Welcome. Thank you for showing up at 8 30. I know it's it's early I guess we ran through that anyone need checking go again I'll leave it on here while I kick off So Revy cycle management, so yeah, I've been in RCM for 23 years now I was talking to somebody the other day and said I was an undergrad and found stock camp and blacked out 23 years later I'm still here and I'm amazed that in all these years that the systems that we use to treat patients and to Build claims are not capable of telling you who's effective at actually doing the job and the extent of the work effort It takes them to do the job. It's ironic ironic, right? It's talking to some biotech friends of mine who are talking about all these amazing new things They're doing to treat patients to get them back to health quicker. And I said who pays for that? And they're looking at me like what do you mean? Well, somebody's got to pay for it So today is going to be a lot of dialogue I'm super excited at will here to talk about some of these new measures of success that we've been able to establish working together Okay, if anyone needs to code I'll go back to that later we already did this I think you're good on that right, yeah Only thing I'll point out here because I do every time I speak is I a founder of my lifelink to it's a free app It's a virtual community for those suffering from addiction behavioral emotional and or physical most times. It's all three. It's a global There's tens of thousands of people now that go in and connect with each other So if you know anyone in your in your life That's struggling right now and they feel like they're alone haven't download the app and check it out. We've got a great community there And I've been in recovery six years and I can tell you I log in every day and I stay connected with with everybody. So Some disclosures All right current state of our shame and planets I'll kick this off and then we'll move move to will to talk about some case studies and how he's used this new model of Effective intelligence, which I'll define here in a little bit We'll talk about staffing challenges and why the incentive based revenue cycle is something that we have to really start looking at How do we reward people beyond what we pay them per hour to actually show up and do a good job? Want to do a good job, so we'll talk about that and we'll close with what what this concept of effective intelligence is And why do we need it now, you know, and and what do we do when our PM's and our HR's can't deliver it That's the the biggest thing Staffing challenges great resignation. That was the first one and then it's quiet quitting. I'm just gonna do enough to not get fired Then it's acting your wage. That was a new one. I'm like, so if you pay me $19 an hour I'm only giving you $19 an hour worth of work It's like ninth place trophies, right? participation, right But it's a reality that we actually have to think about now because labor is still a high heavy commodity in revenue cycle management Okay Remote workforce Kovac. Yay Outside of Kovac was I went from traveling every week to not traveling every week. So I was able like, you know coach Little League Try to not yell at eight-year-olds who just like to watch the ball go into the strike zone and not swing They want flexibility Well, you're not gonna give me a work at home option and I'm gonna go to the clinic down the street Right. I want to work from Starbucks. I want to I want freedom in my day. I want to do my workout from 1 to 2 right So when people work remote, how do we measure them? If they're in their cubicle you can see they're sitting or Chatting you still don't know whether they're effective at what they're doing But at least you can see them But now this is all changed when I do this I asked I spoke at MGM a in the fall I spoke a couple conferences this year already I said show of hands how many people have gone to a full at home or a hybrid? It's like 80% now say yet that whereas a year and a half ago. It was like 20% Okay Let's talk about why we show up to work This is actually one of my favorite slides here because this really talks about generation I used to think this was a Gen X or not Gen X a Gen Z or a young millennial challenge It's not I was at dinner last night with with some clients and they were saying it's it's everywhere We all had a reset in life all of us in this room how to reset a life the last few years But look at what motivates These different Areas, you know attitude toward work is just getting the job done Look at the Gen Z's like I just want to get whatever you want me to do done and then up but nothing more I'm like, I'm not gonna get curious. I'm just gonna get the job done and move on, right? Going above and beyond job. Look at how it drops off. Okay feeling purpose from their work. I Got to work eight hours a day Am I excited about what I do or is it just a job, right? Right, look at that 19% and then this is this is really important because these are the folks we're starting to hire now, okay Disenchanted with the nine-to-five lifestyle. It's not a health care issue. It's everywhere. I Promise I there are some funny parts to this presentation. It's not just doom and gloom I got I got called out at a presentation last month. It said you're just a jaded old angry consultant and I'm like, you're right It's exactly what I am No filter nowadays So I was a couple of our board member we had a board meeting this week a couple of board members orthopedic surgeons and one of them said I work five times harder today and Make less money than I did 20 years ago, and I said that's true But you also are spending 15 to 20 percent more on labor clinical and administrative and supplies To deliver that service your margin is getting crushed technical term crushed So when this by the way, this is accelerating, you know supply companies aren't going to give you guys breaks Oh, you know what? I feel bad for you. Let me drop that 10% and employees are not going to go back So well, you're paying me 20 bucks an hour I'm okay with just 18 now because I realize your margins are under pressure. All right, and we love the payer Medicare It's not going to be like