Latest / Becker’s Healthcare Podcast / How Healthcare Organizations Can Strengthen Revenue Cycle Integration to Maximize the Value of Mergers and Acquisitions

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How Healthcare Organizations Can Strengthen Revenue Cycle Integration to Maximize the Value of Mergers and Acquisitions · Becker’s Healthcare Podcast

• 0:00
  - Hi, everyone. This is Brian Zimmerman with Becker's
• 0:02
  - Healthcare. Thank you so much for tuning into
• 0:04
  - the Becker's Healthcare podcast.
• 0:06
  - Today, we're gonna talk about how healthcare organizations
• 0:09
  - can strengthen revenue cycle integration to maximize
• 0:12
  - the value of mergers and acquisitions.
• 0:15
  - Joining me for today's discussion is Joe Davi,
• 0:17
  - CEO of MedMetrics.
• 0:19
  - Joe, thanks for being here. Hi. Thanks for
• 0:21
  - having me. It's a pleasure. So to to
• 0:24
  - start here, maybe we can, get into some
• 0:25
  - of your personal experience with mergers and acquisitions
• 0:28
  - so listeners can really get a a sense
• 0:30
  - of where you're coming from here, what what
• 0:31
  - your perspective is. Sure. Sure. I've been fortunate
• 0:35
  - to participate in many mergers and acquisitions over
• 0:38
  - the course of my career. I've been both
• 0:40
  - a buyer and a seller along the way.
• 0:43
  - I have certainly
• 0:45
  - been on the,
• 0:46
  - periphery of, a lot of the m and
• 0:48
  - a activity out of the provider marketplace
• 0:50
  - as anybody that's in the health care industry
• 0:52
  - is no stranger. There's been a tremendous amount
• 0:54
  - of consolidation
• 0:56
  - among providers,
• 0:57
  - large organizations
• 0:59
  - at significant scale that have come to fruition
• 1:02
  - over the last, ten, fifteen years, and,
• 1:05
  - you know, those trends, continue. We see the
• 1:08
  - large organizations
• 1:09
  - getting larger, and, you know, there's a fewer
• 1:12
  - number of independent organizations out in the landscape
• 1:15
  - today. It's just the, the economics are such
• 1:18
  - that it's really difficult to remain a smaller
• 1:21
  - independent community based provider these days, and so
• 1:24
  - we we expect those trends to continue.
• 1:27
  - Yeah. And can can you unpack those economics
• 1:30
  - for for for listeners just a bit? The
• 1:32
  - so much of the increased acquisitions, that inability
• 1:35
  - to to be an independent smaller organization
• 1:38
  - is really getting tough. Can you just sort
• 1:40
  - of give listeners a lay of the land
• 1:42
  - here in terms of the financial challenges you're
• 1:45
  - seeing health care leaders face?
• 1:47
  - Well, we're seeing some of the more sophisticated
• 1:50
  - organizations
• 1:51
  - that have achieved scale in different geographies,
• 1:54
  - start to deploy some of their capital
• 1:57
  - in areas,
• 1:58
  - out in the community with community based assets,
• 2:01
  - ASCs,
• 2:03
  - things that they're meeting patients where they're at
• 2:05
  - rather than waiting for the traditional referral patterns
• 2:09
  - through the ED, certain inpatient admissions. And so,
• 2:12
  - you know, it's a difficult dance because
• 2:15
  - hospital systems are large capital intensive organizations,
• 2:19
  - and they can't pivot away from what was
• 2:21
  - largely an inpatient
• 2:23
  - centric model
• 2:25
  - overnight. But because of different trends in reimbursement
• 2:28
  - and also
• 2:29
  - improvements in technology
• 2:31
  - and evidence based
• 2:33
  - care trends where people can be effectively treated
• 2:36
  - in an outpatient or ambulatory
• 2:38
  - setting today for many types of procedures
• 2:41
  - that historically would have required a a lengthier
• 2:44
  - stay in an inpatient environment. People are moving
• 2:46
  - more into ambulatory
• 2:48
  - and community based medicine
• 2:50
  - that is a little bit of a change
• 2:53
  - to the to the historical model where, you
• 2:55
  - know, people are getting
• 2:57
  - big to get big.
