Latest / Becker’s Healthcare Podcast / Courtney McNamee on Modernizing Revenue Cycle and Improving the Patient Financial Experience

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Courtney McNamee on Modernizing Revenue Cycle and Improving the Patient Financial Experience · Becker’s Healthcare Podcast

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  - This is Scott Becker with the Beckers HealthCare
• 1:01
  - podcast. I'm thrilled today to be joined by
• 1:03
  - your brilliant leader. We're joined today by Courtney
• 1:06
  - McNamee.
• 1:08
  - Courtney is at All True Health System,
• 1:11
  - I believe out of Minnesota.
• 1:13
  - A fantastic career.
• 1:15
  - Courtney, I know you're in the revenue cycle
• 1:17
  - and reimbursement area. You're you're a director there.
• 1:20
  - Tell us a little bit about yourself
• 1:22
  - and your career and then about All True
• 1:24
  - Health System.
• 1:26
  - Yeah. Absolutely. I'm Courtney McNamee and I serve
• 1:28
  - as the director of revenue cycle and reimbursement
• 1:30
  - at Altru. I've been in revenue cycle,
• 1:34
  - I've got... Going on about twelve years. So
• 1:36
  - I've been in a variety of different roles.
• 1:38
  - But right now, I lead the teams and
• 1:40
  - processes that really connect the care that we
• 1:42
  - provide with the reimbursement that we receive. So
• 1:46
  - oversee admitting, billing, coding, HIM,
• 1:49
  - the patient financial services area and experience,
• 1:53
  - including a number of other areas, but really
• 1:55
  - that whole span of revenue cycle.
• 1:58
  - Altru is an independent nonprofit health system
• 2:01
  - located in Grand Forks, North Dakota, but we
• 2:04
  - serve a largely rural region across Northeast North
• 2:06
  - Dakota
• 2:07
  - and Northwest Minnesota.
• 2:09
  - Our system includes acute and specialty hospital care,
• 2:12
  - a level two trauma center,
• 2:14
  - multiple practice locations, and a broad range of
• 2:17
  - specialty services.
• 2:19
  - My role is a little unique because reimbursement
• 2:22
  - fits really at the intersection of almost everything
• 2:24
  - that we do as a health system. It's
• 2:26
  - not just sending a bill, but it really
• 2:28
  - is how the care model, the site of
• 2:31
  - service, documentation,
• 2:33
  - regulatory compliance and the patient financial experience
• 2:36
  - ultimately become
• 2:38
  - payment.
• 2:38
  - When we piece those things together, we protect
• 2:42
  - the organization
• 2:43
  - financially, but we also make health care easier
• 2:46
  - for our patients
• 2:47
  - and clinicians to navigate.
• 2:49
  - I really,
• 2:50
  - am passionate about revenue cycle. I feel strongly
• 2:53
  - that if you're not,
• 2:55
  - rev cycle is a really good area to
• 2:56
  - get burnt out in health care quick.
• 2:58
  - But really what keeps me passionate about the
• 3:01
  - work is the patient impact. So the revenue
• 3:03
  - cycle can feel very technical,
• 3:05
  - but every number represents a patient who needed
• 3:08
  - care, an employee who helped deliver it, and
• 3:10
  - a community that depends on those services remaining
• 3:13
  - available. So I really try to bring
• 3:17
  - my
• 3:18
  - as a leader and as an organization
• 3:20
  - back to two questions.
• 3:21
  - Is it consistent with our values and does
• 3:24
  - it help our patients?
• 3:26
  - And it seems that's just an amazing, amazing
• 3:28
  - perspective
• 3:29
  - of how does this connect. You know, there's
• 3:31
  - this great notion of always being able to
• 3:34
  - connect your mission
• 3:35
  - to what you do and this ability to
• 3:38
  - see revenue cycle is, look, we're really trying
• 3:40
  - to make sure we take care of patients
• 3:41
  - well
• 3:42
  - and that our providers get treated fairly
• 3:45
  - and they're taken care of well.
• 3:47
  - It's such a beautiful, beautiful perspective.
