Dave is an operations focused business leader partnering with executive leadership, boards, private equity, financial institutions, stakeholders and vendors to deliver  exceptional results. His expertise lies in business development, mergers and acquisitions, operational metric management, team development and corporate leadership.

In this interview, Dave talks to me about his journey in the RCM domain, the challenges he has overcome, and his vision for the future of the industry.

Starting In The RCM Domain

Dave mentions that his career path to RCM was coincidental.  He was engaged with a private equity firm for the financial side of investments which connected him with an RCM company in Chicago. This company was in a position to grow with the right leadership.

The company sought someone who could change its direction, enabling it to grow from a small business into a major player. After extensive discussions, Dave became the CFO of what was then known as Springfield Service Corporation. At the time of joining the team, the organization specialized in revenue cycle for small to midsize practices of limited clinical specialty scope.

Under his leadership, the company executed on significant investment and growth. The team fundamentally changed the company which was very rewarding, both in terms of organizational value and also as an example of how valuable excellence in this space can be for all stakeholders – patients, providers, payers, and employees.

One of the most appealing things about the revenue cycle to Dave is that its purpose is to  connect the payer and the patient constructively and efficiently, and to reduce administrative burden on behalf of the provider and patient.,

Dave and his team are providing the service that is necessary for the successful financial operations of healthcare. This is the fundamental mission of everything that they do.

‘It is very appealing to me that we can accomplish something that benefits all three parties, we can do it consistently and efficiently and accurately while providing a financial return on investment in those services, and we can leverage technology to get it done.’

Building Enriching Life Experience In The Early Years

Recalling his first client, Dave mentions taking a single-specialty client in Chicago and expanding the engagement to include all of their employed physicians. The team went from 40 providers in radiology to over 450 providers covering all sub specialties across three hospitals.

‘When we were given the opportunity, it was probably the scariest moment of my professional career. I think it certainly worked out to our advantage, as we stepped back and took an honest look and realized that the worst thing we can do is to fail, and if we do not successfully pull this off, we will never land a deal like this again in the rest of our professional lives.’

The pressure of this engagement had the team spending an extensive amount of time eliminating the risk factors that would cause failure. Dave states that this relentless preparation helped them be ready in terms of staff, physical space, systems, hardware, software, and more.

The success of the project not only impressed the client but also enabled Dave and his team deliver feedback to them, allowing the provider group to make changes that created opportunities for their business.

‘That contract will hit its 20th anniversary in 2024 and it is the same 20 some page document that was signed back then, and I think that was a credit to a lot of people that had worked very hard. But we should also credit the preparation that was driven by the leadership team that was required to digest something that big successfully.’

Prior to Value-Based RCM, Dave has been invaluable in the private equity space of growing small companies and then selling them to larger companies.  His first deal with Springfield Service Corporation was sold to PLDT (Philippine Long Distance Telephone Company). Following this, he worked with another startup, Bolder Healthcare, which sold to Cognizant Technology Solutions, a Fortune 200 company.

While growing companies, Dave had an enriching experience as a result of having a tremendous amount of autonomy. This allowed him to be in direct contact with the team on a day to day basis and get to know every associate. He believes it is rewarding to know each employee personally, to understand their needs, and to be flexible with them so that the job is not something that impedes their life but becomes part of it.

‘I am a firm believer that when you do that you get more out of every person by treating them that way and it has been fun, it really has.’

Current Business Structure And Organization

Talking about the type of clients the company is serving at the moment, Dave says that they have two primary service lines.  They service anesthesia practices as a subspecialty, and a recently created division to provide RCM services for behavioral health and substance use disorder facilities.

Anesthesia is an area where the complications of the billing requirements is very different than everything else out there in the professional space, and he felt that it is a niche that is underserved in the market.

The company entered the behavioral health/substance use disorder market for multiple reasons.  Dave mentions that the reason the company is named Value-Based RCM is because they wanted to call out the “value” aspect of what they do.  It is a play-off of value-based care and the reimbursement that comes with it, but the idea of the term value was to deliver value to the clients.

Entering into this space is about helping in an area where the issue and source of the patient care is exploding.  The number of opioid overdose deaths last year was 93,000 in the United States. This is expected to grow at a double-digit rate in 2021 and 2022.  It is an area that is facing its version of a pandemic and an area that needs help. Dave and his team designed the company to assist everyone involved. The substance use disorder space is  passion-driven, not business-driven.

Currently, the company is servicing about 65 different facilities across the United States since its inception in December 2020. The company employs over 175 people globally.

Dave mentions that they established the Indian entity before the US entity. This allowed time for the hiring and training of experienced people in key specialties.  One of the flaws in the RCM industry is that when one has a global model, they rapidly hire and train associates, resulting in a less effective workforce.

When this occurs, the organization has associates that can perform in a role but don’t understand the business and the domain. Value-Based RCM  grew the Indian business first by hiring experienced people that had depth of knowledge in anesthesia and started training before they had a client.

