margin.
How do you how does your executive team
try to strike that balance in today's complex
challenge and landscape, particularly when we see
the financial challenges that so many hospitals are
up against? I believe 43%,
a little under of hospital still operating in
the red.
Academic systems, nonprofit systems, obviously, I'd love to
kinda hear how you strike that balance because
it is so challenging,
arguably more challenging than it ever has been
in today, I imagine.
It is. It definitely
is. And, for any of our executive team
that's listening, I love what I do, and
it's really hard.
And I'm gonna keep doing the best I
can. Yeah. But no. I just I I
love it. And I think, our organization when
I got here, you know, nine plus years
ago, we had probably about 25%
of our business was commercial,
which is not in the you know, it's
not insignificant
for, a county owned facility
that had, you know, a fourth of our
businesses uninsured
because we're in Texas. They didn't expand Medicaid
way back when. So we still have a
decently,
large uninsured population in Texas.
We had about a fourth of our business
then was Medicare, and about a fourth of
it was Medicaid.
Where we are today, we're closer to a
third commercial.
So that big pickup in commercial business, I
like to think, is because, you know, the
market shifted a bit.
The exchange products are out there. We count
them as as commercial.
And at the same time, I like to
think that the contracting that we've done has
increased access to what we do.
Our reputation
has grown quite a bit. We've got a
beautiful facility. It is it's unbelievable.
We just opened the women's and children's hospital.
Like I said, we're opening two new facilities
in the next year or so. We're expanding
our our medical group, like, leaps and bounds.
It's hard to even stay up with what
they're doing nowadays.
But the fact that we're a little different
that way from most governmental,
you know, academic medical centers, I think helps.
We we picked up a lot of at
least in my opinion, I'm not gonna say
this is an official opinion, but in mine,
I think we picked up a lot of
community support through the whole pandemic.
We jumped in both feet in terms of
making sure that the needs were being met,
that the vaccination
programs were out there and available readily available,
and we didn't charge for them.
A lot of things like that, I think,
helped. Our chief medical officer was on the
news just about every day talking about updates
and things like that, and that that was
wonderful. And I believe that's what we should
be doing. You know, we're the county facility.
We should should be there helping folks.
So I think that helped in terms of
visibility.
But I think that the growth we've had
and the growth we expect is also going
to be helping us in that area because
we are seeing a bigger exposure
to the commercial patient base, which as you
know is what offsets what we don't get
paid from
Medicare and Medicaid.
A lot of people think we get our
costs there, you know, and theoretically on Medicare
we're supposed to.
Medicaid we're not close.
So and plus we still have a good
size insured
population. So
I think it's difficult. I think the folks
in finance,
and the folks that are in collections in
our business office do a phenomenal job.
I like to think we have a little
part of that in terms of contracting, so
that's helpful.
But trying to go through, what we're gonna
be doing, I guess, within the next year
or so is is we're gonna be looking
at our payer partnerships a little more closely.
I've heard different guests on the show talk
about the fact that that you really need
to assess where they are with Medicare Advantage
contracting.
We're in just about every network,
and we wanna be generally because we're the
county facility. We wanna make sure people have
access to us.
But at the same time, there are some
that are just really underperforming,
more denials, more, you know, hassle in terms
of everything, you know,
collections efforts, you name it. And we probably
need to go through some of those and
see whether it's worth continuing.
I think, you know, there are some tough
choices being made,
but I'm optimistic, and,
the growth that we've had, I think, is
is probably gonna continue, especially with the new
hospitals. But let me give you an example,
I guess, in how our our commercial mix
has probably changed.
About two or three years ago before we
opened the new women's and children's hospital,
we were delivering, I want to say, it
was about 4,000,
newborns a year.
We're probably gonna end this year close to
six,
which is know, 50% increase,
in a couple of years.
And it's to me, it's it's completely credited
to the the new facility we have,
the medical staff who is, you know, amazing,
the leadership folks that are running the women's
and children's hospital, I I love talking to
them. I meet with them at least once
a month to talk about what's going on
and what's new.
I just think it's, it's a great opportunity
for the community. It's state of the art,
and I just I'm impressed with it myself.
One of our, team members actually had her
most recent her baby recently there, and
she was pretty impressed as well. So,
I just think the challenges we have can
be met.
I think part of it is you've got
to look at, you know, where your strengths
are and what your mission is. And I'm
one of those people that just believes that
if you have a good mission, you live
your mission, the rest of it will work.
It'll come to you because you're in it
for the right reason.
I know that sounds a little touchy feely,
and I've got an accounting degree, so I
don't know how to reconcile those two.
