Today’s hospitals are operating in an increasingly complex environment, marked by shrinking margins, rising payer denials, and evolving regulatory demands. In response, Utilization Management (UM) has become more than a compliance function; it is now a critical driver of both financial performance and patient access to care. Dr. Simon Ahtaridis, MD, MPH, CHCQM, Lead Physician Advisor for the UM service line, shares how Physician Advisors help hospitals navigate these challenges and where opportunities remain.

Connecting Clinical Care with Reimbursement

As the gap between clinical care and reimbursement continues to widen, hospitals are facing a familiar challenge: delivering appropriate care that isn’t always fully reflected in the medical record. While physicians are highly skilled at diagnosing and treating patients, they are not always trained to clearly demonstrate medical necessity in documentation, an issue that has become increasingly important as payers intensify their review processes.

This is where the Physician Advisor plays a critical role. By working alongside physicians, case management, and Clinical Documentation Integrity (CDI) teams, Physician Advisors help ensure that the patient’s story is accurately captured in real time. These collaborative efforts not only strengthen compliance but also support more accurate reimbursement.

Moving from Reactive to Proactive Utilization Management

For many hospitals, Utilization Management has traditionally been reactive, identifying issues after a patient has been discharged, when opportunities to correct documentation or clarify status are limited. In today’s environment, that approach is no longer sustainable.

Competing priorities, limited resources, and complex electronic medical records can make it difficult to consistently capture patient complexity during the hospital stay. As a result, missed opportunities often translate into avoidable denials and lost revenue.

Leading organizations are shifting toward a more proactive model, focusing on early identification of patient status, stronger alignment across UM, CDI, and case management, and the use of real-time insights to guide decisions during the inpatient stay. This shift allows teams to address issues before they escalate, reduce denials, and improve overall performance.

Helping Hospitals and Communities Thrive

The impact of these challenges extends beyond hospital operations. Financial instability can directly affect access to care, particularly in rural communities where resources are already limited. When hospitals are not reimbursed appropriately, the consequences can ripple outward, impacting staffing, services, and long-term sustainability.

Addressing these challenges requires coordinated effort across clinical, operational, and financial teams. Physician Advisors play a key role in bringing these groups together, aligning priorities, and ensuring that care decisions are both clinically sound and financially supported.

At the same time, many hospital leaders lack the tools needed to fully interpret their data and identify where opportunities exist. As Dr. Ahtaridis notes, having clear visibility into performance is essential for making informed decisions. Advanced analytics can help bridge this gap, turning complex data into actionable insight and enabling a more proactive approach to Utilization Management.

As healthcare continues to evolve, so does the role of the Physician Advisor. Increasing complexity demands deeper expertise, a more proactive approach to Utilization Management, and stronger collaboration.

Ultimately, the goal is clear: ensure hospitals are accurately reimbursed for the care they provide so they can continue delivering high-quality services to the patients and communities that depend on them.

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Why Workflow-Driven Physician Advisor Programs Are Defining the Future of Healthcare

After the National Physician Advisor Conference (NPAC), we spoke with Cheryl Ericson, Senior Director of Clinical Policy and Education, to identify what stood out and where healthcare organizations still have work to do. She made it clear that hospitals continue to face challenges, but people now expect faster and better responses.

Validation: The Industry Is Catching Up—We’re Already There

A main takeaway from NPAC was that Brundage Group is moving in the same direction as the industry. Cheryl pointed out that federal regulations and payer expectations are becoming increasingly complex, yet many organizations still only react rather than embed compliance into their daily work.

At Brundage Group, we use our regulatory expertise and real-world workflows to stay ahead. Instead of just explaining rules, we embed them in the daily decisions clinicians and Physician Advisor teams make.

From Compliance to Competitive Advantage

One big theme from NPAC is that hospitals need to do more than react to compliance issues. They need to strengthen their Physician Advisor programs not only to minimize the risk of denials but also to improve teamwork and financial health.

This is where Brundage Group’s model stands apart:

• At Brundage Group, we combine strict compliance with payer-level sensitivity, enabling us to adapt quickly to new payer behaviors and regulatory changes.
• Brundage Group uses insights from diverse clients to spot trends early, giving hospitals a broader view than they could achieve on their own.
• At Brundage Group, we put these insights into workflows so they drive real action, not just reports.

