One Physician’s Exciting Journey from Clinician to Executive Entrepreneur

Transcription PNC Podcast Episode 424

One Physician's Exciting Journey from Clinician to Executive Entrepreneur

- Interview with Dr. Heather Signorelli

John: Today's guest has tackled and conquered really several goals during her relatively brief career, at least compared to some people I've spoken with. She's a young physician. Anyway, she's been a clinician, she's doing management and leadership, executive roles, and more recently, I think, entrepreneur. There's a lot going on there, a lot we can learn from today's guest. And I think we're going to focus a little bit more on the entrepreneurial work because it also potentially could be something that listeners, you would benefit from. So with that, let me say, Dr. Heather Signorelli, welcome to the podcast.

Dr. Heather Signorelli: Perfect. Thanks so much for having me. I appreciate it.

John: I'm looking forward to this. This is going to be good. Physicians are torn in different directions and subject to burnout and all kinds of things. And they're all looking for, well, maybe there's other options. And so, I think you're a good example of that could be pretty inspirational, but why don't we start by just you telling us about your medical background briefly and what your first sort of clinical jobs were, and then we'll get into some of the unconventional roles.

Dr. Heather Signorelli: Yeah. Thanks so much. Pathologist by background did anatomic clinical kind of that typical pathology residency, went into an atypical fellowship. So did chemistry, which I think a lot of people don't do chemistry as a fellowship because I liked the clinical lab. I really knew that I didn't want to look under a microscope pretty early on, did a lot of consulting and residency and fellowship and was really interested in the business side.

I grew up in a household of healthcare business folks. And so I think it was just hammered into me and then really finished fellowship, actually left a year early so that I could take a job in an administration. So looked at a slide my first day of work, and then I never saw a slide and was really kind of in more of the administration world, literally within 24 hours of finishing fellowship. So it wasn't necessarily like the plan. It just kind of found me. I do really enjoy that side of medicine though. And then everything has kind of snowballed from there, started with one hospital, moved to nine. And now I've got close to 200 hospital labs that I help oversee from my day job world.

John: Okay. How much management of people is involved in that? Because I know sometimes for roles I've seen in the past, you can be a medical director or even a chief medical officer, and they try to keep everything with the CFO and other people.

But I don't know, how does it work for you? Do you get a lot of time interacting with the staff and do some of them directly report to you? And how big is that enterprise?

Dr. Heather Signorelli: Yeah. And my role has kind of shifted ebbed and flowed over the years. So I've had anywhere from 20 to 40 people kind of rolling up to me. And at one point in time, 8,000 people that rolled up to me, obviously with a few layers in between. But I've kind of balanced both. I've done a little ops, a little medical side.

I would say right now, I'm kind of in that 30 to 40 people range rolling up to me. And that's a good sweet spot. Quality typically reports up to the medical director or chief medical officer. I've got quality in a lot of the clinical subspecialists. But yeah, it's always fun managing people.

John: Yeah. Fun. Sometimes it can be a little challenging. Most of us as we're in residency and fellowship, we don't get a lot of exposure to that. I was a CMO for a hospital and I don't have an MBA and so it just kind of learned as I went. So how did you, what was that like? And was it, did it feel different? Were certain skills you had to learn to help kind of be more of a manager and leader as opposed to a physician on a team?

Dr. Heather Signorelli: I think the two biggest things is communication. How do you communicate with others, whether those are people on your team or outside of your team. And those were things I had to learn trial by error. I would say I naturally like to be in a room where I'm able to communicate. And so there are some of that that I think I was born with, and some of it I had to nurture along the way. And then the second skill set is management.

I think being able to understand where you're at and then how to get to where you need to go and the steps involved and the people involved is a thing that takes time to learn and practice. But then once you get good at that, I honestly think you can do anything.

John: I think physicians can be natural leaders if they just promote those skills over time, but there's definitely some new skills they have to learn. Just for, to make it clear to the audience, to the listeners you're working with in a large system and you're overseeing all the labs in those individual hospital components.

Dr. Heather Signorelli: Correct. Correct. So, think of a hospital. It has a lab. So all of the labs within that healthcare system roll up to me from a clinical perspective. And we have some centralized laboratories as well that are, that are offsite, but still all-encompassing hospital work. So hospital laboratory work, which is a lot from stats to esoterics to everything in between.

John: All right. I'm assuming that your role in that situation is really to try to have some consistency to assure quality, things of that nature so that each place isn't doing things their own way.

Dr. Heather Signorelli: Yeah. A lot of that, anywhere from turnaround times to quality metrics, regulatory readiness, clinical stewardship. So right test, right time sort of stuff, which is a lot of what we did. I honestly think COVID was a big reason why I am where I'm at because COVID testing, COVID was a big deal with COVID testing. And so who do you need to explain COVID testing? A pathologist. And so, it really ramped up things a little bit of right time, right place sort of thing. But yeah, that's a big picture view of what I do.