This is a continuing model for Value-Based RCM: hire in advance of need, provide training, and create capacity early. When they receive new business, they are able to move experienced people directly into required roles.

Standout Moments As A Business Leader In The Domain Of RCM

The biggest standout moment is watching technology change the evolution of the business. In his 20 years of experience, Dave has watched things change from the manual submission of claims to electronic claims, the ability to edit claims before they go out, the use of everything from IVRs when it comes to calls, to auto-dialers, to the advent of EHRs, and what Epic has done to the space.  All of this has been very exciting because it means that the team can focus their efforts on other value add activities that benefit providers, patients, and payers because they are not involved in the mundane tasks.

‘It is exciting to watch everything as it is applied and how it changes the landscape of what we do – and it is exciting to be a part of this change, and to contribute to using this technology meaningfully for the improvement of financial outcomes for patients, providers, and payers.’

Talking about moments of pride in the company’s achievements, Dave lists the fact that they have been able to support providers to grow businesses that were thoughts, ideas, and dreams, as number one.  The challenge of running a practice is that many who become healthcare providers chose their career because they have a passion for patient care.  They may not be business people, but they want to establish a successful practice because they are dedicated to treatment and successful patient outcomes.  What Value-Based RCM has been able to do is allow providers to focus on achievement of these outcomes while having the financial wherewithal to make this a reality.

Overcoming Challenges In The RCM Domain

One of the biggest challenges that everyone in the RCM space faces is the ever-changing regulations. Dave states that changes are expected in the regulations around surprise billing and out-of-network care that will be a major hurdle for many providers.  It is going to transform the way that a patient is treated depending on the decisions that they may have made. Additionally, the concept of median reimbursement rates and arbiters to determine what is fair and reasonable -and- defining usual and customary is going to tilt the entire industry from historic standards.

Dave recalls that at the beginning of his career all the HIPAA regulations came out and were constantly refined.  First, there were patient disclosure regulations and now an added challenge is cybersecurity.  These are major hurdles that, if not addressed, have the risk of not only harming the business but also clients.

‘You not only harm the client but the client and all the patients that they see and therefore all of the health systems that are tied to it are also harmed as things go downstream.  I think it is often overlooked when you see a change that occurs.’ 

Many look at regulation and believe it is not a big deal. However, the trickledown effect is very dramatic. Everywhere along the line, the additional layer of security and process has to be implemented, and in many cases it is difficult to review processes from end to end. Because of this, required changes to be in compliance with new regulation are often  overlooked.

Dave recalls a recent cybersecurity incident out of an IT storage facility in Colorado which occurred not because somebody was aggressively trying to breach a system, but because someone skipped a step. This resulted in a database of 100,000 plus medical records that become public over the internet.

In this business, skipping steps puts everything at risk. The increasing regulatory burden can have unintended consequences on what is expected to happen – which is a straightforward transaction of requesting and receiving care at the appropriate reimbursement level so that the system can work as intended.

Staying on top of the regulatory framework is important even though there may be nothing in that effort that improves patient care or business operations.

Business Plans For The Future

Talking about plans to grow the business, Dave says the current focus is on their new behavioral health/substance use disorder offerings. The goal in the next five or so years is ultimately to end up with a diversified revenue cycle company that has four to five different divisions and different areas of focus.

At a high level, the plan is to have a very strong physician subspecialty division, a strong physician multispecialty division, the behavioral health business and then one or two divisions that are focused on the hospital side. This could be the denial space, complex claims, or eligibility – and is still to be determined.

‘What we would like to do is by the time we look back five years in is to see a very well-rounded revenue cycle focused company that has several different divisions within it.’

Regarding the methods used to grow the business, Dave states that this is a business of relationships and referral more than anything else.  He hasn’t employed any specific marketing methods but instead keeps the focus on doing a good job for clients which encourages them to tell others about the company.

‘It is not the traditional word of mouth, it is the clinicians that talk to clinicians to get their view of what is going on, and when you have a client that cannot say enough good things about you it becomes contagious and other people come looking for you.’

Top Philosophies And Core Values In Business

The core value in business is to look at the three sides of this business and go beyond just the company and the client. The client can be a major hospital or a single provider but the responsibility here is much greater than just looking at the client as the only impacted stakeholder.  A company is made up of people, and it is important to be mindful of the opportunities being provided to them and what they can bring to the company.

The client is critical as the second component and the team understands how their service impacts the client, the providers and the executives that support those providers.  However, Dave says patients also need to be a focus as they are the reason the clients are in business.

‘If you pull all three of those constituencies together and you treat them all as equally important through the entire revenue cycle continuum, you look at things differently. When we worked on our strategy, we wanted to ensure that at all times all three of those parties were addressed and we do that first internally by assessing who we hire, why do we hire those people, and why do they want to stay.’ 

At Value-Based RCM, the focus is on outreach.  It is important to ensure that patients understand what is going to happen, why they received a bill, the difference between a bill and an EOB, and how those are different.