In short, Brundage Group helps turn Physician Advisor programs into high-performing, best-practice teams. Our clients have seen measurable results, including fewer claim denials, faster case reviews, higher throughput, and a stronger bottom line—showing the value of a workflow-driven approach.

The Shift in the Physician Advisor Model

Another important point is that the usual setup for Physician Advisor programs needs to change.

On-site Physician Advisors often spend too much time on routine review tasks. Cheryl stressed that it’s time to rethink this model and let internal Physician Advisors focus on the work for which they are best trained.

A Modern Approach Makes It Possible To:

• Leverage Brundage Group’s external Physician Advisors to handle high-volume, transactional reviews, ensuring consistency and scalability.
• Work more closely with IT and clinical teams to remove barriers and improve workflows.
• Clarify the division of Physician Advisor roles:
  • Transactional tasks such as case reviews, initial chart assessments, and routine documentation checks are best handled by external Physician Advisors, freeing up internal teams for more strategic activities.
  • Internal Physician Advisors can make an impact by working with the C-suite, leading committees, teaching providers, interacting with revenue cycle teams, developing policies, improving documentation, and supporting complex case consultations.
  • This clear delineation helps executives allocate resources efficiently and position their teams as organizational leaders.

In conclusion, Cheryl’s insights showed that the future of utilization management and Physician Advisor programs is already happening. The organizations that adapt the fastest will see the biggest benefits.

The post NPAC 2026 Takeaways appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – May 1, 2026 

Brundage Group is proud to announce it has been recognized as one of the Best Places to Work in Tampa Bay for the third year in a row. This distinction matters because it is based on direct feedback from employee surveys, reflecting the voices and experiences of the people who power the organization every day.

This award reflects Brundage Group’s ongoing commitment to a workplace culture rooted in its core values: integrity, collaboration, accountability, and innovation. Earning this recognition for a third consecutive year underscores the company’s consistency not only in defining those values but also in actively living them across all levels of the organization.

“Our people are the foundation of everything we do,” said Tim Brundage, MD, CEO and Founder of Brundage Group. “To receive this honor three years in a row, based on their feedback, is incredibly meaningful. It validates that we are creating an environment where employees feel supported, valued, and empowered to do their best work.”

Employee survey results showed strong marks in leadership transparency, team collaboration, professional development opportunities, and overall workplace satisfaction. We continue to invest in initiatives that support employee well-being, career growth, and a sense of purpose aligned with our mission.

As Brundage Group expands its impact in healthcare solutions, we keep a people-first culture at the heart of our strategy. This recognition serves as both a milestone and a motivator to keep raising the bar.

About Brundage Group
Brundage Group is a leading provider of physician-led, tech-enabled clinical and revenue integrity solutions for U.S. hospitals and health systems. Its team of top-tier Physician Advisors, proprietary analytics, and educational programs empower health care providers with ensuring inpatient care is thoroughly documented, clinically justified, and compliant with regulatory standards. Founded in 2007, Brundage Group is dedicated to enhancing clinical accuracy, regulatory compliance, and financial health for hospitals and health care systems nationwide, so they can focus on providing exceptional care to their patients and communities.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Brundage Group Named Best Place to Work in Tampa Bay for Third Consecutive Year appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

In a recent executive spotlight by Capital Analytics Associates, Dr. Timothy Brundage, CEO and founder of Brundage Group, shares a clear mission: helping hospitals stay financially strong so they can keep caring for their communities. With health systems facing tighter margins, more regulations, and higher denial rates, this focus is more important than ever and sets his approach apart.

The Expanding Role of Physician Advisors

A key part of Dr. Brundage’s view is how the role of Physician Advisor has changed. Instead of just reviewing cases, Physician Advisors now work at the intersection of clinical care and business performance. By focusing on medical necessity, accurate documentation, and payer alignment, hospitals can ensure proper reimbursement while staying compliant and maintaining high-quality care.

