‍In the latest episode of 'The Efficient Care Podcast' we're opening a crucial conversation on the complex world of patient financial clearance, specifically how to forge a strong provider-technology partnerships that deeply impact all- the front-office staff, the provider and the patients.

Joining me, Shruti Mehrotra, for this two-part series are two incredible guests: Michael Ball, the Vice President of Clinical Services at Neurology Consultants of Dallas (NCD) and Kashyap Purani, co-founder at Aarogram. Here at Aarogram, we specialize in AI-powered solutions for patient price transparency and insurance verification automations. We're thrilled to have NCD on board as one of our valued clients and have Mike come in and share his experience with us.

This episode delves into Mike's successful strategies for boosting operational efficiency and staff productivity through his explorations of various software tools. We'll explore crucial factors to consider when choosing a revenue management product, Mike's firsthand experience with startups in integrating tech into existing practices, and the secrets to maintaining profitability at independent practices.

Get ready for a knowledge-packed conversation that will equip you with the tools to optimize your practice's operations. Let's dive in!

Listen to the full episodes here: Part I, Part II

Transcript of the full episode:

Shruti: Welcome to the podcast, Mike. Thank you so much for being with us. Please tell us a little bit about your professional journey so far.

Mike: Yeah, yeah, for sure. Thanks for having me. My name is Mike Ball. I'm the VP of Clinical Integrations at Neurology Consults of Neurology Consulting. We're located in North Dallas, and we have about 27 neurologists that span the outpatient and inpatient sectors. At several hospitals in Dallas, my job currently is to help facilitate integration of services within our practice and that maps well with my career path too.

I started originally in healthcare as a physical therapy assistant. As I was in college, and so I never really had planned to go into health care. I just needed a job. You know how that is, right? You just need a job. You have got to get through college. I was going into behavioral health and psychology. I found a niche opportunity to work in electroencephalography. Studies for concussions and seizure and epilepsy testing at the University of Utah and Salt Lake City. And so, my career kind of went down this road of working closely with physicians in outpatient and inpatient settings, doing diagnostic testing, and then gradually working into the surgical suite, and doing epilepsy, resection testing, diagnosis of epilepsy focuses and, resection of the lobes of the brain that that have the epilepsy focus. I did go into administration as I was growing and so University of Texas Southwestern UT Southwestern over here in Dallas hired me as an epilepsy manager, neurosciences manager, and I just slowly became more and more in administrative positions and now I find myself trying to integrate neurology practice services, throughout, our current practice here and neurology consultants, we offer a wide range of services. And so, the complexity of how we use those, for example, we have MRI, we have a sleep testing center, we have a pharmacy, we have a rehab.

So, my job is to integrate how we use all those services the best that we can. Outcomes for the patient and how we can make money doing that. So that's that's kind of my quick notes version of my job and my history.

Kashyap: That's great Mike. You and I have worked together for a long time on a few projects, and you've been great partners to us here at Aarogram. You're a perfect partner in terms of how we collaborate on implementing those innovations and always thinking about the outcome and the value. I always found you very passionate about utilizing technology to improve operational efficiency and you understand both the clinical side as well as the administrative side.

What motivates you? How do you approach working with newer technologies and especially with startups and what's your motivation, where does it come from?

Mike: I love the concept of startups because they're so flexible and nimble, and so at NCD, we started looking into working more with startups because we think outside the box a little bit more than others. And from my position. There's some interest in working with startups because you guys aren't fully grounded in your philosophies about how to do things. You have a concept; you have a great idea. And a lot of times the technology is very well built, but it's adaptable. It's still fresh.

That we can add things to it, or we can modify, and you can kind of pivot. You're not going to pivot completely, but you can pivot a little bit to help. And so we started working with your company, for example, to find a solution for authorization support for our practice. We do sleep testing, which is what Aarogram specializes in, but we also do MRIs. We do, EEGs, long term EEGs. We do infusions, we do Botox injections, we do several types of types of services. And so we asked you, hey, we love that. You can help us with sleep. How about these tests as well, and going down that road with you has been great because you've been flexible and understanding.

Okay. They're not that different than sleep. How hard could it be and so we've kind of discovered together that there's a great solution with a startup like yours. And working with you to find the needs, find the benefits for our patients, but also finding a scalable solution for our practice.

