John is an accomplished Medical Director and Physician Advisor with over 25 years of General Surgery clinical experience, followed by 15 years of experience in Compliance, Utilization Review, and Clinical Revenue Cycle. In his current role as a Consultant, John has successfully analyzed and helped implement holistic best practices in revenue cycle management. In this interview, John talks to me about his years of experience in the field and his vision for the future of RCM.

Starting Out In The RCM Domain

John was a practicing general surgeon for 26 years after which he transitioned out of clinical practice and ended up working for a corporation, Optum360. While the company was involved in providing remote physician advisor services and more, John was attracted to the consulting aspect of healthcare including knowledge of regulations, physician documentation, helping poor performing clients, and client relationships, among others.

Having stayed with the company for over 13 years, in 2020 John decided to start his consulting practice. He discovered his core passion lay in clinical revenue cycle which according to John a lot of experts fail to look at and miss its important role in affecting the variability of the charges that hospitals charge.

‘Overall revenue cycle does not have an idea of the variability that can be caused in the clinical revenue cycle area.’ 

Clinical revenue cycle is five components of utilization review, case management, clinical documentation integrity, physician advisor, and coding. If the experts in the field are not diligent in their job it can have a significant impact on hospital revenue – this is the understanding that led John to develop the concept of Utilization Management 360.

He began to look at clinical revenue cycle from a holistic point of view which meant every aspect was given equal importance. The five modules of clinical revenue cycle tend to operate in silos and so they don’t communicate with each other. John’s focus was to rebuild them for cross-functionality, knowledge sharing, interoperability, standardization, and accountability because the common factor for those five modules is the documentation in the chart.

Each one of those five modules looks at the same documentation, but they look at it through their own lens and the challenge is when they look at it through their own lens, they don’t communicate with the other four. This is where knowledge-sharing becomes a necessity.

Since then, John has also worked with an organization to create an IT platform that breaks down those silos and puts all of that documentation in a single location.

‘The goal was to take these five modules, put them into one platform to be able to see at a click of a button what UR had to document, what CDI had to document, what coding is doing etc.’

Additionally, for the past 8 years, John has also worked with physician advisors. In clinical revenue cycle, the physician advisor is not really a silo but a facilitator that helps those other four modules work together. Recognizing the importance of their role, John has worked on evaluating existing physician advisor programs, establishing new programs, as well as helping with hiring and physician advisor training.

Current Business Structure And Organization

‘I am in my second year of existence, and I have no regrets because I can do what I believe is right and I can help the people that need it.’

Presently, John is single-handedly operating his firm Streamline Solutions Consulting. Aside from helping physician advisor programs, John is also helping people understand the benefits of his IT platform.

He believes it stands the chance to solve many of the problems that organizations are dealing with by breaking down those silos to look for that cross-functionality and knowledge sharing that is lacking in the industry. Another aspect of the platform is that it allows for customization based on the needs of the people working with it.

‘What a lot of big companies do with their products is that they customize the client to their product instead of customizing the product to their client and our goal is to customize the product to the needs of the client.’

Standout Moments As A Business Leader

For John, his interactions with experts in the industry have been quite memorable. He believes there is a need for collaboration between different people to make things work. One challenge that many experience is the amount of “ghosting” that exists today, not just in the healthcare industry. This has taken away personal interactions.

‘I have met some amazing people with high standards, and high levels of integrity. I think personal interaction is so important in today’s world and we have lost so much of that with all of these remote functions.’

Overcoming Challenges Over The Years

Burnout was a major challenge for John during his years practicing general surgery. After doing it for 26 years, he felt like he started taking patients’ problems, the severity of their illness and their outcomes home with him. Once that happens, it impacts a person’s ability to be objective which is a huge contributor to burnout. Using his experience, John wrote ‘I Want To Live, The Power We Have’ which was based on his experience with patients.

‘There were so many patients I dealt with that just melted my heart and I empathized with them but I also learned from them at the same time.’

Business Plans For The Future

Currently, John is focused on reaching out to people. During his interactions he often meets people who tell him about a potential opportunity which he enjoys exploring. At the moment he is excited about promoting the IT platform created in collaboration with Glenn Krauss and Tiffany Ferguson, President and CEO of Phoenix Medical Management. The platform is called Toney Healthcare, and has potential services associated with it as well.

Talking about marketing methods that have worked for him so far, John rates networking at the top of his list. He claims that it is important to put yourself out there and constantly look for contacts and be willing to accept failure.

‘Be willing to accept no and to move on. It’s not a personal affront to you, they’re just saying no to what you’re offering and in the business world you can’t take it personally.’

Top Philosophies And Core Values In Business

One philosophy for John is that the care and the quality provided to patients should not suffer because of management metrics. He feels that the healthcare system is complicated and expensive which in the long run leads to the patients who suffer.

There are a high number of thoughtful, conscientious healthcare workers starting from physicians down to the person that sweeps the floor who are trying so hard to do a good job, but sometimes management has these metrics over them that they must complete which can interfere with the quality of care provided.

Another concept that John has incorporated into his work is team empowerment. The strength is in the team and many times people say organizational teams need to be rebuilt and modified from the top down when in fact it needs to be rebuilt from the bottom up.

‘Management needs to play their role. They need to work on helping get rid of the bottlenecks and the constraints that these teams are working with because if you make your team successful, they’re going to make you successful also.’

Advice For Newcomers Looking To Start A Career In RCM

Hard work.  This is not an 8 to 5 job.  People need to be willing to put the time in. They need to be willing to put the effort in, take the focus off themselves, and put it into the service that they provide.

Key Benefits Of Services At Streamline Solutions Consulting

Process improvement and team empowerment. These are generic descriptions of the benefits but they encompass a lot. Also, education and having an understanding of what the world is all about, what the healthcare world is all about, offer valuable insight. None of the federal regulations that exist are exact and they have their own interpretations. Integrity here is what is most important.

‘Once you start not doing the right thing, you lose your integrity, once you’ve lost your integrity, the battle is over.’

Vision For The Future Of The Industry

The industry needs to improve.  It is not just a matter of collecting money, it is a matter of providing services with integrity.  Revenue is not a goal, it is an outcome.  If one does the right thing, the revenue will produce itself.

Leadership Lessons Learned Over The Course Of Life

The best leadership advice John believes in is to have integrity.  If someone has integrity, and if they can put their head on the pillow at night and realize that they did the right thing for the right reasons for the right time and the right people, that’s what’s going to help them.

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