John: Okay. That isn't really the main reason that I asked you to come today, because in addition to that, you, you have been doing something which is outside of that realm, correct? Yes. I'm reminding myself about exactly what you have gotten yourself into. Tell us then what you did that goes beyond that because you're still doing this role, of course, you've just described. Tell us about that next thing that came up that was a major part of your life.

Dr. Heather Signorelli: I think as physicians, and for your listeners, I think your audience may feel the same. You get into that five to 10 year mark post-training and you're like, okay, I've got, I've got my day job down. I understand it. Like it's moving along and I don't want to use boredom in the sense of time. Cause it wasn't like I had all this extra time. I craved that creativity. I craved that desire to build something and to solve a problem, which again, I think physicians in general enjoy those challenges. That's why we went to medical school.

It's a lot of why we enjoy what we do. And so I saw a problem with physicians who were struggling with revenue. They didn't really understand the financial metrics with regards to private practice. And that's a piece that my dad was an OB-GYN, ran his own practice for 30 years. My mom ran hospitals. So I loved the revenue side of things, deal with it in my day job.

And so we created a medical billing company about four or five years ago. It was my husband and I doing it together. We now have a team of over 70. It's a very different view of what it looks like today than it did four or five years ago. But yeah, we started that you know, I know it's combination of a spreadsheet and process, which I really enjoy. And how could we go into a practice and say, okay, let's fix the process so that the revenue flows better. Let's hire the right people. And we kind of mashed all that together. And here we are serving a couple hundred physicians nationwide and just going as we go.

John: Cool. We're going to learn more about that, but I want to reflect on what you said, because I think a lot of people that are in, this is a generalization obviously, but a lot of people that are in healthcare are kind of focused more on the people side. Some people would say the softer side and the right brain, left brain, whatever you want. And so we really are focused on taking care of people, but yeah, the business side can get away from us pretty quickly. And yeah, reading spreadsheets, including PNLs and things aren't really our first skill.

Dr. Heather Signorelli: No, no. But if you're going to have a private practice, I mean, that's, I think that's the struggle. Is you're not taught that it's not a skill that we've practiced throughout our training and, but it is something you need to know if you want to choose to be independent.

And of course you can choose to be employed and have less hands-on or choose to join a large group and just kind of ignore that side of things. And everybody's different, but if you want to have that independent practice, if you want to have your own business, it is imperative to learn those skills.

John: Yeah. I was going to mention another thing. Here's something that struck me when I saw what you were doing. It's like, I probably not so much anymore, but I used to get a phone call pretty much every week from someone offering to do my billing and collections, even though I wasn't even managing that, but I kept getting these calls and of course I'd just hang up. But yeah, it seems like it would be super competitive and it's pretty impressive to say you've got dozens and dozens, I don't know, a hundred, whatever you said of clients at this point. How are you able to get ahead of the crowd on that?

Dr. Heather Signorelli: We never marketed. It was our podcast, to be honest with you. And it just came from a place of education. It's a two-way street in terms of finding a right fit that we can bring value and then finding a right fit for the practice as well in terms of specialty and what they need. There are certainly plenty of billing companies out there, but I think for us, we really focus on really high touch and working with the practices on operations. I think that's the biggest, you see a lot of practices, they'll start with a billing company, they're happy for a year and then year two, they're like, oh it's a struggle. And I really think it comes down to the workflow in the practice. And if you can hammer that down and get the right workflow in the practice front office staff signing up the charts, doing all the things that you need to do to get the revenue, both parties can be much more successful. So that's, that's really how we structure it. It's just kind of grown organically, I would say podcast.

John: Well, I think if someone's in private practice and they're struggling with their billing for whatever reason, and they try different things and they get to a point where I got to try and learn everything I can. And so, tell us about the podcast now. We might as well jump into that. I was going to do that later, but let's tell me it's been out for at least a year or two, hasn't it?

Dr. Heather Signorelli: Yeah. A couple of years. I think we're on episode 115-ish. Not quite two or four hundreds, but we aspire to be there one day. But yeah, NatRevMD. You can check it out on any wherever you listen to podcasts. And we have guests and really just trying to teach the basics of what folks need to learn from a business perspective.

John: Besides learning how to produce a podcast, which anybody can do, give it a little bit of time. What were the new skills you needed to do this job, as opposed to the job that we've talked about earlier in terms of managing people or just more, it sounds like the financial was involved for both.