• 2:58
  - Yeah. And
• 2:59
  - and the reimbursement landscape is changing there too.
• 3:02
  - Right? The CMS is adding more procedures to
• 3:04
  - the list. Commercial payers are are kinda going
• 3:07
  - in that direction as well.
• 3:09
  - But as you said, this is a this
• 3:10
  - is a difficult dance. There's a lot of
• 3:13
  - a lot of moving parts here to do
• 3:14
  - this effectively.
• 3:15
  - So where from your point of view are
• 3:17
  - are maybe the watch out? You know, like,
• 3:19
  - where where are the places where
• 3:21
  - organizations might fall short in in the merger
• 3:24
  - process specifically?
• 3:26
  - Well, I'll touch on that. I did I
• 3:28
  - did wanna circle back to one of the
• 3:30
  - comments that you made, Brian, about some of
• 3:32
  - the, you know, financial challenges that, the providers
• 3:35
  - are facing.
• 3:36
  - They really are
• 3:38
  - struggling with a shifting landscape on a number
• 3:41
  - of fronts, and there's not really any easy
• 3:43
  - money to be had anymore.
• 3:45
  - And, you really have to be at the
• 3:47
  - top of your game from an execution
• 3:49
  - standpoint.
• 3:51
  - And you've got to stick to your knitting
• 3:53
  - and make sure that you are really performing
• 3:56
  - well in the areas that you're best positioned
• 3:58
  - to perform well. And so a lot of
• 4:01
  - folks are trying
• 4:02
  - to move into more specialized,
• 4:04
  - delivery mechanisms, and they're not trying to keep
• 4:07
  - up with everybody on all fronts.
• 4:10
  - We're seeing the places that are successful, not
• 4:12
  - try to get in a space race and
• 4:14
  - pay all things to all people.
• 4:16
  - And, the folks that that have a strategy
• 4:18
  - there are successful because
• 4:21
  - you have a
• 4:23
  - relentless,
• 4:24
  - inexorable
• 4:25
  - march towards
• 4:26
  - declining reimbursement
• 4:28
  - coupled with a landscape where labor expenses have
• 4:31
  - been growing faster than inflation for a number
• 4:33
  - of years,
• 4:35
  - and those trends only accelerated coming out of
• 4:37
  - the pandemic. One data point that we've noted
• 4:40
  - working with providers across the country is that
• 4:43
  - denial rates spark spiked markedly coming out of
• 4:46
  - the pandemic. And even after they've settled down
• 4:49
  - to a lower level, they're still about 200
• 4:51
  - basis points than they were pre pandemic.
• 4:54
  - And if you think about the payers, you
• 4:56
  - know, they're struggling themselves. You look at the
• 4:58
  - publicly traded insurers. Right? All of their margins
• 5:01
  - have come in. Many of them take have
• 5:02
  - taken a beating at Medicare Advantage and and
• 5:05
  - other plans that they jumped in on and
• 5:07
  - underestimated
• 5:08
  - the utilization. And so their medical loss ratios
• 5:11
  - have come under pressure and, you know, they've
• 5:13
  - passed along some of that pressure downstream to
• 5:15
  - the providers.
• 5:16
  - You couple that practical
• 5:18
  - environment
• 5:20
  - with the optics
• 5:21
  - where providers,
• 5:22
  - unfortunately,
• 5:23
  - don't have the dollars to spend in a
• 5:26
  - lobbying environment
• 5:27
  - similar to big pharma or the payers.
