S1E9: Lessons from Behind Closed Doors (ft. Scott Becker, Beckers Healthcare, MaGuireWoods)
Healthy Uptime Podcast Scott Becker (Becker's, McGuireWoods) _ Jordan Cooper (Rackspace)-20261001_133211-Meeting Recording
October 1, 2026, 5:32PM
21m 20s
Jordan Cooper started transcription
Jordan Cooper 0:03
We are here today with Scott Becker of Becker's Healthcare and McGuire Woods. Scott, thank you so much for joining us today.
Scott Becker 0:10
Jordan, a pleasure to be with you. Thank you so much for having me. You know, I wish I can compete at your level in tennis, but I'm doing the best I can here on the podcast. Thank you so much for having me. It's fantastic.
Jordan Cooper 0:17
Okay.
So as context for our listeners who don't know, Scott Becker is the founder and publisher of Becker's Healthcare, a leading healthcare media company. Scott's also a longtime partner at McGuireWoods, a top am law firm with leading private equity and healthcare practices, where he served for nearly 14 years as a chair of the healthcare department. He is, like me, a host of some podcasts. He hosts Becker's Healthcare Podcast and Becker Private Equity Podcast.
He's the author of several books, including his most recent book, Building Great Businesses. So Scott, that was a mouthful, but we're off to the races now. You've hosted hundreds of CIOs and health system leaders on stage at your Becker's Healthcare events. What's the biggest gap you notice between what they say publicly and what they say once the mic is off?
Scott Becker 1:05
Yeah, no, I don't know that there's so much of A gap. I think that so many people are struggling to try and figure out how to make healthcare, you know, how to make it work. You know, when you look at sort of where we're at in healthcare, you know, in terms of the triple aim, people talk about the triple aim of cost, quality of access. We're sort of all moving in the wrong direction on all three of those.
I think that health system leadership is very much trying to make this work. You know, everybody comes at this from their own perspective. When a health system, for example, you know, we reported today on another hospital closing in California, moving towards closing. What health system leaders think is that
Every answer is about more reimbursement. And you've got this real challenge of everybody comes at every problem, like the proverbial carpenter or hammer with a nail, instead of looking at it a different way. And so you've got these different challenges. And I'm not sure this goes to your question exactly, but we've got this incredible shortage of physicians.
And so we always say to physician societies, physician communities, we have to make the path to becoming a physician shorter. Right now, it's four years of college, four years of medical schools, four years of residency, and even more, 12, 14 years, more and more of the best and brightest go into other fields. They go into
law, they go into finance, they go into tech, they go into everything. We need the best and brightest in medicine and science too. But when you talk to physician communities and societies, like, oh no, the holy grail, it's now 12, 14 years, even if all of healthcare education was developed prior to the internet. It's just, it's backwards. And we've got this problem in our system.
where everybody's looking at it from their own perspective. And somehow or no, we've got to cut through that. When I talk to health system leaders, health system CIOs, they're very much interested in problem solving. But if I see the gap between what they're saying and thinking, it's that they're all looking at it from their own perspective.
of how do we solve this. And I see great leaders, you know, you know, very smart about adopting new technology solutions, new artificial intelligence solutions. I see more and more people just trying to solve problems and great at it. The blind spot I see is people looking at this so parochially and not from a core perspective of, you know, where do we make changes? How do we fix this?
Jordan Cooper 3:30
Sounds like you're hearing a lot of healthcare executives look to invent a longer lasting candle instead of considering a light bulb, for example.
Scott Becker 3:40
Well, I think that's exactly right. And I think what you've got is by necessity, and I'll take aim at the physician professional societies, and I'm a huge fan of our physicians. I think we need more of them. And when you need more highly trained specialists. But what happens is you have physicians upset that more and more CRNAs, PAs, and Ps are taking their jobs, taking their positions,
or filling the gap. And the reality is, if the physician societies don't make it more attractive to produce more doctors, you have no choice in our system but to fill the gaps in other ways. So when you mentioned the idea of they're looking at a candle when we should be looking at a light bulb,
Absolutely right on. I think that's exactly right on. I think they're looking at this totally backwards. Rather than suppressing CRNAs and Ps, PAs, how do we get the best and brightest into medical school? How do we get them out by 27, 28, 29? It's being done in other countries. We're the great beneficiary of it. Nurse education has accelerated tremendously this year. We're educating twice as many nurses.
today than we were 15 years ago, we're educating 20% more doctors. We're just, we're just backwards in trying to find the solutions. And I think your point on, like Henry Ford used to say famously, if I asked people what they wanted, they would say a faster horse. You know, it's the same thing what you just said on a, I think that's a brilliant point is that they're saying,
Jordan Cooper 4:59
Yeah.
