Latest / Becker’s Healthcare Podcast / Tracy Peffley, System Vice President of Revenue Cycle Management at Cleveland Clinic

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Tracy Peffley, System Vice President of Revenue Cycle Management at Cleveland Clinic · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - visit beckershospitalreview.com
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  - upper right.
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  - This is Alan Condon back with another episode
• 0:54
  - of the Becker's Health Care Podcast. And today,
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  - I'm thrilled to be joined by Tracy Peffley,
• 1:00
  - system vice president of revenue cycle management at
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  - Cleveland Clinic. Tracy,
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  - a real pleasure to have you make your
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  - your debut Becker's podcast appearance with us today.
• 1:10
  - For those of our listeners who mightn't be
• 1:12
  - as familiar with some of the great work
• 1:13
  - that you, that your team does at Cleveland
• 1:15
  - Clinic, can you take a moment to share
• 1:17
  - a little bit about yourself and your role
• 1:19
  - at the health system?
• 1:21
  - Yeah. Thanks, Alan.
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  - So I bring more than thirty years of
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  - revenue cycle experience,
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  - both in acute care and ambulatory,
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  - with both from a facility and corporate level
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  - perspective.
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  - For most of my career, I've led clinical
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  - revenue cycle, also known as mid the middle
• 1:37
  - rev cycle, as well as experience on the
• 1:39
  - back end as well.
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  - I worked here at Cleveland Clinic for the
• 1:43
  - past twelve years, joined in 2013,
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  - including the last two years serving as the
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  - vice president of revenue cycle across the system.
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  - Prior to the clinic,
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  - I worked at Centura Health based in Denver,
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  - Colorado,
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  - which has since dissolved about two and a
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  - half years ago.
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  - While I was there, progressively advanced,
• 2:02
  - during my tenure there in my last role,
• 2:05
  - served as the senior director
• 2:07
  - of HIM across the enterprise.
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  - You know, regarding my role today at Cleveland
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  - Clinic, I'm blessed to lead the revenue cycle
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  - team comprised of over 3,800
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  - FTEs,
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  - inclusive of
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  - in seat or employed FTEs as well as
• 2:24
  - vendor FTEs. About 40% of our operations
• 2:27
  - is outsourced.
• 2:29
  - Additionally, I also support international,
• 2:33
  - locations, London and Abu Dhabi, in their rev
• 2:35
  - cycle operations.
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  - So,
• 2:38
  - diverse,
• 2:39
  - very different reimbursement,
• 2:43
  - operations both in those global locations.
• 2:46
  - Now as I reflect on '25, the revenue
• 2:48
  - cycle team, the US team, we collected over
• 2:51
  - 15,000,000,000
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  - in net patient revenue just to kinda put
• 2:54
  - size complexity
• 2:55
  - together,
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  - coming in at 41.9,
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  - net days receivable outstanding
• 3:01
  - and a cost to collect of 2.92%.
• 3:05
  - That's combined both hospital billing and professional billing.
• 3:08
  - And we've really tried to
• 3:10
  - focus on
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  - sustainability,
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  - revenue as well as cost savings, really
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  - trying to strive for that top tier level
• 3:18
  - of performance, leveraging technology,
• 3:20
  - advancing our operating model,
• 3:23
  - and and today bringing us to present, you
• 3:25
  - know, really focusing in on top three strategic
• 3:28
  - initiatives,
• 3:30
  - building financial resilience,
• 3:32
  - you know, strengthening our our financial performance,
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  - as well as the second one, enhancing our
• 3:38
  - patient financial experience. We're really working hard to
• 3:41
  - redesign the end to end patient financial journey,
• 3:45
  - through aligned workflows and integrated,
• 3:47
  - digital platforms.
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  - And so
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  - really trying to provide patients flexibility, meet them
• 3:53
  - where they're at.
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  - We want them to pay, and we wanna
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  - make it convenient for them. And we've recently
• 3:58
  - rolled out Apple Pay and Google Pay, so
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  - we've seen some great success
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  - along with other things that we're doing in
• 4:03
  - that space. And then third, really hyper focused
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  - on advancing technology and AI, big buzzword in
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  - the industry.
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  - You know, we wanna be leaders in this
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  - and,
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  - really wanna optimize Epic as well as how
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  - do we leverage other technology
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  - platforms,
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  - with AI, Gen AI,
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  - to streamline our operations. It is the future,
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  - and we've gotta take out cost,
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  - current revenue cycle operations,
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  - our model, our cost structure, it's not sustainable.
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  - And so how do we leverage technology in
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  - the future
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  - to, look differently, operate differently?
