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Would you like to exchange best
practices and ideas to improve care,

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enhance operational efficiency,

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and address financial
challenges with your peers?

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Becker's Healthcare is facilitating these
conversations at their eighth annual

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health, IT digital
health and R C M meeting.

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You can check your
eligibility for complimentary
attendance at the link in the

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description. We are excited
to welcome you in October.

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This is Laura Dedo with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Michael Mercurio,

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vice President of Physician Billing
Services at Mass General Brigham and

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co-founder of Coda Metrics. Michael,

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it's a pleasure to have
you on the podcast today.

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Really great to be here, Laura. Thank you.

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Now, I know we've got a lot to talk about.

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There's so much happening in
healthcare and really a lot of, uh,

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interesting and exciting things,

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both on the revenue cycle side
as well as the technology.

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But before we dive into my questions,

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I would love for you to tell us a
little bit more about yourself and your

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background.

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Sure, thanks. Um, I've been with, uh,

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mass General Brigham for about 25 years.

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I've spent the entire parity of my time
in the, uh, physician billing office,

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um, and, uh, currently lead our, our
physician billing team for, for the, uh,

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for the system. Uh, I've also been
involved, as you mentioned earlier,

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with the bringing to life of, uh,

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AI autonomous coding tool that started
out in our organization a number of years

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ago as a workflow enhancement product
and has, uh, since, uh, turned into a,

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a startup that is no longer, uh,
owned by M G B, and we're really,

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really proud of that.

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That's amazing.

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And what was that journey like to kind
of begin and incubate and then spin out,

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I guess, into your own company and
really, uh, be able to thrive in that way?

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It was really exciting to be doing
something other than typical billing work

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because it gave us a,

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a way to think outside the box and bring
a lot of value to our patients and to

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our providers because we were able to
reduce the cost of our services to them

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while improving, uh, a lot of quality.

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And our team actually liked it as well
because we were able to remove a lot of

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the repetitive high volume, low risk,

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not overly exciting work that they
were doing by transitioning that, uh,

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to the machine. Um, on the other hand,
it was a little bit of a challenge, um,

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from a bureaucratic perspective.

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We that we were like the bucket
off a battleship because, uh,

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M G B is not at all in the business of
bringing technology startups to life. So,

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uh, we were doing something
new, uh, and innovative and, uh,

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it just took a lot of, uh, administrative
patience in order to, um, to to, uh,

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to build it up and then
to, um, spin it out.

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Absolutely. Yeah, I can imagine that's
quite a feat. So, um, congratulations on,

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on that and definitely, you know,

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amazing to hear the story and
then definitely to see, um,

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the results after your team, you know,

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included the technology and were able
to incorporate that into their daily

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routines. Now, based on your role
with Mass General Brigham, um,

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what are some of the opportunities and
headwinds you have your eye on right now?

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Yeah,

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I think we're struggling with similar
with some of the similar challenges most

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of the organizations around
the country are doing now,

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trying to find ways to reduce our length
of stay so we can improve the services

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and expand our services to, to
our, our patient populations.

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There's a challenge with higher
costs, uh, and labor shortages, uh,

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which is where, you know, r p A
and AI have been been very helpful,

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not only in the rev cycle
and administrative areas,

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but hopefully soon in the clinical areas.
And, uh, in our space specifically,

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we're trying to find ways to
continue to improve our performance,

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reduce our cost, and reduce
our expense. And, uh,

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we've got a number of strategies
in place to do that and, uh,

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we're executing against those.

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Got it. Absolutely. Yeah, I
think that makes a lot of sense.

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And certainly kind of having those, uh,

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labor and financial headwinds is
something that a lot of folks are,

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are facing right now. You know,
when you look at it and say,

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you got a lot of different
things in, in the works here, um,

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to try to kind of mitigate some of
the, the burden of those headwinds. Um,

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you know,

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is there any one or two
things in particular that
have been particularly, um,

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successful for you or really have
early results, I suppose, in, in, um,

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being able to, uh, just kind of
meet those challenges head on?

