Beyond Healthcare Compliance with Joanna Lambert, Director Healthcare Consulting & Advisory

Joanna Lambert:

Thanks, Tony. Thanks for having me on. So I'm Joanna Lambert. For your audience that doesn't know me. I'm a Director of Healthcare Consulting and Advisory at EisnerAmper based out of our Boston office, focusing mostly on the New England market, but we've got clients all across the country. I've been in this role for almost three years, and before this I was doing contract consulting for other Boston healthcare organizations like community health centers. I started my career in finance actually at JP Morgan for many years. And then after that, about 10 years ago, I started working in the healthcare sector specifically. So I spent some time at Boston Children's Hospital, Boston Medical Center in a variety of finance, analytics and operations roles.

Tony Davis:

Well, let's talk a little bit about, as you've come into the consulting space the last few years, what are some of the key areas with your background and with the Eisner team that you work with that you really focus in on? Is there some key categories that are really part of the work that you guys provide to a lot of your clients?

Joanna Lambert:

Yeah, good question. Sometimes I joke like, what don't we do? Because our team are generalists, so we help in a lot of functions, but I always say that healthcare consulting lives at the intersection of finance, operations and strategy. So it's really bringing those three things together. And personally, I love using the business lens, but also marrying that with patient care and public health needs of our clients.

Tony Davis:

I think we find a lot in the physician space particularly, there's a challenge between the focus that the providers bring to the table, which is their education and backgrounds about providing the care they enjoyed bringing to the patient and the need that they're serving with the business side of it. And that's a challenge that I think a lot of the practices that we work with a lot find. And so let's talk through each of those a little bit. You mentioned finance. I think that's one that's for both of us a sweet spot. Talk about a few things and specifically in the finance space that you see that some of our audience might be interested in learning about.

Joanna Lambert:

Yeah, sure. So I think one big area is all things compensation related. So our clients look to us to help design physician compensation models and help structure those offers to their providers and also to their executive team. But on the physician side, that can really include what their base compensation is like, what sort of bonus structures they have for productivity or quality, other types of benefits that they may offer them, and how they're measuring those too. Is it work our views? Is it the volume of patients seen, or is it outcome based?

Tony Davis:

Yeah. So quickly on that, what sort of tools do you use to bring a market comparative to that? Or obviously there's some confidentiality that kind of comes into play there. So talk me through that a little.

Joanna Lambert:

Yeah, that's a great question. So we do use a lot of market data, and Eisner has the advantage of having subscriptions to a variety of great resources where we get more healthcare data than your average person might have access to. So we can use that, because we serve so many physician groups and similar healthcare organizations we also have access to a lot of proprietary data that we can leverage and use in a blinded fashion to drive our recommendations. And then of course, we work with the clients to tailor something to what they think suits their business needs.

Tony Davis:

And again, just thinking back to some of the corporate structures of these clients such that some might be nonprofit, so there's rules and regulations around that. Some might be solo owners, some might have a large partnership where there's many owners. I'm assuming that's an area that you have to walk through those potential landmines that might come up, and then the communication back to providers about how these models work. That's a trick at times too, right?

Joanna Lambert:

Yeah it is. And it's funny because sometimes we'll do some modeling or projections on what it might look like based on their receipts and their profit margins and where they may land. And you make a good point about regulations and also tax structure. So it's so wonderful that we've got tax professionals on our team so we can talk with our clients about the difference between an S Corp, a partnership and other entity types and how that affects the compensation model.

Tony Davis:

For sure. So staying on the finance track just for a little bit longer, we talked a little bit about benchmarking, again, an area that I think we have a lot of strength in and have great access to. But walk me through that a little bit and maybe that delves a little bit more into the accounting pieces and the profit and loss analysis and some of the overhead work that we do. Talk me through some of those sorts of scenarios for you guys.

Joanna Lambert:

Yeah, so I always tell clients it's really important to keep a pulse on your financial activity and your billing activity. So we really like to help our clients benchmark. It's such a good exercise and it's not limited to salaries we were just discussing, but also our staffing ratios, volume. But really as you mentioned, looking at our revenue and expenses and where they are to market for healthcare organizations and expectations. So that could be what's your total payroll relative to revenue? How much are you spending on your rent, your medical supplies? So really fixed and variable costs and making recommendations for potential cost savings or revenue enhancements.

Tony Davis:

And those often tie those analysis into the comp formula too, because we see a lot of the comp formulas designed around overhead and what's a direct expense, what's a variable expense? And I think those marry out very nicely together.