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  - And part of our strategy in doing so,
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  - we recently created a dedicated
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  - technology and innovation domain
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  - within our operating model,
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  - that's really going to be hyper focused on
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  - driving those advancements
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  - now and in the foreseeable future. And so
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  - that is an investment we've made here at
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  - the organization
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  - in partnership working lockstep with our information technology
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  - department as well.
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  - Mhmm. Yeah. Fantastic. I mean,
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  - love to kinda break down. And there's there's
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  - obviously so many key areas. You touched on
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  - quite a lot of the trends there, the
• 5:12
  - kinda core focuses in terms of areas you're
• 5:14
  - focused on the revenue cycle.
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  - 3,800
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  - FTEs and your revenue cycle team alone, 40%
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  - of operations, I believe you said, outsourced.
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  - Yeah.
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  - Would love to hear,
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  - you touched on kind of some of the
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  - trends that you're kinda focused on really there
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  - in terms of,
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  - AI, kind of automation, kind of some of
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  - your your initiatives in the patient experience and
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  - whatnot.
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  - There's so much you can go down. But
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  - in terms of, like, your one or two
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  - core focuses through the end of twenty twenty
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  - six, when you look at two or three
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  - trends they're really focusing on to to make
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  - a difference in your revenue cycle,
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  - what might that be?
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  - I would say one of the biggest opportunities
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  - we're focusing in on is reducing denials.
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  - Mhmm.
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  - Rising denial rates,
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  - just creates unnecessary cost, administrative burden,
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  - creates friction for providers,
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  - payers, our clinicians,
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  - and most importantly, our patients. They're right in
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  - the middle.
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  - And so, you know, as we look at
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  - the impact denials have, it delay can delay
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  - patient care,
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  - creates confusion and financial complexity for our patients,
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  - contributes to burnout
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  - for our revenue cycle team who are constantly
• 6:25
  - chasing a problem, trying to fix a problem
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  - while reacting to ongoing, payer requirements.
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  - So we gotta be agile. And so really
• 6:35
  - trying to lean in here and leverage data
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  - analytics to, one, prevent the denials. How can
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  - we predict the denials?
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  - And so
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  - as an industry, I think we have an
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  - opportunity really to move away from a reactive
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  - model, which is what exists today,
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  - to more collaborative one, bringing the provider and
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  - payer community together
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  - to simplify the processes,
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  - improve the alignment, reduce the friction,
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  - reduce the cost, the waste that's all associated
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  - with the denials,
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  - and work towards a closer near real time,
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  - claim adjudication.
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  - Mhmm. Yeah. It's so interesting. I had the
• 7:12
  - pleasure speaking with, your CFO, Dennis Tharaway, on
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  - a podcast recently and also around your meeting.
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  - Unsurprisingly,
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  - denials is something that he brought up as
• 7:20
  - well. And I think something that really stuck
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  - out to me, maybe you can elaborate on
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  - this, is he he said that with Cleveland
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  - Clinic, I believe still facing denial rates of
• 7:28
  - around about fifteen percent or more, and that
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  - starts this cascade of rework in terms of
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  - resubmissions,
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  - medical director reviews, appeals, and so on and
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  - so forth. This process full of friction often
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  - drags on the provider, the physician,
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  - even sometimes the patient, consumes so much time,
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  - energy, and resources. And then from that fifteen
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  - percent, eventually gets down to a sub two
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  - percent denial rate, I believe.
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  - But all that cost and energy and time
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  - consumed to get down to that two percent,
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  - excuse me, seems simply unsustainable.
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  - I'd be curious to just kinda hear your
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  - thoughts and kind of
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  - the the the energy that it takes to
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  - get down to that and what that ultimately
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  - says about the system.
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  - Yeah. So when you when you say the
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  - 15%, just for clarity, that is incoming denials.
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  - So that's inclusive of initial denials
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  - and subsequent denials.
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  - Mhmm. And so,
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  - we have in 2025,
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  - we successfully overturned 92%
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  - of our denials.
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  - So think about the waste
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  - in advocating for the patient,
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  - as well as our clinicians, the medical necessity,
• 8:35
  - the care that was provided.
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  - And so there's resources built by us as
• 8:40
  - a provider as well as the payer. And
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  - you got the patient right in the middle
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  - as as I mentioned. And they're seeing the
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  - back and forth that's going on, and and
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  - that's just constant.
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  - You know? And and when we look at
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  - the final denial rate,
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  - it's definitely less than two percent.
