Spark Joy, Vanquish Vapor: How Mass General Brigham Uses Tech to Rev Up RCM

Chief among the system's drivers of ROI is a coding automation platform grown close to home.

Let's face it: We're not getting any younger.

"Our population [is] getting older, more complex, more challenging, so there's always going to be more volume than we can keep up with," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.

For revenue cycle teams, it means the pressure is on "to not only perform well and bring in as much cash as we can as effectively, compliantly, and quickly as we can, but [to] do it at a cost that isn't burdensome to the organization," he explains. "Because every dollar that they spend on me is one dollar [that] they don't spend on a clinician or on research or on community assistance or on direct patient care."

To help those dollars more readily reach their intended targets, Mercurio has half a dozen "bot builders" implementing robotic process automation (RPA). "We're looking to continue to expand that as quickly as we can," he explains.

Ahead, more ways Mercurio taps tech to keep pace with RCM's ever-upping ante.

Cracking the CAC code

Today, Mass General Brigham's rev cycle team is automating more than 80% of their radiology-related coding activity with CodaMetrix's platform, which Mercurio helped launch in 2019 to commercialize the computer-assisted coding (CAC) solution developed by the system's physician organization billing office.

This focus has paid off big, Mercurio says. "The quality is excellent, and we've seen a reduction in denials and therefore a reduction in cost on the backend, which we've been able to pass on to our practices or reinvest in ourselves by redeploying staff to areas [that] need it as opposed to working things that would have been denied."

When considering automation, Mercurio recommends starting with higher-volume service lines where notes typically follow a standard template or format, such as radiology or pathology. "There's significant volumes of those, so the machines can learn very well on past history and do a really good job predicting the future," he explains.

Making humans happier

Apart from creating economies of scale in house through CAC and RPA, Mercurio sees an opportunity for tech advances to make work more joyful for the humans in the loop.  

"Our providers are severely overburdened and that's causing a lot of challenges clinically from an access perspective and doctors losing the joy of medicine. So AI is going to help there," Mercurio says. "From our [RCM] perspective, it's really making us think, ‘do we really want to do X if technology is going to maybe potentially give us a boost or a lift or resolve this problem for us?'"

He points to new AI tools on the horizon, along with companies offering tech that tees up appeals to denials likeliest to get overturned based on a payer's policies and historical activity.

Laying the groundwork

Though such possibilities are ripe for ROI, they risk being waylaid by waning budgets and bandwidths. "There are so many companies and technologies and opportunities out there," Mercurio says. Though there's no silver bullet for these "killer bees," the following strategies are some worthy repellants.

Talk shop

"I rely heavily on my network," Mercurio says. "If someone's already using a vendor or a process, that's a good head start to narrow it down." He recommends asking peers which partners and solutions they've chosen and/or shortlisted, and based on what criteria, "so we don't have to do that market scan ourselves."

Avoid vaporware

Tapping your network also means you can learn from their mistakes. Mercurio recalls a peer who ran into early misunderstandings about an AI product they were purchasing that, one full year after implementation, left them where they thought they'd be on day one.

"It's so new, and there's a lot of hype, and people are quick to jump on to that," Mercurio explains. "If you're not asking the right questions or doing the right reference checks, and really digging in to understand the full breadth and depth and scope of your potential partner—which you should do for anything, not just AI—then you could end up getting bitten."

To sniff out potential snake oil, he recommends connecting with a peer organization already using a prospective solution to discuss how implementation went. "There's a very big difference between selling and installing," he notes.

Empower teams

System leadership is generally supportive of tech-enabled experimentation to "drive more value at a lower cost and a higher quality," Mercurio says.

As for staff whose roles might be directly impacted, such as coders, buy-in "comes down to the communication and the trust that your team has in you as a leader and your leadership team," he explains. The objective, he tells his staff, is to elevate team performance so members can build capabilities and take on more valuable work—not lose their jobs.

"We're not looking to eliminate any of the coders on our teams because of technology. We have more volume than we can keep up with," he says. "We want to make sure that we have the right coders who are trained in various subspecialties and are experts in their field and can really provide the value to our overall organization."  

Put value over cost

Though price is "obviously important," Mercurio is "more interested in the quality of the outcome of the service we're buying, the relationship that we're going to have with that vendor," he explains. "We want them to be sticky. It's not a great idea to save 60% and then have seven times as many problems and constant turnover with account managers or teams where you're then managing more than you were to begin with and you're spending more than you were to begin with."

See the vision

"I like to try to find the companies that are really trying to do something different and special," Mercurio says. "That's who we would want to partner with to see if we can elevate our game and provide more value to our patients and our providers and our practices."