If you were to believe all the headlines you read about AI in healthcare, you’d probably think that AI will be curing cancer and replacing doctors within the year. I mean, there have certainly been some exciting advancements. For instance, medical teams at MIT and Mass General Cancer Center recently developed and tested an AI tool that was able to look at an image and accurately predict the risk of a patient developing lung cancer within six years.
On the other hand, Elizabeth Holmes, the founder of Theranos, stands as a prominent example of what happens when people blindly believe the hype about healthcare and technology. Her fraudulent claims about a supposedly revolutionary blood testing technology raised concerns about the oversight and regulation of AI and healthcare innovations, and ultimately ended with her being sentenced to eleven-years in prison.
To make the most of AI without getting blinded by the hype, I recommend treating it like any other new technology: subject it to rigorous scrutiny, demand transparency, and emphasize responsible implementation. AI isn’t a magic wand that will instantly cure all ailments or replace the expertise of medical professionals. It’s a tool – a potentially powerful one – but it’s still just a tool.
Which medical fields benefit most?
Some fields of medicine will benefit from using AI more than others. For instance, the field of medical imaging and diagnostics has already seen the benefits of AI. Again, radiology departments can now utilize AI algorithms to analyze medical images such as X-rays, MRIs, and CT scans. These algorithms can identify abnormalities and assist radiologists in making more accurate and timely diagnoses.
Another field that will benefit from AI is drug development in pharmaceuticals. Scientists can use AI to analyze massive datasets of molecular structures and predict potential drug candidates. This is much more efficient than having organic chemists sift through datasets by hand. AI can also expedite clinical trial recruitment by matching eligible patients with suitable trials based on their medical records. So, AI can accelerate drug discovery, reduce research and development costs, and bring life-saving treatments to market more quickly.
Even more human-oriented tasks, such as patient engagement and remote monitoring, stand to benefit from AI. AI-powered healthcare CRM systems can enable personalized patient communication and remote health monitoring. These systems can send automated follow-up messages, answer patient queries, and detect potential issues based on patient-reported symptoms. AI enables enhanced patient engagement, improved adherence to treatment plans, and early detection of health issues. This frees up time for healthcare staff, allowing them to focus on more complex tasks.
Autonomous coding enjoys a high level of trust among healthcare finance professionals who use or plan to use the technology, with 45 percent indicating it often works well and 16 percent placing complete trust in it. Yet despite its emergence as a powerful tool for streamlining and improving error-prone manual coding processes, autonomous coding suffers from an awareness problem, with 52 percent saying they do not know what it is.
Those are the findings of a new survey from the Healthcare Financial Management Association (HFMA) on behalf of AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S. More than 450 healthcare finance professionals were surveyed during the 2023 HFMA Annual Conference on their knowledge of and value expectations for autonomous coding, including 60 percent that use or plan to use autonomous coding.
More than half (52%) of respondents said they don’t know what autonomous coding is and 30 percent either did not or were unsure if it could be trusted.
Thomas Thatapudi
“Despite high expectations around its potential to increase coder productivity and coding accuracy, reduction in denials, missed charges and low-risk scores, and accelerated provider decision-making, autonomous coding suffers from a knowledge gap that must be closed if we are to see broader adoption,” said Thomas Thatapudi, CIO of AGS Health. “Until we can fully educate finance leadership on the potential autonomous coding holds for improving the healthcare revenue cycle, we are unlikely to see an acceleration in use cases for AI-powered technology which includes autonomous coding.”
Among the key benefits of autonomous coding is its ability to eliminate the potential for human errors that result in missed reimbursement opportunities, backlogs, delays, and claims errors, and its ability to push accuracy levels to near perfect percentages. All of which can be achieved in near real time with the right integration pipelines. Autonomous coding is also faster than its human counterparts – it can complete charts in seconds – yet it also understands what it does not know, flagging it for human review.
Accidents can be confusing and scary, whether they’re small accidents or big ones. When accidents happen, it’s not just the physical pain that people have to deal with; they also have to navigate the complicated world of healthcare.
While it might seem easier to let the experts handle everything, it’s important for accident victims to take an active role in their recovery. This means understanding their rights when it comes to medical care and the potential compensation they may be entitled to. For those who want to know about compensation, learn more about personal injury law here.
Here are the seven essential healthcare rights that every accident victim should know.
Right to Timely Medical Care
Right after an accident, getting medical help as soon as possible is super important. Even if the injuries don’t seem too bad at first, some problems might not show up until days later. Getting medical help quickly makes sure that any potential issues are found and treated early, which reduces the chances of having long-term problems. Plus, it can make a difference in compensation for legal actions later because it shows a clear connection between the accident and the injuries.