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  - As I mentioned,
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  - the the ninety two percent overall success rate,
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  - but it just stems from,
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  - really, are there things that we can do
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  - better? Absolutely. Some of that self inflicted.
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  - We're not perfect. And learning from those mistakes
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  - to really hone in on
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  - standard work,
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  - leveraging technology, make sure we're optimizing it,
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  - ensuring,
• 9:19
  - our we're giving feedback back to the clinicians.
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  - You know, we're blessed. We have two,
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  - medical directors embedded, integrated into revenue cycle here
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  - at Cleveland Clinic,
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  - here most recently over the last, couple years
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  - as part of our new operating model. We
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  - have a medical director of documentation excellence
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  - as well as the, physician advisory program. And
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  - so they have been pivotal in
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  - really closing the gap, bringing together the financial
• 9:46
  - and the clinical operations together
• 9:48
  - to help drive
• 9:50
  - and,
• 9:52
  - the better understanding
• 9:54
  - as well as how do we leverage the
• 9:56
  - data to do better as well as be
• 9:58
  - proactive sitting down with the payers and, this
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  - is what we're seeing. What are you seeing?
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  - And working together to try to improve it.
• 10:06
  - This is like a mountain,
• 10:08
  - and we are not unique in that situation.
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  - It is gonna take really the,
• 10:13
  - entire community coming together to really change this
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  - paradigm.
• 10:18
  - It's not right to the patient,
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  - and
• 10:21
  - it's not sustainable
• 10:22
  - for the payer or the provider. And so
• 10:24
  - how do we work smarter, not harder to
• 10:27
  - streamline this and drive greater efficiencies?
• 10:30
  - Yeah. No. I really appreciate the kinda level
• 10:32
  - of specificity in terms of what exactly you're
• 10:34
  - doing, the kind of setup there, and kind
• 10:36
  - of some of your core areas of focus.
• 10:39
  - Tracy, you'd mentioned in,
• 10:41
  - your opening remarks kind of AI being a
• 10:43
  - core unsurprisingly, I imagine it's not a day
• 10:45
  - goes by where I'm sure you don't hear
• 10:46
  - about AI and automation, the revenue cycle, but,
• 10:50
  - no doubt there's some big opportunities there on
• 10:52
  - the provider side to kinda play catch up
• 10:54
  - in terms of,
• 10:55
  - what the payers have been leveraged for quite
• 10:57
  - some time. I'm so curious in terms of
• 10:59
  - how you see this, for lack of a
• 11:01
  - better term, quote, unquote, AI arms race
• 11:04
  - evolving in the coming years as we see
• 11:07
  - AI become more sophisticated,
• 11:09
  - really more deeply integrated in the revenue cycle
• 11:12
  - of both the payers and the providers. I've
• 11:15
  - heard some some optimists, some pessimists, some realists
• 11:17
  - on this side of the equation, but I'm
• 11:19
  - curious to kinda hear your thoughts. Granted, no
• 11:22
  - no silver bullet here, but, how are you
• 11:24
  - kinda how are you thinking about this for
• 11:26
  - the future? Yeah. Great question.
• 11:29
  - You know, I I think the AI arms
• 11:31
  - race in health care is moving beyond
• 11:35
  - who has the best model, but to who
• 11:38
  - has an embedded
• 11:40
  - AI most effectively into real and integrated clinical
• 11:43
  - and revenue cycle workflows.
• 11:45
  - As AI matures, the biggest opportunity is the
• 11:48
  - intersection of clinical integration and financial performance.
• 11:52
  - For example,
• 11:53
  - ambient listening and AI assisted documentation coding solutions,
• 11:57
  - bringing those together, you've right now, you have
• 12:00
  - AI, point solutions out there available that are
• 12:03
  - functioning independently.
• 12:05
  - I envision that they will likely,
• 12:08
  - of all, come together and integrate,
• 12:11
  - which will help make make
• 12:14
  - excellence more visible through documentation,
• 12:17
  - more accurate coding,
• 12:19
  - stronger quality capture,
• 12:21
  - as well as better risk adjustment.
• 12:24
  - And at the same time, AI will also
• 12:27
  - help us
• 12:28
  - prioritize and automate prior authorization,
• 12:31
  - help reduce the friction.
• 12:33
  - And going back to our earlier conversation,
• 12:36
  - also help with predicting and preventing denials.
• 12:39
  - So it identifies the gap earlier in the
• 12:41
  - process, move it further upstream
• 12:44
  - so we can fix it before it goes
• 12:45
  - out the door.
• 12:46
  - I know who oh, go ahead. Alright, Tracy.