• 3:50
  - Courtney, I'm gonna ask you the tough question,
• 3:51
  - and you have to let me know if
• 3:52
  - you're ready for a tough question. I'm gonna
• 3:55
  - ask you some follow-up questions too because, you
• 3:57
  - know, you're in the area of the country
• 3:58
  - where Fargo was based and everybody loved the
• 4:01
  - show. They loved the the drama, the the
• 4:04
  - comedic value of it, everything about it. But
• 4:06
  - the first question is, are the people nicer
• 4:08
  - in North Dakota or in Minnesota? Where are
• 4:11
  - the nicer people or is it basically
• 4:13
  - they're all Midwestern nice and a pleasure?
• 4:16
  - I would say, for the most part, all
• 4:18
  - midwestern
• 4:19
  - nice and a pleasure, but I've gotta stick
• 4:21
  - with Minnesota as as that's really where my
• 4:23
  - roots are.
• 4:25
  - God bless you. And then, Fargo,
• 4:27
  - how... I mean, you have the accent that
• 4:30
  - comes out of the TV show. It's a
• 4:32
  - beautiful accent. I love it.
• 4:34
  - How much of, like, the personalities...
• 4:37
  - Obviously, Fargo is dramatized and and a great
• 4:40
  - show and crazy.
• 4:42
  - But but how much are the Midwestern nice
• 4:44
  - people,
• 4:45
  - you know, really like this? That nice, that
• 4:48
  - straightforward, that much of a pleasure with a
• 4:50
  - little bit of drama on the side?
• 4:52
  - I think the drama is is the key
• 4:55
  - word there. There's there's drama that comes with
• 4:57
  - everything, but
• 4:59
  - in the rural towns that we have in
• 5:01
  - Minnesota, North Dakota, you know, Fargo being semi
• 5:04
  - one of them, I would say,
• 5:07
  - the drama is key, but but most people
• 5:10
  - are nice.
• 5:12
  - Fantastic. I I love that. And talk a
• 5:14
  - little bit about...
• 5:15
  - You've been a lifelong learner,
• 5:18
  - a lifelong learner. You also serve as president
• 5:21
  - of the HFMA Minnesota.
• 5:24
  - How important is that lifelong learning? I think
• 5:26
  - you went back for a graduate degree.
• 5:28
  - You also...
• 5:30
  - You have leadership roles outside of health care
• 5:32
  - or outside of at least your system.
• 5:34
  - How important is that to being a full
• 5:36
  - leader?
• 5:37
  - And did that come naturally to you or
• 5:39
  - do you have to be intentional about seeking
• 5:41
  - out opportunities to grow in leadership or a
• 5:44
  - little bit of both?
• 5:45
  - Yeah. I think a little bit of both.
• 5:47
  - I think one thing as a leader is
• 5:49
  - that I,
• 5:51
  - I really stay curious. I I like to
• 5:53
  - learn. I like to ask questions. I like
• 5:56
  - to dig.
• 5:56
  - I I oftentimes say that I probably know
• 6:00
  - a little bit about too much, which can
• 6:02
  - be a dangerous place to be, but
• 6:05
  - it keeps me growing and keeps me really
• 6:07
  - learning.
• 6:08
  - As a leader, I think that
• 6:10
  - one really important piece of that is
• 6:13
  - I don't want people to confuse leadership with
• 6:16
  - having all the answers. So while
• 6:18
  - I, you know, participate and am present in
• 6:21
  - HFMA and other associations and I've received my,
• 6:25
  - you know, master's degree in health care administration,
• 6:28
  - that doesn't mean that I have all of
• 6:29
  - the answers and I'm continuously learning with my
• 6:33
  - teams and with those around me.
• 6:35
  - Really being a servant leader and helping
• 6:38
  - direct...
• 6:39
  - Set direction,
• 6:40
  - create clarity,
• 6:42
  - and develop people
• 6:43
  - to trust them to do meaningful work is
• 6:46
  - really at the core of my
• 6:48
  - my leadership and what I strive for. So
• 6:52
  - it really is staying curious,
• 6:54
  - asking questions,
• 6:56
  - and really being that servant leader for my
• 6:59
  - people.
• 7:01
  - That is remarkable. I I love that. Talk
• 7:04
  - a little bit about payer trends today, reimbursement
• 7:07
  - trends today.