Breaking Down Silos in Healthcare Operations

Dr. Brundage points out that lasting success depends on better teamwork between areas that are often separated, like utilization management, clinical documentation, and revenue cycle. When these areas are disconnected, it can lead to problems such as denials and compliance risks. Working together under physician leadership helps improve accuracy, makes processes easier to defend, and builds a stronger operation.

Scaling Impact Through Growth and Innovation

The spotlight also highlights Brundage Group’s steady growth, fueled by national demand for physician advisory services and advanced analytics. Strategic investments have helped the firm expand its reach while staying focused on clinical expertise. By combining expert advice with technology, they help health systems withstand greater payer scrutiny and more complex operations.

AI as an Enabler—Not a Replacement

When it comes to artificial intelligence, Dr. Brundage believes AI should support, not replace, clinical judgment. Used well, it can make workflows smoother, reveal useful insights, and help people make better decisions. But its real value lies in fitting into actual clinical processes and being carefully integrated into provider workflows.

Physician-Led Vision for the Future of Healthcare

Since its founding in 2007, Brundage Group has focused on the idea that clinical leadership is key to running a successful operation. Dr. Brundage keeps stressing the need to connect care quality, compliance, and financial results, which helps the company and its clients adjust to the fast-changing healthcare world.

The post Spotlight on Leadership: Dr. Brundage appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – April 27, 2026 

Brundage Group, a physician-led leader in revenue cycle management (RCM) consulting and Physician Advisor services, today announced the launch of its newly redesigned Certus Navigator Utilization Management portal—a configurable, workflow-driven platform designed to deliver personalized, role-based experiences and real-time patient and case management. 

The platform represents a major transformation, enabling healthcare teams to manage patient records, track cases, and act directly within the system. Users can leverage Certus Radar to view patient census data, identify actionable items, and execute built-in workflow actions, from submitting cases to updating records, without leaving the portal.

Key enhancements include: 

• Role-based experiences tailored to user responsibilities  

• Real-time patient and case management through Certus Radar with actionable workflows  

• Built-in workflow actions that allow users to submit and manage cases directly from patient records  

• Enhanced dashboards with advanced, configurable filtering for customized insights  

• Built on Salesforce Experience Cloud with Apex-powered data integrations, ensuring seamless connectivity and performance  

The redesigned Certus Navigator portal underscores Brundage Group’s commitment to delivering technology-enabled, physician-led solutions that support the evolving demands of today’s healthcare environment. 

About Brundage Group 
Brundage Group is a leading provider of physician-led, tech-enabled clinical and revenue integrity solutions for U.S. hospitals and health systems. Its team of top-tier Physician Advisors, proprietary analytics, and educational programs empower health care providers with ensuring inpatient care is thoroughly documented, clinically justified, and compliant with regulatory standards. Founded in 2007, Brundage Group is dedicated to enhancing clinical accuracy, regulatory compliance, and financial health for hospitals and health care systems nationwide, so they can focus on providing exceptional care to their patients and communities.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Brundage Group Launches Redesigned Client Portal  appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – April 24, 2026 

Brundage Group announced that its Chief Medical Officer, Dr. Brett Hoggard, earned recognition from Becker’s Hospital Review as one of the “Great Leaders in Healthcare 2026.” Becker’s Hospital Review is a leading source for healthcare industry news and analysis.

Dr. Hoggard, Chief Medical Officer and Director of Quality at Brundage Group, guides the clinical team and oversees the development of clinical service lines. He shapes clinical strategy, sets rigorous standards, and advises executives and clinical leaders nationwide.

A diplomate of the American Board of Internal Medicine, Dr. Hoggard brings a unique combination of clinical expertise and operational insight. His leadership helps healthcare organizations implement strategies that balance high-quality patient care with compliance and financial performance.

Dr. Hoggard plays a key role in product innovation, working with product, technology, and operations teams to keep solutions clinically relevant, easy to use, and part of provider workflows. His involvement helps Brundage Group’s offerings support clinicians effectively.

In addition to his executive leadership, Dr. Hoggard is a recognized authority in physician documentation. He co-authored the Association of Clinical Documentation Integrity Specialists course, Clinical Documentation Essentials for the Hospital Provider, which equips clinicians across the country with practical tools to improve documentation accuracy, compliance, and the representation of patient complexity.

