1 00:00:00,080 --> 00:00:01,860 This episode is brought to you by Veradigm, 2 00:00:02,159 --> 00:00:04,639 the only health care technology company connecting all 3 00:00:04,639 --> 00:00:07,859 corners of care. Some companies deliver clinical data. 4 00:00:08,000 --> 00:00:09,859 Others turn that data into insights. 5 00:00:10,160 --> 00:00:12,000 A few provide point of care tools to 6 00:00:12,000 --> 00:00:12,500 clinicians. 7 00:00:13,039 --> 00:00:15,779 Veradigm does it all at a national scale. 8 00:00:15,974 --> 00:00:18,295 That's why leading health care organizations are part 9 00:00:18,295 --> 00:00:19,515 of the Veradigm network. 10 00:00:19,815 --> 00:00:23,495 By enabling smarter, more connected workflows, Veradigm helps 11 00:00:23,495 --> 00:00:25,095 close care gaps right at the point of 12 00:00:25,095 --> 00:00:26,795 care where it matters the most. 13 00:00:27,175 --> 00:00:30,054 Whether you're provider, a biopharma company, or a 14 00:00:30,054 --> 00:00:32,759 health plan, visit veradigm.com. 15 00:00:32,899 --> 00:00:36,500 That's veradigm.com 16 00:00:36,500 --> 00:00:38,600 to learn how Veradigm can help you too. 17 00:00:39,140 --> 00:00:41,719 This is Alan Condon back with the Becker's 18 00:00:42,100 --> 00:00:42,600 CFO 19 00:00:42,899 --> 00:00:44,679 and revenue cycle podcast, 20 00:00:45,075 --> 00:00:47,234 And I'm thrilled to be joined today by 21 00:00:47,234 --> 00:00:50,854 Kevin Baron, deputy vice president of payer relations 22 00:00:51,234 --> 00:00:52,054 at University 23 00:00:52,435 --> 00:00:54,454 Health in San Antonio, Texas. 24 00:00:54,835 --> 00:00:56,674 Kevin, a pleasure to have you make your 25 00:00:56,674 --> 00:00:58,695 debut appearance with us on the Becker's podcast. 26 00:00:59,530 --> 00:01:01,130 For those of our listeners who mightn't be 27 00:01:01,130 --> 00:01:02,890 as well acquainted with the work it is 28 00:01:02,890 --> 00:01:04,730 that you do at University Health, do you 29 00:01:04,730 --> 00:01:06,409 mind just, opening it up a little bit 30 00:01:06,409 --> 00:01:07,689 and kind of share a little bit more 31 00:01:07,689 --> 00:01:08,969 about your background at the at the health 32 00:01:08,969 --> 00:01:09,469 system? 33 00:01:10,010 --> 00:01:10,510 Sure. 34 00:01:10,890 --> 00:01:13,295 My role is deputy vice president for payer 35 00:01:13,295 --> 00:01:15,775 relations. So essentially, I'm responsible for all of 36 00:01:15,775 --> 00:01:17,234 our managed care contracting, 37 00:01:17,935 --> 00:01:20,495 on behalf of the health system facilities and 38 00:01:20,495 --> 00:01:22,355 our about 800 member, 39 00:01:23,055 --> 00:01:24,034 provider group. 40 00:01:24,829 --> 00:01:26,989 I've been here for about nine years or 41 00:01:26,989 --> 00:01:29,010 so. Been doing this one way or another 42 00:01:29,310 --> 00:01:31,230 for probably, I hate to say it, over 43 00:01:31,230 --> 00:01:31,969 thirty years, 44 00:01:33,709 --> 00:01:35,870 and got started many years ago back in, 45 00:01:36,109 --> 00:01:36,930 in New Orleans, 46 00:01:37,454 --> 00:01:39,774 out of college working for a hospital there 47 00:01:39,774 --> 00:01:41,314 doing number crunching, and, 48 00:01:41,694 --> 00:01:43,854 it's led to where I am now. And 49 00:01:43,854 --> 00:01:46,174 San Antonio is a great place. University Health 50 00:01:46,174 --> 00:01:48,174 is is probably the most mission driven place 51 00:01:48,174 --> 00:01:50,494 I've ever worked. So I'm happy to be 52 00:01:50,494 --> 00:01:51,935 here and and happy to be on the 53 00:01:51,935 --> 00:01:52,435 show. 54 00:01:53,150 --> 00:01:55,709 Fantastic. So born in thirty years in the 55 00:01:55,709 --> 00:01:58,189 health care finance, like you said, from number 56 00:01:58,189 --> 00:02:00,109 crunching at a a hospital in the New 57 00:02:00,109 --> 00:02:03,469 Orleans area and now to deputy vice president 58 00:02:03,469 --> 00:02:05,969 of payer relations at University Health. 59 00:02:06,305 --> 00:02:07,984 No doubt you've seen a lot of movement, 60 00:02:07,984 --> 00:02:09,444 a lot of change, a lot of evolutions 61 00:02:09,504 --> 00:02:10,724 in that time. But 62 00:02:11,104 --> 00:02:13,025 what are you focusing on at the moment 63 00:02:13,025 --> 00:02:15,444 in your current role? Certainly a lot happening, 64 00:02:15,745 --> 00:02:17,585 at any one point in time. But what 65 00:02:17,585 --> 00:02:19,824 are the two or three kinda key trends 66 00:02:19,824 --> 00:02:22,560 that you're paying closest attention to today in 67 00:02:22,560 --> 00:02:23,299 health care? 68 00:02:24,239 --> 00:02:26,239 Well, the biggest one I guess is that 69 00:02:26,239 --> 00:02:27,919 we've seen a lot of changes over the 70 00:02:27,919 --> 00:02:29,919 years and it seems to be getting a 71 00:02:29,919 --> 00:02:32,080 little bit more challenging to deal with our 72 00:02:32,080 --> 00:02:32,819 payer partners. 73 00:02:33,614 --> 00:02:36,334 They're much more aggressive on denials and their 74 00:02:36,334 --> 00:02:38,974 work. And what, you know, has been known 75 00:02:38,974 --> 00:02:41,614 to the industry is, terminate the contract or 76 00:02:41,614 --> 00:02:42,094 contract, 77 00:02:42,414 --> 00:02:43,155 by termination. 78 00:02:43,935 --> 00:02:45,775 We've seen that happening in other parts of 79 00:02:45,775 --> 00:02:46,275 Texas. 80 00:02:46,655 --> 00:02:48,754 Thankfully, we haven't been there, but, 81 00:02:49,239 --> 00:02:51,739 the whole environment is is much more difficult. 82 00:02:52,280 --> 00:02:54,280 I kinda say that providers need to know 83 00:02:54,280 --> 00:02:55,560 when to hold them and know when to 84 00:02:55,560 --> 00:02:57,900 fold them, to quote the, the gambler, 85 00:02:58,599 --> 00:03:00,039 because you just never know. 86 00:03:00,680 --> 00:03:03,014 What we are as a governmental health system, 87 00:03:03,254 --> 00:03:05,675 we're the Bexar County Hospital District, and, 88 00:03:06,294 --> 00:03:08,134 we have one of the busiest ERs in 89 00:03:08,134 --> 00:03:08,794 the state. 90 00:03:09,655 --> 00:03:10,134 We're, 91 00:03:10,534 --> 00:03:13,014 about we're staffing probably a little over 700 92 00:03:13,014 --> 00:03:15,254 beds right now. We're about to open, within 93 00:03:15,254 --> 00:03:17,370 the next year or so, two new hospitals 94 00:03:17,370 --> 00:03:18,669 as well in the community. 95 00:03:19,210 --> 00:03:20,729 There's a lot of things that we wanna 96 00:03:20,729 --> 00:03:22,810 make sure that the community has access to. 97 00:03:22,810 --> 00:03:25,389 And to me, what drives me generally is 98 00:03:25,530 --> 00:03:27,550 making sure that people that need the care, 99 00:03:28,009 --> 00:03:30,009 have access to the care regardless of their 100 00:03:30,009 --> 00:03:31,069 ability to pay, 101 00:03:31,555 --> 00:03:33,474 and regardless of, you know, of where they 102 00:03:33,474 --> 00:03:35,875 are in our community. We try to bring 103 00:03:35,875 --> 00:03:36,935 things to them. 104 00:03:37,474 --> 00:03:40,375 So the whole payer situation is is challenging. 105 00:03:41,155 --> 00:03:42,534 There's a lot of delay. 106 00:03:43,155 --> 00:03:45,175 There's a lot of changes in staffing, 107 00:03:45,909 --> 00:03:49,030 turnover, and contracting folks. At least we're seeing 108 00:03:49,030 --> 00:03:50,949 that in Texas, and that makes it difficult 109 00:03:50,949 --> 00:03:52,870 to build relationships, which is what it's all 110 00:03:52,870 --> 00:03:54,709 about and what we do. So I guess 111 00:03:54,709 --> 00:03:56,169 the second one is probably, 112 00:03:56,469 --> 00:03:58,094 where we're going with rev cycle. 