October 29, 2025 • 43 mins
What if your ASC could see problems weeks before they hit your bank account? We dig into a practical playbook for turning raw data into clear decisions, from daily flash reports that act like your financial heartbeat to monthly benchmarks that expose where performance drifts and why. Instead of waiting for cash-basis financials to tell a late story, we focus on questions that move leaders to action: Where did payer mix shift? Which referrals slowed? Are we prioritizing the right cases at capacity? And are our fee schedules quietly capping revenue?
We share a simple, powerful benchmark strategy that applies to various reporting needs and decision points. With that lens, a steady month of cases can still produce a revenue dip if Medicaid volume rises or a commercial contract underperforms. Using NPIs to track referral sources brings transparency to relationships, helping you target outreach when a group’s volume fades. Then we layer in forecasting: take the last 90–180 days, project cash forward, incorporate known inflows and takebacks, and set thresholds so partner distributions and capital decisions stop being guesses and start being planned.
Revenue cycle details matter. Patient liability collection should approach 95% of allowable, and the fastest wins often come from pre-surgical estimates, up-front collection workflows, and early-out strategies. Denials and zero-pay encounters can reveal coding issues or outdated charge masters; many groups unknowingly bill below allowable after Medicare updates. On profitability, we break down incremental contribution by service and payer to guide site-of-service choices and give you real leverage in payer negotiations. The outcome is a lean, repeatable reporting cadence that matches daily triage, weekly initiatives, and monthly strategy—keeping your data working for you, not the other way around.
If this playbook sparks ideas, follow the show, share it with a colleague, and leave a quick review. Your feedback helps us bring sharper tools and real-world examples to every episode.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_03 (00:31):
Hey everyone, welcome back to Beyond the
Stethoscope, the StrategicHealthcare Partners podcast.
I'm Jason Crosby, and I'm joinedby my esteemed partner as usual,
Aaron Henry.
Aaron, how are you, bud?
SPEAKER_01 (00:45):
I'm doing pretty good, Jason.
A little tired, but having a14-month-old does that to you.
But hey, I'm excited to be here.
It's been a few weeks since ourlast podcast.
Speaking of just to remindeverybody, we're doing things a
little bit different this.
Okay, well, uh happy recappingsome of the great webinars that
we've had and giving you anopportunity to dive a little bit
deeper into the gobble gobble.
(01:06):
So our most recent one was dataanalytics through decisions
reporting, which lots of great,very insightful information was
to be found.
SPEAKER_03 (01:19):
Yeah, totally agree, Aaron.
In fact, we work for all ASCsjust like we work with various
physician practices andhospitals.
And at the crux of what we do isa lot of analytics.
And so we came to realize justhow much of a treasure trove or
gold mine of data that our ASCsactually sit on.
But as usual, sometimes youdon't know what to do with the
data once you've got it, right?
(01:40):
And what we'll hear updates,I've seen all of this in
Thanksgiving.
I've done it recently and turnedit into a webinar where they'll
unpack all the big ideas andreal-world examples that many of
us need that lead our ASCs.
And so really good informationon not just the data, but the
story behind the data.
SPEAKER_01 (02:01):
And before you switch us off and you go, I'm
not an ASC, or look, I thinkthere's plenty that other
medical practices and hospitalscan glean from this information
too.
This is not ASC specific,although we talk a lot about
ASCs.
Obviously, that was the primaryfocus, but I don't want to scare
you away from this episode byany means.
(02:22):
So with that, let's jump intothe first big theme that Mike
Scribner laid out at the verybeginning: the data gap.
SPEAKER_02 (02:30):
Those that are born out of independent physician
practices tend to be prettyskinny in how they are
administratively run.
Thus, a lot of times there's nota CFO, there's not a lot of
in-house analyst support.
Um, so there tends to be a tonof data that's available within
all the systems that are outthere, but there's this gap
(02:51):
between this mass of data that'savailable and what kind of
typically gets turned intodecision-making tools within the
practice.
The other problem that we tendto see is that we're in this
position a lot where because alot of y'all run from cash-based
accounting, and so you'relooking at the cash-based income
statement, and the doctors aresaying, I'm working as hard as I
(03:13):
used to.
However, our bottom line andwhat I'm able to draw out of the
ASC side is lower, and or thepractice side, either one, and
it's lower.
And it the problem is that thefinancial statements, as
reported cash basis-wise, tendto be a lagging indicator for
almost all the problems thatyou'd have.
You got a revenue cycle problem,a volume slowdown, some kind of
cash flow interruption, payermix has shifted, and you don't
(03:36):
see it in the month that itoccurs or then month after it
occurs.
You see it when the collectionsslow down later on.
So you're in this positionwhere, or we're in this
position, if we get drawn in onit, where the question is I
think I don't know for sure, butI think volume is basically the
same, but cash is down by 20%over the last 60 days.
(03:57):
What's happened?
And that's a accrual-basedfinancials probably would have
helped with that B.
That's a lot of the issues withrunning financially with the
barometer being the cash basisfinancials.
Our typical question as we'restarting into this.
SPEAKER_03 (04:14):
So, as you heard there, Mike, obviously that in
sugar coat it, right?
A lot of ASCs, they're flyingblind.
We just mentioned there's a lotof data, not sure how to use it,
but at the same time, not surehow to extract, what to extract,
which tools to use, which a lotof times they do not have.
A lot of times they don't havenecessarily the people or the
resources either.
So it kind of leads the questionof if you're collecting the data
(04:35):
every day but not using it, thenwhat's the point?
What kind of time are youwasting by going about
extracting it, but then not ableto interpret at the same time?
SPEAKER_01 (04:44):
I think this is a bigger problem specifically for
those physician-owned centerswhere they don't necessarily
have a big team.
They don't have, say, a CFO oran analyst, or they do have a
CFO who's also one of theproviders.
All I end up is a mountain ofspreadsheets and just a wish and
a prayer that the cash flow isstaying positive.
But hope is not a strategy, notfor ASCs, not for hospitals, not
(05:07):
for anybody.
SPEAKER_03 (05:08):
Yeah.
And as you're about to hear aswell, Mike and I'll will touch
on cash-based financial,cash-based accounting, right?
And so is that how much of anadvantage can that be, or
actually a disadvantage whileyou're trying to steal the ship?
Wouldn't you rather have theradar, if you will, while
steering it?
SPEAKER_01 (05:28):
It's about thinking about what's ahead of you in
addition to understanding what'sbehind, but you can't drive by
looking in the rearview mirror.
You're gonna smash into a wall.
So this is where those decisionsupport tools really come into
play.
But how do we start making thatshift?
That gives us the answer.
SPEAKER_02 (05:44):
Our typical question as we're starting into this is
as I'll get into the next coupleof slides, is not like what will
the system produce.
It's what information do youneed and what questions go not
very well answered or notanswered from a specific data
points underneath it.
And then so, like that lastpoint, um, we run into a lot of
(06:06):
time where there's a data pointthat's available, but there's
not a care there's not acomparison point to it.
So our mantra internally is thatall data has to have some kind
of a comparison point, eitherits own trend, a benchmark,
something in order to determinewhether or not it's good or bad.
It's not and the the one that Iwe tend to throw under the buff
a lot is like net net to gross,net collections to gross revenue
(06:29):
is 32% a good number.
Very hard to tell unless you'relooking at your own trend or you
know what you're charging as apercentage Medicare and you have
a methodology to tie that backto something to tell you whether
or not you're successful or not.
And so it's those are very hardto do.
SPEAKER_03 (06:44):
So, Aaron, as you heard there, Mike's advice on
how to go about gathering andinterpreting such data.
Don't ask what the system canproduce.
Ask what you need to ask whatyou need to know, right?
And so let me ask you that.
You're in the analytics group.
When was the last time youlooked at a report and thought,
you know what?
This time is it tells me exactlywhat I need to act on.
(07:05):
Not too frequent, is it?
SPEAKER_01 (07:07):
No, it's not.
And I kept thinking, boy, thissure sounds a lot like that
famous JFK quote.
And in some ways, that's whatwe're looking at here, right?
So, hey, why is the data tellingme this?
And what do I need to do aboutit?
So, why in this case, like, whyis cash down 20%, but our volume
is staying the same?
(07:28):
That's the sort of questionsthat you need to ask of the
data, and it needs to be able totell you the answers.
SPEAKER_03 (07:35):
Yeah, and another point he hit on that I found
interesting, regardless of thedata points you're looking at or
what context, is how do you knowif it's good or bad, right?
There's got to be a comparisonpoint.
We look at that in our personallives, it can be your lab
results or something along thoselines.
How do you know something istrending well, not trending
(07:55):
well, good or bad or another?
And he touched on the netcollection rate, for example.
Are you doing well or aren'tyou?
You don't really know unless youhave that benchmark.
And I found that to be a goodpoint that might brought up.
SPEAKER_01 (08:06):
You bring up the example of lab results.
I think everybody listening hasgone to the doctor and you get
your lab results back in, andit's either within spec or
outside of spec.
There is that benchmark, thereis that baseline of what is
healthy and you know what youshould be.
You neither want to be too highor too low.
The analogy starts to break downfor sure.
(08:27):
But I think we can allunderstand that when our
cholesterol is creeping up toohigh, maybe we need to start
having less maple syrup on ourpancakes, you know.
But whatever the case is, weneed to be changing something in
our diet.
And the same goes in ourbusiness.
And so, where do you get thesebenchmarks from?
Like in the lab, they have theirbenchmarks, they have what their
(08:47):
normals are, it's peer-reviewed,it's understood.