“Dr. Hoggard’s recognition by Becker’s Hospital Review shows the impact of his leadership at Brundage Group and in healthcare overall,” said Dr. Tim Brundage, Founder and CEO of Brundage Group. “His ability to combine clinical excellence with new ways of working brings real results for our clients and their patients.”

The full list of honorees can be viewed here.

About Brundage Group
Brundage Group is the trusted choice of hospital systems for revenue cycle management solutions. We support hospitals nationwide with customized solutions, including a full suite of physician advisory services, proprietary level of care analytics, and physician-led education to relay quality care. Our programs help hospital organizations break down departmental silos by unifying all departments in the mid-revenue cycle. Learn more at brundagegroup.com.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Dr. Hoggard Named 2026 Great Leader in Healthcare appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

By Robin Sewell, CDIP, CCS, CIC, CPC, CCDS

How did the phrase “Clinical Validation” get coined when it comes to queries? As Clinical Documentation Integrity (CDI) professionals, we use that term essentially to “invalidate”, not “validate”, a clinical condition when there are insufficient clinical indicators to support it. …But do providers know CDI speak? Do they understand why they are receiving the query? Have we “mis-named” the query type, creating a misnomer? 

How often have you submitted a clinical validation query to rule out a diagnosis only to have the provider “confirm” or “validate” the diagnosis? 

To test out my theory, I “crowd-sourced” several Physician Advisors using a query that was the subject of a denial. The denial was for acute postoperative respiratory insufficiency.  The payer stated that the patient had normal postoperative weaning status post CABG, and as such, acute postoperative respiratory insufficiency was invalid.  

When I read the query, it was obvious to me that the query writer did not think the documented postop respiratory insufficiency was clinically valid, and it appeared their intent was to have it removed, aka “invalidated.”  

The Query In Question

Documentation includes the diagnosis of respiratory insufficiency on the pulmonary consult date xx/xx/25. 

Clinical Indicators: 

xx/10/25 Op note: Operation performed-CABG x2: LIMA to LAD, saphenous vein graft to diagonal, endoscopic harvest of left long saphenous vein… 

Post-Op diagnosis: Multi-vessel CAD 

XX/10/25 Pulmonary Consult: “… Acute respiratory insufficiency, postoperative-on vent postop, tolerating weaning per protocol…” 

XX/11/25 Pulmonary Consult: “… successfully extubated XX/10/25…” 

XX/11/25 Hospitalist Consult: “…Acute respiratory insufficiency, postoperative. Symptoms have resolved. Patient is currently on 3 L nasal cannula. He will be weaned off…” 

Based on the above, please further specify the patient’s respiratory status:

The intention of the query seemed clear to me: The patient was extubated on the same day as the procedure and was tolerating normal weaning.  I agreed with the payer that this was invalid; however, it was not so obvious to the physician.  

The Query Hypothesis

To test my hypothesis that physicians often misunderstand “clinical validation” (and to campaign for reforming the query process), I submitted the query to several physicians to get their opinion. It was an informal poll with these options, while encouraging feedback on their thought process:

1. The query writer wants me to select respiratory insufficiency (regardless of whether it is postop/pulmonary, etc.). 
2. Since the diagnosis is already documented, the query writer does not understand/read the clinical indicators very well.
3. The query writer suspects the diagnosis of acute pulmonary insufficiency is not clinically valid.
4. The query writer wants you to rule out acute or postop pulmonary insufficiency.  
5. Other

Providers who were not involved in CDI functions and who did not participate in clinical validation denials and appeals confirmed the hypothesis. Here were some of the comments by the physicians involved in the experiment:

• “Why would they think it’s not clinically valid? At the minimum the sedation is not allowing the patient to breath on their own.” 
• “I tried to take my knowledge out of the picture, and yes, if you sent this to a physician with minimal insight into coding and CDI, they absolutely would not know what the question is about.”  
• “I think I was asked so often in clinical life about these sorts of issues that maybe I never gave it much thought and just answered the best I could, assuming there was a good reason to be asked.” 
• “I would pick option 2 since the note on xx/10 states that dx. Also, it states that the patient had adequate oxygenation, with no mention of respiratory distress or hypoxia. Instead, it leans towards a quick wean off oxygen.” 
• “…for this case I think it’s straightforward. I don’t think you’d need an MD to validate it.”