hey Sorry about those cuts over the years, but we're gonna just slap another 5% on your reimbursement and I can promise you As God is my witness the commercial managed care players Who are now using AI bots to deny your claims hoping that you don't see it and then you end up in a timely filing Situation are not going to start paying you more money Unless you can go to bat with with with data and we'll talk a little bit about that. But this is not good in any business, right I Look at margin in a very simple fashion. I bill this which means nothing I Collect this which is not likely what I expect to get All right There's your net collection rate and this is what it costs me now to deliver the services that allows me to build this, right? There's your margin down there. So margins have shrunk now because of what I just mentioned on a prior slide So what do we control right? We don't control a lot of things anymore in health care Except if we have the right measurements, we can start to look at our employees It's not just administrative RCM employees the clinical to Okay, I Live in San Diego used to have like seven dollars and fifty cents a gallon for a gas I walked in and I said, I'm not feeling like 750 today. Can you give me like a 20% discount? We'll just call it a contractual ounce guys like, huh? So the world other than health care gets what they ask for grocery stores But health care never it doesn't We never get really what we ask for it's very rare and then it's so hard to figure out whether you got what? Raise your hand if you're in spreadsheets all day long Where's your hand if you still use pivot tables? I? Left Deloitte to start that company because I refused to do another pivot table and now when I do pivot tables It's just like some sick thing that I'm like, I'm just gonna do it for old times sake Okay, the other thing here is that physician physician services, you know You're contracting for two or three years at a time. So you're just stuck it whatever you were. I mean, no, that's why they're on the bottom Yeah That's right. You know the insurance companies go look at quarterly profit margins for your big commercial managed care Let's just pick on United Healthcare Go look go look at what they make I was interviewed by advisory board a couple weeks ago And they asked what the big problem in health care was. I said, there's still no alignment between the payer The provider and the consumer right epic said they would solve all that they didn't right so so that's a problem Right, and unfortunately, it's not going to get solved in the next year I mean never not get solved in the rest of our careers in health care So if we're gonna run a revenue cycle We better know that we have got to protect the biggest asset we have which is the people that are still getting involved And getting you paid for the services you deliver right AI bots. It's not going to automate everything We're not going to you know, Space Odyssey or whatever, you know, where it's just robots doing things. It's not some right Pocketbooks, I'm still paying my deductible and it's mid-april Sometimes I mess with the providers and Tom can I have like a four-year payment plan at like 15 bucks a pot now? I don't do that I'll be like six months, but it's serious though, right? I mean think about consumerism right now So I may lose my job the economy sucks Inflation is high. Maybe I'll delay the surgery shoulder hurts, but I'll just stand meds for another six months, right? Think of what that's doing the practices consumer behavior and then and we'll talk a lot a lot about this. I Can't pay you all that right now Can you can you help me out? That's impacting everything right first quarter of the year how much of your dollars coming from consumers versus insurance companies? You can hold claims for January and try to beat the system Let the hospital process their part first and then you know, you get paid at the end of the day These deductibles are getting too high So you have to have flexibility and how you're going to collect, you know 20 years ago fitting five cents on the dollar came from The consumer that's what provider income relied on now. It's like 55 60 percent And there's still clients of ours believe or not that don't collect it while I go to church with them on Sundays You can still do that, but if you're out of business You can't help them That's the thing we're seeing now in the critical access and the rural health care, right? If you go out of business that community suffers we all suffer um Enough about me Mr. Well, yeah, I just would you like me to be the advancer for you? Thank you. Okay. Yeah I Just go to the next slide So, uh, can you hear me? Rebound is a It's been around for 50 years. It's a about 20 orthopedists seven neurosurgeons Five physiatrists and a couple of sports PCPs. We have 25 each PA's physical therapists Where we span the river Columbia River in Portland and I Think I've been told that we're the last independent group that has that are the official NBA team doctors And It was founded founded by Army hospital physicians from the Vietnam era. They all they came from Walter Reed and they they they came with some new new techniques that they learned in Japan and Germany and It's a progressive group they they're You know, they were early on with ASC it's an odd group They they divide money equally even across specialties and That's and so they're very egalitarian. They also take a lot of time off and so It makes it all the more challenging to run the revenue cycle because you don't have a lot of room for error So, you know 2020 we had lots of turnover we were shut down for you know a month or two and it seemed like It seemed like it was a good opportunity In in sort of back office as opposed to clinic to try to get more efficiency And so I was looking for a software solution We Was gonna say We With yeah, we were having shrinking margins. We're looking looking for better systems. We both wanted to collect more money Money and more efficiently So we wanted to drive down the cost and That was you'll hear a lot today about the zero-touch resolution rate It just means you know, how many claims just sail through