I believe that working with young companies and startup groups has been valuable for us and then working with technology in general to find new ways to make things more efficient. That's one of the things that we focus on. It's a priority for us.

Kashyap: That's awesome. And we're so excited to do what we can achieve together and what the future could be.

And I really like that thing about you that you are not like satisfied with the status quo. You are thinking about how things could be better, right? And a lot of providers are also thinking like that. But that's awesome. You know, not all the health care providers we work with are lucky to have somebody like you, they don't have a Mike to help them.

But that is still important for them to actually make use of this change that is happening. So I want to focus on the other perspective and then we have a large audience of healthcare providers, practitioners who listen to this podcast. So what can you tell them, if they were to evaluate different technological solutions or evaluate different vendors or what software programs they want to implement, how can they evaluate those things?

Sometimes they get overwhelmed with so many different choices and so many new technologies coming up. So, is there any practical advice you can share with them that will help them to go about how they should approach this?

Mike: Yeah, so I could tell you my approach and I hope that would help others.

Change is always hard in any practice, whether you're a 3 doctor office, or you're a 30 doctor office, or you're an academic center with a large group of physicians, change is tough. But sometimes change is necessary, and so what I've done is that I've become somewhat of a of a focal point for opportunities and so when there's an opportunity to change. We like to look at a ton of different operational systems, we like to look at whatever vendor comes to us and try to vet it before we push it to a doctor. We have a team and it's really a tight knit team. It's our onboarding specialist, referral specialist, operations leader. And we're all non-clinical. We're not physicians. We are very much a business, in the sense that we're looking at things from a business standpoint. Does this system make sense? Does it help us first of all? Because if it doesn't help us, then we know it's going to be a very challenging tool to use, even if it's a very good clinical tool. If it's not an operational business tool that would help us. It's going to be a difficult challenge.

So when we get approached by companies, one of the things that we do is due diligence as well. We'll do Demos right away with these groups.

Those demos sometimes go pretty well, and sometimes, they crash hard. We don't put everything into the demo. For example, we've had a few companies that we know the demo didn't go great, but we had them come back. We have them come on site, look at our practice. And then we continue to look at the demo from the standpoint of 'can this solution help us even though the demo didn't go well? Even if it isn't fully baked, is there some component that could help us once we go through that?' The next question we ask is, we grab a couple of key providers that are flexible. You know, everybody knows providers within their practice that are flexible and listen.

They don't have to be leadership providers. They don't have to be owners or partners. They can just be providers that are willing to try something new. And those are the providers we lean on quite a bit for advice. They're the ones that help us and give us the true feedback of 'okay, this does make sense' or 'this wouldn't really work' with those key providers. Feedback, we can then kind of write an assessment of the platform and push it out to our other groups or other providers for testing along the way. One of the conversations we typically have with these companies, or these vendors is how much of a partner do you want to be with and see what do you need out of our group.

Because we like to have a very honest, transparent conversation with them. We know that they're going to get feedback and that feedback's going to help them refine and build their product. That's okay. Cause that's really what we want to give you, but what else do you want? Do you guys need us to test or beta test a new solution?

Is it something that you're trying to do? Is there a way for us to help you advance in your goals as a company? Because we often find that a company will come in and they have goals and we have goals and they're the same thing, but we never talk about those in that way, as a partner, once we have those conversations with these platforms that we like, and that we work with, it becomes a much easier, conversation to have in run changes.

They adapt better for us. We adapt better to their limitations. We find solutions instead of finding complaints about the product. They also don't see us as much of a client as a partner. And so, they can call us, they can work with us. In many cases, we work with these vendors on a chat-by-chat basis.

So, we loop them into our team's environment as external contact. We can just teams chat with these vendors. We don't have to do it via email. It's so much easier and seamless when we do this. And all of it is for the purpose of integration into our practice. And once that integration occurs to the doctor and to the patient, we want them to see these platforms as NCD's platforms.

We don't want them to see difference. And so, that's my goal whenever I integrate a technology, it's to make it seem as if it's a seamless platform that the patient doesn't see any difference in, the company. Maybe there is a different branding or something, but from the standpoint of how it works within NCD, it's a seamless transition.

