1 00:00:00,080 --> 00:00:02,080 Hello, everyone. My name is Molly Gamble with 2 00:00:02,080 --> 00:00:04,000 Becker's Healthcare. Thank you for tuning into the 3 00:00:04,000 --> 00:00:06,480 Becker's Healthcare podcast series. Today, I'm pleased to 4 00:00:06,480 --> 00:00:08,400 be joined by Amar Kassem. He is the 5 00:00:08,400 --> 00:00:10,719 area vice president of Veradigm. Amar, thank you 6 00:00:10,719 --> 00:00:12,160 so much for being here and for joining 7 00:00:12,160 --> 00:00:14,355 me. Thanks for having me. Great. Well, to 8 00:00:14,355 --> 00:00:15,634 get us started, can you share a bit 9 00:00:15,634 --> 00:00:17,554 more about yourself and your work in health 10 00:00:17,554 --> 00:00:19,015 care? Get us up to speed. 11 00:00:19,475 --> 00:00:22,035 Sure. I've been in health care IT pretty 12 00:00:22,035 --> 00:00:23,734 much my whole adult career, 13 00:00:24,274 --> 00:00:25,175 eighteen years, 14 00:00:25,989 --> 00:00:27,609 specializing a 100% 15 00:00:27,670 --> 00:00:30,250 in outpatient ambulatory medical practices. 16 00:00:31,269 --> 00:00:34,469 Early on, I was here when Meaningful Use 17 00:00:34,469 --> 00:00:38,229 started. Meaningful Use was a federal initiative that 18 00:00:38,229 --> 00:00:39,914 then president Bush passed, 19 00:00:40,475 --> 00:00:43,995 with the American Recovery and Restitution Act. That 20 00:00:43,995 --> 00:00:46,234 was getting us out of the financial crisis, 21 00:00:46,234 --> 00:00:48,655 but in that bill was something called meaningful 22 00:00:48,715 --> 00:00:50,734 use. And that's when I joined 23 00:00:51,115 --> 00:00:53,274 the industry, and it's one of the best 24 00:00:53,274 --> 00:00:55,929 decisions I've ever made. I've had a front 25 00:00:55,929 --> 00:00:58,969 row seat, seen the whole country go from 26 00:00:58,969 --> 00:01:01,869 paper folders to electronic medical records. 27 00:01:02,570 --> 00:01:04,489 Well well, let's move to current day. What 28 00:01:04,489 --> 00:01:06,409 what current trends are you seeing really unfold 29 00:01:06,409 --> 00:01:08,430 in the MSK space specifically, 30 00:01:09,064 --> 00:01:11,545 the revenue cycle space right now? How are 31 00:01:11,545 --> 00:01:13,885 those trends reshaping the way you're seeing practices 32 00:01:13,944 --> 00:01:16,685 really approach their financial operations and performance? 33 00:01:17,545 --> 00:01:18,844 What are you seeing out there? 34 00:01:19,385 --> 00:01:21,465 Yes. So I I mentioned I was able 35 00:01:21,465 --> 00:01:23,885 to see the the whole country adopt electronic 36 00:01:23,944 --> 00:01:24,924 medical records. 37 00:01:25,519 --> 00:01:28,799 While doing that, most practices also adopted an 38 00:01:28,799 --> 00:01:29,299 integration 39 00:01:29,599 --> 00:01:33,219 financial accounting record, a integrated financial ledger. 40 00:01:33,760 --> 00:01:36,239 So what we see now is everyone is 41 00:01:36,239 --> 00:01:39,185 trying to optimize the technology that they've installed. 42 00:01:39,185 --> 00:01:40,704 I don't know if you've ever installed an 43 00:01:40,704 --> 00:01:41,204 EHR. 44 00:01:41,744 --> 00:01:42,884 It takes blood, 45 00:01:43,665 --> 00:01:46,004 sweat, tears, and and a whole lot more. 46 00:01:46,384 --> 00:01:49,204 So most practices that have invested in EMR 47 00:01:49,344 --> 00:01:51,744 wanna see the full capabilities out of it. 48 00:01:51,744 --> 00:01:54,180 And and now that's what we are seeing 49 00:01:54,180 --> 00:01:54,680 mostly 50 00:01:55,620 --> 00:01:58,359 is how can practices use software 51 00:01:58,659 --> 00:01:59,159 to 52 00:01:59,700 --> 00:02:01,640 drive revenue, drive efficiencies, 53 00:02:02,100 --> 00:02:03,560 and even more specific, 54 00:02:04,100 --> 00:02:05,079 revenue cycle. 