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