Latest / Becker’s Healthcare Podcast / Transforming Revenue Cycle at Mount Sinai Health System with Debra Jaeger

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Transforming Revenue Cycle at Mount Sinai Health System with Debra Jaeger · Becker’s Healthcare Podcast

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upper right.
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This is Andrew Cass with the Becker's Healthcare
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podcast. I'm thrilled to be joined today by
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Deborah Jagger, chief revenue officer at Mount Sinai.
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Deborah, it's a pleasure to have you on
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podcast.
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Thank you so much. It's a pleasure to
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be here. Before we begin, why don't you
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tell us a little bit about your background?
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Sure. So,
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my original background was,
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in nursing. So I spent most of my
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nursing career
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as a,
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working in critical care and emergency room, but
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really worked across all of the levels of
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care, including the post acute and home care.
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I transitioned
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into,
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revenue,
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early on in my career,
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while maintaining
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some clinical presence.
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So, back,
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in my first transition, I got into working
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with an insurance company
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and setting,
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reserves for traumatic,
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injuries
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and, long term disability, which really
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sort of ignited a fire of really loving
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the fact that I could use my clinical
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expertise
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and build that into,
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finance. And then as my career grew and
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took on different roles,
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I really viewed myself as a liaison between
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the clinical teams who really,
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didn't have as much insight,
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to the financial,
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ramifications
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of, you know, payers and,
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coding.
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And so it was really a nice space
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for me, and that's where I thought I
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could be the most impactful,
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being a, a clinical person as well as
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a a finance person.
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Yeah. I think that nursing background is so
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interesting.
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How do you think that has informed how
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you approach your role as a revenue cycle
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leader? So I think that, you know, when
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you look at revenue cycle,
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historically
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in the past going back many years, fifteen,
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twenty years, it was very much of a
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back end office
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practice,
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and there really was no talking to the
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front, staff that was actually driving all of
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this revenue.
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And, you know, some of the,
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EMR systems really kind of,
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helped us change that view
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and really tried to focus us into a
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clinically driven revenue cycle. So
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that is the best practice. And in order
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to be
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effective in my role,
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it is very, very helpful to understand
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clinical operations
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and understand how providers and caregivers,
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approach a patient and what their workflow is.
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And so our goal, you know, is really
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to make the, work that they do, taking
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care of patients,
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you know, their their main priority and making
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all the revenue capture
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as easy as possible. So
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utilizing technology
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templates
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and really educating them on this, I think,
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is one of the benefits I have to
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have been
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working in the clinical delivery areas.
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And so you are, Mount Sinai's first chief
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revenue officer. Can you tell us a little
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bit about what your role entails and how
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that's going so far?
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Sure. Yes. I am the first,
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chief revenue,
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officer and very, thankful to be in this
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role,
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to be at such a great organization.
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So,
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Mount Sinai has a,
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terrific
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outstanding,
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reputation
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on clinicals,
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delivery and what they do in both research
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and
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what they do,
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in those clinical areas.
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That is,
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really a nice place to be. And with
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this new role,
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it's really to move our revenue cycle into
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that type of, center of excellence.
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And so when I came here,
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the one of the things was to say
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that there was very fragmented shadow revenue,
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operations,
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so not under one leader. And so the
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goal of our, CFO, who was also new
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to,
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to the organization, Vinny Tamaro,
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was that we then unite this and create
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really an industry best practice revenue cycle. So
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pulling those areas altogether
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was,
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our
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top priority. Right? Because nothing else really could
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be done in, the, you know, into the
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improvements that we needed to make until we
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created a front end revenue cycle, a middle,
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and then,
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the back end on billing, and then wrapping
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around really revenue,
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engagement,
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and,
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working with all of the departments and looking
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at our revenue across the board. So not
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just
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the transactional revenue, but but really looking into
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any of those value,
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payments as well. So that was the idea,
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of,
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you know, really creating this role. And so
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how is it going? I'm one year just
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almost exactly exactly one year into things,
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and, we've made a a lot of accomplishments.
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We really have made improvements
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in our cash collections and reducing our denials.
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Much of that is done by just bringing
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these teams together and having
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collaborative conversations
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and leveraging each other's skills in this area
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to be more uniform.
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We are continuing on that journey, so we're
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not completely
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at a central,
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centralized process
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right now, but that is to be completed
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by the end of this first quarter.
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We spent a lot of time focused on
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standardization
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of practice, policies,
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and epic optimization.
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And, by pulling those teams together, we could
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do that versus working in a lot of
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fragmentation.
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Congratulations
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on, hitting the year marker just about hitting
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it.
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So next, I wanted to pivot to see
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what the biggest headwind you're facing right now
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as a revenue cycle leader.
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So I think that one of the, biggest
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ones is
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the complexity of getting paid.
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That has been increasing.
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So no you know, long gone are the
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days where a claim goes out and then,
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you know,
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it comes back. So looking at what is,
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the issues around that. So pay the payers
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have gotten more complex. Your contracts have gotten
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more complex.
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And,
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and then, of course, everybody's resources, both our
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own and on the payer side, has, you
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know, really have,
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people have thinned out their workflow,
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forces. And so getting
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resolution
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from the payer is,
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you know, is is been more and more
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challenging over the years. So I think that
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that is one of the biggest headwinds is
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is the delays
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of of payment.
