Latest / Becker’s Healthcare Podcast / Tami McMasters on AI, Workforce Strategy and the Future of Revenue Cycle at UC Davis Health

Transcript

Tami McMasters on AI, Workforce Strategy and the Future of Revenue Cycle at UC Davis Health · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
• 0:04
  - leaders right now is not a short list.
• 0:07
  - Growth in a consolidating market, sustainable margins in
• 0:09
  - a reimbursement environment that rarely moves in your
• 0:12
  - favor,
• 0:12
  - a tech investment cycle that demands both urgency
• 0:15
  - and discipline,
• 0:16
  - and a workforce story that is still being
• 0:19
  - written.
• 0:20
  - Eker's fourteenth annual CEO CFO roundtable brings together
• 0:23
  - more than 1,500 executive level attendees and nearly
• 0:27
  - 400 speakers across four days of sessions that
• 0:30
  - are designed to help c suite leaders benchmark,
• 0:32
  - pressure test, and sharpen their priorities.
• 0:35
  - Not in the abstract, but against the real
• 0:37
  - decisions they'll face heading into the next year.
• 0:39
  - It's the kind of event you leave with
• 0:40
  - a clear sense of where you stand and
• 0:42
  - what comes next.
• 0:44
  - So join us November second through the fifth
• 0:46
  - at the Hyatt Regency in Chicago,
• 0:48
  - and come ready to do the hard thinking.
• 0:50
  - Register on our events page at beckershospitalreview.com
• 0:54
  - by clicking on the events tab in the
• 0:56
  - upper right.
• 0:58
  - This is Laura Dierdo with the Becker's Healthcare
• 1:00
  - podcast. I'm thrilled today to be joined by
• 1:02
  - Tammy McMasters Gomez, executive director of midorefinal cycle
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  - at UC Davis Medical Center. Tammy, it's a
• 1:09
  - pleasure to have you on the podcast today.
• 1:11
  - Thanks for having me, Laura. We're excited.
• 1:13
  - Absolutely. Well, we're excited to have you here.
• 1:15
  - I think it's gonna be a lot of
• 1:16
  - fun. We're gonna talk a little bit about,
• 1:18
  - some of the things you're doing at UC
• 1:20
  - Davis Medical Center as well as how you're
• 1:22
  - thinking about the future. But before we dive
• 1:24
  - in, can you tell us just a little
• 1:25
  - bit more about yourself and your background?
• 1:27
  - Yeah. So
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  - I, come from a background of health information
• 1:31
  - management,
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  - have been in a variety of roles over
• 1:34
  - over the last thirty years in health in
• 1:36
  - in in this industry and health,
• 1:38
  - and then better cycle. So I,
• 1:41
  - been a coder. I've been an auditor. I've
• 1:43
  - been a manager, a supervisor, director, executive director,
• 1:46
  - have really evolved over the years. But, currently
• 1:49
  - in my role, I'm the executive director over
• 1:51
  - mid revenue cycle at UC Davis Health, which
• 1:53
  - is a large
• 1:54
  - integrated team of coders and CBIs and HIM
• 1:57
  - and includes some revenue integrity and denials management
• 2:00
  - as well as,
• 2:02
  - some coding education and auditing and physician trainers.
• 2:06
  - Wow. That's a lot of different skills that
• 2:08
  - you put up there. So,
• 2:10
  - amazing to hear.
• 2:11
  - I'm curious. Can we start off with you
• 2:13
  - giving us a little state of the union
• 2:15
  - for UC Davis Medical Center? Where are you
• 2:17
  - at right now, and how are you thinking
• 2:19
  - about the next, rest of the year or
• 2:21
  - so?
• 2:22
  - Sure. So I I mean, I would say
• 2:23
  - 2026
• 2:24
  - has been pretty transformational for us in revenue
• 2:27
  - cycle.
• 2:28
  - We've made some significant progress in leveraging AI
• 2:31
  - and automation,
• 2:32
  - to support our coding workforce,
• 2:34
  - which is really intended to improve efficiency and
• 2:36
  - strengthen the quality of our coding, but also
• 2:38
  - to really help around late national labor shortages
• 2:42
  - with coders. So
• 2:43
  - one of our key successes has been implementing
• 2:45
  - autonomous coding with a strong governance framework, including,
• 2:50
  - technology augment,
• 2:51
  - augmenting our team's,
• 2:54
  - you know, ability,
• 2:56
  - to to get to all of the work
• 2:58
  - as we grow. We augment with with, people,
• 3:01
  - process, and then technology.
