Hello, everyone. This is Jacob Emerson with the
Becker's Healthcare Podcast. Thrilled today to be joined
by 2 special guests. Andrew Lockhart is the
CEO of Fathom, and doctor Yogan Patel is
the CEO of Apollo MD. Doctor Patel, Andrew,
thank you so much for taking the time
to be with us on the podcast today.
Thank you for having us.
So, gentlemen, before we dive into everything we
wanna talk with you about, can we hear
a little bit more about yourselves? What do
you do right now with your respective organizations?
And what led you to this point in
terms of health care career backgrounds? Doctor Patel?
Thanks, Jacob. I serve as the chief executive
officer for Apollo MD. I'm a practicing emergency
physician.
I've been in the space now,
17 years with Apollo MD. So
thrilled to be part of the organization and
to serve.
We have the distinct honor of serving over
4,000,000 patients a year,
mostly in emergency medicine. We also do some
hospital medicine,
anesthesia, and radiology.
And we are, you know, a private practice
model, private independent group. I've been in the
space for over 40 years. How about you,
Andrew?
My name's Andrew Lockhart. I'm the cofounder and
CEO of Fathom.
My background in health care so I really
got the bug,
from Toronto originally
and was working for a design firm there
where are a lot of our
our clients were US based health care organizations,
Mayo Clinic, UHG,
and was spending a lot of time,
you know, exploring the US health care system.
And
the infinite complexity
of the system was something that just was
like a mind trap for me that got
me very excited, interested in health care.
Went on to do my MBA at Stanford,
and then coming out of that, really had
a distinct desire to do something in health
care.
My first swing there was in an on
demand pharmacy,
which, you know, I can give you lots
of color on what's problem problematic about the
way the pharmaceutical industry works. But, ultimately,
you know, that journey eventually led us towards
finding Fathom, a solution that we felt was
much needed,
timely,
and, you know, ultimately, something that, you know,
is very scalable. Sure. Absolutely. And, you know,
for our listeners who might not be familiar,
let's take a step back and talk about
how the partnership between your two companies
came about. How long you've been working together,
and what were you trying to achieve when
you when you first began working together?
Yeah. I'll I'll start. Thanks, Jacob. I was
actually just looking back at our emails. So
we actually
first,
started talking to Fathom back in December of
2019.
So, we were,
fortunately now an early adopter.
And for us, you know, as a private
group that's been in this space for a
long time,
we had always
relied on kind of a human
centered RCM
model. So rep all of our revenue cycle
required human coders.
We actually do the entire revenue cycle in
house. But the one component that we had
historically outsourced was our coding.
And what we found was over the years,
that human workforce
just didn't have the same resiliency.
And the quality started to become a little
bit more variable, especially as coding guidelines were
changing.
And so we were looking for a higher
fidelity solution.
And and ultimately, as we started to explore
the idea of automation,
we
stumbled upon Fathom. And, you know, at the
time, we probably looked at several
different coding solutions,
you know, computer assisted coding,
you know, other other groups that were early
in this space.
But really we're looking for somebody that could
deliver
top quality and accuracy,
sustainability,
and and great value.
And I think, even from the very first
conversations, Fathom
clearly kind of met those benchmarks.
And then really as a organization that was
naive
to artificial intelligence and automation,
they were great about kind of holding our
hand as we kind of journey together. And
it was,
you know, it's been a,
it's been a good collaboration. Sure. Absolutely. And
I wanna get into what some of those
outcomes are in just a second. But, Andrew,
do you remember the initial goals you you
set out to achieve with your partnership?
Yeah. I mean, like, when we started Fathom,
I think,
we would have thought that
50% automation for emergency department coding, which, you
know, I'd put in the, like, moderate high
complexity on the scale Mhmm. Was something that
was maybe within reach.
And then by the time we were able
to connect with Apollo MD, we felt pretty
confident we could get to 70.
And
the fact that we're able to jump to
where we are today is really,
you know, just a testament to the to
the to the engineering prowess of the team,
but also partners
who were able to work with us and,
you know, iron out edge cases. Sure. And
you're at 90% today. Correct?
