Spotlight On: Tim Brundage, CEO, Brundage Group

Key points:

• • Strategic investment is enabling Brundage Group to scale physician advisory services and expand nationally.
• • Physician advisors and technology help hospitals secure proper reimbursement and protect financial stability.
• • AI is enhancing efficiency and decision-making, not replacing clinical judgment.

April 2026 — Invest: sat down with Dr. Tim Brundage, CEO of Brundage Group, to discuss how the company is helping hospitals protect financial viability through physician advisory services, technology, and AI-enabled workflows. “We help hospitals maintain financial viability so they can continue to serve our communities,” Brundage said.

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What changes over the past year have most impacted Brundage Group, particularly in terms of expanding your presence and impact?

The biggest recent development for us is that we brought on a strategic investment partner. Chicago-based Water Street Healthcare Partners invested in us, and that partnership marks a major new phase for the company. Water Street invests only in healthcare, so there is strong alignment in mission and long-term goals.

Our objective through that partnership is to expand our ability to support hospitals. We have built a technology platform and paired it with what I believe are some of the best physician advisor minds in the industry. Those strengths have allowed us to survive, grow, and thrive, but we have done so bootstrapped. We needed a financial partner to help us penetrate the market more deeply and bring our model to more hospitals.

We are currently active in 32 states, and while not every hospital will need Brundage Group specifically, we believe every hospital needs physician advisor support. What makes us different is that we have tools that support physician advisors in a way that we think is unique in the market. We can also demonstrate return on investment by showing the revenue hospitals recover compared with the dollars they spend on physician advisory services.

That matters in today’s environment. Hospitals are under real financial pressure, and our role is to help them remain sustainable. We help hospitals maintain financial viability so they can continue to serve our communities.

How does your approach strengthen alignment within hospital systems, and what impact are you already seeing?

We support hospitals in their revenue cycle across several service lines, but our most impactful area from a financial perspective is utilization management. Our Physician Advisors help determine whether a patient should be classified as outpatient with observation services or inpatient based on medical necessity and compliance.

That distinction does not change the care the patient receives. What it changes is the reimbursement the hospital receives for that care. On average, that decision can represent roughly $7,000 in additional reimbursement per case for the hospital.

Because of that, there is naturally a great deal of scrutiny from payers. Insurers want to pay the lowest appropriate amount for care provided, while hospitals want to be reimbursed appropriately for the services delivered. Our Physician Advisors operate in the middle of that conversation. They assess medical necessity and determine whether inpatient status is justified or whether observation is the right designation.

We make those decisions thousands of times each month, and when payers disagree, our Physician Advisors stand behind the determination through peer-to-peer conversations. In those cases, our doctors speak directly with the payer’s medical directors to discuss the merits of the case. About 55% of the time, we are successful in getting the hospital reimbursed at the higher level through that process.

That is where our impact becomes very tangible. We are directly helping hospitals preserve appropriate reimbursement and strengthening the alignment between medical necessity, compliance, and revenue integrity.

What key trends are shaping healthcare finance today, and how are providers adapting?

I come to this conversation with a bias toward the hospital, because my job is to help hospitals remain financially sound and viable. From that vantage point, one of the biggest trends in healthcare finance today is the growing amount of friction in the payment system. That friction shows up when payers deny payment, delay payment, or reduce payment.

From the payer’s perspective, there is logic to that scrutiny. No one wants to pay for care that was not medically necessary, and payers absolutely should evaluate whether care could have been delivered at a lower-cost setting. Hospital care is expensive, and inpatient care is among the most expensive forms of care delivery.

The challenge is that when medically necessary care is provided, hospitals need to be paid appropriately and in a timely manner. We are seeing denials increase, and that creates a real strain on providers. Hospitals are already operating with tight margins, and when reimbursement is delayed, downgraded or denied, it affects their ability to invest in facilities, technology and patient care.

The broader reality is that healthcare in the United States is very expensive for many reasons. Part of that comes from utilization, part from administrative complexity and part from a litigious environment that can encourage defensive medicine. All of those factors shape the financial landscape hospitals are trying to navigate today.

How are you approaching culture and talent as the company grows?

We have been fortunate to grow to more than 100 employees, and that growth has been rapid. As we scale, we have made a very intentional effort to preserve culture.

My wife, Patty Brundage, serves as our Chief Culture Officer, and she is a nurse. She sits down with every new hire and ensures they understand our company’s story, mission, vision, and values. We spend a lot of time talking about why we exist, because if people understand the why, they are much more likely to feel connected to the work.

We also believe that people spend a tremendous amount of their lives at work, so the environment matters. We aim to build a culture of positive reinforcement, appreciation, and accountability. We believe people achieve more when they work together and when they feel supported. That mindset has been central to how we have grown, and it is reflected in the recognition we have received as one of the best places to work.

For us, culture is not separate from performance. It is one of the reasons performance is possible.

How do you see the healthcare finance landscape evolving over the next three to five years?

The biggest force shaping the landscape will be AI. It is not just a business issue or an industry issue. It is a human issue because everyone is trying to understand how to use AI effectively while also guarding against its downsides.

Our view is that AI should be used to make Physician Advisors more efficient and better informed, not to replace their judgment. We still want doctors making the decisions. What AI can do is accelerate access to the right information at the right time so those decisions can be made more effectively and at greater scale.

We are already applying that philosophy in our utilization management platform by using AI to route work to physicians at the right moment. We are also applying it to appeals, where AI can help draft the initial structure of an appeal letter, so the doctor can focus on reviewing the clinical argument rather than doing administrative busywork.

That is the near-term opportunity as we see it. AI can help the workforce get work done more efficiently and effectively today. Where it goes beyond that is still an open question. We do not fully know where AI will be in five years, but we do know it will play a major role in how healthcare organizations operate.

What are Brundage Group’s key goals and priorities for the years ahead?

Our main priority is to continue scaling in a way that allows us to support more hospitals. We believe it is too expensive to rely entirely on people manually reviewing every chart and every case. Instead, we are building technology that can analyze large volumes of healthcare data, identify opportunities, and escalate the right cases to Physician Advisors.

We do that in multiple areas, including DRG review and medical necessity. The platform helps us surface the cases where there is the greatest opportunity and directs physician attention where it can have the most impact. That allows us to use our clinical expertise more efficiently and extend our reach.

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