Dan has spent a career working in and working for hospital financial management. He has been instrumental in helping large and small organizations find their weak spots, change processes, and realize immediate returns in bottom-line cash. In this interview, Dan talks to me about his journey in the field and the challenges he has overcome.

Starting Out In The Revenue Cycle Management Domain

Dan recalls working at UCI Medical Centre in Southern California. Being a newly acquired entity from Orange County Medical Centre, there were opportunities to work in the business aspect of the emergency room which is where he started the revenue cycle business.

The industry consistently presented challenges, every year, and every decade there was another set of challenges to the healthcare system in trying to maintain a viable relationship between the patient, the provider, and the payer, which kept Dan interested in the field.

Regulatory and statutory changes, whether that was something with COBRA with HIPAA, with EMTALA, always presented new challenges to healthcare managers to be able to support their providers. Dan believes it is all about supporting the health care provider whether that is an MD physician, doctor of osteopathy, nurse practitioner or physician’s assistant, CRNA, or (most importantly) the nurses who give care at the bedside, and it is all about making that dynamic work.

‘The patient’s caregiver relationship is paramount and my job and the job of other people in the revenue cycle is to try to be as transparent as possible in getting the business aspects of healthcare resolved promptly and this keeps me interested.’

Before his current job at Allina, Dan has worked in the vendor space doing outsourcing of accounts receivable management from several different healthcare delivery systems, working with durable medical equipment companies and laboratory outsourcing companies; always in the business of helping them resolve unpaid balances from insurance companies and developing order-to-cash processes for them to be able to manage all of the constant changes that exist in that reimbursement space.

Current Business Role And Organization

Presently, Dan works within the Revenue Cycle Performance Management group which does all of the support functions for the revenue cycle. This includes managing vendor invoices, doing the analytics to identify root cause issues relating to denial management, talking to vendors about their solutions, doing RFPs and RFP response management.  The team takes over these concerns which frees up the directors of operations, the directors of patient access, and utilization management, coding, the CBO, to be able to do their business.

Talking about their clients, the Minneapolis St. Paul Metroplex is Allina’s main customer base. Dan reveals that numerous patients from around the world come here for treatment and dealing with the ongoing changes in how providers and payers are going to interact in the future may present a challenge moving forward.

‘There have been dynamic efforts to achieve equity in care, reduction in cost, great outcomes, and patient satisfaction, no burnout on the caregiver side.  These are important goals to achieve, and we consistently look for better solutions that meet each of those four goals.’

Currently, the revenue cycle performance management group is a team of 20 people, doing the analysis and vendor management, expected to grow to 25 or 30 over the next year.  Overall, over 1,700 people are working on all aspects of the revenue cycle for Allina.

Additionally, Dan also owns a consulting firm wherein he works independently with revenue cycle companies helping them improve their performance, building training modules, for example, or working with them on consulting services. However, Dan states that at present the consulting arm is in suspense as he is fully engaged with revenue cycle issues with Allina Health.

Standout Moments As A Business Leader In RCM

For Dan, a standout moment is helping an organization realize how the whole organization can embrace the complexity of that revenue cycle to make it work in the context of giving care to patients.

He believes sometimes people don’t realize what the rules are in the background, so they continue to give care to their patients as they have been trained to do and yet not be aware of constraints that need to be addressed to be able to recover the payment from the insurance companies appropriately, from Medicare and Medicaid, from other federal payer entities.

Additionally, being able to bring an organization up to the level of awareness that they are not making serious mistakes that negatively impact the recovery of payments from all of these entities is a standout moment for Dan.

Regarding the organization, Dan feels pride in their ability to continue to staff and deliver services in a time of healthcare crisis.  With some great professionalism and great results, the firm has managed to deliver revenue cycle services to the healthcare system that has made it a very positive experience from a customer satisfaction perspective as well as from a dollar recovered perspective.

Overcoming Challenges Over The Years

Staffing in the time of COVID followed by the great resignation across the US has been challenging. Dan states that they have seen some significant changes in upper-middle level management across the healthcare system and the teams in place continue to deliver good services despite some of these significant changes.

Business Plans For The Future

Dan states that the focus is on looking at new technical opportunities and discovering how they can bring technology and process improvement to the revenue cycle so that they are doing better work, getting the right level of reimbursement for the charges on the books.  Technology, process, quality, and cost are the prime areas of focus.

Top Philosophies And Core Values In Business

Dan states that whether one is a vendor or a healthcare provider, compliance has to be one of the top concepts that drive the organization.

Understanding the laws and statutes surrounding the ethics of the business of healthcare, the need for confidentiality and privacy, and having a healthy organization that daily addresses each of these kinds of compliance mandates from both the federal government, and from state governments – these are important driving forces of an organization.

Another philosophy is the balance between insourcing and outsourcing the use of technology, building trusted vendor partnerships rather than looking at a vendor relationship in any situation as just a commodity.

‘I think that the healthcare systems that survive the best have good critical thinkers on their management teams.’

Advice For Newcomers Looking To Start A Career In RCM

Be ready for change and understand the balance between regulatory changes and how operations need to flex to be able to continue to meet those challenges.

As an example, in the last 10 years or so, changing from 4010 to 5010 standards for billing, changing from ICD-9 system to ICD-10-CM PCS, two major changes that had a big impact on the operations of healthcare billing in a big way.  Even with planning, some people weren’t able to generate a claim for months and months, because they were not ready for the changes.

Key Benefits Of Services At Allina Health

Among the several key benefits is identifying the right next new vendor to come on board.  Not only does the team sweat the details on the relationships with prospective vendors but also maintains those relationships moving forward, so that there is no loss of focus on the aims of the relationship, the path forward or the use of the technology.

When it comes to vendor relationships, stability and talent form the top criteria for Dan. Other characteristics are system competence, compliance competence, process and education competence, and delivery of the goods, all of which are important.

Vision For Future Of The Industry

Dan believes something has got to give because of the mounting pressure to control the constantly rising cost of healthcare in America. He states that the interesting partnerships are coming out of payer and provider relationships, like direct contracting with payers to figure out how to equitably deliver healthcare to a payer’s subscribers in the best possible manner.

He feels the payer-provider collaboration activity will continue to grow along with looking at ways to use artificial intelligence and machine learning to identify what work needs to be done and what accounts don’t need to be worked because they don’t meet that criteria.

For companies and professionals looking to remain successful in this domain, Dan believes critical thinking, communication, collaboration are important.  The successful path is to figure out what is wrong and that is the critical thinking part; then how to go about fixing it which is the collaboration part.

‘If you are going to get into the healthcare system, recognize that it is a society that wants clear answers quickly and it takes a lot of work to get there.’

Leadership Lessons Learned Throughout Life

‘I think honesty and personal dignity of yourself and the other persons are important as you work through relationships.’

Kindness is at the bottom and top of leadership and for Dan, the most important piece to have.  He states that when crises happen and somebody is struggling, it is important to maintain their sense of dignity, their sense of self-worth because without that the problem continues and the person is defeated.

Another factor is regular education on the issues. For someone in the revenue cycle, understanding healthcare financial management issues, joining an organization that has a great teaching characteristic to it, and reading the right source material to understand what is happening are important.

 

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