Artificial Intelligence (AI) has unlocked new possibilities that are pushing boundaries in healthcare. The U.S. Department of Veterans Affairs partnered with an AI company to create a system that diagnoses a deadly kidney disease up to 48 hours faster than a human could.
Virtual patients are utilized by medical schools, and Moxi the robot can be found in a Philadelphia-area hospital, performing non-clinical tasks so nurses can focus on their patients. The CDC says AI was even used as a research and public health tool at the height of the COVID-19 pandemic. AI advancements are quickly reshaping the healthcare experience for both the provider and the patient.
Beyond its critical uses in life-saving equipment, diagnosis, and treatment, AI can be harnessed to create innovative solutions on the administrative side — particularly through payment technologies. Let’s dive into three ways AI can improve healthcare outside the exam room.
AI can quickly analyze trends in a data set of payments to then create a database of typical charges for a given type of service or insurance. That would give patients — at the very least — a predicted range for the cost of an appointment or procedure. It wouldn’t be an exact number, but at least patients would have some sort of idea of how much money they will be spending. This would create more transparency between the provider and patient, therefore increasing trust in the relationship. AI is going to help the healthcare industry handle costs and payments in a clearer, more open way.
As we head into the new year, healthcare organizations will reevaluate their internal processes, procedures, and business plans to ensure they are ready to best serve patients and continue to operate successfully. There are many considerations and adjustments that are likely on the minds of organizational leaders based on aspects of the industry that have changed throughout the past three, tumultuous years. The new year is a prime time to assess the state of the industry and make shifts in processes for the betterment of overall patient care.
At SCALE Healthcare, we help healthcare organizations elevate their management performance and fine-tune their processes. Here is what healthcare organizations should keep an eye out for in 2023 and what internal considerations they may need to make to shift with the changing times in the healthcare industry.
The state of the industry
Today’s healthcare industry has been colored by what our world has endured since the onset of the pandemic, and many offices and organizations are still grappling with issues brought about by COVID. Cost and supply challenges continue to hamper the work that healthcare professionals can complete successfully. Problems with talent retention, the need for better invoicing and payment options, and the rise of healthcare IT technology advancements are all contributing to a rapidly evolving industry overall.
Women occupy 65% of the healthcare workforce yet seem to be missing in C-suite roles, holding approximately 30% of senior leadership positions and a mere 13% of coveted CEO titles. With female consumers making the majority of buying and usage decisions when it comes to healthcare products and services, the disparity between female leaders and end users in the industry is difficult to ignore.
In fact, we must pay attention to this gap that is slowly closing at a snail’s pace, as fortune 500 healthcare company boards slightly grew female leadership from 22.6% in 2018 to 26% the following year. And although U.S. hospitals tend to have more women at the top, a 2019 Rock Health report revealed that the metric of female representation is just over 37% in this arena. Certainly, progress is being made, but the diversity of welcoming women into leadership roles in all facets of healthcare – particularly healthtech – is crucial to meeting the diverse care needs of all patients and consumers across the board.
Diversity is a Must in the Industry
Spanning all industries, diversity is crucial at all levels of the workforce. Not only is it socially the right thing to do, but studies prove that a diverse workplace improves financial returns by 35%. Additionally, having a variety of perspectives boosts innovation, creativity, decision making, and opportunities to reach new customer demographics like never before.
Inclusive companies are almost two times more innovative and are better at making decisions 87% of the time. Similar to how diverse voices drive business outcomes, gender diversity is needed to continue pushing tech advancements in healthcare to deliver improved care for people of all backgrounds.
In the healthtech sphere specifically, women make up 20% of executive roles at the top 100 medical device companies. While many companies are hiring diversity and inclusion leadership roles to quicken the pace of change in the lack of diversity in healthtech, it’s crucial to share how gender diversity is taking control of the market and benefiting the industry. As a female executive of a telehealth platform with over 15 years of industry experience, I have seen significant growth as well as process and product improvements in our company – a company that is proud to possess a workplace culture that has been recognized by Forbes, Comparably, Inc. Magazine, Modern Healthcare, USA Today, and San Diego Magazine.
By Robert G. Hauser, MD, FACC, FHRS, chair of the Cardiac Insight, Inc. scientific advisory board.
A decade ago, my 72-year-old wife suffered a major stroke while we were attending a medical meeting in France. Fortunately, that country has excellent acute stroke care, the blood clot blocking blood flow to the dominant side of her brain was quickly dissolved by an intravenous drug. While in the intensive care unit, her ECG monitor revealed a short burst of a fast, irregular rhythm: it was atrial fibrillation, a rhythm that diminishes blood flow and allows blood clots to form in the heart. My wife had had no signs or symptoms of atrial fibrillation until that moment when she was suddenly paralyzed by a clot that dislodged from her heart and traveled to her brain.
