Jim Grigsby – President &
CEO, Jim Grigsby Consulting
Jim is a revenue cycle and management consulting expert for providers. He specializes in providing revenue cycle and management consulting solutions that provide long-term improvement, efficiency, and increased cash flow.
In this in-depth interview with me, Jim talks about his journey in the revenue cycle domain as well as his experience as a consultant. He also talks about his vision for the future of the industry.
Starting in the RCM Domain
When Jim was looking for a job, he landed a role as a financial counselor/collector in a for-profit chemical dependency center. He enjoyed the healthcare aspect of his job and worked with several good people after which he moved on to an acute care hospital as a supervisor of financial counseling and manager of Credit and Collections. Following this, he became a director of a smaller hospital.
‘Once I got into it, I really liked it, but I have to admit it wasn’t a lifetime goal, it was an opportunity to get a job.’
One thing that keeps Jim attracted to this field is that they are helping people. He believes his job is to ensure that the hospital in his community was full-service and that people could go there for service.
Recounting his first account as a consultant, Jim recalls a time after he left the sales job at revenue cycle sales. A friend reached out to him for help on a project. On completion, he found another and continued to do so through his network and build a reputation. Jim credits networking and word-of-mouth as paramount in growing his business without having to do much selling which occurred through interviews with CFOs.
Before his consulting business, Jim was involved in sales and realized that he succeeded here because he understood the challenges that the revenue cycle people faced. However, he wasn’t a salesperson at heart and realized that at his core he was a consultant. He was a problem solver and that’s where the consulting business began.
Jim states that he finds consulting more rewarding than sales because he sees the results of his work.
Current Business Structure and Organization
In his current business, Jim is the sole practitioner. He has worked with several notable clients including multi-hospital systems as a subcontractor, small hospitals, physicians, skilled nursing facilities, specialty hospitals, clinics, and federally-qualified healthcare centers.
His range of expertise is expansive and the services he provides clients include analysis, training, redesign, and management consulting. One of the important aspects of Jim’s job he believes is that he tries to help the managers, the directors, and the staff get on the same page to get things done. A lot of times gaps exist between what the director thinks is being done than what is being done. The larger the gap, the bigger the problems, smaller the gap, the less problem there are. Jim helps identify the gap and its root cause and then point the team in the right direction.
‘I take pride in getting in and out of engagements, not extending them beyond what was needed.’
Standout Moments As a Business Leader in the Domain of RCM
Jim recalls that when he started, managed care, preadmission and precertification were first coming in. He worked with a lot of doctors and nurses who were not required to do those things for most of their careers. However, Jim thought it was a good thing that they comply with the changes to make sure they got paid. He was able to explain things to them and understand their side of things as well.
‘One of the things that helped me in my career the most was that I was always good at dealing with the cross-cultural committees. I can work with nurses, doctors, social workers, and I understand what everybody’s trying to do.’
Another matter of pride for Jim is that over 20 people who worked for him in the past have been in leadership positions in healthcare. He states that he has worked for several people over the years and it feels good to know that every place is better off, at least in the financial realm than it was, before he got there.
‘I got into consulting just because I felt that I didn’t like being confined by four walls, so if I could help improve the revenue cycle at a lot of various places, I could help a lot of different people.’
Overcoming Challenges Over the Years
‘I had to learn early how to work with people. I can’t just tell you to do something, I need to respect the fact you may want to know why you need to do it and what it’s going to accomplish.’
Jim states he had to learn to manage people as well as to delegate and manage the time. As a person, Jim believes he is very driven. However, not everyone is proactive and looking to succeed to the extent he is. Learning how to motivate people to move forward or knowing when to fire them was a challenge and a learning process.
‘I had to learn to work with different people. Everybody is not driven to the same thing, everybody has different priorities and if you cannot get them to understand which priority you need to match, it’s going to be a long, long process.’
Top Philosophies and Core Values in Business
Jim believes the first thing is to gain the trust of one’s employees. One of the simplest ways to gain their trust is to make sure they get credit for the work they do. A lot of people work at their desks and that is all they do. They do not understand how it affects other people.
‘You have to know what you’re doing; you cannot fake it. You might fake it for a year, you cannot fake it for a career, and you have to understand how things work, you have to continue to learn.’
Things change in the revenue cycle daily. One insurance company does it one way, a second insurance company does it another way, which makes flexibility important. People have to understand that what they do is important, there’s a reason they are there but they are not the only reason that the hospital exists. The hospital is there to save lives, and as an RCM leader, one’s job is to make sure there is a hospital for the community.
Advice for Newcomers Looking to Start a Career in RCM
Jim advises being prepared to learn because there’s nothing that can be taught in a University course that can prepare someone for the revenue cycle. Worker’s comp is different in every state, sometimes every county, every insurance company does things differently. Insurance companies are profit-driven and hence are incentivized not to pay accounts at the end of the month.
It is important to understand that checks need to be mailed to get paid in time and understand different terminology used by the payers. If an insurance company says they are going to pay someone on the 25th, does that mean the check is mailed on the 25th, that it is sent for processing on the 25th or its cut on the 25th but not mailed until 28th?
People also have to be open to change and open to learning how the whole industry works. Hospitals are difficult to understand and for someone from the outside, it does not seem clear. The payment patterns do not make sense. There’s a lot of adapting to do.
Vision for Future of the Industry
One of the things, Jim finds interesting is that there are a lot of situations where patients are price shopping. When it comes to healthcare, people want to make sure that they are getting quality at a fair price. This is likely to affect how a lot of hospitals operate and may increase the need for financial counseling on the front end.
Jim believes surprise bills need to be reduced and patients are going to want price estimates which needs to be an estimate based on their insurance. There may be medical complications that impact the costs but the problem won’t be in the estimate, but the complications.
There are likely to be a lot of situations where people do not have the money to pay the self-pay portion. There are medical complications related to the pandemic and there are financial complications from the pandemic.
‘There’s going to be a lot of artificial intelligence where mundane tasks are done through computers and remotely. A lot of things, verifying insurance, scheduling, etc. can be automated.’
Another thing Jim expects is an improvement in the quality of people working with education and professional certifications gaining increased importance in the future. The future RCM staff will need to explain complex financial transactions to people. They will need to be problem solvers and researchers.
Remote work will increase as everyone including transcriptionists, coders, billers, and collectors can work remotely. It is likely to be a mix of remote and hybrid working which will require a different kind of management. Additionally, the way hospitals and clinics are merging, especially the larger systems, there’s going to be less and less tolerance for mistakes by a manager.
There is a major payment problem. While commercial payers cannot be eliminated, there needs to be a way for the government and commercial payers to be better aligned and more consistent. Providers cannot continue to receive less money while their costs increase.
For an organization or a professional who would aim to remain successful in this domain, Jim advises them to be leaders that absorb things. They will need to stay current within the industry and the political side of it. They will need to be people who are advocates for the patients.
Leadership Lessons Learned Throughout Life
Leadership is not for everybody but the people who do it well. They’re knowledgeable, they listen, and they understand that not everybody can be motivated to the same level for success.