55 00:02:05,380 --> 00:02:06,600 Mhmm. Mhmm. 56 00:02:07,375 --> 00:02:09,294 Revenue cycle is just it's such a pain 57 00:02:09,294 --> 00:02:09,794 point 58 00:02:10,175 --> 00:02:11,634 for so many providers. 59 00:02:11,935 --> 00:02:14,834 When you speak with financial leaders at MSK 60 00:02:14,895 --> 00:02:16,435 practices and the ASCs, 61 00:02:17,455 --> 00:02:20,310 are are you finding yourself making any frequent 62 00:02:20,310 --> 00:02:22,949 or common recommendations about what they should closely 63 00:02:22,949 --> 00:02:24,969 examine in their revenue cycle workflows 64 00:02:25,509 --> 00:02:27,610 to really uncover big inefficiencies? 65 00:02:27,990 --> 00:02:29,909 Or on the on the bright side, growth 66 00:02:29,909 --> 00:02:30,409 opportunities. 67 00:02:30,870 --> 00:02:32,629 Can you give us some examples of of 68 00:02:32,629 --> 00:02:34,650 what you spotted or recommended to them? 69 00:02:34,965 --> 00:02:36,985 Yes. No. Absolutely. So 70 00:02:37,444 --> 00:02:40,405 now that everyone's on an integrated electronic medical 71 00:02:40,405 --> 00:02:43,125 record and and practice management system or PM 72 00:02:43,125 --> 00:02:45,465 as as commonly referred to in the industry, 73 00:02:46,405 --> 00:02:48,485 as I mentioned, people are looking for ways 74 00:02:48,485 --> 00:02:51,359 to optimize that. And as far as revenue 75 00:02:51,359 --> 00:02:53,379 cycle goes, there's a few key things. 76 00:02:54,000 --> 00:02:55,299 First is just creating 77 00:02:56,000 --> 00:02:56,739 key performance 78 00:02:57,039 --> 00:02:59,939 indicator dashboards, being able to track yourself, 79 00:03:00,560 --> 00:03:02,719 being able to track the performance of your 80 00:03:02,719 --> 00:03:03,699 billing staff. 81 00:03:04,335 --> 00:03:06,974 And and I think most practices recognize that 82 00:03:06,974 --> 00:03:08,814 as a need. But one of the key 83 00:03:08,814 --> 00:03:11,295 things that's needed to do that is to 84 00:03:11,295 --> 00:03:13,715 have efficient contract management. 85 00:03:14,175 --> 00:03:16,835 If your contracts aren't loaded into your software, 86 00:03:17,319 --> 00:03:20,439 if you don't know what your allowable rates 87 00:03:20,439 --> 00:03:23,159 are for your for your insurance payer that 88 00:03:23,159 --> 00:03:24,460 you have a contract with, 89 00:03:24,760 --> 00:03:26,760 it's, you're gonna have a really hard time 90 00:03:26,760 --> 00:03:28,780 being able to grade yourself accurately. 91 00:03:29,675 --> 00:03:31,754 The days of the past, you you had 92 00:03:31,754 --> 00:03:34,655 your your fee schedule or your charge master, 93 00:03:35,034 --> 00:03:37,995 and then you had various contractual allowables depending 94 00:03:37,995 --> 00:03:39,134 on you what you've negotiated. 95 00:03:40,074 --> 00:03:42,074 Now the the the point is getting all 96 00:03:42,074 --> 00:03:44,550 of that data into your EMR and practice 97 00:03:44,790 --> 00:03:45,849 management system 98 00:03:46,150 --> 00:03:48,150 so you could literally track by the penny. 