• 5:30
  - And it's those latter two
• 5:32
  - components,
• 5:33
  - or portions of the of the industry that
• 5:35
  - have really more effectively shaped
• 5:38
  - the public's perception,
• 5:40
  - on the optics. And so oftentimes,
• 5:42
  - large not for profit health care providers get
• 5:45
  - painted unfairly with a brush that they're not
• 5:48
  - executing efficiently.
• 5:49
  - There's a lot of administrative bloat.
• 5:52
  - There is waste, and they pass along some
• 5:56
  - of those inefficiencies
• 5:57
  - in the form of higher costs to their
• 5:59
  - patients. And
• 6:01
  - that's not true, but the court of public
• 6:03
  - opinion,
• 6:04
  - has been skewed against them because
• 6:06
  - those other participants in health care have have
• 6:09
  - a bigger pocketbook to help shape that narrative
• 6:12
  - on Capitol Hill and and with public opinion.
• 6:15
  - So it's a tough time, but we find
• 6:17
  - that a lot of our clients are up
• 6:19
  - for the challenge. They are investing aggressively in
• 6:22
  - their in their businesses, and they're revolutionizing
• 6:25
  - how they deliver care so that they can
• 6:27
  - be more efficient in the landscape as it
• 6:29
  - evolves.
• 6:30
  - When you think about that through the lens
• 6:32
  - of of M and A,
• 6:34
  - you know, we see
• 6:35
  - a lot of that activity regularly. Some organizations
• 6:39
  - are relatively more successful than others when it
• 6:42
  - comes to executing
• 6:44
  - on those mergers. Right? When you're going through
• 6:46
  - the process of evaluating the potential synergies on
• 6:50
  - paper,
• 6:51
  - there's a lot of daylight between
• 6:53
  - the abstract and the practical. And capturing a
• 6:56
  - lot of the synergies and the value that
• 6:58
  - people expect in an acquisition
• 7:02
  - really comes down to execution.
• 7:04
  - And the folks that that execute well
• 7:07
  - generally become the platforms
• 7:09
  - and consolidate and further their scale and dominance
• 7:12
  - in a given geography.
• 7:14
  - Yeah. And and and for those folks that
• 7:16
  - that become successful for those organizations that
• 7:19
  - get that execution component right, what are some
• 7:23
  - common traits characteristics,
• 7:25
  - either organizationally speaking or from the leaders sort
• 7:28
  - of helming the transition? What what stands out
• 7:31
  - to you from from from those organizations that
• 7:33
  - find success here?
• 7:35
  - Well, it comes down to to a number
• 7:37
  - of factors. I don't know that there's a
• 7:39
  - a single discipline that that that chunks out.
• 7:41
  - You know, some of them
• 7:43
  - are qualitative,
• 7:44
  - some are quantitative.
• 7:46
  - On the qualitative side,
• 7:48
  - it doesn't get as much attention,
• 7:50
  - but it's a very important aspect when you're
• 7:53
  - bringing together two different organizations
• 7:56
  - with
• 7:57
  - different cultures. Particularly, if you have the joining
• 8:00
  - of a faith based not for profit with
• 8:02
  - a secular organization, there's additional challenges. But
• 8:06
  - people use the term m and a.
• 8:09
  - It's
• 8:10
  - less frequently a merger of equals these days.
• 8:13
  - It's more of of an acquisition.
• 8:15
  - And
• 8:16
  - oftentimes,
• 8:17
  - a target health system or provider group
• 8:20
  - can feel disenfranchised
• 8:22
  - that they're subordinate to the acquirers, that they
• 8:24
  - don't have as many people in positions of
• 8:27
  - influence among the executive leadership.
• 8:30
  - When it comes to integration, page one from
• 8:32
  - the playbook should be about a coherent and
• 8:34
  - specific plan around centralization
• 8:37
  - of corporate functions,
• 8:39
  - technology being the biggest one,
• 8:41
  - finance,
• 8:42
  - human resources,
• 8:44
  - getting people together, capitalizing on some of the
• 8:47
  - synergies there as well as, you know, people
• 8:49
  - getting comfortable with a uniform set of processes
• 8:52
  - for those corporate functions or important criteria
• 8:55
  - and a good predictor for success for people
• 8:57
  - that have that as part of their playbook.
