Sheldon is a well-known Healthcare Transformation Leader recognized for his expertise in healthcare economics. He works with multi-hospital and Physician integrated networks as a consultant for enhancing improvement in operations and strategies to boost revenue.

Sheldon’s knowledge and experience lend themselves to holistic operational improvement for healthcare organizations. In this interview, Sheldon talks about his experience of over 2 decades in healthcare and the dire need for revenue cycle management in this industry.

Starting out in the healthcare industry

Sheldon has always been drawn to the healthcare industry and was passionate about helping people. At Wilmington University, he majored in accounting and finance and adapted his skill-set to further his passion. As he didn’t have the clinical expertise to care for people medically, he entered the financial domain in healthcare.

Sheldon began his career as a file clerk in the business office, followed by a biller and a supervisor of insurance verification. He then found himself working as a managed care analyst and moving into the realm of operational opportunities, where he entered the revenue cycle management field.

Sheldon was later based in Philadelphia in a Chief of Revenue Cycle Management role where he was working as the interim revenue cycle leader. However, owing to an acquisition in the industry, the hospital was about to be sold, causing Sheldon to reassess his future. He then decided to start his own company when he was offered a prestigious position in International healthcare in Abu Dhabi.

The new role brought together a diverse team of revenue cycle experts to help promote revenue cycle management in Abu Dhabi. One of the factors that attracted Sheldon to this project was the opportunity to build something from the ground up. Established organizations often have set practices and guidelines. This opportunity, on the other hand, was a new challenge that allowed creativity and innovation to flow.

‘What they were asking was to build this from the ground up. For me, it was a new challenge and very intriguing.  I stepped to the plate and said, “Let’s do it.”’

Current business scope

Sheldon is the owner of his consulting firm Krystal Rock Innovation Group aka KRIG.  Over the last couple of years, he has been involved with various consulting projects. His recent most project was in Abu Dhabi for about nine months wherein he was a part of a team that helped the government-run hospital system build up an entire revenue cycle from the ground up.

At the time, the hospital had tried to establish a financial cycle but was still unsure about the intricacies that made a well-functioning revenue cycle.

He recalls some of the inconsistencies in the system such as the Patient Access and Revenue Integrity departments had shared responsibility across the organization; no true centralized function under a leader. Managed Care department had to be structured for not only contracting, but denials management.

Presently, Sheldon is involved with a multi-billion-dollar health system. His past experience includes clientele from Fortune 500 health systems as well as contract opportunities with several consulting firms.

His current team comprises of three key personnel. While Sheldon holds the responsibility for all operational activities, his team manages data analytics and administrative responsibilities. Together they are currently serving four clients between them.

‘I am a strategic partner for the organization, one who focuses on innovation, strategy, and helping to maximize operational efficiency.’

Formative moments along the journey

For Sheldon, a key standout moment was taking control of various projects when the industry shifted to different integrated platforms. At the time, a lot of the systems were archaic. As an RCM leader, Sheldon was able to build and develop unique workflows that better served the needs of the system.

‘That is one of the standouts moments I can honestly say, just a transition of where a revenue cycle leader had to come from and evolve to become successful.’

Another aspect that Sheldon lists as a proud accomplishment is the team. He claims that he has been lucky enough to work with strong individuals. Additionally, growing and mentoring different individuals has also been rewarding as a strong team is what helps drive success.

‘It’s not about how good you are, it’s about how good your team is. The reality is that you can’t do everything yourself, so as long as you’re making sure that you build and grow individuals around you to be just as successful as you are, it defines success in this industry.’

Adapting to changes and overcoming challenges

Sheldon started his journey in 2000 and has witnessed numerous changes over the course of 21 years. He recalls how revenue cycle was largely a backend function initially and often likened to Patient Financial Services. The past decade saw the emergence of numerous departments. For instance, there was only compliance in revenue cycle outside of standard billing procedures. These days there are separate departments for various functions such as revenue integrity, managed care, and Clinical Documentation Integrity.

Talking about challenges he’s faced in this domain, the biggest concern is often capital. A lot of the hospitals that needed their revenue cycle optimized are low on capital which is the main aspect that stands between them and higher revenues. Often, there are several great ideas that can be implemented to optimize the revenue cycle, however, they are million-dollar ideas that are out of bounds for most hospitals.

‘One of the challenges I would have to overcome is how do you make a hospital that has gross revenues of 150 million to  400 million, be competitive in those markets against the institutions who exceed billion-dollar revenue streams and have the money to put towards infrastructure and innovation.’

Plans for growing the business

Sheldon had several plans that he was considering but owing to the COVID-19 pandemic, he had put some of them on hold. With so many changes in the industry and economy, Sheldon feels it may be better for things to stabilize before finalizing a direction.