99 00:03:48,150 --> 00:03:50,389 Did I get paid every single penny for 100 00:03:50,389 --> 00:03:52,569 what I delivered, or did I get underpaid? 101 00:03:53,189 --> 00:03:55,110 Right. And when we talk about these MSK 102 00:03:55,110 --> 00:03:57,030 practices, I mean, how many contracts are we 103 00:03:57,030 --> 00:03:59,305 talking about? You said it's really important to 104 00:03:59,305 --> 00:04:00,604 have a dashboard that 105 00:04:00,905 --> 00:04:01,405 efficiently 106 00:04:01,705 --> 00:04:05,145 and accurately reflects their current contracts. How many 107 00:04:05,145 --> 00:04:06,824 in the neighborhood are we are we talking 108 00:04:06,824 --> 00:04:09,145 about here? Oh, when when you start thinking 109 00:04:09,145 --> 00:04:11,705 of Medicare Advantage and all the commercial plans, 110 00:04:11,705 --> 00:04:14,209 it could be pretty pretty burdensome. It could 111 00:04:14,209 --> 00:04:17,029 be upwards of fifty, sixty contracts. However, 112 00:04:17,810 --> 00:04:20,689 you'll you'll commonly see that 80% of a 113 00:04:20,689 --> 00:04:23,970 practice's revenue is maybe five to six different 114 00:04:23,970 --> 00:04:26,370 contracts. Okay. So we that that's what we 115 00:04:26,370 --> 00:04:28,629 recommend is if you don't have those contracts 116 00:04:29,675 --> 00:04:30,634 loaded, get those, 117 00:04:31,275 --> 00:04:34,555 your top payers. Start there. Start tracking those. 118 00:04:34,555 --> 00:04:37,514 Start building key performance measures around the those 119 00:04:37,514 --> 00:04:39,995 payers, and then you could continue to to 120 00:04:39,995 --> 00:04:42,395 build out your platform. Mhmm. And like you 121 00:04:42,395 --> 00:04:44,399 said, understand which ones make up the lion's 122 00:04:44,860 --> 00:04:47,259 share, and stay close to those. You know, 123 00:04:47,259 --> 00:04:50,160 we we're hearing so much continually about AI 124 00:04:50,620 --> 00:04:52,959 continues to dominate so many headlines and conversations 125 00:04:53,180 --> 00:04:55,579 across every corner of, I would say, American 126 00:04:55,579 --> 00:04:58,365 life, but also American health care. From your 127 00:04:58,365 --> 00:05:00,285 perspective, what what are some of the most 128 00:05:00,285 --> 00:05:03,324 impactful and practical uses of AI in the 129 00:05:03,324 --> 00:05:05,644 MSK revenue cycle today? I think it's important 130 00:05:05,644 --> 00:05:08,204 to talk about impactful and practical because a 131 00:05:08,204 --> 00:05:09,185 lot of the AI 132 00:05:09,564 --> 00:05:11,824 conversations have been in some ways hypothetical. 133 00:05:12,409 --> 00:05:14,970 What's actually working as you see it? Where 134 00:05:14,970 --> 00:05:17,289 do you think practices should focus, and maybe 135 00:05:17,289 --> 00:05:19,310 where should they exercise a bit more caution? 136 00:05:19,610 --> 00:05:21,769 Sure. There there's several places where we're seeing 137 00:05:21,769 --> 00:05:24,189 real use cases of AI in practices. 138 00:05:25,129 --> 00:05:25,629 First, 139 00:05:26,185 --> 00:05:28,745 one of the issues every practice is struggling 140 00:05:28,745 --> 00:05:31,324 with, and this is nothing new, is labor. 