• 9:00
  - I appreciate you you laying out the the
• 9:02
  - the page one, sort of what that playbook
• 9:04
  - should should should look like here. What
• 9:06
  - we're drilling down to the revenue cycle specifically,
• 9:09
  - I guess, what what what should people be
• 9:11
  - doing to shore things up there and and
• 9:13
  - get get ready to to to really drive
• 9:15
  - success post merger?
• 9:18
  - Yeah. You know, that is an area that
• 9:20
  - can sometimes
• 9:22
  - not have the same level of attention and
• 9:25
  - focus assigned to it than other areas of
• 9:28
  - the integration playbook. But make no mistake, it
• 9:31
  - is a critical component.
• 9:33
  - And when you think about the cash flow
• 9:35
  - and the revenue stream in an organization, that
• 9:38
  - is the lifeblood.
• 9:39
  - And so people that have a disciplined approach
• 9:43
  - for revenue cycle management and an integration plan
• 9:46
  - are well served.
• 9:48
  - And I'll tell you by way of example,
• 9:49
  - I was talking with a large health system
• 9:52
  - just yesterday. They're a $10,000,000,000
• 9:54
  - health system, and they've done many, many acquisitions.
• 9:57
  - And they've got a pretty solid plan, a
• 9:59
  - great team of integration and process improvement folks.
• 10:03
  - But they're
• 10:04
  - also limited by the practical reality on the
• 10:06
  - ground of their targets. And, you know, they
• 10:09
  - acquired,
• 10:10
  - a health system recently that is on a
• 10:12
  - different platform.
• 10:14
  - They have many disparate functions that have not
• 10:16
  - been centralized.
• 10:18
  - And as a result, their overall
• 10:21
  - cost to collect for the combined organization increased
• 10:24
  - by about 50 basis points, which is a
• 10:27
  - very significant increase. And while it can be
• 10:30
  - temporary in nature, if there's not a good
• 10:32
  - plan
• 10:33
  - for moving on to the consolidated
• 10:36
  - IT platform
• 10:38
  - to streamlining and centralizing
• 10:40
  - what are disparate functions.
• 10:42
  - Those increased costs can hang around and create
• 10:45
  - a real drag on the organization's
• 10:47
  - financial
• 10:48
  - performance.
• 10:49
  - And so
• 10:51
  - they have a very developed playbook
• 10:53
  - around assimilation
• 10:55
  - of people into a shared culture.
• 10:58
  - They have a policy
• 11:00
  - of,
• 11:01
  - regular town halls with folks from the target
• 11:04
  - organization as well as from their legacy team
• 11:07
  - so that folks quickly
• 11:09
  - begin to feel that they are one group
• 11:12
  - working towards a common set of goals, that
• 11:15
  - they're celebrating the wins together,
• 11:17
  - that everybody feels that they're a part of
• 11:20
  - the team.
• 11:21
  - And that really
• 11:22
  - goes a long way towards
• 11:25
  - improving people's
• 11:26
  - psychological perspective, and and everybody is able to
• 11:29
  - derive a lot of psychic income from that.
• 11:31
  - And you get everybody's best when they feel
• 11:34
  - like they're all in it together, they're part
• 11:36
  - of the same team, and they're celebrating those
• 11:38
  - wins together.
• 11:39
  - You couple that qualitative approach
• 11:42
  - with a strong approach from integration
• 11:45
  - with project management wrapped tightly around it to
• 11:48
  - keep people singing from the same hymnal, if
• 11:51
  - you will, and executing to a codified
• 11:54
  - set of goals
• 11:55
  - with timelines and deliverables associated,
• 11:58
  - you've got a recipe for success.
