Doug is a healthcare financial executive with over 42 years of experience in driving healthcare transformation. He is well recognized for his consulting expertise regarding provider, vendor, and financial services. In this interview, Doug talks to me about the challenges he has faced in this industry and his expectations for the future.  

Starting Out In The RCM Domain

Doug’s career in the revenue cycle field was not planned. He remembers working as a bill collector in Washington DC for a finance company. After two of his coworkers got shot, he decided to change tracks and applied for a job as a collection supervisor at a hospital in New England. This occurred in 1979 when he was 20 years old and has been in the field ever since.

Current Business Structure And Organization

Doug is currently working as a partner at Mazars USA, a financial service firm.  There are 28,000 people in 92 countries, and he is responsible for the transformation practice for the US which specializes in provider-related operations. This may be a hospital, physician, or RCM company. Doug is responsible for a team specializing in healthcare operations including clinical and financial operations, strategy, compliance, and regulatory functions. The firm delivers advisory services across the country and while Doug’s team is focused on providers, they have others in their healthcare division focusing on healthcare payers.

The transformation practice has about 25 people that are dedicated to healthcare transformation. This could be quality, clinical, case management, revenue integrity, financial, revenue cycle, finance operations, budget, rate strategy, pricing strategy, charge master work, the full outsourcing of a hospital’s management team, or any other service related to healthcare.

‘Anything a provider does is under my team.  If you are a provider, we can fix it!’

Regarding dealing with vendors as part of his advisory role, Doug mentions that they conduct vendor management assessments where they look at the contractual relationship, the fee structure, the performance, the reconciliation, the placement activity, and then make recommendations around that.

‘Vendors need to learn to be better business partners and not take advantage of their clients, because once you do that you are usually done.’

He also states that these days vendor management is a major aspect of every organization. Vendor management needs to treat their partners the same as company’s employees, with the same accountability, the same amount of communication, the same level of reporting, and understanding of performance being achieved on a regular basis.

A lot of companies don’t understand what is important from the providers’ lens and they also don’t understand the level of scrutiny and visibility the services they perform might be under, especially on the expense side when it comes to senior leaders.  When it comes to churning and client retention the focus needs to be on the organization.

‘When you have done both sides of the fence and then have assessed both sides of the fence, you start to get a better understanding of where the gaps are going to be and where you can enhance processes to make the relationship work.’

Standout Moments As A Business Leader

Doug states that healthcare is an industry where there is no financial benefit to be tenured at one organization. For him, it was bouncing back and forth between providers, consulting financial service firms, and RCM companies; each time gaining more and more compensation and benefits.

Doug says that he made several sacrifices and was willing to relocate with the businesses to further his career which may not be everyone’s cup of tea. In healthcare, if one is going to grow up in this business working in the RCM company side, or in the financial service side they can grow their career rather quickly, but it if they are going to be on the provider side for 20 years, financial growth and security may not be guaranteed.

Talking about his organization, Doug is proud that they have managed to go from a small advisory group to a large advisory group in six years and their services now include full management of hospitals.

They have hospital clients where the firm serves as the CEO, COO, CIO, CMO, CNO, and CFO. Mazars employees run an organization in multiyear contracts turning those organizations around which speaks to the talent of the company, possessing the ability to parachute in and run an entire organization.

Overcoming Challenges Over The Years

For Doug, one of the biggest challenges is having a dialogue with a client-leader who is not financially trained. It is always a challenge when the organization’s leader struggles to grasp the value of what their spend will bring.

An increasing number of people are emerging into leadership roles that come from nursing and quality, and they struggle with understanding the business model.  The biggest challenge is trying to articulate to a non-financial prospect what the real value of the service will be and getting them to pull the trigger.

‘Our deliverables are exceptional and proven but there are still those in the industry that are suffering financially that do not want to spend a dime to get it fixed.’

Top Philosophies And Core Values In Business

The most important thing is leadership. Quality and integrity are important, whether it is running a company, working for a provider, or working in financial services.  Some tend to deflect and point fingers as a means of insulating themselves from their superiors.

‘I have always taken a posture that my staff must get credit for everything successful, and if it doesn’t work, I take full responsibility for that initiative. At a senior level role, you have to be willing to go bat for your team and take the heat.’ 

Another thing Doug believes in is creating space for independent thought. People get to their goal in different ways, and it is important to sit back, even if it is not as fast, or the way that is expected, and be willing to let people grow their own abilities to be successful.

Advice For Newcomers Looking To Start A Career In RCM

Doug believes that the best entrance point for one looking to grow a career in healthcare is in a provider.  As a starting point, it allows one to go into a small hospital, even a critical access one, and gain exposure to all aspects of revenue cycle operations. When working for a large organization, one often gets siloed into a component of the revenue cycle because of the size of the organization.

In healthcare, there are many vendors doing work for providers and there has been an emergence of whole departments that do nothing but manage vendor relationships.  It is a good idea to work on both sides, and it starts to open up many more doors.

‘I think if someone is willing to commit at the right stage in their life to the work and travel a few years on the road in financial service firms, regardless of the firm you will learn more in those 3-4 years working there than you will learn anywhere else.’

Vision For Future Of The Industry

Doug expects to see less employees in the market, especially on the provider side. He believes providers are excited about AI opportunities even though right now they are being inundated with something dressed as AI.

There are a lot of redundant processes that can be automated, and providers are looking in that direction for help. They want to be offering patients digital help, having an established easy-to-use digital front door, and making things self-service.

Doug feels that if there was more of a willingness on the payer side to raise the level of compensation for digital appointments and telehealth, there would be a lot more migration in that direction. The challenge right now is that there is not a lot of financial incentive to offer this as a hospital. Telehealth is a very low reimbursed line-of-business thus far.

For anyone looking to remain successful in the RCM domain, Doug advises that they should never think that they have all the ideas, and they should leverage their team and the experience of their people.

Companies need to be willing to let their management be more active in the direction of where they are going. It is more important to invest in client engagement than it is in new sales.  Churn is expensive.  You need to focus on retention which will help with your ability to introduce new business lines to existing relationships.  Success results from managing that relationship closely.

Leadership Lessons Learned Throughout Life

The number one thing is to be transparent, to take accountability for all direct reports, and in case of a misstep, be willing to share that and not try to minimize, hide or pass blame. It is also important to be someone of your word.

‘People need to know they can trust you and that they won’t be sold something that you can’t deliver.’

As a company in the RCM space, it is important to know that some clients are not going to be good clients, and they could possibly hurt the overall performance placing the company’s reputation at risk. Healthcare is a very small community and taking on new business just for the revenue without looking at the big picture will not always work out well. It is important to know when to walk away from a project. Regardless of the sales relationship, there should be some due diligence about whether to bring a new client on board.

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