Dr. Heather Signorelli: Yeah. Finances were for both. People were for both. I would say it's a different group of individuals that you're hiring for. And so I think figuring that piece out in terms of how to hire and train individuals on very detailed tasks and setting up the policies and procedures some as a pathologist we deal with procedures. That's like our thing.

And so it kind of was a natural fit, but it's applying it to a different group of individuals. And there were definitely some lessons along the way. And I think for a lot of listeners you probably kind of have folks who are in that entrepreneurial space, who are starting things on their own.

The first year, year and a half is just hard, no matter what you start. And I think understanding that to a point and realizing, okay, if I can get through that and I can, the revenue can get there and I can hire again the right people and then start delegating, it gets easier. But that first year to two is just, is just hard. And then you start to figure it out. It gets easier and easier. And it kind of cycles through that throughout business. I think that's just the way business is.

John: Well, I think I probably have a number of listeners who do have their own practices who aren't employed by a hospital and or maybe they've even recently started up. And I'm sure that this is going to be one of their pain points is how to collect the money. We're one of the weird professions that typically write off tons of stuff. It's like, why do we have to write this crap off? Maybe you can just go down a list of things and maybe some unique things you found that, that are common problems or errors that can be fixed.

Dr. Heather Signorelli: I'll give you three. I'll give you three. Number one is eligibility. So the folks in the front office staff who are typically your lower level in terms of a pay, most important people in your office, they truly are the gatekeepers to your revenue. And so if they are checking insurance eligibility, collecting patient payments upfront, all of that stuff, which sounds simple is the number one thing we see where practices are losing revenue. And so really having a good training program around that is really, really key. We just that's a big part of what we do with practices.

Number two, understanding your denials. Why are you getting denied claims? Is it coding? Is it eligibility? Is it prior off? Whatever it is. And then fixing that root cause. And then number three is just having metrics that actually you follow and make sense to you. And if you don't follow any today, pick two, pick three, start somewhere, understand what they mean. And if your billing team really needs to be the one helping educate you on this is what these metrics mean.

This is what the trends mean and do that every month, every single month without fail. And those three things honestly can take a practice from struggling to thriving very, very quickly as long as you have the patient volume and all that stuff, which I am going to just assume that that's the case.

John: Now, is I'm assuming I haven't done this in a long time personally, but you know, it all depends on the systems that you have. Not, I mean, not the people's systems, but the electronic systems. So is our most billing systems and EMRs they integrated and do they do everything they need to do? Or is there some manual things that you find you have to add to the mix or how does that working these days?

Dr. Heather Signorelli: So most are electronic. Cloud-based softwares. Most of them are integrated. Most integrated with the payers, but the manual stuff still exists. Connecting it to the payer, making sure that the insurance card matches the payer you're sending it to, managing the denials and understanding what's the reason for the denials? Did it come to the system?

Are we having to go to the payer portals? All of that stuff still is clunky in my opinion. We're kind of waiting for this like angel to appear called AI that just like creates all of these magical wins.

We haven't found it yet. I keep meeting with AI companies after AI companies going, ah, you're so close, but you're not there yet. And I was listening to a podcast earlier this week and they said humans are, AI will not replace businesses and humans because humans will still be running the AI tools.

It's just another tool that a group of humans are going to run. And So, we keep thinking that this magic wand is going to appear and it's going to make this all simpler and maybe it will one day. We're not quite there yet, but again, it's very different than what it was 20 years ago. And I anticipate in 20 years, it'll be very different than it is today.

John: Now, one of the things that certain insurers did to the, on the hospital side was, and I don't even know what this was called, but you would bill and you would get paid and then they would claw it back at the end of the year because I don't know if there's one payer that still does that. Does that affect physicians as well?

Dr. Heather Signorelli: There's two things that can happen. There's a recoupment, meaning the insurance company looked at that specific claim and they say, Oh, they didn't actually have insurance or they didn't actually have something or there was something wrong with the claim and they'll recoup that money.

Then there's also a Medicare, for example, has quality programs where if you don't submit the data, right, if you're not submitting data and telling them how you did on your quality metrics, they will recoup a percentage in your, in your claims. And that happens at the time that they pay. It's typically not retroactive. It is at the time of claim submission, looking at data that was submitted or not submitted three years ago. There's a lot of those painful nuances. I have actually a whole podcast just on that topic called MIPS part one and part two. So people can go, go check that out.

John: All right. Boy, now that your clients, some are old, some are new. I mean, how do they have a pretty good handle on that at this point? Or is there just like a mix of some that have just been burned by that?

Dr. Heather Signorelli: Mix, a mix. Some just don't want to do it. And they're like, I'll just eat the 2%. And then some are really small, they don't qualify. You don't have to submit it. And then some are just really large and they if you utilize your EMR system, a lot of them can produce the data for you. And it's a very easy thing. Like medium to large size practices who have an office manager and it really rock solid EMR, easy peasy. So I would say it's a range.

