Latest / Becker’s Payer Issues Podcast / How University Health Is Tackling Payer Pressure and Driving Mission-Driven Revenue Cycle Innovation with Kevin Barron

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How University Health Is Tackling Payer Pressure and Driving Mission-Driven Revenue Cycle Innovation with Kevin Barron · Becker’s Payer Issues Podcast

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  That's veradigm.com
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  to learn how Veradigm can help you too.
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  This is Alan Condon back with the Becker's
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  CFO
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  and revenue cycle podcast,
• 0:45
  And I'm thrilled to be joined today by
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  Kevin Baron, deputy vice president of payer relations
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  at University
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  Health in San Antonio, Texas.
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  Kevin, a pleasure to have you make your
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  debut appearance with us on the Becker's podcast.
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  For those of our listeners who mightn't be
• 1:01
  as well acquainted with the work it is
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  that you do at University Health, do you
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  mind just, opening it up a little bit
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  and kind of share a little bit more
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  about your background at the at the health
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  system?
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  Sure.
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  My role is deputy vice president for payer
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  relations. So essentially, I'm responsible for all of
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  our managed care contracting,
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  on behalf of the health system facilities and
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  our about 800 member,
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  provider group.
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  I've been here for about nine years or
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  so. Been doing this one way or another
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  for probably, I hate to say it, over
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  thirty years,
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  and got started many years ago back in,
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  in New Orleans,
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  out of college working for a hospital there
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  doing number crunching, and,
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  it's led to where I am now. And
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  San Antonio is a great place. University Health
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  is is probably the most mission driven place
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  I've ever worked. So I'm happy to be
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  here and and happy to be on the
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  show.
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  Fantastic. So born in thirty years in the
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  health care finance, like you said, from number
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  crunching at a a hospital in the New
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  Orleans area and now to deputy vice president
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  of payer relations at University Health.
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  No doubt you've seen a lot of movement,
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  a lot of change, a lot of evolutions
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  in that time. But
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  what are you focusing on at the moment
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  in your current role? Certainly a lot happening,
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  at any one point in time. But what
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  are the two or three kinda key trends
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  that you're paying closest attention to today in
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  health care?
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  Well, the biggest one I guess is that
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  we've seen a lot of changes over the
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  years and it seems to be getting a
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  little bit more challenging to deal with our
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  payer partners.
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  They're much more aggressive on denials and their
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  work. And what, you know, has been known
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  to the industry is, terminate the contract or
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  contract,
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  by termination.
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  We've seen that happening in other parts of
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  Texas.
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  Thankfully, we haven't been there, but,
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  the whole environment is is much more difficult.
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  I kinda say that providers need to know
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  when to hold them and know when to
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  fold them, to quote the, the gambler,
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  because you just never know.
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  What we are as a governmental health system,
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  we're the Bexar County Hospital District, and,
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  we have one of the busiest ERs in
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  the state.
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  We're,
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  about we're staffing probably a little over 700
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  beds right now. We're about to open, within
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  the next year or so, two new hospitals
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  as well in the community.
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  There's a lot of things that we wanna
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  make sure that the community has access to.
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  And to me, what drives me generally is
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  making sure that people that need the care,
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  have access to the care regardless of their
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  ability to pay,
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  and regardless of, you know, of where they
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  are in our community. We try to bring
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  things to them.
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  So the whole payer situation is is challenging.
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  There's a lot of delay.
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  There's a lot of changes in staffing,
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  turnover, and contracting folks. At least we're seeing
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  that in Texas, and that makes it difficult
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  to build relationships, which is what it's all
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  about and what we do. So I guess
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  the second one is probably,
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  where we're going with rev cycle.
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  We're working actually right now with AI. We're
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  trying to get a system in that's gonna
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  help us with redlining documents, tracking contracts,
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  managing the the contents of them when we
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  need to do polls for specific information on
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  performance or anything else.
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  And then, I guess the
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  the piece of that that goes along with
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  the digitization
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  is the fact that,
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  we're part of the revenue cycle. We're the
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  way I put it is we're kind of
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  embedded.
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  When I started here years ago, we had
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  a news chief revenue officer who's still my
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  direct supervisor a while ago, and he's he's
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  fantastic.