• 7:08
  - What are you watching? What what... What's... What
• 7:11
  - are you seeing in payer trends and reimbursement
• 7:13
  - trends?
• 7:14
  - How daunting is it?
• 7:16
  - How much pay is coming from patients directly
• 7:19
  - versus
• 7:20
  - government or the payers? What are some of
• 7:22
  - the trends you're watching?
• 7:23
  - Yeah. There's several, but I think they all
• 7:25
  - connect to one larger reality and and that
• 7:28
  - really is that health care organizations
• 7:29
  - are being asked to do more with greater
• 7:32
  - complexity while reimbursement is not necessarily keeping pace
• 7:35
  - with the cost of providing the care. So
• 7:38
  - really watching government reimbursement and policy pressure, I
• 7:41
  - think the Medicare
• 7:43
  - and Medicaid policy
• 7:45
  - is what I watch probably most closely,
• 7:47
  - really making sure that what the organization
• 7:51
  - is expecting in future years for the IPPS
• 7:54
  - and OPPS,
• 7:55
  - you know, interim rules or final rules, that
• 7:58
  - we're ready for those. But really the site
• 8:01
  - neutral payment proposals,
• 8:02
  - three forty b policy, pricing transparency requirements,
• 8:06
  - the evolution of value based and bundled payment
• 8:09
  - models, I think it's real. It's here. We
• 8:11
  - have to prepare for it. And then for
• 8:13
  - rural regions,
• 8:15
  - or rural and regional systems,
• 8:17
  - you know, the small change in reimbursement methodology
• 8:21
  - can really create meaningful
• 8:23
  - effect on our ability to maintain access for
• 8:26
  - our patients. So really watching those,
• 8:29
  - we're really seeing
• 8:31
  - a lot more administrative friction, I would say,
• 8:33
  - between healthcare systems and payers.
• 8:36
  - Revenue cycle,
• 8:37
  - we have to move beyond the conventional denial
• 8:40
  - management
• 8:41
  - and become much stronger in expected reimbursement,
• 8:44
  - underpayment detection, contract enforcement, payer accountability,
• 8:48
  - but then also developing those relationships with our
• 8:51
  - payers and making sure that we have a
• 8:53
  - source of
• 8:54
  - contact or or a point of contact with
• 8:57
  - our payers and our contracted payers to make
• 8:59
  - sure that we can have open dialogue about
• 9:01
  - what's working, what isn't working,
• 9:04
  - and how can we work together to advance
• 9:06
  - health care and bring a better patient experience.
• 9:08
  - And then really leaning into that patient financial
• 9:11
  - experience, patients are increasingly responsible for a larger
• 9:15
  - and more
• 9:16
  - confusing portion of healthcare costs. Unfortunately, I think
• 9:19
  - there's
• 9:20
  - a lack of understanding because we make it
• 9:23
  - confusing.
• 9:25
  - And so revenue cycle has to become more
• 9:28
  - proactive, meaning we have to communicate earlier, we
• 9:31
  - have to improve our patient estimate process,
• 9:34
  - we have to help people understand their coverage
• 9:37
  - and offering realistic payments and financial assistance options
• 9:41
  - before
• 9:42
  - something becomes a crisis. We really need to
• 9:44
  - make sure that patients feel like they can
• 9:46
  - get
• 9:47
  - the care that they need in the community
• 9:50
  - that they reside in or or in a
• 9:53
  - community that they they feel connected to.
• 9:56
  - And then really
• 9:58
  - scale standardization
• 9:59
  - and growth. So as systems grow or integrate
• 10:02
  - across multiple communities, we have to find the
• 10:05
  - balance between
• 10:07
  - standardization but also local needs.
• 10:10
  - We can't scale really effectively if every location
• 10:13
  - has a different definition,
• 10:15
  - a workflow... A different workflow, a different decision
• 10:17
  - making process, but at the same time,
• 10:20
  - rural communities
• 10:21
  - are not interchangeable
• 10:23
  - and so systemness
• 10:25
  - can't
• 10:26
  - mean losing control of understanding
• 10:28
  - in these
• 10:30
  - smaller rural communities that that, you know, North
• 10:32
  - Dakota has and and North West Minnesota has.
