VA is a much more complicated rollout since there are so many different interactions and configurations of VistA. In addition,…
Peter Butler is president and CEO of Hayes Management Consulting of Newton Center, MA.
Tell me about yourself and the company.
I’ve been with Hayes for 22 years. I’ve been running the company since 2007. From a company milestone standpoint, at the end of 2015, we did a management-led buyout and bought Paul Hayes, our founder, out of the company so he could go off into retirement and enjoy the fruits of his work. We’re excited to continue carrying on the legacy.
Hayes started as a consulting company. We started in revenue cycle management and optimization. We grew from there into clinical optimization, always with an IT component, but also the business of delivering care and operating a business. That’s where we got our grounding.
We got into the software business in 2006. We have a software solution that we call MDaudit to help billing compliance managers run their business more efficiently and identify risk areas for their organization.
Sometimes it’s hard to tell whether a given company does true consulting versus providing staffing services. Is that ratio changing in the industry in general?
We’ve seen over the last several years firms that started as consulting firms have become staff augmentation firms, mostly around Epic implementation services. There’s just been so much demand in the industry. Those services have been commoditized over the years.
There’s still a need for consulting firms. Where I see the differentiation is where people can come in and do interim leadership, management, business process change on those levels, coupled with the IT implementations as well.
How does a company grow from just letting their individual warm bodies wing it versus developing mature, repeatable processes?
From repeat types of projects or very similar projects, you develop a methodology that’s packageable. You can replay that and bring in along with it best practices. What the client is getting is for that targeted effort — whatever that might be, a revenue cycle improvement project — here are the top six steps that we follow and it’s a methodology. Sometimes it’s not a software solution or something that’s easily demoable, but it is a methodology that could be followed.
For example, bringing in key leadership stakeholders, interviewing at that level, understanding what they have a need for, and then dropping down a level into the management level and saying, "What are you really executing in the delivery of your business?" Then looking further, you get into the IT side of things and have a certain methodology there as well that you’re looking for these top 25 items. You put that together in one methodology and you can make some improvement.
Is it easier or harder to recruit people into consulting compared to two or three years ago?
It hasn’t been harder. We tend to see a lot of people who are later in their careers who want to get into consulting if they haven’t been there previously. For them, it’s the thrill of a new project and not being tethered to the politics of any one organization. They also have to have a pretty strong willingness and interest in travel.
For us, it’s been fairly easy to recruit people that are interested in making a difference one project at a time. We haven’t see many people pulling back from the consulting ranks from the types of projects that we’re hiring into.
How important is developing relationships with prospects or current customers?
It’s absolutely critical. I was under the misunderstanding when I solicited Paul Hayes and said, "Can I go out to the West Coast? I’d really like to live out there first of all, but I think there’s some business opportunity.” I thought it would be a matter of setting up a shingle and publishing a phone number on a website.
What I found was a lot of hard work over the next couple of years being a face of an organization, meeting a lot of people, and seeing them on a regular basis at industry conferences or speaking at industry conferences to the point where they knew you and knew what you were capable of and could trust you enough to ask questions. It took awhile to get to that point because, typically, people are very defensive of a new face or new player. Being able to build up that trust opened up a lot of doors through many many conversations.
What makes someone decide to hire a new firm instead of continuing working with their current one?
You’re really only as good as your last project. Typically, firms will get replaced if they if they stub their toe. The client will cut you some slack if you put a resource if it’s not quite a good cultural fit. They’ll give you an opportunity to replace that person. If you have a couple of events like that, they start to lose confidence in you. Or if you’re asked to present before their board and you’re not prepared enough, or you don’t understand the politics in the room when you walk in, you can really stub your toe there.
Those provide opportunities for firms like us to get an opportunity to, “Give me a shot — I think we can make this right.” Then, you just got to put on your A game.
Can you usually tell ahead of time when a consultant or engagement is having problems?
We try as hard as we can. One of the best ways to do that is a regular touch point with the client. We’re checking in and you’ll hear, "Hey, everything’s going great. Everything’s going great." On a regular tempo, as you’re checking in, you might start to hear, "This meeting didn’t go as well as we thought it would." You make some changes and identify potentially what the reasons were and address it early and often. That’s key to managing client expectation and the way the consultant is presenting themselves.
What are the biggest changes that have occurred in consulting in the last few years?
There’s an incredible amount of anxiety in the industry and attention to detail around expense management and revenue. As we know, there’s a razor-thin line on the healthcare bottom line. That’s only getting tighter. We’re seeing an increased level of need or concern around, “Are we getting every dollar we possibly can? Are we leaving anything on the table? What tools can we employ to help us run our business more efficiently? What reporting functions can I get, dashboards or analytics, that will help us identify risk areas before they become problems?”
What does MDAudit do?
When it first launched, it was really a work flow improvement tool. Clients were using spreadsheets and so forth, a very manual process for conducting physician audits and identifying physicians on a manual basis with no audit. Where are they improperly coding? Where are we as an organization at risk for fraudulent billing?
What it’s morphed into in the last couple of years is, as organizations are buying up practices and adding physicians at a very rapid clip, they’re going out and auditing those physicians — usually after they’re bought — and identifying risk areas and then providing educational opportunities to those physicians to fine tune their coding practices.
What we’re seeing now as a trend is more risk-based audits. Rather than looking at every individual physician, it’s looking at what the RAC auditors are looking for in the current coming year.
There’s a whole list of other auditors who are coming knocking and looking for improper billing practices. Where is my organization most at risk? Seeing that on the dashboard, and being able to drill in and say, the greatest risk is coming from this particular department or these physicians. Let’s go target a training effort there to get them coding properly so we can mitigate that risk and move on. We also see that as an important area with the new billing regulations that are coming out and the diminished need for fee-for-service type billing and being able to run a proactive effort as you’re managing physician billing and facility billing.
How will MACRA impact the industry?
It’s going to be a huge burden to the industry. I feel for the physicians, as Dr. John Halamka mentioned in his blog. It’s going to be difficult to manage. It’s very onerous. But it’s a necessary direction that we need to go as an industry. The larger organizations should be able to deploy the resources around helping position the organization and physician billing appropriately to manage against those metrics. It’s the smaller practices that are going to struggle in meeting the requirements.
Do you have any final thoughts?
It’s an exciting time in the industry. I know it’s painful for many clinicians and physicians. There’s so much work that needs to be done and so much modernization. I look forward to the next 10 years working in this industry and helping our clients to migrate and manage through the process of transitioning from fee-for-service into more of a value-based delivery system. As a patient, I’m really looking forward to that.