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description. We are excited to welcome you in October.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by James Linn,
executive director of Revenue Cycle Systems Optimization at University of Miami
Health. James, it's a pleasure to have you on the podcast today.
Thank you so much. Happy to be here, Laura.
Now I'm looking forward to our discussion because I know that the revenue cycle
is such an important area of any organization,
but especially for hospitals and health systems,
and there's a lot changing around the revenue cycle right now.
Some very exciting things happening. So I'm looking forward to our discussion.
But before we dive into my questions,
I was wondering could you tell us a little bit more about yourself and your
background?
Yeah, absolutely. Um,
so I've been at the University of Miami for about a year and a half now. Um,
came down in October of 2021. But, um, in this role that I'm in today,
sort of building a team of architects that works collaboratively between
operations and it, um, to develop solutions,
whether it's core revenue cycle or some of the ancillary administrative things
that surround revenue cycle. Um, before coming to the Miami,
I did work for Epic Systems, um, large E M R in the,
in the healthcare space in Verona, Wisconsin. Um,
had a privilege of working with a lot of health systems, um,
throughout my time there,
understanding various revenue cycle demands and revenue cycle needs, um,
before making the jump over to Miami.
Amazing. Wow, that's awesome to hear. And definitely from your time at Epic,
you know, I know that's a huge organization and like you mentioned,
I'm sure you connected with and touched on lots of different health systems.
Was there anything that you consistently saw, um, with the systems that were,
you know,
kind of the top performing ones or those that were really able to adopt the
technology in and move forward in the swiftest fashion?
It sounds cheesy sometimes, but the an,
the honest answer is those that truly put the patient at first. Uh,
and I mean that in the sense that while obviously financials matter,
while obviously everything around a health system is important,
those that made their decisions and drove every single aspect
of their business around the patient's experience,
both medically from an administrative perspective,
from a financial revenue cycle, statements, claims and billing perspective,
if they use that as their true north,
those are the groups that are consistently in the news of of being outstanding,
the doctors of technology, outstanding industry leaders in other all aspects.
It that,
that seemed to really be the common thread because it allowed them to be,
it allowed them,
it opened them up and allowed them to be more focused on questions around,
you know,
what's best for the business through the lens of what's best for the patient.
And if they focus on what's best for the patient, the business comes. Um, and,
and I'd say that's probably the most common theme is, is,
is making sure that the patient part was in the very forefront of their,
of their decision making,
both at the clinic clinical and clinician level all the way through the,
the business and the administrative function.
That's such a great point. Thank you so much for pointing that out, James.
Now what are some of the opportunities that you're seeing from your vantage
point at University of Miami Health as well as the headwinds that you have your
eye on?
So the University of Miami and,
and not unlike other academic medical centers all across the United States,
we pride ourselves on being, having the best faculty. And,
and I think when I worked at Epic, a lot of people said that,
and I think Miami means it and they have the data to support it. Um,
in terms of, at the forefront of it is how do we empower our faculty,
our our physicians and our providers to do what they do best. Um,
so the opportunities we have in front of us is how to make their job more
efficient in what their core mission is.
Their core mission is caring for patients.
The core mission is designing and developing in new research studies to find new
treatments and new diagnoses, methodologies. Um,
and if we are not doing everything we can in from a revenue cycle perspective
and from an IT perspective, then we're not doing our jobs.
So the opportunities are to find ways to make what they do more efficient.
So I see AI as a huge opportunity for physician efficiency and physician
development. I see automation and coding, um,
and automation of understanding what the physician's documentation are.
I think if you look back over the last 20 years, the,
the driver of clinical documentation wasn't necessarily medical necessity.
It was billing , um, and billing requirements and,
and and billing obligations to in,
whether that's insurance audits or insurance payments and insurance
reimbursement. And as we move to a more AI driven or automation driven world,
we can infer and drive the conversation to the right place and empower the
physicians to say what they wanna say,
say what they need to say to speak to their peers.
The the doctors they're referring to the pathologists,
they're sending lab labs to the patient who's trying to understand and,
and deal through this treatment plan or various diagnosis or comorbid conditions
that they have. The, the physician at the,
at the fundamental core of what they do is to translate what's happening into an
actionable next step. And I think through AI and through automation,
we can make it easier for them to document charge, um,
and prove the level of medical necessity to meet the requirements that we have
for charging and doing those various other things.
And I think the headwind in that is the industry's moving there fast, right?