113 00:03:58,974 --> 00:04:01,615 We're working actually right now with AI. We're 114 00:04:01,615 --> 00:04:03,455 trying to get a system in that's gonna 115 00:04:03,455 --> 00:04:06,514 help us with redlining documents, tracking contracts, 116 00:04:07,615 --> 00:04:10,110 managing the the contents of them when we 117 00:04:10,110 --> 00:04:12,830 need to do polls for specific information on 118 00:04:12,830 --> 00:04:14,289 performance or anything else. 119 00:04:14,669 --> 00:04:16,210 And then, I guess the 120 00:04:16,509 --> 00:04:18,110 the piece of that that goes along with 121 00:04:18,110 --> 00:04:18,769 the digitization 122 00:04:19,149 --> 00:04:20,370 is the fact that, 123 00:04:20,750 --> 00:04:22,670 we're part of the revenue cycle. We're the 124 00:04:22,670 --> 00:04:23,949 way I put it is we're kind of 125 00:04:23,949 --> 00:04:24,449 embedded. 126 00:04:25,095 --> 00:04:26,935 When I started here years ago, we had 127 00:04:26,935 --> 00:04:29,915 a news chief revenue officer who's still my 128 00:04:29,975 --> 00:04:32,694 direct supervisor a while ago, and he's he's 129 00:04:32,694 --> 00:04:33,194 fantastic. 130 00:04:34,295 --> 00:04:36,634 His vision was to make sure that contracting 131 00:04:36,775 --> 00:04:38,535 was smack in the middle of everything the 132 00:04:38,535 --> 00:04:39,120 revenue cycle 133 00:04:39,759 --> 00:04:41,733 cycle does. So I've grown quite a bit 134 00:04:41,733 --> 00:04:43,439 even though I've been in this game for 135 00:04:43,439 --> 00:04:45,120 a while. The last nine years or so, 136 00:04:45,120 --> 00:04:46,979 I've grown a lot. I've learned a lot, 137 00:04:47,439 --> 00:04:49,839 mostly due to his kind of mentorship and 138 00:04:49,839 --> 00:04:51,519 the folks that I work with across the 139 00:04:51,519 --> 00:04:52,625 rev cycle. So 140 00:04:53,084 --> 00:04:55,485 that's something that I'm working on. We're still 141 00:04:55,485 --> 00:04:57,964 trying to get a few new opportunities like 142 00:04:57,964 --> 00:05:00,925 education set up, implementation of contracts to be 143 00:05:00,925 --> 00:05:01,425 better. 144 00:05:01,884 --> 00:05:03,725 And I guess the last thing is one 145 00:05:03,725 --> 00:05:05,165 that we hear about a lot on the 146 00:05:05,165 --> 00:05:07,345 clinical side, but I'll bring it up here, 147 00:05:07,910 --> 00:05:09,589 And that's just making sure we have the 148 00:05:09,589 --> 00:05:11,129 right people in the right jobs, 149 00:05:11,669 --> 00:05:13,370 they call workforce sustainability. 150 00:05:14,149 --> 00:05:15,290 My end of it, 151 00:05:15,910 --> 00:05:17,990 is that we have a good bit of 152 00:05:17,990 --> 00:05:19,990 turnover in some of the entry level positions 153 00:05:19,990 --> 00:05:21,669 in the revenue cycle, and that's kind of 154 00:05:21,669 --> 00:05:23,290 a challenge like patient access. 155 00:05:23,644 --> 00:05:25,644 But if you give them opportunities and training 156 00:05:25,644 --> 00:05:27,725 and all, I think that helps. When you 157 00:05:27,725 --> 00:05:30,384 look different to more of the technical jobs, 158 00:05:30,764 --> 00:05:33,404 we have three folks who are certified with 159 00:05:33,404 --> 00:05:35,964 EPIC as contract analysts and that can build 160 00:05:35,964 --> 00:05:37,618 our contracts in EPIC. They work in our 161 00:05:37,618 --> 00:05:38,214 department instead of IT at this point, 162 00:05:40,910 --> 00:05:42,670 and I love it because it helps us 163 00:05:42,670 --> 00:05:44,910 translate what we negotiate into contracts in the 164 00:05:44,910 --> 00:05:46,449 system a lot more quickly 165 00:05:46,830 --> 00:05:47,730 and more accurately. 166 00:05:48,830 --> 00:05:51,629 But keeping someone who's Epic certified, as folks 167 00:05:51,629 --> 00:05:53,685 out there may know, is is not easy. 168 00:05:54,245 --> 00:05:55,384 They're in high demand, 169 00:05:56,084 --> 00:05:58,725 and they're very talented people. So, you know, 170 00:05:58,725 --> 00:06:00,485 keeping making sure that we've got the right 171 00:06:00,485 --> 00:06:00,964 folks, 172 00:06:01,285 --> 00:06:03,365 in the right positions and can hold on 173 00:06:03,365 --> 00:06:04,004 to them, 174 00:06:04,324 --> 00:06:06,245 is a priority for me. So I guess 175 00:06:06,245 --> 00:06:08,105 those would be the the big ones. 176 00:06:08,620 --> 00:06:09,360 Yeah. No. 177 00:06:09,660 --> 00:06:11,259 Great kind of bird's eye view with some 178 00:06:11,259 --> 00:06:12,620 of those key trends, some of the things 179 00:06:12,620 --> 00:06:15,339 that you're focusing on at university health. I 180 00:06:15,339 --> 00:06:17,740 heard quite similar from other revenue cycle leaders 181 00:06:17,740 --> 00:06:19,899 that are CFOs and other health systems across 182 00:06:19,899 --> 00:06:21,360 the country in recent conversations. 183 00:06:22,860 --> 00:06:24,399 But to kinda pick up on 184 00:06:24,964 --> 00:06:26,805 the first trend that you'd that you'd noted, 185 00:06:27,125 --> 00:06:29,365 Kevin, in terms of, you know, the health 186 00:06:29,365 --> 00:06:31,444 systems taking a bit more of an aggressive 187 00:06:31,444 --> 00:06:34,245 stance, to fight back on the equally or 188 00:06:34,245 --> 00:06:36,324 probably a little bit more aggressive stance that 189 00:06:36,324 --> 00:06:38,189 a lot of the commercial payers have have 190 00:06:38,189 --> 00:06:41,149 talked in recent quarters, recent years when it 191 00:06:41,149 --> 00:06:43,389 comes to no secret to you or myself 192 00:06:43,389 --> 00:06:44,750 or any of our listeners here, but the 193 00:06:44,750 --> 00:06:46,129 the alarming rate of denials, 194 00:06:46,750 --> 00:06:48,209 slow payments, prioritization 195 00:06:48,669 --> 00:06:49,169 burdens. 196 00:06:49,550 --> 00:06:52,289 Granted, there there's no silver bullet to these 197 00:06:53,095 --> 00:06:55,175 epidemic of challenges here on the payer side. 198 00:06:55,175 --> 00:06:57,254 But is there one or two things that 199 00:06:57,254 --> 00:07:00,774 University Health is doing or has done to 200 00:07:00,774 --> 00:07:03,594 fight back against denials, fight for those dollars, 201 00:07:03,735 --> 00:07:05,574 maybe see a little bit more success in 202 00:07:05,574 --> 00:07:08,074 terms of protecting your financial performance? 203 00:07:08,990 --> 00:07:10,350 Well, I don't know that any of these 204 00:07:10,350 --> 00:07:12,829 are really, super innovative apart from the fact 205 00:07:12,829 --> 00:07:15,949 that our our contracting team that I, I 206 00:07:15,949 --> 00:07:16,449 manage 207 00:07:16,750 --> 00:07:18,449 is part of the rev cycle directly. 208 00:07:18,990 --> 00:07:22,050 But in terms of just the operational side, 209 00:07:22,430 --> 00:07:24,785 we've built within the managed care team, that 210 00:07:24,785 --> 00:07:26,145 may be a little different, but we built 211 00:07:26,145 --> 00:07:29,525 within our team a contract performance audit function. 