Yeah. I think 91. Wow. So even even
higher than that. I mean, can you discuss
that journey of of improving automation rates to
90 over 90%?
And, also, you know, doctor Patel, why is
such high automation? Why is that an important,
achievement for the organization?
Yeah. I mean, as I mentioned, you know,
this has been a 4 year journey for
us. And at the start of the journey,
I think we would have been, you know,
we would have been thrilled at 70%. So
it really is a testament to how well
the platform
has learned and developed over the years.
It also allowed us
for the more complex cases
to really focus the human coders
on those cases.
And so we're really deploying the right resource
to the to the right work workflow.
And so for us, that has been kind
of a game changer. I mean, we have
a what I'd like to think of as
a kind of 6 Sigma process almost where
the auditing process is best of breed now.
And really the partnership with Fathom allowed for
that. Mhmm. You know, in addition to kind
of automation accuracy, I would say is even
more important.
And for us,
it's been a pleasure to see that that
has been a priority for Fathom.
And every time we've had kind of a
question,
a query,
they have been right there to kind of
investigate,
walk that path with us, and improve the
technology. Yeah. Any other outcomes you'd you'd point
out, Andrew? Well, maybe to answer your question
about the journey to 90%.
Sure.
One
extraordinarily challenging to get there with any organization.
Yeah. But Appol MD is a physician group
servicing, what, how many emergency departments? Like, over
a 100? Yeah. You've got disparate coding guidelines,
disparate EHR formats, disparate documentation
practices
that you need to cover go all the
way across.
And that's where, you know, really the benefit
of a technology platform that's continuously snowballing data.
So we're able to get going with with
clients like ApolloMD. As we've got more and
more clients, the AI became more and more
aware. And I'd say at this point, you
know, our system has seen north of 3
quarters of a 1000000000 encounters. Wow.
And that's enabled it to get this very
nuanced understanding of the ins and outs of
all these different data formats
and let it work across that so effectively.
And then, also, like, I I wanna give
credit to the team. Like, we've been very
fortunate that we've been able to pull in.
We've got engineers on our team who have
joined us from
AI teams at meta, AI teams at, like,
teams at Neuralink, literally building brain computer interfaces,
Amazon,
Microsoft. And
these folks, you know, have been really attracted
to the idea. Interestingly, like, basically, probably half
our engineering team is pre med.
And
so they're interesting in this idea that, one,
enormous amount of data, 2, something that has
a really scalable impact,
and then 3, like, a really hard problem.
Like,
you know, our CTO has a lot of,
like, vision and really pushes the team to
continually work with the latest, greatest. Sure. Sure.
Absolutely.
So, doctor Patel, you're in over a 100
emergency
departments.
What would you say have been the direct
and indirect impacts of autonomous coding on your
physician's
day to day experiences
and work life satisfaction?
Yeah. We are unique in the industry, I
think, in that we actually
compensate
our physicians,
on a almost a purely performance driven model.
And what that requires is our ability to
understand their productivity in a given month, and
within 2 weeks, translate that into payroll.
And so what we're talking about is their,
you know, RVU
productivity,
their collaboration
with,
advanced practice clinicians, so PAs and nurse practitioners.
And at some practices, their collaboration with resident
physicians.
And so it's a fairly complex box. Right?
And it does require this kind of precision
and execution
on a very tight timeline.
And with human coders that had always historically
been a challenge,
we have some unique workflows that that complicated
that further.
And what we found is as we partnered
with Fathom, you know, it took a lag
of several days,
that human coders required down till, like, less
than 2 hours. And so really, it just
closed the feedback loop to our team, you
know, dramatically.
And that allowed us to, you know, improve
our chart delinquency rates. That allowed us to
improve the accuracy and capture of the procedures
and
and documentation,
and really ultimately translated, I think, into a
more
accurate compensation model for our clinicians. So
it has been, you know, I think we're
we're thrilled with where we are today. The
system continues to improve.