These comments were very insightful. They revealed that many physicians do not understand clinical validation, and, as we already know, many do not understand coding guidelines. 

Where To Go From Here

So, what can be done to rectify this knowledge/communication gap? As we patiently await more guidance from AHIMA and ACDIS from an updated Query Practice Brief, can we at least call a spade a spade? What is it we really need from the provider? I vote we label these queries very plainly as “Rule Out Diagnosis.” Then, within the query itself, we clearly explain why.  

Dear Doctor: 

The documentation includes the diagnosis of respiratory insufficiency on the pulmonary consult date xx/xx/25, which has limited clinical evidence supporting it as a valid diagnosis.

Clinical Indicators: 

xx/10/25 Op note: Operation performed-CABG x2: LIMA to LAD, saphenous vein graft to diagonal, endoscopic harvest of left long saphenous vein… 

Post-Op diagnosis: Multi-vessel CAD 

XX/10/25 Pulmonary Consult: “… Acute respiratory insufficiency, postoperative-on vent postop, tolerating weaning per protocol…” 

XX/11/25 Pulmonary Consult: “… successfully extubated XX/10/25…” 

XX/11/25 Hospitalist Consult: “…Acute respiratory insufficiency, postoperative. Symptoms have resolved. Patient is currently on 3 L nasal cannula. He will be weaned off…” 

Based on the above, was the respiratory status normal postoperative weaning from vent, and thus acute respiratory postoperative insufficiency was ruled out: 

_ Yes- Normal postoperative weaning from vent (ruled out) 

_ No- Abnormal postop weaning from vent: Acute respiratory insufficiency, postoperative is clinically valid.

The Takeaway

This isn’t about changing compliance standards. It’s about improving communication clarity.

Because if the provider doesn’t understand the question, we shouldn’t be surprised when we get the wrong answer. 

Maybe it’s time to rethink the term “clinical validation query.” 

Because right now? 

It might be doing the exact opposite of what we intend. 

The post Query IQ: Clinical Validation Queries appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Unifying CDI, Coding, and Physician Advisors

The landscape of hospital revenue integrity is rapidly evolving, and the once-separate worlds of Utilization Review (UR), Clinical Documentation Integrity (CDI), coding, and Physician Advisors are now converging into a unified strategy. Cheryl Ericson, RN, MS, CCDS, CDIP’s career journey exemplifies this transformation. With experience in public health, nursing, insurance, and hospital administration, Cheryl witnessed firsthand how siloed functions led to inefficiencies and missed opportunities. Coders, nurses, and physicians often operate independently, unaware of how their work impacts the broader clinical revenue cycle. Claims data (also referred to as administrative data) both directly and indirectly impact hospital revenue as a function of reimbursement and value-based care.

The Power of Collaboration

Today, effective revenue integrity depends on structured collaboration. Cheryl emphasized the importance of regular meetings, case reviews, and open dialogue among UR, CDI, coding, and Physician Advisors. This collaborative approach breaks down barriers, fosters mutual respect, and ensures that each group’s expertise is leveraged toward shared organizational goals. It all begins with physician documentation; without physician support, we can’t achieve optimization. Having physicians actively involved is invaluable; sometimes, when you’re coding or working through cases, their direct input can clarify ambiguities and ensure that the documentation reflects the true clinical picture. Physician Advisors, once seen as peripheral, are now central to bridging clinical and administrative priorities. Their involvement ensures that physician intent is accurately captured; coding reflects true patient acuity, and documentation supports both reimbursement and quality metrics. Cheryl noted, “Physician Advisors have gained a lot more confidence and a lot more knowledge. I think before they used to be very dependent on CDIs and coders, and so they didn’t necessarily express their own opinions as much.” This evolution highlights how Physician Advisors now play a more assertive and informed role, contributing their own perspectives alongside the expertise of other revenue cycle teams.