212 00:07:30,225 --> 00:07:32,785 So we have, three positions there. We have 213 00:07:32,785 --> 00:07:34,785 a senior manager who's over that and then 214 00:07:34,785 --> 00:07:37,560 two contract auditors and essentially what they do 215 00:07:37,560 --> 00:07:39,399 is go through all of the trends and 216 00:07:39,399 --> 00:07:40,220 payment issues, 217 00:07:40,839 --> 00:07:42,919 make sure that they're identified, that we get 218 00:07:42,919 --> 00:07:44,839 the scope and depth as we say of 219 00:07:44,839 --> 00:07:46,139 what the problems are, 220 00:07:46,680 --> 00:07:48,680 get those to the payers and try to 221 00:07:48,680 --> 00:07:49,245 fix them. 222 00:07:49,725 --> 00:07:51,485 That's something that, you know, happens a lot 223 00:07:51,485 --> 00:07:53,964 of times in the business offices of different 224 00:07:53,964 --> 00:07:54,704 health systems. 225 00:07:55,404 --> 00:07:57,324 We've pulled some of that over on our 226 00:07:57,324 --> 00:07:59,485 end to help with what the business office 227 00:07:59,485 --> 00:08:01,084 has to manage because they have a lot 228 00:08:01,084 --> 00:08:02,160 to say grace over. 229 00:08:03,040 --> 00:08:05,060 But on our end, it's been successful. 230 00:08:05,360 --> 00:08:07,680 One of the specific programs that we have 231 00:08:07,680 --> 00:08:09,759 with them is that we pull everything that's 232 00:08:09,759 --> 00:08:11,439 a high dollar claim. At a certain time, 233 00:08:11,439 --> 00:08:13,379 it hits one of our epic work queues, 234 00:08:14,000 --> 00:08:15,699 and they go through and do that. 235 00:08:16,080 --> 00:08:16,720 Over the last 236 00:08:17,439 --> 00:08:19,245 I think it was last fiscal year when 237 00:08:19,245 --> 00:08:21,404 we did the report, we were able to 238 00:08:21,404 --> 00:08:24,125 assist in collecting an additional $12,000,000, 239 00:08:24,444 --> 00:08:27,964 on high dollar claims. And, basically, every claim 240 00:08:27,964 --> 00:08:29,884 that we were able to assist the business 241 00:08:29,884 --> 00:08:30,600 office with, 242 00:08:31,160 --> 00:08:34,519 we're able to collect about another $150,000 243 00:08:34,519 --> 00:08:37,080 on those services. So we we focus on 244 00:08:37,080 --> 00:08:39,639 the high dollar ones. We look at when 245 00:08:39,639 --> 00:08:41,480 they hit a certain age in the AR 246 00:08:41,480 --> 00:08:43,080 where we know that it's gonna be hard 247 00:08:43,080 --> 00:08:43,634 to collect. 248 00:08:44,355 --> 00:08:46,355 Our opportunity to do that, you know, maybe 249 00:08:46,355 --> 00:08:48,595 has passed a bit. But we go back 250 00:08:48,595 --> 00:08:50,035 at them hard and we try to go 251 00:08:50,035 --> 00:08:51,495 to the payers themselves, 252 00:08:52,035 --> 00:08:54,294 and explain what's going on with the claim, 253 00:08:54,434 --> 00:08:55,235 make sure that they have the records they 254 00:08:55,235 --> 00:08:57,009 need. Records they need. All the rest of 255 00:08:57,009 --> 00:08:58,850 that stuff, we kinda do from our team 256 00:08:58,850 --> 00:08:59,590 as well 257 00:08:59,970 --> 00:09:01,250 as, you know, it gets done in the 258 00:09:01,250 --> 00:09:02,870 business office for other times. 259 00:09:03,330 --> 00:09:04,930 But working on that, I think, has been 260 00:09:04,930 --> 00:09:06,930 very helpful. Just being part of the rev 261 00:09:06,930 --> 00:09:09,090 cycle generally, as I said, is helpful because, 262 00:09:09,410 --> 00:09:11,804 I meet with our business office folks, our 263 00:09:11,804 --> 00:09:15,085 reimbursement folks, our revenue integrity folks, and our 264 00:09:15,085 --> 00:09:17,485 CRO every Friday morning. We have an AR 265 00:09:17,485 --> 00:09:17,985 meeting, 266 00:09:18,524 --> 00:09:20,764 and having the contracting folks in the AR 267 00:09:20,764 --> 00:09:22,365 meeting, at least from what I've seen, is 268 00:09:22,365 --> 00:09:23,985 not not always common, 269 00:09:24,684 --> 00:09:25,440 but it helps. 270 00:09:26,000 --> 00:09:27,759 It gives me an opportunity to hear where 271 00:09:27,759 --> 00:09:28,980 the pain points are, 272 00:09:29,440 --> 00:09:30,740 try to follow-up immediately, 273 00:09:31,200 --> 00:09:33,440 when I'm sitting there, with whoever I need 274 00:09:33,440 --> 00:09:35,039 to at the payers to try to address 275 00:09:35,039 --> 00:09:37,299 a problem or get something kicked off anyway. 276 00:09:38,235 --> 00:09:40,315 So a few of those things. I guess 277 00:09:40,315 --> 00:09:42,315 the most recent thing that we started and 278 00:09:42,315 --> 00:09:44,735 we've hired a dedicated manager for this, 279 00:09:45,274 --> 00:09:47,674 and that's to we were building a contract 280 00:09:47,674 --> 00:09:48,174 implementation 281 00:09:48,634 --> 00:09:49,134 process. 282 00:09:49,830 --> 00:09:51,509 You know, every time you do a contract, 283 00:09:51,509 --> 00:09:53,110 it seems like, you know, it takes forever. 284 00:09:53,110 --> 00:09:55,029 Like we talked about, it's challenging now more 285 00:09:55,029 --> 00:09:57,110 than ever. But once you have the contract 286 00:09:57,110 --> 00:09:59,269 done, sometimes, at least in my career years 287 00:09:59,269 --> 00:10:01,029 ago, we would just move on. We'd send 288 00:10:01,029 --> 00:10:02,629 a copy of it to legal. We send 289 00:10:02,629 --> 00:10:04,629 it to the business office and whoever else 290 00:10:04,629 --> 00:10:05,370 needed it. 291 00:10:05,865 --> 00:10:07,485 Then we go on to the next negotiation. 292 00:10:08,184 --> 00:10:09,625 We haven't done that in a very long 293 00:10:09,625 --> 00:10:11,225 time where I am now, but what we're 294 00:10:11,225 --> 00:10:13,485 trying to do is really focus on it. 295 00:10:14,024 --> 00:10:15,465 So the goal is to build, 296 00:10:15,785 --> 00:10:17,644 what we call our packed program, 297 00:10:18,184 --> 00:10:19,725 and it's essentially just 298 00:10:20,070 --> 00:10:21,750 making sure that we have the right education 299 00:10:21,750 --> 00:10:24,710 for the revenue cycle teams, identifying where the 300 00:10:24,710 --> 00:10:26,889 the knowledge gaps are, the access gaps, 301 00:10:27,670 --> 00:10:29,529 to portals and that kind of thing, 302 00:10:29,990 --> 00:10:32,845 getting the payers on-site or through some type 303 00:10:32,845 --> 00:10:35,725 of, teams or Webex or something to do 304 00:10:35,725 --> 00:10:38,285 in services for the staff and the leaders 305 00:10:38,285 --> 00:10:39,504 of the revenue cycle. 306 00:10:40,205 --> 00:10:42,924 We've, we've had good success with it. We've 307 00:10:42,924 --> 00:10:44,684 only done a couple so far because it's 308 00:10:44,684 --> 00:10:45,424 pretty new, 309 00:10:45,809 --> 00:10:47,990 but I'm excited about what it's gonna bring. 310 00:10:48,370 --> 00:10:50,529 And that person that's managing that is also 311 00:10:50,529 --> 00:10:53,009 gonna manage our our joint operating committee meetings 312 00:10:53,009 --> 00:10:54,549 or JOCs with our payers. 313 00:10:55,169 --> 00:10:56,769 So we're gonna make sure that we're bird 314 00:10:56,769 --> 00:10:58,529 dogging whatever is out there that needs to 315 00:10:58,529 --> 00:10:59,384 be followed up on. 316 00:11:00,345 --> 00:11:02,345 And the person we have in it is, 317 00:11:02,585 --> 00:11:04,445 is a new grad, undergrad, 318 00:11:04,904 --> 00:11:07,304 but she is really excited about the job, 319 00:11:07,304 --> 00:11:09,304 and, she's helped us build it when she 320 00:11:09,304 --> 00:11:10,924 was with us as an intern. 