Andrew, other things that kinda stood out to
you in that journey?
No. I mean, I like, I think the
one thing that gets maybe understated
with AI solutions is everyone's like, oh, this
is, like, a thing that's getting rid of
people.
But,
I I think, really, it just empowers people.
Sure. You know, the coders
on, you know, both our teams and
Paul and Dee's team, they're able to rather
than focus on things that are pretty rote
and monotonous
and
really dive into the details and, like, build
better systems rather than just, like, basically plugging
holes in the dam. Yeah. And I think
that that is something that is, you know,
really exciting. And, you know, ultimately, the promise
of this is, like, you
with these tools, you can basically
maximize your executive function rather than just, like,
getting tasks done. Yeah. And to hit home
on that where you use empowerment of these
physicians, are you finding that that really fits
into how Apollo MD prefers to operate?
Absolutely.
You know, we are we're kind of a
clinician cooperative. So we have,
an ownership model that allows our physicians, our
PAs, our nurse practitioners, our company employees to
all own in the organization.
So that need for empowerment
and autonomy of work,
is kind of ingrained in us. Sure. And
frankly, the ability to have better transparency
and reliability on the coding
really kind of facilitates that. It also, as
Andrew pointed out, rather than displace people, we
were a lot we were able to focus
our coding folks into an audit program that
really has taken,
I think, the fidelity of the entire system
to another level. So, you know, and when
we onboard new clinicians,
we're able to focus those auditors on their
work and give them early feedback, which, you
know, is kind of a it's it's a
lifelong journey for them. Right? So,
yeah, very excited about the future with Fathom.
Sure. So, Andrew,
let's talk about another
administrative favorite for for physicians,
and I use favorite lately. The issue with
payers administrative processes,
processes, prior authorization,
denials,
submitting claims,
all considering all of that, how does Fathom
help Apollo MD navigate what we know are
increasing challenges with payer denials and audits right
now? So this touches nicely on your earlier
question around why automation rates matter. Mhmm. The
biggest benefit to AI is your ability to
programmatically
perform certain tasks. And a lot of the
denials, they come about because,
you know, what a lot of payers work
on is they have these sort of disparate
guidelines that, you know, this will never reimburse
this procedure with this diagnosis code, etcetera. And
these can be insanely hard to track and
enforce against a large, you know, manual
pool of workers, but, like, basically, like, the
Paul and d MD team comes to us
and says, like, hey. For this payer, we
can't submit something that looks like this anymore.
You know, that's a that's a code change.
And then it's enforced across
not 50% of the volume, 90% of the
volume. And so you're inherently
your your coding related denials go down.
And, also, you know, the other benefit is
with that high automation rate, your compliance processes
go up because you've you've created these very
robust coding guidelines and documentation on how you're
gonna approach things, and it's enforced consistently. So
that if you are in an audit and
they're like, hey. Why did something happen this
way? There's not a ton of inconsistencies in
the system. There basically is like, hey. This
is very consistent.
The same way we wrote this down, the
same thing that we agreed to, and this
is our logic.
Yeah. No. That makes sense. And, doctor Patel,
what's your experience? And what are you hearing
from your employees?
Yeah. I mean, I for us, you know,
it has taken a lot of the variability
of documentation
out of the work. And, you know, an
earlier point that Andrew made is I'd say
half of our practices are epic sites.
The other half are are spread across a
smattering of EHR. So, you know, Cerner, Meditech,
Med Host,
and and each has its own documentation
kind of idiosyncrasies.
So the ability for us to message to
our teams to use
standard language
in the way they talk about
certain procedures.
FATHOM, you know, picks that up with such
a high degree of accuracy
that it has minimized, you know, lost procedures,
missing,
you know, electrocardiograms
or CPTs.
So for our clinicians, it's, you know, I
I think net net has been a huge
validation of their work
because they're doing the work at the bedside.
But, you know, documentation
documentation challenges,
sometimes leave them without getting full credit for
the work they do. Sure. So fair to
say you've seen payer denials decrease then? Yes.
