Reid B. Gavin – Vice President Revenue
Cycle, Advanced Monitoring Services
Reid is an accomplished medical practice leader with expertise in caseload management, quality assurance, business analytics, customer service, and revenue cycle management. His expertise lies in streamlining operational processes to navigate medical practices through periods of extensive growth and change.
In this detailed interview with me, Reid talks about his journey in the revenue cycle management domain, the challenges he has overcome, and his vision for the future of this industry.
Starting Out in Revenue Cycle Management
Reid graduated with his doctorate in audiology in 2008 when he was first introduced to the field of intraoperative neuromonitoring (IONM). At the time Reid was preparing to remove earwax and prescribe hearing aids in his career. He interviewed for a role at Neurodynamics and after understanding the inner workings of the role, found himself drawn to it.
He worked there for well over a year as a clinician and went back 10 years later to run the practice. As a managing director for two years at Neurodynamics, Reid revamped the operations and digitized all the important processes to promote a culture of accountability and investment in each other.
He got certified as an intraoperative neuromonitoring neurophysiologist and worked in the OR for three years. After about 500 surgeries, Reid helped start the first in house IONM team at Vanderbilt Medical Center and gained a lot more clinical experience.
In 2011, Reid met a neurologist who owned a private practice called Real Time Neuromonitoring Associates and that was when he switched from being a clinician to working in the operations and administration of healthcare practices. The new role involved scheduling, reporting, quality assurance, credentialing and eventually the revenue cycle.
Reid found himself specializing in revenue cycle and focusing on operations that are tied directly to revenue generation such as doing analytics for profitability, determining the process of the clinical operational scale, and strategically determining which clients to take on.
‘Even though I have other operational skill sets that have been applied in practices, the hardest thing to deal with, especially in intraoperative neuromonitoring, is to get paid. There is a niche there and it helps when you have a clinical background to be able to understand the clinical services being provided and how to generate the revenue for the services.’
One of the factors that attracted Reid to this domain is that he is challenged by the difficulty and success requires continuous learning and improvement. The target is always shifting, and the rules are constantly changing from insurance companies and payers.
Current Business Role at Advanced Monitoring Services
Reid is a consultant or a strategic advisor for several aspects of the practice, owing to his extensive background, but he primarily serves as the VP of Revenue Cycle. His primary areas of focus include appropriate medical billing and coding and ensuring adherence to the standard operating procedure. Reid holds fast to the concept that when things go awry, it is most often a process issue, as opposed to a people issue. He is also responsible for supervising the daily checks and balances of the revenue and profitability for the practice.
‘It is a daily duty to make sure everybody is doing their job and that spreadsheets get filled in and that we are not too far off, if it is red can we get it to black or even green? But ultimately, it is attempting to guide the strategic vision for the practice as well.’
He currently has a team of seven in his department. Additionally, he is tangentially related to a few other departments where, although they are not his direct reports, employees report to him in a dotted-line fashion for specific responsibilities.
He also manages an external team that is their outsourced billing company who performs the actual claim submission, payment posting, and appeals, and there are another seven on that team as well.
Reid has been an integral part of several published papers. Recently, he published a paper on the application of blockchain technology for personal health record storage. Reid states this was the project he presented to the Masters of business administration group at the University of Tennessee.
He believes that people equate a new product with patient benefit. What they fail to realize is that technology is completely agnostic of healthcare, including data and documentation.
‘As someone who has built an EMR, that at this point has covered hundreds of thousands of surgeries, I see the specificity you have to have with your data records. Now a big problem is a lack of communication of health records.’
For Reid, the motivation behind writing the paper was bringing forth the realization that sometime in the future will see a mass public health records system that not only the individual can access themselves, but is shareable in a protected method between providers who are not on the same systems and may not even be in the same countries.
With hackers becoming a growing concern, data security has become increasingly important. Blockchain provides data protection while reducing the risk of error and increasing accessibility.
‘I think that an insurance company would recognize cost savings ultimately if they created a system like this because that communication would begin to cut down on miscommunication between providers and miscommunication between patient and provider.’
Reid is a nationally certified and board-certified audiologist, credentials that he has proactively upheld to maintain a knowledge base of clinical audiology. He focuses at the operations and the administration of the audiology practices and how that relates to intraoperative neuromonitoring practice.
He has also been a member of various intraoperative neuromonitoring organizations. One of the organizations he is largely involved with is ACHE because they bring together several different disciplines, many different specialties, all in one organization. ACHE is comprised of people that function in the entrepreneurial or business side of healthcare and, to a lesser degree, on the provider side which allows for valuable revenue networking interactions.