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  His vision was to make sure that contracting
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  was smack in the middle of everything the
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  revenue cycle
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  cycle does. So I've grown quite a bit
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  even though I've been in this game for
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  a while. The last nine years or so,
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  I've grown a lot. I've learned a lot,
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  mostly due to his kind of mentorship and
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  the folks that I work with across the
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  rev cycle. So
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  that's something that I'm working on. We're still
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  trying to get a few new opportunities like
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  education set up, implementation of contracts to be
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  better.
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  And I guess the last thing is one
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  that we hear about a lot on the
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  clinical side, but I'll bring it up here,
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  And that's just making sure we have the
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  right people in the right jobs,
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  they call workforce sustainability.
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  My end of it,
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  is that we have a good bit of
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  turnover in some of the entry level positions
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  in the revenue cycle, and that's kind of
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  a challenge like patient access.
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  But if you give them opportunities and training
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  and all, I think that helps. When you
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  look different to more of the technical jobs,
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  we have three folks who are certified with
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  EPIC as contract analysts and that can build
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  our contracts in EPIC. They work in our
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  department instead of IT at this point,
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  and I love it because it helps us
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  translate what we negotiate into contracts in the
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  system a lot more quickly
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  and more accurately.
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  But keeping someone who's Epic certified, as folks
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  out there may know, is is not easy.
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  They're in high demand,
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  and they're very talented people. So, you know,
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  keeping making sure that we've got the right
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  folks,
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  in the right positions and can hold on
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  to them,
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  is a priority for me. So I guess
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  those would be the the big ones.
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  Yeah. No.
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  Great kind of bird's eye view with some
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  of those key trends, some of the things
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  that you're focusing on at university health. I
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  heard quite similar from other revenue cycle leaders
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  that are CFOs and other health systems across
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  the country in recent conversations.
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  But to kinda pick up on
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  the first trend that you'd that you'd noted,
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  Kevin, in terms of, you know, the health
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  systems taking a bit more of an aggressive
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  stance, to fight back on the equally or
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  probably a little bit more aggressive stance that
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  a lot of the commercial payers have have
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  talked in recent quarters, recent years when it
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  comes to no secret to you or myself
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  or any of our listeners here, but the
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  the alarming rate of denials,
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  slow payments, prioritization
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  burdens.
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  Granted, there there's no silver bullet to these
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  epidemic of challenges here on the payer side.
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  But is there one or two things that
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  University Health is doing or has done to
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  fight back against denials, fight for those dollars,
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  maybe see a little bit more success in
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  terms of protecting your financial performance?
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  Well, I don't know that any of these
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  are really, super innovative apart from the fact
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  that our our contracting team that I, I
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  manage
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  is part of the rev cycle directly.
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  But in terms of just the operational side,
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  we've built within the managed care team, that
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  may be a little different, but we built
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  within our team a contract performance audit function.
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  So we have, three positions there. We have
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  a senior manager who's over that and then
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  two contract auditors and essentially what they do
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  is go through all of the trends and
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  payment issues,
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  make sure that they're identified, that we get
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  the scope and depth as we say of
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  what the problems are,
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  get those to the payers and try to
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  fix them.
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  That's something that, you know, happens a lot
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  of times in the business offices of different
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  health systems.
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  We've pulled some of that over on our
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  end to help with what the business office
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  has to manage because they have a lot
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  to say grace over.
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  But on our end, it's been successful.
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  One of the specific programs that we have
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  with them is that we pull everything that's
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  a high dollar claim. At a certain time,
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  it hits one of our epic work queues,
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  and they go through and do that.
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  Over the last
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  I think it was last fiscal year when
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  we did the report, we were able to
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  assist in collecting an additional $12,000,000,
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  on high dollar claims. And, basically, every claim
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  that we were able to assist the business
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  office with,
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  we're able to collect about another $150,000
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  on those services. So we we focus on
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  the high dollar ones. We look at when
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  they hit a certain age in the AR
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  where we know that it's gonna be hard
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  to collect.
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  Our opportunity to do that, you know, maybe
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  has passed a bit. But we go back
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  at them hard and we try to go
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  to the payers themselves,
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  and explain what's going on with the claim,
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  make sure that they have the records they
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  need. Records they need. All the rest of
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  that stuff, we kinda do from our team
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  as well
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  as, you know, it gets done in the
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  business office for other times.
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  But working on that, I think, has been
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  very helpful. Just being part of the rev
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  cycle generally, as I said, is helpful because,
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  I meet with our business office folks, our
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  reimbursement folks, our revenue integrity folks, and our
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  CRO every Friday morning. We have an AR
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  meeting,
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  and having the contracting folks in the AR
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  meeting, at least from what I've seen, is
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  not not always common,
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  but it helps.
