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Revenue Anxiety: The Invisible Voice Shaping Clinical Decisions · The Operator | Healthcare Business

• 0:01
  All right, well,
• 0:01
  welcome back to The Operator.
• 0:02
  Last week,
• 0:03
  we talked about AI giving clinicians back
• 0:06
  their presence.
• 0:07
  This week asks an even more uncomfortable
• 0:11
  question.
• 0:12
  Who's actually making the clinical
• 0:14
  decisions in the room?
• 0:15
  Because if you've practiced long enough,
• 0:17
  you know there's another voice in the
• 0:19
  room, not the patients,
• 0:21
  but maybe the payers.
• 0:22
  It's somewhere in there.
• 0:23
  You don't want it to be.
• 0:24
  And if that's influencing what you
• 0:26
  recommend before you've even finished your
• 0:28
  evaluation,
• 0:30
  Larry argues we've got a much bigger
• 0:33
  problem than AI.
• 0:35
  So let's start there.
• 0:36
  You really begin this article in a series
• 0:38
  by saying there's another voice in the
• 0:41
  treatment room, not the patients,
• 0:43
  but the payers.
• 0:44
  When did you first realize that that was
• 0:47
  true?
• 0:48
  Yeah, I would say actually, you know,
• 0:50
  years before I even sort of had words
• 0:53
  or could articulate it.
• 0:54
  You know,
• 0:55
  you feel something oftentimes before you
• 0:57
  can explain it, right?
• 0:58
  Yeah.
• 0:59
  So you're the patient.
• 1:01
  they're telling you where it hurts,
• 1:03
  what they can't do anymore,
• 1:05
  what they're scared of.
• 1:06
  And somewhere in the back of your head,
• 1:07
  there's a second kind of conversation or
• 1:09
  noise going on.
• 1:11
  Is that covered?
• 1:12
  Will I have the time to do that?
• 1:14
  Will that take up too many of my
• 1:15
  minutes and interfere with the next
• 1:17
  patient who's already probably in the
• 1:18
  waiting room?
• 1:19
  Do I need a pre-auth on it?
• 1:21
  Did I document it?
• 1:22
  Do I have functional goals?
• 1:24
  Do I have all these kind of things
• 1:25
  that are going in your head that we've
• 1:26
  kind of
• 1:27
  placed onto medical providers.
• 1:31
  That's the payer uninvited.
• 1:33
  That's the unintended consequences of us
• 1:37
  having payers rule the room.
• 1:39
  They're sitting there with us.
• 1:41
  And here's the part that should bother all
• 1:43
  of us.
• 1:43
  Nobody put that chair in there on purpose.
• 1:46
  you know it got there added one
• 1:48
  requirement at a time just incremental
• 1:50
  over a third year period until it felt
• 1:52
  like furniture in your office right and
• 1:54
  the day that i knew was real was
• 1:56
  the day i watched great clinicians you
• 1:59
  know either shorten a conversation or be
• 2:01
  hurried or do something they wouldn't have
• 2:03
  normally done
• 2:05
  interrupting the patient, for example,
• 2:08
  because they were too busy thinking of
• 2:09
  minutes and coverage and productivity and
• 2:12
  units and all those things.
• 2:13
  You know,
• 2:14
  no one decided to put the insurance
• 2:15
  company in the treatment room, Jimmy.
• 2:17
  It got there the way most things happen,
• 2:21
  one at a time over a long period
• 2:22
  of time until it starts now to look
• 2:24
  normal.
• 2:25
  And those little things contribute
• 2:28
  incrementally to burnout.
• 2:31
  You introduced a phrase that I actually
• 2:33
  hadn't heard before,
• 2:34
  but like you said a second ago,
• 2:35
  sometimes we feel it before we can put
• 2:37
  words to it, which is revenue anxiety.
• 2:40
  It sounded like you were describing
• 2:43
  something that happens almost beneath the
• 2:46
  clinician's awareness until you can
• 2:47
  actually verbalize it.