Standout Moments as a Business Leader
One of the standout moments Reid recalls was during his previous practice at RTNA. He realized that the systems they were using were not communicating with each other very well and there were not any software applications available that could answer those particular issues because intraoperative neuromonitoring is a specialized niche industry.
Recognizing this as an issue, Reid and his IT director at that time in 2014 wrote a custom software solution for that practice that managed everything from scheduling to the “day of” clinical operations and then the claim management afterwards. That software solution was a central repository for the data. The platform has morphed and developed over time and is still in effect for the practice helping over 40,000 patients per year.
‘For me, looking back and saying we need a software solution and a holistic solution in place to address how to capture our revenue better, actually wound up developing a software that runs the largest national neurology practice in IONM today.’
Another thing that has impacted Reid is the ability to be in different types of practices, delve into the minute details of the operations, and push the big picture changes that make those practices more sustainable, more profitable, and better for the clinicians, while avoiding clinician burnout.
At an organizational level, Reid says AMS’s ability to be dynamic and change with the times is a huge source of pride because revenue cycle targets are continually shifting.
Another aspect is being smart and efficient enough in the practice to see some of the issues ahead of time and then develop the processes or start making phone calls to insurance companies and set up different contracts to see it ahead of time. That is something that the company is becoming very good at while also starting to diversify its service lines to move beyond just sending clinicians into the operating room, to now working in physician clinics and other non-OR settings.
‘To me our ability to be a liaison between our industry and individual customers and clients has been very much a strong suit for us at AMS.’
Overcoming Challenges in the RCM Domain
Within the company’s RCM department, Reid says it can be challenging to learn what the insurance companies are doing and communicating that effectively across the team. To counteract this challenge, at least once a week and most of the time several times a week the team sets up meetings between the people in the organization. This helps people discuss difficult interactions as well as learn about innovative approaches to tackle any challenge they may be facing.
‘The way that I tackle learning, growing, improving is honestly to make sure everybody comes together and it is a nonjudgmental, “everybody is on the same team, humble” environment and then I sit back and just let people think and figure things out.’
Reid states that most of the time, people can overcome hurdles if they are able to connect and engage with their teammates. If things get extremely difficult, that is when Reid steps in.
Talking about other challenges, Reid explains that the challenges for intraoperative neuromonitoring and revenue are very significant. To begin with, the CPT codes used in intraoperative neuromonitoring originated as codes that are for a physician’s clinic. These codes are limiting in a sense and don’t describe intraoperative neuromonitoring services causing the entire industry to be out-of-network.
This makes IONM revenue generation extremely difficult. Due to billing out of network, practices have to have higher rates because the insurance companies now work on a discount model. That being said, Reid ensures that the balance never touches the patient.
The company collects deductibles, but ultimately they try to get the money from the insurance company, limiting the patient’s responsibility to what would be owed if AMS was in-network, and never balance billing. One of the reasons that this domain is so drastically different in its code utilization between clinic and IOM is that it is far more expensive to run an intraoperative neuromonitoring practice compared to a clinic.
Often, a code used in a clinic for a test may refer to a 30-minute process. The same code could mean a 12-hour surgery in intraoperative neuromonitoring. The differences between the RVUs (Relative Value Units) that are applied to those CPT codes are so off that this industry is forced to maintain an out of network stance.
To go in-network, heavy negotiations need to be held with insurance payers to understand all these differences to get fair rates for the services. This does not work every time.
According to Reid, the biggest problem that intraoperative neuromonitoring as an industry has today is that revenue generation is very difficult based on limitations that have been put in place by insurance companies.
‘The biggest challenge is that we have a disconnect between the coding and structure we are required to use to ask for reimbursement for our services and the actual reimbursement RVUs that are being applied by the insurance company.’
Top Philosophies and Core Values in Business
At AMS, the business functions of five core values which Reid believes also align with his personal values allowing for a synergistic collaboration.
The first one is humbly serve beyond what one’s title may be and without putting the individual ego ahead of the team.
‘The title does not mean anything, we are a team. You break the barriers down for people if you can and get out of the way and that is what you need to do, you do not put that ego in there.’
Another value is the delivery of ‘WOW’ moments that refers to the Zappos.com WOW model. On every single instance of any customer interaction, whether it is a surgeon, patient, or a hospital administrator, the aim is always to try to give that person a ‘WOW’ moment and make sure the person knows that they will get 110% of whatever they need.
The next one is the ‘figure it out factor’ and what that means is sometimes nobody has the answer and people just have to figure it out. This is an attitude of go do it, don’t hold back, ask questions that are non-judgmental but figure it out.
