Hello, everyone. My name is Molly Gamble with
Becker's Healthcare. Thank you for tuning into the
Becker's Healthcare podcast series. Today, I'm pleased to
be joined by Amar Kassem. He is the
area vice president of Veradigm. Amar, thank you
so much for being here and for joining
me. Thanks for having me. Great. Well, to
get us started, can you share a bit
more about yourself and your work in health
care? Get us up to speed.
Sure. I've been in health care IT pretty
much my whole adult career,
eighteen years,
specializing a 100%
in outpatient ambulatory medical practices.
Early on, I was here when Meaningful Use
started. Meaningful Use was a federal initiative that
then president Bush passed,
with the American Recovery and Restitution Act. That
was getting us out of the financial crisis,
but in that bill was something called meaningful
use. And that's when I joined
the industry, and it's one of the best
decisions I've ever made. I've had a front
row seat, seen the whole country go from
paper folders to electronic medical records.
Well well, let's move to current day. What
what current trends are you seeing really unfold
in the MSK space specifically,
the revenue cycle space right now? How are
those trends reshaping the way you're seeing practices
really approach their financial operations and performance?
What are you seeing out there?
Yes. So I I mentioned I was able
to see the the whole country adopt electronic
medical records.
While doing that, most practices also adopted an
integration
financial accounting record, a integrated financial ledger.
So what we see now is everyone is
trying to optimize the technology that they've installed.
I don't know if you've ever installed an
EHR.
It takes blood,
sweat, tears, and and a whole lot more.
So most practices that have invested in EMR
wanna see the full capabilities out of it.
And and now that's what we are seeing
mostly
is how can practices use software
to
drive revenue, drive efficiencies,
and even more specific,
revenue cycle.
Mhmm. Mhmm.
Revenue cycle is just it's such a pain
point
for so many providers.
When you speak with financial leaders at MSK
practices and the ASCs,
are are you finding yourself making any frequent
or common recommendations about what they should closely
examine in their revenue cycle workflows
to really uncover big inefficiencies?
Or on the on the bright side, growth
opportunities.
Can you give us some examples of of
what you spotted or recommended to them?
Yes. No. Absolutely. So
now that everyone's on an integrated electronic medical
record and and practice management system or PM
as as commonly referred to in the industry,
as I mentioned, people are looking for ways
to optimize that. And as far as revenue
cycle goes, there's a few key things.
First is just creating
key performance
indicator dashboards, being able to track yourself,
being able to track the performance of your
billing staff.
And and I think most practices recognize that
as a need. But one of the key
things that's needed to do that is to
have efficient contract management.
If your contracts aren't loaded into your software,
if you don't know what your allowable rates
are for your for your insurance payer that
you have a contract with,
it's, you're gonna have a really hard time
being able to grade yourself accurately.
The days of the past, you you had
your your fee schedule or your charge master,
and then you had various contractual allowables depending
on you what you've negotiated.
Now the the the point is getting all
of that data into your EMR and practice
management system
so you could literally track by the penny.
Did I get paid every single penny for
what I delivered, or did I get underpaid?
Right. And when we talk about these MSK
practices, I mean, how many contracts are we
talking about? You said it's really important to
have a dashboard that
efficiently
and accurately reflects their current contracts. How many
in the neighborhood are we are we talking
about here? Oh, when when you start thinking
of Medicare Advantage and all the commercial plans,
it could be pretty pretty burdensome. It could
be upwards of fifty, sixty contracts. However,
you'll you'll commonly see that 80% of a
practice's revenue is maybe five to six different
contracts. Okay. So we that that's what we
recommend is if you don't have those contracts
loaded, get those,
your top payers. Start there. Start tracking those.
Start building key performance measures around the those
payers, and then you could continue to to
build out your platform. Mhmm. And like you
said, understand which ones make up the lion's
share, and stay close to those. You know,
we we're hearing so much continually about AI
continues to dominate so many headlines and conversations
across every corner of, I would say, American
life, but also American health care. From your
perspective, what what are some of the most
impactful and practical uses of AI in the
MSK revenue cycle today? I think it's important
to talk about impactful and practical because a
lot of the AI
conversations have been in some ways hypothetical.
What's actually working as you see it? Where
do you think practices should focus, and maybe
where should they exercise a bit more caution?
Sure. There there's several places where we're seeing
real use cases of AI in practices.