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I think that, the other thing is,
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you know, some of the other challenges is
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is along that line with workforce, you know,
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how do we pull in new young future
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leaders, right, and getting them engaged and wanting
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to be in rev cycle and then growing
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and nurturing them. So,
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having,
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those plans for succession is is another challenging,
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thing that I'm trying to do,
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in the organization. I think everybody's faced with
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that is just the younger generation isn't necessarily
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migrating to these positions.
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So how do we do that? And then
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the shift,
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through technology. Right? There's just so many
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different tech options out there and really,
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navigating through which one is the best fit
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for us.
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Even though we're an epic first shop, it's
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it is, we do need other technology, and
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that that is another challenge.
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Yeah. And so, on the, you know, developing
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talent,
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side of things, how are you working to
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develop that next generation of revenue cycle leaders?
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Yeah. So,
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so couple things that we have in the
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works right now is creating a mentorship program.
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So for people who are in those entry
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level positions or first level management, how do
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I pair them with a more seasoned leader,
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as a mentor? So we're,
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we're developing our mentorship, formalizing our mentorship program.
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We also
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are, take on interns, so both college,
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interns,
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both bachelor's and master's,
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and then, looking at developing a high school
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internship
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because many of these roles within rev cycle,
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are entry level from a high school graduation.
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So how do I expose
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them to this whole other world that they
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can transition
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right away from high school into some of
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these, you know, entry level positions.
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This is a, you know, sort of a
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passion considering, like, where we are in our
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community.
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We you know, not only do we wanna
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be a care provider there, but we're also
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an, a large employer for, for New York.
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And,
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you know, people who don't go on to,
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you know, post high school education,
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this gives them an opportunity if they're not
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interested in the trade to
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have a really,
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a career and to be able to go
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and develop that and look for promotional opportunities.
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We do have a partnership too with a
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community,
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college as well. And so these are the
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things that we're trying to do both internally
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and externally with recruiting.
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And,
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what are three of the top trends you're
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following in health care today?
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I am following a,
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AI and technology, which I think everybody is,
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and really
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interested
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on
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not just currently what's going on in AI,
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but what does that world look like,
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down the road and how can we rethink
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how we do things.
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So, you know, the this area is kind
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of in the same sort of biz like
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workflow churn
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year over year, you know, and what would
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AI do that would make it look differently?
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And
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it's, you know, really about how do I
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leverage the human component
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and leverage the AI component to be
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better at what we're doing, and to, you
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know, be able to do more. So
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that is,
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one of the, you know, the big things
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we're watching,
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as well.
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I would say that we're definitely opposed on,
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you know, this back and forth with our
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payer challenges. It's everybody's,
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sort of issue. Payers state the same issue.
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Really,
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watching to see is, like, when you know,
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what bubble's gonna burst that's gonna bring us
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to a better model in this. So really
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interested in that.
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And then, the other thing that's really we're
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folk, we're focused on and the and the
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really looking at is is how do we
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create,
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you know, a patient financial experience.
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And, you know, health care is so complicated
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for patients, and it's only getting more complicated,
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you know, with high deductible plans, people enroll
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in plans, employer offerings are different these days,
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and
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many people do not understand their benefit plan
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until they, you know, are actually faced with
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something and
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don't really have a foresight on what that,
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you know, out of pocket's gonna be. So
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how do I leverage tools
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and education to create a better financial experience
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and and educate that consumer?
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Yeah. And, so what are you most excited
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about right now in your role?
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Oh, so,
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I think,
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you know, one of the things that's really
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exciting is, first of all, bringing all the
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teams together. And,
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I think that's really exciting because it'll allow
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us to move to the next level.
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And, the other thing that I'm really excited
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is about, you know, how we can grow,
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and this is one of our our projects,
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is how do we get into
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more utilizing predictive analytics?
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So how can I,
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use this to predict cash or predict
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heat heat spots, right, if you wanna call
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them,
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in in the certain,
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evolution of the claim? So how do I
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get ahead of that? You know,
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by saying, okay. Normally, when x happens, it's
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going to delay payment by ninety days.
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So that's one area that I'm really excited
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to, continue to work towards.
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And then how do I use predictive analytics,
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to drive, you know, your overall cash all
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the way back from the point of scheduling
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that patient, you know, and then what converts
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into a surgery based on so many visits.
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And then how would I, then be able
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to predict my, you know, cash a couple
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months out from that, from all the way
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back from the point of, like, looking at
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scheduling
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of, you know, ambulatory
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or
13:30
providers. And then what can I do to
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implement a change in that? So is it
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something I can do that would pull patients
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in or move patients up, balance loading, all
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of those things. So really looking at the
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life cycle where the, you know, the revenue
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starts all the way down to,
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when we, you know, have, obviously have cash
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goals and and, you know, where we're gonna
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land with them before we don't before we're
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looking back and we can be proactive and
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change that trajectory.
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The last question I have for you today
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was, how are you thinking about growth over
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the next twelve to twenty four months?
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So I think we are,
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you know, from that, perspective is
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really,
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finishing up our integration efforts,
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and then, like I said, really developing that,
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patient financial experience
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and utilizing those tools and implementing that. So
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we've started a lot of that work. So
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by the end of the year, I think
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that we will have a very, we'll have
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a lot of a
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of a different approach to how we welcome
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that patient in the door from that financial
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experience.
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And then I'm really, you know, excited
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about,
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some of the new AI that is out
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there and implementing,
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that we have in the works and what,
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how we're gonna look to redesign how we
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do things.
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So they're my big excitements.
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Yeah. Well, thank you so much for joining
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us today, Deborah. It's been a pleasure speaking
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with you, and I look forward to talking
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you with you again soon. This is great.
15:06
Thank you so much for having me.