So, where do you get those thatdata?
Is it your own benchmarks?
There are definitely a lot ofcompanies out there.
Medicare has its own index.
Context is king in this case.
SPEAKER_03 (09:02):
Yeah, yeah.
So far, we've heard from Mikeand Janie about the importance
of knowing why you're pullingthe data, what to pull, how to
interpret it.
We just heard about benchmarks.
Now we're gonna pivot to thenext step of trending, cadence,
timing.
How often do you need the data?
So the daily kind of reporting,weekly, monthly.
(09:25):
From that, you start gettinginto trends.
So we're gonna expand a littlebit on these first couple of
segments you heard with Mike'spoint here about cadence.
SPEAKER_02 (09:34):
I get this is gonna feel like a lot of overkill, but
when we sort of design, again, adecision support function for
folks, whether that's hospital,ASC, practice, what have you,
the question tends to be we whatdo you need to know daily?
What do you need to know weekly,monthly?
And then what do you need toknow more farther out?
(09:55):
We just need to reset yourunderstanding of it, and then
what's ad hoc that you needavailable when you need it, but
you just don't tend to knowexactly when you need it or when
the situation might arise forit.
And so to put some, you know,just a couple of examples with
these, from a cash flowperspective, we I'll go over a
slide or two that from a that adaily cash flow mechanism to
(10:16):
understand where that where westand with the ins and outs of
that.
That feels like something youwould want to know daily.
Yeah, it's a bit of a pain inthe butt to pull together and
maybe you only want it weekly,but that information might be
helpful to know.
A fairly frequent clip from arevenue cycle perspective, where
we are versus benchmarks.
That feels like a monthly kindof analysis and where you update
(10:40):
your initiatives and put sometargets with that and keep that
rolling forward.
And I won't go through allthese, but the the point is that
the replica being able toreplicate the key reports in
some kind of cadence that goesalong with the with the
decisions that you're makingaround all of it, it needs to
that the reporting needs tomatch that cadence.
(11:03):
For example, if you're halfwaythrough the month and you know
that you're way off of the cashtarget for the month, then what
information do you need to knowwhat's going wrong for you to do
something about that?
And that's what this is isintended to at least show
(11:51):
examples of.
SPEAKER_01 (11:52):
Mike talked about matching your reporting cadence
to your decision making.
So ask yourself, what do I needto know daily, weekly, monthly?
So think about it from abudgeting standpoint in your own
life.
How much money do I need to havetoday to go to the grocery
store?
But overall, over the week, howmuch money am I going to be
(12:14):
bringing in monthly, et cetera,paying all the bills and that
sort of thing?
So think about it from thatstandpoint.
SPEAKER_03 (12:21):
And we all log into portals now.
It doesn't matter theenvironment personally or coming
from the health systembackground.
There were daily reports wewould generate, weekly, monthly.
You heard Mike talk touch on thedaily flash report.
That stood out.
And it's it feels like yourASC's heartbeat, right?
You're tracking all the key dataelements so you know where
(12:42):
things stand on a daily basis.
So every morning you come in,you look at the report, you're
able to see the cash flow, thecharges, AR days, volume.
It's all set up.
And that shouldn't take but afew minutes.
After you're used to looking atit, those daily reports, you
know exactly what you're lookingat and you're moving on in just
a minute or two.
But it gives you that real,up-to-date pulse of the day of
(13:02):
your practice.
SPEAKER_01 (13:04):
Yeah.
So let me ask you this, Jason.
If you were bleeding out, wouldyou wait a month to go see your
doctor, or would you want tostop that bleeding right away?
Again, same sort of deal.
You want to find out right awayif you have a major problem.
You don't want to be 30 daysbehind understanding that you
(13:24):
have a problem.
You need to stop that bleedingnow.
You need to address the rootcause as soon as you can.
SPEAKER_03 (13:30):
Yeah, exactly.
It's like checking your vinyls.
You mentioned you don't wait foryour annual physical, you want
to know if something's wrong,you monitor it daily.
And over time, we've seen thatreport again, whether it's ASC
or hospital, you start gettingused to knowing, okay, on
Mondays or Tuesdays, we cananticipate cash flow lagging
because of the weekend, thingsof that nature.
So another great point by Mikethere.
SPEAKER_01 (13:50):
A fun fact if you don't step on the scale, you
don't actually increase inweight.
Just thought I would drop thatlittle knowledge bomb there.
But at the end of the day,having these tools is going to
help you better predict the mostimportant line in your
financials, and that's thebottom line.
And so you need to know whatthat is.
I think everybody, whenever youpicked up any kind of financial
(14:13):
report, it could be pages andpages.
Where's everybody flipping to?
They're flipping to the lastpage.
They want to see what is thatlast line, how much money is in
my bank account at the end ofclose, at the end of day.
That's important.
And you need to try to be ableto predict that.
And these are the tools thatMike was talking about that can
help you get there.
So, speaking of getting there,let's talk about the
(14:35):
forecasting.
SPEAKER_02 (14:36):
One of the things that kind of tends to is an
extension of the point I wasbringing up before, that the
doctors getting them tounderstand where the cash flow
sits, when distributions mightbe able to be done, and being
able to project that out withoutjust waiting for financials to
occur month after month and thenjust guess at it at the end can
(14:58):
be done.
And so the point of this is whatif you took your cash flow over
the net last 90 to 180 days andprojected it forward and then
layered into that the largerpayments that you know you have
coming with, you know, takebacks, inflows, all that.
And if you push that out farenough, you can predict when
(15:22):
there's gonna be, you know, whenthere's gonna be money for a
distribution, when you might begoing the other way and you
might need to pull down on theLLC and make that not a we're in
this position, you gotta makepayroll, and so doctors, we need
funding right now.
It's to be able to project thatout ahead of time and come up
with mins and maxes around allthat to give some heads up to
(15:44):
it, as well as keep tabs on ityourself to know what's going
on.
And again, it feels like a painin the butt.
Once it's set up, the dailyversion of it is fairly
straightforward.
You're only updating this maybeonce a month.
And so it's just a matter ofanother methodology, been able
to keep up with it a little bitbetter.
SPEAKER_03 (16:02):
So first few segments, we've worked up from
gathering data, benchmarking tocadence and frequency.
We just heard from like weswitched over to cash flow.
Well, now a bigger pulse checkof your practice than checking
your cash flow, right?
So in that instance, using thehistorical cash flow, whether
it's 90 or 100 days, a lot ofpeople use 90, forecasting
(16:24):
future distribution.
If you do that personally, whywould you not do it on your ASC
here?
So here's a question for you: Are you planning your cash flow (16:29):
undefined
or are you just cleaning youreyes and hoping it works out?
I don't know about you, but ifI'm watching that, I'm gonna be
looking at it prettyconsistently.
SPEAKER_01 (16:41):
There's something to be said by flying by the seat of
your pants, but it doesn'talways work out.
In fact, I'd say most of thetime it doesn't.
Forecasting is going to allowyou to really control the
situation here.
It's everything fromdistributions to your partners,
what sort of capital investmentsare you going to be able to do,
staffing decisions, all of thatbecomes strategic value to you.
(17:05):
So you're now maximizing yourdollar.
It doesn't make sense to run outand buy a new CT scanner if
you're not doing CTs.
So take a look at that and beingable to better understand and
spend your capital in a wisemanner so you get it back over
time.
SPEAKER_03 (17:22):
That's right.
That's right.
You had a whole nother point ofkind of peeling the underback
behind issues, right?
If you're seeing cash flow notmaking sense, do you have a
volume issue?
Do you have a scheduling issue,or what you're going to hear up
next that we often find is youmight have some underlying
revenue cycle issues.
So it's just another report thatacts like a layer, if you will,
(17:42):
to give you that radar of what'sgoing on.
But other things happeningunderneath.
All right.
So as you just heard there, wewent to cash flow review, right?
So Mike talked a lot abouthistorical cash flow, 90, 100
days, whatever your progress maybe, most usually using 90 to
forecast all those cash flowdistributions.
Not only are you trying to lookat where cash flow might be, but
(18:04):
the underlying issues that maysit within that.
So the important question (18:06):
are you actually watching your cash
flow, or are you just hoping itworks out?
SPEAKER_01 (18:14):
Flying by the seat of your pants works out
sometimes, but it's not a goodstrategy.
At a minimum, forecasting isgoing to allow you to take
control.
It allows you to take control ofthings like partner
distributions, what capitalinvestments you're going to do,
staffing decisions, all of thosebecome important key strategic
factors that you can plan for.
(18:35):
Think about the capitalimprovements.
Does it make sense to invest inequipment if you're not really
doing many of those procedures?
So this allows you to be morestrategic.
SPEAKER_03 (18:47):
Yeah.
Good point.
Good point.
And not only that, but helpfinding other underlying issues
as we were just talking about.
So do you want to lead to theissue or kind of react to the
issues with the cash flowstatement?
You get that good basis, a goodfoundation that you can start
peeling that onion back andrealizing do I have some
contracting issues, volumeissues, or as you're about to
(19:07):
hear from Janie, potentialrevenue cycle issues.
So let's listen to the segmenthere by Janie on revenue cycle
and benchmarking.
SPEAKER_00 (19:14):
If you're going to benchmark, we have to have some
sort of target.
And for most practices, somespecialties are a little bit
different, but indexing toMedicare in some mechanisms
should give us a sense of kindof the overall performance.
We don't want to be paidsub-Medicare, but trying to
match up each and every singleservice that we deliver to an
(19:35):
actual Medicare reimbursementmethodology can be very
cumbersome.