141 00:05:31,464 --> 00:05:34,665 There is a labor shortage. We have more 142 00:05:34,665 --> 00:05:36,285 jobs than we have applicants 143 00:05:36,985 --> 00:05:39,324 get to health care. That's even more so. 144 00:05:39,865 --> 00:05:40,365 And 145 00:05:41,009 --> 00:05:44,389 practices are having a hard time keeping staff 146 00:05:44,689 --> 00:05:47,729 in their seats to have an effective revenue 147 00:05:47,729 --> 00:05:48,229 cycle. 148 00:05:48,769 --> 00:05:50,849 And that's one of the main places where 149 00:05:50,849 --> 00:05:52,949 we see AI as being adopted. 150 00:05:53,250 --> 00:05:56,204 I think everyone is, you know, short of 151 00:05:56,204 --> 00:05:57,985 maybe radiology in MSK. 152 00:05:58,524 --> 00:06:00,845 I don't think anyone is ready for AI 153 00:06:00,845 --> 00:06:03,165 to take over any kind of clinical decision 154 00:06:03,165 --> 00:06:05,725 making. I I personally think we're we're years 155 00:06:05,725 --> 00:06:08,204 away from that still. But where we are 156 00:06:08,204 --> 00:06:10,704 seeing AI in use are things like 157 00:06:11,229 --> 00:06:11,729 eligibility, 158 00:06:12,669 --> 00:06:13,169 coding, 159 00:06:14,029 --> 00:06:14,529 scribing, 160 00:06:15,149 --> 00:06:17,550 being able to record a voice, being able 161 00:06:17,550 --> 00:06:20,449 to record multiple voices in an examination room 162 00:06:20,589 --> 00:06:22,370 and be able to discern those voices 163 00:06:23,004 --> 00:06:25,404 and provide a summary of the conversation back 164 00:06:25,404 --> 00:06:26,704 to the rendering physician, 165 00:06:27,725 --> 00:06:30,925 that's becoming very popular. So to to to 166 00:06:30,925 --> 00:06:33,665 recap that, if you're gonna look at AI, 167 00:06:34,365 --> 00:06:35,904 I would say coding, 168 00:06:36,289 --> 00:06:38,709 some real life use cases of AI coding, 169 00:06:39,569 --> 00:06:40,069 scribing, 170 00:06:40,449 --> 00:06:43,810 being able to go into an exam room, 171 00:06:43,810 --> 00:06:46,709 turn on your mic on your mobile phone, 172 00:06:47,490 --> 00:06:49,895 record the conversation, and you don't want a 173 00:06:49,895 --> 00:06:52,455 thirty minute conversation in your EHR. No one 174 00:06:52,455 --> 00:06:55,275 wants that. You want a short concise 175 00:06:55,654 --> 00:06:58,694 soap note formatted note, and and AI scribe 176 00:06:58,694 --> 00:07:01,514 technology now is is quickly becoming 177 00:07:01,975 --> 00:07:03,835 an effective means of doing that. 178 00:07:04,569 --> 00:07:06,169 The scribing piece, I know, has been in 179 00:07:06,169 --> 00:07:07,769 play for a while, but I think some 180 00:07:07,769 --> 00:07:08,669 of the more, 181 00:07:09,769 --> 00:07:10,829 ability and sophistication 182 00:07:11,129 --> 00:07:12,669 of these tools to identify 183 00:07:13,370 --> 00:07:15,370 things that otherwise would not have been built 184 00:07:15,370 --> 00:07:16,269 for or captured, 185 00:07:16,745 --> 00:07:18,425 It just strikes me as such an important 186 00:07:18,425 --> 00:07:19,805 tool for so many reasons. 