SIMITREE
PODCASTS

00:00:00

Wayne: Hey good afternoon everybody. This is Wayne Regan. I'm the managing director for SimiTree. Today I'm fortunate to have a colleague of mine, Cynthia Sikina, with me. Cynthia is the VP of financial strategy. We're going to talk a little bit about the industry, how we support our clients, how we can bring in some interim leadership to them, some of our experiences that have gone really well, and some that we're going to share that maybe haven't gone that well and we can improve upon them. But I want to introduce Cynthia and Cynthia, do you want to tell them a little bit about your background and what you do?

00:00:32

Cynthia: I am all finance from, I think, the day I was born, but I have served in CFO roles in industry mostly. Most of my career has been in health care most recently. The last 10 or 15 years has been fundamentally in the behavioral health space. Uh, so. Yep.

00:00:53

Wayne: You know, you mentioned behavioral health. SimiTree has been in the post-acute space for over 50 years, and we started out that way. Over the last couple of years. We've been growing quite a bit into that behavioral health space. Could you kind of clarify for folks what that really means? Because there's a, I think, a mystique or an unknown that's out there, what does it truly mean and how do we help our clients?

00:01:17

Cynthia: Right. Well, behavioral health is it is a specialty within health care, just like you have ophthalmology and surgery. There is behavioral health. It is psychiatric services. It is the services of psychologists and advanced practitioners, your social workers. The services range from your individual and group therapy to substance use disorder services. A lot of behavioral health agencies are in the autism space. In addition to behavioral health. And then there's a lot there's a whole service line, if you will, called child and family, which is foster care, adoption, and family preservation. So again, it's a broad range of services that actually have a lot of unique and challenging billing requirements, which is why you have electronic health records specifically designed for behavioral health because it is its own animal. It's a very and again, and you don't realize it if you've been in it your whole life. But I started in physical health, and so I saw what I thought was complicated. And then I moved into behavioral health, and I realized what I was in before. It wasn't so complicated. So it is some and I think that's why when

you are providing CFO services in the behavioral health space, having some understanding of the revenue cycle and its, you know, best practices and how you interpret billing data, it's an important piece to bring to the equation. So I know that's what a lot of our clients value when I'm serving in that interim role is, again that behavioral health understanding the revenue cycle space. So. It is it's own. Like I said, it's.

00:03:16

Wayne: Yeah, it's an old saying of mine. No margin, no mission. Right. So if we can't get paid for what we do, which is extremely important. But, you know, let me back up just a little bit. You know, you mentioned revenue cycle and I know that's your expertise. But what we do is we do a lot of things that we provide not only CFO roles like you fulfill, but we do CEO roles all the way down to that clinical leadership. Recently, we worked with an organization that's going through an acquisition, and they've acquired another entity, and it was something that they weren't used to at Child Services. And one of those Head Start programs, which is a fabulous, fabulous program that's out there. And so they're looking for somebody that can come in. And I know you worked with them on that, that that expertise on the back end helping integrate systems, integrate IT systems is systems doing that cost-benefit analysis of a merger. So bringing two large organizations together takes a lot. So tell me a little bit about your experience when you come into an organization and come in as that interim leader and provide that guidance and support to whether the CEO or down to that director of Rev Cycle or that that controller level.

00:04:32

Cynthia: That's interesting. I was going back and thinking about what were the circumstances under which my services were needed. Right. And in most cases, it's been because as much as I hate to say it, a vote of no confidence in the Chief Financial Officer. Financial. There's been financial challenges, things like that. So it's usually in where I'm stepping in where they have lost their CFO for one reason or another, and it's normally not retirement. Let's just put it that way.

00:05:02

Wayne: I would just say it's.

00:05:03

Wayne: Usually not a good.

00:05:04

Cynthia: No, it usually isn't.

00:05:05

Cynthia: So really the role first and foremost is providing some stabilization, making sure that nobody, you know, there is no disruption in their financial deliverables. Again, keeping the team intact. So really it's about again, stabilization. Restoring the confidence in the board is another key goal, if you will, in serving in this role. And a lot of times it's a matter of implementing cash flow forecasting. Because guess what? They lost sight of cash, right? And now you bring in a cash flow forecast. And it's like wow. She really has her arms around us. She knows where we're going. She can, she can.

00:05:47

Wayne: It was all about the deal. Exactly.

00:05:48

Wayne: The deal closed and they forgot. Oh, we've got to keep payroll going.

00:05:50

Cynthia: Exactly.

00:05:52

Cynthia: So I think the fundamental things are again that stability, ensuring deliverables are flowing timely, accurately, and accurate financial statements. A lot of times you're walking into the middle or the start of their annual audit. So there's a whole nother, you know, exercise of making sure that you get a clean audit opinion. I'm helping in a large organization here in the state of Michigan that is divesting of its senior living facilities. So it's helping with those working towards the closing date and getting all of the payoff notices. I mean, it's it's again something that doesn't happen, you know, every day. So again, concentrated effort on some of their key strategic priorities and again, helping with moving those initiatives forward. So most of the time I'm involved when there are strategies and.

00:06:47

Wayne: Yeah, but you just mentioned financial strategy. And I know that's something you're very involved with. And it's not always that you're going to acquire something. You may want to divest something because it's a loss leader at that point. And I think you're referring to one right like that. So what are the expectations of the client when you come in? Is there a scope of work that you're you're you're working with?

