From site-neutral payments to AI’s prominence, shifts in the healthcare landscape are changing revenue cycle needs for ASCs, Matthew McGirt, MD, told Becker’s.
Dr. McGirt is chief medical officer of PracticeCore, a revenue cycle management services organization made to support spine and neurosurgery specifically. PracticeCore was born from the need for specialty-specific services.
“To achieve the highest level of key performance indicators in the field financially and to drive profits for groups we think larger retail, unspecialized RCM companies are not built to reach that elite top one and two percentile of national norms of performance,” Dr. McGirt said.
Dr. McGirt shared the ways RCM in healthcare is changing and what will push it forward.
Note: This conversation was lightly edited for clarity.
Question: How do you see RCM evolving in the spine specialty space and especially with ASCs?
Dr. Matthew McGirt: There are a couple of things that are evolving. With site neutral payments starting to occur from private payers and the federal government, the amount of spine care and surgery that moves to ASCs is going to grow rapidly. It’s already happening, but now that there’s some removal of financial disincentives to a hospital system, we’re going to see that as a force multiplier. MSOs like ours that have a 20-year history managing revenue cycle and operations for spine surgery, injection therapy, and pain management in ASCs are going to be needed. An expertise in ASC management is going to be at a premium. That’s an evolving market demand.
For independent groups providing neurosurgery, spine surgery, physiatry and pain management services where PracticeCore specializes, the challenge to maintain profitability has never been greater. Rising overhead, human capital expenses and turnover, and decreasing payments have not slowed. Other than volume, revenue cycle efficiency and performance is a great way to restore margin and quickly.
Q: In your own day-to-day work, what are you doing to get ahead of different regulatory policy shifts, disruptions, economic challenges as well?
MM: This is a company that has been right in the middle of a very progressive large neurosurgery practice for decades. Because PracticeCore spun out of a 45 neurosurgeon and physiatrist practice nearly a century old, its iterative process of continuously improving efficiencies developed in the clinical arena, not in a boardroom. Hence, the structure and process needed to follow evolving payer policy, physician culture, hospital dynamics, and revenue cycle mechanics are already in place. We have a huge head start because of that, compared to a purely administrative non specialty MSO that is built by business and nonsurgical caregivers. Moving forward, nothing would change.
We have numerous shareholders. About 80% of our shareholders are actually content experts and providers in the spaces that we specialize. We’re fiscally and financially supported and built by folks who are not only living the challenges of care delivery every day but leading it at regional and national level. Keeping our finger on the pulse is one of our advantages based on that.
Q: What are the top healthcare trends you’re following right now?
MM: First is consolidation, which is happening everywhere in healthcare. We haven’t quite seen that in independent physician groups that are finding ways to maintain their independence. And we think we’re going to start seeing that, and we think PracticeCore’s can help facilitate that. Consolidations and economies of scale we think will appeal to physicians wanting to maintain their independence more than acquisition and employment.
Specific for RCM, the emergence of artificial intelligence and large language models that are validated in processing medical documents at unprecedented rates are here and ready. PracticeCore will be incorporating such AI solutions. We don’t plan to replace seasoned two decade employees at PracticeCore, but it will allow us to scale quickly at a fraction of the cost using the same number of staff. That is probably one of the most clear advances that we’re seeing in the RCM spaces, the power of AI to allow scaling to take on more medical record documentation, diligence and management.