187 00:07:20,345 --> 00:07:22,264 So I'm looking forward to seeing, where that 188 00:07:22,264 --> 00:07:24,104 will continue to evolve and take shape. But 189 00:07:24,185 --> 00:07:25,805 so it sounds like coding, 190 00:07:26,585 --> 00:07:29,324 scribing, also, is there anything about 191 00:07:29,649 --> 00:07:32,310 areas of caution you would recommend for providers 192 00:07:32,449 --> 00:07:34,689 or practices as you see it today? I 193 00:07:34,689 --> 00:07:37,649 understand enthusiasm might be high. But to your 194 00:07:37,649 --> 00:07:39,349 point about, you know, the medical 195 00:07:40,129 --> 00:07:42,289 expertise needed for so much of this work 196 00:07:42,289 --> 00:07:44,944 in this practice versus AI, is Is there 197 00:07:44,944 --> 00:07:46,305 somewhere you feel like there's a a good 198 00:07:46,305 --> 00:07:47,845 amount of caution that should be exercised? 199 00:07:49,024 --> 00:07:50,865 Yes. And I think I already alluded to 200 00:07:50,865 --> 00:07:53,365 it. On the clinical side, I don't think 201 00:07:54,305 --> 00:07:56,384 the industry is at a place where AI 202 00:07:56,384 --> 00:07:59,045 can be used to place the physician's 203 00:07:59,425 --> 00:07:59,925 orders. 204 00:08:00,250 --> 00:08:02,410 Sure. I think it's at a place where 205 00:08:02,410 --> 00:08:03,949 it could capture a conversation. 206 00:08:04,250 --> 00:08:05,470 It could do a very 207 00:08:06,009 --> 00:08:07,069 elegant summary 208 00:08:07,449 --> 00:08:08,430 of the conversation. 209 00:08:09,930 --> 00:08:12,649 The physician still needs to be involved to 210 00:08:12,649 --> 00:08:14,110 execute the plan. 211 00:08:15,014 --> 00:08:17,254 And that's where I would be cautious. If 212 00:08:17,254 --> 00:08:19,754 I was a physician evaluating AI platforms, 213 00:08:20,134 --> 00:08:22,055 if if there is an AI platform that's 214 00:08:22,055 --> 00:08:23,814 saying they're gonna take it a step forward 215 00:08:23,814 --> 00:08:26,154 and actually put your orders in and execute 216 00:08:26,294 --> 00:08:27,354 your your plan, 217 00:08:27,735 --> 00:08:30,610 I wanna make sure because that's that's patient 218 00:08:30,610 --> 00:08:33,090 care that is being ordered now. It's one 219 00:08:33,090 --> 00:08:34,789 thing to to record you 220 00:08:35,090 --> 00:08:37,250 you tore your ACL while skiing. It's a 221 00:08:37,250 --> 00:08:40,690 different thing to place a medication order based 222 00:08:40,690 --> 00:08:42,149 off of a voice conversation. 223 00:08:43,445 --> 00:08:45,945 So that's that's where we see AI scribing 224 00:08:46,004 --> 00:08:47,924 has gone up to up until that point 225 00:08:47,924 --> 00:08:49,625 up until that point of orders. 226 00:08:50,404 --> 00:08:52,644 But I'm in health care IT, and I 227 00:08:52,644 --> 00:08:55,125 have no doubt that AI is gonna be 228 00:08:55,125 --> 00:08:58,230 placing orders and and and actually running plans 229 00:08:58,230 --> 00:09:00,870 for patients, but I I feel we're we're 230 00:09:00,870 --> 00:09:02,470 a few years out, and I would be 231 00:09:02,470 --> 00:09:04,709 cautious about that when evaluating it. That's a 232 00:09:04,709 --> 00:09:07,350 great distinction. Well, I I wanna ask, Amr, 233 00:09:07,350 --> 00:09:09,110 is there anything else we did not touch 234 00:09:09,110 --> 00:09:10,789 on or any other final thoughts you'd like 235 00:09:10,789 --> 00:09:12,169 to leave our listeners with? 236 00:09:12,705 --> 00:09:15,345 Prepare for AI coding. Come up with an 237 00:09:15,345 --> 00:09:17,285 AI playbook for your organization. 238 00:09:17,825 --> 00:09:18,325 And 239 00:09:18,785 --> 00:09:20,945 you could start small, but just having a 240 00:09:20,945 --> 00:09:23,105 policy in place, I think, is a good 241 00:09:23,105 --> 00:09:25,605 stepping stone. Like, you just don't want everyone 242 00:09:25,850 --> 00:09:26,750 logging in ChatGPT 243 00:09:27,290 --> 00:09:28,429 and using it differently. 