without human intervention. That's sort of nirvana and For the ones that get denied or there's a problem. We just want to minimize the work effort that's required Some of that is just sort of not working on you know, not working on the or working on the right stuff We wanted we wanted a quick way to find out what was holding up the Collections and we wanted to reduce avoidable write-offs So what appealed to me was the notion that You would you would assign Assign an order of work for the billers that would it was a Machine learning AI kind of stuff data analytics. It says if you work it in this order You are most likely to You're most likely to have success. You know collect the most money and and that was it was appealing to me because I think it's a human nature to want to do the easy stuff you know go get a cup of coffee and go work on the easy stuff or if or be overzealous and just Jump in and start touching everything and this is you know There's certain claims that would never have been paid by a certain date. So you don't waste your time on them and and it sorts it sorts between those claims that have a certain kind of denial by a certain payer and it it Recognizes patterns in order to structure the day-to-day work of the staff I think that's all I have there So the questions we have are you know, what what is the what is the zero touch? Claim what how many you know, what percentage of claims are zero touch? Where for those that require touches, where did it break down? For those who have balances, you know, when when did we have contact with a patient? Why didn't we ask for those co-pays and deductibles? And it allows it allows you to track in a very granular fashion What individuals are doing? What what they're working on the number of touches per day? Well again, whether they're working on the right they're touching the right ones and it allows you to calculate sort of effort per claim and That's that's the effectiveness that Matt's talking about So this kind of speaks to To the but what was talking about around the carve-outs, right when I look at like account receivable Right when I look at like account receivable, I'm always amazed at how many claims are being worked that don't require intervention today But you staff for it, right? I haven't seen a PM EMR system carve out more than 40% and you should be carving out like 80 to 85 percent There's probably should only be 15 to 20 percent of claims at most that require action and somebody look at it today So there's a big reduction in labor cost opportunity by just getting systems in place to tell your staff what to do. No choice Dictatorship, but friendly no democracy and revenue cycle Here's what I need you to do because the system is programmed to tell you when you do and now I'm going to measure what? you did Insight to action to outcome, right? Yeah, and I and our system the system we had before Metavolve, I think we were using pretty crude crude techniques to measure productivity. It's just How many how many claims you work? But again, it didn't it didn't didn't mean they were the right claims or in the right order Yeah It's you know, it's all about the discipline of following a process and it and you want the computer to do the work for you so You know the front end the front end financial clearance is, you know analogous to medical clearance for surgery, make sure that the patient's ready to, we have all the information we need, we've got their eligibility, we've got the authorization, and that we are, on that one, we have just set up auto-tasking, so the moment we receive a denial, if it's a denial for coding reasons, it goes to the coding team, if it's a denial for auth, it just shoots it to the auth team if it's a denial for eligibility or coordination of benefits it shoots it to the financial clearance team, and that has a couple of benefits, one is there's no time wasted, you're not waiting for the biller to sort of come across it later, you're not waiting for the biller to sort of come across it later, it's just fix it now, and it also has educational effect and makes it more likely that you won't repeat any mistake that was made, and I'm pretty excited about that. And we've also, we have a whole lot more work to do on it, but we're starting now to use a pricer for surgery cases, and collect in the old, until recently we would just charge $200 regardless of the insurance or the type of surgery, because the clinic had been scarred by earlier experience of having tried to get more aggressive and collect some of the deductible, and then having a massive amount of refunds to make, so they dialed it way back, but now we know what the insurance is, we're pretty sure that the ASC and hospitals are gonna collect the deductible before we are, so it's generally just 20% of what we think the bill's gonna be, and we're gonna collect it before the surgery, we've had to staff up to make sure that we can make that determination several weeks before the surgery, so we can have the chance to reschedule, or backfill that appointment that is now empty. One thing I would just say on financial clearances, I'm always amazed at the millions of dollars that are coming through our clients, they're already scheduled to be seen again, and they already owe you that money. Like again, I'll go back to my church on Sunday, well, I'll still see you, free care doesn't work you guys, that's triangle margin slide, it's not there, like I wanna see you again, but I need you to pay, otherwise again, I'm out of business, and you're gonna have to go to another doctor, so that's a big way to accelerate your AR before you send that stuff to collections, is focus on your schedule, and get them on payment plans, credit card on file, if you have credit financing options through like an access one or care credit, do what you need to do, but get them financially secured there. The people that run the front end of the revenue cycle when they make mistakes, we know what happens, so when we get into this zero touch rate phenomenon, this is the driver of improving that, so when I talk about accountability, this isn't just a back office accountability, every single person in your revenue