So our method of doing that is amatter of indexing.
So you know, to walk throughsort of the quick math of that,
if Medicare pays us 50 cents forwhatever we're doing and Blue
Cross is paying us 75 cents,then we would say we're getting
150% of Medicare for Blue Cross.
(19:56):
And so that's going to give usthat benchmark because our
charges are consistent, ourreimbursement should be
relatively consistent.
Our patient mix and the servicesthat we're delivering should be
in a lot of cases veryconsistent.
Of course, all of those thingscan change it and can skew it a
little bit.
So we have to know our book ofwhat we're delivering.
SPEAKER_01 (20:16):
Now that was, of course, Janie.
She took control of thesituation and showed us how to
benchmark payers using Medicareindexing.
Again, going back to that pointabout what are our thresholds
here?
What is good cholesterol?
What is bad cholesterol?
And looking at things like BlueCross, which is typically 150%
of Medicare.
So here's the thought Do youknow what your payers are really
(20:38):
paying you compared to Medicare?
So that's, I think, a questioneverybody needs to be asking
themselves.
Use Medicare as your benchmark.
SPEAKER_03 (20:47):
Yeah.
Again, you guys are starting tohear a theme of you've got good
data.
What do you want to tell you?
How do you know it's good?
The benchmark knows if you justsit there and the benchmark in
this case being commonly beingMedicare.
Those again, practice hospitalASE side, it doesn't matter.
But she also referenced, okay,how do I extract which one of my
filters for my extract the data?
(21:08):
And the preference being wealways use data service versus
transaction dates.
Because you just have thattiming of when items are posted.
So why not eliminate thatconcern, pull off a data
service, and then therefore yougot a consistent filter built
in?
SPEAKER_01 (21:24):
From a reporting standpoint, and I do a lot of
reporting.
It is easier to report off atransaction date.
Your data stays relativelystatic, it's less data to pull.
But are you really getting thefull picture?
It is a far better picture ofwhat's happening within your
organization if you're doing byservice state.
So just bear that in mind.
(21:45):
When you're pulling yourreports, pull it by service
date.
Yeah, it means you have to pullfor a longer period of time.
Your reports might be larger, alittle harder to manage, but
it's worth it in the end.
That's right.
SPEAKER_03 (21:56):
That's right.
And so let's pivot a little bit.
We talk about tracking, in thiscase, resolved charges, right?
So what's been paid, what's beendenied, what's sitting out there
in that unknown bucket that wehate that still sits a large
opportunity for us, which bringsus to that next layer of
reviews.
We all use it, and that's in thepayer mix realm.
(22:19):
So let's listen to Janie Miketalk about pair mixes and
referral sources.
SPEAKER_02 (22:22):
The next few slides, we're thinking less revenue
cycle and more kind ofgrowth-oriented within the
practice.
And there's multiple ways tolook at this.
Janie's going to talk in aminute about referral source
reporting and getting at our keyreferral sources and ferreting
out and putting sometransparency on that.
But to back up before that, thethis you know, we tend to spend
(22:46):
a lot of time looking at theparametric adjustments in pair
mix over time.
And a lot of times it's justratifying that things are
basically the same.
But because there are such largeswings between the various
categories, like in the way wehave it displayed here, let's
take it all and let's index itto Medicare.
Medicare is at 100%, MedicareAdvantage will be at 100 to
105%, Medicaid for an ASC willbe 60, 70 of Medicare, and so it
(23:12):
tends to be a third lessreimbursed on the ASE side,
maybe only 10 to 15 on the MDside, but way less on this side.
Commercial can be anywhere from30 to 100% more, so call it 130
to 200% of Medicare.
And so it's wildly different.
And then HIX tends to bell curvearound 30, 40, 50% better than
(23:35):
Medicare.
So 130 to 150 Medicare.
SPEAKER_00 (23:38):
And so then who is driving those revenue shifts and
how can you have some handle onwhat's happening there?
This is looking at our newpatient referrals coming into
the practice.
Sometimes we get really goodinformation on this on the ASC
side as well.
Depends a lot on what data youcap data you capture.
Some practices do a reallyfantastic job of it.
(23:58):
My personal bin, I'll make aplug for putting in NPIs because
those can be cross-walked andyou can get back to individual
physicians and kind of grouppractices.
Had a practice before, put inreferral source is the billboard
on 17.
Not super helpful in figuringout where your referrals are
coming from.
But if you want to make surewhere your marketing dollars are
going, that can be helpfulthere, I guess.
(24:18):
What we're trying to figure outis are there groups that have
been referring to us and ourdownturns in volume are?
Is this a physicianrelationship?
So group one, we've got somegreat referrals here, and then
all of a sudden we're trendingfurther and further down.
This is probably an incompletequarter, so we'll pause on that.
But what's happened?
(24:38):
Is that something that's worthour practice manager reaching
out?
Did we have a doctor retire?
Is that is group one now asmaller practice?
And where are their patientsgoing if they've dropped them
from that versus some others?
Overall, we've got somedownturns, but wanting to keep a
finger on the pulse of who'ssending us things because that's
ultimately going to be thelifeblood of the ASC.
SPEAKER_03 (25:01):
Again, reviewing the data, pulling it back.
If even if when your volume isconsistent, nothing is jumping
out to you, that shift in payormix will definitely jump out to
you, right?
It's gonna wreak havoc on yourrevenue and you're gonna know it
pretty quickly.
Again, going back to projectionsand benchmarking and knowing
where things should stand.
So if Medicaid's paying 70% ofMedicare and your commercials
(25:25):
are in the upper 100, 160, 170%.
How has that changed now thatyou're going back and looking at
data?
What's it saying today orlately?
SPEAKER_01 (25:36):
Exactly right.
And think of it this way, right?
The this is crazy.
This kind of breaks my braincoming from the retail world.
You may be busier than you werebefore, but your revenue is
dropping.
All because your parameticshifted, right?
You could be shifting and doingmore Medicaid patients, for
example, which is the 60, 70% ofMedicare, and you're doing more
(25:59):
cases than you're ever doingbefore.
But if your commercial payersare paying$13,200, like boy, you
got to do three or four Medicaidpatients to equal one
commercial.
So you may be busier than youever thought possible, and yet
your revenue is still falling.
SPEAKER_03 (26:15):
Yeah.
And in this day and age, too,when payers are coming into the
market, they're coming out ofthe market so quickly, and ebbs
and flows of it.
You've got different networksevolving.
It's not a stagnant of a lineitem on your reports as it used
to be.
You knew payer mix.
Now it's going to ebb and flow.
So it's really important to keeptrack of.
(26:36):
Another item that Jamie touchedon, the pivot that she referred
to is referral source.
We always look at this,especially without migration
type pattern.
So another important elementthat Jamie touched on was
referrals.
You and you do this for quite abit for us, Aaron, pulling NPI
type data.
And what we're trying to doagain is seeing who sends what
(26:58):
where, basically.
SPEAKER_01 (26:59):
Yeah.
It is really important.
And I think most EHRs do an okayjob of tracking this, but I
think most clinics don't do agood job tracking it.
Instead, they're putting thingsin saw a billboard or Googled
it.
That's not useful information.
What is useful information iswhat providers are sending you
(27:21):
patients, right?
At the end of the day, that'smore important.
So if a provider stops sendingyou patients, do you know why?
Did they retire?
Did they move practices?
Or were they dissatisfied withpatient outcomes coming from
your ASC?
All of those things areconversation starters, but you
(27:41):
only get that information ifyou're collecting that
information.
So if you're not sure if youare, or if your EHR supports it,
I'd certainly find out and getright on that, or find some
mechanism maybe outside of yourEHR if it's if it's not built
in.
It's important to know.
SPEAKER_03 (27:58):
Absolutely.
And once you know who'sreferring what, it's a great
time to go have thatconversation with that other
practice facility about how youcan do more with them, build the
relationship, become more of areferral source.
And on the flip side, who's notreferring patients to you that
you think we're friends of thefamily?
(28:20):
It allows you to have thatconversation with concrete data
versus just a feel of thevolume, right?
So another important data pointbrought up Pajani, and then
going into profitability.
A lot of times you can doprofitability by service by
referral source, whatever thecase may be.
But look, she's going to touchon more here, her or Mike, both.
So let's listen to the segmenthere.
SPEAKER_00 (28:40):
So this first version that we're going to look
at is our a litany of servicesthat we're rendering, what are
average cost of implants?
And this is all very rolled up.
But what is the averageincremental contribution to the
facility of doing these sort ofservices?
And so if we've been doing thisand we're seeking to project out
(29:00):
what cases do I already have onthe books, what cases do I
anticipate?
What is that going to do to myprofitability overall for the
group?
Really a neat way of looking atit.
Are these, are these perhapscases we might need to consider
shifting to a hospital so thatthey may have better
reimbursement, they may havebetter better implant
negotiations, but at the veryleast, we're not losing money on
(29:22):
the service.
Or is this very minimal comparedto some of our other profit
lines worth keeping ourphysicians happy?
A lot of physicians prefer towork in the ASC because of the
convenience, the ability tocontrol kind of their
environment and theirscheduling.
But letting Dr.
A know these aren't really greatcases for us to be doing here
and they're costing us money isworth a discussion, especially
(29:43):
as you get into some of thoseother dialogues about draws and
how they're seeing profitabilityand how they're seeing things
produce revenue for them intoindividually.
SPEAKER_01 (29:53):
Profitability analysis was yet another
highlight.
They showed us how to assessincremental contributions by
payer type and by service type.