I would recommend to some of the young, or I guess even seasoned administrators is to highlight and find those doctors within your practice that are willing to try something new. Some of them are young physicians and they want to, climb the ladder, but that's great because they're the physicians that you want to help, contact a lot.

You want to message more, you want to put stuff in front of them more often. That feedback from even the young physicians is incredibly valuable because. Physicians, in general, bring value when their opinions are voiced. If it works, great. If it doesn't, that's still really good feedback. Because then you can pivot, you can manage changes based on a physician's feedback.

And then as an administrator, I can start to build more relationships with physicians. With physicians that are willing to modify, willing to move, willing to be flexible and they can then trust me that I'll come to them with opportunities, and it's been a very good positive experience overall to try it that way.

And that's kind of some of my 1st recommendations on on how to integrate with newer technologies in the healthcare space.

Kashyap: You took very comprehensive approach because a lot of times it's not just about selecting a solution, evaluating and selecting, but it's also like bringing all of the stakeholders in the picture so that you're more likely to succeed and you covered the physician side, how to go about it, then you covered the patient experience side that how, it should come out as a single solution, not from different, entities, right?

And then what about the other stuff like clinical or non-clinical aspects? For administrative software you still have to get them to buy and have them make comfortable and sometimes change the behavior as well. Like, how do you get that? You know, because that also determines the success of any new product and implementation of any new product.

Mike: You know, it's kind of a funny analogy, but it's a lot like survivor. You have to just, you gotta, you gotta build your team and you got to get them on board. And then you gotta also politic a little bit with you. So you have to find. If there are people within your group that are resistant to change, find out why.

And so including them in those initial conversations sometimes is very important. So, if there is a billing coordinator, or somebody, or let's say, Even an operations manager or a team member within your team, that's resistant to change and really hard to, get them to adjust to the new platforms or even listening to a new idea, putting them on the first call with these companies, I found puts them in a different state of mind.

Because now that you've made your problem their problem, meaning they're looking at it from a totally different angle now, because we don't know if this is a product that would help us. That's what you're here to help me understand. And so I actually don't have to convince them of anything. It's up to the vendor to convince them.

And then they start to see it from my point of view, which is, yeah, it's not perfect, but if it's 90 percent good, is that 10%? Can we work with that? And they start to then be a little bit more flexible. Yeah. Okay. I get that. That would help. That would help, but they got to fix this, and they got to fix that.

Tell them and they do and they, they just tell them. Uh, okay. I like this and this and this, but can you change this? And they start to be involved in the conversation. And then it's easier for me. I'm not fighting with them. I'm not trying to convince them. It's them working with me and the vendor to find a solution.

And sometimes, you know, it works and sometimes the vendor's resistant to change and that's okay. But then they're at least coming , from the same perspective I am. And by the end of those conversations, it becomes we're one, we're united on our side and trying to find solutions. And we're also open to the changes.

And as you do that with more and more people within your group that push back. Those people feel ownership in this in the problems. They feel like they're part of the solution because they're actually looking at these vendors closely, you start to see a side of these people that that you don't usually see when they think critically about the problem as a whole.

I'm going to take a step back and look at it from a macro level instead of their day-to-day issues. And so, I have no issue, in fact, a lot of the times I will just let other people decide on what to do as we bring them in. And it's not that I'm letting them as much as I'm involving them, and their feedback is sometimes more valuable than mine.

And so, giving up some of  I guess decision making to others has been very helpful for me because then I don't have to fight with them and, I also see a good side of them and they feel more ownership. I don't know if that helps, but that's kind of the way I approach it

Shruti: Mike, with your extensive experience, can you please state a picture for our listeners of the current state of reimbursements for neurology practices? What are the biggest challenges when it comes to getting fairly compensated? For services that you provide, and if you can talk about some of your own personal predictions for the future of reimbursement in neurology, that would be great.

Mike: That's a good question. It's a big topic. Neurology experienced a reduction in 2024 for CMS in general. I think, you know, if we were to add up all the different. Reductions, it was approximately 3 percent reduction and overall, you know, and overall reimbursement from CMS that is. Like, that is a very hard hit, especially when the rate of inflation is high, you know, rent, real estate is very high.