cycle has to be measured, and every touch has to be measured to understand true effort, i.e. labor cost, to get you hopefully paid what you're supposed to be paid in a reasonable timeframe, okay, starts here. I think this is a new one. Yeah, this really just speaks to what I was talking about, is why have a collector call an insurance to tell them there's a coding issue or an auth issue, to then send an email or put a spreadsheet out there or call somebody, just get it to the person who needs to look at it, again, we're talking about touches, every touch costs you money, every touch, so if you don't have automation in your revenue cycle, and you don't have intelligence that's driving the outcomes that are happening to your claims to the right person, you've got to look at that, you've got to look at that. And this kind of, this plays in, I'm not trying to steal your thunder, well, I think I missed it. That's okay. This kind of plays into, again, what is critical to be done? I mean, 42% of, some of our businesses, recycle management, 42% of our denials or first pass denials are front end mistakes. Do you know what the number two is? COB eligibility. And everyone's out here talking about waiting room apps and oh, I'm going to get this one, I'm not going to name names, but you know, this one company, the consumer's going to do all their stuff on their own, they're going to verify their own benefits, they're going to get the planning right, woof, woof, woof, nope. 30% maybe. But if you don't have a gatekeeper on the back of that, I would be very, very careful. Nobody's solving 100% out there, and if they did solve 100%, you wouldn't have first pass denials telling you otherwise. So we got to put process improvement in place and technology to be able to start reducing these nonsense denials. You're going to have your work already with the insurance companies, they're still going to deny you for BS stuff, it's a technical term. So let's not give the easy stuff away. So this, here's the sort of information we can get. I'm one of those, I'm one of the last of the boomers, so I work hard, first slide, altruistic, but I'm tech phobic, and I've been sort of amazed at how easy it is to pull information from the workflow tool. And this is one of the things that's nice is that every payer may have a different contract, different RBRBS year, different rules, pay different for ancillaries and E&M visits. And it's hard to say, well, okay, well, is Aetna better than Cigna? Or, you know, when you come to negotiation time, and you're trying to get everybody up to some parity, this just works it out for you with the net collections rate. So I know that, I mean, why is it that I'm getting paid, you know, 98% from Cigna and only, you know, less than 94% for Providence? What exactly is happening there? If I can't figure it out, I can just go back to Providence and insist on them paying me more money. Not that it always works, but at least you know, you know, you're not trying to pile onto your best payer, you're focusing your negotiation chits on places where you're getting shaved. I think that's it. And this also is a, this is a sort of negotiation slide too, where you can see that, here you see that Aetna is, hang on, this is, I got my pointer. Aetna is denying, first bounce, they're denying over half of the claims versus in the 30s for Blue Cross, Regents Blue Cross and Cigna. And so again, when I'm talking to Aetna, I'm going to say, you know, it's cost, it's costing me a whole lot more money to collect a dollar from you than it is other people. And there's, there's a number, here the zero touch visit is that second column. And again, that's, if we had one thing we were keeping score on, that would be it for payers. We appreciate that being higher. And I think the theoretical maximum might be it's not a hundred, 70% unless robots take over. Well, actually no, it's still win because the payers are still going to play games and deny claims. So one thing that's note here is, and we kind of did a drill down for Will, but you know, so if you're 47% of this population of claims we're looking at went out the door and got paid without a single human touch. It's not a clean claim pass rate. That's a BS measure in my opinion. Your edits, there's your clean claim pass rate, right? It's the old Iowa 97% life is good, right? Life's not that good, right? But let's not just pick on an insurance company here. Let's actually look at the locations and the financial clearance processes that are now broken, clearly they're generating these. So if I'm Will, I'm going to go after UnitedHealthcare, Southwest Regional ASC first to try to figure out why his clean claim pass rate is 60%, not 97. And look at the amount of work effort going into overturning denials, account receivable, and look at the task. This is all the chit chat going back and forth along his staff. Hey, I need you to do something for me, Bob. That's not my responsibility. I'm going to send it over to Sally. Sally's like, no, I think it was you, Bob. All that stuff has to be measured because again, we have to measure touches if we're going to look at labor costs. It's a simple fact. So being able to start at a measure, and I'll talk more about these measures at a high level macro measure, and then quickly assess why it is what it is and what to do about it. This can't be months. It's got to be in your face. That's where the effect of intelligence comes in, what we'll talk about. Yeah, and since we were just talking about Aetna, you can see on the exhausted visit column, you know, there's a whole lot. An exhausted visit, I looked up the definition as like you touched it five times and it hasn't paid. It's the stuff that keeps getting touched. Yeah, I've been doing some work on this claim. Up shows up 30 days later. I'm doing some more work on this claim, shows up. We found a $250 balance, unpaid balance in our RCM team that had worked 56 times when we launched this measure. Let that sit for a second. Yeah, 56. We never got paid for it either. Entire days, a day and a half of productivity calling on the same low dollar claim. So again, we have to have science now driving, right? We have