• 3:03
  - We've also continued to deepen collaboration between coding,
• 3:07
  - CDI compliance, and clinical operations to ensure documentation
• 3:10
  - and coding practices are aligned around, you know,
• 3:12
  - some of our quality initiatives and accuracy and
• 3:15
  - our financial integrity.
• 3:17
  - And I think for the remainder of 2026,
• 3:19
  - our focus is on scaling these capabilities
• 3:22
  - responsibly,
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  - which means expanding automation where it adds value,
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  - continuing to invest also and develop in our
• 3:29
  - workforce and our,
• 3:31
  - technology as well as using data to more
• 3:33
  - strategically
• 3:35
  - identify where we have opportunities and operational improvement,
• 3:38
  - but
• 3:38
  - really focused on ensuring that innovation remains balanced
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  - with transparency and there's compliance and we can
• 3:43
  - measure those outcomes.
• 3:46
  - That makes a lot of sense. You know,
• 3:47
  - it's interesting to see how the dynamic as
• 3:49
  - we're, introducing new technologies and how quickly technology,
• 3:53
  - especially with AI, is changing.
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  - You know, integrating that within the workflows and
• 3:57
  - the people, workforce, and the management, everything there.
• 4:00
  - So what has it been like for you
• 4:02
  - to lead that transition around change? Have you
• 4:04
  - been able to ensure adoption of the technology
• 4:07
  - and then kind of rethink workflows and and,
• 4:09
  - figure out what's gonna be the best way
• 4:11
  - to,
• 4:12
  - optimize the work that your team is doing,
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  - and we'll also continue to grow and develop
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  - in in knowing what the the broader organization
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  - needs from you.
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  - Yeah. So,
• 4:22
  - as we grow, our our our our biggest
• 4:25
  - challenge is labor.
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  - Labor finding labor and finding talent, right, to
• 4:29
  - augment that growth. And so we look to
• 4:32
  - other creative ways to do that and is
• 4:33
  - and that is to bring in AI. But
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  - I think it's it's just not a plug
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  - and play and walk away. Right? You're always
• 4:38
  - gonna need to have the human in loop.
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  - You need to you're you're gonna need to
• 4:40
  - curate that data. You're gonna need to build
• 4:43
  - rules.
• 4:43
  - And, you're you're going to have to refine,
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  - and you're gonna have to continue to ensure
• 4:48
  - that the that the technology meets your your
• 4:51
  - needs organizationally
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  - and that you're augmenting with, with people in
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  - the process and ensuring you have some type
• 4:57
  - of AI governance and auditing structure behind the
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  - scenes,
• 5:01
  - so that you're mitigating risk,
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  - with adoption of technology. So that's kind of
• 5:06
  - my strategy on how we continue to evolve
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  - and and measure and,
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  - and, you know, augment where we need to
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  - augment in in spaces
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  - where, you know, there's a a shortage of
• 5:16
  - of of qualified staff to do the work.
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  - That makes a lot of sense. It's really
• 5:21
  - helpful to understand how you're thinking about things
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  - then going about,
• 5:24
  - strategically,
• 5:26
  - you know, what the next, iteration of the
• 5:28
  - workforce is gonna look like. And to that
• 5:30
  - point, you know, I wanted to ask you
• 5:32
  - about the future as well. What are some
• 5:34
  - of the big headwinds that you have your
• 5:35
  - eye on and you're planning for right now?
• 5:38
  - You know, I think the biggest challenge I
• 5:40
  - see is the intersection of workforce shortages and
• 5:43
  - increasing kind of complexity in health care. Like,
• 5:46
  - across the industry, experience coding and revenue sector
• 5:49
  - profession professionals are becoming harder to recruit and
• 5:52
  - retrain, and I I touched on that earlier.
• 5:54
  - Other regulatory requirements,
• 5:56
  - payer scrutiny, and documentation expectations continue to re
• 6:01
  - increase. And we just saw that CMS,
• 6:03
  - is focusing on UR and CDI
• 6:06
  - in in 2027.
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  - So they're gonna be looking at documentation integrity.
• 6:10
  - You know, at the same time, organizations are
• 6:12
  - adopting AI at unprecedented paces. Like, we haven't
• 6:16
  - seen things move this quickly in the industry
• 6:17
  - in a very, very long time.
• 6:20
  - So while the opportunity is tremendous, there's also
• 6:22
  - risk of moving too quickly without establishing that
• 6:25
  - governance, that putting those quality controls in place.