Adapting to a Changing Environment

Hospitals today face pressures like shrinking margins and staffing shortages. Cheryl emphasizes that achieving sustainable revenue integrity requires integrating UR, CDI, coding, and Physician Advisors into a cohesive reporting framework. At many hospitals, UR, CDI, and coding report to different departments, creating silos and communication barriers. Cheryl notes, “Often departments are so focused on their own silo and trying to meet those metrics instead of considering how their metrics relate to organizational goals.” By integrating these functions into a single clinical revenue cycle structure, organizations can improve coordination, oversight, and accountability. This alignment ensures that committees, such as those focused on sepsis, readmissions, or mortality, make decisions that consider clinical functions and downstream impacts associated with patient status and coding, while supporting organizational goals such as the case mix index, denial prevention, and quality. Cheryl recommends practical steps, including unified leadership, transparent technology, and a shared culture of learning, to help teams work toward common objectives and strengthen both financial and clinical outcomes.

Looking Ahead

As outpatient volumes rise and inpatient cases become more complex, the need for integrated expertise will only grow. The migration of procedures from the inpatient to the hospital outpatient setting will be hastened by the elimination of the inpatient only list, likely resulting in an eventual shift to independent ambulatory surgical centers leading to significant loss of revenue for most hospitals. For example, the National Patient and Procedure Volume Tracker by StrataSphere® for 12/31/24 shows that inpatient primary knee replacement is down 21.2% in 2024 compared to 2023. Inpatient primary hip replacement is down 3.8% when comparing 2024 rates to 2023. The healthcare industry is changing more rapidly than at any other time, as payers fight to maintain profits by challenging hospital billing practices. In contrast, hospitals contend with new regulations designed to reduce fraud and waste. Cheryl’s insights and ongoing thought leadership reinforce a clear message: revenue integrity is a team sport, and success depends on breaking down silos in favor of unified, strategic, measurable action. The future of hospital financial health lies in the seamless integration of UR, CDI, coding, and Physician Advisors, ensuring hospitals remain viable, compliant, and focused on delivering high-quality patient care.

The post Spotlight: Cheryl Ericson – From Silos to Synergy appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – April 8, 2026 

Brundage Group, a leading provider of physician-led, tech-enabled clinical compliance and revenue integrity solutions for U.S. hospitals and health systems, announced today that it has partnered with strategic health care investor, Water Street Healthcare Partners. The partnership comes as hospitals and health systems are facing mounting financial pressures, increasing medical necessity denials, and escalating regulatory and payer demands for patient care.

Through their partnership, Water Street and Brundage Group will enhance the company’s solutions, helping hospitals and health systems ensure patient care is thoroughly documented, clinically justified, and able to withstand payer and regulatory scrutiny. Brundage Group provides a full suite of clinical status integrity and denials management services, real-time analytics, and utilization management education delivered by top-tier physician advisors through a tech-enabled platform. Founded in 2007 by Timothy Brundage, M.D., Brundage Group has attracted a growing base of health systems and hospitals across the country.

“Our mission is to help hospitals and health systems remain viable to the communities they serve by ensuring clinical accuracy that supports fair reimbursement for patient care. Water Street shares our mission and brings deep industry expertise and resources to help us advance it. Together, we will invest in expanding our elite team of physicians and developing cutting-edge technology to empower more hospitals and health systems in delivering exceptional care to their patients and communities,” said Dr. Brundage, founder and CEO, Brundage Group.

About Water Street
Water Street Healthcare Partners is a strategic investor dedicated to building market-leading businesses in three critical health care sectors: medical products and diagnostics, pharmaceutical and life sciences, and health care services. The firm has completed more than 165 investments and acquisitions to build 48+ companies contributing to improved patient care, innovation, and a more efficient health care system. Working closely with leadership teams, Water Street contributes its industry experience and network of resources to support businesses’ growth objectives. Based in Chicago, Water Street’s team is a distinctive blend of health care executives, investment professionals, and functional specialists with decades of experience investing in and operating global health care businesses. For more information, visit waterstreet.com.