321 00:11:11,304 --> 00:11:13,085 So that's one of my pet projects, 322 00:11:13,540 --> 00:11:15,220 and I'm I'm excited about it because I 323 00:11:15,220 --> 00:11:16,820 think it's gonna help us do things we 324 00:11:16,820 --> 00:11:18,360 haven't been able to in the past, 325 00:11:18,820 --> 00:11:20,820 by just making sure that the contracts get 326 00:11:20,820 --> 00:11:22,040 rolled out appropriately. 327 00:11:22,660 --> 00:11:24,259 Yeah. Yeah. And that's maybe so you might 328 00:11:24,259 --> 00:11:25,860 be able to expand on that maybe just 329 00:11:25,860 --> 00:11:28,360 one bit more. But but one, one quick 330 00:11:28,535 --> 00:11:31,654 follow-up, Kevin. You'd mentioned the the the high 331 00:11:31,654 --> 00:11:33,754 dollar the high dollar claims that you'd mentioned. 332 00:11:33,815 --> 00:11:35,335 Are they are they, 333 00:11:35,894 --> 00:11:37,274 higher acuity procedures 334 00:11:37,654 --> 00:11:40,315 or longer inpatient stays in the hospital 335 00:11:40,750 --> 00:11:44,029 or spine orthopedic surgeries, cardiology. What what what 336 00:11:44,029 --> 00:11:46,269 specifically are those high dollar claims that you're 337 00:11:46,269 --> 00:11:47,250 referring to? 338 00:11:48,110 --> 00:11:50,110 Well, they could be pretty much anything. 339 00:11:50,430 --> 00:11:52,590 We're the only the region's only level one 340 00:11:52,590 --> 00:11:54,450 trauma center for adults and peds. 341 00:11:55,085 --> 00:11:56,545 We're the level four NICU. 342 00:11:57,085 --> 00:12:00,305 We're the only level four maternity care center, 343 00:12:00,925 --> 00:12:03,585 and we also do solid organ transplants. 344 00:12:04,365 --> 00:12:05,965 So it could be a lot of different 345 00:12:05,965 --> 00:12:06,465 things. 346 00:12:06,940 --> 00:12:08,299 The way we have it set up right 347 00:12:08,299 --> 00:12:10,699 now, is that we have a specific work 348 00:12:10,699 --> 00:12:11,519 queue in Epic, 349 00:12:12,059 --> 00:12:14,059 where the claims will hit that if they're 350 00:12:14,059 --> 00:12:16,539 in the AR for over seven months, which, 351 00:12:16,539 --> 00:12:18,379 you know, you could arguably say it's gonna 352 00:12:18,379 --> 00:12:19,839 be hard to collect after that. 353 00:12:20,144 --> 00:12:21,425 They hit seven months and they have a 354 00:12:21,425 --> 00:12:23,745 balance of 50,000 or more. So even if 355 00:12:23,745 --> 00:12:25,825 we've gotten some version of payment, if we're 356 00:12:25,825 --> 00:12:27,665 not adequately paid the way we think we 357 00:12:27,665 --> 00:12:29,524 should be through our epic calculations, 358 00:12:30,465 --> 00:12:32,549 it hits the queue and we follow-up on 359 00:12:33,110 --> 00:12:35,190 So it's a partnership between us and the 360 00:12:35,190 --> 00:12:37,429 billing team. We make sure that we do 361 00:12:37,429 --> 00:12:39,190 everything we can to help when they get 362 00:12:39,190 --> 00:12:40,789 that old. And a lot of times, it's 363 00:12:40,789 --> 00:12:42,950 nothing to do with, you know, a lack 364 00:12:42,950 --> 00:12:45,164 of collections effort on the billing team's part. 365 00:12:45,324 --> 00:12:47,504 It comes down to either payer response, 366 00:12:48,365 --> 00:12:50,284 turnover with the folks on the payer side. 367 00:12:50,284 --> 00:12:51,424 We've seen that a lot, 368 00:12:51,964 --> 00:12:53,725 or just getting to the right person at 369 00:12:53,725 --> 00:12:54,945 the payer to pay attention. 370 00:12:55,565 --> 00:12:57,404 We've had some issues recently. I won't say 371 00:12:57,404 --> 00:12:58,384 who it was with, 372 00:12:59,004 --> 00:13:00,269 but we had a payer, 373 00:13:00,750 --> 00:13:03,889 that we sent 2,000 pages of records to, 374 00:13:04,350 --> 00:13:06,370 for a given one single claim. 375 00:13:06,830 --> 00:13:09,149 They couldn't locate them. They wanted them hard 376 00:13:09,149 --> 00:13:11,149 copy. We sent them hard copy certified, and 377 00:13:11,149 --> 00:13:12,210 they couldn't find them. 378 00:13:12,554 --> 00:13:14,794 And when we tried it again, they still 379 00:13:14,794 --> 00:13:16,875 couldn't find them. So we essentially I just 380 00:13:16,875 --> 00:13:18,315 reached out to the person and said, look. 381 00:13:18,315 --> 00:13:20,394 We got an issue here with a potential 382 00:13:20,394 --> 00:13:22,794 HIPAA violation because these records are out there 383 00:13:22,794 --> 00:13:24,809 someplace, guys. Help us with this. 384 00:13:25,610 --> 00:13:27,370 So I just got on the phone, talked 385 00:13:27,370 --> 00:13:29,149 to him. We also sent him an email, 386 00:13:29,769 --> 00:13:32,009 documenting this. And lo and behold, they found 387 00:13:32,009 --> 00:13:33,710 the records within, like, three days, 388 00:13:34,169 --> 00:13:36,350 and the claim got paid. So, you know, 389 00:13:36,490 --> 00:13:38,330 you just you gotta be aggressive, but you 390 00:13:38,330 --> 00:13:40,009 gotta be nice about it. You gotta find 391 00:13:40,009 --> 00:13:40,669 new angles. 392 00:13:41,664 --> 00:13:43,664 And the high dollar process has led us 393 00:13:43,664 --> 00:13:45,824 to learn a lot about, you know, what 394 00:13:45,824 --> 00:13:48,464 payers sometimes do as well as what we 395 00:13:48,464 --> 00:13:50,784 may not do so great ourselves. It it's 396 00:13:50,784 --> 00:13:53,024 not always a payer problem. Sometimes it's something 397 00:13:53,024 --> 00:13:55,110 to do with our own processes, and we 398 00:13:55,110 --> 00:13:56,470 we try to feed that back to the 399 00:13:56,470 --> 00:13:58,570 rep cycle folks as well where we can. 400 00:13:59,190 --> 00:14:01,269 Yeah. I mean, I certainly don't envy about 401 00:14:01,269 --> 00:14:03,190 trying to strike that balance in that scenario 402 00:14:03,190 --> 00:14:05,110 of being aggressive in terms of chasing down 403 00:14:05,110 --> 00:14:07,190 those high dollar claims, but also in some 404 00:14:07,190 --> 00:14:09,095 way, shape, or form, trying to be nice 405 00:14:09,095 --> 00:14:10,875 about it. Must be challenging. But, 406 00:14:11,254 --> 00:14:13,254 Kevin, that that's a lot of the challenges 407 00:14:13,254 --> 00:14:15,334 we talked about there. You talked about one 408 00:14:15,334 --> 00:14:17,174 or two things you're quite excited about now. 409 00:14:17,174 --> 00:14:19,254 But maybe, if you could elaborate, what what 410 00:14:19,254 --> 00:14:21,414 are you most excited about, when you think 411 00:14:21,414 --> 00:14:23,799 about the future of university health, the future 412 00:14:23,799 --> 00:14:25,639 rev cycle? What what kinda comes to mind 413 00:14:25,639 --> 00:14:26,220 for you? 414 00:14:26,839 --> 00:14:28,759 I think the the piece that I wouldn't 415 00:14:28,759 --> 00:14:30,759 have had in as to perspective many years 416 00:14:30,759 --> 00:14:33,079 ago before coming here and and working with 417 00:14:33,079 --> 00:14:33,740 the wall, 418 00:14:34,279 --> 00:14:36,039 is the fact that we are, you know, 419 00:14:36,039 --> 00:14:37,514 part of the rev cycle. The fact that 420 00:14:37,514 --> 00:14:39,115 we get to see it from a lot 421 00:14:39,115 --> 00:14:40,014 of different angles. 422 00:14:40,475 --> 00:14:42,394 Literally every place I've ever worked, I've worked 423 00:14:42,394 --> 00:14:44,475 in five states, had the privilege to work 424 00:14:44,475 --> 00:14:46,154 for a lot of governmental not for profit 425 00:14:46,154 --> 00:14:46,894 health systems, 426 00:14:47,514 --> 00:14:49,830 and I've never had that vantage point before. 