The Rise of the Interim Revenue Cycle Leader

Expertise on demand: there's an exec for that.

As health systems face razor-thin margins, executive upheaval, and sky-high expectations, some are calling on a burgeoning type of leader to helm the revenue cycle: the fleet-footed interim exec.

"The demand for interim revenue cycle executives is poised to grow significantly in 2025," wrote WittKieffer consultant Robert Springall in a recent LinkedIn post. "As healthcare systems navigate constant changes and challenges, interim revenue cycle leaders are essential in ensuring smooth operations and achieving financial success."

It's something Patrick McDermott, who's partnered with WittKieffer to land interim contracts, can attest firsthand.

Once a full-time health system exec, McDermott is on his fifth on-demand gig in five years, with stints at ProMedica, Scripps Health, and Lawrence General Hospital under his belt.

He knows he's in good company.

"The turnover rate among the revenue cycle VP and the CFO really jumped up" in the past few years, McDermott says. Culprits include ever-tight margins and return-to-work mandates that are driving some senior leaders to retire early or leave for more flexible roles, such as remote or interim ones.

But the gig is not for the faint of heart.  

McDermott has come up against a culture in need of total rehabilitation, plus two cyberattacks: the nationwide Change Healthcare attack that would have drained the organization he was partnering with, which relied on state Medicaid, of their operating income within two weeks without swift intervention, plus a more targeted breach that took another system's EHR down for 30 days, sending the revenue cycle into a spiral.

"We had to completely rebuild the accounts receivable [in] a blitz sprint formation," McDermott recalls. "If you don't do it quickly, then you can be set up for denials and bad debt and bad customer service."

Ahead, he shares how rev cycle execs and teams can ensure success when entering the high-octane world of interim leadership.

'Endless' possibilities for partnership

To initiate an interim engagement, which can range in length from a few months to a year and change, prospective partners often work through an executive search and consulting firm like WittKieffer or the boutique Boca Raton, Florida–based Rudish Health, says McDermott. Once the two parties are matched, the leader is typically onboarded to the organization through their standard process for a vendor or supplier. It all "plays like lightning speed," he explains, and therein lies the opportunity.  

Interims can help systems thrive in times of transition, such as after an executive has departed, a crisis has emerged, or an exciting initiative has gotten off the ground but requires specialized expertise to succeed.

In such cases, an on-demand leader presents a cost-effective, quick-start alternative to a lengthy — and risky — search for full-time talent. "You can't just let an executive seat be empty for a month or three months because everything just comes to a halt," McDermott says.

And interim engagements aren't just for teams looking to fill gaps — organizations in many different circumstances can benefit.

"I think it's something that's going to be permanent in the industry," Adam Burns, principal of WittKieffer's interim leadership practice, recently told Newsweek. "Once [health systems] start to think about all the different ways they could use somebody — when you take the org chart out of it and just think about the lists of challenges and projects and opportunities they have — it's endless."

As an example, systems with strong revenue cycle leadership intact can tap a short-term co-executive as a change agent.

"Someone once taught me, you should work on today's problems in the morning and work on future problems in the afternoon," McDermott says. Having two leaders lets you do both at once, with one focused on the "blocking and tackling" for personnel, initiative and vendor management, and technology improvement, and the other handling "acceleration and amplification," he explains.

Trust (is) the process

Given today's fraught staffing and security landscape, health systems should consider adding on-demand leadership to their crisis response plans, says McDermott. "[You] can't just be caught flat footed," he stresses. "You have to be ready for a cyberattack. You have to be ready for the key executive to leave the organization. You have to be ready."

He suggests having an executive recruiting firm on standby so an interim leader can be engaged swiftly during unexpected transitions.

For their part, interim leaders — and those vetting them — should prioritize "really good situational leadership skills and EQ," McDermott explains. "You can't just go in with a preconceived toolkit and just start doing things. In fact, it'll backfire on you if you do that."

To gain buy-in out the gate, it's vital to put people over processes. "If you put the results first, the machine first, then you'll never gain the trust," he says. "And once you want to start making changes and improvements, you will be resisted because you didn't put the time in to build the trust."

There are no shortcuts, but there's also not a lot of time to waste: Trust-building is "an important element of success in the first 30 days," McDermott says.

To put in the reps that get teams past skepticism, he follows these three principles:

• Listen to understand (not prepare your reply)
• Show appreciation and recognition
• Create an inclusive culture

"Just like in regular revenue cycle management, there's a front, middle, back. You have to get everybody involved," he says. "Otherwise, people feel like they're excluded."

And finally, don't forget to honor who and what has come before you.

"You have to really respect and take some time to understand the history, vision, values," says McDermott. "Otherwise, culture will eat you for breakfast, lunch, and dinner."