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  It gives me an opportunity to hear where
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  the pain points are,
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  try to follow-up immediately,
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  when I'm sitting there, with whoever I need
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  to at the payers to try to address
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  a problem or get something kicked off anyway.
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  So a few of those things. I guess
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  the most recent thing that we started and
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  we've hired a dedicated manager for this,
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  and that's to we were building a contract
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  implementation
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  process.
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  You know, every time you do a contract,
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  it seems like, you know, it takes forever.
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  Like we talked about, it's challenging now more
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  than ever. But once you have the contract
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  done, sometimes, at least in my career years
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  ago, we would just move on. We'd send
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  a copy of it to legal. We send
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  it to the business office and whoever else
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  needed it.
• 10:05
  Then we go on to the next negotiation.
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  We haven't done that in a very long
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  time where I am now, but what we're
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  trying to do is really focus on it.
• 10:14
  So the goal is to build,
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  what we call our packed program,
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  and it's essentially just
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  making sure that we have the right education
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  for the revenue cycle teams, identifying where the
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  the knowledge gaps are, the access gaps,
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  to portals and that kind of thing,
• 10:29
  getting the payers on-site or through some type
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  of, teams or Webex or something to do
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  in services for the staff and the leaders
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  of the revenue cycle.
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  We've, we've had good success with it. We've
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  only done a couple so far because it's
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  pretty new,
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  but I'm excited about what it's gonna bring.
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  And that person that's managing that is also
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  gonna manage our our joint operating committee meetings
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  or JOCs with our payers.
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  So we're gonna make sure that we're bird
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  dogging whatever is out there that needs to
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  be followed up on.
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  And the person we have in it is,
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  is a new grad, undergrad,
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  but she is really excited about the job,
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  and, she's helped us build it when she
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  was with us as an intern.
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  So that's one of my pet projects,
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  and I'm I'm excited about it because I
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  think it's gonna help us do things we
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  haven't been able to in the past,
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  by just making sure that the contracts get
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  rolled out appropriately.
• 11:22
  Yeah. Yeah. And that's maybe so you might
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  be able to expand on that maybe just
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  one bit more. But but one, one quick
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  follow-up, Kevin. You'd mentioned the the the high
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  dollar the high dollar claims that you'd mentioned.
• 11:33
  Are they are they,
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  higher acuity procedures
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  or longer inpatient stays in the hospital
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  or spine orthopedic surgeries, cardiology. What what what
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  specifically are those high dollar claims that you're
• 11:46
  referring to?
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  Well, they could be pretty much anything.
• 11:50
  We're the only the region's only level one
• 11:52
  trauma center for adults and peds.
• 11:55
  We're the level four NICU.
• 11:57
  We're the only level four maternity care center,
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  and we also do solid organ transplants.
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  So it could be a lot of different
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  things.
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  The way we have it set up right
• 12:08
  now, is that we have a specific work
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  queue in Epic,
• 12:12
  where the claims will hit that if they're
• 12:14
  in the AR for over seven months, which,
• 12:16
  you know, you could arguably say it's gonna
• 12:18
  be hard to collect after that.
• 12:20
  They hit seven months and they have a
• 12:21
  balance of 50,000 or more. So even if
• 12:23
  we've gotten some version of payment, if we're
• 12:25
  not adequately paid the way we think we
• 12:27
  should be through our epic calculations,
• 12:30
  it hits the queue and we follow-up on
• 12:33
  So it's a partnership between us and the
• 12:35
  billing team. We make sure that we do
• 12:37
  everything we can to help when they get
• 12:39
  that old. And a lot of times, it's
• 12:40
  nothing to do with, you know, a lack
• 12:42
  of collections effort on the billing team's part.
• 12:45
  It comes down to either payer response,
• 12:48
  turnover with the folks on the payer side.
• 12:50
  We've seen that a lot,
• 12:51
  or just getting to the right person at
• 12:53
  the payer to pay attention.
• 12:55
  We've had some issues recently. I won't say
• 12:57
  who it was with,
• 12:59
  but we had a payer,
• 13:00
  that we sent 2,000 pages of records to,
• 13:04
  for a given one single claim.
• 13:06
  They couldn't locate them. They wanted them hard
• 13:09
  copy. We sent them hard copy certified, and
• 13:11
  they couldn't find them.