So, leasing costs are not going to go down 3 percent to help you. How do you adjust when you have an off the top 3 percent change in your revenue? And we, as a practice, have a heavy Medicare population. So, we're approximately 35 to 40 percent Medicare. And we, we see that also growing. Because of the population health changes, we're starting to see quite a few dementias, cognitive impairment.

We start to see a lot of these chronic conditions and those patients when they come to us, they stay with us. And so all the services that we do under their Medicare policy are reduced 1 of the things that neurology consultants of Dallas has done to kind of adapt is to offer more ancillary support services within our practice.

So, we've grown our footprint to offer more like MRI rehab. We have a specialty neuro rehab. We also have a very heavy chronic care management. , CCM and remote physiological monitoring. practice that gives us the ability to help patients before they get to an acute, critical state, we manage their meds better.

We, investigate referral networking a lot better when we have a CCM or a chronic care management person and those are all billable services as well. Those monthly billable services, they're very. Time consuming, but they're worthwhile. Now, we can do all the services in the world. If we don't get reimbursed, that's a huge problem, right?

Because now you're doing the work and then you're not getting paid for it. This is where, uh. Revenue cycle management, authorizations and billing are very key. So, we focus quite a bit on managing expectations with the patient on eligibility benefits, making sure they understand what their cost is.

And making sure that we give them an accurate estimate that can be done multiple ways. Our staff have an authorization team that works closely, but we also use technology for that purpose. We use it for. Quick checks as if they've met their deductible, what their benefits are, it's kind of like a viewpoint into what their expectations would be for the services we provide.

That also gives them the ability to plan out and bundle their services. So, if they've met their deductible in many cases, once they know that there are. There are very few barriers to doing more tasks, or at least to getting the test done that they need quickly. We found out also that it's very important to review with our physicians their charting and diagnosis codes.

And I'm sure any practice managers like, yeah, that's. That's the most basic thing, but it's very important to do that before they sign off on their charts. We have a very focused group looking at how are the doctors charting. Are they copying and pasting? Are they using the same verbiage?

Those things are vital to understanding why we're getting denials. We're getting denials because if a doctor just copies and pastes their previous note into their current note, that doesn't justify the test you ordered today because you didn't order it last time, you're ordering it today. These kind of, I won't say lazy habits, they're trying to be efficient.

They're trying to better manage their time. How can we use technology to better help us? One of the things that we're testing out now is how transcription helps us with charting. That voice to text transcription, so listening to the appointment and then summarizing that into a charting note, is a very hot topic.

Is it ethical? Is it appropriate? Is it, you know? Is it something you want on no record where the whole conversation's been recorded? I, I, um, I think that that's a huge conversation in health care in general, but for us, it's been very, very nice to be able to summarize those appointments, what really happened in that appointment into a chart.

Going back to what I said about those doctors that are more open to trying new things, that's the type of doctor that's trying these things. Now, being very open with the patient and making sure that the patient's aware and that they're okay with that, but anything that we can do to improve not only the charting that goes into the reports, will also likewise improve the revenue cycle management at the back end. We'll see improvements so far; it's been an interesting and engaging activity to go down this road with technology and charting

Shruti: Regarding the reimbursements that we spoke about, which is that I'm seeing a trend where a lot of independent practices are being acquired by larger health care groups and the reimbursement rates for independent practices is one of the big reasons why this is happening. What can independent practices do to resist this, because I'm sure there are lots of practices who don't want to be acquired by a bigger system. What are they doing to stay afloat?

Mike: It really a good question because. You have this problem within private practice that needs a solution. You have new physicians joining and old physicians retiring and private practice. But, you know, unless it was run very well and efficiently, it is going paycheck to paycheck just to survive. And so, any reduction in reimbursement means, okay, somebody's got to cut a check or somebody's going to have to go without a paycheck this week.

What if you're an older physician in that practice and you've built that practice for 30 years and you're ready to retire? And you have no equity or no buyout or no option to leave with any assets for the work that you've done. It's not like a company where you can just sell a company and then somebody can buy you out of that company.

A private practice is not cash heavy. They do not have a lot of cash and some, some of them do because of the virtue of the services they provide. But ours, for example, is not one of those. So, what we're doing to address that is we're starting to see the long benefits of establishing ancillary services within our practice.