to have science driving work to our people. We have to be able to measure people. And I think it also speaks to, it also speaks to this work effort measure, which is how hard is Will having to work, right? In different areas. I mean, look at how hard he's having to work to get paid, right? And he's not even in your collection effectiveness. That should be 100%, right? And he's not anywhere close there for some of these. And so now we're able to go diagnose why and now measure in real time the performance improvement. And it all comes down to people, process and technology gaps, right? And most of the time it's alignment between the three that you all have to look at. And that's really, really important. I know that's a consultee thing, but it's not just go buy another technology because someone had cool squishy balls and an espresso machine, which by the way, nobody had an espresso machine, which really bothered me yesterday. I don't need popcorn. I need three shots of espresso right now. So it's really important to measure. So we're going to talk about these measures of success because of the old measures of, oh, my AR days are 24. It's like, great. What's your net collection rate? Not sure. How many people did it take you to collect that 24 days an hour? Too many. Not enough? We don't know, right? So we have to level set. We have to up our game in metrics and what we're able to do. Yeah, and this slide, it shows you that in the surgery center, we have three times more volume with Regence than with United. But the coding denials on Regence are five times higher than United. And the COBs are 25 times higher. So clearly an issue there. And then if you look at United, you have, your auths are a problem because you have about the same total denials, dollar value of the denials. It's 31,000 for Regence and it's 26,000 for United, but United is a third of the volume. So if you were diagnosing what you needed to work on and sorting by payer, you'd pay a lot of attention on auths for United and you'd pay a lot of attention to COB on Regence. I don't know that this one tells me anything more than that. Well, you know, I'll tell them something. Come on now. I throw random slides in sometimes to see how well it takes it. But I, so when we start working with a potential client, we ask for data. I know that's a shocking thing for a vendor because I insist on doing an ROI to understand where there could be opportunity in accelerating cashflow, improving the P&L, your net collection rate, reducing labor costs. Simple as that. Like I won't even have a conversation unless I'm able to get some insights. Closed balance net collection rate. I can almost never get anything around that collection rate. It's very difficult for us to get that when we're asking for data and information, okay? The closed balance NCR is a very, very, very important measure, okay? That is literally, if I bill a dollar and my contract says 97 cents, do I get 97 cents? It's simple. But I gotta understand my contractual allowances. Those codes have to be mapped correctly. Do you know how many times I see denials being written off as contractual? Well, contractually, the timely filing should have been. I'm like, timely filing is not a contractual allowance. Data, you guys gotta make sure your data is right. But look at like the variability here between a region. So Medicare is great, right? They only pay you 30.19 cents on the dollar. That's your government getting the best of you. But Will's collecting 99 too. It's pretty good. It's not 100, but it's good. But look at regions. Regions who pays him twice Medicare is not even at 98%. Where's that extra penny? I know it seems silly when he's talking about a penny. Pennies add up. And then, how many pennies did it actually cost you to not collect that extra penny? Okay, remember, going back to labor cost here. Then you start to drill down into plans. So I'm not gonna just go after regions. I'm gonna go look at the insurance plan that's driving us down, which in his case is Blue Cross Oregon 25, let's get on the phone with them. Or maybe it's front office. So we'll start there, 96.9. If I can improve that, then I'm gonna be in the 98s. You see? So again, you start with one measure that says you're good or bad. But then, in a second, you need to understand where to improve. That's the intelligence side. This isn't dashboards, scorecards, like all that crap. This is intelligence at your fingertips to help you make rapid decision making. And then, measure the changes that you make to see if it's working or not. And it's not three months down the road. We don't have that time anymore. You wanna talk through? Yeah, so what I like is that it gives us a few key variables to track and see whether we're making progress on collections and driving the hours of work, unnecessary work down. The 3.8 is, it's actually not a percent, right? Yeah, it basically means that he has a lower work effort to get the outcomes that he expects, which is good. A higher percent means more people it takes to get paid for mistakes, right? It's number of touches per claim. It's an algorithm that measures that, yeah. We talked about exhausted visits. That's just denials that never got overturned or didn't get overturned in time. Zero touch is, again, the one measure, I think, that matters the most. And collection effectiveness is just how much of what was collectible you got. And while you're doing some stuff around zero touch with incentives too, aren't you? Aren't you looking at it? Looking at it, yeah. Because you think about where this, people ask me, well, what's the benchmark? Well, there's no benchmark because a PM system can't calculate that for you. There's no PM EMR that can do that. So we're building our own benchmark. So when I look at all of our orthopedic clients, I can tell, well, that he's actually, 62% is actually pretty good. I've seen as low as 38%. And I've seen as high as I've got a couple ortho groups that are 72%. So again, as you improve your zero touch rate, your labor cost goes down. As your zero touch rate degrades, your labor cost goes up. And it's all a measure of work effort. And we'll talk more of that here