Right to Choose the Healthcare Provider
Even though insurance companies might suggest certain healthcare providers, accident victims don’t have to use them, and a legal attorney can help assert this right. Picking a healthcare provider they trust ensures that they get fair and impartial care. Also, the records and documents from the chosen provider can be important when talking to insurance people or making a case in court. It’s your health, so you should have a say in who takes care of you.
Right to Informed Consent
Medical procedures can be scary, so doctors have to explain everything to the patient before any treatment begins. This means telling them exactly what will happen, what the risks are, what other options are, and what could happen. Being well-informed lets victims confidently make decisions so they’re never in the dark about their healthcare. It’s all about making sure you have a say in what happens to your body.
By Andy McDonald, vice president of operations, Salucro.
Every profession has its own ‘bucket list’ — a collection of goals that people aim to achieve during their career. For revenue cycle leaders in healthcare, their bucket list items tend to center on strategic objectives designed to modernize the healthcare financial experience, enhance the patient experience, and streamline operations.
As vice president of operations at Salucro, a payment technology company exclusively focused in the healthcare space, I talk to clients, partners, and revenue cycle leaders every day and these are five of the most common priorities I hear:
Upgrading and Consolidating Revenue Cycle Tools
With the complexity of modern health systems comes a continuous influx of new technologies designed to optimize revenue cycle management. But the key to truly reaping the benefits of these advancements lies not in simply adopting the latest tool on the market, but in integrating and streamlining these solutions into a single, efficient system.
Patients have also begun to recognize the digital shift in their financial experience, with 93% saying they expect healthcare providers to use more and more technology to collect payments, according to a recent report.
The integration and consolidation of tools can dramatically improve the productivity of your staff. When they are spending less time navigating multiple systems, rectifying errors, and piecing together data from different sources, they can focus more on enhancing the patient financial experience and other high-value tasks that cannot be automated.
Improving the Patient Financial Experience
The patient experience encompasses all touchpoints of a patient’s journey, from the first call to schedule an appointment to the final payment transaction. Patients expect and deserve a seamless, intuitive, and personalized experience at each of these touchpoints – and with 50% of patients stating that their last billing encounter was bumpy, painful, or confusing, the quality experience that providers strive to offer doesn’t always carry throughout the full patient journey.
Leveraging technology can greatly enhance the patient experience. According to a 2023 survey of healthcare consumers throughout the U.S., 62% of patients pay their bills by credit or debit card via an online patient portal. These digital platforms not only cater to the modern patient’s preference for online interactions, but also help to improve revenue cycle efficiency.
Revenue cycle tools can automate patient communications, ensuring that patients receive timely billing notifications and follow-up messages. Survey data shows that patients are responding positively to these tools, as 51% of patients said a text message reminder would prompt them to pay their bill faster.
Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.
This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.
The appearance of artificial intelligence (AI), specifically conversational AI, is promising to change that, making it possible to convert the highly unstructured data populating the audit process into information that can be both analyzed and automated.
The Audit Environment
Ferreting out fraud and abuse remains high on the federal government’s priority list. In fiscal year 2022, the U.S. Department of Justice (DOJ) collected more than $1.7 billion in improper payments, while the Office of the Inspector General (OIG) reported identifying more than $200 million in expected audit recoveries and over $277 million in questioned costs in its 2023 Semi-Annual Report to Congress.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is expected to claw back $4.7 billion from Medicare Advantage plans over the next decade thanks to recent adjustments to its risk adjustment data validation (RADV) program. Add to all that the influx of demand letters in the wake of the expiration of the federal PHE – along with many of the waivers that kept external audits in check – as well as claim changes and heightened regulatory and billing practice scrutiny by federal contractors and commercial payers.
All this comes at a time when hospital margins remain “well below historical norms,” per Kaufman Hall, and revenue cycle leaders are facing severe labor shortages, with more than 41% reporting that up between 51% and 75% of RCM and billing department roles are currently vacant.
FutureRx (FRx) announced today that its FRx cloud-based healthcare platform for health plans and pharmacy benefits managers (PBMs) will be implemented by Imperial Health Plan of California, Inc. to enhance medication adherence among its Medicare Advantage population. The health plan will leverage the platform’s Part D Stars module to automate business processes, enhance medication adherence, and improve Part D Star ratings.