Those benefits bring more reimbursable services back to us. So the sleep testing, epilepsy testing, rehab, those are hard to stand up. It is definitely a strategic play, meaning as we acquire more services under our umbrella, we will have a better chance. To keep the patients within our network, to keep them within our, our services.

We'll also be able to approach payers with value-based care opportunities. Now, value-based care opportunities mean direct contracts. So, direct contracting. Is, a lot of the ways and large health care groups are starting to see, uh, starting to see benefits. So, they'll direct contract with large organizations, large employers.

They'll do direct contracting with some of these payers. And so, with those direct contracts they're ensuring that those patients can stay within the network and that you'll get paid without having to go through the revenue cycle. Hassle direct contracts are, I think, going to grow in the future, so you will see quite a few more cash for services outside of the insurance model.

So, cash pay concierge health care is growing quite a bit and we're starting to experiment a little bit with that with some services that we offer. You do have to be careful when you do concierge cash services that you don't. Once we've identified that other insurance groups don't cover these services. So, another way that some practices could benefit from these for not getting the reimbursements they need and avoiding private equity cells is they can start to look at.

Partnerships with these young companies that you work with those partnerships like neurology consultants of Dallas does with some of our vendor groups and our partners is also a long game, right? Build equity in companies that you trust, you build equity in pre-IPO companies for the hope that they will IPO, they will get acquired.

There will be a liquidation event by which you can then capitalize on your partnership. What can private practice do for a young company? I mean, that's something I would ask cash, but. You know, a private practice could provide incredible value to a young company because there's no red tape, you know, there's no issues with trying to, get this implemented into the practice.

If you were to go to academic centers or large organizations, implementing one tool can take years, but at a private practice, implementation of a tool could be overnight. You know, and that is invaluable, in my opinion, to some of these young companies. And so NCD has taken a unique approach to approach some of these, very neat concept companies that are young, that are also willing to go in on this, these, um, these equity partnership deals.

And we don't anticipate any of these to pay off in the next year or 2 or even 3. Sometimes they will, but, you know, in our experience, it takes a long time, but any good thing takes a long time. And so, if we can weather the storm. Of getting through the reimbursement issues, offering more ancillary services, and then looking at revenue uniquely in concierge, but also equity partnerships.

That's our way of looking at, okay, this might be our path to wealth and our path also to prosperity within our practice so that we don't have to sell part of our practice to stay afloat, or to let people retire comfortably.

Kashyap: It's surprising, some of these practices are running paycheck to paycheck. Right? And that's where the suggestion you made, partnering can be a way among other ways.  And you mentioned the cash price as well, so I think that's a good segue to the last main thing that I would like to focus on, we are so much focused on, as a company, on patient price transparency and patient care.

Estimate side as well, because in my observation is that when you talk about RCM or every cycle management, getting paid by the insurance side is one thing, but then there is the other side, which is the patient payment side. And that is also part of the equation. And that's becoming more important these days for two reasons, I would say one is

And then, you know, we've been hearing from other providers, that patients have expectations these days, you know, they want to know what's going to be their out of pocket estimate upfront and whether you collect upfront from the patient or not, that could vary practice to practice, but , they do want to know, at least get some idea,, what they're getting into.

And so are you also experiencing that way or do you also have patients asking for upfront pricing and how do you manage and communicate those scenarios?

Mike: We do, you know, it's interesting. There are so many ways to pay for health care now. And there's there from the whole spectrum, there's people that just have 100 percent cash.

They don't have any insurance coverage, they don't want to do that, or can do that. And then you have the other spectrum, which is 100 percent Medicare with a supplemental, and it's just covered. and anything in between. Our patients have those expectations of what am I getting into? Especially when you got high dollar tests, like an MRI, or an epilepsy test, or Rehab, you know, series of rehab appointments following a stroke.

The approach that we've taken is transparency. We really want to give the patient the most accurate estimate we can give them. And whether that's a cash estimate after they ask for it, or whether that's an accurate understanding of where their pay, or where their insurance, what it would pay, given the very moment that we're at right now. It's a matter of how we can put it into the patient's hands. And so, what we've done is we've taken this approach of we would love to give our patients a tool that's available on our website or available somewhere they can access easily.