So here's a real question foreverybody listening: are all of
your cases profitable?
And do you know for sure?
SPEAKER_03 (30:14):
It's an important question, right?
So not only that, if you're atcapacity and you need to decide
which ones to prioritize, you'reobviously you want to prioritize
those on the higher margin side.
And maybe there are some thatare actually better off at the
hospital versus in your client.
But how would you know thatunless again you looked at such
reports?
SPEAKER_01 (31:06):
Yeah.
And we now know this, thanks toall the transparency data,
right?
ASCs are only getting paid about30, 35% of what hospitals are
receiving for doing the sameprocedures.
To maybe your more medicallycomplex patients, those that
might need a higher level ofcare anyway, they would do okay
(31:26):
at an ASC, but they would dobest at a hospital.
And it's a low profitability.
I think the decision there iseasy.
Of course, we don't want tocompromise patient care.
We're not saying that at all.
But what we are saying is thatif a call needs to be made,
they're on the side of thehigher profitability cases.
SPEAKER_03 (31:45):
That's right.
And again, you've got now you'vegot more data points and which
to go negotiate with.
And so if we all see the samereports, ASCs have become
traditionally more efficient,higher quality, less costly.
And now that you got thisinternal data that goes along
with this industry-wide trend,you've got a lot more ammo to go
(32:08):
to negotiate on your contracts.
SPEAKER_01 (32:11):
Oh, yeah.
It's all about the leverage.
And making the most of yournegotiation with your payers is
huge.
If you come into that roomprepared, yeah, I would say 90%
of the time the pair goes in,they slap their final and best
offer down on the table, andthey walk out smelling like
(32:32):
roses, and you're left holdingthe bag.
But if you come in and you haveyour own spreadsheets, you have
your own evidence, you have yourown proof, man, that makes for a
much different negotiation.
I think a lot of people leavemoney on the table because they
don't come in armed with thedata.
So speaking of money left on thetable, let's not forget patient
liability and denials.
SPEAKER_00 (32:52):
Patient liability collections.
And this is again, a lot of thisis internal reporting that we've
developed.
Most systems provide some metricto allow you to see how you're
collecting on things.
We choose to group these in kindof all of our self-pay patients
after insurance, is how we'relooking at this particular cut.
And what we're looking at arethe total charges month by
(33:13):
month, again, date of servicedriven, what we estimate the
final patient liability.
So these are based on thediscount percentages that we're
seeing, the what's actually beenadjudicated, what's sitting
there as we get into morecurrent months.
This is going to be some ratioof percentages to that to
anticipate it.
And what are we seeing ascollected up front?
Is it this portion is dated, istransaction based.
(33:37):
So that we're looking.
Did we collect that while we hadthe patient in hand while they
came to the ASC?
Did we collect it before thesurgery was scheduled?
And we can see very real dollarsdropping.
Charges are down ever soslightly, but not enough to
warrant that.
These sections here that are inthis bold italic are projections
(33:58):
of where we think our finalcollections are going to be.
And then this is really helpingus try to identify where are the
breakdowns in our process ifthings are changing.
We've got some improvement incollections in our 30s, 60s,
probably after first set ofstatements have gone out.
Do we need to consider an earlyout vendor?
Are we sending things to baddebt?
But what are we projecting asour total completion?
(34:19):
What are we projecting as ourtotal patient cash collection
and ultimately what amount ofour total allowed?
Because you spend a lot of timenegotiating contracts and trying
to get better contractualreimbursement.
But if you don't go after everypenny that you're due, then
you're leaving, you've done allthat work on the front end,
which is a very difficult workand very time consuming.
(34:43):
But this is all due to poorplace of service collections.
The flip side of this is whatare the things that are being
paid at 100%?
And again, we're looking at nocontractual adjustment.
We've got either a fullinsurance payment for that, or
the insurance has paid somethingand the rest of it is sitting in
patient liability, which we mayor may not collect, but is
(35:04):
something going on with ourcharges?
As Mike said earlier, net togross charges can be a false
metric.
Contractuals are not, in myopinion, your enemy.
We want to make sure that wehave our charges high enough
that we collect every portion,every penny of what is due to us
in the very best way that wecan.
These items typically look at isthere something going on with a
(35:27):
with the fee schedule?
Maybe the fee schedule haschanged.
We had back in not ASC specific,but again, a physician example.
And that was when we had thelarge change in the Medicare
physician fee schedule.
I had a practice that wascharging 125% of Medicare.
And when those EMs went up, insome cases 25% close to 30%,
(35:48):
they were actually charging lessthan their allowables.
And so they were leaving$25 anencounter on the table.
Again, worth reviewing if you'renot in a cycle of doing annual
charge master reviews and makingsure that you're set at a good
target or comparing that to yourcontract, worth at least taking
a peek to see if there'sanything that's happening.
(36:14):
And then similarly, these areitems where we can look at again
the physician, the particularpayer, and looking where we're
actually seeing.
We collected every single pennyof that.
And why did that happen?
SPEAKER_03 (36:26):
All right.
So there we talked about patientcollections.
Again, a couple of segments ago,we were talking about how some
of these reports weredovetailing into Rev cycle
conditions and issues that youneed to look at.
Well, Janie again touched on akey element there with patient
collections, right?
So many ASCs, as she touched on,collect far less than they
should.
And those in practice in thehospitals, you probably want to
(36:49):
say the same thing.
With the target being that 95%of allowable amounts, the
question then becomes if you'renot at that benchmark, again,
another key word we keep hittingon, where are you?
And what amount of money are youleaving on the table if you're
not looking at it in that way?
SPEAKER_01 (37:09):
I need to find all these tables, the money's being
left on.
SPEAKER_03 (37:14):
Used to be trees.
I guess it's tables now.
SPEAKER_01 (37:16):
Yeah, I guess it's tables.
They were all cut down andturned into tables.
Janie recommended using ourprojections or your projections
to identify where the breakdownsare happening and considering
early out vendors or collectedcollection agencies when needed.
SPEAKER_03 (37:42):
So everybody listening to those denials are
like the back of your hand, insand outs of it.
But zero pay encounters canactually reveal a whole nother
set of issues that can dive intocoding or outdated fee
schedules, which of course,Aaron, in your word, you guys
look in day in and day out.
And of course, what we justtouched on before payer behavior
and trends.
So another reason or way inwhich to look at the nials that
(38:04):
Jamie touched on is what'shappening on the market with the
payers.
SPEAKER_01 (38:09):
Yeah, and like the example Jamie gives specifically
about that practice that wasmissing out on EM reimbursements
purely because they hadn'tupdated their fee schedule.
That's money lost.
I see it all the time.
Practices, they send us theirfee schedule, it hasn't been
updated since 2019, which folkshate to break it to you.
(38:30):
That was the better part of adecade ago.
It is time to update your feeschedules.
It needs to be done annually.
SPEAKER_02 (38:37):
One kind of closing comment is that we try real hard
to have education not be likejust trying to sell our
services.
We're trying to put goodinformation out for you guys to
react to.
And so I I hope this didn'tleave you with the impression
that this is all a bridge toofar and that all of these
reports are just like I'd neverbe able to replicate that.
(38:58):
Some of them with some effort,maybe building it the first
time, maybe a little bit, butreplicating it may not be that
tough.
Hopefully, we've left you withsome ideas of reporting that you
can do that might give a littlebit more transparency over the
revenue cycle cash flow, volume,et cetera, et cetera, that you
can react to versus just beingoverwhelmed with the amount of
(39:21):
data coming out of your systemand not being able to turn it
into something that assistsdecision making.
SPEAKER_00 (39:28):
I would tack on to that.
That while the reports thatwe've shown you are the ones
that we develop internally tocoalesce this information, most
DMRs have some form of reportingmodule that should be intrinsic
to that.
And perhaps it's just a matterof digging around in your system
a little bit and seeing whatdata points you can get out.
Because any data and any reportmonitoring is going to be better
(39:52):
than.
SPEAKER_03 (39:53):
All right.
So just to recap, a lot ofinformation.
We get that.
But so many points to hit on.
I recently saw Aaron where Ithink it was in Becker's, where
they're projecting the 10,000 orso ASCs there in the country.
Revenue just in the next fiveyears should go from about, I
want to say 45 billion to about60 billion.
(40:14):
How?
There's obviously a lot ofgrowth there, right?
So there's a lot to say whenwhat's the big picture?
I think it's quite a lot that wecan't get our hands around.
SPEAKER_01 (40:22):
Yeah, no doubt.
And really, this is about takingthe data you already have in
your system and turning it intoa decision-making tool.
Ask the questions of the data,benchmark all the things,
everything, benchmark it.
Align your reporting cadence towhat makes sense for your
(40:44):
organization.
Figure out what you need to seedaily, weekly, monthly, yearly.
Figure that out.
Sit down.
It's going to vary from practiceto practice, organization to
organization, no doubt.
Now, there's going to be somethings that are pretty much the
same across the board, but whatis interest to you is going to
change.
And be willing to change yourreporting cadence too as your
(41:07):
organization grows.
And finally, use thetransparency data to your
advantage.
The data is just sitting outthere.
You just have to go get it.
It takes a little bit of work,takes a lot of bit of work,
actually.
It's something I do all thetime.
And not to pitch ourselves toohard, this is something SHP can
do for you.
SPEAKER_03 (41:27):
Yeah, good point.
Don't be afraid to ask.
It's no dumb question sort ofapproach when you're talking
about what data you should bepolling, how, why, when, where,
and that sort of thing.