• 6:27
  - Like I said, we're not gonna just plug
• 6:29
  - and play and walk away,
• 6:31
  - and oversight,
• 6:32
  - for long is really gonna be necessary for
• 6:34
  - long term success. So we'll we're gonna continue
• 6:36
  - to prepare by focusing on AI literacy, strengthening
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  - auditing,
• 6:40
  - and monitoring all capabilities and and continuing to
• 6:43
  - redefine roles so that our staff can operate
• 6:45
  - at at the top of their expertise. And
• 6:47
  - that may be upskilling people. That may be
• 6:49
  - getting people credentialed in, you know, AI second
• 6:52
  - level review work.
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  - So that future workforce will need to be
• 6:56
  - both in health you know, have that both
• 6:58
  - have that health care expert, background and maybe,
• 7:02
  - a good technology steward would be a skill
• 7:04
  - set we would be looking for.
• 7:06
  - That's really cool to hear. And and definitely,
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  - you know, having those challenges of the workforce
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  - and and thinking through all the different requirements
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  - from CMS are certainly,
• 7:15
  - challenges that leaders across hospitals and systems are
• 7:18
  - thinking about. But I love the very,
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  - simple and systematic approach you're taking to thinking
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  - about what you need in order to create
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  - that workforce of the future.
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  - And and
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  - I'd love to hear some of the opportunities
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  - for growth that you're looking at as well.
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  - As you mentioned, having that workforce with some
• 7:36
  - of the technical expertise with some other things
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  - gonna be critical. So where do you see
• 7:39
  - some opportunities for continued growth on the revenue
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  - cycle side?
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  - Yeah. I think the greatest opportunity lies in
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  - transforming how revenue cycle teams create value within
• 7:49
  - health care organizations. Like, historically, coding has been
• 7:51
  - viewed primarily as a transaction function, productivity based.
• 7:55
  - Over the next few years, I see coding
• 7:57
  - professionals evolving into more strategic reviewers,
• 8:00
  - auditors, upscaling them into educators, data analysts, maybe
• 8:04
  - even AI validators, as I mentioned.
• 8:06
  - I think with the combination of AI and
• 8:08
  - advanced analytics
• 8:10
  - and
• 8:11
  - clinical expertise,
• 8:12
  - it kinda creates a unique opportunity to improve
• 8:15
  - documentation quality and and at the same time,
• 8:17
  - maybe think about how we can reduce administrative
• 8:20
  - burden while still enhancing complicate
• 8:23
  - compliance and reducing complications
• 8:25
  - around denials that occur from
• 8:28
  - problematic documentation.
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  - And then I think it's important that you
• 8:32
  - generate actual insights for all of our providers
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  - and operational leaders.
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  - So I think
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  - it's a combination
• 8:39
  - of human expertise with responsible automation,
• 8:43
  - and being able to be more scalable,
• 8:46
  - and adaptive, and
• 8:48
  - at the same time being able to improve
• 8:50
  - financial and clinical outcomes. So there's gonna be
• 8:53
  - a kind of a balance there,
• 8:55
  - between making sure that, you know, we don't
• 8:57
  - impact,
• 8:59
  - clinical outcomes,
• 9:00
  - with, you know, enhancing too much AI too
• 9:03
  - quickly,
• 9:03
  - and that it disrupts,
• 9:05
  - that delicate balance.
• 9:08
  - That makes a lot of sense. And, you
• 9:09
  - know, I I think, having that critical
• 9:12
  - approach, you know, thinking through the human expertise,
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  - what the operations are relying on, and then
• 9:17
  - from the technological
• 9:19
  - side to,
• 9:20
  - knowing, you know, how to balance the right
• 9:22
  - way. And what balance have you found, based
• 9:24
  - on your expertise?
• 9:25
  - You're looking at both of those things and
• 9:27
  - making sure you're not going too far to
• 9:29
  - automation AI, but also not missing opportunities by
• 9:33
  - keeping things with the the human team as
• 9:35
  - well.
• 9:37
  - Yeah. I think the way that I, think
• 9:39
  - about this is is kinda twofold. Right?
• 9:44
  - We're I've I've mentioned that, you know, we're
• 9:46
  - not gonna plug and play and walk away.
• 9:48
  - Right? We we have to have that human
• 9:49
  - in the loop to ensure integrity and governance,
• 9:51
  - but I also think things are moving so
• 9:54
  - quickly in the industry today. Right? You you
• 9:57
  - spend a lot of time
• 9:59
  - going through,
• 10:01
  - procurement processes, going through IT security evaluations, going
• 10:04
  - through AI governance structures to make sure that
• 10:06
  - you're not putting the organization at risk, where
• 10:09
  - maybe PHI is being transmitted to a server
• 10:11
  - offshore.
