← Becker’s Healthcare Podcast
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- [00:00]
A
This is Madeline Ashley with the Becker CFO and Revenue Cycle podcast. And I'm excited to be joined Today by Andrew DeVoe, executive vice president and CFO of Tufts Medicine. Andrew, thanks for joining me.
- [00:13]
B
Great to be here, Madeline.
- [00:14]
A
So, Andrew, before we begin, I would love to have you share just a little bit about yourself, you know, your background and a little bit more about Tufts medicine with our listeners.
- [00:24]
B
Happy to start with, most important, been married for 35 years, have six kids, seven grandkids, been in healthcare for 38 years. And yes, I'm old. I spent my first 15 years, almost 16 years in the for profit world with HCA and with Tennant. I left Tennant for the CFO role at UPenn. I had a short stint there, put about a billion three on their balance sheet and then I left UPENN to go into private equity. I was the CEO of Apollo Health street and then I was the CEO of Physiotherapy, had two nice exits, sort of retired. And then my wife had to come to Jesus talk with me and basically said, I married you for rich or poor, sickness and health, but not to have breakfast, lunch and dinner with you. Go get a job. So I went back in the nonprofit world and ended up at Tri Health in Cincinnati. Was there for about eight years, really accelerated at Tri Health, our value based mission, which is really about getting healthcare right. And then recently In February of 2024, I joined Tufts Medicine to really help lead the turnaround. So that is, that is my career.
- [01:52]
A
Wonderful. Thank you so much for sharing. I really appreciate that. And I just, you know, the first thing I think of when you say that, you know, you've been at Tufts for a little over a year now, so could you kind of just share how it's been, you know, kind of getting introduced to the system and, and how things are going for you?
- [02:09]
B
I think they've gone really, really well. It was tough at, in the beginning getting, getting the urgency kind of in place. But you know, with transparency and with getting to the right parties, we, we broke through that barrier and I can tell you that we, when I, when I started, we were on a 300 million dollar loss run rate. And the good news is in April we actually turned a profit. So it's about 14 months and it was a heavy lift, but we have turned the corner and we're starting to rebuild the balance sheet at this point.
- [02:58]
A
That's incredible to hear. Is there a, a secret sauce here to, to your, your plan to re. To turn around the company?
- [03:07]
B
Yeah, there are probably five or six different specific things that we did. So we got rid of contract labor. We centralized benchmarking. By centralized benchmarking, we lowered the FTE count by almost 1000 FTEs. And we really maintained that while we were growing the institution improve the quality of care. We fixed revenue cycle. We, we had a certain number of departments, a percentage of our departments that probably a third of the procedures were not even getting pre authorization. We fine tuned epic so it could really, we could make sure that we were maximizing. One metric I like to give is our collections per rvu. When before we started down this journey were I think $68 per RVU. Today it's right at $84 per RVU. So we've a pretty substantial lift. And of course on the HP side it's, it's almost $100 million of improvement. So it really is that that took us a long way along with labor, you know, controlling your costs and also collecting the revenue and collecting the revenue for the services that you deliver. Very, very important.
- [04:28]
A
Sounds like you're pretty optimistic about, about the future at Tufts. Could you share with me before we move on, maybe just, you know, one piece of advice that you might have for another financial leader coming in and kind of helping rework a system similarly to what you've done.
- [04:44]
B
One of the things I learned when I got the pen that I absolutely, it kind of went against my grain coming from the for profit world is you don't necessarily hire a consultant to because they're smarter than you or because they've got experiences that you might not have. You hire a consultant, especially if they are experts at the particular thing you're hiring them for and they have the resources behind them to get things done fast. So at Penn, when I arrived at Penn, they had days in AR were 95 or so and it really was broken. And our CEO had decided he wanted to bring in the old Stockamp group to come in. And at first when I got there, I said, I don't need Stockamp. I've done revenue cycle my whole career. I can do this. And the head of revenue cycle, big Kahuna Tom McCormick, took me for a beer and he basically said, look, Ralph really wants to do this. I think it would be wise for you to go along with the trend. And besides, we'll get it done quicker. I said, what do you mean? He says, they're going to be in here and it'll be done in nine to 10 months. I'm like impossible. It takes three or four years. He says, Exactly. We put a cap on the contingency amount. It was contingent. And Steve Norris was the head of the project, came in and they went to work. And I learned so much in that engagement. Additional things that the for profits hadn't taught me. But what I learned is what. What I could have probably done in four or five years, they were able to do in nine or ten months. And we. That was $400 million in a very, very quick period of time of extra cash that we collected. So I guess my. The most important lesson here is it's. There's no shame in asking for help, especially if you can get the consultants to work on a contingency deal. And that's exactly what we did at Tufts, and we've done it in many other places I've worked.