So, my my I guess summation of aquestion, I guess, at the very
end is if your ASC indeed hadall the data, you love your EMR,
you love your practicemanagement system, but have you
(41:48):
ever asked, would you changeanything when it comes to
reporting?
What are you not getting?
What do you not know?
Maybe that's the question youshould be asking.
SPEAKER_01 (41:59):
Yeah, that's a great question.
And I think that's a perfectplace to leave it, Jason.
Everyone, thank you for joiningus for this recap.
We know it was a lot.
You can go to our YouTubechannel, maybe where you're
watching this, and you can watchthe whole 50-minute webinar
there.
Or go to our website, shplc.com.
(42:19):
You can reach out to us if youhave any questions, or you want
us to help you with yourreporting.
We're happy to help.
And until next time, keep yourdata working for you, not the
other way around.
We'll see you, Jason.
Thanks, guys.
Thanks, everybody.
Hey everyone, welcome back to Beyond the
Stethoscope, the StrategicHealthcare Partners podcast.
I'm Jason Crosby, and I'm joinedby my esteemed partner as usual,
Aaron Henry.
Aaron, how are you, bud?
SPEAKER_01 (00:45):
I'm doing pretty good, Jason.
A little tired, but having a14-month-old does that to you.
But hey, I'm excited to be here.
It's been a few weeks since ourlast podcast.
Speaking of just to remindeverybody, we're doing things a
little bit different this.
Okay, well, uh happy recappingsome of the great webinars that
we've had and giving you anopportunity to dive a little bit
deeper into the gobble gobble.
(01:06):
So our most recent one was dataanalytics through decisions
reporting, which lots of great,very insightful information was
to be found.
SPEAKER_03 (01:19):
Yeah, totally agree, Aaron.
In fact, we work for all ASCsjust like we work with various
physician practices andhospitals.
And at the crux of what we do isa lot of analytics.
And so we came to realize justhow much of a treasure trove or
gold mine of data that our ASCsactually sit on.
But as usual, sometimes youdon't know what to do with the
data once you've got it, right?
(01:40):
And what we'll hear updates,I've seen all of this in
Thanksgiving.
I've done it recently and turnedit into a webinar where they'll
unpack all the big ideas andreal-world examples that many of
us need that lead our ASCs.
And so really good informationon not just the data, but the
story behind the data.
SPEAKER_01 (02:01):
And before you switch us off and you go, I'm
not an ASC, or look, I thinkthere's plenty that other
medical practices and hospitalscan glean from this information
too.
This is not ASC specific,although we talk a lot about
ASCs.
Obviously, that was the primaryfocus, but I don't want to scare
you away from this episode byany means.
(02:22):
So with that, let's jump intothe first big theme that Mike
Scribner laid out at the verybeginning: the data gap.
SPEAKER_02 (02:30):
Those that are born out of independent physician
practices tend to be prettyskinny in how they are
administratively run.
Thus, a lot of times there's nota CFO, there's not a lot of
in-house analyst support.
Um, so there tends to be a tonof data that's available within
all the systems that are outthere, but there's this gap
(02:51):
between this mass of data that'savailable and what kind of
typically gets turned intodecision-making tools within the
practice.
The other problem that we tendto see is that we're in this
position a lot where because alot of y'all run from cash-based
accounting, and so you'relooking at the cash-based income
statement, and the doctors aresaying, I'm working as hard as I
(03:13):
used to.
However, our bottom line andwhat I'm able to draw out of the
ASC side is lower, and or thepractice side, either one, and
it's lower.
And it the problem is that thefinancial statements, as
reported cash basis-wise, tendto be a lagging indicator for
almost all the problems thatyou'd have.
You got a revenue cycle problem,a volume slowdown, some kind of
cash flow interruption, payermix has shifted, and you don't
(03:36):
see it in the month that itoccurs or then month after it
occurs.
You see it when the collectionsslow down later on.
So you're in this positionwhere, or we're in this
position, if we get drawn in onit, where the question is I
think I don't know for sure, butI think volume is basically the
same, but cash is down by 20%over the last 60 days.
(03:57):
What's happened?
And that's a accrual-basedfinancials probably would have
helped with that B.
That's a lot of the issues withrunning financially with the
barometer being the cash basisfinancials.
Our typical question as we'restarting into this.
SPEAKER_03 (04:14):
So, as you heard there, Mike, obviously that in
sugar coat it, right?
A lot of ASCs, they're flyingblind.
We just mentioned there's a lotof data, not sure how to use it,
but at the same time, not surehow to extract, what to extract,
which tools to use, which a lotof times they do not have.
A lot of times they don't havenecessarily the people or the
resources either.
So it kind of leads the questionof if you're collecting the data
(04:35):
every day but not using it, thenwhat's the point?
What kind of time are youwasting by going about
extracting it, but then not ableto interpret at the same time?
SPEAKER_01 (04:44):
I think this is a bigger problem specifically for
those physician-owned centerswhere they don't necessarily
have a big team.
They don't have, say, a CFO oran analyst, or they do have a
CFO who's also one of theproviders.
All I end up is a mountain ofspreadsheets and just a wish and
a prayer that the cash flow isstaying positive.
But hope is not a strategy, notfor ASCs, not for hospitals, not
(05:07):
for anybody.
SPEAKER_03 (05:08):
Yeah.
And as you're about to hear aswell, Mike and I'll will touch
on cash-based financial,cash-based accounting, right?
And so is that how much of anadvantage can that be, or
actually a disadvantage whileyou're trying to steal the ship?
Wouldn't you rather have theradar, if you will, while
steering it?
SPEAKER_01 (05:28):
It's about thinking about what's ahead of you in
addition to understanding what'sbehind, but you can't drive by
looking in the rearview mirror.
You're gonna smash into a wall.
So this is where those decisionsupport tools really come into
play.
But how do we start making thatshift?
That gives us the answer.
SPEAKER_02 (05:44):
Our typical question as we're starting into this is
as I'll get into the next coupleof slides, is not like what will
the system produce.
It's what information do youneed and what questions go not
very well answered or notanswered from a specific data
points underneath it.
And then so, like that lastpoint, um, we run into a lot of
(06:06):
time where there's a data pointthat's available, but there's
not a care there's not acomparison point to it.
So our mantra internally is thatall data has to have some kind
of a comparison point, eitherits own trend, a benchmark,
something in order to determinewhether or not it's good or bad.
It's not and the the one that Iwe tend to throw under the buff
a lot is like net net to gross,net collections to gross revenue
(06:29):
is 32% a good number.
Very hard to tell unless you'relooking at your own trend or you
know what you're charging as apercentage Medicare and you have
a methodology to tie that backto something to tell you whether
or not you're successful or not.
And so it's those are very hardto do.
SPEAKER_03 (06:44):
So, Aaron, as you heard there, Mike's advice on
how to go about gathering andinterpreting such data.
Don't ask what the system canproduce.
Ask what you need to ask whatyou need to know, right?
And so let me ask you that.
You're in the analytics group.
When was the last time youlooked at a report and thought,
you know what?
This time is it tells me exactlywhat I need to act on.
(07:05):
Not too frequent, is it?
SPEAKER_01 (07:07):
No, it's not.
And I kept thinking, boy, thissure sounds a lot like that
famous JFK quote.
And in some ways, that's whatwe're looking at here, right?
So, hey, why is the data tellingme this?
And what do I need to do aboutit?
So, why in this case, like, whyis cash down 20%, but our volume
is staying the same?
(07:28):
That's the sort of questionsthat you need to ask of the
data, and it needs to be able totell you the answers.
SPEAKER_03 (07:35):
Yeah, and another point he hit on that I found
interesting, regardless of thedata points you're looking at or
what context, is how do you knowif it's good or bad, right?
There's got to be a comparisonpoint.
We look at that in our personallives, it can be your lab
results or something along thoselines.
How do you know something istrending well, not trending
(07:55):
well, good or bad or another?
And he touched on the netcollection rate, for example.
Are you doing well or aren'tyou?
You don't really know unless youhave that benchmark.
And I found that to be a goodpoint that might brought up.
SPEAKER_01 (08:06):
You bring up the example of lab results.
I think everybody listening hasgone to the doctor and you get
your lab results back in, andit's either within spec or
outside of spec.
There is that benchmark, thereis that baseline of what is
healthy and you know what youshould be.
You neither want to be too highor too low.
The analogy starts to break downfor sure.
(08:27):
But I think we can allunderstand that when our
cholesterol is creeping up toohigh, maybe we need to start
having less maple syrup on ourpancakes, you know.
But whatever the case is, weneed to be changing something in
our diet.
And the same goes in ourbusiness.
And so, where do you get thesebenchmarks from?
Like in the lab, they have theirbenchmarks, they have what their
(08:47):
normals are, it's peer-reviewed,it's understood.
So, where do you get those thatdata?
Is it your own benchmarks?
There are definitely a lot ofcompanies out there.
Medicare has its own index.
Context is king in this case.
SPEAKER_03 (09:02):
Yeah, yeah.
So far, we've heard from Mikeand Janie about the importance
of knowing why you're pullingthe data, what to pull, how to
interpret it.
We just heard about benchmarks.
Now we're gonna pivot to thenext step of trending, cadence,
timing.
How often do you need the data?
So the daily kind of reporting,weekly, monthly.
(09:25):
From that, you start gettinginto trends.
So we're gonna expand a littlebit on these first couple of
segments you heard with Mike'spoint here about cadence.
SPEAKER_02 (09:34):
I get this is gonna feel like a lot of overkill, but
when we sort of design, again, adecision support function for
folks, whether that's hospital,ASC, practice, what have you,
the question tends to be we whatdo you need to know daily?