We're seeing massive developments, um,
both from Epic but also all many other tech companies and other health systems
like the University of Miami who are innovating in this space.
And so it's actually the type of work that gets me most excited, um,
cuz it truly has an opportunity to benefit without getting in the way. Um,
I think the next big category, if you think of,
if you think maybe go more broad outside of just providers and think about how
do we make sure their prov their schedules are as full as possible, um,
in a way that is meets the expectations of their contract and their clinic
panel.
So we obviously don't wanna overburden providers with more than what they're
expected and are capable of doing.
So I'm not saying go to five minute slots or something that's unattainable and
un non feasible. We're not trying to work like a factory here,
but patients knowshow for reasons we can predict, um,
patients late cancel for reasons we can predict and intervene against. Um,
and provider time might not always be optimally used, um,
both in a clinic, in a hospital, in a research setting.
So thinking about how can technology inform operational decisions.
Um, and so that's one of the big opportunities we have is leveraging these,
you know, you know,
machine learning and natural language model processes to understand where the
opportunities are,
both for documentation but also just using time that the providers are giving us
most efficiently and effectively.
I love that. I think it makes a lot of sense, you know,
and it's really forward looking in terms of how the technology can
boost the providers, make them happier, make the organization more efficient,
and certainly get to a space where you're smartly um,
connecting with patients and,
and doing what needs to be done to deliver that care.
So I think that is such a great example in and really dovetails into my next
question.
And looking at revenue cycle obviously is important for the entire organization
as a foundation for it. Um,
but as you're thinking about growth and development in the future, how, uh,
are you,
I guess how are you adding value to the health system and and what does that
really look like?
That's great. So the, from a true finance perspective,
from my finance hat on, there's two ways to grow a business,
grow revenues or reduce cost.
And we are focusing on both very aggressively.
The University of Miami is making substantial investments in our community in
terms of additional facilities. We have a lot of,
we have three major construction projects in flight right now that are
deploying new state-of-the-art facilities to various communities within the
Miami-Dade Broward County area. Because at the end of the day, in order to grow,
you have to physically grow, you have to hire more faculty,
create new positions,
create new state-of-the-art facilities that have both research capabilities as
well as patient care, um,
facilities to see patients across all the spectrums of all of our service lines
cuz we're, you know, a fully diversified academic medical center.
So when I think about growth,
I think about making sure that we can do those investments and do those
investments smartly. Um,
that means making sure we have the margin to purchase and pay for the
construction,
but also we have the technology that allows us to be innovative in the way that
those clinics are being built.
So we're not just building another 1980s hospital,
we're building something that would be appropriate and we'd be proud of in the
nine, in the 2000 forties or 2000 fifties.
I think the way that we help with that and the way that my team focuses
on this is how do we do more with less than, um,
so as we scale up and add more visits per day,
add more providers on in our clinics,
how do we make sure we're doing that in a way that empowers the patient to
schedule themselves, to register themselves,
to reach out and get ahold of someone when they have a question and get to the
right place most efficiently?
And that's all focused primarily on the revenue side and a and a lot of those
things, I'll admit, they drive cost, right? We do.
We have to pay for the technology, we have to pay for the faculty,
we have to pay for the construction. Um,
and so it's important that we're also having,
we're focusing on the other side of that equation, which is cost. Um,
and that's the, the work that we do, the,
the relationships we have with vendors, um, whether that's one,
how we process statements or how we process insurance verifications or
authorizations.
If they were being strategic about are we leveraging all the technology we
should and are we getting all, everything we could out of it? Um,
a good example is Epic comes out with new technology,
new code sets every quarter. Um, something that is,
is hard for a health system to keep up with at our scale, but we,
we've put a lot of energy into making sure that every time Epic says, Hey,
university of Miami and all their other customers,
look at this new programming that we developed or this new workflow or this new
content that we're putting out. Use it. Um, and we find ourselves if,
if health systems don't focus on that and make sure that's a core priority is
keeping up to date with your, with your software updates,
so to say that you then are not taking advantage of the licensing costs you're
spending money on. So it's a big focus. So it's not all,
it's making sure we're not duplicating our costs fo buying things more than once
to do the same outcome, outcome and function. Um,
and then making sure that for everything that we're doing we're appropriately
incurring the right at cost and not over not too many costs that we shouldn't be
incurring overall in the first place.
I think the combination of those two things, the, you know,
making sure that we're actively growing and growing at the rate that we need to,
we're keeping our costs controlled and then also finding places to reduce cost.