• 13:12
  And when we tried it again, they still
• 13:14
  couldn't find them. So we essentially I just
• 13:16
  reached out to the person and said, look.
• 13:18
  We got an issue here with a potential
• 13:20
  HIPAA violation because these records are out there
• 13:22
  someplace, guys. Help us with this.
• 13:25
  So I just got on the phone, talked
• 13:27
  to him. We also sent him an email,
• 13:29
  documenting this. And lo and behold, they found
• 13:32
  the records within, like, three days,
• 13:34
  and the claim got paid. So, you know,
• 13:36
  you just you gotta be aggressive, but you
• 13:38
  gotta be nice about it. You gotta find
• 13:40
  new angles.
• 13:41
  And the high dollar process has led us
• 13:43
  to learn a lot about, you know, what
• 13:45
  payers sometimes do as well as what we
• 13:48
  may not do so great ourselves. It it's
• 13:50
  not always a payer problem. Sometimes it's something
• 13:53
  to do with our own processes, and we
• 13:55
  we try to feed that back to the
• 13:56
  rep cycle folks as well where we can.
• 13:59
  Yeah. I mean, I certainly don't envy about
• 14:01
  trying to strike that balance in that scenario
• 14:03
  of being aggressive in terms of chasing down
• 14:05
  those high dollar claims, but also in some
• 14:07
  way, shape, or form, trying to be nice
• 14:09
  about it. Must be challenging. But,
• 14:11
  Kevin, that that's a lot of the challenges
• 14:13
  we talked about there. You talked about one
• 14:15
  or two things you're quite excited about now.
• 14:17
  But maybe, if you could elaborate, what what
• 14:19
  are you most excited about, when you think
• 14:21
  about the future of university health, the future
• 14:23
  rev cycle? What what kinda comes to mind
• 14:25
  for you?
• 14:26
  I think the the piece that I wouldn't
• 14:28
  have had in as to perspective many years
• 14:30
  ago before coming here and and working with
• 14:33
  the wall,
• 14:34
  is the fact that we are, you know,
• 14:36
  part of the rev cycle. The fact that
• 14:37
  we get to see it from a lot
• 14:39
  of different angles.
• 14:40
  Literally every place I've ever worked, I've worked
• 14:42
  in five states, had the privilege to work
• 14:44
  for a lot of governmental not for profit
• 14:46
  health systems,
• 14:47
  and I've never had that vantage point before.
• 14:50
  It's created some challenges for me. It's created
• 14:53
  some growth opportunities for me, some frustrations. But,
• 14:57
  what it's allowed me to do is to
• 14:58
  see how what we do in contracting and
• 15:01
  payer relations really matters,
• 15:03
  how it connects directly to the patients that
• 15:06
  we're trying to see, especially
• 15:08
  as the type of organization we are.
• 15:10
  We try to reach patients, as I said,
• 15:13
  wherever they may be and regardless of their
• 15:15
  financial situation.
• 15:17
  I have personally, I have my wife and
• 15:19
  I have a daughter
• 15:20
  with special needs who's had a lot of
• 15:22
  challenges when she was born. She was born
• 15:24
  very early, so I also have a personal
• 15:26
  perspective of seeing how challenging it can be
• 15:29
  to get the care you need, especially for
• 15:32
  a child or even an, you know, an
• 15:33
  adult with different types of disabilities.
• 15:37
  And I want this place,
• 15:39
  I want university health as good as it
• 15:41
  is and as mission driven as it is
• 15:42
  to be here fifty years from now. I
• 15:44
  I want them to be here for my
• 15:45
  daughter when I'm not.
• 15:47
  So there needs to be organizations like ours
• 15:49
  that care about the mission,
• 15:51
  and the mission to me is always forefront.
• 15:53
  We talk about it in our team all
• 15:55
  the time,
• 15:56
  because it's it's rare that when you're in
• 15:58
  rev cycle, you you have an opportunity to
• 16:00
  see how what you do affects a given
• 16:02
  patient.
• 16:04
  But we had an example recently that, our
• 16:06
  director of managed care analytics did.
• 16:09
  We had a
• 16:10
  outreach from our pharmacy folks who said we
• 16:13
  had a patient,
• 16:14
  that was really in need of a certain
• 16:16
  drug. There was a problem in terms of
• 16:18
  coverage.
• 16:19
  What could we do to set up a
• 16:20
  single case agreement?