What do you need to know weekly,monthly?
And then what do you need toknow more farther out?
(09:55):
We just need to reset yourunderstanding of it, and then
what's ad hoc that you needavailable when you need it, but
you just don't tend to knowexactly when you need it or when
the situation might arise forit.
And so to put some, you know,just a couple of examples with
these, from a cash flowperspective, we I'll go over a
slide or two that from a that adaily cash flow mechanism to
(10:16):
understand where that where westand with the ins and outs of
that.
That feels like something youwould want to know daily.
Yeah, it's a bit of a pain inthe butt to pull together and
maybe you only want it weekly,but that information might be
helpful to know.
A fairly frequent clip from arevenue cycle perspective, where
we are versus benchmarks.
That feels like a monthly kindof analysis and where you update
(10:40):
your initiatives and put sometargets with that and keep that
rolling forward.
And I won't go through allthese, but the the point is that
the replica being able toreplicate the key reports in
some kind of cadence that goesalong with the with the
decisions that you're makingaround all of it, it needs to
that the reporting needs tomatch that cadence.
(11:03):
For example, if you're halfwaythrough the month and you know
that you're way off of the cashtarget for the month, then what
information do you need to knowwhat's going wrong for you to do
something about that?
And that's what this is isintended to at least show
(11:51):
examples of.
SPEAKER_01 (11:52):
Mike talked about matching your reporting cadence
to your decision making.
So ask yourself, what do I needto know daily, weekly, monthly?
So think about it from abudgeting standpoint in your own
life.
How much money do I need to havetoday to go to the grocery
store?
But overall, over the week, howmuch money am I going to be
(12:14):
bringing in monthly, et cetera,paying all the bills and that
sort of thing?
So think about it from thatstandpoint.
SPEAKER_03 (12:21):
And we all log into portals now.
It doesn't matter theenvironment personally or coming
from the health systembackground.
There were daily reports wewould generate, weekly, monthly.
You heard Mike talk touch on thedaily flash report.
That stood out.
And it's it feels like yourASC's heartbeat, right?
You're tracking all the key dataelements so you know where
(12:42):
things stand on a daily basis.
So every morning you come in,you look at the report, you're
able to see the cash flow, thecharges, AR days, volume.
It's all set up.
And that shouldn't take but afew minutes.
After you're used to looking atit, those daily reports, you
know exactly what you're lookingat and you're moving on in just
a minute or two.
But it gives you that real,up-to-date pulse of the day of
(13:02):
your practice.
SPEAKER_01 (13:04):
Yeah.
So let me ask you this, Jason.
If you were bleeding out, wouldyou wait a month to go see your
doctor, or would you want tostop that bleeding right away?
Again, same sort of deal.
You want to find out right awayif you have a major problem.
You don't want to be 30 daysbehind understanding that you
(13:24):
have a problem.
You need to stop that bleedingnow.
You need to address the rootcause as soon as you can.
SPEAKER_03 (13:30):
Yeah, exactly.
It's like checking your vinyls.
You mentioned you don't wait foryour annual physical, you want
to know if something's wrong,you monitor it daily.
And over time, we've seen thatreport again, whether it's ASC
or hospital, you start gettingused to knowing, okay, on
Mondays or Tuesdays, we cananticipate cash flow lagging
because of the weekend, thingsof that nature.
So another great point by Mikethere.
SPEAKER_01 (13:50):
A fun fact if you don't step on the scale, you
don't actually increase inweight.
Just thought I would drop thatlittle knowledge bomb there.
But at the end of the day,having these tools is going to
help you better predict the mostimportant line in your
financials, and that's thebottom line.
And so you need to know whatthat is.
I think everybody, whenever youpicked up any kind of financial
(14:13):
report, it could be pages andpages.
Where's everybody flipping to?
They're flipping to the lastpage.
They want to see what is thatlast line, how much money is in
my bank account at the end ofclose, at the end of day.
That's important.
And you need to try to be ableto predict that.
And these are the tools thatMike was talking about that can
help you get there.
So, speaking of getting there,let's talk about the
(14:35):
forecasting.
SPEAKER_02 (14:36):
One of the things that kind of tends to is an
extension of the point I wasbringing up before, that the
doctors getting them tounderstand where the cash flow
sits, when distributions mightbe able to be done, and being
able to project that out withoutjust waiting for financials to
occur month after month and thenjust guess at it at the end can
(14:58):
be done.
And so the point of this is whatif you took your cash flow over
the net last 90 to 180 days andprojected it forward and then
layered into that the largerpayments that you know you have
coming with, you know, takebacks, inflows, all that.
And if you push that out farenough, you can predict when
(15:22):
there's gonna be, you know, whenthere's gonna be money for a
distribution, when you might begoing the other way and you
might need to pull down on theLLC and make that not a we're in
this position, you gotta makepayroll, and so doctors, we need
funding right now.
It's to be able to project thatout ahead of time and come up
with mins and maxes around allthat to give some heads up to
(15:44):
it, as well as keep tabs on ityourself to know what's going
on.
And again, it feels like a painin the butt.
Once it's set up, the dailyversion of it is fairly
straightforward.
You're only updating this maybeonce a month.
And so it's just a matter ofanother methodology, been able
to keep up with it a little bitbetter.
SPEAKER_03 (16:02):
So first few segments, we've worked up from
gathering data, benchmarking tocadence and frequency.
We just heard from like weswitched over to cash flow.
Well, now a bigger pulse checkof your practice than checking
your cash flow, right?
So in that instance, using thehistorical cash flow, whether
it's 90 or 100 days, a lot ofpeople use 90, forecasting
(16:24):
future distribution.
If you do that personally, whywould you not do it on your ASC
here?
So here's a question for you: Are you planning your cash flow (16:29):
undefined
or are you just cleaning youreyes and hoping it works out?
I don't know about you, but ifI'm watching that, I'm gonna be
looking at it prettyconsistently.
SPEAKER_01 (16:41):
There's something to be said by flying by the seat of
your pants, but it doesn'talways work out.
In fact, I'd say most of thetime it doesn't.
Forecasting is going to allowyou to really control the
situation here.
It's everything fromdistributions to your partners,
what sort of capital investmentsare you going to be able to do,
staffing decisions, all of thatbecomes strategic value to you.
(17:05):
So you're now maximizing yourdollar.
It doesn't make sense to run outand buy a new CT scanner if
you're not doing CTs.
So take a look at that and beingable to better understand and
spend your capital in a wisemanner so you get it back over
time.
SPEAKER_03 (17:22):
That's right.
That's right.
You had a whole nother point ofkind of peeling the underback
behind issues, right?
If you're seeing cash flow notmaking sense, do you have a
volume issue?
Do you have a scheduling issue,or what you're going to hear up
next that we often find is youmight have some underlying
revenue cycle issues.
So it's just another report thatacts like a layer, if you will,
(17:42):
to give you that radar of what'sgoing on.
But other things happeningunderneath.
All right.
So as you just heard there, wewent to cash flow review, right?
So Mike talked a lot abouthistorical cash flow, 90, 100
days, whatever your progress maybe, most usually using 90 to
forecast all those cash flowdistributions.
Not only are you trying to lookat where cash flow might be, but
(18:04):
the underlying issues that maysit within that.
So the important question (18:06):
are you actually watching your cash
flow, or are you just hoping itworks out?
SPEAKER_01 (18:14):
Flying by the seat of your pants works out
sometimes, but it's not a goodstrategy.
At a minimum, forecasting isgoing to allow you to take
control.
It allows you to take control ofthings like partner
distributions, what capitalinvestments you're going to do,
staffing decisions, all of thosebecome important key strategic
factors that you can plan for.
(18:35):
Think about the capitalimprovements.
Does it make sense to invest inequipment if you're not really
doing many of those procedures?
So this allows you to be morestrategic.
SPEAKER_03 (18:47):
Yeah.
Good point.
Good point.
And not only that, but helpfinding other underlying issues
as we were just talking about.
So do you want to lead to theissue or kind of react to the
issues with the cash flowstatement?
You get that good basis, a goodfoundation that you can start
peeling that onion back andrealizing do I have some
contracting issues, volumeissues, or as you're about to
(19:07):
hear from Janie, potentialrevenue cycle issues.
So let's listen to the segmenthere by Janie on revenue cycle
and benchmarking.
SPEAKER_00 (19:14):
If you're going to benchmark, we have to have some
sort of target.
And for most practices, somespecialties are a little bit
different, but indexing toMedicare in some mechanisms
should give us a sense of kindof the overall performance.
We don't want to be paidsub-Medicare, but trying to
match up each and every singleservice that we deliver to an
(19:35):
actual Medicare reimbursementmethodology can be very
cumbersome.
So our method of doing that is amatter of indexing.
So you know, to walk throughsort of the quick math of that,
if Medicare pays us 50 cents forwhatever we're doing and Blue
Cross is paying us 75 cents,then we would say we're getting
150% of Medicare for Blue Cross.
(19:56):
And so that's going to give usthat benchmark because our
charges are consistent, ourreimbursement should be
relatively consistent.
Our patient mix and the servicesthat we're delivering should be
in a lot of cases veryconsistent.
Of course, all of those thingscan change it and can skew it a
little bit.
So we have to know our book ofwhat we're delivering.
SPEAKER_01 (20:16):
Now that was, of course, Janie.
She took control of thesituation and showed us how to
benchmark payers using Medicareindexing.
Again, going back to that pointabout what are our thresholds
here?
What is good cholesterol?