That's where my team,
and that's how we think of where our value is to the organization. Um,
because at the end of the day, you can keep, you can keep adding more people,
you can keep dropping more charges,
but if you're not doing it within the realm of what is needed,
you're doing something because of something of a workflow you did 20,
30 years ago,
you're gonna fall behind and your cost curve's gonna catch up with your revenue
curve. Um, and you're gonna, you're, you're,
it's gonna happen before you realize it and before you know it,
you're gonna be losing millions if not billions of dollars a year,
which we see in the press all the time.
But these massive health systems all over the US that are, you know, for many,
many quarters,
not just cuz of covid but even post covid we're reporting massive operating
losses is because they really struggled to control cost while,
while also pushing various levels of, of revenue growth.
I think the last thing that I would note on this topic is
there's always opportunity in your existing, we call this your same store.
So the existing faculty with the existing clinic time with the existing or time
with the existing inpatient beds,
we find that we're not always utilizing those resources to the highest
potential. So a lot of our projects are actually just analytics in nature.
It's helping develop reports that aren't just numbers on a page,
but are are, you know,
graphical representations that provide a directional recommendation for what the
business can do. A good example,
we recently had a project where we started monitoring more discreetly all of our
outpatient ambulatory rooms, um, when were patients being put in them,
when were they being removed, when were providers and c nurses entering them,
and how effectively were we using that real estate because as we add more
faculty,
we can't all of a sudden add a bunch of more rooms unless we build a new
building. Um, and we found that we had a bunch of,
of our satellite locations that were operating at like 70, 80% utilized.
Um,
and we were able to use the data to find out where was the time not being used,
um,
and then suggest that maybe that's where we put the new faculty member or maybe
we could adjust some sessions or some panels around to be a, uh,
to be aligned in a model that is more conducive to the real estate that we have.
Just one example of, of a project that we've done that doesn't,
it's not changing the revenues, it's not changing the costs,
but it's providing insights into the, the how we're using the things that,
that we have at our disposable, whether that's real estate or time, um,
you know, advanced practitioner time, physician time, et cetera is a, you know,
big analytical focus for my team to, to drive growth at the organization.
Absolutely. I love that.
I think that makes a lot of sense and definitely great examples of areas and
spaces where it really is helpful for the organization to make sure
that, you know, as you mentioned, the revenue's in a good spot,
their costs are controlled,
they're set up for the future and success once you know you're able to do that.
And along those lines, you know, I,
I know as you have been talking about a lot of the hospitals and health systems
are in a, a more financially challenging spot than they were a few years ago,
especially before the pandemic,
but it's still so critical and crucial to make sure you're set yourself up to be
successful in the future for growth and development, et cetera.
So from your perspective,
where do you see is one area that's still really important to make investments
in this coming year?
The, the first one is people. Um, I think the,
you can't build greatness without greatness, right?
You need people that have experience, passion,
and a desire to be involved in the mission of the business.
So, and that means, you know,
evaluating our people in the right positions that they're currently in,
are there people that aren't here that we need to bring here?
And that's hard cuz it's a, it's ultimately just a game of, of, of good,
good challenging recruiting.
I think there's a recruiter here that I talked to on a regular basis. I,
as I find, you know, great talent for my teams and they said to me,
and I'm sure they're quoting someone else,
so I don't know the appropriate original quotation on this is that the best
people aren't looking. Um,
so the most talented employees that you could have, the most gifted, creative,
um, urgent individual who can help drive innovation,
whether it's clinical or IT or business administration,
most of them aren't looking for jobs, right? They're in a job,
they're doing outstanding work, they're crushing it, right?
They're doing something, adding a ton of value at another organization.
And in order to recruit, you can't always go to the, the, the,
the places that you think of when you think of recruiting.
We can't just post on LinkedIn,
we can't just post on Indeed or post on our jo in Workday for a job posting.
You'll, you'll absolutely find great people doing that.
I'm not saying that no one great is looking,
but a lot of the people that you want are in a stable job that they like
and you have to find a way to convince them that your mission is worth them
leaving and fighting for. So that, that, that's one,
and I'm gonna cheat and add another one, um, because I can,
I guess since we've got the time, um, is that the,
the other big I think place that I think it's worth taking risk on is
pushing the envelope on ai, right?