About Brundage Group
Brundage Group is a leading provider of physician-led, tech-enabled clinical and revenue integrity solutions for U.S. hospitals and health systems. Its team of top-tier Physician Advisors, proprietary analytics, and educational programs empower health care providers with ensuring inpatient care is thoroughly documented, clinically justified, and compliant with regulatory standards. Founded in 2007, Brundage Group is dedicated to enhancing clinical accuracy, regulatory compliance, and financial health for hospitals and health care systems nationwide, so they can focus on providing exceptional care to their patients and communities.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Brundage Group Partners with Water Street to Expand Clinical & Revenue Integrity Services for U.S. Hospitals & Health Systems appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

According to Becker’s Hospital Review, which referenced Kaufman Hall’s National Hospital Flash Report, hospitals ended 2025 with an adjusted operating margin of only 1.3%.

This number is well below the usual 3 to 4% margin hospitals need to:

• Maintain infrastructure and physical plants.
• Service debt obligations
• Fund baseline technology investments

With a 1.3% margin, hospitals lack financial stability that could lead to a reduction in services or closure.

Kaufman Hall characterizes the financial challenges facing hospitals in 2026 as a “new normal” defined by:

• Rising labor and supply costs
• Increasing bad debt associated with increasing uninsured and underinsured rates
• A deteriorating payer mix with increased payer friction
• A more complex and acute inpatient population
• Persistent margin compression

The Structural Deficit: Service Lines That Lose Money

The American Hospital Association’s (AHA) data show a deeper problem: core hospital services are losing money, regardless of payer.

These aren’t optional services. They are essential for community care. Hospitals can no longer offset these shortfalls with profits from other areas.

The Only Remaining Lever: Revenue Cycle Integrity

When core services lose money, and the payer mix worsens, hospitals have only one thing they can control.

Collect their earned revenue and fight hard to keep it. This shifts the revenue cycle from an administrative task viewed as a cost center to a margin-protection strategy. Payer friction is driving up the cost of healthcare. The AHA estimates that revenue cycle function account for as much as 40% of hospital costs. If current trends continue, the cost of collecting earned revenue could exceed the cost of delivering patient care.

Why Physician Advisors Are Now Mission-Critical

Hospitals are trying a variety of strategies, with the most common being the implementation of technology. However, the complexity of the inpatient revenue cycle is proving beyond the capabilities of many of these tools. Human intervention is still required. The bottom line is that hospitals need to expect more from their revenue cycle departments. In this environment, defensibility of clinical decision-making becomes the core asset.

Physician Advisors play a central role by:

• Educating admitting physicians about how to document to support medical necessity and accurate billing.
• Supporting status determinations (inpatient vs. observation) with clinical judgment.
• Conducting peer-to-peer reviews with payer medical directors to overturn adverse determinations.
• Leading appeals that convert denials into revenue recovery.

Successful status upgrades or appeals can yield thousands per case—critical when margins are 1.3%. This is a tangible, immediate benefit that accumulates over time.

Revenue Cycle as a Clinical Strategy

Hospitals that succeed in this environment share a common approach.

They treat the revenue cycle as:

• A clinical function, not purely administrative
• Real-time discipline and accountability, not retrospective cleanup
• A strategic capability, not a cost center

This includes:

• Embedding Physician Advisors into utilization management workflows
• Aligning utilization review, CDI, coding, and clinical documentation practices by breaking down silos
• Using data to identify denial patterns and problematic payer behaviors

The Bottom Line

The convergence of:

• Structurally negative service line margins
• Sub-2% operating performance
• Increasingly aggressive payer tactics

…creates a healthcare environment where: Revenue cycle performance is the margin.

Hospitals are fighting for financial stability, not just small improvements.

Hospitals that invest in physician advisors will protect their revenue. Those that don’t will see their margins shrink even faster.

Final Thought

The future of hospitals depends on decisive action. As financial pressures grow and essential service lines lose money, investing in efficient and effective physician-led revenue cycle strategies is not optional; it is vital. Hospitals that make revenue cycle integrity a top clinical and strategic priority will define the next era of healthcare. Defending every earned dollar is the difference between stability and decline. Organizations that act with urgency will lead; those that hesitate will fall behind, risking their mission and their communities. Now is the moment to lead. Protect your hospital’s future by investing in revenue cycle excellence.

The post Why Revenue Cycle Performance Is Now a Clinical Imperative appeared first on Physician-Led Advisory & Revenue Cycle Analytics.