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| | | Healthcare executives have big plans for technology in their revenue cycle management operations. Over the next 12 months, AI, machine learning and other RCM automation solutions are a top investment priority. The findings are from a survey conducted by the Healthcare Financial Management Association (HFMA) and analyzed by Guidehouse. The researchers received completed questionnaires from 134 hospital CFOs, VPs and other executive-level leaders. The respondent pool showed “payer challenges” to be the overall most vexing area of concern affecting RCM. Some 41% said they’re experiencing claims denial rates above 3.1%. Meanwhile staffing shortages continue to thwart operations, including RCM, although 71% are happy with vendor outsourcing as a fix. Guidehouse analysts offer a number of observations from the project. Among the most edifying are these five: 1. Providers are planning to heavily invest in automation, AI and machine learning to address staffing shortages while streamlining operations, improving efficiency and filling gaps.Research shows AI adoption alone has led to accelerated payment cycles, the report authors write, with payments processed within 40 days versus the standard 90. More: ‘This trend aligns with broader industry movements, as noted in Guidehouse’s 2023 Digital and Technology Report, which found that providers have increased their digital and IT budgets over the past few years.’
2. As the need continues to grow for effective EHR integration, revenue cycle automation and modernization, provider technology systems have become prime targets for cybercriminals.Laying the groundwork for a strong cybersecurity posture and risk mitigation program is imperative in today’s healthcare environment, Guidehouse comments. More: ‘Testing incident response programs by implementing executive security simulations for revenue cycle management and clinical operations in the face of any level of cyber risk is critical to avoid detrimental financial and operational disruptions.’
3. Higher-than-average denial rates indicate internal process breakdowns, documentation issues and payer delay tactics such as requesting additional information. Plus, the time and effort needed to research and collect documentation to appeal fatal denials has become unsustainable. More: ‘The goal should be to achieve a final denial rate of 1% or less; however, staffing shortages impact an organization’s ability to counter the increased level of activity.’
4. Both providers and payers continue to face workforce shortages. For providers, being understaffed and experiencing increases in denials is a disastrous mix, the authors point out. “To overcome these compounded complexities, providers need the staff necessary to bullishly manage the entire process—from front-end staff handling patient access to back-end processing and collection.” More: ‘The struggle to recruit and retain qualified staff members—and the resulting high turnover—is costing organizations in more ways than one: Providers invest significant time and money in training, onboarding and benefits for new employees who often don’t stay long enough for employers to realize a return on investment.’
5. Healthcare organizations seeking to optimize results from RCM automation, AI and machine learning capabilities should take four steps: - Assess data and technology governance, cybersecurity and quality.
- Determine whether the application is appropriate for each user’s use case and patient population.
- Identify metrics for validation, testing, measuring impact and managing expectations.
- Never lose sight of the human element.
The full report is available in exchange for contact info. |
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| | | Nabla Now Supports 35 Languages to Advance Culturally Responsive Care - Clinicians can now leverage AI-powered documentation in any of the 35 languages supported to cut down on charting time, focus on patient care and enjoy better work-life balance. Patients receive care instructions in their preferred language, ensuring clarity and compliance throughout their healthcare journey. Read more here.
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| | | Buzzworthy developments of the past few days. - CIOs are commanding bigger paychecks than ever before. They’re also increasingly reporting directly to the CEO rather than, as in the past, a C-suite denizen of lesser rank. And they have the soaring demand for AI expertise to thank for both developments. One executive headhunter tells CIO.com compensation for both CIOs and CTOs has jumped more than 7% over the past year—and upward of 20% over the past five. Thing is, great expectations often come with ticking impatience. “When AI projects peter out, frustration builds, and ‘the fall guy happens to be the CIO,’” explains another executive expert. Read the rest.
- Care denials spiked 55.7% for Medicare Advantage claims between 2022 and 2023. Denials for commercial claims rose pretty sharply too, 20.2%, in that window. The American Hospital Association says you can thank AI algorithms for the unhappy trend. “Poor applications of these technologies can result in automatic denials of care without consideration of a patient’s individual clinical circumstances or review from a clinician or plan medical director as required,” AHA states in a September report. “In these situations, hospital staff must expend valuable time and resources to overturn inappropriate denials, adding unnecessary cost and burden to the healthcare system, and creating uncertainty for patients about whether their insurance will pay for their care.” Read the report.
- The clinical documentation integrity (CDI) profession has remained mostly unchanged since at least 2008. AI is soon to shake it up. Revenue cycle veteran Glenn Krauss looks at the coming rebuild in an opinion piece published by ICD-10 Monitor. “Given the advancement of AI, ambient clinical intelligence tools and other AI-driven tools, there will soon be less opportunity for CDI as currently exists in the marketplace,” Krauss writes. “Change in present-day CDI practices is inevitable; pivoting away from a primary focus on diagnosis capture to an approach that incorporates the top 10 requirements of an effective CDI program will drive the achievement of far better and sustainable documentation.” If you want to consider the requirements to which he refers, click here.
- Across the pond, physicians are conflicted about generative AI. In a new survey by Medscape UK, almost half of 745 respondents say they would not use the technology to care for patients while very close to the same number say they would consider it. Meanwhile some 86% worry about AI supplying patients with bad information and 82% fret over patients intent on self-diagnosis might take AI more seriously than their doctor. More results here.
- Healthcare AI meets It’s a Wonderful Life. The result is a rough equivalent of the angel Clarence Oddbody showing AI what healthcare would be like had the technology never been born. Kamya Elawadhi, chief client officer of the healthtech startup Doceree, conducts the thought experiment at Forbes. Thinking through the “consequences of an AI-free healthcare system,” she describes delayed diagnoses and treatments, increased operational inefficiencies, reduced access to personalized medicine and compromised data-driven decision making. Ring a bell and get your wings here.
- Anticipation over healthcare AI is bubbling just below the surface of daily life in Southeast Asia. The region’s digital healthcare market may reach $6 billion in 2024 revenues, and much of that will trace to the penetration of AI. The reporting is from Channel News Asia, or CNA, an English-language network based in Singapore. AI and other emerging technologies “can transform Southeast Asia’s rehabilitation efforts, aid critical diagnoses and streamline administrative processes,” journalist Rashvinjeet Bedi writes. “But for some in the sector, technology is not a cure-all. For those ‘entrenched in traditional methods,’ trust will take time to build, say experts.” Interesting reporting.
- Hustling the physician-patient relationship: Just one of 11 frights lurking in the dark side of large language models for healthcare. Researchers in France lay out the list in a paper published in The Lancet Regional Health: Europe. “Biases can emerge not merely because of biased datasets or algorithms but [also] because of factors involved in real-world implementation,” the authors warn. “Clinician-, patient-, and social-level factors can interact to create biases in the adoption of AI for clinical decision support.” Also making the list are disproportionate fashion, alienating work and—possibly losing something in translation—“humans under influence.” The journal has posted the paper in full for free.
- A dermatology practice is using AI to head off suspicious characters entering with drawn guns. “Unfortunately, we turn on the news and we see these events occur again and again,” explains Joshua Lane, MD, owner of the practice, to a local TV station in Columbus, Georgia. “And the ‘offering thoughts and prayers’ [routine] isn’t enough for us. We want to have action.” Lane Dermatology is probably not the first doctor’s office to go this route. And they probably won’t be the last.
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