• 2:49
  How would you describe what revenue
• 2:50
  anxiety feels like?
• 2:53
  Yeah, it's a hum.
• 2:54
  It's a very,
• 2:54
  very low grade noise or a hum,
• 2:57
  and it never shuts off.
• 2:59
  And it's that underlying issue.
• 3:02
  That's why I call it anxiety.
• 3:05
  that is going on while you're trying to
• 3:07
  be present for a patient right it's not
• 3:09
  the panic of the day it's the background
• 3:12
  dread that you do the right thing
• 3:13
  clinically um but it won't get paid right
• 3:17
  that's that fear if i do it right
• 3:18
  it won't get paid that you'll finish a
• 3:20
  note at seven p.m and it's gonna get
• 3:22
  denied anyhow or that you have to have
• 3:24
  your note reviewed by a peer reviewer or
• 3:27
  that something's gonna come back and as an
• 3:29
  edit
• 3:31
  And the crude part about all of this
• 3:32
  is the therapist can't tell you that it's
• 3:34
  there.
• 3:35
  Ask them and they'll say, I'm fine.
• 3:38
  I love my patients.
• 3:39
  I do patient care.
• 3:40
  But that anxiety is there.
• 3:42
  It's not about the patients and their
• 3:45
  problems.
• 3:46
  It's about the machinery wrapped around
• 3:48
  the patients.
• 3:48
  It's all this,
• 3:51
  the mental tax that goes with
• 3:53
  all that you have about your boss,
• 3:55
  about your company,
• 3:56
  about the insurance company,
• 3:58
  about your peers,
• 4:00
  all those kind of things.
• 4:02
  And the burnout research is interesting
• 4:04
  because it's sort of very clear on this.
• 4:07
  People don't leave the work because it's
• 4:09
  difficult work.
• 4:11
  They go into it for patient care, right?
• 4:13
  They leave because something keeps them
• 4:15
  from doing the work.
• 4:17
  Revenue anxiety is one of those things.
• 4:21
  It doesn't feel like fear.
• 4:23
  It feels like static, noise, hum,
• 4:26
  and you can't do great work over static.
• 4:29
  You can't hear yourself think.
• 4:32
  It's like the good cop,
• 4:33
  bad cop going on in your brain.
• 4:37
  And when you talk to therapists on a
• 4:40
  one-to-one level or medical providers,
• 4:43
  they tell you this, yeah,
• 4:44
  I'm thinking about this,
• 4:45
  but this is going on and
• 4:47
  And, you know,
• 4:48
  we get all this multitasking going on and
• 4:50
  then they got social media in their brain
• 4:52
  and they got text messages and other
• 4:53
  messages coming at them.
• 4:55
  All of that collectively,
• 4:57
  I'm sort of calling revenue anxiety or
• 4:58
  these underlying things that are
• 5:00
  distracting from what really drove you
• 5:03
  into what you love, which is patient care.
• 5:06
  Yeah.
• 5:06
  Well, we would never let a parent.
• 5:08
  into the room and actively say, hey,
• 5:11
  I'd like you to make the clinical
• 5:12
  decision.
• 5:12
  But there was a sentence in your article
• 5:14
  this week where training clinicians to let
• 5:16
  the payer make the clinical decision,
• 5:19
  almost like a Trojan horse.
• 5:20
  They didn't show up and knock on the
• 5:21
  door and say,
• 5:22
  I wanted to make that decision.
• 5:23
  We sort of let them in.
• 5:25
  That's a serious accusation.
• 5:26
  But so how do we end up there?
• 5:30
  Yeah, well,
• 5:30
  I love your analogy of the Trojan horse,
• 5:32
  by the way.
• 5:32
  But we got there slowly,
• 5:33
  which is one of the serious things.
• 5:36
  Why did we ever let this happen, right?
• 5:38
  Nobody ever stood up and announced.
• 5:39
  From now on,
• 5:40
  insurance company decides what the plan of
• 5:42
  care is.