First,
one of the issues every practice is struggling
with, and this is nothing new, is labor.
There is a labor shortage. We have more
jobs than we have applicants
get to health care. That's even more so.
And
practices are having a hard time keeping staff
in their seats to have an effective revenue
cycle.
And that's one of the main places where
we see AI as being adopted.
I think everyone is,
you know, short of maybe radiology in MSK.
I don't think anyone is ready for AI
to take over any kind of clinical decision
making. I I personally think we're we're years
away from that still. But where we are
seeing AI in use are things like
eligibility,
coding,
scribing,
being able to record a voice, being able
to record multiple voices in an examination room
and be able to discern those voices
and provide a summary of the conversation back
to the rendering physician,
that's becoming very popular. So to to to
recap that, if you're gonna look at AI,
I would say coding,
some real life use cases of AI coding,
scribing,
being able to go into an exam room,
turn on your mic on your mobile phone,
record the conversation, and you don't want a
thirty minute conversation in your EHR. No one
wants that. You want a short concise
soap note formatted note, and and AI scribe
technology now is is quickly becoming
an effective means of doing that.
The scribing piece, I know, has been in
play for a while, but I think some
of the more,
ability and sophistication
of these tools to identify
things that otherwise would not have been built
for or captured,
It just strikes me as such an important
tool for so many reasons.
So I'm looking forward to seeing, where that
will continue to evolve and take shape. But
so it sounds like coding,
scribing, also, is there anything about
areas of caution you would recommend for providers
or practices as you see it today? I
understand enthusiasm might be high. But to your
point about, you know, the medical
expertise needed for so much of this work
in this practice versus AI, is Is there
somewhere you feel like there's a a good
amount of caution that should be exercised?
Yes. And I think I already alluded to
it. On the clinical side, I don't think
the industry is at a place where AI
can be used to place the physician's orders.
Sure. I think it's at a place where
it could capture a conversation.
It could do a very
elegant summary
of the conversation.
The physician still needs to be involved to
execute the plan.
And that's where I would be cautious. If
I was a physician evaluating AI platforms,
if if there is an AI platform that's
saying they're gonna take it a step forward
and actually put your orders in and execute
your your plan,
I wanna make sure because that's that's patient
care that is being ordered now. It's one
thing to to record you
you tore your ACL while skiing. It's a
different thing to place a medication order based
off of a voice conversation.
So that's that's where we see AI scribing
has gone up to up until that point
up until that point of orders.
But I'm in health care IT, and I
have no doubt that AI is gonna be
placing orders and and and actually running plans
for patients, but I I feel we're we're
a few years out, and I would be
cautious about that when evaluating it. That's a
great distinction. Well, I I wanna ask, Amr,
is there anything else we did not touch
on or any other final thoughts you'd like
to leave our listeners with?
Prepare for AI coding. Come up with an
AI playbook for your organization.
And
you could start small, but just having a
policy in place, I think, is a good
stepping stone. Like, you just don't want everyone
logging in ChatGPT
and using it differently.
Come up with a policy of this is
the AI tool we wanna
use. Come up with some use cases that
you wanna start using it for. You keep
it non patient facing, things like marketing or
even just drafting emails. And, you know, it's
it's the latest version of spell check on
on steroids.
So
if if you don't have a policy in
place, that would be my one recommendation is
come up with a policy, even if it's
just a one page policy,
and then start evaluating
technology out there. Because as I just said,
software eats world and AI is coming. Whether
you wanna use it now or use it
later, get ready because it will be in
use. Such an important note about the policy
piece because you can start using these tools
and just you you you start going down
with so much momentum and you have to
pause. Remember, policy, even if you start with
a one pager like you said, you have
to start somewhere and just make sure you're
actively thinking about that because that's gonna be
so important for scaling.
Absolutely. And if you could just chunk it
down to to something bite sized that's easy
for you to start using a a new
technology, then I think that's I I I've
seen it used with other clients, and it's
helped them. And and now the the those
clients that started with a one page policy
two years
ago, they're now, you know, a a 20
page policy and using it in all different
corners of their offices. Small binder. Yeah. That
makes sense. Thank you so much, Amber, for
your time and this great discussion today. We
we really do appreciate it. I'd also like
to thank Veradigm for sponsoring today's episode. You
can tune in to more podcasts from Becker's
Healthcare by visiting our podcast page at beckershospitalreview.com.
Thank you.