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Sure. We've,

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we've used probably three of the main
things that we've been able to leverage,

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uh, have been, uh,

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relying much more heavily in the last
few years on data to make decisions and

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having that data be made
more available to us, uh,

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more readily and more accessible to
more people so that we can identify

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opportunities, uh, for
improvement, uh, before they, um,

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become real problems.

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We've got a number of alerts that
we get when something is, uh,

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outside of baseline so we can react, uh,

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on the middle of the month instead of
waiting for month end close and for

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reports to be generated in two or three
weeks. So we're, we have a lot of, um,

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capability in that space that's really
allowed us to be more proactive, uh,

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as opposed to be reactive. Uh,

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the second thing that we've done is we've
tried to leverage technology wherever

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we can. We have an extremely
robust, uh, R p A program, uh,

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between our physician billing
team and our hostile billing team.

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We've got about 30 bots in,
in place that, uh, on an,

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on an annual basis, um,

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are saving maybe 35 to 40 FTEs a year
worth of work. And we've been able,

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we've been able to build those and roll
them out without impacting any of our

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staff from a reduction
in force perspective.

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We've been able to
transition our staff to,

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to open vacancies or to higher level more
complex work, and that's been a real,

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uh, benefit for us. Um, and then
the third thing that we've been, uh,

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second technology route that we've been
using is, is, uh, code metrics and,

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and similar tools, uh, wherever we can,
uh, identify opportunities for, uh,

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again,

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leveraging technology in order to reduce
the burden of either our team or of our

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physicians. And we're now, uh,

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leveraging four of their modules in
our clinical and rev cycle space,

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and that's been extremely beneficial for,

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to us from a quality as well as the
performance and a cost reduction

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perspective.

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And then the last thing that is that
we've been doing for the last seven or

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eight years is we've been on a,
an offshoring journey, uh, and we,

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we work with three partners in the
physician space at M G B in order to

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reduce the cost to collect and our
onshore headcount while still maintaining

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high quality and high performance.
And we're really proud of that,

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that work because again,

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we've been able to do that without any
reductions in force through shifting

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staff to other roles to open vacancies
or to absorbing growth without having to

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add onshore staff. And so
that's allowed us to drop our,

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our overall cost to collect by
about 17% in the last six years.

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And that's been a cost that
we've been able to pass on, um,

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directly back to our practices,
um, which is what our mission is,

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is to support them, uh, and, uh,
they've been very appreciative of that.

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That's amazing to hear, and thank
you so much for sharing with us.

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It's definitely helpful to understand
what's driving results and, and you know,

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really, um, how you're able to kind of
navigate some of these troubling waters.

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Um, and you mentioned it a little bit or
touched on it a little bit in your last

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response, but I was wondering if you
could go a little bit further as well in,

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in how you're thinking about growth
and adding value to the organization

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overall. I can imagine, um,

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just with the technology and digital
transformation as well as, you know,

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some of the ways that healthcare revenue
cycle is evolving naturally. Um, I,

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I'd just love to hear what you're really
focused on right now and that way is,

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and how you see that, um, growth and
development, um, from your vantage point.

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Well, we, we only serve the patients
of the masculine Brigham network,

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so our growth is basically determined
on either what it would sever either

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organic growth or if there is
any growth through the acqui,

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through acquisitions. And,
and our acquisition, uh,
pipeline right now is, is,

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um, slowed down, uh, quite a bit.
And so most of the growth that we're,

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we're working on is, uh, is organic, uh,

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as an organization and we're doing a
lot of work to reduce our length of stay

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and to improve our patient experience to
hopefully continue to attract patients

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from around the region, the
country, and around the world.

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And my job as a leader in the physician
revenue cycle space is to make sure

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those patients have the best possible
experience, wanna minimize the,

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the mistakes that we make that impact
their bills or their lives, obviously.

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And we want to collect our, uh,
cash as quickly, efficiently,

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and compliantly as possible so that we
can contribute to a positive experience,

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not only for the patients,

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but obviously to the financial
health of the organization.