• 5:43
  Instead,
• 5:43
  we built a system where the payer decides
• 5:45
  what gets authorized,
• 5:47
  what gets reimbursed,
• 5:48
  and how many visits are allowed.
• 5:50
  And then we act surprised when the
• 5:52
  clinical plan quietly sort of reshapes
• 5:55
  itself to these three things.
• 5:58
  It's interesting,
• 5:59
  I spoke at a dental conference and there's
• 6:02
  a difference here because in dental,
• 6:04
  a good portion of it is out of
• 6:06
  pocket pay and dental insurance isn't
• 6:09
  really underwriting insurance like it is,
• 6:12
  but it's the exact same thing happened,
• 6:14
  different problems, same identical trap.
• 6:17
  And here's how I put it to them.
• 6:20
  I said,
• 6:20
  here's the piece that almost nobody in the
• 6:22
  building got in their training.
• 6:25
  When we train a dentist,
• 6:26
  and you could say a therapist,
• 6:27
  you could say a doctor,
• 6:28
  to be clinically excellent and then never
• 6:31
  teach them to separate their clinical
• 6:33
  judgment from an insurance company fee
• 6:35
  schedule,
• 6:36
  we're training a clinician to let the
• 6:39
  payer make clinical decisions.
• 6:42
  And think about what that means, Jimmy.
• 6:44
  You've invested in building a highly
• 6:45
  skilled practitioner.
• 6:47
  They sit down with a patient,
• 6:48
  they see clearly what the patient needs,
• 6:52
  And then what happens?
• 6:53
  They open up the benefit portal,
• 6:54
  the insurance portal,
• 6:55
  and suddenly the treatment plan bends.
• 6:58
  That's not clinical autonomy.
• 7:01
  That's sophisticated form of learned
• 7:03
  helplessness.
• 7:04
  It's just dressed up.
• 7:06
  It's just dressed up in a clinical
• 7:07
  language.
• 7:08
  In physical therapy, dentistry,
• 7:10
  pick your white coat, same mechanism.
• 7:13
  You know, clinicians thinking, well,
• 7:14
  I can't do that because it's not approved.
• 7:16
  I like doing this dry kneeling,
• 7:17
  but it's not approved.
• 7:18
  Oh, if I do manual therapy,
• 7:19
  is it too many units now that I'm
• 7:22
  on the patient?
• 7:23
  All of that is going by.
• 7:24
  You don't lose clinical judgment in a
• 7:27
  dramatic moment.
• 7:28
  You lose it the day you think,
• 7:30
  will it get approved?
• 7:31
  Think about that.
• 7:33
  That's not clinical judgment.
• 7:34
  It's the opposite of clinical judgment.
• 7:36
  And if that is clouding your mind and
• 7:38
  we've let it cloud minds,
• 7:40
  that is a problem.
• 7:42
  Yeah.
• 7:42
  I think if we were to do control
• 7:45
  F and see which word would pop up
• 7:47
  the most in this,
• 7:48
  it wouldn't be AI or even insurance.
• 7:50
  I think the word we've said so far
• 7:51
  most is judgment.
• 7:53
  So I'm struck by the fact that this
• 7:54
  article really wasn't about insurance.
• 7:56
  It is about that word judgment.
• 7:58
  Would you say what you're actually – is
• 8:01
  that what you're actually writing about?
• 8:03
  No.
• 8:03
  Yeah, a hundred percent.
• 8:06
  insurance is the villain of the story,
• 8:08
  but judgment is the subject.
• 8:10
  Yeah.
• 8:11
  I don't actually care about billing codes
• 8:14
  for the sake of billing codes.
• 8:15
  What I care about is getting a highly
• 8:17
  trained clinician,
• 8:18
  somebody with a doctorate or a dentist or
• 8:20
  a primary care doctor,
• 8:21
  who's trained for years to be an
• 8:24
  interpreter of the body or interpreter of
• 8:26
  the mouth.