It gives them the ability to run their own benefits with our tools for our vendors. That tool gives them transparency then to go to their payer and say, you know, ask the questions that they typically ask of us, you know, why is it cost so much? Well, it's because you're a payer and you're deductible and there's a series of reasons.

I guess, giving them the information they need to go to their payer also helps the payer because then they can talk through the differences of why their plan does certain things. Better information for the patient equals better understanding of what they're going to pay for or what they have to pay for or what their responsibility is.

And then it also leads to better planning. So maybe they don't plan that test this month or maybe they wait until the end of the year when their deductibles have been met because they know. After a certain period, their deductible will be met. So, let's wait until the end of the year to do our high dollar tests.

In my opinion, gives them so much more information and such a better understanding of how healthcare works the other thing to think about that we're playing with these, concepts is those that do cash pay or those that

want these concierge type services. How do we bundle tests together for their benefit? How do we offer multiple services so that they can benefit from some of those discounts? You know, a lot of our patients will come in and they'll get a new patient appointment evaluation. But part of that includes any test or part of that will include an MRI.

Some of our direct contract discussions are centered around that, where if somebody has a neurological issue, when they come in, meeting with a doctor doesn't really give you anything because they need to do testing to understand better. So direct contracting with some of these groups to say, if there's a neurological patient who needs a new evaluation, it's going to include an MRI and it's also going to include labs and it's going to include potentially EMG testing or EEG testing or a sleep test, then it's covered and it's paid for and the patient doesn't have to go to five different places and the patient doesn't have to be responsible for five different bills that come in from five different doctors that interpret those tests.

That in our opinion improves healthcare, and it also improves patient experience. So our goal and our focus now is to like I said, to reiterate, we're making it more transparent for them to get their information based on their circumstance, their insurance policies, then giving them the ability to bundle or do things, do these things in a different way, meaning they can save as they do more here, because we know they're going to have to go get those tests somewhere.

We know part of what they want to know requires diagnostic testing. So we're going to try to offer that up front so that they understand, okay, I'm not going to get an answer at first appointment. It's probably going to take a second or third appointment after I get all these tests before I get an answer to what my real question is.

And that helps us with revenue cycle. It helps us with managing and projecting out our revenues and our accounts payable. And so, thinking outside the box is kind of what we must do to manage how health care is in person.

Shruti: Verification teams play a critical role in ensuring smooth patient intake and reducing payment risks. Can you share some practical tips you've used to empower your team at Neurology Consultants of Dallas to overcome common roadblocks and streamline these processes? Or, and can you share some battle tested tactics you've implemented to navigate the prior authorization maze and secure approvals?

Kashyap: Or what would it be your wish list, when it comes to verification, scenario when there is no limit to what we can do that in ideal world.

Mike: In my opinion, technology has a lot of good resources when it comes to authorizations. There are some groups that you can completely farm it out and get it done outside of your practice.

However, that's a risk because at the end of the day. You can deny coverage for a service at any point, for any reason, and you're risking letting another group do that for you unless they're sharing in the liability of that. My experience with prior authorization is different for every type of test you do.

Some of them are very easy and some of it's very vanilla and we could do it with 1 person that has a limited experience. When you start to get more into the high end testing, like infusion, rheumatoid, you know, rheumatoid therapy and you start to do some of these things with even some MRI, all of that, EEG, sleep testing authorization is tough because you can't, you got to go through that payers information and it takes time and there could be peer to peer, requirements for this, or there could be hurdles that you don't anticipate. And so, using technology to kind of cross off the easy things, in my opinion, is our way is our way of approaching this.

We have quite a few tests. Let's use technology to its fullest to meet the demands of those prior. Once we utilize the technology. How do we dive deeper and further training AI to do those things we anticipate will make it a lot easier. So, once you do several sleep tests or several infusions, and it's the same pair, and it's the same type of drug, you start to understand the needs of that authorization, how we can utilize that for our benefit is what we're trying to do now.

To be honest, we don't want to have to rely on one person who knows everything about authorizations. And I know that that's probably what every practice has is one person that's worked with them for, you know, for a number of years and they know everything about that. And so that person inevitably gets burnt out.

Our dream scenario is we have solutions and systems that can help us with these scenarios. And we continue to have these one or two people, but those one or two people can transfer their knowledge into some of these technologies for the betterment of the practice and then they don't have to get burnt out.