“At Imperial Health Plan, our vision is to deliver clinically effective and sustainable value-based care that achieves exceptional outcomes, a significant aspect of which is ensuring medication adherence by our members,” said Dr. Paveljit Bindra, CEO, Imperial Health. “By automating and streamlining much of this high-touch, resource-intensive process, FRx Part D Stars will help our pharmacy team prioritize its outreach to focus on members who are most at-risk for adverse health events, supporting improved health outcomes and enhanced performance on CMS Star Adherence measures.”
The FRx Part D Stars modulesimplifies the complex process of tracking and improving CMS Part D Star ratings with actionable insights and data-driven recommendations that drive performance. It identifies those members who are not getting their prescribed medications, which can negatively impact the member’s health and a health plan’s Part D Stars rating, while reducing administrative burdens and enhancing member and provider satisfaction and retention. The FRx architecture allows for rapid implementation and corresponding market-leading speed-to-value.
“FRx platform is ideal for a rapidly growing health plan like Imperial Health Plan that prioritizes quality care and outcomes,” said Anil Kottoor, CEO, FutureRx. “We are excited for our FRx Part D Stars module to play a key role in helping Imperial achieve Imperial Health’s care quality and Star rating goals through the transformative power of cutting-edge technology, advanced analytics, and expert support.”
In the vast landscape of healthcare, underserved hospitals often face unique challenges in attracting and retaining qualified medical professionals. With limited resources and remote locations, these facilities must devise innovative strategies to overcome the odds and secure the essential workforce needed to deliver quality care. In this blog, we will explore five inspiring ways underserved hospitals have successfully recruited medical professionals, showcasing their resilience and ingenuity in the face of adversity.
Embracing Technology to Bridge the Gap
In an era where technology permeates every aspect of our lives, underserved hospitals are turning to digital solutions to bridge the gap between them and prospective medical professionals. Virtual recruitment fairs, video interviews, and online job portals have emerged as powerful tools for connecting talent with remote healthcare providers. Through these innovative methods, underserved hospitals can cast a wider net and attract candidates from various geographic locations.
Additionally, telemedicine has proven to be a game-changer for underserved hospitals. By adopting telehealth practices, these institutions can collaborate with specialists from urban centers, offer remote consultations, and enhance patient care without compromising on quality. The seamless integration of technology into their operations has not only improved patient outcomes but also positioned these hospitals as attractive employers for tech-savvy medical professionals seeking a blend of tradition and innovation.
Cultivating Strong Community Partnerships
Underserved hospitals have realized that their success lies in their ability to be a pillar of strength for the local community. To recruit medical professionals, they are actively forging strategic partnerships with community organizations, educational institutions, and local authorities. By creating a support network, these hospitals can demonstrate their commitment to the well-being of the community and showcase unique opportunities for personal and professional growth within their facilities.
Just one generation ago, wearable tech sounded like science fiction. Things have changed profoundly since then. Walk down any street and you’ll pass people wearing all kinds of personal technology. One in five Americans now owns a smartwatch or fitness tracker, or the two combined in a medical alert smartwatch. And Bluetooth-enabled hearing aids were once expensive, experimental and hard to find, but this has now mushroomed into a more than two-billion dollar market.
Wearables and hearables are just the tip of the personal technology iceberg. Tech developers large and small are working on the next wave of wearable technology. Some of the hottest areas of development include smart sensors and mobile personal emergency response systems (mPERS). These are gaining traction for both personal and business-related use. Two of the most promising areas for growth are among seniors and companies that have vulnerable employees.
Wearable Tech for Healthier, Safer Seniors
Seniors were some of the earliest adopters of mPERS technology. The well known pendant from Life Alert came out in the late Eighties and continues to serve the market. The earlier iterations of this tech had just one function, connecting the wearer with a monitoring service at the press of a button. However, modern options have gotten much more sophisticated. Features now include emergency alerts, GPS tracking, fall detection, voice-activation and biometrics such as heart rate.
Many seniors are choosing to age in place or with family caregivers. They don’t have the safeguards of round-the-clock monitoring in an assisted living facility. Meanwhile, overstretched caregivers can’t watch their loved one 24 hours a day. The right mPERS device acts as a valuable safety net. It can give the older adult the confidence to stay independent while taking pressure off of caregivers.
Despite these advantages, tech developers need to solve some barriers to use. Cost is a major issue. Insurance companies and Medicaid often don’t cover device purchase or monitoring subscriptions. To persuade insurance companies, developers will need publish solid data on efficacy.
Another major barrier is privacy concerns. Seniors are disproportionately targeted by scammers seeking their personal information. Some hesitate to pick up more sophisticated mPERS devices, worrying that this may be another avenue for hackers to access their information. And technology that monitors their health may be constrained by privacy laws like HIPAA. Tech developers are still working on solving these challenges as they expand into this space.