What is bad cholesterol?
And looking at things like BlueCross, which is typically 150%
of Medicare.
So here's the thought Do youknow what your payers are really
(20:38):
paying you compared to Medicare?
So that's, I think, a questioneverybody needs to be asking
themselves.
Use Medicare as your benchmark.
SPEAKER_03 (20:47):
Yeah.
Again, you guys are starting tohear a theme of you've got good
data.
What do you want to tell you?
How do you know it's good?
The benchmark knows if you justsit there and the benchmark in
this case being commonly beingMedicare.
Those again, practice hospitalASE side, it doesn't matter.
But she also referenced, okay,how do I extract which one of my
filters for my extract the data?
(21:08):
And the preference being wealways use data service versus
transaction dates.
Because you just have thattiming of when items are posted.
So why not eliminate thatconcern, pull off a data
service, and then therefore yougot a consistent filter built
in?
SPEAKER_01 (21:24):
From a reporting standpoint, and I do a lot of
reporting.
It is easier to report off atransaction date.
Your data stays relativelystatic, it's less data to pull.
But are you really getting thefull picture?
It is a far better picture ofwhat's happening within your
organization if you're doing byservice state.
So just bear that in mind.
(21:45):
When you're pulling yourreports, pull it by service
date.
Yeah, it means you have to pullfor a longer period of time.
Your reports might be larger, alittle harder to manage, but
it's worth it in the end.
That's right.
SPEAKER_03 (21:56):
That's right.
And so let's pivot a little bit.
We talk about tracking, in thiscase, resolved charges, right?
So what's been paid, what's beendenied, what's sitting out there
in that unknown bucket that wehate that still sits a large
opportunity for us, which bringsus to that next layer of
reviews.
We all use it, and that's in thepayer mix realm.
(22:19):
So let's listen to Janie Miketalk about pair mixes and
referral sources.
SPEAKER_02 (22:22):
The next few slides, we're thinking less revenue
cycle and more kind ofgrowth-oriented within the
practice.
And there's multiple ways tolook at this.
Janie's going to talk in aminute about referral source
reporting and getting at our keyreferral sources and ferreting
out and putting sometransparency on that.
But to back up before that, thethis you know, we tend to spend
(22:46):
a lot of time looking at theparametric adjustments in pair
mix over time.
And a lot of times it's justratifying that things are
basically the same.
But because there are such largeswings between the various
categories, like in the way wehave it displayed here, let's
take it all and let's index itto Medicare.
Medicare is at 100%, MedicareAdvantage will be at 100 to
105%, Medicaid for an ASC willbe 60, 70 of Medicare, and so it
(23:12):
tends to be a third lessreimbursed on the ASE side,
maybe only 10 to 15 on the MDside, but way less on this side.
Commercial can be anywhere from30 to 100% more, so call it 130
to 200% of Medicare.
And so it's wildly different.
And then HIX tends to bell curvearound 30, 40, 50% better than
(23:35):
Medicare.
So 130 to 150 Medicare.
SPEAKER_00 (23:38):
And so then who is driving those revenue shifts and
how can you have some handle onwhat's happening there?
This is looking at our newpatient referrals coming into
the practice.
Sometimes we get really goodinformation on this on the ASC
side as well.
Depends a lot on what data youcap data you capture.
Some practices do a reallyfantastic job of it.
(23:58):
My personal bin, I'll make aplug for putting in NPIs because
those can be cross-walked andyou can get back to individual
physicians and kind of grouppractices.
Had a practice before, put inreferral source is the billboard
on 17.
Not super helpful in figuringout where your referrals are
coming from.
But if you want to make surewhere your marketing dollars are
going, that can be helpfulthere, I guess.
(24:18):
What we're trying to figure outis are there groups that have
been referring to us and ourdownturns in volume are?
Is this a physicianrelationship?
So group one, we've got somegreat referrals here, and then
all of a sudden we're trendingfurther and further down.
This is probably an incompletequarter, so we'll pause on that.
But what's happened?
(24:38):
Is that something that's worthour practice manager reaching
out?
Did we have a doctor retire?
Is that is group one now asmaller practice?
And where are their patientsgoing if they've dropped them
from that versus some others?
Overall, we've got somedownturns, but wanting to keep a
finger on the pulse of who'ssending us things because that's
ultimately going to be thelifeblood of the ASC.
SPEAKER_03 (25:01):
Again, reviewing the data, pulling it back.
If even if when your volume isconsistent, nothing is jumping
out to you, that shift in payormix will definitely jump out to
you, right?
It's gonna wreak havoc on yourrevenue and you're gonna know it
pretty quickly.
Again, going back to projectionsand benchmarking and knowing
where things should stand.
So if Medicaid's paying 70% ofMedicare and your commercials
(25:25):
are in the upper 100, 160, 170%.
How has that changed now thatyou're going back and looking at
data?
What's it saying today orlately?
SPEAKER_01 (25:36):
Exactly right.
And think of it this way, right?
The this is crazy.
This kind of breaks my braincoming from the retail world.
You may be busier than you werebefore, but your revenue is
dropping.
All because your parameticshifted, right?
You could be shifting and doingmore Medicaid patients, for
example, which is the 60, 70% ofMedicare, and you're doing more
(25:59):
cases than you're ever doingbefore.
But if your commercial payersare paying$13,200, like boy, you
got to do three or four Medicaidpatients to equal one
commercial.
So you may be busier than youever thought possible, and yet
your revenue is still falling.
SPEAKER_03 (26:15):
Yeah.
And in this day and age, too,when payers are coming into the
market, they're coming out ofthe market so quickly, and ebbs
and flows of it.
You've got different networksevolving.
It's not a stagnant of a lineitem on your reports as it used
to be.
You knew payer mix.
Now it's going to ebb and flow.
So it's really important to keeptrack of.
(26:36):
Another item that Jamie touchedon, the pivot that she referred
to is referral source.
We always look at this,especially without migration
type pattern.
So another important elementthat Jamie touched on was
referrals.
You and you do this for quite abit for us, Aaron, pulling NPI
type data.
And what we're trying to doagain is seeing who sends what
(26:58):
where, basically.
SPEAKER_01 (26:59):
Yeah.
It is really important.
And I think most EHRs do an okayjob of tracking this, but I
think most clinics don't do agood job tracking it.
Instead, they're putting thingsin saw a billboard or Googled
it.
That's not useful information.
What is useful information iswhat providers are sending you
(27:21):
patients, right?
At the end of the day, that'smore important.
So if a provider stops sendingyou patients, do you know why?
Did they retire?
Did they move practices?
Or were they dissatisfied withpatient outcomes coming from
your ASC?
All of those things areconversation starters, but you
(27:41):
only get that information ifyou're collecting that
information.
So if you're not sure if youare, or if your EHR supports it,
I'd certainly find out and getright on that, or find some
mechanism maybe outside of yourEHR if it's if it's not built
in.
It's important to know.
SPEAKER_03 (27:58):
Absolutely.
And once you know who'sreferring what, it's a great
time to go have thatconversation with that other
practice facility about how youcan do more with them, build the
relationship, become more of areferral source.
And on the flip side, who's notreferring patients to you that
you think we're friends of thefamily?
(28:20):
It allows you to have thatconversation with concrete data
versus just a feel of thevolume, right?
So another important data pointbrought up Pajani, and then
going into profitability.
A lot of times you can doprofitability by service by
referral source, whatever thecase may be.
But look, she's going to touchon more here, her or Mike, both.
So let's listen to the segmenthere.
SPEAKER_00 (28:40):
So this first version that we're going to look
at is our a litany of servicesthat we're rendering, what are
average cost of implants?
And this is all very rolled up.
But what is the averageincremental contribution to the
facility of doing these sort ofservices?
And so if we've been doing thisand we're seeking to project out
(29:00):
what cases do I already have onthe books, what cases do I
anticipate?
What is that going to do to myprofitability overall for the
group?
Really a neat way of looking atit.
Are these, are these perhapscases we might need to consider
shifting to a hospital so thatthey may have better
reimbursement, they may havebetter better implant
negotiations, but at the veryleast, we're not losing money on
(29:22):
the service.
Or is this very minimal comparedto some of our other profit
lines worth keeping ourphysicians happy?
A lot of physicians prefer towork in the ASC because of the
convenience, the ability tocontrol kind of their
environment and theirscheduling.
But letting Dr.
A know these aren't really greatcases for us to be doing here
and they're costing us money isworth a discussion, especially
(29:43):
as you get into some of thoseother dialogues about draws and
how they're seeing profitabilityand how they're seeing things
produce revenue for them intoindividually.
SPEAKER_01 (29:53):
Profitability analysis was yet another
highlight.
They showed us how to assessincremental contributions by
payer type and by service type.
So here's a real question foreverybody listening: are all of
your cases profitable?
And do you know for sure?
SPEAKER_03 (30:14):
It's an important question, right?
So not only that, if you're atcapacity and you need to decide
which ones to prioritize, you'reobviously you want to prioritize
those on the higher margin side.
And maybe there are some thatare actually better off at the
hospital versus in your client.
But how would you know thatunless again you looked at such
reports?
SPEAKER_01 (31:06):
Yeah.
And we now know this, thanks toall the transparency data,
right?
ASCs are only getting paid about30, 35% of what hospitals are
receiving for doing the sameprocedures.
To maybe your more medicallycomplex patients, those that
might need a higher level ofcare anyway, they would do okay
(31:26):
at an ASC, but they would dobest at a hospital.
And it's a low profitability.
I think the decision there iseasy.
Of course, we don't want tocompromise patient care.