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So we spend a lot of time trying to
find opportunities to reduce our payer

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denials, reduce our write-offs, how can
we be more efficient, reduce clicks.

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We have really, uh, weekly
conversations around staffing.

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So if there's ever a vacancy we we meet,

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we talk about whether or not that can
be a position that needs to be offshored

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or it needs to be, be held, uh,
or, and then determined later,

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or if it's something that a technology
might be able to, to take on.

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Got it. I think that makes a
lot of sense. And, you know,

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for those conversations,
I can imagine, um,

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it's definitely a very delicate balance
you have to bring in terms of, um,

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looking at things, you know, proactively
in, in leveraging technology,

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but then at the same time, understanding
the human workforce as well. Um,

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how do you approach those kinds of
conversations to make sure they're as

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productive as possible,

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knowing that some people might be a
little bit nervous about getting into the,

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um, that space.

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That was one of the biggest challenges
we've had with our offshore partners as

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well as with the technology is what's
gonna be the impact to me. Um, you know,

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most, most people in the working
environment, um, like, uh,

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hot food and shelter and
heat. And so if you want,

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you wanna be very careful around, you
know, whether, how you're gonna, uh,

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staff the work that you need to do. So
we've taken a, a long-term approach and,

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and trying to be very thoughtful
in, in how we, uh, implement, uh,

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either new technologies or how we, um,

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increase our participation with
offshore staff so that we are, um,

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not causing any panic amongst our
teams. And we've been able to, to, uh,

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stand by those commitments for the last
few years, which has been really, uh,

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beneficial for us. We also
have taken the approach of,

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of not offshoring everything
and, and closing our eyes.

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And as Ron Popiel used to say a few
decades ago, said it and forget it,

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we keep an onshore team, uh,

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of subject matter experts for
everything that we offshore.

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So they help us with
qa, uh, reporting and,

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and management of our offshore partners
just like they would if those partners

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were onshore. So they're
basically an extension of us, uh,

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and we don't treat them as
vendors, we treat them as partners,

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and that's really helped us to, uh,

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build strong relationships with our
partners as well as internally have people

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feel committed to the work that we're
doing and not feel that they're only, um,

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working to, you know, eventually
offshore, offshore their jobs.

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That makes a lot of sense. And,
you know, it's just such a,

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a delicate balance again,

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so thank you so much for your perspective
there and how you approach, um,

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some of those conversations to really,
you know, make sure that the team onsite,

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um, feels, you know,

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taken care of and understands
the direction of the
department as a whole. Now,

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you know, along those lines,
I, I was wondering, um,

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in some of these challenging times,
in times of immense change, you know,

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it can sometimes be a challenge to
take risks or, or make investments, um,

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in spend resources,

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but what do you think is one risk or
investment that is still worth making this

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year?

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I think in the industry,

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healthcare has been slow to adapt
technology and it takes a big change.

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It's a very paper dependent,
manual work industry.

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And so I think that if
you're an organization that
hasn't already dipped its toe

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into the R P A or to the AI space, and
it's something you need to really get,

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get involved with this year,
because otherwise you're,

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you're gonna be well
behind the eight ball,

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and the cost pressures are already
tremendous and they're already,

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they're only gonna get more
difficult not only from the, um,

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the cost perspective, but also the labor
shortage perspective, in particular,

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the coding area. Uh, there's
a, a global shortage of coders,

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and that's only gonna get worse as the
co labor force for coders in the US is

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aging out and there are more people
retiring than entering the, the,

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the workforce. And so if you're
not not leveraging technology, uh,

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then it's something that you're
really gonna be challenged with.

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So we think we have a,

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a pretty good strategy that we've been
executing on for a number of years

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related to R p a leveraging, uh,

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the great work that our E H R does with
regard to automation, um, expanding our,

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our relationship with, uh, with
econometrics wherever we, we,

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they have a product that fits in with,
with our budgets and, and our needs and,

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and the quality that, um,
that we want. And so far, um,

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we've been able to achieve
that with, with four of their,

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their offerings and we've,

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there are a couple more coming down the
pike that we're really excited about.