And I think it's easy to sit and wait for some tech company with a bunch of
venture capital funding to come around and offer you this product at 50% margin
that adds value to the business. That's easy, that's lazy.
I would almost say I don't,
I don't mean that to say there's no good products out there, but that's,
that's the, that's the,
that's the reactionary approach as a business or as an innovative,
as an innovative company.
What a company who's innovative should be doing is get out in front of this and
play with the technology. Go invest in chat G B T private for healthcare.
Go invest in, you know,
Amelia AI for conversational s m s and voice conversations.
Go invest in, um, Microsoft facial recognition api.
So like,
go find something that even though there might be a big sticker price for what
it's going to do, invest in it, bring it in and challenge the heck out of it,
right? Rip it apart,
put it back together and build something that can help disrupt the way
you do the business today. Um, because the worst thing,
the worst you could do is that you install a product that
works somewhere else, right? You,
you help build your portfolio of tools to help empower users.
That's the worst thing that could happen. The best thing that could happen,
or probably the most likely thing is you're gonna disrupt so many workflows and
so many things that you do in your health,
in the health system to help improve the patient experience,
improve the bottom line, increase utilization for providers,
do all these things that we've talked throughout this podcast about, um,
in terms of, you know,
innovating and disrupting the way that business is done in healthcare.
But the only way health systems can do that is if they take a risk and invest in
those technologies and invest in the base technology.
Don't invest in the most shiny thing over here that has the prettiest sales
pitch deck.
Invest in the best brain and the best tech stack that you can get your eye
hands on and then play with it,
invest in it and spend the time that you need to spend to make it work for you
and it'll pay dividends down the road. Um, those are,
those are things I think it's worth taking a risk on cuz you're, you're,
you're gonna make your r o i it might not be right away. Um,
but as long as you believe in the product, you believe in the technology,
it's gonna pay dividends. And then to my first point,
if you've got really smart people working for you,
people that are motivated by the mission, motivated to do good,
motivated to care about the patient first,
you're gonna make magical things happen. Um, in terms of innovation, innovation,
growth, reducing costs, improving the patient experience, all the things that,
that those fancy pitch decks that you got from the venture firm show you,
you're gonna do that yourself. You're gonna do that with your team,
with your technology, with your partners that care about you, um,
rather than just being another line item in someone else's p and l.
I love that. That's such an amazing way to look at it and think about it.
And I can imagine, you know, it's uh, easier said than done,
but certainly it makes a lot of, uh, um,
a lot of sense for hospitals and health systems and you know,
when you have your internal team set in place,
how do you empower them and embolden them to do some of these exciting,
the fancy things that you're talking about?
Freedom. I give them freedom, right? And I,
and that's because I'm given freedom. I'm, I don't, you know,
my boss and my leadership team gives me the ability to go kind of
take risks and,
and tackle projects that I think you're gonna help us in partner with operations
and convince them of the value. They, they, they trust me in doing that.
And I do the same thing for my team. Um, I have a good example.
I have this patient flow architect who I recruited out of a happy job.
I went and called him and I said, I want you down here in Miami.
After some negotiation, I convinced him to move down to the, the beautiful,
the beautiful south Florida. And he is not,
he's not turned back or regretted it, but I said to him when he first came here,
I'm not just gonna assign you tickets.
I'm not just gonna assign you a PM and assign you a project and tell you to go
do it. I'm gonna introduce you to people that matter here.
I'm gonna introduce you to our c e o of the hospital.
I'm gonna introduce you to the head of patient movement.
I'm gonna introduce you to the head of patient safety and, and public safety.
And I want you to work with them and figure out what they need. I,
I think I know what they want.
They've talked to me about it before and here's some starter points to start
preparing. I, you know, I don't leave them stranded off in the world,
but I just sort of say,
I'm gonna let you go figure out what you want to do and come back to me and let
me know and then we'll workshop it together.
Then in our one-on-ones that we have every week, they bring in ideas,
we workshop 'em, some of 'em die, some of 'em evolve,
some of them get put on the table for later. Um,
but I sort of, I, you know, like I said, I, I'm trying to find these geniuses,
these unicorns out in the industry, bring them to University of Miami,
the exciting place to work and then give them freedom to do what they do best,
which is think creatively develop. And then I sit there,
I sit in my seat and one help workshop with them,
hoping if I can even keep up with their speed of, of work, um,
and then help bring down barriers, whether that's an IT barrier,
whether that's a decision making barrier or operational barrier,
a technical whatever the thing is, the,
the thing that could potential potentially roadblock a project like this. Um,
and then I intervened to help with that type of stuff to keep them out of the
messiness of some of that. Mm-hmm ,
I'm sure a lot of people listening experience that in their own,
in their own in, in their own industry or in their own health systems. Um,
and I try to tackle that for my team cause it can be really easy for them to get
these really creative minds to get bogged down in politics
or bogged down in process.