• 10:37
  - And then lastly, I think the thing that
• 10:39
  - we're keeping a good pulse on is, you
• 10:40
  - know, the AI and automation.
• 10:43
  - It excites me. I'm super excited about it,
• 10:47
  - but I also believe that we have to
• 10:48
  - start with the problem and not the technology.
• 10:50
  - So
• 10:51
  - the goal should should not be to automate
• 10:54
  - a broken process. It should be to remove
• 10:56
  - the low value administrative
• 10:58
  - work, improve our accuracy,
• 11:00
  - give employees better information, and create more time
• 11:04
  - for for that
• 11:05
  - complex problem solving and patient support
• 11:09
  - and leverage AI and automation where it makes
• 11:12
  - most sense and where we can
• 11:15
  - really reduce that administrative work throughout that entire
• 11:18
  - process. So a lot of trends that we're
• 11:21
  - watching,
• 11:22
  - but the common thread really is that we
• 11:25
  - have to simplify the administrative
• 11:27
  - side of health care without losing compliance, without
• 11:31
  - losing accuracy
• 11:33
  - and most importantly, without losing compassion for our
• 11:35
  - patients and our community.
• 11:38
  - Fantastic.
• 11:39
  - And and talk about,
• 11:40
  - Courtney,
• 11:42
  - what are you most focused on and excited
• 11:44
  - about through the end of this year and
• 11:45
  - into next year? Where are you most focused
• 11:47
  - and excited?
• 11:49
  - Yeah. There's quite a few things, but I
• 11:51
  - would say one big focus is building a
• 11:53
  - revenue cycle that's more proactive,
• 11:56
  - patient
• 11:58
  - centered, data driven, and integrated within the rest
• 12:01
  - organization.
• 12:02
  - Revenue cycles shouldn't enter the conversation
• 12:04
  - after a problem problem occurs.
• 12:06
  - We should be involved, you know, when a
• 12:08
  - new service, a location, care model, technology, strategy,
• 12:13
  - whatever it might be is first being considered,
• 12:15
  - so that we can make sure sure we're
• 12:17
  - staying ahead of it and we're not, you
• 12:18
  - know, retroactively
• 12:20
  - picking up pieces or trying to fix things
• 12:21
  - and and we're really focusing on what matters
• 12:24
  - the most.
• 12:25
  - I'm really excited
• 12:27
  - as Altru is looking to grow its presence
• 12:29
  - across North Dakota,
• 12:31
  - it gives us an opportunity
• 12:32
  - to serve more patients and strengthen access to
• 12:36
  - quality of care closer to home for for
• 12:38
  - rural North Dakota.
• 12:40
  - And that growth isn't simply about being larger,
• 12:43
  - it's about supporting more communities, about supporting more
• 12:46
  - patients,
• 12:47
  - expanding services thoughtfully and building consistent systems that
• 12:51
  - allow patients to receive the care they need
• 12:55
  - without unnecessary
• 12:56
  - travel, without unnecessary
• 12:58
  - expense.
• 12:59
  - From a revenue cycle perspective, I'm really excited
• 13:02
  - about helping create
• 13:04
  - the foundation needed to make that growth sustainable.
• 13:08
  - And then really at Altru, we're focusing heavily
• 13:11
  - on redesign...
• 13:12
  - Redesigning the patient financial experience. So
• 13:15
  - it is my goal for patients to understand
• 13:17
  - their options,
• 13:19
  - know who to contact within the organization,
• 13:21
  - making sure that they receive
• 13:23
  - accurate information
• 13:25
  - earlier in the process and starting those conversations
• 13:28
  - early in the process. So that's what I'm
• 13:30
  - looking forward to most. I would say what
• 13:32
  - I'm most proud of is that we've been
• 13:34
  - able to keep the focus on measurable performance
• 13:37
  - while investing
• 13:39
  - in our people behind the performance. We've seen
• 13:42
  - a sustained improvement in overall collection performance,
• 13:46
  - positive trends in inpatient and outpatient collection activity
• 13:50
  - and progress in, you know, payer relationships and
• 13:53
  - relationships,
• 13:54
  - among peers within the organization. So we've worked
• 13:57
  - really hard to make revenue cycle more understandable
• 14:00
  - across Altru.
