Would you like to exchange best practices and ideas to improve care,
enhance operational efficiency,
and address financial challenges with your peers?
Becker's Healthcare is facilitating these conversations at their eighth annual
health, IT digital health and R C M meeting.
You can check your eligibility for complimentary attendance at the link in the
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 Michael Mercurio,
vice President of Physician Billing Services at Mass General Brigham and
co-founder of Coda Metrics. Michael,
it's a pleasure to have you on the podcast today.
Really great to be here, Laura. Thank you.
Now, I know we've got a lot to talk about.
There's so much happening in healthcare and really a lot of, uh,
interesting and exciting things,
both on the revenue cycle side as well as the technology.
But before we dive into my questions,
I would love for you to tell us a little bit more about yourself and your
background.
Sure, thanks. Um, I've been with, uh,
mass General Brigham for about 25 years.
I've spent the entire parity of my time in the, uh, physician billing office,
um, and, uh, currently lead our, our physician billing team for, for the, uh,
for the system. Uh, I've also been involved, as you mentioned earlier,
with the bringing to life of, uh,
AI autonomous coding tool that started out in our organization a number of years
ago as a workflow enhancement product and has, uh, since, uh, turned into a,
a startup that is no longer, uh, owned by M G B, and we're really,
really proud of that.
That's amazing.
And what was that journey like to kind of begin and incubate and then spin out,
I guess, into your own company and really, uh, be able to thrive in that way?
It was really exciting to be doing something other than typical billing work
because it gave us a,
a way to think outside the box and bring a lot of value to our patients and to
our providers because we were able to reduce the cost of our services to them
while improving, uh, a lot of quality.
And our team actually liked it as well because we were able to remove a lot of
the repetitive high volume, low risk,
not overly exciting work that they were doing by transitioning that, uh,
to the machine. Um, on the other hand, it was a little bit of a challenge, um,
from a bureaucratic perspective.
We that we were like the bucket off a battleship because, uh,
M G B is not at all in the business of bringing technology startups to life. So,
uh, we were doing something new, uh, and innovative and, uh,
it just took a lot of, uh, administrative patience in order to, um, to to, uh,
to build it up and then to, um, spin it out.
Absolutely. Yeah, I can imagine that's quite a feat. So, um, congratulations on,
on that and definitely, you know,
amazing to hear the story and then definitely to see, um,
the results after your team, you know,
included the technology and were able to incorporate that into their daily
routines. Now, based on your role with Mass General Brigham, um,
what are some of the opportunities and headwinds you have your eye on right now?
Yeah,
I think we're struggling with similar with some of the similar challenges most
of the organizations around the country are doing now,
trying to find ways to reduce our length of stay so we can improve the services
and expand our services to, to our, our patient populations.
There's a challenge with higher costs, uh, and labor shortages, uh,
which is where, you know, r p A and AI have been been very helpful,
not only in the rev cycle and administrative areas,
but hopefully soon in the clinical areas. And, uh, in our space specifically,
we're trying to find ways to continue to improve our performance,
reduce our cost, and reduce our expense. And, uh,
we've got a number of strategies in place to do that and, uh,
we're executing against those.
Got it. Absolutely. Yeah, I think that makes a lot of sense.
And certainly kind of having those, uh,
labor and financial headwinds is something that a lot of folks are,
are facing right now. You know, when you look at it and say,
you got a lot of different things in, in the works here, um,
to try to kind of mitigate some of the, the burden of those headwinds. Um,
you know,
is there any one or two things in particular that have been particularly, um,
successful for you or really have early results, I suppose, in, in, um,
being able to, uh, just kind of meet those challenges head on?
Sure. We've,
we've used probably three of the main things that we've been able to leverage,
uh, have been, uh,
relying much more heavily in the last few years on data to make decisions and
having that data be made more available to us, uh,
more readily and more accessible to more people so that we can identify
opportunities, uh, for improvement, uh, before they, um,
become real problems.
We've got a number of alerts that we get when something is, uh,
outside of baseline so we can react, uh,
on the middle of the month instead of waiting for month end close and for
reports to be generated in two or three weeks. So we're, we have a lot of, um,
capability in that space that's really allowed us to be more proactive, uh,
as opposed to be reactive. Uh,
the second thing that we've done is we've tried to leverage technology wherever
we can. We have an extremely robust, uh, R p A program, uh,
between our physician billing team and our hostile billing team.
We've got about 30 bots in, in place that, uh, on an,
on an annual basis, um,
are saving maybe 35 to 40 FTEs a year worth of work. And we've been able,
we've been able to build those and roll them out without impacting any of our
staff from a reduction in force perspective.
We've been able to transition our staff to,
to open vacancies or to higher level more complex work, and that's been a real,
uh, benefit for us. Um, and then the third thing that we've been, uh,
second technology route that we've been using is, is, uh, code metrics and,
and similar tools, uh, wherever we can, uh, identify opportunities for, uh,
again,
leveraging technology in order to reduce the burden of either our team or of our
physicians. And we're now, uh,
leveraging four of their modules in our clinical and rev cycle space,
and that's been extremely beneficial for,
to us from a quality as well as the performance and a cost reduction
perspective.
