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Becker’s Healthcare Podcast
Transforming Revenue Cycle at Mount Sinai Health System with Debra Jaeger
00:15:12
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit BeckersHospReview.com and click on the events tab in the upper right.
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B
This is Andrew Kass with the Becker's Healthcare Podcast. I'm thrilled to be joined today by Deborah Jagger, Chief Revenue Officer at Mount Sinai. Deborah, it's a pleasure to have you on the podcast.
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C
Thank you so much. It's a pleasure to be here.
- [00:50]
B
Before we begin, why don't you tell us a little bit about your background?
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C
Sure. So my original background was in nursing. So I spent most of my nursing career as a working in critical care and emergency room, but really worked across all of the levels of care, including the post acute and home care. I transitioned into revenue early on in my career while maintaining some clinical presence. So back in my first transition I got into working with an insurance company and setting reserves for traumatic injury and long term disability, which really sort of ignited a fire of really loving the fact that I could use my clinical expertise and build that into finance. And then as my career grew and took on different roles, I really viewed myself as a liaison between the clinical teams who really didn't have as much insight to the financial ramifications of payers and co coding. And so it was really a nice space for me and that's where I thought I could be the most impactful, being a clinical person as well as a finance person.
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B
Yeah, I think that nursing background is so interesting. How do you think that has informed how you approach your role as a revenue cycle leader?
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C
So I think that, you know, when you look at revenue cycle historically in the past, going back many years, 15, 20 years, it was very much of a back end office practice and there really was no talking to the front staff that was actually driving all of this revenue. And you know, some of the EMR systems really kind of helped us change that view and really tried to focus us into a clinically driven revenue cycle. So that is the best practice. And in order to be effective in my role, it is very, very helpful to understand clinical operations and understand how providers and caregivers approach a patient and what their workflow is. And so our goal is really to make the work that they do, taking care of patients their main priority and making all the revenue capture as easy as possible. So utilizing technology templates and really educating them on this, I think is one of the benefits I have to have been working in the clinical delivery areas.
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B
And so you are Mount Sinai's first chief revenue officer. Can you tell us a little bit about what your role entails and how that's going so far?
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C
Sure, yes. I am the first chief revenue officer and very thankful to be in this role, to be at such a great organization. So Mount Sinai has a, a terrific, outstanding reputation on clinical delivery and what they do in both research and what they do in those clinical areas. That is really a nice place to be. And with this new role, it's really to move our revenue cycle into that type of center of excellence. And so when I came here that one of the things was, is that the, there was very fragmented shadow revenue operations, so not under one leader. And so the goal of our cfo, who was also new to, to the organization, Vinnie Tamaro, was that we then unite this and create really an industry best practice revenue cycle. So pulling those areas all together was our top priority. Right. Because nothing else really could be done in the, you know, into the improvements that we needed to make. We created a front end revenue cycle, a middle and then the back end on billing and then wrapping around really revenue engagement and working with all of the departments and looking at our revenue across the board. So not just the transactional revenue, but, but really looking into any of those value payments as well. So that was the idea of, you know, really creating this role. And so how is it going? I'm one year, just almost exactly one year into things and we've made a lot of accomplishments. We really have made improvements in our cash collections and reducing our denials. Much of that is done by just bringing these teams together and having collaborative conversations and leveraging each other's skills in this area to be more uniform. We are continuing on that journey. So we're not completely at a central centralized process right now, but that is to be completed by the end of this first quarter. We spent a lot of time focused on standardization of practice policies and epic optimization. And by pulling those teams together, we could do that versus working in a lot of fragmentation.
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B
Congratulations on hitting the year marker. Just about hitting it. So next I wanted to pivot to see what the biggest headwind you're facing right now as a revenue cycle leader.
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C
So I think that one of the biggest ones is the complexity of getting paid that has Been increasing. So no, you know, long gone are the days where a claim goes out and then you know, it comes back. So looking at what is the issues around that. So paying the payers have gotten more complex. Your contracts have gotten more complex. And then of course everybody's resources, both our own and on the payer side has, you know, really have people have thinned out their workflow forces. And so getting resolution from the payer is, you know, is been more and more challenging over the years. So I think that that is one of the biggest headwinds is the delays of payment. I think that the other thing, you know, some of the other challenges is along that line with workforce. You know, how do we pull in new young future leaders? Right. And getting them engaged and wanting to be in rev cycle and then growing and nurturing them. So having those plans for succession is another challenging thing that I'm trying to do in the organization. I think everybody's faced with that is this the younger generation isn't necessarily migrating to these positions. So how do we do that? And then the shift through technology. Right. There's just so many different tech options out there and really navigating through which one is the best fit for us. Even though we're an epic first shop, it's. It is, we do need other technology and that, that is another challenge. Yeah.