• 14:02
  - We've created a ton of different education opportunities
• 14:05
  - for leaders who may not have reimbursement background.
• 14:08
  - We've clarified how revenue cycle functions connect and
• 14:11
  - reinforce that
• 14:13
  - reimbursement is a strategic responsibility
• 14:15
  - and not just a back office function.
• 14:18
  - And I think most of all, I'm proud
• 14:20
  - of the team that we've created. We're becoming
• 14:23
  - less reactive.
• 14:24
  - We're identifying risks earlier, we're using data more
• 14:27
  - effectively, we're engaging leaders sooner
• 14:30
  - and really giving patients and employees
• 14:32
  - better tools to do their job.
• 14:36
  - The team isn't afraid to ask hard questions
• 14:39
  - or challenge processes that might... May, you know,
• 14:41
  - may not serve us any longer at Altru
• 14:44
  - and and that's great. And then really that
• 14:46
  - patient support that we're focusing on and expanding
• 14:50
  - tools available to,
• 14:52
  - our employees to better explain to patients what
• 14:54
  - their options are and really being able to
• 14:57
  - provide those to the patients.
• 14:59
  - We really are
• 15:01
  - making sure that the patient is at the
• 15:03
  - center of the decisions
• 15:05
  - that we're making as a revenue cycle and
• 15:07
  - and and as an organization,
• 15:10
  - which I think is a really great thing
• 15:12
  - for our community and the patients that we
• 15:14
  - serve.
• 15:16
  - Really, Courtney, magnificent leadership and a magnificent
• 15:20
  - passion and purpose behind what you do. It...
• 15:23
  - It's really inspiring to listen to. I I
• 15:25
  - wanna thank you for joining us on the
• 15:27
  - Becker's Healthcare podcast today. What a pleasure. I
• 15:30
  - do have one last question.
• 15:32
  - So here is my last question.
• 15:35
  - Detroit Lakes, Minnesota.
• 15:37
  - When I look at the name Detroit Lakes,
• 15:40
  - which is I think where maybe the system
• 15:42
  - is originally located or is... I I assume
• 15:45
  - or something like that,
• 15:47
  - I get thrown off when I see Detroit
• 15:49
  - Lakes because I think Michigan.
• 15:51
  - Tell me about the genesis of
• 15:54
  - Detroit Lakes if you can.
• 15:57
  - Yeah. Absolutely. So I actually live and reside
• 16:00
  - in Detroit Lakes, Minnesota, but Ultra is in
• 16:03
  - Grand Forks, the the main hospital and the
• 16:05
  - main hub, which is about two hours
• 16:08
  - from where I live. So I work primarily
• 16:10
  - remotely. I go into the office, as needed
• 16:13
  - and and quarterly for leadership development training.
• 16:18
  - But Detroit Lakes is my home. I've lived
• 16:20
  - here,
• 16:21
  - on and off for, you know, forever, basically.
• 16:25
  - And we're the we're the land of 10,000
• 16:27
  - lakes. So I couldn't be happier with where
• 16:29
  - I'm at. I have a family here, and
• 16:32
  - we... We're definitely not ready for summer to
• 16:34
  - be done. But... Let me ask you a
• 16:36
  - question. If you live in Detroit Lakes,
• 16:38
  - do you then cheer for the Detroit sports
• 16:41
  - teams like the Lions, or does it still
• 16:43
  - make you more of a Vikings fan?
• 16:45
  - So interestingly,
• 16:47
  - I am actually a Green Bay Packer fan.
• 16:51
  - Chanel, we have to hang up. Chanel, Chanel,
• 16:53
  - we can't talk to Packers fans. Chanel, done.
• 16:55
  - Done. Done.
• 16:56
  - No. Just kidding. There we go.
• 16:59
  - You are a magnificent leader. Just fantastic
• 17:02
  - even if a Green Bay Packer fan. Thank
• 17:05
  - you so much for joining us today on
• 17:06
  - the Becker's Healthcare podcast. What a great pleasure
• 17:09
  - to visit with you. Thank you so much.
• 17:11
  - Thank you both. Have a great day.