Talking about marketing, Sheldon believes that a lot of his success comes from word-of-mouth. The company website is the prime source of connection supported by LinkedIn and networking at conferences.

Top philosophies and core values

Choosing the right partner to work with and focussing on ROI are critical aspects to consider. For Sheldon, working with a partner that can blend in with the organization and be the right partner for the business is more important than just someone successful. Every organizational environment is different. Just because someone was successful in one organization, doesn’t necessarily make them a great fit for every organization.

It is important to understand and navigate through one’s environment and select the right partners to work with while moving ahead to meet the goals of the organization.

Advice for people entering the RCM domain

‘It’s something that you got to love.  It’s not one of those occupations where you get to work at 9 o’clock, you leave at 5:00 every day. It’s a more demanding position.’

Sheldon’s advice is to have a real breadth of knowledge of the different areas in the revenue cycle. It is also highly beneficial to gain experience by sitting with one’s peers periodically. The revenue cycle is not something that people join at the start of their career. Often it is an organic journey within the healthcare domain.

It is helpful to understand how every department works. Not just those that fall under the revenue cycle but the clinical departments as well, the finance department, the compliance department, etc. it is important to understand how hospital operations work because ultimately the cycle of a patient touches all aspects of the hospital.

Two key learnings in the industry

1. Always listen to your peers.

Be open to new ideas when listening to the presentations of others. Ask questions, don’t be too proud to ask your friend, your colleague, hey, ‘how’re you guys handling this’. There’s a lot of great ideas out there. For Sheldon, peers aren’t competitors. Instead, the healthcare community needs to come together to meet the ultimate purpose of providing a great financial experience for the patient.

2. Be innovative

It is important to be informed about all the latest developments and constantly try to improve the system. Sharing ideas, brainstorming sessions are great ways to come up with new and innovative solutions to boost revenue.

Defining the main needs of clients in RCM

Talking about the biggest concerns or gaps for clients in this field, Sheldon believes that most of them lack experience. A lot of clients have been stuck in their environment for a long time and they truly don’t know what else is out there. Their views are very parochial in some cases, and they need help in understanding new ideas and implementing them.

Implementation is really the biggest key.  That’s where a lot of organizations struggle sometimes, it’s navigating through their own politics and understanding how to sell a really good idea to the other stakeholders in the organization.

Key benefits offered by the Krystal Rock Innovation Group (KRIG)

Sheldon considers the expertise of his team to be a massive advantage. A lot of the team members have had a rich experience performing varied roles within healthcare. For instance, within finance, Sheldon has been through several mergers, acquisitions, due diligence processes, and three large implementations. He has also helped manage the supply chain system. This varied knowledge about the different areas of the hospital has been very helpful to clients.

‘In each of my roles in my career, as a revenue cycle leader and consultant, I’ve been very vital in helping build a strategic vision for revenue cycle.’

Vision for the future of RCM 

The new age revenue cycle leader is going to have to become a business partner. Traditionally, the philosophy in the revenue cycle domain was only focused on billing patients that come to the hospital. However, with numerous changes occurring within this industry, hospital administration and the C-Suite are going to look to revenue cycle leaders for strategic foresight about expanding into different service lines, acquisitions or realignment of operations with the social distancing guidelines. This is where the revenue cycle is really going to have to evolve and become a strategic business partner rather than a department managing the cash flow to organizations.

Moving forward, for a revenue cycle leader to be successful it is critical to understand the different departments in the hospital. It is important to take the time to learn and grow because what has worked in the past is not going to continue in the future.

‘Nobody in our generation has done anything like this before and managed through a pandemic, now is the time that we need to learn and share from each other and be willing to take some risk but make sure they’re calculated.’

Keeping up with the latest RCM trends

With changes constantly occurring in this field, Sheldon spends about 4-5 hours a day reading different articles, from Becker’s, ACHE, or HFMA. Additionally, he and his team are constantly in touch with other health systems known for their innovative ideas.

One of the organizations that Sheldon holds in high esteem is ACHE. He values their work in building relationships with community hospitals, focusing on leadership development, healthcare governance and nursing; as well as excellent presenters that have helped several leaders in the RCM domain learn and grow.

In conclusion, Sheldon believes that a company is only as strong as the team. It is important to be a good mentor and have a team that is willing to grow and evolve.

‘From a leadership aspect, there are many leaders who don’t support the educational progression in their teams.  They’ve laid out a lot of expectations but they don’t lay out a lot of options to help them achieve those expectations. One of the things I focus on is not only what I need from you; but what you need from me so that you can get this done?’

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