Full Transcript

Q+A with Scott Cooper, president of Amplify Revenue Cycle Management at Ovation 

Introduction

Ben Reigle: We are here with my good friend Scott Cooper for our first episode. The intention of the series is to talk with RCM leaders, hear what they are going through and how they are approaching their challenges. 

I’m drinking coffee, but Scott doesn't drink coffee. Scott, do you at least have a good mug? 

Scott Cooper: It’s true I don't drink coffee. My wife gave me this mug on the way out the door. 

By the way, I'm surprised you haven't received a copyright cease and desist from Jerry Seinfeld yet on the name (Cardigans and Coffee). 

Professional Challenges

BR: Scott, we had a chance to work together in the past. Tell us about your latest role. I don't think that people know what Ovation is, so you probably have to explain it a bit.

SC: In June of 2023, I joined Ovation as the President of Amplify Revenue Cycle Management. It’s useful to think of Ovation as a shared services provider for independent community hospitals. Our firm has 5 pillars, one of which is a revenue cycle division, called Amplify. We also have an IT division (Tempo), supply chain division (Elevate), Advisory (Octave), etc. We can serve independent community hospitals, who are often struggling to make ends meet, with our suite of services. We can provide these solutions at the scale they can't do on their own.

BR: Does the Ovation own the hospitals, run them, or just handle all the administrative work?

SC: We don't own or run the hospitals. We do (mostly) administrative functions based on what the organization needs. For example, some organizations might get Amplify Revenue Cycle Management and Elevate Supply Chain together. 

Our sweet spot is hospitals earning around 100 million in net revenue. So not the giant 20, 30 billion dollar systems. 

BR: That is really important. Your team must deal with all kinds of EMRs and different systems. What is that like? 

SC: In my previous life, I always dealt with Epic, which is a behemoth that most of the big hospitals use. Now, it's a whole different ball game. Most of our clients now are on Meditech, Cerner, CPSI, and some other systems that I’ve never heard of in many cases. That creates its own challenge for a few reasons. 

One, it's very difficult to provide a standardized offering because it's not plug and play. We have to build and provide custom solutions. The standardization effort is difficult. 

Two, we have a hard time just getting data. We have our own proprietary workflow systems (tools, reporting, etc.). We have to overcome the challenge of poor data being fed into our systems, because our systems will be ineffective if the data is of poor quality. We spent a lot of time upfront getting that portion right. It is terribly difficult. 

BR: I can't even imagine. There must be limited IT teams, too, right? 

SC: Very limited IT teams. You don't necessarily have professional IT folks at every hospital. We have an IT organization as part of Ovation called Tempo that will often help us with new revenue cycle projects, which is helpful. 

BR: It has to be a struggle just for the independent hospitals, right? I bet they are commonly on the community version of Epic and they aren’t getting tons of support. 

SC: Correct. We have clients who are on the community version of Epic, so even if you want to change, you can't ask the hospital (our client) to do it because they've got to go ask the person who owns the Epic instance. Same thing with Cerner. Half our clients are on Cerner or CommunityWorks. Anything they want to change, they've got to go back and forth and try to finagle.

BR: So what are the other things in the revenue cycle that are stressing you out? 

SC: I think the top challenges that come to mind are obviously the payer dynamics, but I don't know that we need to go too in-depth on that. 

BR: Does Ovation manage payer contracting for your clients?

SC: We actually do in some cases. Part of Amplify, let's call it 80% of the Amplify business that I run are traditional revenue cycle services. The other 15 or 20% is managed care. So we have a managed care group within Amplify they're effectively doing two things. One, they're doing the analysis and the assessment to make sure that our clients are getting the performance that they expect out of their existing contracts. And two, they're also working like an outsourced managed care or contracting group for these hospitals who don't have the resources to do it themselves. So we have team members who spend the majority of their time on the phone negotiating with payers to try to make sure that our hospitals get what they deserve.

Yeah, so anyway, back to your initial question. I think payer changes, payer environments, and payment integrity are a challenge.

The second thing is a challenging talent environment, especially with an organization like ours who is delivering tech-enabled services. Remote jobs have opened up opportunities for a lot of people to go all over and to try new things.

If you can't find the right people or talent, it's going to make it very difficult to do any of those things. 

We're lucky at Ovation that we have an incredible revenue cycle staff. I have about 600 people in the Amplify group just to give you a sense of scale. And they're awesome. They come to work; they kick the crap out of it. And a lot of them have been doing revenue cycle work for 10, 15, 20 years. A majority of our staff are not entry-level folks that we're trying to train up.

BR: What is your team doing in the automation space now that we're talking about technology enabled services? What is your strategy as you go forward?

SC: Right now, we're focused on three different areas. 

First, we have partnered with Tarpon over the last six months to identify the highest-impact RPA opportunities. I believe that the magic with RPA is not the technology but the design, application to your organization’s workflows, and going after the best use cases. We have around 31 RPA use cases that are going to create value.

Second is our own small in-house AI group. I won't go too far into it, but we acquired an organization last year that was doing professional fee billing. We've also started to figure out how to use AI to automate some of our own coding. We felt like we had to build our own because the products of the major players aren’t a good fit for our business model. I think we just finished testing it as of a week or two ago, and we're going to start rolling it out. It's going to  allow our coders to focus on the bigger picture things rather than the highly transactional things. So that's the second thing we're doing on automation. 

Third is trying to tweak our workflow systems. We talked about how the data coming from these systems is a challenge. We want to normalize our client data, put it in our system, so that we can create some standardization and scale. Once that is established, we will start to build intelligence into that workflow driver so that it is making decisions for you. For example, you want the system to tee up the highest value claims. 