427 00:14:50,470 --> 00:14:53,190 It's created some challenges for me. It's created 428 00:14:53,190 --> 00:14:56,570 some growth opportunities for me, some frustrations. But, 429 00:14:57,190 --> 00:14:58,950 what it's allowed me to do is to 430 00:14:58,950 --> 00:15:01,110 see how what we do in contracting and 431 00:15:01,110 --> 00:15:02,889 payer relations really matters, 432 00:15:03,565 --> 00:15:06,125 how it connects directly to the patients that 433 00:15:06,125 --> 00:15:07,425 we're trying to see, especially 434 00:15:08,205 --> 00:15:10,384 as the type of organization we are. 435 00:15:10,925 --> 00:15:13,165 We try to reach patients, as I said, 436 00:15:13,165 --> 00:15:15,565 wherever they may be and regardless of their 437 00:15:15,565 --> 00:15:16,465 financial situation. 438 00:15:17,110 --> 00:15:19,190 I have personally, I have my wife and 439 00:15:19,190 --> 00:15:20,250 I have a daughter 440 00:15:20,629 --> 00:15:22,389 with special needs who's had a lot of 441 00:15:22,389 --> 00:15:24,230 challenges when she was born. She was born 442 00:15:24,230 --> 00:15:26,950 very early, so I also have a personal 443 00:15:26,950 --> 00:15:29,610 perspective of seeing how challenging it can be 444 00:15:29,835 --> 00:15:32,154 to get the care you need, especially for 445 00:15:32,154 --> 00:15:33,754 a child or even an, you know, an 446 00:15:33,754 --> 00:15:36,254 adult with different types of disabilities. 447 00:15:37,195 --> 00:15:38,575 And I want this place, 448 00:15:39,035 --> 00:15:41,035 I want university health as good as it 449 00:15:41,035 --> 00:15:42,795 is and as mission driven as it is 450 00:15:42,795 --> 00:15:44,500 to be here fifty years from now. I 451 00:15:44,500 --> 00:15:45,860 I want them to be here for my 452 00:15:45,860 --> 00:15:47,080 daughter when I'm not. 453 00:15:47,620 --> 00:15:49,940 So there needs to be organizations like ours 454 00:15:49,940 --> 00:15:51,160 that care about the mission, 455 00:15:51,860 --> 00:15:53,860 and the mission to me is always forefront. 456 00:15:53,860 --> 00:15:55,300 We talk about it in our team all 457 00:15:55,300 --> 00:15:55,960 the time, 458 00:15:56,660 --> 00:15:58,894 because it's it's rare that when you're in 459 00:15:58,894 --> 00:16:00,975 rev cycle, you you have an opportunity to 460 00:16:00,975 --> 00:16:02,894 see how what you do affects a given 461 00:16:02,894 --> 00:16:03,394 patient. 462 00:16:04,174 --> 00:16:06,894 But we had an example recently that, our 463 00:16:06,894 --> 00:16:08,995 director of managed care analytics did. 464 00:16:09,455 --> 00:16:10,274 We had a 465 00:16:10,659 --> 00:16:13,059 outreach from our pharmacy folks who said we 466 00:16:13,059 --> 00:16:13,720 had a patient, 467 00:16:14,340 --> 00:16:16,019 that was really in need of a certain 468 00:16:16,019 --> 00:16:18,019 drug. There was a problem in terms of 469 00:16:18,019 --> 00:16:18,519 coverage. 470 00:16:19,059 --> 00:16:20,259 What could we do to set up a 471 00:16:20,259 --> 00:16:21,399 single case agreement? 472 00:16:21,779 --> 00:16:22,279 And 473 00:16:22,659 --> 00:16:24,404 we did, essentially. It took a little bit 474 00:16:24,404 --> 00:16:27,924 of doing, but, between him and our, senior 475 00:16:27,924 --> 00:16:29,845 coordinator, the person that handles all of our 476 00:16:29,845 --> 00:16:30,904 single case agreements, 477 00:16:31,365 --> 00:16:33,285 they got together. They found a way to 478 00:16:33,285 --> 00:16:34,644 make it work. They found a way to 479 00:16:34,644 --> 00:16:36,165 make sure we got our cost coverage that 480 00:16:36,165 --> 00:16:38,504 we needed to, and put it in place. 481 00:16:38,949 --> 00:16:40,949 And through that, the two of them got 482 00:16:40,949 --> 00:16:42,949 to know who this patient was, what their 483 00:16:42,949 --> 00:16:46,089 circumstances were, how what they did actually mattered, 484 00:16:46,789 --> 00:16:48,709 directly to that patient. Because the patient was 485 00:16:48,709 --> 00:16:49,929 in house at the time, 486 00:16:50,709 --> 00:16:53,304 it really it really hits home. I had 487 00:16:53,304 --> 00:16:56,125 a similar situation years ago with a pediatric 488 00:16:56,264 --> 00:16:57,245 patient with cancer, 489 00:16:58,024 --> 00:16:59,625 and was working with his father to make 490 00:16:59,625 --> 00:17:01,225 sure that because they were out of network, 491 00:17:01,225 --> 00:17:02,664 they were still able to come to our 492 00:17:02,664 --> 00:17:05,085 service, to come get service at our facility. 493 00:17:05,704 --> 00:17:08,910 And it was extremely rewarding. That little boy 494 00:17:08,910 --> 00:17:11,390 was actually put on, one of our, health 495 00:17:11,390 --> 00:17:13,009 system commercials years ago, 496 00:17:13,549 --> 00:17:15,549 as a success story, and I can't tell 497 00:17:15,549 --> 00:17:17,710 you how good that made me feel. So 498 00:17:17,710 --> 00:17:19,390 I think, you know, what I'm excited about 499 00:17:19,390 --> 00:17:21,644 is making sure that we somehow get the 500 00:17:21,644 --> 00:17:24,605 rubber, onto the road. The rev cycle does 501 00:17:24,605 --> 00:17:27,085 what it's supposed to do. It's efficient as 502 00:17:27,085 --> 00:17:28,924 it can be. We work together as a 503 00:17:28,924 --> 00:17:29,424 team. 504 00:17:29,884 --> 00:17:32,125 And before it's all said and done, the 505 00:17:32,125 --> 00:17:33,805 patients out there, you know, they don't need 506 00:17:33,805 --> 00:17:35,130 to worry about all the back end stuff. 507 00:17:35,130 --> 00:17:37,049 Stuff. They just get the care they need, 508 00:17:37,289 --> 00:17:38,509 and we can move on. 509 00:17:38,809 --> 00:17:41,130 So I I can ramble about this stuff 510 00:17:41,130 --> 00:17:43,529 forever, but that's, that's what gets me excited. 511 00:17:43,529 --> 00:17:44,990 Now the the day to day, 512 00:17:45,529 --> 00:17:47,049 of the work that we do, I love 513 00:17:47,049 --> 00:17:48,490 also. I'm a bit of a nerd in 514 00:17:48,490 --> 00:17:49,309 a lot of ways. 515 00:17:49,994 --> 00:17:51,835 But the big picture, I guess, it's it's, 516 00:17:52,075 --> 00:17:54,075 you know, affecting the community that we have 517 00:17:54,075 --> 00:17:55,434 out there and meeting the needs that they 518 00:17:55,434 --> 00:17:55,934 have. 519 00:17:56,315 --> 00:17:59,275 Yeah. Well well, I love those specific examples 520 00:17:59,275 --> 00:18:01,674 of those those patients and how rewarding it 521 00:18:01,674 --> 00:18:03,275 is for for you and the rev cycle 522 00:18:03,275 --> 00:18:05,195 team. No doubt your care team, your hospital 523 00:18:05,195 --> 00:18:06,849 health system being able to take care of 524 00:18:06,849 --> 00:18:10,369 patients in similar troubling challenging situations like that 525 00:18:10,369 --> 00:18:11,029 as well. 526 00:18:11,890 --> 00:18:14,690 I guess one one last question on that 527 00:18:14,690 --> 00:18:16,369 before we move on to our last question, 528 00:18:16,369 --> 00:18:18,194 Kevin, because it's something that no doubt a 529 00:18:18,194 --> 00:18:18,755 lot of, 530 00:18:19,394 --> 00:18:22,434 hospitals, nonprofit systems really struggling with grappling with 531 00:18:22,434 --> 00:18:24,275 today. That's something you brought up in terms 532 00:18:24,275 --> 00:18:26,534 of that mission versus margin. 