• 16:21
  And
• 16:22
  we did, essentially. It took a little bit
• 16:24
  of doing, but, between him and our, senior
• 16:27
  coordinator, the person that handles all of our
• 16:29
  single case agreements,
• 16:31
  they got together. They found a way to
• 16:33
  make it work. They found a way to
• 16:34
  make sure we got our cost coverage that
• 16:36
  we needed to, and put it in place.
• 16:38
  And through that, the two of them got
• 16:40
  to know who this patient was, what their
• 16:42
  circumstances were, how what they did actually mattered,
• 16:46
  directly to that patient. Because the patient was
• 16:48
  in house at the time,
• 16:50
  it really it really hits home. I had
• 16:53
  a similar situation years ago with a pediatric
• 16:56
  patient with cancer,
• 16:58
  and was working with his father to make
• 16:59
  sure that because they were out of network,
• 17:01
  they were still able to come to our
• 17:02
  service, to come get service at our facility.
• 17:05
  And it was extremely rewarding. That little boy
• 17:08
  was actually put on, one of our, health
• 17:11
  system commercials years ago,
• 17:13
  as a success story, and I can't tell
• 17:15
  you how good that made me feel. So
• 17:17
  I think, you know, what I'm excited about
• 17:19
  is making sure that we somehow get the
• 17:21
  rubber, onto the road. The rev cycle does
• 17:24
  what it's supposed to do. It's efficient as
• 17:27
  it can be. We work together as a
• 17:28
  team.
• 17:29
  And before it's all said and done, the
• 17:32
  patients out there, you know, they don't need
• 17:33
  to worry about all the back end stuff.
• 17:35
  Stuff. They just get the care they need,
• 17:37
  and we can move on.
• 17:38
  So I I can ramble about this stuff
• 17:41
  forever, but that's, that's what gets me excited.
• 17:43
  Now the the day to day,
• 17:45
  of the work that we do, I love
• 17:47
  also. I'm a bit of a nerd in
• 17:48
  a lot of ways.
• 17:49
  But the big picture, I guess, it's it's,
• 17:52
  you know, affecting the community that we have
• 17:54
  out there and meeting the needs that they
• 17:55
  have.
• 17:56
  Yeah. Well well, I love those specific examples
• 17:59
  of those those patients and how rewarding it
• 18:01
  is for for you and the rev cycle
• 18:03
  team. No doubt your care team, your hospital
• 18:05
  health system being able to take care of
• 18:06
  patients in similar troubling challenging situations like that
• 18:10
  as well.
• 18:11
  I guess one one last question on that
• 18:14
  before we move on to our last question,
• 18:16
  Kevin, because it's something that no doubt a
• 18:18
  lot of,
• 18:19
  hospitals, nonprofit systems really struggling with grappling with
• 18:22
  today. That's something you brought up in terms
• 18:24
  of that mission versus margin.
• 18:27
  How do you how does your executive team
• 18:30
  try to strike that balance in today's complex
• 18:33
  challenge and landscape, particularly when we see
• 18:36
  the financial challenges that so many hospitals are
• 18:38
  up against? I believe 43%,
• 18:40
  a little under of hospital still operating in
• 18:42
  the red.
• 18:44
  Academic systems, nonprofit systems, obviously, I'd love to
• 18:47
  kinda hear how you strike that balance because
• 18:49
  it is so challenging,
• 18:51
  arguably more challenging than it ever has been
• 18:53
  in today, I imagine.
• 18:55
  It is. It definitely
• 18:57
  is. And, for any of our executive team
• 19:00
  that's listening, I love what I do, and
• 19:01
  it's really hard.
• 19:04
  And I'm gonna keep doing the best I
• 19:05
  can. Yeah. But no. I just I I
• 19:08
  love it. And I think, our organization when
• 19:11
  I got here, you know, nine plus years
• 19:13
  ago, we had probably about 25%
• 19:16
  of our business was commercial,
• 19:18
  which is not in the you know, it's
• 19:19
  not insignificant
• 19:20
  for, a county owned facility
• 19:23
  that had, you know, a fourth of our
• 19:25
  businesses uninsured
• 19:26
  because we're in Texas. They didn't expand Medicaid
• 19:29
  way back when. So we still have a
• 19:31
  decently,
• 19:32
  large uninsured population in Texas.
• 19:34
  We had about a fourth of our business
• 19:36
  then was Medicare, and about a fourth of
• 19:38
  it was Medicaid.
• 19:40
  Where we are today, we're closer to a
• 19:42
  third commercial.