Joanna Lambert:

That's right.

Tony Davis:

Yeah. So let's jump into operations a little bit. Let's maybe touch on a couple of things there that your team and your background is sort of exposure to in many times.

Joanna Lambert:

So we have myself, but several of our team members come out of industry. So we have folks with practice management experience, which just allows us to do all kinds of operation support. We help with human resources, challenges, documentation, hiring support. We often come in and practices approach us and say, "We need to do some restructuring. Can you help us look at do we have too much administrative burden? Should we be outsourcing this function?" Really stepping back and looking at the business side of the group. And then also I would say we really assist with anything that you might give to your CEO, CFO. So for example, let's say a client wants to go with a new vendor that's critical to the practice, their IT consulting or their REM cycle company. We can help identify those vendors, vet them, negotiate the contracts and implement them.

Tony Davis:

Yeah. You touched on an item that I think we've seen a lot of in the space I'm working in as well, and that is sort of fractional leadership or fractional C-suite roles where a particularly physician practice might have this scenario where they probably aren't maybe of the size that they might need a full-time, CEO, CFO, COO or whatever title you want to give it, but they definitely need someone to be in that higher level of management within their organization. And then also, interim roles as they're moving from one leader to another. So talk me through some of those roles that you guys have played for your clients?

Joanna Lambert:

Yeah, we love doing that because one of the things that I think separates us is how well we know our clients and their businesses. So when we get to play that role, we know the business even more intimately. So an example might be we've got a large ENT group where we serve as the fractional CEO. They don't really need somebody full time, but we get to partner with their on-the-ground management, so their ops manager, their billing manager, and help them improve workflows, really be a resource. And we can also focus on, like you mentioned, the finance and the high level strategy. So for example, debt positioning, cash flow, hiring providers, things like that so that we can work in tandem and they can get the right amount that they need at that strategic leadership.

Tony Davis:

Yeah, wonderful. I want to touch on one thing before we jump into the strategy. You just mentioned that rev cycle think this is an area that as well up in the northeast. You guys have done a lot of work in. In a previous episode where I spoke with Steven Bisciello who runs our rev cycle group, but I think there's some similarities to that and obviously maybe talk about some of the resources you have in that rev cycle space.

Joanna Lambert:

Yeah, good question. So we do all kinds of rev cycle projects or ongoing support. I know Steven talked about this a bit, but really looking at key metrics, doing a full scope review of our clients' revenue cycle health, what are their collection rates like denial rates, accounts receivable balances. So we do those types of analyses and assessments. We help manage our clients that have an outsourced billing vendors. So sort of being that liaison, we help hire.

Tony Davis:

And help evaluate that outsourced billing vendor to see if they're actually doing the job you're paying them to do. Correct. Yes. Yeah.

Joanna Lambert:

Yeah, that's exactly right. And help look at things that our clients may not have taken a peek at for a while. For example, are their fee schedules accurate? Have they renegotiated their payer contracts if that's something they're doing directly?

Tony Davis:

No full circle stuff. And again, as I mentioned, Steven and I went into this in great depth in a previous episode, so please check that out as well if you want to want more information. And then the last area we touched on as far as sort of trying to cover the gamut of services that the Eisner team provides, we talked a bit about strategy and that's a very wide-ranging word. How would you define it, I guess, within the healthcare space around health systems or private groups?

Joanna Lambert:

Yeah, it is a broad term. Strategy can mean a lot of things. I do think of it as the vision for the organization and a little bit of a five-year plan. So where is the organization headed? Do they envision themselves, for example, consolidating with a healthcare system or going to private equity? Have they thought about succession planning for their older physicians? Are they interested in expanding? Do they want to invest in their own ASC? Do they want to open a new clinic? And we really help them with all facets of that. So that could be financial projections, real estate negotiations, really any aspect.

Tony Davis:

Yeah, and I'm assuming you could work across the gamut, again, within the medical space around private primary care groups, specialty practices. Have you worked in the MSO world with the management services organizations? I'm assuming that those... We've seen a lot of growth in that area, especially the last decade or two.

Joanna Lambert:

Yeah, absolutely. We have many clients that are leveraged that two-entity, MSO model or sometimes called the friendly PC for a variety of reasons. We're seeing a lot of entrepreneurs, new entrants to the market starting healthcare organization. So one, we've seen a bit of a trend with our concierge medicine practices starting up, and those may not be by physicians or mid-level providers. This allows them to operate within, you mentioned regulatory earlier, they're compliant with the corporate practice and medicine laws specifically in Massachusetts, but each state has regulations.