• 12:49
  - Is there, specifically in terms of what you've
• 12:51
  - mentioned there in terms of more proactively predicting
• 12:53
  - some of these denials upstream, is there a
• 12:55
  - specific example or a specific specialty or subset
• 12:58
  - where you're really implementing this now and seeing
• 13:01
  - results? Just out of curiosity.
• 13:02
  - Yes. I will say right now, we are
• 13:04
  - really hyper focused and have seen some set
• 13:06
  - success on the inpatient coding side.
• 13:09
  - And so,
• 13:11
  - we have, a partner here and,
• 13:13
  - we've been leaning in here really looking at,
• 13:18
  - how to ensure that we're accurately coding
• 13:22
  - and properly being reimbursed.
• 13:24
  - And how do we streamline that to ensure
• 13:27
  - that we're capturing everything that we need to
• 13:30
  - so we've got that accurate quality capture
• 13:33
  - as well as fostering that accurate reimbursement.
• 13:36
  - So we've not reduced headcount. That's not our
• 13:40
  - intent
• 13:42
  - really it's augmenting the inpatient
• 13:45
  - coder and the work that they're doing
• 13:47
  - and leveraging a large language model to bring
• 13:50
  - forth those potential opportunities.
• 13:52
  - There's a human in the loop 100% of
• 13:55
  - the time right now validating those opportunities
• 13:57
  - being presented,
• 13:59
  - and then it goes out the door. And
• 14:01
  - so we've really seen some great success,
• 14:03
  - of that in our outcomes data, our our
• 14:05
  - quality outcomes,
• 14:07
  - as well as our caregivers really leaning in
• 14:10
  - and being part of the solution. You know,
• 14:11
  - when you're,
• 14:13
  - moving someone's cheese and we solve this, with
• 14:16
  - computer assisted coding with coders, fearful, hey, I'm
• 14:19
  - gonna lose my job.
• 14:21
  - We saw it with RPA. We've got 200
• 14:23
  - digital RPA bots within revenue cycle. I'm gonna
• 14:27
  - lose my job. People aren't losing their jobs
• 14:29
  - relative to this. I'm not envisioning that in
• 14:31
  - the media with AI. Within patient coding, it
• 14:33
  - really is
• 14:34
  - augmenting the great work that they're doing, leveraging
• 14:37
  - them top of license, that critical thinking skills
• 14:40
  - that are so necessary.
• 14:42
  - Mhmm. Yeah. We often hear about kind of
• 14:44
  - leveraging positions, clinicians at the top of their
• 14:46
  - license. What does leveraging revenue cycle leaders in
• 14:49
  - the workforce at the top of their license?
• 14:51
  - What does it kinda free them up more
• 14:52
  - so they do?
• 14:54
  - Yeah. Great question. You know, I I would
• 14:56
  - say really having them focus on the more
• 14:59
  - complex,
• 15:01
  - work that's involved,
• 15:03
  - higher dollar cases. You know, here at Cleveland
• 15:05
  - Clinic, we have one of the highest case
• 15:08
  - mix
• 15:09
  - in the country.
• 15:10
  - And so, you know, when we look at
• 15:12
  - our incoming denials going back to that, you
• 15:14
  - know, really peeling the onion away,
• 15:18
  - why are we receiving these secondary and tertiary
• 15:21
  - denials? How do we look at this a
• 15:23
  - more integrated clinical revenue cycle approach
• 15:26
  - and leaning in here with our clinical providers
• 15:29
  - so we can be better thought partners
• 15:32
  - in preventing those denials
• 15:34
  - and a better experience for clinicians as they're
• 15:37
  - taking care of the patient, and they're staying
• 15:39
  - focused on that and not having to worry
• 15:41
  - about the prior authorizations
• 15:43
  - or helping with peer to peer reviews.
• 15:45
  - It's really
• 15:47
  - leveraging one another's expertise
• 15:50
  - from a financial perspective, us, the clinicians, the
• 15:53
  - clinical side of the house, and bringing that
• 15:55
  - together,
• 15:56
  - in that delivery model to the patient.
• 15:59
  - Yeah. It is fascinating to kinda hear where
• 16:01
  - where we've gone in the last couple of
• 16:02
  - years with AI and just how fast it's
• 16:04
  - been quickly implemented and integrated across, not just
• 16:07
  - health care, but across the board.
