The following is a profile of just one of the thousands of revenue cycle leaders at healthcare providers across the U.S. I'd like to thank Vishal Ganju for generously offering his time to provide his insights. If you are a revenue cycle professional at a healthcare organization and would like to participate in a profile like this, please contact me. I would love to hear from you.
What's your name, organization & position?
Vishal Ganju, Regional Vice President - Revenue Cycle - Central at Byram Healthcare
What path brought you to working on improving the hospital rev cycle?
I was born in India and trained in school to be an electronics engineer. Not long after my college graduation, I was on a plane, on my way to visit my parents and have a rest before gearing up for the business school admissions process. On that plane ride, I ended up meeting the head honcho at Siemens in Southeast Asia. He offered me a job in Nepal selling biomed equipment, and I took it. That was my career’s genesis: Selling CT scans, MRI machines, etc. in Nepal. Then, as sometimes happens, geopolitical turmoil (the assassination of the King of Nepal and several family members) urged me back to India. Once there, while I prepped for the GMAT, I got back into the medical space and joined a company that was really pioneering EMR in India. My role was to research the kinds of EMR products that would play well in the hospital community.
The time came when I got word of my admissions to some MBA programs in the US. Since half of my family was already here, I decided to come to America. My first post-MBA employer was in Kentucky--a small physician-run cancer center. This was really my first exposure to the American insurance landscape. In India, the medical business is a cash business. If you have cash, you get decent healthcare. If not, you languish in overburdened government hospitals. It’s a very extreme situation. I learned a lot about the insurance business and the patient journey during my time in Kentucky.
I went from there to Zimmerman Healthcare Revenue Cycle, which is a boutique rev cycle consultancy in Milwaukee. I had a tremendous education there for almost four years. On behalf of our clients, I worked on basically every problem you could find in the healthcare rev cycle spectrum: self-pay collection re-design, developing financial policies, pre-access, ED point of service collection, in-patient coding--you name it. I think I consulted for 50+ hospitals in the next four years all over the United States. It was an incredible amount of exposure at a break-neck pace.
By the time I transitioned to a hospice rev cycle team, I was a newlywed, and expert at physician practice issues. Moving to the hospice medical environment was a nice change of pace, and I had an opportunity to keep learning. The work there was to transition the revenue cycle operations from manual to automated systems. The CFO wanted work on exceptions only, so we built a logic tool to enable that. We saw a huge bump in our collections--no small task in a delicate setting in which many patients have passed away by the time the bills are generated. By the fourth year, the hospice had stabilized its revenue cycle and with such an excellent team in place, my work there seemed done.
You sound like a “fixer.” Am I right?
I like the adrenaline that comes with chaos. Yes, I admit to being a fixer! I like to get places to be stable, and then I move on. When Byrum called me, I knew my next challenge was ready for me, and I went for it.
Byram had planned to engage PWC to do a process re-vamp. With that information, we’ve made huge strides in automating our services: our aging A/R is down, we’re working smart, we’re getting more transparent. Overall, we’re doing a better job at educating patients and communicating with them.
How has this business changed most profoundly?
Co-pays used to be $50. Nowadays, a small-end deductible is $2000. The patient collections landscape has totally transformed. In response, I think we need to soften the blow and show patients how to navigate huge bills. When I arrived in my current role, I mapped out the current state. We were doing some very counter-productive things. We would send invoices without any details, no options for resolution, no clear call to action. I had done a ‘patient-friendly statement’ workshop at HFMA, and we fixed that. For starters, this small step alone has dramatically cut calls to our back (customer service) end. This means consumers are less confused about their statements.
Our second step was to scrub our data and figure out what we should be keeping in-house, and what can be sent out. We try to keep accounts of consumers whose patient credit score indicates that they pay their medical bills. If you’re not making that payment in the first 30-45 days, we call with an extra nudge. Our data revealed that it made sense for us to send our C & D patients to a collections vendor. So in many ways, we’re still pretty old school. Here we are, living in an Amazon world where I can order pizza by talking to Siri, and yet we’re still sending paper statements in the collections department at huge, state-of-the-art medical facilities. We have to move forward. Hopefully, one day, the minute that EOB hits, it triggers a text to consumers with a link to show the breakdown with an explanation, and offer easy and flexible ways to pay. We can get there.
What do you think will relieve the mounting pressure of the self-pay crisis?
Common sense. We have to face the fact that high balances get crickets. The message consumers need to get is that we can work with them. We have to, really. No one wants to duck a bill, so we have to offer ways to manage these bills. Simple things like self-pay discounts and prompt-pay discounts do matter. If nothing else, these sorts of tactics help focus the business office on those patients with exceptional circumstances who need extended payment plans.
If you could thank one person in this business, who would it be?
My mentor, Ann Chandler, with whom I worked at Zimmerman. I owe her so much.
What would you choose if you had to choose another career?
I’d be a chef. My wife hassles me about how infrequently I cook. I get tired of explaining that the great painters and other artists in history did not produce works of art every day! Masterpieces are infrequent! But they’re worth the wait!
What needs to change the most in this business?
Our capacity to change needs to grow. We have to keep evolving. We can make or break the patient experience with a poorly-handled rev cycle experience, and no one can afford that. The key to helping consumers deal with bills is a mix of education, transparency and communication. We have to adapt to this reality. The sooner the better!