Tony Davis:

Yeah, for sure. Well, you touched on, in our time remaining here, a couple of things that are trending in healthcare. I sort of mentioned the MSO world, it's been around for a while, but I think we've seen a lot of more transactional stuff recently. What are some of maybe the top three things that you are seeing in that space right now that you're getting a lot of calls on, maybe the opportunity to speak to organizations about? Maybe pick a couple?

Joanna Lambert:

Sure. Well, I guess just full circle on transaction activity, that's always hot. So in addition to the startups with the MSO model, we're also seeing spinoffs, which I feel like is kind of the antidote to consolidation that we've seen previously. So we've been approached by orthopedics groups, cardiology groups to help them spin off and start their own practices so that they can have more autonomy around the direction of their business and also clinical care. So that's been exciting to support. And then we're still seeing a lot of activity with private equity, especially, I know you have a lot of expertise in dermatology, which continues to be an interest area for private equity firms.

Tony Davis:

Absolutely. Yeah, no, we are working through that and navigating through that. And I think you said there's certain parts of the country have sort of already gone through it and maybe turning a page and maybe back to the beginning again. And you spend a lot of time in healthcare, you start to see things repeating themselves. Other markets in the country are just ripe for acquisition at the moment. So I think one of the beauties of the Eisner team is our geographic reach and the ability for us to be able to work together in those spaces where others have already been through something and are maybe coming out of it, or likewise, folks are going into things and I think that's the wonderful value we bring to the table. You would probably agree with that wholeheartedly.

Joanna Lambert:

Yes.

Tony Davis:

Well, in our last few minutes, let's just talk a little bit about, I think these, a couple other trends you might be seeing. You mentioned labor earlier and hiring and helping groups navigate through that. Maybe touch on that maybe combined with say, outsourcing answers or solutions?

Joanna Lambert:

Of course. So I think everybody knows it continues to be a competitive labor market, especially in healthcare. So we really work with our clients to make sure that they remain competitive so that their offers are at the right salaries or rates, their benefits are comprehensive and they're considering flexible options, for example, letting triage nurses work remotely as opposed to in the practice. Similarly, we're really seeing a lot of outsourcing and globalization in healthcare ancillary and support services. So examples might include virtual medical assistants, scribes, billing companies, of course, and accounting. Not to toot our own horn, but why we're seeing this I think is the healthcare industry is trying to be more flexible, especially when we're looking at cost reduction opportunities. And depending on the size and nature of your business, it can make more sense to say, "Okay, my whole call center team can be offsite at a lower cost point." So we're really seeing a lot of that happening today.

Tony Davis:

Well, I think you touched on that a little bit, is being creative, offering solutions that you might think are outside the box or odd in some cases. You mentioned dermatology. We've seen a little bit of that in the scheduling call center business where they've taken that to Colombia and offshore that to countries where that price point might be a bit better. But there's also great work ethic and a very nice fit within an area that is a challenge for most practices with turn over. And so it's a nice balance, but thinking a little differently, I think that's where I think I enjoy the consulting work we do because we can be sort of a little bit more intimate, innovative, if that's the right word.

Joanna Lambert:

Yeah, I think so. And also we offer a fresh perspective because coming with an outside, we know we're an objective. And I know I mentioned this earlier briefly, but I do think because our healthcare team is so dynamic in that we have accounting, and bookkeeping and tax and consulting really all together, we can really act as an extension of the practice and give them that expertise they're looking for.

Tony Davis:

Yeah, I think that is as well said as anyone could do it. So I thank you for that. Well, we're going to finish on that note. I think a great place to stop. I really want to thank Joanna for being part of this podcast today. It was very informative. I'm looking forward to doing some more episodes with you on some of these subjects that we touched on today and maybe greater depth. So Joanna, thanks so much for your time today.

Joanna Lambert:

Thanks, Tony. This was so much fun. Thanks for having me. Appreciate it.

Tony Davis:

Well, thanks everyone for listening today. I want to point out that you can find our podcasts in a couple places. The website, the EisnerAmper website, EisnerAmper.com/insights, you'll find it there. And also on your favorite podcast platform. We're hitting the world with Spotify, and Apple and YouTube now. So look forward to sharing the word to your colleagues if you enjoyed what you home today and look forward to bringing this content, more content to you down the road here. So thanks Joanna again, and look forward to the next episode. Thanks everybody.

_{Transcribed by Rev.com}