• 12:01
  - Yeah. And and, yeah, you're gonna when you
• 12:02
  - have that buy in, that sort of synergy,
• 12:04
  - you're gonna be better equipped to solve maybe
• 12:07
  - some challenges you didn't see coming right right
• 12:09
  - away, right, than, like, the the specific example
• 12:11
  - you shared, Joe.
• 12:13
  - Indeed. And as it relates to some of
• 12:15
  - the revenue cycle functions specifically,
• 12:17
  - having been in this space for the better
• 12:19
  - part of thirty years now, what I've learned
• 12:22
  - is that the revenue cycle
• 12:25
  - is a very linear set of functions, and
• 12:27
  - you can solve
• 12:28
  - for the finite
• 12:30
  - set of actions that management would like
• 12:35
  - the team members to execute upon at every
• 12:38
  - step along the way.
• 12:40
  - And if you have a strong EMR and
• 12:43
  - financial system
• 12:44
  - like an epic, which is a workflow system,
• 12:47
  - it allows management to codify the set of
• 12:49
  - rules
• 12:51
  - by which they want the team members to
• 12:52
  - execute.
• 12:53
  - And so
• 12:55
  - you think about a series of if, then,
• 12:56
  - and, or statements. You can solve with technology
• 13:00
  - how you want people to work. And in
• 13:02
  - the revenue cycle,
• 13:04
  - the people that are most successful in our
• 13:07
  - experience are those
• 13:09
  - that create a homogenized
• 13:11
  - set
• 13:13
  - of rules around specific functions so that the
• 13:16
  - same things are done the same way at
• 13:19
  - scale and everything is centralized. You should not
• 13:22
  - have pockets of disparate processes
• 13:24
  - by way of example
• 13:26
  - in the patient access functions around scheduling and
• 13:29
  - registration.
• 13:30
  - The top decile performing organizations
• 13:33
  - are those who have
• 13:35
  - created a centralized
• 13:38
  - set of functions for each of those different
• 13:40
  - areas
• 13:41
  - according to a codified playbook,
• 13:44
  - and they're measuring themselves
• 13:46
  - regularly
• 13:47
  - against
• 13:48
  - best practice metrics.
• 13:51
  - Excellent. And and and wanna ask this final
• 13:54
  - question here. I I think it's probably a
• 13:55
  - rule now on the podcast where we can't
• 13:57
  - have a podcast guest on and not have
• 13:59
  - them speak about AI. So so wanna get
• 14:02
  - to
• 14:03
  - what you think about because there is there
• 14:05
  - does seem to be a lot of of
• 14:07
  - possibility here, when you when you think about
• 14:09
  - AI, the RCM functions, some of these RCM
• 14:12
  - integration pain points to really resolve those issues
• 14:15
  - as they come up. What are you seeing
• 14:16
  - there? How are you thinking about that sort
• 14:19
  - of AI helping helping to aid in this
• 14:21
  - integration process?
• 14:23
  - Yeah. And, you know, Brian, you used a,
• 14:26
  - I think, a very relevant turn of phrase,
• 14:29
  - AI helping.
• 14:30
  - And we very much view
• 14:32
  - AI as a
• 14:34
  - new
• 14:35
  - type of technology that
• 14:37
  - is gonna redefine how a lot of work
• 14:39
  - happens in society. You know, you had a
• 14:42
  - a couple of big
• 14:44
  - watershed
• 14:45
  - advances in technology
• 14:47
  - over the years going way back to the
• 14:49
  - industrial age and and the advent of the
• 14:51
  - combustion engine and mass manufacturing.