Then they're not on the phone 7 days a week to answer questions to try to sort out denials. They're the ones training the or training the technology, and they're definitely needed. They're definitely valuable. But once that technology is there, using it correctly and disseminating that information is our hope.

Shruti: At Aarogram, we believe that being efficient in your businesses as a health care provider also means providing more patient centric care. Therefore, we ask this question to every guest on our podcast. Can you please share a learning or an aha moment you've experienced in managing your health care practice that would be valuable for our listeners?

Kashyap: Admin staff, practice managers, all of them included. Yeah, it could be something, you know, very clever or witty or, something funny as well, you know, that it's a pretty out of the box solution that you have tried.

Mike: I got one for you and this isn't my solution is actually one that I read about. It caught me off guard when I heard it. You'll become a good administrator or practice manager when you start to put patients second. Now, that that's a weird thing to think about it. Why would you put patients second, right?

So, I read a book a while ago, it's called 'Patients come Second'. and it is written by an administrator that ran a hospital, his name's Brit Barrett, and the book was about, how do you treat your staff and how do you treat those that support the hospital?

And if you do that correctly, patients will, as a result, become the most prioritized. They will get the benefits. Of how you run your hospital, because when you have staff turnover, when you have, a culture that's not positive when you have problems within your organization, patients feel the result of that, right?

It's not the staff, it's patients. They're the ones that see the problems with untrained staff. They're the ones that feel that the challenges when you don't have authorization support that you need. They're the ones that feel the difficulty in not being able to answer the phone to get their medication.

And all of that is a result of not fostering a culture that's supportive to the people that run the practice or the people that work in the organization. And so his premise was, if you treat your people right, the good downstream effects will Will transfer to patients and and that's why patients come second because you treat your your staff, right?

You treat people right and they become more willing to help, more supportive to patients and the organization as a whole and can give patients a much better experience. When it's well run and it has a great culture, it just has a great environment. For growth and development. So, my aha moment has always been the best thing I could do for my patients is to make it better for my staff because they're the ones that are here for patients.

Every doctor that I've met wants to be a good doctor for their patient. They have personal, you know, stories that tell you why they want to be a clinician. This is a passion for them. So, if I can make their job better, if I can make their job easier, I know they're going to do that. To the patient, I make their job harder, if I don't give them the resources they need, the patient suffers.

Yeah, they're not happy, but the patient will suffer. So that's kind of my aha moment. That's a weird one. But, you know, if I were to put a term on it, it's just patients come second.

Kashyap: That's very interesting. And a little bit counterintuitive as well, as you think about it, though.

Shruti: You're a hero, Michael, for doing this, for recognizing. Where you fit in, into the whole system. It's lovely. It's a great takeaway for, for an audience as well, if you take this away from, listening to this podcast and, and I think it's especially important in this time when we are dealing with staffing crisis, in the U. S. healthcare.

Mike: That's tough because there's a lot of staffing turnover. It is huge and especially was during the COVID, you know, the COVID dilemma. And so, burning out staff, I see every day a person that comes to work and helps in a hospital or in a healthcare system. They're coming because they like being there and they like helping with something in their DNA, which means they want to be a helpful person naturally.

But when you make it hard for them to be what they naturally want to be, it burns them out faster for some reason. They become more disenfranchised to do what they naturally would do when it's harder to do it or it's difficult. So, they're not going to point towards their job to do those things.

They're going to go home and do more of it to neighbors or they're going to be more helpful to others elsewhere, because they're not being able to do it at their job. I want to make the job the place they want to do that the most so that when they come to work, they want to get out what they naturally want to by helping there and they feel fulfilled at the end of the day, they feel great because I was able to do what that patient expected of me, because I had the resources to do it. I had a team that helped me do it. And that patient left with some answers, that family, you know, left with some support for their patient. The more I can help do that, I feel fulfilled. So, it's kind of a positive loop all around.

Shruti: Wow. What a team player, Michael. It was lovely to have you on the podcast. Thank you for taking time out for us. It was lovely to meet you and to speak with you.

Mike: Great. Thanks, Kash. I appreciate it.

Kashyap: Thank you, Mike.

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