• 16:09
  - Last question. It kinda ties nicely onto what
• 16:11
  - we just talked about there, Tracy, in terms
• 16:13
  - of expecting these revenue cycle teams evolving with
• 16:16
  - AI as it becomes more deeply embedded in
• 16:18
  - their workflows. You touched on it just a
• 16:19
  - little bit there, but what skills do you
• 16:21
  - see will really define that next generation of
• 16:24
  - revenue cycle leaders like yourself? I'm so curious
• 16:27
  - to hear maybe how your actual role as
• 16:29
  - system vice president of revenue cycle has actually
• 16:30
  - evolved perhaps relatively quickly over the last couple
• 16:33
  - years with the advent of this technology as
• 16:35
  - well.
• 16:36
  - Yeah. I would say this the key skills
• 16:39
  - really are gonna be centered around data literacy.
• 16:42
  - Digital fluency, having that foundational knowledge of what
• 16:45
  - AI is and can and empowering our caregivers
• 16:49
  - to be able to build and understand how
• 16:52
  - to leverage the automation
• 16:54
  - and apply those critical thinking skills in a
• 16:56
  - more cross functional collaboration.
• 16:59
  - You know, while
• 17:00
  - AI may improve efficiency and provide valuable insights,
• 17:03
  - we have to keep in mind it doesn't
• 17:05
  - take the human out of the process,
• 17:08
  - and especially where empathy and understanding and human
• 17:11
  - judgment are essential
• 17:13
  - in health care. At the end of the
• 17:15
  - day, a patient is behind every claim. We
• 17:17
  - need to make sure that we're taking care
• 17:19
  - of that patient. We don't lose sight of
• 17:20
  - that.
• 17:21
  - Yeah. Fantastic.
• 17:23
  - Tracy,
• 17:23
  - last last question before I let you go.
• 17:26
  - I've been fascinated to kinda pick your brains
• 17:27
  - a little bit in here. Just just how
• 17:28
  - much fascinating work is going on. Within your
• 17:31
  - team across the board at Cleveland Clinic,
• 17:34
  - what are you most about when you kinda
• 17:36
  - think about the future, whether it's out outside
• 17:38
  - of AI or beyond? When it comes to
• 17:40
  - the revenue cycle and the things that you're
• 17:41
  - focusing on at Cleveland Clinic, is there one
• 17:43
  - or two things you'd really like to highlight
• 17:45
  - before we wrap up?
• 17:47
  - The first thing I would like to say
• 17:49
  - is the value revenue cycle brings to the
• 17:51
  - organization.
• 17:52
  - I am really excited to see
• 17:55
  - that our executives are really seeing the value
• 17:57
  - we bring to the organization
• 18:00
  - and the impact
• 18:01
  - positively
• 18:02
  - that we have
• 18:04
  - and garnering the support all the way up
• 18:06
  - to our CEO, Doctor Tom Mihalovich.
• 18:08
  - What do you need, Tracy?
• 18:10
  - And really understanding,
• 18:12
  - the return on investment and the strategic initiatives
• 18:15
  - we have underway and getting his support.
• 18:18
  - You know, real and and then the second
• 18:19
  - thing is really
• 18:21
  - redesigning that patient financial experience.
• 18:24
  - You know, we want patients to pay. We
• 18:26
  - want to make it easy for them to
• 18:27
  - pay.
• 18:28
  - Our healthcare industry is so complicated.
• 18:31
  - We have a lot of patients that don't
• 18:32
  - understand their benefits.
• 18:33
  - You have a greater shift of,
• 18:36
  - employer shifting more expenses to the our patients.
• 18:40
  - You have higher,
• 18:42
  - rise in high deductible plans. And
• 18:45
  - so we've gotta figure out how to make
• 18:47
  - it a better experience, more seamless,
• 18:49
  - simplified,
• 18:53
  - and the ability to pay making it easy
• 18:55
  - and customize it. You know? Those self serve
• 18:57
  - models are making it easy.
• 19:00
  - They have choices, and we wanna make sure
• 19:02
  - that they clearly understand that transparency is really
• 19:05
  - important. So we're really leaning in here and
• 19:07
  - redesigning to have a much more effective
• 19:10
  - and positive financial experience for the patients so
• 19:12
  - they understand we're transparent
• 19:14
  - and giving them tools to self serve and,
• 19:17
  - pay in a way that meets them where
• 19:19
  - their needs are.
• 19:21
  - Fantastic.
• 19:22
  - Tracy, I think, such a pleasure to have
• 19:23
  - you make, your debut appearance on the Becker's
• 19:25
  - podcast with us today. So greatly appreciate your
• 19:27
  - time. So greatly respect a lot of great
• 19:29
  - work that you and your teams are doing,
• 19:30
  - and really look forward to catching up with
• 19:32
  - you again down the line. Thank you. Thanks,
• 19:34
  - Alan.