And then the last thing that is that we've been doing for the last seven or
eight years is we've been on a, an offshoring journey, uh, and we,
we work with three partners in the physician space at M G B in order to
reduce the cost to collect and our onshore headcount while still maintaining
high quality and high performance. And we're really proud of that,
that work because again,
we've been able to do that without any reductions in force through shifting
staff to other roles to open vacancies or to absorbing growth without having to
add onshore staff. And so that's allowed us to drop our,
our overall cost to collect by about 17% in the last six years.
And that's been a cost that we've been able to pass on, um,
directly back to our practices, um, which is what our mission is,
is to support them, uh, and, uh, they've been very appreciative of that.
That's amazing to hear, and thank you so much for sharing with us.
It's definitely helpful to understand what's driving results and, and you know,
really, um, how you're able to kind of navigate some of these troubling waters.
Um, and you mentioned it a little bit or touched on it a little bit in your last
response, but I was wondering if you could go a little bit further as well in,
in how you're thinking about growth and adding value to the organization
overall. I can imagine, um,
just with the technology and digital transformation as well as, you know,
some of the ways that healthcare revenue cycle is evolving naturally. Um, I,
I'd just love to hear what you're really focused on right now and that way is,
and how you see that, um, growth and development, um, from your vantage point.
Well, we, we only serve the patients of the masculine Brigham network,
so our growth is basically determined on either what it would sever either
organic growth or if there is any growth through the acqui,
through acquisitions. And, and our acquisition, uh, pipeline right now is, is,
um, slowed down, uh, quite a bit. And so most of the growth that we're,
we're working on is, uh, is organic, uh,
as an organization and we're doing a lot of work to reduce our length of stay
and to improve our patient experience to hopefully continue to attract patients
from around the region, the country, and around the world.
And my job as a leader in the physician revenue cycle space is to make sure
those patients have the best possible experience, wanna minimize the,
the mistakes that we make that impact their bills or their lives, obviously.
And we want to collect our, uh, cash as quickly, efficiently,
and compliantly as possible so that we can contribute to a positive experience,
not only for the patients,
but obviously to the financial health of the organization.
So we spend a lot of time trying to find opportunities to reduce our payer
denials, reduce our write-offs, how can we be more efficient, reduce clicks.
We have really, uh, weekly conversations around staffing.
So if there's ever a vacancy we we meet,
we talk about whether or not that can be a position that needs to be offshored
or it needs to be, be held, uh, or, and then determined later,
or if it's something that a technology might be able to, to take on.
Got it. I think that makes a lot of sense. And, you know,
for those conversations, I can imagine, um,
it's definitely a very delicate balance you have to bring in terms of, um,
looking at things, you know, proactively in, in leveraging technology,
but then at the same time, understanding the human workforce as well. Um,
how do you approach those kinds of conversations to make sure they're as
productive as possible,
knowing that some people might be a little bit nervous about getting into the,
um, that space.
That was one of the biggest challenges we've had with our offshore partners as
well as with the technology is what's gonna be the impact to me. Um, you know,
most, most people in the working environment, um, like, uh,
hot food and shelter and heat. And so if you want,
you wanna be very careful around, you know, whether, how you're gonna, uh,
staff the work that you need to do. So we've taken a, a long-term approach and,
and trying to be very thoughtful in, in how we, uh, implement, uh,
either new technologies or how we, um,
increase our participation with offshore staff so that we are, um,
not causing any panic amongst our teams. And we've been able to, to, uh,
stand by those commitments for the last few years, which has been really, uh,
beneficial for us. We also have taken the approach of,
of not offshoring everything and, and closing our eyes.
And as Ron Popiel used to say a few decades ago, said it and forget it,
we keep an onshore team, uh,
of subject matter experts for everything that we offshore.
So they help us with qa, uh, reporting and,
and management of our offshore partners just like they would if those partners
were onshore. So they're basically an extension of us, uh,
and we don't treat them as vendors, we treat them as partners,
and that's really helped us to, uh,
build strong relationships with our partners as well as internally have people
feel committed to the work that we're doing and not feel that they're only, um,
working to, you know, eventually offshore, offshore their jobs.
That makes a lot of sense. And, you know, it's just such a,
a delicate balance again,
so thank you so much for your perspective there and how you approach, um,
some of those conversations to really, you know, make sure that the team onsite,
um, feels, you know,
taken care of and understands the direction of the department as a whole. Now,
you know, along those lines, I, I was wondering, um,
in some of these challenging times, in times of immense change, you know,
it can sometimes be a challenge to take risks or, or make investments, um,
in spend resources,
but what do you think is one risk or investment that is still worth making this
year?
I think in the industry,
healthcare has been slow to adapt technology and it takes a big change.
It's a very paper dependent, manual work industry.