But, it's just kinda who I am. We
just wanna do the best we can for
the patients we have, make sure we're as
efficient as we can be,
and be around for, you know, decades to
come. Hopefully, we're over a 100 years old
now. So I think it's very possible.
Yeah. No. No. I certainly appreciate it. It
goes back to that old,
deal
no mission, no margin, but no margin, no
mission.
Right. Right. Kevin, you touched on
a little bit there, but I wanted to
expand on the last question I have for
you. You talked a little bit about the
growth at University Health. 100 year old health
system, lot of exciting things happening at the
moment in the future. You've mentioned the the
new women's and children's hospital just opened up.
You're opening a couple other facilities. Sounds like
rapidly expanding your medical group, leaps and bounds
as well. But over the next twelve months
or so,
how are you looking at growth, whether the
health system more broadly or or specifically in
your revenue cycle department? What are the kind
of key things that you're focused on?
Well, for the growth, again, I think you're
just kind of fine tuning what we do,
at least in my opinion. Our like I
said, our CRO has a definite vision for
where he wants to go, and I I've
seen it take shape over the years.
From my little perspective, I guess,
I wanna see us implement that contract implementation
process, that education program for our rev cycle
and leaders. I wanna make sure that that's
available. It's closing the gaps in knowledge
and access that they have. We have, taken
a lot of, a lot of effort and
a lot of time to meet with them
to make sure that we understand their needs.
We're gonna continue to do that, and we're
gonna build the program around them.
So I'm excited about that. I think that's
gonna be something we our little team's gonna
focus on. I think we're gonna look at
some of our contracts and try to make
sure that they're doing what they need to
be doing for us,
as well as, they're balancing, you know, the
access for the community that is so important.
The other piece of it, I guess, just
goes on to data. We do a lot
in our little team that probably some contracting
departments don't do. We do build the contracts
in Epic,
and through our three certified folks,
we do do have a,
a contract performance audit function.
We are doing this implementation
training part, which is not something that a
lot of managed care contracting departments do.
But the other piece of it is we
wanna build a reporting structure. We wanna build,
reporting that we can look at our contracts
through, our payer scorecards,
can look at performance by service line, can
look at, you know, everything from time to
pay to accuracy of payment, all the rest
of that, and build something that we can
then share,
with our executive team,
and with the rest of the leaders in
the revenue cycle.
We have something called our payer performance evaluation
team, and essentially that's just a group of
of revenue cycle folks that that are my
peers.
We get together once a month,
and we go through what the latest contract
proposals are like
so they can understand what the payers are
trying to, you know, to ask us to
do, rate structure wise or operationally.
We also get their feedback on our own
contract checklist. We have a a toolkit
that helps us to go through and make
sure we have the right language in place.
One, because we're governmental, but two, because operationally
we've learned a lot of things over the
years and we want to make sure that
that's included.
So they help us evaluate that.
And then the other piece is we do
a quarterly meeting,
that we call our managed care committee, but
essentially it's the executive group. And we talk
about where the contracts are performing,
what negotiations are happening, and how things are
going there and have happened over the last
quarter,
and then also, to make sure that they're
up to speed on what networks we're in,
what networks other folks are in, and, you
know, where there may be some gaps that
we need to close.
We're a partner with the the University of
Texas Health Science Center in San Antonio.
They make up the majority of our medical
staff at University Hospital right now, and probably
will for many years,
so we want to make sure we're aligned
as best we can in participation with them.
Our own medical group, University Medicine Associates, does
all of our anesthesia,
a lot of our hospitalist work,
all of our NICU work, and that kind
of thing. So
we want to make sure that they're in
the right contracts and their services are being
covered.
So a lot of making sure I think
that,
down the road that we're we're contracted with
who we need to be.
We try to expand access where we can.
There are some exchange products we're not in
now that I really want us to join
if we can get access to them.
But as the the local county governmental hospital,
we wanna be available to everybody. So that's
one of my personal goals is to to
try to close those gaps where I can.
A lot happening, but it's all exciting stuff.
So I hope that answered the question. And
if, I went in too many directions,
just let me know, and I'll focus where
you need me to. No. No. Not at
all. I think, Kevin,
it's almost going on at any one point,
but I think so so greatly respect,
so greatly appreciate,
the work that you that your teams do,
University Health. That was great to catch up
with a leader at such a fantastic health
system.
Kevin, really, really enjoyed this conversation that those
thirty minutes or so absolutely flew by. I
really really look forward to connecting with you
again down the line, and thanks again for
taking the time out of your busy, busy
schedule to have a word with us on
the Becker CFO and Rev Cycle podcast.
Oh, no. Thank you so much. I really
appreciate it, Alan. This is a great opportunity,
and I'll be listening to all the other
episodes. That's for sure.
Thank you, Kevin.