244 00:09:28,970 --> 00:09:30,649 Come up with a policy of this is 245 00:09:30,649 --> 00:09:32,190 the AI tool we wanna 246 00:09:32,649 --> 00:09:34,730 use. Come up with some use cases that 247 00:09:34,730 --> 00:09:36,570 you wanna start using it for. You keep 248 00:09:36,570 --> 00:09:39,529 it non patient facing, things like marketing or 249 00:09:39,529 --> 00:09:41,835 even just drafting emails. And, you know, it's 250 00:09:41,835 --> 00:09:44,595 it's the latest version of spell check on 251 00:09:44,595 --> 00:09:45,375 on steroids. 252 00:09:45,754 --> 00:09:46,254 So 253 00:09:46,634 --> 00:09:48,315 if if you don't have a policy in 254 00:09:48,315 --> 00:09:50,394 place, that would be my one recommendation is 255 00:09:50,394 --> 00:09:51,914 come up with a policy, even if it's 256 00:09:51,914 --> 00:09:53,294 just a one page policy, 257 00:09:53,720 --> 00:09:54,779 and then start evaluating 258 00:09:55,160 --> 00:09:57,420 technology out there. Because as I just said, 259 00:09:57,799 --> 00:10:01,019 software eats world and AI is coming. Whether 260 00:10:01,240 --> 00:10:02,759 you wanna use it now or use it 261 00:10:02,759 --> 00:10:05,240 later, get ready because it will be in 262 00:10:05,240 --> 00:10:07,434 use. Such an important note about the policy 263 00:10:07,434 --> 00:10:09,355 piece because you can start using these tools 264 00:10:09,355 --> 00:10:11,754 and just you you you start going down 265 00:10:11,754 --> 00:10:13,355 with so much momentum and you have to 266 00:10:13,355 --> 00:10:15,274 pause. Remember, policy, even if you start with 267 00:10:15,274 --> 00:10:16,634 a one pager like you said, you have 268 00:10:16,634 --> 00:10:18,154 to start somewhere and just make sure you're 269 00:10:18,154 --> 00:10:19,835 actively thinking about that because that's gonna be 270 00:10:19,835 --> 00:10:20,975 so important for scaling. 271 00:10:21,769 --> 00:10:24,090 Absolutely. And if you could just chunk it 272 00:10:24,090 --> 00:10:26,570 down to to something bite sized that's easy 273 00:10:26,570 --> 00:10:29,050 for you to start using a a new 274 00:10:29,050 --> 00:10:32,009 technology, then I think that's I I I've 275 00:10:32,009 --> 00:10:33,769 seen it used with other clients, and it's 276 00:10:33,769 --> 00:10:36,014 helped them. And and now the the those 277 00:10:36,014 --> 00:10:38,254 clients that started with a one page policy 278 00:10:38,254 --> 00:10:38,914 two years 279 00:10:39,215 --> 00:10:41,534 ago, they're now, you know, a a 20 280 00:10:41,534 --> 00:10:43,774 page policy and using it in all different 281 00:10:43,774 --> 00:10:46,414 corners of their offices. Small binder. Yeah. That 282 00:10:46,414 --> 00:10:48,330 makes sense. Thank you so much, Amber, for 283 00:10:48,330 --> 00:10:50,169 your time and this great discussion today. We 284 00:10:50,169 --> 00:10:52,090 we really do appreciate it. I'd also like 285 00:10:52,090 --> 00:10:54,730 to thank Veradigm for sponsoring today's episode. You 286 00:10:54,730 --> 00:10:57,049 can tune in to more podcasts from Becker's 287 00:10:57,049 --> 00:11:00,490 Healthcare by visiting our podcast page at beckershospitalreview.com. 288 00:11:00,490 --> 00:11:01,230 Thank you.