momentarily. In 2002, I was working with University of Colorado Hospital and the CEO, after we did our RCM engagement, wanted us to stay on for a few months to look at patient experience. He wanted to have the most amazing experience, almost a Ritz Carlton-like experience for his patients. So I went out and started interviewing companies like Ritz Carlton, Walt Disney, companies that seemed to get it right. And they came back with the same thing. We don't focus on that. Same thing. We don't focus on the customer. We focus on our internal customer, our people. We make sure our people are highly motivated, love what they do, show up every day, excited about their job. They never leave us. Staff turnover, I think, is an issue in RevCycle right now. If it's not, you guys are in good shape. You create employees for life here. And if this goes right, guess what happens? Customer experience is amazing. Customer loyalty is amazing. And your revenue and profitability move in the right direction. All right, this is from like the 1980s. Theodore LeVitt wrote this article, republished in Harvard Business Review. This is right. So here I am in 2002, obsessed about this model here. And now I'm talking to you in 2023, saying that we have to get back to this now. It's a must, which means we've got to figure out ways to engage our employees and create customers for life within that employee base. And remember, we're doing this right now on our own teams. We have a RevCycle. This is like, we're having the same challenges that you all are having, okay? So Maslow, I'm not picking on Maslow. I think he was right back when he did his thing, but the triangles kind of change, right? So what used to be assumed, right? This is now assumed down here. Oh, I'm going to take a gap year after college, mom. Anybody in that situation? I'm not, my kids are still too young. I don't know what I want to do. I'm going to hit the road for a while. I'm going to find myself, right? There's nothing wrong, but you're going to take care of me, right? It's almost like an entitlement. You know, I don't want to get into politics here, right? But this is just assumed. This though, this is so important. How many likes are on my post? Did you like my post? Did you view, did you watch my video? This isn't just a generational, it's not just a Gen Z, it's everywhere, right? Esteem, love me, respect me, right? For me, for me, right? This is important. I know this is getting softer, which is not my personality, but this is really, really important. What happened to this? I read a lot of David Goggins. I got a slide on him in here. If you don't read David, I highly recommend you do it. I was in my workout this morning, listening to his second book, and he just got me fired up about how limiting I am on my own life. Where is the self-actualization gone in this world? Where is, and this isn't just Recycle, folks. This is everything. I want to lose weight. I want to get in shape. I want to run a marathon. I want to learn a foreign language. I want to retire at 55. Great, those are outcomes. I coach a ton of youth sports, and I tell my kids, I said, you control actions in life, not outcomes. Don't think that you control outcomes. You don't, but if you want to be a college baseball player at Stanford, like my son wants to be, I said, that's a great thing. Put it up on a whiteboard. Put it right in your bedroom, but then ask yourself every day what you're doing. How obsessed are you at doing the things that you need to do to give you the best shot at being there, knowing that you still might not get there, but what are you going to learn along the way? We have to get people back to being goal-setters. You're showing up eight hours a day, and you're just not happy, and you're just doing enough. That's really sad. If you sleep for seven and eight, and you're miserable for eight, that misery is probably carrying into the remaining seven or eight hours. What we found in our organization is by getting people back to self-actualization in their professional lives has actually transitioned into personal lives. I'm going to go back to school. I always wanted to be a manager. What do I need to do to become a manager? So this is real, because I firmly believe with the dilemma we're in in healthcare right now, the only thing that we have an opportunity to impact is the people that are having to get involved in getting you paid for the services that your doctors are delivering, and your nurses are delivering, your PAs are delivering. See, I told you I had a slide. Life is one big tug-of-war between mediocrity and trying to find your best self. It's true. We limit ourselves every day. Mine's like, my body, I've had just enough. Have you? Push for a second. Passed out, barrier, mental barrier. Just one second, see how it feels. It's amazing when you do it. I highly recommend, he's rough, by the way, so if you get insulted by swear words and crazy talk, sorry for recommending it, but the audio book, by the way, is actually, I find, better than the, because I like to listen to it when I work out, so just when I think I've had enough of push-ups or whatever, I'm like, ah, David, god damn, I'm gonna do another five. But it is, it is really, really good. Both his books. What if I told you that the labor problem is not a shortage, it's the fact that your software can't actually tell you who's effective? This is scary. How many people have left your organizations this year where maybe subjectively you thought they weren't good, but objectively, maybe they were good? We don't know the objective. We go off of feelings. I don't think Bob's doing a good job. He left, it's okay. What if Bob was one of your higher performers and he just walked out the door for two bucks more an hour? So you gotta think about it. It's not a shortage. It's the gap that's been in this industry between the PM and the HR and getting you paid that I've been battling since 2000, literally. So when we talk about incentive-based revenue cycle, what do we mean? So I know a lot of you are like, well, I'm paying people more today than yesterday, more today than a year ago. I'm asking you to find ways to actually reward them