• 14:54
  - I'm not gonna take us all through all
• 14:55
  - those advances over the years, but, you know,
• 14:58
  - in my lifetime,
• 14:59
  - the last very significant technology development was the
• 15:02
  - advent of the Internet. And there was a
• 15:05
  - a similar today, you know, that ubiquitous feeling
• 15:08
  - of wherever you turn around, people are adding
• 15:10
  - .com to their name. And it took a
• 15:12
  - little bit longer
• 15:14
  - for a lot of the hype to become
• 15:17
  - reality
• 15:18
  - with the Internet, but it did.
• 15:20
  - I expect with artificial intelligence that, like many
• 15:23
  - things in our lives, the iterations and the
• 15:25
  - speed with which evolution happens, is going to
• 15:28
  - be geometrically faster.
• 15:30
  - But it doesn't change the reality,
• 15:33
  - in my opinion, that AI are tools,
• 15:37
  - and they're designed to help people be more
• 15:39
  - efficient. But at the end of the day,
• 15:41
  - it's not just the tools,
• 15:43
  - it's the operators
• 15:45
  - that together, collectively,
• 15:47
  - will help realize,
• 15:48
  - the tremendous productivity and efficiency gains that people
• 15:52
  - are touting. And we do think that's going
• 15:54
  - to become a reality.
• 15:55
  - But, anecdotally,
• 15:57
  - sometimes I'll say to people, you know, using
• 15:59
  - that that tool metaphor,
• 16:01
  - I enjoy playing golf. And I'm not very
• 16:03
  - good at it, but, I'm always trying to
• 16:06
  - find the next, you know, great product or
• 16:08
  - tool or putter. And I say to people,
• 16:10
  - you know, if Rory McIlroy gave me his
• 16:12
  - driver, I might hit it a little bit
• 16:14
  - better
• 16:15
  - than I hit mine, but I won't hit
• 16:16
  - it as good as he does. It's not
• 16:18
  - just the tool, it's the operator.
• 16:20
  - And so the subject matter expertise
• 16:23
  - and the
• 16:25
  - practical
• 16:26
  - know how that people have developed over the
• 16:29
  - course of their careers
• 16:30
  - will not be a wasted resource. I think
• 16:33
  - that
• 16:34
  - the technology will be a great augmenter and
• 16:37
  - enabler to unlock people to work at higher
• 16:40
  - levels of proficiency and realize their full potential
• 16:43
  - of productivity.
• 16:44
  - But we very much believe in the human
• 16:46
  - in the loop as a meaningful part of
• 16:49
  - AI
• 16:51
  - realizing its its potential, in the months and
• 16:53
  - years to come. And like everybody else, we're
• 16:56
  - sprinting down the path
• 16:58
  - of embracing machine learning and large language models.
• 17:01
  - And there are a lot of practical use
• 17:03
  - cases where we're deploying
• 17:05
  - that technology. And as it becomes more sophisticated,
• 17:09
  - we expect that some of the more nuanced
• 17:11
  - complex functions will lend themselves to additional automation,
• 17:15
  - and we're really excited about the potential there.
• 17:19
  - Yeah. And and speaking to your point too
• 17:20
  - about it,
• 17:22
  - all that expertise, all that all that stuff
• 17:24
  - is gonna be come in handy, but people
• 17:25
  - are gonna have to change the way they
• 17:27
  - work a little bit.
• 17:28
  - Do you do you think about that in
• 17:29
  - terms of I I think sometimes
• 17:32
  - people can get kind of,
• 17:34
  - addicted might be the a strong word, but
• 17:36
  - really into, like, those checkbox
• 17:38
  - tasks.
• 17:39
  - Like, did that, did that, did that, and
• 17:41
  - now it's gonna be the the task is
• 17:43
  - gonna be a little bit more robust,
• 17:45
  - bigger, more judgment. Is that a fair sort
• 17:47
  - of assessment,
• 17:49
  - in terms of of how you're thinking about
• 17:51
  - the use of these tools and how people
• 17:53
  - will use them?