533 00:18:27,474 --> 00:18:29,894 How do you how does your executive team 534 00:18:30,250 --> 00:18:33,309 try to strike that balance in today's complex 535 00:18:33,450 --> 00:18:36,029 challenge and landscape, particularly when we see 536 00:18:36,409 --> 00:18:38,490 the financial challenges that so many hospitals are 537 00:18:38,490 --> 00:18:40,890 up against? I believe 43%, 538 00:18:40,890 --> 00:18:42,984 a little under of hospital still operating in 539 00:18:42,984 --> 00:18:43,644 the red. 540 00:18:44,424 --> 00:18:47,544 Academic systems, nonprofit systems, obviously, I'd love to 541 00:18:47,544 --> 00:18:49,865 kinda hear how you strike that balance because 542 00:18:49,865 --> 00:18:50,845 it is so challenging, 543 00:18:51,384 --> 00:18:53,785 arguably more challenging than it ever has been 544 00:18:53,785 --> 00:18:54,845 in today, I imagine. 545 00:18:55,669 --> 00:18:57,289 It is. It definitely 546 00:18:57,750 --> 00:19:00,069 is. And, for any of our executive team 547 00:19:00,069 --> 00:19:01,669 that's listening, I love what I do, and 548 00:19:01,669 --> 00:19:02,650 it's really hard. 549 00:19:04,150 --> 00:19:05,829 And I'm gonna keep doing the best I 550 00:19:05,829 --> 00:19:08,154 can. Yeah. But no. I just I I 551 00:19:08,154 --> 00:19:11,035 love it. And I think, our organization when 552 00:19:11,035 --> 00:19:13,275 I got here, you know, nine plus years 553 00:19:13,275 --> 00:19:16,234 ago, we had probably about 25% 554 00:19:16,234 --> 00:19:17,694 of our business was commercial, 555 00:19:18,234 --> 00:19:19,674 which is not in the you know, it's 556 00:19:19,674 --> 00:19:20,335 not insignificant 557 00:19:20,634 --> 00:19:22,734 for, a county owned facility 558 00:19:23,410 --> 00:19:25,170 that had, you know, a fourth of our 559 00:19:25,170 --> 00:19:26,230 businesses uninsured 560 00:19:26,849 --> 00:19:29,250 because we're in Texas. They didn't expand Medicaid 561 00:19:29,250 --> 00:19:31,170 way back when. So we still have a 562 00:19:31,170 --> 00:19:31,670 decently, 563 00:19:32,049 --> 00:19:34,230 large uninsured population in Texas. 564 00:19:34,769 --> 00:19:36,529 We had about a fourth of our business 565 00:19:36,529 --> 00:19:38,875 then was Medicare, and about a fourth of 566 00:19:38,875 --> 00:19:39,775 it was Medicaid. 567 00:19:40,714 --> 00:19:42,875 Where we are today, we're closer to a 568 00:19:42,875 --> 00:19:43,694 third commercial. 569 00:19:44,634 --> 00:19:47,035 So that big pickup in commercial business, I 570 00:19:47,035 --> 00:19:48,714 like to think, is because, you know, the 571 00:19:48,714 --> 00:19:49,920 market shifted a bit. 572 00:19:50,480 --> 00:19:52,480 The exchange products are out there. We count 573 00:19:52,480 --> 00:19:53,700 them as as commercial. 574 00:19:54,240 --> 00:19:55,920 And at the same time, I like to 575 00:19:55,920 --> 00:19:58,160 think that the contracting that we've done has 576 00:19:58,160 --> 00:20:00,100 increased access to what we do. 577 00:20:00,799 --> 00:20:01,460 Our reputation 578 00:20:01,920 --> 00:20:03,944 has grown quite a bit. We've got a 579 00:20:03,944 --> 00:20:05,964 beautiful facility. It is it's unbelievable. 580 00:20:06,825 --> 00:20:09,065 We just opened the women's and children's hospital. 581 00:20:09,065 --> 00:20:11,005 Like I said, we're opening two new facilities 582 00:20:11,065 --> 00:20:13,325 in the next year or so. We're expanding 583 00:20:13,384 --> 00:20:15,785 our our medical group, like, leaps and bounds. 584 00:20:15,785 --> 00:20:17,429 It's hard to even stay up with what 585 00:20:17,429 --> 00:20:18,490 they're doing nowadays. 586 00:20:19,269 --> 00:20:21,109 But the fact that we're a little different 587 00:20:21,109 --> 00:20:22,809 that way from most governmental, 588 00:20:23,509 --> 00:20:26,089 you know, academic medical centers, I think helps. 589 00:20:27,029 --> 00:20:29,190 We we picked up a lot of at 590 00:20:29,190 --> 00:20:30,789 least in my opinion, I'm not gonna say 591 00:20:30,789 --> 00:20:32,549 this is an official opinion, but in mine, 592 00:20:32,549 --> 00:20:34,375 I think we picked up a lot of 593 00:20:34,375 --> 00:20:36,474 community support through the whole pandemic. 594 00:20:37,174 --> 00:20:39,894 We jumped in both feet in terms of 595 00:20:39,894 --> 00:20:42,234 making sure that the needs were being met, 596 00:20:42,454 --> 00:20:43,515 that the vaccination 597 00:20:43,815 --> 00:20:46,555 programs were out there and available readily available, 598 00:20:46,615 --> 00:20:48,474 and we didn't charge for them. 599 00:20:49,100 --> 00:20:50,779 A lot of things like that, I think, 600 00:20:50,779 --> 00:20:53,100 helped. Our chief medical officer was on the 601 00:20:53,100 --> 00:20:55,259 news just about every day talking about updates 602 00:20:55,259 --> 00:20:56,859 and things like that, and that that was 603 00:20:56,859 --> 00:20:58,779 wonderful. And I believe that's what we should 604 00:20:58,779 --> 00:21:00,619 be doing. You know, we're the county facility. 605 00:21:00,619 --> 00:21:02,295 We should should be there helping folks. 606 00:21:02,595 --> 00:21:04,115 So I think that helped in terms of 607 00:21:04,115 --> 00:21:04,615 visibility. 608 00:21:05,315 --> 00:21:07,075 But I think that the growth we've had 609 00:21:07,075 --> 00:21:09,154 and the growth we expect is also going 610 00:21:09,154 --> 00:21:11,494 to be helping us in that area because 611 00:21:11,875 --> 00:21:13,734 we are seeing a bigger exposure 612 00:21:14,460 --> 00:21:16,380 to the commercial patient base, which as you 613 00:21:16,380 --> 00:21:18,460 know is what offsets what we don't get 614 00:21:18,460 --> 00:21:19,279 paid from 615 00:21:19,819 --> 00:21:21,119 Medicare and Medicaid. 616 00:21:21,660 --> 00:21:23,019 A lot of people think we get our 617 00:21:23,019 --> 00:21:25,339 costs there, you know, and theoretically on Medicare 618 00:21:25,339 --> 00:21:26,400 we're supposed to. 619 00:21:26,779 --> 00:21:28,400 Medicaid we're not close. 620 00:21:28,974 --> 00:21:30,734 So and plus we still have a good 621 00:21:30,734 --> 00:21:31,634 size insured 622 00:21:32,254 --> 00:21:33,315 population. So 623 00:21:33,694 --> 00:21:35,454 I think it's difficult. I think the folks 624 00:21:35,454 --> 00:21:36,194 in finance, 625 00:21:36,734 --> 00:21:38,654 and the folks that are in collections in 626 00:21:38,654 --> 00:21:40,829 our business office do a phenomenal job. 627 00:21:41,549 --> 00:21:42,909 I like to think we have a little 628 00:21:42,909 --> 00:21:44,829 part of that in terms of contracting, so 629 00:21:44,829 --> 00:21:45,490 that's helpful. 630 00:21:46,109 --> 00:21:48,429 But trying to go through, what we're gonna 631 00:21:48,429 --> 00:21:50,029 be doing, I guess, within the next year 632 00:21:50,029 --> 00:21:51,950 or so is is we're gonna be looking 633 00:21:51,950 --> 00:21:53,970 at our payer partnerships a little more closely. 634 00:21:54,304 --> 00:21:56,065 I've heard different guests on the show talk 635 00:21:56,065 --> 00:21:57,424 about the fact that that you really need 636 00:21:57,424 --> 00:21:59,984 to assess where they are with Medicare Advantage 637 00:21:59,984 --> 00:22:00,484 contracting. 