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And then obviously continuing to
work with our offshore partners.

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So I'm not sure from
our perspective, we're,

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we're taking too many risks because I
think we've already done that and we're

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now executing against those strategies.

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Got it.

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That's fantastic to hear and definitely
a great foresight to really dive in and

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then, um, be in execution mode. Now,

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I guess as we wrap up
our conversation here,

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I'm wondering where do you see the best
opportunities for growth and development

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in the future?

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I know we've talked a lot about where
we're at today and some of the big, um,

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changes occurring right now, and
and how do you see that evolving?

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What do you see over the next
two to three years or so?

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Well, I think that the cost pressures
aren't gonna go away anytime soon, uh, in,

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in our industry or around the
country. There's, uh, I said,

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as we talked about earlier, there's
labor shortages. I think that, uh, if,

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I think if you, we had
a crystal ball, our,

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the number of people that are working in
this industry is going to shrink pretty

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dramatically from the administrative
perspective of healthcare.

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I think you're still
gonna need, obviously,

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all the clinicians that
do the real important and
difficult work on a day-to-day

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basis. And we're here to
support them as, as best we can.

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But our headcount has dropped
pretty significantly over,

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over the course of the last few
years then. But our average, um,

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salary has gone up, and that's because
we have, um, machines doing, uh,

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a lot of the lower level work that
we used to have people doing 10,

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15 years ago. And I think that's
gonna accelerate in the coming years.

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And so we're gonna have fewer people
that instead of managing people,

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they're gonna be managing
processes and managing work.

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And that's an adjustment to finding those
people that have the right skills that

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understand processes, but
can, can manipulate data,

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can understand more complex transactions,
and how to interact with, uh,

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companies, uh,

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that are overseeing processes
that are based on R P A or AI is

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very different than managing
a sta a charge entry staff
or managing a production

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team. So I think that's gonna be
a continued adjustment for us,

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and we've been able to
do a lot of that, uh,

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so far and build up a pretty good
muscle memory in that perspec in that

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perspective, but there's still a lot of
work to do. Um, we've still got a num,

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uh, number of challenges ahead of us
with regard to, as, as I mentioned,

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cost and labor shortage and, uh,

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it's something that we think about
and try to react to and plan for, um,

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on a week to week basis.

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That's fascinating to hear.
And definitely, you know,
the future of work, uh,

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is gonna be completely different. And
when you look at moving in that direction,

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is it a situation where you can kind
of equip your team members now to, uh,

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make that transition and manage the
processes and work more than people, um,

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and, and kind of look to that direction?
Or is it a sense that, you know,

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potentially you'd have to bring in folks
with a different type of skillset? Um,

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how do you manage all of that?

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I think it's something we're
gonna have to tackle. I'm hoping,

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and I'm confident that we have the
right team to, to do that work,

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but it is gonna be a mindset change
and potentially some upskilling for,

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for all of us. It's just a di
it's just a different world.

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As we roll out more technology that
removes charge capture from our,

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from our physicians, uh,
and we have machines doing,

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we've gotta make sure the machines
are doing the right thing and,

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and that they're processing timely and
appropriately and with high quality.

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And similar to lead,

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we're gonna always have or continue
to have offshore partners. And again,

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managing those relationships when it's
all of your business as opposed to just a

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part of your business is,
is a very different, um,
um, perspective. And it's a,

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a different, uh, amount of
pressure for, for us when, uh,

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much more is out of, outside
of our direct control.

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Michael, thank you so much for
joining me on the podcast today.

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This has been such a fun and interesting
discussion and I look forward to

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connecting with you again soon.

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Thanks very much. It was a
real pleasure to talk with you.

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Absolutely.

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And it'll be great to see you as well in
October at the Health IT Digital Health

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and Revenue Cycle event,
um, at Navy Peer in Chicago.

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Looking forward to it.

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