Scott Becker 5:04
You know, we need a candle that lasts a little bit longer, a little bit differently, runs a bit differently, and they need a light bulb, they need a different way of going at it. Everybody's so stuck in their territorial positions that we're just screwing ourselves and you end up, you're screwing the doctor community. So the doctor community becomes by necessity less needed as we seed
Jordan Cooper 5:18
So.
Scott Becker 5:23
capacity to others.
Jordan Cooper 5:24
So Scott, I love how you're saying you're reframing kind of some of the problems that we're seeing in the healthcare provider space as supply problems more than revenue problems. I love that you're bringing that outside perspective. What I'd like to segue into is when you're looking at health systems, specifically older, more academic, consolidated, financially strained health systems and competitive urban environments, perhaps in Chicago, like where you are,
maybe New York, where I am, what problems keep surfacing that leaders may be reluctant to talk about, whether it's legacy infrastructure or technical debt, cyber exposure, cloud migrations that stall, vendor sprawl, things that may be embarrassing. And I don't need you to name names. In fact, you don't need to at all. But without naming names or necessarily logos,
I'm sure you've heard some things that are embarrassing. They don't want to talk on the stage or it's broadcast, but what are you hearing?
Scott Becker 6:15
Right. No, I think what happens is you've got hospitals and health systems overall, you know, they and the physicians in our country do the Lord's work. They take care of so many of us. I mean, you know, without hospitals and health systems, if COVID proved nothing else, the hospitals and health systems are the safety net of our country and we need them. Now, what are the challenges?
What you don't talk about is hospitals right now, we spend 5.5 trillion a year on healthcare in our country. Nearly 31% of that is hospital expenditures, health system expenditures. You can't fix healthcare without at least slowing the inflation in those costs. You just can't.
do it. And so you've got the situation where health systems are overwhelmed. They know they're a big part of overall healthcare cost, but the answer to everything is to raise reimbursement and get more people paying for healthcare. And what you're seeing is, what you're seeing is more and more healthcare go around the systems.
go around the clinicians' offices. And I think that people talked about it years ago in terms of leakage. We're seeing leakage of cases to other places. And I think that problem is 1 problem. Another problem we see is, you know, I was on the phone recently or today with someone who's talking about the secret at their health system is they can't find primary care doctors.
They're just not enough. And that's not a surprise. There's 350,000 or so primary care physicians in our country. There's 350 million of us. Just if primary care physicians just did, you know, the amount of physicals we needed by that population, they'd be able to do nothing else. So there's just not enough primary care physicians. And what's happening is
People are not really getting to the root of the problem. You've got systems have opened up new medical schools, but not new residency spots, but they've not addressed the real problem is how do we make this a more attractive pathway so we get more and more doctors into medical school, into residencies and now practicing
in a more attractive way. But it's just as a, yeah, no, your health system space, you know, I've got a great health system CEO locally who talks constantly about margin and mission and he's right on. They got to have margin, got to have mission, trying to take care of their local community. And he has to constantly fight the board on how do I spend enough money to take care of the community while delivering margin.
really in a tough spot. I mean, it's a really challenging situation.
Jordan Cooper 8:35
So...
I hear you saying that especially academic health systems are quiet, are building up their capacity. They're opening new schools of medicine. There may be some other challenges with making the system, the profession of being a physician more attractive. I'm wondering if there are other areas where health systems are potentially
quietly spending money or quietly pulling back. What are the CFO and CIOs actually prioritizing now versus what's in press releases? If you, you know, obviously we're seeing a lot of M&As and we're seeing big billions spent on Epic, but what are we not hearing now?
Scott Becker 9:05
Yeah.
Right. And you're still seeing billions spent on building. What you're seeing is this great divide between health systems, health systems that are substantially investing in artificial intelligence and technology and new ways of doing things that are sort of needed, and then systems that can't.
And I think the great reality of it is, like people will ask me.
Where's the next great spot that AI is going to have a real impact? And what I would say is that AI is like the iPhone, and bear with me as I work through this. 15 years ago, if you would have told me all the things I do on my iPhone, I would have never in a million years believed it. You know, never believed it, never understood it. But I couldn't have predicted those things. Most sales system leaders,
that are really intelligent, in my perspective, will take a similar perspective. I don't know exactly where it's going to be having the most active and important use cases. If you would have told me three to five years ago that everybody would need ambient listening as a need, not a want, I wouldn't have thought that. I wouldn't have known that.