more. Seems crazy. I had an example recently where a call center turnover rate was 35%, 50 people in this. They were using a staffing agency that was charging a 30% premium for the first 90 days. Most of that turnover occurred in the first 30 to 45 days. So that's exciting. Hire someone, put them on the floor, have a good person train them, and then they walk out the door. So I said, what are you paying them, 16 bucks an hour? I said, pay him $2 more an hour to show up to work, to show up. Pay him two bucks more for basically, well, actually, no, what I said, I said, pay him $2 more right now just off the bat for just being them. Two more to show up to work, right? And two more if they hit the performance measures. And the person's looking at me, he's like, so you want me to pay $6 more times 2,080 hours in a year times 50? I said, that's exactly what I'm doing. He's like, well, I'll never make that back in revenue. I said, if you had those people showing up every day, fired up about answering those calls, solving patient problems, collecting money, you wouldn't need 50 people, probably need 25. And you're collecting more money too, which is exciting, because now you have an uptick in revenue. So all of a sudden that six bucks more, it's not that expensive. We have to change our thinking here. We do, right? We have to change our thinking. You don't just give away stuff. You have to have an objective measurement that sets the field and says, this is what you're achieving. Thank you. And for those of you that don't want to be achievers, that's okay. There's 10 clinics down the street that'll probably give you a dollar more an hour to show up and just hang out for eight hours, right? I talked about incentives, right? It goes back to the service profit chain slide. If you have employees that love their, you're recognizing them, they get to go home and say, I got recognized. The whole business office, they saw my name up on the board. I got points, which I traded in for merch, or I put in for a half a day of PTO, or maybe it's a potluck, whatever, right? There's different ways in which you can incentivize people beyond just paying them money. This is a real study on our teams, is I wanted to look at the work effort by our day of week. Now, most people say Mondays are kind of the ho-hum day. Well, not here. Mondays are actually pretty good. 892 working units occurred on Monday. What happened the rest of the week? 138 less on Tuesday, 88, 122, 122. If I could get my team to just give me Monday, I don't need 100% productivity. I just want Monday. Look at what this did. We get about 2,950 per working unit in revenue. $665,000 by just giving me Monday. Now, what if you improved your productivity on Monday? David Goggins would say Monday is only 40%, right? That's what he'd say. What if you gave me 75%? Not 100 yet. I don't need 100. I don't need eight hours. I'm just asking for like six. So start thinking about it in the context. So this is a quick incentive-based model that I wanted to show you all. So if you have a 25-doc ortho group that collect 30 million a year, there's 20 FTs running a revenue cycle, we'll assume 50% productive, meaning I show up and I give you a solid four hours of undivided attention to the job that I'm doing. I see some laughing back there. I know, it seems high. It seems high. I'm thinking about my own day. So I just want you to give me 25% more. Just give me 75%, not 100, 75. Look at this. New hours of productivity, FTE reduction, 6.3, $312,000 a year of labor cost savings because people are giving you 75%. Oh, net revenue improvement? I love the billboards out there. Buy my software and I'll collect one to 3% more net revenue. Okay. How are you gonna tell me who's actually performing that's gonna give you a shot at collecting actually three to 5% net revenue? So in this model, I just assume a 3% increase in net revenue, so there you go. You got 1.8 million between the labor cost savings and the new money coming in. That's your net collection rate going up. I'm not suggesting 10%, everyone makes fun of me when I say this, but I want her to have a shock and awe. What if you gave 10% of that back to the winners? They get $10,000. What would you do if you went to a $19 employee and said, if you show up and you give it all and you're better today than yesterday, make $10,000 more or $5,000 more. Look at the net benefit of the doctors. Your doctor's gonna come back and say, well, I don't wanna, I'm already paying $19 an hour. It's like, okay, so you don't want the extra 65K here? That's what you're telling me, doctor, right? So you see how I'm disrupting this model of thinking, right? Is that as much as we don't wanna incentivize and I'm paying you good money, in the 1980s, work ethic should just be there. Guys, Mapp's Law's not wrong. It's workforce is changing, it has changed. So as I kind of accelerate quickly through a few of these, when I talk about measuring people, I am literally, we are literally talking about the entire revenue cycle. This probably right here is the most important thing, gap that I see, is that I'm amazed that there is not integrated tasking system, tasks systems in these PMEHRs that track every unit of work, right? Some of them have a task system, but they're not tied to the visit and they're not tailored in to measuring all that structured data. Again, this is the world of touches now. We are measuring labor costs in terms of touches. Fewer touches, fewer labor cost dollars, okay? I think we've beat up on zero touch rate enough and work effort, that is the two new measures. Somebody asked me the other day, I was having breakfast with one of our prospects and she's like, your analytics are amazing. I feel like there's a lot there. And I said, well, you don't have to worry about a lot. You have to worry about two measures. This is your true north. When this is right, you don't have to worry. When it's not right though, you need to quickly know why. That's your insight. This was actually pulled. I actually pulled this together, kind of what Will was going through, but look at if I look at zero touch and work effort, look at location one. So this client has a 53% zero touch, which