• 10:13
  - So you you do all that work, and
• 10:15
  - then you spend time building interfaces. So IT
• 10:17
  - resources, change management for the teams,
• 10:21
  - you know, coders now learning how to interact
• 10:23
  - with a new tool.
• 10:24
  - And the next shiny toy comes out the
• 10:27
  - next week. Right? You just you just can't
• 10:29
  - keep jumping to the next shiny toy because
• 10:31
  - you'd be in this constant cycle of project
• 10:33
  - work. And so I think
• 10:34
  - what I've learned is that you have to
• 10:36
  - kind of stay the course once you pick
• 10:38
  - a vendor unless they're really not delivering on
• 10:40
  - that ROI.
• 10:42
  - It's difficult to
• 10:44
  - just say, I'm gonna decommission this infrastructure and
• 10:47
  - move to the next shiny toy because the
• 10:49
  - cost that it, you know, that it that
• 10:51
  - it really, does yield in terms
• 10:53
  - of resources is quite expensive. So I I
• 10:56
  - think what I would say is that
• 10:59
  - really try to work with who you've selected
• 11:01
  - as a vendor around product development and meeting
• 11:03
  - your needs. And and then if you have
• 11:05
  - and you still can't achieve what it is
• 11:07
  - you set out to achieve, then maybe think
• 11:09
  - about,
• 11:10
  - you know, moving in a different direction. But
• 11:13
  - I think you can also be very, very
• 11:15
  - proactive
• 11:16
  - in your business associate agreements, in your contracts
• 11:19
  - with procurement around doing limited engagements at a
• 11:22
  - year. And if you, you know, you don't
• 11:23
  - yield the return at a year, then then
• 11:26
  - you're not stuck into this five year contract.
• 11:28
  - So gone, I think, are the days where
• 11:29
  - we're locked into these five year contracts and
• 11:32
  - that we don't have any wiggle room.
• 11:34
  - I don't know if that really fully answers
• 11:35
  - your question, but I'm happy to elaborate.
• 11:37
  - No. That that's perfect. I mean, I think
• 11:39
  - it's so helpful to understand, you know, where
• 11:42
  - you're at and how you're thinking about things,
• 11:43
  - what you're doing a little bit differently, especially
• 11:45
  - with, the team infrastructure and contracts too, you
• 11:48
  - know, looking at where those are trending and
• 11:51
  - how they're evolving with the needs of the
• 11:52
  - day and just the fast pace of technology
• 11:54
  - too is just fascinating to hear.
• 11:57
  - Yeah.
• 11:58
  - Before we wrap up, I wanted to ask
• 12:00
  - you about leadership too. Who's a leader that
• 12:02
  - you admire really from any industry and why?
• 12:06
  - I have always admired,
• 12:08
  - Indra Nooyi. I don't know if you're familiar
• 12:10
  - with her, but always admired her for her,
• 12:12
  - you know, kind of ability to be strategic.
• 12:15
  - She's really just a strategic visionary,
• 12:17
  - but she's also an authentic leader. She's challenged
• 12:20
  - organizations to think beyond, like, short term results
• 12:23
  - and focus on sustainable growth, talent development,
• 12:27
  - and how you can impact any organization in
• 12:29
  - a long term way.
• 12:31
  - I think what most resonates with me is
• 12:34
  - is that her belief in leadership is ultimately
• 12:36
  - about people. In health care, that's our greatest
• 12:39
  - asset in our workforce. It's all about empathy.
• 12:41
  - Right?
• 12:42
  - You have to be empathetic. Right? So the
• 12:44
  - best outcomes come when the team feels supported,
• 12:46
  - valued, all of those things. Right? But also
• 12:48
  - we have a larger purpose. And so that's
• 12:50
  - the leadership standard I try to emulate.
• 12:52
  - I love it, Tammy. Thank you so much
• 12:54
  - for joining us on the podcast today. This
• 12:56
  - has been such a fun conversation. I've learned
• 12:58
  - a lot and your perspective,
• 13:00
  - truly, truly is interesting to hear. So,
• 13:03
  - I I appreciate your time today, and I
• 13:05
  - look forward to connecting with you again soon.
• 13:07
  - Thank you so much for having me. It
• 13:08
  - was a pleasure.