• 19:44
  So that big pickup in commercial business, I
• 19:47
  like to think, is because, you know, the
• 19:48
  market shifted a bit.
• 19:50
  The exchange products are out there. We count
• 19:52
  them as as commercial.
• 19:54
  And at the same time, I like to
• 19:55
  think that the contracting that we've done has
• 19:58
  increased access to what we do.
• 20:00
  Our reputation
• 20:01
  has grown quite a bit. We've got a
• 20:03
  beautiful facility. It is it's unbelievable.
• 20:06
  We just opened the women's and children's hospital.
• 20:09
  Like I said, we're opening two new facilities
• 20:11
  in the next year or so. We're expanding
• 20:13
  our our medical group, like, leaps and bounds.
• 20:15
  It's hard to even stay up with what
• 20:17
  they're doing nowadays.
• 20:19
  But the fact that we're a little different
• 20:21
  that way from most governmental,
• 20:23
  you know, academic medical centers, I think helps.
• 20:27
  We we picked up a lot of at
• 20:29
  least in my opinion, I'm not gonna say
• 20:30
  this is an official opinion, but in mine,
• 20:32
  I think we picked up a lot of
• 20:34
  community support through the whole pandemic.
• 20:37
  We jumped in both feet in terms of
• 20:39
  making sure that the needs were being met,
• 20:42
  that the vaccination
• 20:43
  programs were out there and available readily available,
• 20:46
  and we didn't charge for them.
• 20:49
  A lot of things like that, I think,
• 20:50
  helped. Our chief medical officer was on the
• 20:53
  news just about every day talking about updates
• 20:55
  and things like that, and that that was
• 20:56
  wonderful. And I believe that's what we should
• 20:58
  be doing. You know, we're the county facility.
• 21:00
  We should should be there helping folks.
• 21:02
  So I think that helped in terms of
• 21:04
  visibility.
• 21:05
  But I think that the growth we've had
• 21:07
  and the growth we expect is also going
• 21:09
  to be helping us in that area because
• 21:11
  we are seeing a bigger exposure
• 21:14
  to the commercial patient base, which as you
• 21:16
  know is what offsets what we don't get
• 21:18
  paid from
• 21:19
  Medicare and Medicaid.
• 21:21
  A lot of people think we get our
• 21:23
  costs there, you know, and theoretically on Medicare
• 21:25
  we're supposed to.
• 21:26
  Medicaid we're not close.
• 21:28
  So and plus we still have a good
• 21:30
  size insured
• 21:32
  population. So
• 21:33
  I think it's difficult. I think the folks
• 21:35
  in finance,
• 21:36
  and the folks that are in collections in
• 21:38
  our business office do a phenomenal job.
• 21:41
  I like to think we have a little
• 21:42
  part of that in terms of contracting, so
• 21:44
  that's helpful.
• 21:46
  But trying to go through, what we're gonna
• 21:48
  be doing, I guess, within the next year
• 21:50
  or so is is we're gonna be looking
• 21:51
  at our payer partnerships a little more closely.
• 21:54
  I've heard different guests on the show talk
• 21:56
  about the fact that that you really need
• 21:57
  to assess where they are with Medicare Advantage
• 21:59
  contracting.
• 22:01
  We're in just about every network,
• 22:03
  and we wanna be generally because we're the
• 22:06
  county facility. We wanna make sure people have
• 22:08
  access to us.
• 22:09
  But at the same time, there are some
• 22:11
  that are just really underperforming,
• 22:13
  more denials, more, you know, hassle in terms
• 22:16
  of everything, you know,
• 22:18
  collections efforts, you name it. And we probably
• 22:21
  need to go through some of those and
• 22:22
  see whether it's worth continuing.
• 22:25
  I think, you know, there are some tough
• 22:27
  choices being made,
• 22:29
  but I'm optimistic, and,
• 22:31
  the growth that we've had, I think, is
• 22:33
  is probably gonna continue, especially with the new
• 22:36
  hospitals. But let me give you an example,
• 22:38
  I guess, in how our our commercial mix
• 22:40
  has probably changed.
• 22:42
  About two or three years ago before we
• 22:44
  opened the new women's and children's hospital,
• 22:47
  we were delivering, I want to say, it
• 22:48
  was about 4,000,
• 22:50
  newborns a year.
• 22:52
  We're probably gonna end this year close to
• 22:54
  six,
• 22:55
  which is know, 50% increase,
• 22:58
  in a couple of years.