is low. I'd like to see that in the 70s. Look at location one, what's going on there? Look at all the work. There's your clean, clean pass rate. There's refiling, 43% refiling. Any idea what that is? I don't know, let's go find out. This is all work here. Look at all the tasking, chat back and forth. Look at the work effort. Work effort to have the lowest collection effectiveness. They're collecting the least amount of money, spending the most hours. And it all comes back to how many humans are having to get involved. So again, two measures that gives you peace of mind. By the way, peace of mind doesn't always mean that things are good. It means like now I know where to go look at the problem. Is it a payer issue? Is it a location issue? Is it a provider issue? Is it a staff issue? Is it a combination of all three? Look at the representatives. If I have Julie over here, who's working the least, or not Julie, Jordan, she's got a great work effort too. She gets great outcomes on collection effectiveness. Then I go up and I see Julie here, who's working three times, three and a half times as hard as Julie. I'm colorblind, so I can't really see that thing, but for 65% collection effectiveness. Well, Jordan's gonna be getting that incentive kicker, whatever that is. And frankly, Julie might be gone. Or figure out why she's struggling and ask yourself, is it a capability or willingness issue? A lot of times you just have people in the wrong positions. When you ask, when we redesigned our Red Cycle a few years ago, the first thing I did was re-recruit everybody to the team, just like that movie, Moneyball. I literally sat there, I had magnets. Anyone seen Moneyball? And I was like, who's gonna be a payment poster? Do you like payment posting? I actually really don't. I like talking to patients. Okay, call Sarandine. Think about that. If you're having issues in Red Cycle, ask your people, are you capable right now? Do you need to be trained up? Do you wanna be in this role? A lot of times it's that. Stop the chatter. We're not in cubicles anymore, right? Can't shout over the cubicle and say, hey, Bob, I need you to check the off on the, all right, sending email, spreadsheets. How many people send spreadsheets when they need feedback from doctors or anybody, right? It's not trackable to the, it's okay to raise your hand, though. It's not trackable. We live this world, right? Everything has to be measured. Monitor the chatter. It's a unit of work that's costing you money, right? Here's your PMEHR. There's like 1,000 of them on the floor. All these cool all-in-ones. I'm in the cloud, the doctors love it. But then go ask the question. So show me how you measure the people that are getting you paid for all of the services that we're delivering. And they'll be like, what do you mean, right? You've gotta get systems in place to give you the real structured data that tells that story of effectiveness, okay? You have to. It's an upgrade. Think of it as an upgrade. Imagine a world where every employee comes to work incentivized, highly motivated. Self-actualization, right? Measuring your top performance objectively. Like being able to have conversations. It's like, here's where you are today. And they're fired up because they actually know the one or two measures that you're using to measure them. And then they can brag about how well they're doing to their families and their friends, right? A lean, effective organization. When you have a lean, effective RevCycle team, you have a high zero touch rate and you have a low work effort rate, which is gonna give you back some of that margin that I talked about early on in this presentation that's getting crushed. Right? There's too many things negative on our RevCycle, so we gotta focus on people now, right? In closing, should play that closing time song. Did they play that at the bar last time? Closing time. All right. Recognize, reward, retain. Recognize your people. Reward them beyond what you pay them. And they will be retained. Cost of turnover, cost of training, too high. Gotta get employees for life, right? Employees for life, they brag about where they work. They tell their friends about it. They bring in great people to the organization. New measures of success. Zero touch rate work effort. Simple as that. Get away from AR days and all that other stuff that we've been using for years because we were just limited on the data we get out of PM systems. There's nothing wrong with those measures. It's all we had. But the game has changed in the last 12 months. Measure every unit of work. Stop working the 80 plus percent of claims that don't require action. And please trade. I always close with this. Please trade your spreadsheets in. I've talked to a lot of organizations with hundreds and hundreds of providers who still can't get quick data just to do a quick assessment. You can't live like that. Especially if you're acquiring, you're growing. You can't. Intelligence at your fingertips. The way it becomes effective is you actually act on it. If you have intelligence at your fingertips but you choose to do nothing, then nothing changes. So part of the responsibility is to take that intelligence and do something with it and then measure quickly whether that was the right move. Check out codes. Hopefully, anything in closing? I didn't mean to like accelerate. I just was looking at that. Yeah, all right. Everyone got the check out code? Yes, I will. Anyone wants to reach out to us? There's our, you can hit me up on LinkedIn. I think, Will, you're on LinkedIn too. Make sure you like all Will's posts because he really needs that reassurance about how great his stuff is. I just, hey, recognize reward, come on. And if you guys have questions too, I'll be at our booth for a little bit this morning. But let me go back to your. Yeah, I need to get back to it though. It's one, four, three, five, six, nine. There you go. Thank you, guys. Hopefully, you've learned something. Thank you.

recognizing employees

rewarding employees

retaining employees

revenue cycle management

new metrics

efficiency and effectiveness

incentivizing employees

structured data

data-driven decision-making