BR: I am shocked you're trying to build your own coding AI model, but I get why you'd have to do it. I love it.  

Question and Answers

BR: What's your hope for 2024 as we go into the new year? What are you hoping to accomplish? What are you pushing for? 

SC: At the most fundamental level, the job is to do more with less. That is effectively what we're structured to do in 2024. We need to provide more value for our clients at a lower cost structure.

Everything we're doing this year, all of our initiatives such as the automation stuff we talked about is centered on being able to provide more value for our clients and to do it at a lower cost structure. We've got five or six very tangible initiatives that we're doing to make that happen. And at the same time, we've got to keep growing.

We grew a ton last year organically and inorganically. And we need to keep that momentum going. 

BR: I bet if you asked 100 revenue cycle leaders,  98% are going to say the same thing on the first one. They're all being asked to do more with less people or less cost. 

For a new independent hospital, what is the low-hanging fruit that you solve first in terms of revenue cycle automation?

SC: If you're the hospital itself and you're trying to make your revenue cycle more efficient, I would go look at the automated coding and how you can use RPA to work things that are not valuable for your people to work. 

For us, as the service provider for the hospital, one of the highest value automations we have is enabling data flow through automation. For the longest time, once a week or once a month, we would pull down an ATB file from an FTP server manually, and then figure out how to put that into our system.Being able to automate the upfront components that enables the work downstream is important for us. So that is one of the highest impact things for us. 

BR: We have found that when organizations build automation programs there are intangible benefits that are hard to put a number towards. For example, you'll look at processes to automate and you'll figure out how broken the process is (Or that people do it 10 different ways). As a result, you streamline the process. You may not be able to automate it, but you streamlined the whole process and improved it. People underestimate the power of having a culture that's always looking for stuff to automate. 

Now that you've seen your team build an AI model for coding, does it make you more or less of a believer?

SC: I am a big believer in AI, but I'm going to caveat that statement. I do think that AI has the potential to be transformative for the revenue cycle but what I see in the market now is every company saying they're AI and ML. It's just not true.

When you really get under the hood, and we do this because we look at organizations that we potentially want to acquire, you find yourself questioning how real it is. 

Six years ago, I was talking about the future of technology in the revenue cycle. Our clients would always ask about the timelines for technological process and adoption. We used to say 3 years. It's six years later, and effectively, very little has changed.

BR: Yeah, we're still not there. 

SC: And unfortunately, it's a dollars game in terms of development and research. And as most folks on this call know, the payers have way more of that than the providers do. And so you're going to see it accelerate much further on the payer side than you on the provider side.

BR: What are your hospitals seeing on audits from payers, RAC and private payers? Increases or decreases? 

SC: We don’t do audits, but we will support our clients if they get audited. Whether it's Medicare, commercial payers or Medicaid, everybody's trying to tighten their checkbooks. There is a trend towards increased audits, whether it's from government or non-government payers. They are all continuously finding opportunities to pull payments back. So we're seeing that and it is escalating.

Every little thing creates more drama and brings more cost into the structure. Ideally,  if the payers really should be recouping money we should be identifying that earlier in the process upfront. This would be much better than addressing the issue much further downstream. 

BR: What's the hardest part of the job?

SC: I have two answers.

First, our clients are relying on us to be the lifeblood of that organization in terms of collecting cash so they can operate and survive. It is getting increasingly more difficult to meet their expectations because of the changes in the environment, such as payer policies. 

Second, is building a highly motivated and intelligent workforce. We have an unbelievable workforce at Amplify. But again, as client demands get more stringent, it's harder for our people to make them happy. So as the leader of the organization, I've got to figure out what that happy balance is between making sure our clients are happy and that our people are happy too. 

BR: I'm curious about the independent hospitals and expectations, because I’ve had to manage 30 hospital CFOs in my past. The challenge is that each had their own understanding of what was happening at a larger level and they didn't necessarily know the revenue cycle. 

Who are your primary points of contact? 

SC: Every hospital is different. At larger hospitals the revenue cycle usually rolls up under the CFO. Each of our clients are different. The stakeholder changes based on the client (sometimes it's the CEO or COO). That's just one of the demands that we have to solve. We are constantly adjusting to our audience and finding ways to best inform them so they can make the best decision possible. 

One word reaction

BR: I am going to say one-word, and I want you to react. 

Word 1: “AI”

SC: I'll give you two words - “currently overblown”.

BR: People ask us about this all the time. At Tarpon, we're focused on automation. We know AI will be part of it, but right now, there's not a ton of applications. None of which are complete game-changers. 

SC: We're not there yet. There are quite a few use cases that we've explored. There's nothing that's mature or at scale yet. Automated coding, in my opinion, is the only thing that's there right now. And even then, when you talk about automated coding, you're still talking about three specialties - ED, radiology, pathology. 

BR: 

Word 2: “Talent gap”.

SC: Talent, I would say is… I'll just say difficult. It is harder and harder to find qualified folks. And it is getting more and more expensive to recruit those qualified folks.

BR: Is your team remote? 

SC: Yes, we are like 90% remote. It's a dual-edged sword. It's helped in that it's effectively widened the aperture of where talent pools are to find new folks. But it also hurts us in that our existing staff can easily find other remote opportunities for other organizations. It's a give-and-get situation. 

End

BR: Scott, thank you so much. This has been great. 

SC: This was great. And I'll give Tarpon a plug as well. As I mentioned, we engaged with Tarpon for four or five months at the end of last year to accelerate our automation use cases and build them out. The whole team was fantastic to work with. 

BR: Thank you very much. Thanks, everyone on LinkedIn Live for joining. Hopefully it was fun, exciting, and interesting.

SC: Kudos to you and your team.