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B
And so on the, you know, developing talent side of things, how are you working to develop that next generation of revenue cycle leaders?
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C
Yeah. So a couple of things that we have in the works right now is creating a mentorship program. So for people who are in those entry level positions or first level management, how do I pair them with a more seasoned leader as a mentor? So we're developing our mentorship, formalizing our mentorship program. We also take on interns. So both college interns mat both bachelor's and master's and then looking at developing a high school internship. Because many of these roles within rev cycle are entry level from a high school graduation. So how do I expose them to this whole other world that they can transition right away from high school into some of these entry level positions. This is a, you're sort of a passion considering like where we are in our community. We, you know, not only do we want to be a care provider there, but we're also in a large employer for, for New York. And you know, people who don't go on to, you know, post high school education, this gives them an opportunity, if they're not interested in a trade to have a really a career and to be able to go and develop that and look for promotional opportunities. We do have a partnership too with a community colle knowledge as well. And so these are the things that we're trying to do both internally and externally with recruiting.
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B
And what are three of the top trends you're following in healthcare today?
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C
I am following AI and technology, which I think everybody is and really interested on, not just currently what's going on in AI, but what does that world look like down the road and how can we rethink how we do things. So, you know, this area has kind of been the same sort of like workflow churn year over year, you know, and what would AI do that would make it look differently? And it's, you know, really about how do I leverage the human component and leverage the AI component to be better at what we're doing and to, you know, be able to do more. So that is one of the, you know, the big things that we're watching as well. I would say that we're definitely a pulse on, you know, this back and forth with our payer challenges. It's everybody's sort of issue payer state the same issue. Really watching to see is like when you know what bubble's going to burst that's going to bring us to a better model in this. So really interested in that. And then the other thing that's really, we're, we're focused on and that really looking at is how do we create, you know, a patient financial experience. And you know, healthcare is so complicated for patients and it's only getting more complicated. You know, with high deductible plans, people enroll in plans. Employer offerings are different these days and many people do not understand their benefit plan until they, you know, are actually faced with something and don't really have a foresight on what that, you know, out of pocket is going to be. So how do I leverage tools and education to create a better financial experience and educate that consumer?
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B
And so what are you most excited about right now in your role?
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C
So I think, you know, one of the things that's really exciting is first of all bringing all the teams together. And I think that's really exciting because it allow us to move to the next level. And the other thing that I'm really excited is about, you know, how we can grow and this is one of our projects is how do we get into more utilizing predictive analytics. So how can I use this to predict cash or predict heat spots? Right. If you want to call them in. In the certain evolution of the claim. So how do I get ahead of that? You know, by saying, okay, normally when X happens, it's going to delay payment by 90 days. So that's one area that I'm really excited to continue to work towards. And then how do I use predictive analyt analytics to drive, you know, your overall cash all the way back from the point of scheduling that patient, you know, and then what converts into a surgery based on so many visits? And then how would I then be able to predict my, you know, cash a couple months out from that? From all the way back from the point of like looking at scheduling of, you know, ambulatory or providers and then what can I do to implement a change in that? So is it something I can do that would pull patients in or move patients up? Balance loading, all of those things. So really looking at the life cycle where the, you know, rev the revenue starts all the way down to when we, you know, have all obviously have cash goals and you know, where we're going to land with them before we don't, before we're looking back and we can be proactive and change that trajectory.
- [14:03]
B
The last question I had for you today was how are you thinking about growth over the next 12 to 24 months?
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C
So I think we are, you know, from that perspective is really finishing up our integration efforts and then like I said, really developing that patient financial experience and utilizing those tools and implementing that. So we've started a lot of that work. So by the end of the year, I think that we will have a very, we'll have a lot of a, of a different approach to how we welcome that patient in the door from that financial experience. And then I'm really, you know, excited about some of the new AI that is out there and implementing that we have in the works and what, how we're going to look to redesign how we do things. They're my big excitements. Yeah.
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B
Well, thank you so much for joining us today, Deborah. It's been a pleasure speaking with you and I look forward to talking you with you again soon.
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C
This is great. Thank you so much for having me.