638 00:22:01,105 --> 00:22:02,804 We're in just about every network, 639 00:22:03,265 --> 00:22:06,224 and we wanna be generally because we're the 640 00:22:06,224 --> 00:22:08,384 county facility. We wanna make sure people have 641 00:22:08,384 --> 00:22:09,444 access to us. 642 00:22:09,839 --> 00:22:11,440 But at the same time, there are some 643 00:22:11,440 --> 00:22:12,980 that are just really underperforming, 644 00:22:13,839 --> 00:22:16,640 more denials, more, you know, hassle in terms 645 00:22:16,640 --> 00:22:17,859 of everything, you know, 646 00:22:18,319 --> 00:22:21,279 collections efforts, you name it. And we probably 647 00:22:21,279 --> 00:22:22,559 need to go through some of those and 648 00:22:22,559 --> 00:22:24,339 see whether it's worth continuing. 649 00:22:25,294 --> 00:22:27,375 I think, you know, there are some tough 650 00:22:27,375 --> 00:22:28,755 choices being made, 651 00:22:29,294 --> 00:22:30,974 but I'm optimistic, and, 652 00:22:31,615 --> 00:22:33,454 the growth that we've had, I think, is 653 00:22:33,454 --> 00:22:36,015 is probably gonna continue, especially with the new 654 00:22:36,015 --> 00:22:38,174 hospitals. But let me give you an example, 655 00:22:38,174 --> 00:22:40,410 I guess, in how our our commercial mix 656 00:22:40,490 --> 00:22:41,390 has probably changed. 657 00:22:42,090 --> 00:22:44,009 About two or three years ago before we 658 00:22:44,009 --> 00:22:46,269 opened the new women's and children's hospital, 659 00:22:47,130 --> 00:22:48,809 we were delivering, I want to say, it 660 00:22:48,809 --> 00:22:50,029 was about 4,000, 661 00:22:50,570 --> 00:22:51,789 newborns a year. 662 00:22:52,250 --> 00:22:54,410 We're probably gonna end this year close to 663 00:22:54,410 --> 00:22:54,910 six, 664 00:22:55,769 --> 00:22:57,845 which is know, 50% increase, 665 00:22:58,384 --> 00:23:00,085 in a couple of years. 666 00:23:00,545 --> 00:23:03,664 And it's to me, it's it's completely credited 667 00:23:03,664 --> 00:23:05,924 to the the new facility we have, 668 00:23:06,305 --> 00:23:08,484 the medical staff who is, you know, amazing, 669 00:23:09,089 --> 00:23:11,089 the leadership folks that are running the women's 670 00:23:11,089 --> 00:23:13,089 and children's hospital, I I love talking to 671 00:23:13,089 --> 00:23:14,450 them. I meet with them at least once 672 00:23:14,450 --> 00:23:15,890 a month to talk about what's going on 673 00:23:15,890 --> 00:23:16,710 and what's new. 674 00:23:17,009 --> 00:23:19,089 I just think it's, it's a great opportunity 675 00:23:19,089 --> 00:23:21,349 for the community. It's state of the art, 676 00:23:21,569 --> 00:23:23,750 and I just I'm impressed with it myself. 677 00:23:24,335 --> 00:23:26,575 One of our, team members actually had her 678 00:23:26,575 --> 00:23:29,075 most recent her baby recently there, and 679 00:23:29,615 --> 00:23:31,615 she was pretty impressed as well. So, 680 00:23:31,934 --> 00:23:34,015 I just think the challenges we have can 681 00:23:34,015 --> 00:23:34,755 be met. 682 00:23:35,134 --> 00:23:36,575 I think part of it is you've got 683 00:23:36,575 --> 00:23:38,174 to look at, you know, where your strengths 684 00:23:38,174 --> 00:23:40,480 are and what your mission is. And I'm 685 00:23:40,480 --> 00:23:42,480 one of those people that just believes that 686 00:23:42,480 --> 00:23:44,160 if you have a good mission, you live 687 00:23:44,160 --> 00:23:46,579 your mission, the rest of it will work. 688 00:23:46,640 --> 00:23:48,480 It'll come to you because you're in it 689 00:23:48,480 --> 00:23:49,460 for the right reason. 690 00:23:49,920 --> 00:23:51,825 I know that sounds a little touchy feely, 691 00:23:51,904 --> 00:23:53,505 and I've got an accounting degree, so I 692 00:23:53,505 --> 00:23:55,444 don't know how to reconcile those two. 693 00:23:55,744 --> 00:23:57,984 But, it's just kinda who I am. We 694 00:23:57,984 --> 00:23:59,424 just wanna do the best we can for 695 00:23:59,424 --> 00:24:01,345 the patients we have, make sure we're as 696 00:24:01,345 --> 00:24:02,724 efficient as we can be, 697 00:24:03,184 --> 00:24:05,650 and be around for, you know, decades to 698 00:24:05,650 --> 00:24:07,990 come. Hopefully, we're over a 100 years old 699 00:24:08,130 --> 00:24:09,990 now. So I think it's very possible. 700 00:24:10,690 --> 00:24:12,690 Yeah. No. No. I certainly appreciate it. It 701 00:24:12,690 --> 00:24:13,809 goes back to that old, 702 00:24:14,690 --> 00:24:15,009 deal 703 00:24:15,650 --> 00:24:17,650 no mission, no margin, but no margin, no 704 00:24:17,650 --> 00:24:18,150 mission. 705 00:24:18,934 --> 00:24:21,595 Right. Right. Kevin, you touched on 706 00:24:22,054 --> 00:24:23,894 a little bit there, but I wanted to 707 00:24:23,894 --> 00:24:25,494 expand on the last question I have for 708 00:24:25,494 --> 00:24:26,934 you. You talked a little bit about the 709 00:24:26,934 --> 00:24:29,335 growth at University Health. 100 year old health 710 00:24:29,335 --> 00:24:31,414 system, lot of exciting things happening at the 711 00:24:31,414 --> 00:24:33,740 moment in the future. You've mentioned the the 712 00:24:33,740 --> 00:24:35,980 new women's and children's hospital just opened up. 713 00:24:35,980 --> 00:24:38,539 You're opening a couple other facilities. Sounds like 714 00:24:38,539 --> 00:24:41,099 rapidly expanding your medical group, leaps and bounds 715 00:24:41,099 --> 00:24:43,500 as well. But over the next twelve months 716 00:24:43,500 --> 00:24:44,159 or so, 717 00:24:44,619 --> 00:24:46,539 how are you looking at growth, whether the 718 00:24:46,539 --> 00:24:48,695 health system more broadly or or specifically in 719 00:24:48,695 --> 00:24:50,535 your revenue cycle department? What are the kind 720 00:24:50,535 --> 00:24:52,154 of key things that you're focused on? 721 00:24:52,775 --> 00:24:54,455 Well, for the growth, again, I think you're 722 00:24:54,455 --> 00:24:56,055 just kind of fine tuning what we do, 723 00:24:56,055 --> 00:24:57,815 at least in my opinion. Our like I 724 00:24:57,815 --> 00:25:00,855 said, our CRO has a definite vision for 725 00:25:00,855 --> 00:25:02,695 where he wants to go, and I I've 726 00:25:02,695 --> 00:25:04,640 seen it take shape over the years. 727 00:25:05,100 --> 00:25:06,960 From my little perspective, I guess, 728 00:25:07,420 --> 00:25:10,400 I wanna see us implement that contract implementation 729 00:25:10,619 --> 00:25:13,340 process, that education program for our rev cycle 730 00:25:13,340 --> 00:25:15,180 and leaders. I wanna make sure that that's 731 00:25:15,180 --> 00:25:17,644 available. It's closing the gaps in knowledge 732 00:25:18,025 --> 00:25:21,384 and access that they have. We have, taken 733 00:25:21,384 --> 00:25:23,065 a lot of, a lot of effort and 734 00:25:23,065 --> 00:25:24,825 a lot of time to meet with them 735 00:25:24,825 --> 00:25:26,505 to make sure that we understand their needs. 736 00:25:26,744 --> 00:25:29,144 We're gonna continue to do that, and we're 737 00:25:29,144 --> 00:25:30,839 gonna build the program around them. 738 00:25:31,400 --> 00:25:33,159 So I'm excited about that. I think that's 739 00:25:33,159 --> 00:25:35,079 gonna be something we our little team's gonna 740 00:25:35,079 --> 00:25:37,159 focus on. I think we're gonna look at 741 00:25:37,159 --> 00:25:39,079 some of our contracts and try to make 742 00:25:39,079 --> 00:25:40,839 sure that they're doing what they need to 743 00:25:40,839 --> 00:25:41,900 be doing for us, 744 00:25:42,519 --> 00:25:44,839 as well as, they're balancing, you know, the 745 00:25:44,839 --> 00:25:47,134 access for the community that is so important. 