And so I think that if you're an organization that hasn't already dipped its toe
into the R P A or to the AI space, and it's something you need to really get,
get involved with this year, because otherwise you're,
you're gonna be well behind the eight ball,
and the cost pressures are already tremendous and they're already,
they're only gonna get more difficult not only from the, um,
the cost perspective, but also the labor shortage perspective, in particular,
the coding area. Uh, there's a, a global shortage of coders,
and that's only gonna get worse as the co labor force for coders in the US is
aging out and there are more people retiring than entering the, the,
the workforce. And so if you're not not leveraging technology, uh,
then it's something that you're really gonna be challenged with.
So we think we have a,
a pretty good strategy that we've been executing on for a number of years
related to R p a leveraging, uh,
the great work that our E H R does with regard to automation, um, expanding our,
our relationship with, uh, with econometrics wherever we, we,
they have a product that fits in with, with our budgets and, and our needs and,
and the quality that, um, that we want. And so far, um,
we've been able to achieve that with, with four of their,
their offerings and we've,
there are a couple more coming down the pike that we're really excited about.
And then obviously continuing to work with our offshore partners.
So I'm not sure from our perspective, we're,
we're taking too many risks because I think we've already done that and we're
now executing against those strategies.
Got it.
That's fantastic to hear and definitely a great foresight to really dive in and
then, um, be in execution mode. Now,
I guess as we wrap up our conversation here,
I'm wondering where do you see the best opportunities for growth and development
in the future?
I know we've talked a lot about where we're at today and some of the big, um,
changes occurring right now, and and how do you see that evolving?
What do you see over the next two to three years or so?
Well, I think that the cost pressures aren't gonna go away anytime soon, uh, in,
in our industry or around the country. There's, uh, I said,
as we talked about earlier, there's labor shortages. I think that, uh, if,
I think if you, we had a crystal ball, our,
the number of people that are working in this industry is going to shrink pretty
dramatically from the administrative perspective of healthcare.
I think you're still gonna need, obviously,
all the clinicians that do the real important and difficult work on a day-to-day
basis. And we're here to support them as, as best we can.
But our headcount has dropped pretty significantly over,
over the course of the last few years then. But our average, um,
salary has gone up, and that's because we have, um, machines doing, uh,
a lot of the lower level work that we used to have people doing 10,
15 years ago. And I think that's gonna accelerate in the coming years.
And so we're gonna have fewer people that instead of managing people,
they're gonna be managing processes and managing work.
And that's an adjustment to finding those people that have the right skills that
understand processes, but can, can manipulate data,
can understand more complex transactions, and how to interact with, uh,
companies, uh,
that are overseeing processes that are based on R P A or AI is
very different than managing a sta a charge entry staff or managing a production
team. So I think that's gonna be a continued adjustment for us,
and we've been able to do a lot of that, uh,
so far and build up a pretty good muscle memory in that perspec in that
perspective, but there's still a lot of work to do. Um, we've still got a num,
uh, number of challenges ahead of us with regard to, as, as I mentioned,
cost and labor shortage and, uh,
it's something that we think about and try to react to and plan for, um,
on a week to week basis.
That's fascinating to hear. And definitely, you know, the future of work, uh,
is gonna be completely different. And when you look at moving in that direction,
is it a situation where you can kind of equip your team members now to, uh,
make that transition and manage the processes and work more than people, um,
and, and kind of look to that direction? Or is it a sense that, you know,
potentially you'd have to bring in folks with a different type of skillset? Um,
how do you manage all of that?
I think it's something we're gonna have to tackle. I'm hoping,
and I'm confident that we have the right team to, to do that work,
but it is gonna be a mindset change and potentially some upskilling for,
for all of us. It's just a di it's just a different world.
As we roll out more technology that removes charge capture from our,
from our physicians, uh, and we have machines doing,
we've gotta make sure the machines are doing the right thing and,
and that they're processing timely and appropriately and with high quality.
And similar to lead,
we're gonna always have or continue to have offshore partners. And again,
managing those relationships when it's all of your business as opposed to just a
part of your business is, is a very different, um, um, perspective. And it's a,
a different, uh, amount of pressure for, for us when, uh,
much more is out of, outside of our direct control.
Michael, thank you so much for joining me on the podcast today.
This has been such a fun and interesting discussion and I look forward to
connecting with you again soon.
Thanks very much. It was a real pleasure to talk with you.
Absolutely.
And it'll be great to see you as well in October at the Health IT Digital Health
and Revenue Cycle event, um, at Navy Peer in Chicago.
Looking forward to it.
This is the Becker's Healthcare podcast created by the team of Becker's
Healthcare, a multimedia company devoted to the people who power us healthcare.
Four new 15 minute episodes are released daily containing industry news analysis
and thought leadership.
From powerful healthcare decision makers support our show by leaving it a five
star rating and review on Apple Podcast or other platforms you use.
It's a chance to tell us what you like about the show and act on your feedback.
Thanks for listening. Now here's the episode.