Another business philosophy is that in this space it is important to block and tackle effectively. A lot of people overlook the small stuff because there are big things happening.

All the buzz right now, whether it is from Becker’s MGMA, or HFMA, is about the big items: denials, patient payment responsibility, etc.; however, as a revenue cycle vendor, the focus must be on the core job – which is getting a charge from the provider, submitting it to the payer, and then ensuring that the payer is going to adjudicate the claim correctly. All the ‘hot topics’ that everybody wants to talk about can only be done effectively if the core aspects are executed efficiently and consistently.

‘I firmly believe that if everyone ensures that the basics are done well, the entire industry would be able to move forward and reduce the amount of underpayment and confusions and appeals and denials, but lack of focus on the core aspects of the business creates an inability for companies to enhance and innovate and bring more value to the system.’ 

Advice For Newcomers Looking To Start A Career In RCM

Dave claims that the broader one’s exposure is to the healthcare space in general, the better they will be in RCM.  People have to understand not only the business side of it, but also the clinical side. Along with a degree in finance or accounting, exposure to a nurse, a doctor, a clinician of some sort is vital to understand what they face and what they deal with every day.

The more people can get that exposure, the better they are going to be able to truly demonstrate empathy towards them and the challenges that they face. This experience provides credibility that clients in this space really demand.

‘If you go to college to get a management degree, I would encourage an internship at a health center, at a clinic, at a small doctor’s office, understand what they are going through, understand how revenue cycle is going to impact their day to day because if you are in that space, the day to day is very different than talking to the CFO of a five hospital system.’ 

Key Benefits Of Services Offered At Value-Based RCM

A key benefit is that the company delivers the best value in the market to clients. That does not mean being cheap, but the most cost-effective. It is about understanding the overall value that they can deliver to a physician practice or a behavioral health organization and that comes from a variety of factors.

Another invention that Dave is extremely proud of is their Client Executive program. Here, people are assigned as a partner to the clients in an executive role.  It is someone who gets to know the client and is able to support their business at an executive level. While it is the most expensive delivery element of the service offering, Dave believes it is also one of the key features that makes them a true business partner, not just a vendor.

‘What we do differently is we create value in multiple ways beyond the execution of the blocking and tackling necessary for success in the RCM space. We understand a client’s business to help them make better decisions, and the aggregate impact of that confluence of approaches is going to bring more dollars to clients’ bottom-lines.’

Vision For Future Of The Industry

Dave expects that over the next five to ten years, several components of the traditional RCM may fade away, much like it happened with medical transcription. Things that have always been done, whether it is paper claims, manual coding, or paper check reimbursement, are likely to be replaced with technology and AI.

He believes the RCM business is going to shift by removing some of those labor costs and allow companies to move a little bit further up the food chain in terms of getting more involved in what today is a separate industry. For instance, clinical documentation is providing a big subspecialty business that historically has been in the HIM business, not in the RCM business.

Dave expects that companies will be able to free up more resources and can focus more on managed care and potential opportunities in that area. Additionally, there are going to be more things involved in the managed care space that will become real negotiating and leverage points for providers, where they are not today.

The term social determinants of health is dramatically abused and overused, but the reality is that as a revenue cycle vendor the company has more, or as much, contact with patients than anyone else in the continuum of RCM processes.  He believes that there are going to be more things that RCM companies are going to be able to do to benefit the patients by becoming involved with other things that impact care.  Whether it is early screenings or communication about care or care follow-up, the industry is expanding beyond simple billing and collections.

Now there is talk about food and what does food mean to the delivery of care.  RCM is going to play a very significant role in expanding services to take advantage of information that can be gathered, organized, and leveraged for the benefit of all stakeholders.

If someone has recurring care, whether it is physical therapy, drug therapy, or follow-up visits, if it is followed correctly the likelihood of reoccurrence drops. All these factors can add more value for patients by giving them more opportunities,  and creates more value for clients by reducing the amount of care they are going to have to deliver by improving the outcomes for the patient.

For organizations and professionals who aim to remain successful in this domain, Dave advises to never to stop looking ahead.  Always look for what is going to be happening and try to prepare for it.

‘We never can predict exactly what any agency or any specific industry is going to do, but plan for the likely contingencies.  Look at what is coming, anticipate what is coming, take a stand, take a few chances, but make sure that you are there when it happens, do not let it happen to you. Be ready for those changes and be ready to introduce those changes to your clients.’ 

Leadership Lessons Learned Over The Course Of Life

‘I think the best leadership lesson that I learned is you need to empower those people that are important to you that are key to you and let them run.’

Building a strong team is valuable for Dave who believes people should want to hire people who can expand their knowledge and strength and make results in a bigger, better, stronger team.  One of Dave’s guiding leadership principles is to give people the tools that they need, empower them to take risks and get them to run on their own.

Another lesson is to acknowledge one’s mistakes and fix them.  The worst thing that people can do is to make a bad decision that then permeates throughout the company because they didn’t recognize and address that mistake.

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