But you see it now three to five years later, every system is acquiring and using and getting to ambient listening because it's making the job of their clinicians easier, their physicians or nurses and others. And I can't tell you the next five to six cascading use cases, but I think the really smart systems are really good at intentionally focusing on
Jordan Cooper 10:14
And.
Scott Becker 10:34
here's the four or five, six years we're focusing on right now. And then here's the next things we're going to look at at some point. And they mix intentionality with what they're going after with opportunism of, okay, we saw this solution, somebody's really using it. And I don't think you have to be the first mover in everything, but you got to be in the game. So I think
Jordan Cooper 10:52
Do you have examples of where somebody either A, identified what they thought would be the future trend, but that didn't pan out and they had to roll it back? Or do you have any examples of things where they have been successful? I guess you could say other than ambient listening or where you're thinking may be successful next few years, where, you know, what's the big thing for 2032?
Scott Becker 11:13
Yeah.
No, I think the biggest success right now would be ambient listening and the places where revenue cycle is helping and moving. You know, there's more and more, you know, revenue cycle, we're spending a trillion dollars a year in administrative costs. We're spending 200, 250 billion a year on revenue cycle. And it's partly by having a very, very, you know, multi
system, payer system is to how you get paid, good or bad. But, you know, I think revenue cycle is one of the areas where people just couldn't stay off. And they've got more and more of the artificial intelligence technology, RPA, doing stuff that just, they just can't staff, they couldn't do before. And it allows them to focus on more important stuff. And on failed use cases,
Jordan Cooper 11:38
Mhm.
Scott Becker 11:56
I don't know if I'd say failed use cases, but there's so many different solutions that people are selling at people that just don't get used, that just don't get used. And so systems are getting better and better at sort of being intentional about, we're just not going to even start that solution until we really think we've got a populist that's going to use it. But you've got so much of it over the last several years, people that
Jordan Cooper 12:09
Mhm.
Scott Becker 12:17
bought so many solutions that aren't using them.
Jordan Cooper 12:19
So Scott, in addition to supporting health IT and the provider space, Becker's Healthcare also supports the payer space. There have been articles enumerating kind of an arms race with that that is AI enabled between payers and providers.
where providers are trying to use AI to improve their claims, to have the top code that they possibly can, and payers are trying to use AI to deny claims or to make it accurate as in their opinion. You know, what's going on in the arms race between payers and providers with AI?
Scott Becker 12:55
No, I think that's exactly right. You have an AI arms race. In fact, some of the companies are selling solutions to both, of course, some of the technology companies. You have this arms race. It's very expensive. The big payers just have abundantly more resources than the typical health system or provider. And so when you
You know, when you see this, you know, four of the biggest payers are...
for the largest companies in America by revenue. So right after Amazon and Walmart, you've got United and CVS. So they've got a lot of resources to spend on technology. They're managing more and more of the government healthcare programs through Medicare Advantage and Medicaid programs. You know, at the end of the day, value-based care
is a euphemism. I don't know that it really means anything, but you do have the big payers who have been put in charge of making federal health spend and state health spend more predictable. And at the end of the day, a lot of that comes down to denying, pre-authorizing and everything else, all the things we don't like, but they're exactly what the government has signed in up to do.
Health systems are at a disadvantage just because they don't have the resources. The largest health systems, taking aside HCA and taking aside Kaiser Permanente, which is both a health system and an insurance company, you know, are 30 to $40 billion in revenues compared to 400 billion in revenues. You know, Common Spirit is about 40 billion in revenues. I don't know the exact numbers today. Advocates up there. Advent Health has become
Jordan Cooper 14:09
Mhm.
Scott Becker 14:23
very big, but they're nowhere near the size of the big payers. So when a technology race, it's just a struggle to keep up. And it's again, it's part of the absurdity of our system right now that we've got so much money being spent on both sides of the equation to fight with each other over claims processing. I mean, it's absolutely
Absurd.
Jordan Cooper 14:44
So kind of pivoting a little bit, but again, kind of looking at the future. I'm wondering if there are any health IT or operations challenges that you think may be underestimated by the industry or something that may be in crisis in two and three years that people aren't, maybe they're planning for a little bit, but they're not really, like it could be cyber resilience.
talent shortages in IT, post-merger, system consolidation, cloud modernization. What are you seeing?