The fourth one is ‘be honest and be real’ and what that means is don’t veil things. Nobody is out to hurt feelings, nobody is out to be mean, but at the same time it hurts to be honest sometimes and being real with someone means saying something to them that they may not like.
The final core value is ‘investing in each other’. It is important to constantly check in with people. Anybody that needed help or can offer help is an investment and if the relationship is treated and nurtured that way it creates a long-term investment.
‘One thing I will add on top is that leadership is about service. It’s about serving people and it is not telling people what to do. In fact, I would submit that if you have to constantly tell people what to do that probably means you are not leading very well.’
Advice for Newcomers Looking to Start a Career in the Field of RCM
As a revenue cycle leader, the focus is constantly on data. But for Reid, to fully capture the big picture of revenue cycle, it is important to understand qualitative elements. And that is why it is valuable for a revenue cycle leader to understand the workflow for a technologist in the OR. It is likely that there are some qualitative components that a clinician is either good at, bad at, indifferent to, or has no idea about that can drastically bring up or sink that particular claim.
‘My advice would be don’t get too focused on the numbers and the data, focus on qualitative elements. And also select your mentors very carefully. That is something I want to always advise to a newcomer, be very judicious on who you let into your inner circle.’
Best Practices Implemented in Business Processes
One thing that has been vital has been never getting too far away from the day-to-day operations. Also, the ability to quickly get training on the system by the person who is doing it. Reid believes it is vital to immerse oneself in the details of the operations. Inevitably any revenue cycle specialist who starts to have conversations with other out-of-/in-network providers and other elements of the practice wind up learning something that ends up creates positive change.
It is important not to stay in that revenue cycle bubble. Understand on a holistic level what the services are and why these services are being provided.
‘I have definitely been a person throughout my time who likes to learn the details, take things slowly first, never “a bull in a china shop” type vibe. It’s yes, thank you, please on whoever’s timeline it is I can learn from, I learn from them on their time. I am not going to barge in the office and say tell me this now.’
Reid is a firm believer in the importance of an organization, hospital or even a medical practice to be educated and trained in the revenue cycle process. He believes healthcare needs to be approached on a holistic level and that means every person in the organization has to understand their component in patient care.
It is important to have a sense of ownership over the entire process and part of that is understanding how and why money is generated to do what is done. Clinicians should have at least a base level understanding of what revenue generation means in healthcare and why.
Even credentialing people or scheduling people need to have at least a base understanding of the revenue model used, the reason behind doing certain things, and the legitimacy of the services provided and the legitimacy of the company requesting money for them. If everybody across the organization, has 5% or 10% knowledge on revenue cycle, it is going to allow that person to make better decisions during their day.
Vision for Future of the RCM Domain
Talking from an intraoperative neuromonitoring perspective, Reid mentions the changes that will be brought in by the no surprise billing laws coming in January 2022. Even though AMS does not surprise bill, being out-of-network providers puts them under the magnifying glass which will be something to work around in the future.
The future will involve developing new ways to explain to insurance companies and to stakeholders who control the revenue, the value of the services for intraoperative neuromonitoring, the protections offered to patients and the value and protection neuromonitoring offers surgeons.
Another focus will be on trying to create contracts that are feasible, whether it is local or statewide, regional insurance providers, or even national.
‘My hope is that we will figure out ways as an industry to bridge this gap between insurance companies not wanting to pay and understanding the service we provide for their members. We are not trying to get surgeons’ prices or anything, we are simply trying to cover our overhead and keep the lights on and grow a little bit.’
For organizations and professionals who aim to remain successful in this domain, Reid states that it is important to treat the revenue holistically. Insurances are always looking for ways to not pay.
‘My advice would be don’t be myopic, don’t think that revenue is your only job just because you are in revenue.’
Leadership Lessons Learned Over the Course of Life
Culture is key. Reid says that over the decades, he has begun practicing the 24-hour rule with difficult decisions and difficult conversations. If someone is upset, the ability to acknowledge them and ask for 24 hours to think it over helps cooler heads prevail every time. It is great for business, it is great for healthcare.
The reactionary way that a lot of people do business is very negative and does not typically give the best answers for everybody. And in that vein learn how to accept feedback gracefully.
It is important to be able to distance yourself from believing feedback is a personal judgment and believing that the person is not trying to do anything but is simply making a statement.
Another is the ability to extend trust and be vulnerable. As a leader extending trust on occasion and occasionally offering vulnerability to people to let them understand it is okay to be human has been of great value.
‘It is okay to extend trust as a leader and get burned. It is also necessary to be vulnerable as a leader because ultimately there is at least one person in that room that you helped and that is what is important.’