• 17:54
  - I think it is. I've made plenty of
• 17:56
  - mistakes in my career, and I hope that
• 17:57
  - I continue to make them because,
• 17:59
  - if I'm not, it means that I'm not
• 18:01
  - challenging myself enough. And, you know, we as
• 18:04
  - an organization
• 18:05
  - lean into and embrace change. And in a
• 18:08
  - dynamic
• 18:09
  - landscape like what we have today with AI,
• 18:12
  - you really need to be pursuing,
• 18:14
  - multiple venues and applications of this technology and
• 18:18
  - seeing where it bears the most fruit and
• 18:20
  - where the tools themselves today are mature enough
• 18:23
  - to perform some of these functions.
• 18:26
  - And there's a lot of other things that
• 18:27
  - need to sort themselves out, which will because
• 18:30
  - of the laws of supply and demand. But
• 18:32
  - there are a lot of things where the
• 18:33
  - technology is capable of, but it's not really
• 18:35
  - cost effective as yet to have
• 18:38
  - the AI perform the functions maybe in lieu
• 18:40
  - of robotic process automation
• 18:43
  - or even a person. You know, token costs
• 18:45
  - are a real thing.
• 18:46
  - There's a lot of infrastructure
• 18:48
  - that needs yet to be developed to create
• 18:50
  - the bandwidth and throughput
• 18:53
  - and cost effectiveness
• 18:55
  - of, some of the technology
• 18:58
  - that we're excited about, but we know it's
• 18:59
  - going to take a little bit of time.
• 19:02
  - But we're very much about a
• 19:05
  - crawl, walk, run approach where we are sitting
• 19:09
  - with our operators, sitting with our clients.
• 19:12
  - We're identifying
• 19:13
  - those practical use cases that lend themselves
• 19:17
  - to automation
• 19:19
  - with the tools that exist today.
• 19:21
  - And we're very cognizant that it's not a
• 19:24
  - scenario in which you set it and forget
• 19:26
  - it. You know, you've gotta stay close to
• 19:28
  - this technology and ensure that when you deploy
• 19:31
  - it, that it's performing consistent with how you
• 19:34
  - developed, and intended it to. And there's gonna
• 19:37
  - be an iterative process of modifying and improving
• 19:40
  - the efficacy
• 19:42
  - of these products. And that's where, you know,
• 19:43
  - the people or the human in the loop,
• 19:45
  - if you will, come into play.
• 19:47
  - And I think it's, it's gonna be an
• 19:49
  - exciting time, and we're gonna see tremendous gains
• 19:51
  - in productivity and efficiency over the next twelve
• 19:54
  - to twenty four months.
• 19:56
  - And, beyond that, my crystal ball's a little
• 19:58
  - hazy, but,
• 19:59
  - I'm excited,
• 20:00
  - about what we have right in front of
• 20:02
  - us and some of the benefits that we're
• 20:04
  - seeing our clients deliver and that we're doing
• 20:06
  - in partnership with them.
• 20:08
  - I mean, things things are moving so fast
• 20:10
  - these days, Joe. I mean, total total to
• 20:12
  - twenty four months. I wouldn't I wouldn't push
• 20:14
  - you to to make any more predictions outside
• 20:16
  - of that one. I need to get Nostradamus
• 20:19
  - on the line.
• 20:20
  - For sure.
• 20:22
  - We are we are about out of time
• 20:23
  - here, Joe, but any quick final thoughts from
• 20:26
  - you for for the audience before I let
• 20:28
  - you go?
• 20:29
  - No. I just appreciate the time together with
• 20:32
  - you today, Brian. I enjoyed our conversation. It
• 20:34
  - was my pleasure to be with you. Yeah.
• 20:36
  - It was a it was a pleasure for
• 20:37
  - me as well. Thank you, Joe. I also
• 20:39
  - wanna thank our our podcast sponsor, MedMetrix.
• 20:42
  - You can tune into more podcasts from Becker's
• 20:44
  - Healthcare by visiting our podcast page at beckershospitalreview.com.