746 00:25:47,914 --> 00:25:49,914 The other piece of it, I guess, just 747 00:25:49,914 --> 00:25:51,755 goes on to data. We do a lot 748 00:25:51,755 --> 00:25:54,095 in our little team that probably some contracting 749 00:25:54,154 --> 00:25:56,955 departments don't do. We do build the contracts 750 00:25:56,955 --> 00:25:57,450 in Epic, 751 00:25:58,409 --> 00:26:00,509 and through our three certified folks, 752 00:26:00,889 --> 00:26:02,490 we do do have a, 753 00:26:03,049 --> 00:26:04,909 a contract performance audit function. 754 00:26:05,450 --> 00:26:06,829 We are doing this implementation 755 00:26:07,130 --> 00:26:09,210 training part, which is not something that a 756 00:26:09,210 --> 00:26:11,789 lot of managed care contracting departments do. 757 00:26:12,525 --> 00:26:13,965 But the other piece of it is we 758 00:26:13,965 --> 00:26:16,705 wanna build a reporting structure. We wanna build, 759 00:26:17,404 --> 00:26:19,825 reporting that we can look at our contracts 760 00:26:19,965 --> 00:26:21,585 through, our payer scorecards, 761 00:26:22,445 --> 00:26:24,929 can look at performance by service line, can 762 00:26:24,929 --> 00:26:26,849 look at, you know, everything from time to 763 00:26:26,849 --> 00:26:29,250 pay to accuracy of payment, all the rest 764 00:26:29,250 --> 00:26:31,250 of that, and build something that we can 765 00:26:31,250 --> 00:26:32,069 then share, 766 00:26:32,450 --> 00:26:33,909 with our executive team, 767 00:26:34,289 --> 00:26:35,730 and with the rest of the leaders in 768 00:26:35,730 --> 00:26:36,789 the revenue cycle. 769 00:26:37,355 --> 00:26:40,575 We have something called our payer performance evaluation 770 00:26:40,795 --> 00:26:42,975 team, and essentially that's just a group of 771 00:26:43,115 --> 00:26:45,115 of revenue cycle folks that that are my 772 00:26:45,115 --> 00:26:45,615 peers. 773 00:26:46,075 --> 00:26:47,775 We get together once a month, 774 00:26:48,154 --> 00:26:50,255 and we go through what the latest contract 775 00:26:50,315 --> 00:26:51,390 proposals are like 776 00:26:51,869 --> 00:26:53,630 so they can understand what the payers are 777 00:26:53,630 --> 00:26:55,390 trying to, you know, to ask us to 778 00:26:55,390 --> 00:26:58,130 do, rate structure wise or operationally. 779 00:26:59,070 --> 00:27:01,490 We also get their feedback on our own 780 00:27:02,109 --> 00:27:04,609 contract checklist. We have a a toolkit 781 00:27:05,285 --> 00:27:06,724 that helps us to go through and make 782 00:27:06,724 --> 00:27:08,585 sure we have the right language in place. 783 00:27:08,804 --> 00:27:11,785 One, because we're governmental, but two, because operationally 784 00:27:11,924 --> 00:27:13,365 we've learned a lot of things over the 785 00:27:13,365 --> 00:27:14,724 years and we want to make sure that 786 00:27:14,724 --> 00:27:15,464 that's included. 787 00:27:16,005 --> 00:27:17,785 So they help us evaluate that. 788 00:27:18,180 --> 00:27:19,779 And then the other piece is we do 789 00:27:19,779 --> 00:27:21,160 a quarterly meeting, 790 00:27:22,019 --> 00:27:23,700 that we call our managed care committee, but 791 00:27:23,700 --> 00:27:26,100 essentially it's the executive group. And we talk 792 00:27:26,100 --> 00:27:27,880 about where the contracts are performing, 793 00:27:28,420 --> 00:27:30,900 what negotiations are happening, and how things are 794 00:27:30,900 --> 00:27:33,140 going there and have happened over the last 795 00:27:33,140 --> 00:27:33,640 quarter, 796 00:27:34,375 --> 00:27:36,214 and then also, to make sure that they're 797 00:27:36,214 --> 00:27:38,474 up to speed on what networks we're in, 798 00:27:38,934 --> 00:27:41,414 what networks other folks are in, and, you 799 00:27:41,414 --> 00:27:43,015 know, where there may be some gaps that 800 00:27:43,015 --> 00:27:44,075 we need to close. 801 00:27:44,775 --> 00:27:47,575 We're a partner with the the University of 802 00:27:47,575 --> 00:27:49,879 Texas Health Science Center in San Antonio. 803 00:27:50,259 --> 00:27:52,099 They make up the majority of our medical 804 00:27:52,099 --> 00:27:54,740 staff at University Hospital right now, and probably 805 00:27:54,740 --> 00:27:55,799 will for many years, 806 00:27:56,179 --> 00:27:57,700 so we want to make sure we're aligned 807 00:27:57,700 --> 00:27:59,954 as best we can in participation with them. 808 00:28:00,994 --> 00:28:04,294 Our own medical group, University Medicine Associates, does 809 00:28:04,515 --> 00:28:05,734 all of our anesthesia, 810 00:28:06,434 --> 00:28:08,214 a lot of our hospitalist work, 811 00:28:08,515 --> 00:28:10,274 all of our NICU work, and that kind 812 00:28:10,274 --> 00:28:11,255 of thing. So 813 00:28:11,794 --> 00:28:13,154 we want to make sure that they're in 814 00:28:13,154 --> 00:28:15,394 the right contracts and their services are being 815 00:28:15,394 --> 00:28:15,894 covered. 816 00:28:16,299 --> 00:28:17,740 So a lot of making sure I think 817 00:28:17,740 --> 00:28:18,140 that, 818 00:28:18,539 --> 00:28:20,619 down the road that we're we're contracted with 819 00:28:20,619 --> 00:28:21,680 who we need to be. 820 00:28:22,059 --> 00:28:24,140 We try to expand access where we can. 821 00:28:24,140 --> 00:28:26,059 There are some exchange products we're not in 822 00:28:26,059 --> 00:28:28,059 now that I really want us to join 823 00:28:28,059 --> 00:28:29,759 if we can get access to them. 824 00:28:30,325 --> 00:28:32,805 But as the the local county governmental hospital, 825 00:28:32,805 --> 00:28:35,045 we wanna be available to everybody. So that's 826 00:28:35,045 --> 00:28:36,805 one of my personal goals is to to 827 00:28:36,805 --> 00:28:38,744 try to close those gaps where I can. 828 00:28:39,205 --> 00:28:41,625 A lot happening, but it's all exciting stuff. 829 00:28:42,244 --> 00:28:44,005 So I hope that answered the question. And 830 00:28:44,005 --> 00:28:45,599 if, I went in too many directions, 831 00:28:46,160 --> 00:28:47,599 just let me know, and I'll focus where 832 00:28:47,599 --> 00:28:49,759 you need me to. No. No. Not at 833 00:28:49,759 --> 00:28:50,819 all. I think, Kevin, 834 00:28:51,279 --> 00:28:52,880 it's almost going on at any one point, 835 00:28:52,880 --> 00:28:55,059 but I think so so greatly respect, 836 00:28:55,519 --> 00:28:56,740 so greatly appreciate, 837 00:28:57,279 --> 00:28:59,299 the work that you that your teams do, 838 00:28:59,835 --> 00:29:01,515 University Health. That was great to catch up 839 00:29:01,515 --> 00:29:03,275 with a leader at such a fantastic health 840 00:29:03,275 --> 00:29:03,775 system. 841 00:29:04,234 --> 00:29:07,035 Kevin, really, really enjoyed this conversation that those 842 00:29:07,035 --> 00:29:09,434 thirty minutes or so absolutely flew by. I 843 00:29:09,434 --> 00:29:11,115 really really look forward to connecting with you 844 00:29:11,115 --> 00:29:12,554 again down the line, and thanks again for 845 00:29:12,554 --> 00:29:13,914 taking the time out of your busy, busy 846 00:29:13,914 --> 00:29:15,035 schedule to have a word with us on 847 00:29:15,035 --> 00:29:17,269 the Becker CFO and Rev Cycle podcast. 848 00:29:17,970 --> 00:29:19,409 Oh, no. Thank you so much. I really 849 00:29:19,409 --> 00:29:21,250 appreciate it, Alan. This is a great opportunity, 850 00:29:21,250 --> 00:29:22,769 and I'll be listening to all the other 851 00:29:22,769 --> 00:29:24,069 episodes. That's for sure. 852 00:29:24,369 --> 00:29:25,349 Thank you, Kevin.