And and, you know, some of that is
we've we've layered on other technologies as well,
but Fathom has been a big part of
that for us. Absolutely.
It's
attribution can be difficult because pair denials, generically,
are increasing.
And so to, you know, know
exactly what's what's what and what's because Fathom's
doing a better job versus, you know, what
is some unnamed plan tightening screws? Hard to
know. Yeah. That is a great point. So,
Andrew, for for providers considering autonomous coding that
really haven't dipped their toes into this space
yet,
advice that you'd give for all the leaders
listening in in terms of selecting the right
partner,
managing the implementation,
what what goes into this?
I mean, I'd say the biggest thing in
selecting a partner
is
make the contract reflect the promises made.
You know, the industry has evolved a lot.
It's much more mature. The technology is much
more mature. Sure. You know, serve vendors like
Fathom know what we can deliver.
And, yeah, if we say x, like, put
in the contract. We get punitive if we
didn't. Like, when we got started with Apollo
MD, it was like, hey. Like,
this is new. Like, we think this, but
the range was pretty wide.
But, you know, we're now in a place
where, you know, you should hold your vendors
to SLAs on accuracy, SLAs on
automation. Because automation, it, you know, drives all
these compliance benefits. It drives your ROI. And
if you're not getting that, then, you know,
there should be a penalty. The other thing
is make them demonstrate their wares. Like, see
the AI work across a large volume,
before you commit to anything
or make it contingent on seeing that because,
you know, the nice thing is is, like,
most of these systems can run at relatively
low marginal cost. And so,
you know, push on that. Yeah. Absolutely. And
doctor Patel, let me reframe the question for
you. What do you wish you had known
before
you had entered,
looking for a partner within autonomous coding?
Yeah. I mean, 5 years ago for us,
we were
relatively novice with the whole idea of automation
and artificial intelligence.
So I think there's been a huge leap
in just familiarity
and comfort with with this type of engagement.
What we did do well, I think, was
that quality was our North Star.
And we kind of had this relentless pursuit
of accuracy
and sustainability in this process.
And I think we continually return to that
to say as we're measuring milestones,
are we are we more accurate? Are we
are we higher quality than we were? And
I think that has informed
much of the journey for us.
You know, I we spent we spent our
time on this. Right? And and again, as
Andrew pointed out in the earlier days of
this, we were very methodical about a phase
rollout across our sites,
about
validation,
validation of the model, parallel coding, you know,
third party audits,
and then really developing an auditing system
that could be continued going forward.
I think they have that playbook now. And
and I think for their newer clients,
can expedite a lot of those things, including
the onboarding of new clients. So we're proud
to have been part of that journey. That's
great advice. What else are we missing? Anything
we didn't get to today that our listeners
should know?
I would say if you're a a a
health system out there that still is relying
on
humans
or in particular, physicians to do their own
coding,
you you need to run, not walk to
a
more sustainable,
more compliant solution.
And I think the promise of automating revenue
cycle is already here.
Yeah. I dovetail on that. I think
one of the things that has me most
excited about Fathom is the recent movement in
clients that
are in
practices health systems where clinician coding is being
performed. And what we're seeing in terms of
impact of clinician experience and bandwidth
and ability to better deliver care because an
AI is sitting there performing the coding on
their behalf. Mhmm. And further, what we are
discovering is, generally speaking,
most health care organizations are undercoding.
And so not only do you get a
step up in compliance, but you used to
get a step up in acuity
and ensure that you're being fully reimbursed or
accurately reimbursed for all the work that your
team is performing.
Absolutely. Well, I think that's a great place
to leave it. Gentlemen, thank you so much
for taking the time to be with us
on the podcast,
for sharing your insights with our listeners. We
really appreciate it. Thank you. Thank you. If
you'd like to listen
more podcasts from Becker's HealthCare, you can visit
our podcast page at beckershospitalreview.com.
I'd also like to thank Fathom as well
for sponsoring this episode.