Latest / Becker’s Healthcare - Clinical Leadership Podcast / Michael Mercurio, Vice President of Physician Billing Services & Co-Founder at CodaMetrix, Mass General Brigham

Transcript

Michael Mercurio, Vice President of Physician Billing Services & Co-Founder at CodaMetrix, Mass General Brigham · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Would you like to exchange best practices and ideas to improve care,
• 0:03
  enhance operational efficiency,
• 0:05
  and address financial challenges with your peers?
• 0:08
  Becker's Healthcare is facilitating these conversations at their eighth annual
• 0:12
  health, IT digital health and R C M meeting.
• 0:15
  You can check your eligibility for complimentary attendance at the link in the
• 0:19
  description. We are excited to welcome you in October.
• 0:22
  This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:26
  I'm thrilled today to be joined by Michael Mercurio,
• 0:28
  vice President of Physician Billing Services at Mass General Brigham and
• 0:31
  co-founder of Coda Metrics. Michael,
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  it's a pleasure to have you on the podcast today.
• 0:36
  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.
• 0:54
  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.
• 6:46
  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,
• 12:22
  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.
• 12:41
  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,
• 12:55
  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?
• 13:02
  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,
• 13:42
  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.
• 14:38
  That's fascinating to hear. And definitely, you know, the future of work, uh,
• 14:41
  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,
• 14:54
  and, and kind of look to that direction? Or is it a sense that, you know,
• 14:58
  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?
• 15:05
  I think it's something we're gonna have to tackle. I'm hoping,
• 15:07
  and I'm confident that we have the right team to, to do that work,
• 15:10
  but it is gonna be a mindset change and potentially some upskilling for,
• 15:14
  for all of us. It's just a di it's just a different world.
• 15:17
  As we roll out more technology that removes charge capture from our,
• 15:21
  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,
• 15:26
  and that they're processing timely and appropriately and with high quality.
• 15:30
  And similar to lead,
• 15:31
  we're gonna always have or continue to have offshore partners. And again,
• 15:34
  managing those relationships when it's all of your business as opposed to just a
• 15:37
  part of your business is, is a very different, um, um, perspective. And it's a,
• 15:41
  a different, uh, amount of pressure for, for us when, uh,
• 15:45
  much more is out of, outside of our direct control.
• 15:48
  Michael, thank you so much for joining me on the podcast today.
• 15:50
  This has been such a fun and interesting discussion and I look forward to
• 15:53
  connecting with you again soon.
• 15:56
  Thanks very much. It was a real pleasure to talk with you.
• 15:59
  Absolutely.
• 15:59
  And it'll be great to see you as well in October at the Health IT Digital Health
• 16:02
  and Revenue Cycle event, um, at Navy Peer in Chicago.
• 16:05
  Looking forward to it.
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