My wife’s story is all too common. Undetected and untreated atrial fibrillation is a silent killer. In addition to stroke, it can weaken the heart by causing it to beat too fast. When the heart’s pumping function is weakened, patients may develop heart failure, and some suffer sudden death. The incidence of atrial fibrillation is growing as our population ages. Risk factors include obesity, diabetes, high blood pressure, and heart valve disorders. Women are particularly at risk because, compared to men, their atrial fibrillation tends to cause more severe strokes and worse heart failure.
Nearly all the consequences of atrial fibrillation can be prevented. But the key is early detection and treatment. In the case of my wife, the only way her brief bursts of atrial fibrillation could have been found is if she had worn an ECG monitor for some period of time.
What is the right period of time? Multiple studies have been conducted to assess the proper amount of time required to detect arrhythmias while achieving cost efficiency. For decades, the commonly held belief was that 24- to 48- hours was long enough. However, newer studies have found otherwise. For example, studies in Clinical Cardiology and Pacing and Clinical Electrophysiology concluded that seven days is the ideal length of time. A study in the American Journal of Cardiology found that, for all types of arrhythmias, diagnostic yield increased with a monitoring duration of > 48 hours. Among symptomatic patients, 92% of arrhythmias were detected by the 8th day of monitoring compared to just 47% during the first two days.
Researchers have found that the vast majority of clinically relevant arrhythmias can be identified by continuous ECG monitoring for seven days.
By Darren Ghanayem and Maria Turner, managing directors, AArete.
America boasts the greatest advancements in medical research in the world: more Americans have received the Nobel Prize in medicine than Europe, Canada, Japan, and Australia combined, which together have twice the American population. America has potential to lead the globe in cutting edge medical care, delivering service that is paid for fairly, accurately, and efficiently. It’s time our payer system caught up with our world-class talent and facilities.
The process of connecting the American healthcare ecosystem’s 3Ps (Payer, Provider, and Patient) has been marred with inefficiencies and inconsistencies. Nowhere is this more evident than in the billing area, where inaccuracies and disputes are commonplace. Resolving these issues is both time consuming and labor intensive—payers often have to jump through hoops to get to the real essence of a provider’s claim and translate accurately the real costs to providers and what to collect from patients. Such billing challenges, or even simple opacity, are not isolated instances—they are embarrassingly prevalent. A 2016 study by the Medical Billing Advocates of America found errors in three out of the four bills they reviewed.
These inefficiencies have added to a fractured, disconnected healthcare ecosystem; patients harbor animosity toward health insurance payers when they are billed more than they expected, while payers and providers are in constant dispute over reimbursement and shared payment arrangements. As a result, the tension can be felt across all constituents.
What’s behind these billing errors? Provider administrators sometimes enter incorrect procedure and diagnostic codes. A simple typo might exponentially increase the cost of the claim. For example, with a single misplaced or misread digit, an X-ray on an ankle might incorrectly register as an image of the blood flow to a brain. Many of these inaccuracies can be attributed to well-meaning human error—and payers need to develop strategies to combat these relatively benign mistakes. They must move forward and work together with providers, because playing the blame game harms every facet of the delicate healthcare ecosystem. But this doesn’t completely rule out the possibility of fraud. In some cases, providers have generated inflated revenue by intentionally using the wrong billing code (a practice commonly called “upcoding”) or incorrectly using modifiers to bypass the review process (e.g., the use of Modifier 59 to report distinct procedural services not normally reported together).
Gait is now recognized as the 6th vital sign and serves as a valuable indicator of health and mobility status. Previously, clinically-validated gait analysis technology was only available in lab settings, making it costly and inaccessible. With the development of new digital health technologies, providers can now collect objective gait and motion analysis data about their patients for heightened insight that enables them to better tailor treatment and provide proactive intervention when necessary.
What is there to learn from your patient’s gait analysis?
No two people walk the same way, which is why gait analysis has become a particularly useful tool for better understanding individual patients from a more holistic lens. Mobility status directly impacts how a person can interact with their environment and live a fulfilled life, which is why understanding and addressing functional mobility concerns is imperative for healthcare providers. Gait analysis is applicable across multiple healthcare sectors and can be used to:
Perform multi-faceted, thorough fall risk assessments
Establish a preoperative baseline and track postoperative progress
Understand the impact of disease on mobility
Highlight intervention efficacy objectively
Assess and predict risk for frailty
Leverage data for remote therapeutic monitoring (RTM)
Traditionally, objective gait analysis has only been performed in lab settings with expensive equipment. Observational gait analysis is more commonly used in clinical practice due to the lack of access to gait analysis technology. While observational analysis done by a trained professional can reveal important mobility data, it is difficult to quantify and standardize given the subjective nature.