• 23:00
  And it's to me, it's it's completely credited
• 23:03
  to the the new facility we have,
• 23:06
  the medical staff who is, you know, amazing,
• 23:09
  the leadership folks that are running the women's
• 23:11
  and children's hospital, I I love talking to
• 23:13
  them. I meet with them at least once
• 23:14
  a month to talk about what's going on
• 23:15
  and what's new.
• 23:17
  I just think it's, it's a great opportunity
• 23:19
  for the community. It's state of the art,
• 23:21
  and I just I'm impressed with it myself.
• 23:24
  One of our, team members actually had her
• 23:26
  most recent her baby recently there, and
• 23:29
  she was pretty impressed as well. So,
• 23:31
  I just think the challenges we have can
• 23:34
  be met.
• 23:35
  I think part of it is you've got
• 23:36
  to look at, you know, where your strengths
• 23:38
  are and what your mission is. And I'm
• 23:40
  one of those people that just believes that
• 23:42
  if you have a good mission, you live
• 23:44
  your mission, the rest of it will work.
• 23:46
  It'll come to you because you're in it
• 23:48
  for the right reason.
• 23:49
  I know that sounds a little touchy feely,
• 23:51
  and I've got an accounting degree, so I
• 23:53
  don't know how to reconcile those two.
• 23:55
  But, it's just kinda who I am. We
• 23:57
  just wanna do the best we can for
• 23:59
  the patients we have, make sure we're as
• 24:01
  efficient as we can be,
• 24:03
  and be around for, you know, decades to
• 24:05
  come. Hopefully, we're over a 100 years old
• 24:08
  now. So I think it's very possible.
• 24:10
  Yeah. No. No. I certainly appreciate it. It
• 24:12
  goes back to that old,
• 24:14
  deal
• 24:15
  no mission, no margin, but no margin, no
• 24:17
  mission.
• 24:18
  Right. Right. Kevin, you touched on
• 24:22
  a little bit there, but I wanted to
• 24:23
  expand on the last question I have for
• 24:25
  you. You talked a little bit about the
• 24:26
  growth at University Health. 100 year old health
• 24:29
  system, lot of exciting things happening at the
• 24:31
  moment in the future. You've mentioned the the
• 24:33
  new women's and children's hospital just opened up.
• 24:35
  You're opening a couple other facilities. Sounds like
• 24:38
  rapidly expanding your medical group, leaps and bounds
• 24:41
  as well. But over the next twelve months
• 24:43
  or so,
• 24:44
  how are you looking at growth, whether the
• 24:46
  health system more broadly or or specifically in
• 24:48
  your revenue cycle department? What are the kind
• 24:50
  of key things that you're focused on?
• 24:52
  Well, for the growth, again, I think you're
• 24:54
  just kind of fine tuning what we do,
• 24:56
  at least in my opinion. Our like I
• 24:57
  said, our CRO has a definite vision for
• 25:00
  where he wants to go, and I I've
• 25:02
  seen it take shape over the years.
• 25:05
  From my little perspective, I guess,
• 25:07
  I wanna see us implement that contract implementation
• 25:10
  process, that education program for our rev cycle
• 25:13
  and leaders. I wanna make sure that that's
• 25:15
  available. It's closing the gaps in knowledge
• 25:18
  and access that they have. We have, taken
• 25:21
  a lot of, a lot of effort and
• 25:23
  a lot of time to meet with them
• 25:24
  to make sure that we understand their needs.
• 25:26
  We're gonna continue to do that, and we're
• 25:29
  gonna build the program around them.
• 25:31
  So I'm excited about that. I think that's
• 25:33
  gonna be something we our little team's gonna
• 25:35
  focus on. I think we're gonna look at
• 25:37
  some of our contracts and try to make
• 25:39
  sure that they're doing what they need to
• 25:40
  be doing for us,
• 25:42
  as well as, they're balancing, you know, the
• 25:44
  access for the community that is so important.
• 25:47
  The other piece of it, I guess, just
• 25:49
  goes on to data. We do a lot
• 25:51
  in our little team that probably some contracting
• 25:54
  departments don't do. We do build the contracts
• 25:56
  in Epic,
• 25:58
  and through our three certified folks,
• 26:00
  we do do have a,
• 26:03
  a contract performance audit function.
• 26:05
  We are doing this implementation
• 26:07
  training part, which is not something that a
• 26:09
  lot of managed care contracting departments do.