00:07:11

Cynthia: What I'd like to do is get a clear outline of their key priorities so that. I am meeting their expectations. I know what's important to them, so that's where I can focus my energies in addition to keeping the financial operations, you know, humming along. So it's it's because, as you know, these organizations are complicated. They always have a million balls in the air. And it's like, which ones are the most important not to drop? So it varies by organization, but it's truly that. The other thing that has come up in every single engagement is that a lot of times the actually every time the finance team seems to function in a vacuum, when in fact, the programs, the programs, the clinical programs in these organizations, they really need to work hand in hand with finance so that they both can understand why each party either needs certain information or is. So it's really that creating that collaboration between finance and the programs that I have found has been extremely valuable to the organizations I've been helping. The most current one that's selling off its senior living facilities. It is so clear there that there is no communication or effective communication between finance and their programs. And it's like, I have a schedule here and a schedule here. Two different parties prepare them and they say something completely different. I'm like, okay, where's the somewhere in the middle? It's the truth. So I think working collaboratively with the program so that they understand why accounting is such a pain in terms of, hey, I need this information. I need you to code these invoices. I need data and understanding from their perspective of how the program functions. And that's where I find a lot of organizations fail: it's from an accounting perspective, they don't take the time to understand what drives the program. How they provide their services. Who provides the services because they can't appreciate their perspective without understanding how those programs work. So if I was going to when I onboard a new CFO, which is usually the tail end of an assignment, is not only have I served as interim, but I usually help with the selection of the new CFO, and then I stay involved as part of the transition plan. Absolutely. And the first thing I tell them, it is number one on the list. Go to every location and learn about the programs. Learn about the services that this organization provides, because it gives you the context that you need to make sense of financials and what drives margin in a particular program. So it's you know.

00:09:58

Wayne: I've only been in the industry a short period of time on this side of the house. It seems like there's multiple systems and a lot of systems aren't talking to each other. Am I correct in saying that?

00:10:15

Cynthia: Well, and it's changing though that is changing over time. Technology has gotten better, but that is still somewhat significant in these organizations where you have you may even have multiple EHRs, like one of my local clients here, they have an HR that they use for their behavioral health business. They have an HR that they use for their clinic because they're providing integrated care services. Right. The big buzzword now, you want to look at folk's mental health, but you also want to look at their physical health. So those physical health services are captured in a separate HR. And no one appreciates what that means for accounting. It's not easy. So and they don't. And those systems don't talk to each other. Usually most of your payroll and general ledger systems, they will all integrate. There are a lot of integration improvements that have taken place over the years. So you don't have to worry about that as much. But there are certain programs. Autism is one and foster care is another where no EHR does a great job of helping the organization meet all the documentation needs and the reporting needs of a program like that. So usually there are separate systems where they're documenting their services. And again, there's this juggling act, or coordination and redundancy. Yes. And the payers don't make it any easier. Sometimes you have to enter information into their system as opposed to sending in a claim. That's a very common phenomenon in behavioral health billing. It's not what you think. It's not always just "send a claim to the payer." So yeah, it's believe me. Oh, it has it. Yeah. So again in in that interim role, you're trying to keep all of those processes moving forward in addition to producing, of course, timely accurate financial statements a clean audit as I mentioned, you know, and any of these strategic initiatives helping move those forward.

00:12:22

Wayne: So besides the financial support that we can provide for organizations, it sounds like we do a lot of technology support and integration as well. Is that fair to say?

00:12:37

Cynthia: Assessments and evaluations and analytics, big topic, big thing. These in today's world. And so important because data-driven management decision-making is really important in terms of making sure you're making decisions based on the right information. And since these systems don't talk to each other like the analytics platform we use allows you to pull data from multiple systems into a single database. So you can merge general ledger data, which guess what has all your cost information. Oh, but your EHR has all your service volume information. Oh guess what? I can figure out the cost of my services now because we can grab that data from both systems. So it's it is a very powerful tool. A lot of your ears are now building analytics within the product that they deliver. And they're pretty high-level analytics. But they're you know, it's a good place to start. Um, but the analytics platform that we use and the service that we are the product, guess that we want to call it a product. It's again, we try not to leave data at your doorstep. We actually help you develop the dashboards in addition to the standard dashboards. It's okay. Now let's make them work for you. How can we make these work for you? Right. And that's what happens in the EHRs that they don't do. They literally leave data on your doorstep. And you have to figure out, you know, what should I pull. What view should I what view works for me? So it's but analytics because of those separate platforms that don't necessarily talk to each other, you really have to have a way to pull that data together. And most organizations, when I do a rev cycle assessment when I'm just looking at their revenue cycle, organizations that have that data at their fingertips are usually more successful. Their KPIs for rev cycle performance are better because they can keep their eye on blips that need their attention. Oh look, my my denials for authorization just spiked. Why is that? What payor. What service? Oh, wow. What? What happened? So giving folks access to data helps them keep their eye on the blips that that need some attention. It's a fund and a fundamental or phenomenal tool, I should say. I remember one of our Kentucky clients when he first got access to the data. His quote was, I feel so empowered.

00:15:08

Cynthia: It's a classic line and it's true because otherwise it's like you're running the business blind.

00:15:15

Wayne: So right now I agree with you. And you know, it's interesting when they can do that. I've always had a phrase in a couple of other organizations that have used it. You can't manage what you can't measure. And so if you don't have that behavioral health analytics and the medical billing and the credentialing, that also goes with that to get paid appropriately, that won't roll into your financial and your PNL reviews that you can then make good decisions about.

00:15:45

S3: Absolutely.