And I see my role as their leader to help push through some of that and help
them just do what they do best, which is, you know, create creative ideas, um,
and get them deployed as fast as possible.
I love that. Thank you so much for going through everything there and, and just,
you know, what a, a fabulous system you have set up. It sounds like an amazing,
um, department and organization to work for. Now, before we wrap up,
I wanted to get your thoughts on growth and development.
Where do you see some of the best opportunities for yourself as well as the
teams that you work with?
It's a good question and I think about this a lot. Unfortunately.
I have a boss who, who, uh,
asked me that question on a regular basis cuz he sees the vision, he's,
he has his own vision and I have mine and we try to find places to align them
together. I think the best opportunities that I have, we have, um,
is to continue to go down this path of painful automation.
I think we've gotten to a point where we are playing off of,
we've already taken the low hanging fruit. It was delicious, it got,
it had great outcomes. We, you know,
we baked an amazing apple pie with the low hanging fruit,
but now we gotta get the stuff that's a little bit higher up and a little bit
harder to operationalize, a little bit harder to change it infects more users,
affects more maybe, you know,
technology debt that we have to take that we have to deal with in terms of bloat
or things that need to be cleaned up.
So the biggest opportunity is building a stronger foundation, um, and,
and finding a way to not only think about the really cool things out there like
ai,
but use that type of project to find things in your foundation that are
cracking. Um, and maybe I don't, I don't,
maybe not there's no structural integrity issue, but, or hopefully there isn't.
But if there is, obviously deal with that first, but if there isn't,
it's doing the preventative maintenance you need to do, um,
to ensure that that building continues to stay strong and you can add more
floors, add more, diversify your team and, and do over mul bigger opportunities.
And I,
I think of the things that my architects are focused on and our team is working
on and the things that constantly hold them up. Um, and it's, it's,
it's some of the debt in terms of historical decisions that were made that need
to be revisited. And that's not easy work. I mean that's time intensive.
It's selling the idea to the business owners.
It's convincing them that it's worth the risk of changing,
it's helping them understand the opportunity. Um, and I think the biggest,
the best, biggest,
best opportunity for growth that I see for us is to continue to do more, right?
Find more areas to tackle within the business,
partnering with operations to, to help them deliver faster.
So I think for all the, you know,
for all the greatness that I think I have on my team in terms of the great
people that I, that surround me, um, there's equally,
if not more talent in the business that's being maybe held back by current
policy or current procedure or current decisions. I mean like any health system,
it's every once in a while you gotta open up that policy and say,
is that the right one? Does it need to be redone,
re revisited reoriented to b to better oriented to the new technology we have or
just the new ecosystem.
I think a good example of this in my mind is a lot of workflows got quickly
developed around covid arrivals into clinics. The ways that,
the ways that patients were screened before surgery.
We had to really quickly as an industry figure out how to deal with this,
you know,
this pandemic that came upon and came back multiple times to haunt us
and now we have to sit here and say, how do we continue to drive us, you know,
prioritize the safety of our employees and the safety of our patients while also
innovating and being more creative around how we,
how we can adjust our workflows, not necessarily to a pre pandemic state,
but to a new state in terms of what do we want our arrival to look like?
How do we wanna leverage kiosks or,
or digital front door type experiences now that we have can rethink cuz we have
different things that are pressuring us. Cause it's not that none,
not everything shut down because of the original, you know,
the covid pandemic errors that we, that we saw across the community.
So that's what, that's kinda what I would mention is just the,
the opportunity is to do more by, you know, focusing on the foundation,
developing more core functions, making sure those are running efficiently,
and then intentionally build on that with,
with additional areas of focus and rethinking the way that, you know,
workflows or processes or policies are, are employed.
Fantastic. James, thank you so much for joining us on the podcast today.
This has been such a fun and insightful conversation and I'm looking forward to
meeting you in person as well at our Health IT Digital Health and Revenue Cycle
event in October.
I know we'll definitely be continuing the conversation and it'll be fun to see
you there.
Absolutely. Thank you so much for the time.
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