When I was asked to write this article, I was not sure what I could tell you that is not already common knowledge. I started evaluating how I became the CFO, operations manager, managing one of the largest neurosurgery groups in the city.
I am an acute care nurse practitioner, and I love my profession. I went into nursing because I felt that I could make a difference and make people feel better. It’s the caring part of any provider, to help humanity. I have a special interest in neurosurgery. I worked at a level I trauma center, and I became very familiar with brain and spine surgeries.
When Texas Neuro Spine (TNSPINE) first opened its doors, it was going to be a small business, with 1 physician and 1 nurse practitioner doing very specialized care. I was determined to understand the business, so I took classes about billing and coding at night so I could help the practice with approvals and authorizations. I was seeing patients and managing some of the business aspects. Initially, we had no idea how difficult it would be to deal with insurance companies. “Ignorance is bliss” is so true for the medical profession regarding billing and coding.
I am not sure I would have agreed to open a private practice if I had known what I know now, but God had a plan. Worrying about salaries for the staff, benefits, and their 401Ks was such a daunting task, but finding the right staff was the most difficult part of the business. It’s challenging to bring in staff members who have the same vision, values, and work ethic. After many trials, we are now more confident that we can pick the correct employee with the qualifications we need.
I started to understand the intricacies of the insurance processes and how difficult it was to get authorizations for some of the surgeries we were performing. Providers are not taught anything at school about coding and billing and how to deal with different insurance companies. Just as patients are confused about what to do, so are physicians. We were struggling with getting authorizations. When I called the insurance companies, they made it very difficult for us to understand why they were not approving a surgery or simply denying the claim. I couldn’t understand the reasoning of the denials because it was obvious to me that the patients needed surgery. I understood the medical part well, and it was like having a bucket of cold water thrown on us to realize that the insurance companies did not understand the need for the patient’s surgery. In my view, they were putting up a lot of obstacles to avoid paying doctors for services they had already provided.
As time passed, we teamed up with more doctors. Our founder is exceptionally caring and wants younger doctors to have the opportunities he was never given as a young neurosurgeon. Most groups that work together are not really together. They are together only for financial reasons rather than really collaborating as a team and supporting each other. As one of my doctors describes it, “We are lone wolves”; but I was determined to make it a pack of wolves.
We started with 1 neurosurgeon but grew over the years; we have now added 7 neurosurgeons and 5 nurse practitioners, and we have a partnership with 5 military neurosurgeons. TNSPINE was determined to be different, and we resolved to make each doctor succeed. Our goal was to create a strong foundation for them to get their private practice going. Our vision was straight-forward: we wanted doctors not to have noncompetes, to have the freedom to operate and take calls anywhere, and to make their own decisions regarding what products to use as long as they stayed ethical and carried themselves with integrity. We hired people who are committed to our vision.
You may ask yourself, what is a nurse doing as a CFO of a large neurosurgery group? Remember when I said nurses go into nursing because they want to make a difference? I found myself in this position by default. I wanted to help. I was able to understand both sides of the business, the medical and the business operations. It is funny how destiny can have a plan for you of which you are completely unaware.
A Knack for Business
I realized I had a liking and a knack for business. I found myself excited about negotiating deals. I couldn’t wait for the serotonin that my brain released as we started negotiations with insurance companies or hospitals. At this point, it was a game of chess to me. The harder it got, the better. I was able to sharpen my skills as negotiations were delayed. I would read books about negotiating tactics, and I couldn’t wait to use what I had just learned. The longer the negotiations extended, the better I felt. It became an exciting competition for me. I had all the ammunition at my disposal to get what I wanted.
I believe in our team of doctors; I believe in their skills, and I know they are extremely good at what they do. Because I believe in the team, I can more strongly negotiate their skills with the insurance companies, etc. When you believe in something, you can be very convincing, and I know that I am when it comes to our services and providers. We talk the talk and walk the walk. The advantage I have is that I understand the business and the medical aspects—I live and breathe neurosurgery. One of the best lessons I learned is that absolutely everything is negotiable, if they really want you. If they don’t, then it is not negotiable. It boils down to that. I now understand coding and billing like the back of my hand. I enjoy walking physicians through the proper way to code the surgeries and the policies.
I think medical professionals have an innate understanding of patients’ pain and suffering. We can look into the patient’s eyes and look into their souls. This allows us to integrate specialized care into the business operations, and patients can perceive when a business is operating with compassion and concern. Our vision has always been to provide care that makes the patient feel special and secure. We have created a team that helps us accomplish the goals that we have as a company. The physicians understand that it takes a village to provide quality care. We are quite selective in choosing the staff that will represent us. The front office is the face of the company; it is important that the staff make the patient feel welcome and cared for. The way the front office staff treat patients when they walk through the door sets the tone of the visit. Visiting a surgeon’s office can be frightening: you don’t know what they are going to tell you; will you come out entertaining the need for back surgery or the good news that you don’t need surgery?
Part of my job as a CFO and operations manager is to set the culture for the staff and the doctors. Our culture has been to work as a team. So I do not just lead, I serve the people that I am leading to help the patients. Being a leader is a role of servitude—to serve the staff, doctors, and patients by understanding their needs. Each employee comes with a lot of complexities, no employee is the same as others nor are the needs the same. It’s a coordinated balance to be able to deal with issues that arise with the staff or doctors. It is important to understand where people are coming from, their point of view, and the complexity of their environment, upbringing, beliefs, and their tolerance for certain stressors. I have very high expectations of my staff, and I want the best, but I give them my best. I don’t expect anything I am not willing to do myself. Being in this position has not been easy. We have grown this amazing group based on pure grit and determination. God has blessed us with wonderful business relationships that have facilitated our growth as a company.
Despite the challenges, I wouldn’t change anything about my job. I love my doctors, my staff, and the patients that we serve each day, and there’s absolutely nothing that will stop me from doing what I do. This is not a job for me, it’s part of my life.
ABOUT THE AUTHOR
Cynthia Voorhees, APRN, ACNP-BC, RNFA, MSN, BSN, is an acute care nurse practitioner and CFO at TNSPINE PLLC, in San Antonio, Texas.