We're not saying that at all.
But what we are saying is thatif a call needs to be made,
they're on the side of thehigher profitability cases.
SPEAKER_03 (31:45):
That's right.
And again, you've got now you'vegot more data points and which
to go negotiate with.
And so if we all see the samereports, ASCs have become
traditionally more efficient,higher quality, less costly.
And now that you got thisinternal data that goes along
with this industry-wide trend,you've got a lot more ammo to go
(32:08):
to negotiate on your contracts.
SPEAKER_01 (32:11):
Oh, yeah.
It's all about the leverage.
And making the most of yournegotiation with your payers is
huge.
If you come into that roomprepared, yeah, I would say 90%
of the time the pair goes in,they slap their final and best
offer down on the table, andthey walk out smelling like
(32:32):
roses, and you're left holdingthe bag.
But if you come in and you haveyour own spreadsheets, you have
your own evidence, you have yourown proof, man, that makes for a
much different negotiation.
I think a lot of people leavemoney on the table because they
don't come in armed with thedata.
So speaking of money left on thetable, let's not forget patient
liability and denials.
SPEAKER_00 (32:52):
Patient liability collections.
And this is again, a lot of thisis internal reporting that we've
developed.
Most systems provide some metricto allow you to see how you're
collecting on things.
We choose to group these in kindof all of our self-pay patients
after insurance, is how we'relooking at this particular cut.
And what we're looking at arethe total charges month by
(33:13):
month, again, date of servicedriven, what we estimate the
final patient liability.
So these are based on thediscount percentages that we're
seeing, the what's actually beenadjudicated, what's sitting
there as we get into morecurrent months.
This is going to be some ratioof percentages to that to
anticipate it.
And what are we seeing ascollected up front?
Is it this portion is dated, istransaction based.
(33:37):
So that we're looking.
Did we collect that while we hadthe patient in hand while they
came to the ASC?
Did we collect it before thesurgery was scheduled?
And we can see very real dollarsdropping.
Charges are down ever soslightly, but not enough to
warrant that.
These sections here that are inthis bold italic are projections
(33:58):
of where we think our finalcollections are going to be.
And then this is really helpingus try to identify where are the
breakdowns in our process ifthings are changing.
We've got some improvement incollections in our 30s, 60s,
probably after first set ofstatements have gone out.
Do we need to consider an earlyout vendor?
Are we sending things to baddebt?
But what are we projecting asour total completion?
(34:19):
What are we projecting as ourtotal patient cash collection
and ultimately what amount ofour total allowed?
Because you spend a lot of timenegotiating contracts and trying
to get better contractualreimbursement.
But if you don't go after everypenny that you're due, then
you're leaving, you've done allthat work on the front end,
which is a very difficult workand very time consuming.
(34:43):
But this is all due to poorplace of service collections.
The flip side of this is whatare the things that are being
paid at 100%?
And again, we're looking at nocontractual adjustment.
We've got either a fullinsurance payment for that, or
the insurance has paid somethingand the rest of it is sitting in
patient liability, which we mayor may not collect, but is
(35:04):
something going on with ourcharges?
As Mike said earlier, net togross charges can be a false
metric.
Contractuals are not, in myopinion, your enemy.
We want to make sure that wehave our charges high enough
that we collect every portion,every penny of what is due to us
in the very best way that wecan.
These items typically look at isthere something going on with a
(35:27):
with the fee schedule?
Maybe the fee schedule haschanged.
We had back in not ASC specific,but again, a physician example.
And that was when we had thelarge change in the Medicare
physician fee schedule.
I had a practice that wascharging 125% of Medicare.
And when those EMs went up, insome cases 25% close to 30%,
(35:48):
they were actually charging lessthan their allowables.
And so they were leaving$25 anencounter on the table.
Again, worth reviewing if you'renot in a cycle of doing annual
charge master reviews and makingsure that you're set at a good
target or comparing that to yourcontract, worth at least taking
a peek to see if there'sanything that's happening.
(36:14):
And then similarly, these areitems where we can look at again
the physician, the particularpayer, and looking where we're
actually seeing.
We collected every single pennyof that.
And why did that happen?
SPEAKER_03 (36:26):
All right.
So there we talked about patientcollections.
Again, a couple of segments ago,we were talking about how some
of these reports weredovetailing into Rev cycle
conditions and issues that youneed to look at.
Well, Janie again touched on akey element there with patient
collections, right?
So many ASCs, as she touched on,collect far less than they
should.
And those in practice in thehospitals, you probably want to
(36:49):
say the same thing.
With the target being that 95%of allowable amounts, the
question then becomes if you'renot at that benchmark, again,
another key word we keep hittingon, where are you?
And what amount of money are youleaving on the table if you're
not looking at it in that way?
SPEAKER_01 (37:09):
I need to find all these tables, the money's being
left on.
SPEAKER_03 (37:14):
Used to be trees.
I guess it's tables now.
SPEAKER_01 (37:16):
Yeah, I guess it's tables.
They were all cut down andturned into tables.
Janie recommended using ourprojections or your projections
to identify where the breakdownsare happening and considering
early out vendors or collectedcollection agencies when needed.
SPEAKER_03 (37:42):
So everybody listening to those denials are
like the back of your hand, insand outs of it.
But zero pay encounters canactually reveal a whole nother
set of issues that can dive intocoding or outdated fee
schedules, which of course,Aaron, in your word, you guys
look in day in and day out.
And of course, what we justtouched on before payer behavior
and trends.
So another reason or way inwhich to look at the nials that
(38:04):
Jamie touched on is what'shappening on the market with the
payers.
SPEAKER_01 (38:09):
Yeah, and like the example Jamie gives specifically
about that practice that wasmissing out on EM reimbursements
purely because they hadn'tupdated their fee schedule.
That's money lost.
I see it all the time.
Practices, they send us theirfee schedule, it hasn't been
updated since 2019, which folkshate to break it to you.
(38:30):
That was the better part of adecade ago.
It is time to update your feeschedules.
It needs to be done annually.
SPEAKER_02 (38:37):
One kind of closing comment is that we try real hard
to have education not be likejust trying to sell our
services.
We're trying to put goodinformation out for you guys to
react to.
And so I I hope this didn'tleave you with the impression
that this is all a bridge toofar and that all of these
reports are just like I'd neverbe able to replicate that.
(38:58):
Some of them with some effort,maybe building it the first
time, maybe a little bit, butreplicating it may not be that
tough.
Hopefully, we've left you withsome ideas of reporting that you
can do that might give a littlebit more transparency over the
revenue cycle cash flow, volume,et cetera, et cetera, that you
can react to versus just beingoverwhelmed with the amount of
(39:21):
data coming out of your systemand not being able to turn it
into something that assistsdecision making.
SPEAKER_00 (39:28):
I would tack on to that.
That while the reports thatwe've shown you are the ones
that we develop internally tocoalesce this information, most
DMRs have some form of reportingmodule that should be intrinsic
to that.
And perhaps it's just a matterof digging around in your system
a little bit and seeing whatdata points you can get out.
Because any data and any reportmonitoring is going to be better
(39:52):
than.
SPEAKER_03 (39:53):
All right.
So just to recap, a lot ofinformation.
We get that.
But so many points to hit on.
I recently saw Aaron where Ithink it was in Becker's, where
they're projecting the 10,000 orso ASCs there in the country.
Revenue just in the next fiveyears should go from about, I
want to say 45 billion to about60 billion.
(40:14):
How?
There's obviously a lot ofgrowth there, right?
So there's a lot to say whenwhat's the big picture?
I think it's quite a lot that wecan't get our hands around.
SPEAKER_01 (40:22):
Yeah, no doubt.
And really, this is about takingthe data you already have in
your system and turning it intoa decision-making tool.
Ask the questions of the data,benchmark all the things,
everything, benchmark it.
Align your reporting cadence towhat makes sense for your
(40:44):
organization.
Figure out what you need to seedaily, weekly, monthly, yearly.
Figure that out.
Sit down.
It's going to vary from practiceto practice, organization to
organization, no doubt.
Now, there's going to be somethings that are pretty much the
same across the board, but whatis interest to you is going to
change.
And be willing to change yourreporting cadence too as your
(41:07):
organization grows.
And finally, use thetransparency data to your
advantage.
The data is just sitting outthere.
You just have to go get it.
It takes a little bit of work,takes a lot of bit of work,
actually.
It's something I do all thetime.
And not to pitch ourselves toohard, this is something SHP can
do for you.
SPEAKER_03 (41:27):
Yeah, good point.
Don't be afraid to ask.
It's no dumb question sort ofapproach when you're talking
about what data you should bepolling, how, why, when, where,
and that sort of thing.
So, my my I guess summation of aquestion, I guess, at the very
end is if your ASC indeed hadall the data, you love your EMR,
you love your practicemanagement system, but have you
(41:48):
ever asked, would you changeanything when it comes to
reporting?
What are you not getting?
What do you not know?
Maybe that's the question youshould be asking.
SPEAKER_01 (41:59):
Yeah, that's a great question.
And I think that's a perfectplace to leave it, Jason.
Everyone, thank you for joiningus for this recap.
We know it was a lot.
You can go to our YouTubechannel, maybe where you're
watching this, and you can watchthe whole 50-minute webinar
there.
Or go to our website, shplc.com.
(42:19):
You can reach out to us if youhave any questions, or you want
us to help you with yourreporting.
We're happy to help.
And until next time, keep yourdata working for you, not the
other way around.
We'll see you, Jason.
Thanks, guys.
Thanks, everybody.
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