John: Yeah. Okay. Well, as many things are, and the more complex it gets, then the harder it gets, but then the more expertise you need and you're the people you hire to work and help you, obviously you need to have that expertise like yourself. So let's see, tell me the name of the business again.

Dr. Heather Signorelli: Yeah. NatRevMD.

John: Okay. And we can find that at basically NatRevMD.com. Correct?

Dr. Heather Signorelli: That's correct. NatRevMD.com. And then also the podcast is also named that in any Apple, Spotify.

John: Okay. So, why is it named NatRevMD?

Dr. Heather Signorelli: You want a funny story? Okay. So my husband's a big George Bulldog fan, like huge SEC football. And so, the company was actually called National Revenue Consulting because the team had just won the national championship. And so but you know, oddly enough, revenue is a really hard word for people to spell. And so we had to shorten it.

And so there we are. I mean, nothing, nothing fancy to it. It just kind of shortened over time as we, as we grew, people just started calling it that. And then we were like, okay, we might as well name ourselves that.

John: I don't know, what kind of skills did your husband bring to this partnership as far as it was just something he'd done before or were you both doing something new?

Dr. Heather Signorelli: No, he's been in software and kind of sales for a long time. So that was his partnership to the to the company. And he's my stability, whereas I'm the risk taker. He's kept me grounded.

John: And as we've grown this, so let's see, I was asking something about that. You know, one of the things that people decision people have to make when they go into business is whether to have a partner. But when you have a spouse, it's not that big a deal. But when you think, yeah especially if you both have those skill sets that help each other. Okay, let me ask you this before we go. How about marketing? You said basically you grew quickly without really doing much. So at this point, still, are you doing any kind of formal, aggressive marketing to get the name out?

Dr. Heather Signorelli: I'm going to go to some conferences this year. So that's a new thing. But yeah, no, we've really just been podcast will be a guest on podcasts. And so, that's been helpful. And then, and then just having guests on our podcast. And I did write a book, which I think has been used more by my clients than our, than like an audience at large.

It's called thrive. And I can send you the link, but marketing in general with billing, you do have to be careful that you don't grow too fast. And so we've really targeted, okay, we're going to have no more than a client a month.

And when we take on a new client, we've got to make sure that everything stabilizes because that first 30 to 90 days is just a lot of hands-on with a multiple different team members from our side, just to make sure that we understand the process and we're fixing gaps that may be. So, it's just kind of just been this natural, gradual climb. It's been really great. I have a really good team.

John: Another question. How would someone know that they need to change their billing service or I mean, what are they looking at on either some financial report or receivables or something? What would be the one or two that they should just turn around and check this today? And if they're outside of this, we should think about changing something.

Dr. Heather Signorelli: Yeah. I'd say number one, if you're not getting metrics or denials regularly from your billing team, that's a red flag. Number two is if you look at your metrics and your accounts receivable over 90 days is greater than 25, 30%. Those are really high. We have practices that are in 5% range. Depends on your subspecialty a little bit. I am generalizing this. But really recommend that you take a look at that metric. That's your number one metric. And you can look at that by insurance and patient and understand who's needs some work. Then it's time to start asking the questions of your billing team. And then if you're not getting the answers you need, time to find a new one.

John: Well, any last advice before I do let you go here about running a practice or doing multiple jobs at the same time, or if people are getting frustrated with being in medicine, maybe have some advice for trying to get past that.

Dr. Heather Signorelli: Yeah. I think that if you're feeling complacent and want to do something new, don't be afraid to take that leap. I think it's thrilling to be able to open up your own company. It's fun. It's given me a spark both in my day job as well as keeping me kind of centered in building things. I think it's just fun. I think for physicians in general, like we tend to want the challenge and so go for it. Don't wait for it to be perfect, I would say, in order to just jump and go and you'll figure it out. That would be my advice.

John: Awesome. That makes sense. So if they're looking for you, go to NatRevMD.com. Definitely look for the website. And if you want to look for the book, it's called Thrive. And probably, is it on Amazon under your name, basically?

Dr. Heather Signorelli: It's on Amazon and I can send you the link to put into the show notes and it's on our website as well. You can head to our website, go to resources. We've got a billing course, podcast, and a book.

John: Well, we like to see successful physicians. We like to see fulfilled physicians. So, I mean, this is great. And you're having an impact on other physicians' lives, which is good. And if we can maintain some level of private practice in this world, then you're probably going to be very successful. So I know some have done very well and they've figured it out, but it can be a big challenge. Thanks again for coming on the podcast today, Heather. It's been fun.

Dr. Heather Signorelli: Thanks so much for having me. I appreciate it.

John: Okay. Bye-bye.