- [06:57]
A
That's a great example and some incredible advice that I'm sure our listeners will find useful. You know, I'd like to kind of shift gears a little bit now and ask you what you're most excited about now for the future of Tufts. Anything you're looking at towards the end of this year, maybe 2026.
- [07:11]
B
Yeah, you know, it was exciting to hit profitability in the month of April. That was kind of ahead of our schedule that we had shared with, with our external partners, whether it be the rating agencies, the investment bankers, the botany insurers, et cetera, just various constituents. But some of the hard work is still left. So we really got to work on throughput, which means access, which means length of stay. It also means growing those key clinical programs. And finally, probably the most important is really accelerating the healthcare transformation, which I mentioned this a little bit earlier. Something that we did at Tri Health was we really found a way to deliver care at a much, much more reasonable and less expensive at Tri Health, for our team members, our cost of care year over year on a compounded annual growth rate was less than 3%. While the rest of our corporate partners out there in that particular market, we're seeing 6 to 8% increases each and every year. And how did we do that? We innovated, and we were able to truly bend that cost curve and bring it to something much more reasonable. And that's what we need to do at Tufts Medicine. I think that is the. The key differentiator that Tufts Medicine is going to have against the many, many competitors we have in the Boston market.
- [08:49]
A
That's. That's great to hear. I appreciate you sharing that. And, you know, it sounds like there's a lot of excitement and growth and, you know, just Forward thinking. So I appreciate that. Andrew, any other things you're thinking about in terms of growth in just like the next 12 to 24 months?
- [09:08]
B
Well, you know, we've got to consistently be profitable. We've got to rebuild the balance sheet and we're going to do that through hopefully a little bit of a shift in our payer mix. We're going to have to expand our ambulatory setting. I think that's where the future of healthcare, it's also cheaper, but it is definitely what our consumers, our patients, our customers are demanding. All these things are things that we need to do. It's hard to build and it's hard to expand into ambulatory when you have a balance sheet as weak as is where we are. So we're looking at some other things, non strategic monetization of non strategic assets and things like that to hopefully help bolster our balance sheet. So those are some of the things just top of mind that we're really exploring at this point.
- [10:03]
A
And you know, last, last question for you here. So you know, I think at the beginning you said you've been in healthcare for what was it, 38 years, is that what you said?
- [10:11]
B
Yes, that's correct.
- [10:12]
A
So 38 years. So you know, obviously the industry is seeing some significant shifts and changes right now. Could you maybe share with me maybe two to three trends that you're closely following and why you think these trends are so important to keep an eye on, especially as a financial leader?
- [10:31]
B
Yeah, the first thing is I think we are still dealing with the hangover effects of COVID which obviously created this massive inflation and every cost across our industry. And I think those of you that are still struggling with this stuff, if you haven't taken out the untouchable things that you know are waste and not really beneficial to patient care and quality of care citizen, now's the time to take those out. I think that number two, I would say that the denial trend are really beyond exhausting and that we've got to figure out a way to deal with with the denials. And when you, when you have a denial trends and you overturn 97, 98, 99 of them, you know, it's just a game of delaying payment. But you know, the, the payers actually use a lot of resources with those appeals and those denials as well. And then the final one which I had mentioned twice now, but I think it's absolutely essential that people really consider how we transform healthcare, how do we change healthcare so that we are certainly more consumer facing but also, we deliver more value for the service that we deliver, which is really a transition to value based care.
- [12:02]
A
Some good trends to keep an eye on. Andrew, I truly appreciate you taking the time to connect with us and connect with me, and I look forward to chatting with you again down the line.
- [12:13]
B
Great. Thank you. Madeline.