The healthcare sector is rapidly evolving, with clinical researchers and scientists discovering new diseases and treatments. And with various technological advancements today, medical workers can be supported in providing excellent quality patient care in clinics, assisted facilities, rehabilitation centers, and at-home settings. These tools can also enable them to reach patients remotely and provide online prescriptions and medical recommendations.
With that, healthcare facilities, agencies, and organizations greatly fuel their investments in technological upgrades to benefit from fast, convenient, and affordable services. But what are the important considerations when deciding on a healthcare tech upgrade? Find out the answer by reading this article.
Partner IT Service Provider
Looking for a reputable information technology (IT) service provider is essential as you consider what healthcare tech upgrades to choose. You’d want to partner with a skilled team that understands what tech solutions and services you need. For instance, because cyberattacks are rampant, healthcare businesses must protect their IT infrastructure by hiring experts for multi-layer security implementation, cyber threat monitoring, surveillance, and network security installation. This way, you can keep patient and medical data safe and secure.
In addition, a medical facility or organization may need a more robust business system to handle enormous amounts of data. A software development company can help create a secure, reliable, and scalable centralized system for any healthcare business to meet this need. You can learn more about working with a software development company at https://www.ideas2it.com/nearshore-services/.
Compliance And Emerging Needs
The healthcare sector must comply with strict rules, industry standards, and federal laws because health and life are at stake. For instance, pharmaceutical companies, contract research organizations (CROs), and research sponsors must adhere to the standards set forth by the Clinical Data Interchange Standards Consortium (CDISC) for human clinical trials before developing new vaccines, drugs, or therapies.
Healthcare professionals and facilities must also uphold patients’ rights and data privacy laws. Therefore, any plans for healthcare tech upgrades must carefully consider these rules to ensure ethical and legal compliance. And because every healthcare institution or organization has unique needs, it’s crucial to consider identifying the urgent ones first. Lack of prioritization and organization can lead to overwhelming decision-making, which can be costly for the healthcare company.
Maintaining an organization’s revenue integrity should be a constant activity for compliance and auditing staff. Consider that, despite falling claim volumes in Q3 compared to the first two quarters of 2022, the average denial per claim increased by as much as 9.6%, according to the 2022 MDaudit Annual Benchmark Report. Lag days between claims submission and initial payer response also rose by as many as 6.5 days during the same period.
For health information management (HIM) professionals, this should serve as a wakeup call to make every claim count. Increasingly, organizations are using “risk intelligent” auditing to continuously monitor risk, detect anomalies, and automate workflows to bring efficiencies to formerly manual processes. Organizations that make resolving accuracy issues in billing and coding operations a priority can help retain between 15% and 25% of overall revenue. Revenue retention is going to be as critical as revenue growth for healthcare organizations going into 2023.
Read on to learn how to help your organization keep more of its hard-earned dollars.
Leveraging data to drive outcomes
Not long ago, coding, billing, claims, and auditing processes often operated independently of one another and employed tedious and manual workflows. These processes slowed claims submissions, payments, and auditing functions that help organizations maintain compliance and monitor revenues.
These time-consuming and cumbersome processes became more problematic during the pandemic, when the very foundations of the traditional care experience were upended by a novel disease and the rise of the virtual patient visit. While providers continue to recover from these shocks to their organizations, federal payers have ramped up their efforts to ensure the accuracy of claims.
During FY 2023, the federal Health Care Fraud and Abuse Control (HCFAC) Program and the Medicaid Integrity Program will receive nearly $2.5 billion, an increase of $80 million from the previous year. Inclusive of medical review, Medicare program integrity activities had a return on investment (ROI) of $8 for each $1 spent. With such an attractive return, don’t be surprised that the breadth and depth of these activities continues to increase.
Organizations can support risk-based compliance and revenue integrity by utilizing risk intelligent auditing to mine their billing and remit data to identify billing compliance and revenue risks. The same tools can unearth key metrics focused on current risk areas to monitor provider billing patterns and even benchmark them against peers. Risk intelligent auditing helps prioritize efforts to develop corrective action plans, educate stakeholders, mitigate the need for audits, and prevent future revenue losses.
By Pamela Gould, chief growth officer, 