Scott Becker 15:13
Yeah, I mean, I think the, not the nightmare, the Armageddon situation, and you see this periodically at systems, is we're so reliant on technology, the technology goes down and then you're out of operations for a while. I mean, that's obviously the big daily risk everybody deals with. You know, aside from the
All the new things, all the two new technologies, all the new artificial intelligence, when you talk to CIOs and health system leaders, they will tell you that 80% of their job remains keeping the systems running and resilient 24-7. So notwithstanding all the discussion of all the interesting stuff, the new stuff, the things that could be game changing,
you know, there's still 80% of the time is spent making sure you're 24-7 and you're resilient and there's not downtime and you're protecting the system and cybersecurity risks. And I think as artificial intelligence becomes an arms race, you know,
The payer hospital arms race we could deal with, the state actor AI arms race that is sort of trying to cause trouble and malice, is a scary thing and remains a scary thing for everybody and is likely to continue to be a very scary thing.
Jordan Cooper 16:21
So as many health systems are trying to tackle all these different challenges and keep up in the AI arms race and go through these technology transformation and cloud migration processes and go through a ton of M&A activity, sometimes some organizations are building solutions in-house and other times health systems are outsourcing their health IT work or their IT infrastructure.
to manage services providers. How are health systems feeling about outsourcing IT versus building solutions in-house?
Scott Becker 16:53
Yeah, I don't think there's an absolute uniform thought on it. I mean, my thought on it has generally been that most health systems aren't.
I never want to be a builder or a custom solution. Years ago, I used to work with many different parties that would buy software or custom build software. I want to be with vendors, companies that are constantly improving, constantly doing it, have a...
bench can deploy and so forth. So I see systems that are big, that have the resources to build their own.
their own resources, their own technologies, their own artificial intelligence. I'm largely not a huge fan of it, just because you need enough people then to keep on growing that and make sure you can keep on taking care of it. So I generally, I'm not saying that you outsource all your technology, you outsource all your revenue cycle. I think it's a whole mix of
Inside and outside, for years, it's been too expensive to get the talent internal to to sort of.
meet the talent that's external that's out there. So I think it's hard. But I think at some point you become bigger and bigger and you do more and more stuff through your own information system, through your own CIO, through your own technology program, but you're still relying a lot on outside resources.
Jordan Cooper 18:15
So Scott, as I mentioned at the top of this episode, you've published a lot of books and your new book, Building Great Businesses, actually comes from decades of watching organizations grow. As I mentioned, you're of counsel at McGuireWoods, you're a partner there, and you also are the founder of Becker's Healthcare. So you have an opportunity, especially at your conferences and your podcasts, to speak with a lot of leaders.
What's a lesson that you'd like to share with our listeners from health system leaders that most need to hear it right now?
Scott Becker 18:43
Yeah, no, I think our health system leaders, our physician leaders, our nurse leaders are just overall fantastic. You know, as I said earlier, that they do the wards work. At the end of the day, it's constantly about building great teams, building great leaderships, and making an impact. And the very best leaders,
you know, some of the best leaders. Jenny Spees was a great example of this at UCLA.
Every conversation you have to her comes back to the core of, are we taking care of patients really well? Are we taking care of the customer, the patient really well? Is safety really great? Are we really taking care of people really well? And at the end of the day, that's where it all comes back to, but it's very hard with all the noise out there to filter.
everything out and come back to, it's all about taking care of the patient. We always view it in businesses. There's your customers, which in this case are your patients, and there's your team. And the great organizations are very focused on a handful of things. Their teams, their customers, and just a
few core things. And the more and more you bring it back to that, like the best leaders in technology are always about, is this going to help our physicians? Is this going to help our clinicians? Is this going to help our patients? You know, they're very, very keep on coming back to, does this have a real benefit to us or is this just a nice to have? And so I think it's that constant focus. I don't think it's
necessarily anything that's brand new or any silver bullet. I think it's very much about, you know, how are we taking great care of our teams, how are we taking great care of our patients? And I think that's really what it remains about. And so many of the great systems in our country are really doing that. They're really after that.
Jordan Cooper 20:24
So remember your why, remember constant focus on your mission. For listeners who want to keep learning from you, what's the best way for them to follow your work, Scott?
Scott Becker 20:33
Sure. I think the easiest, simplest way is probably on LinkedIn. We've got a core LinkedIn account with whatever, you know, 50, 60,000 followers, connect with me, LinkedIn with me there. That's probably the easiest way. We also, as you mentioned, wrote a new book this year, Building Great Businesses, which is the 3rd or 4th business book we wrote years ago, four or five healthcare books.
We've got a new healthcare book coming out next year. So yeah, no, but if you follow me on LinkedIn, that's probably the easiest way to follow me and see what we're doing. But, you know, and love to connect with people and help any way that we can.
Jordan Cooper 21:06
So thank you, Scott, for our listeners. This has been Scott Becker, the founder and publisher of Becker's Healthcare and a partner of Aguilar Woods. Scott, it's been a pleasure having you on Healthy Uptime Podcast.
Jordan Cooper stopped transcription