• 26:12
  But the other piece of it is we
• 26:13
  wanna build a reporting structure. We wanna build,
• 26:17
  reporting that we can look at our contracts
• 26:19
  through, our payer scorecards,
• 26:22
  can look at performance by service line, can
• 26:24
  look at, you know, everything from time to
• 26:26
  pay to accuracy of payment, all the rest
• 26:29
  of that, and build something that we can
• 26:31
  then share,
• 26:32
  with our executive team,
• 26:34
  and with the rest of the leaders in
• 26:35
  the revenue cycle.
• 26:37
  We have something called our payer performance evaluation
• 26:40
  team, and essentially that's just a group of
• 26:43
  of revenue cycle folks that that are my
• 26:45
  peers.
• 26:46
  We get together once a month,
• 26:48
  and we go through what the latest contract
• 26:50
  proposals are like
• 26:51
  so they can understand what the payers are
• 26:53
  trying to, you know, to ask us to
• 26:55
  do, rate structure wise or operationally.
• 26:59
  We also get their feedback on our own
• 27:02
  contract checklist. We have a a toolkit
• 27:05
  that helps us to go through and make
• 27:06
  sure we have the right language in place.
• 27:08
  One, because we're governmental, but two, because operationally
• 27:11
  we've learned a lot of things over the
• 27:13
  years and we want to make sure that
• 27:14
  that's included.
• 27:16
  So they help us evaluate that.
• 27:18
  And then the other piece is we do
• 27:19
  a quarterly meeting,
• 27:22
  that we call our managed care committee, but
• 27:23
  essentially it's the executive group. And we talk
• 27:26
  about where the contracts are performing,
• 27:28
  what negotiations are happening, and how things are
• 27:30
  going there and have happened over the last
• 27:33
  quarter,
• 27:34
  and then also, to make sure that they're
• 27:36
  up to speed on what networks we're in,
• 27:38
  what networks other folks are in, and, you
• 27:41
  know, where there may be some gaps that
• 27:43
  we need to close.
• 27:44
  We're a partner with the the University of
• 27:47
  Texas Health Science Center in San Antonio.
• 27:50
  They make up the majority of our medical
• 27:52
  staff at University Hospital right now, and probably
• 27:54
  will for many years,
• 27:56
  so we want to make sure we're aligned
• 27:57
  as best we can in participation with them.
• 28:00
  Our own medical group, University Medicine Associates, does
• 28:04
  all of our anesthesia,
• 28:06
  a lot of our hospitalist work,
• 28:08
  all of our NICU work, and that kind
• 28:10
  of thing. So
• 28:11
  we want to make sure that they're in
• 28:13
  the right contracts and their services are being
• 28:15
  covered.
• 28:16
  So a lot of making sure I think
• 28:17
  that,
• 28:18
  down the road that we're we're contracted with
• 28:20
  who we need to be.
• 28:22
  We try to expand access where we can.
• 28:24
  There are some exchange products we're not in
• 28:26
  now that I really want us to join
• 28:28
  if we can get access to them.
• 28:30
  But as the the local county governmental hospital,
• 28:32
  we wanna be available to everybody. So that's
• 28:35
  one of my personal goals is to to
• 28:36
  try to close those gaps where I can.
• 28:39
  A lot happening, but it's all exciting stuff.
• 28:42
  So I hope that answered the question. And
• 28:44
  if, I went in too many directions,
• 28:46
  just let me know, and I'll focus where
• 28:47
  you need me to. No. No. Not at
• 28:49
  all. I think, Kevin,
• 28:51
  it's almost going on at any one point,
• 28:52
  but I think so so greatly respect,
• 28:55
  so greatly appreciate,
• 28:57
  the work that you that your teams do,
• 28:59
  University Health. That was great to catch up
• 29:01
  with a leader at such a fantastic health
• 29:03
  system.
• 29:04
  Kevin, really, really enjoyed this conversation that those
• 29:07
  thirty minutes or so absolutely flew by. I
• 29:09
  really really look forward to connecting with you
• 29:11
  again down the line, and thanks again for
• 29:12
  taking the time out of your busy, busy
• 29:13
  schedule to have a word with us on
• 29:15
  the Becker CFO and Rev Cycle podcast.
• 29:17
  Oh, no. Thank you so much. I really
• 29:19
  appreciate it, Alan. This is a great opportunity,
• 29:21
  and I'll be listening to all the other
• 29:22
  episodes. That's for sure.
• 29:24
  Thank you, Kevin.