• 8:26
  And they build a plan.
• 8:28
  And then all of a sudden it's being
• 8:30
  reduced to a machine and whether that
• 8:32
  machine says yes or no,
• 8:33
  I can do that.
• 8:34
  Right.
• 8:34
  and so the whole series is one argument
• 8:36
  to protect the clinical judgments you know
• 8:39
  actually sir you know last week's article
• 8:42
  was was really more about being present
• 8:45
  this one is protecting clinical judgment
• 8:48
  you know every one of these ai agents
• 8:52
  and that's where i'm going with this and
• 8:54
  if if ai is to do one thing
• 8:56
  correct is to allow us to do what
• 8:59
  it can't which is be human and so
• 9:01
  week one agent is the scribe week two
• 9:04
  agent is the agent that allows it to
• 9:08
  read all the things around insurance and
• 9:11
  eight minutes and protect it and pre-auth
• 9:13
  and do that in the background so that
• 9:16
  you can focus on doing things clinically
• 9:19
  the scribe allows you to be present
• 9:21
  And AI around insurance needs allows you
• 9:25
  to have clinical judgment without being
• 9:28
  uninhibited or being inhibited,
• 9:30
  I should say,
• 9:31
  from the noise of the machinery around
• 9:33
  insurance.
• 9:34
  Another thing I noticed in this series so
• 9:36
  far is that every AI tool you brought
• 9:39
  up gives something back.
• 9:40
  Last week, you mentioned presence.
• 9:42
  This week, clinical focus.
• 9:45
  We saw a lot of traction, too,
• 9:46
  when I mentioned this on LinkedIn around
• 9:49
  this whole idea of efficiency.
• 9:50
  So why frame AI in terms of restoration
• 9:54
  instead of efficiency,
• 9:55
  which is probably the most used word
• 9:58
  behind AI in that topic?
• 10:00
  Yeah, and we've been warped,
• 10:01
  just like we've been biased by insurance
• 10:04
  companies,
• 10:05
  the vendors are the ones who are selling
• 10:06
  efficiency.
• 10:08
  And that's the smaller part of the story.
• 10:12
  Everybody's out there promising that AI
• 10:14
  will save you time.
• 10:15
  Fine, yeah, I do think that it will,
• 10:18
  but save time is a productivity pitch.
• 10:21
  And this profession has been beaten half
• 10:23
  to death by productivity pitches,
• 10:26
  by unprofessional managers,
• 10:28
  non-PTs in the example of physical
• 10:30
  therapy,
• 10:31
  just pressing down on your schedule
• 10:33
  optimization and open doors and doing this
• 10:35
  and just more throughput, more throughput.
• 10:39
  No, thank you.
• 10:40
  I'm not interested in giving a therapist a
• 10:42
  faster treadmill.
• 10:43
  I'm interested in giving the back the
• 10:45
  things the system took.
• 10:48
  What did it take from us?
• 10:50
  It took presence.
• 10:51
  That was week one,
• 10:52
  all the way in the room.
• 10:53
  Week two, clinical focus.
• 10:56
  I want them to think like a clinician,
• 10:58
  not a coder or a compliance expert.
• 11:00
  Nobody ever became a physical therapist to
• 11:03
  be excellent at compliance.
• 11:05
  Nobody ever came to be the productivity
• 11:07
  king or queen.
• 11:08
  Nobody ever took it to know all the
• 11:10
  insurance rules and regulations.
• 11:12
  Nobody ever went in the profession for
• 11:14
  that.
• 11:14
  We went in there to do patient care
• 11:17
  and to impact people's lives.
• 11:19
  And if AI is to do its job,
• 11:23
  and I think that it can help us,
• 11:25
  those would be what it would be.
• 11:28
  Allow restoration as opposed to a faster
• 11:32
  treadmill.
• 11:33
  All right.
• 11:33
  In your Hemingway moment, I think,
• 11:35
  in this article,
• 11:36
  you wrote this great sentence,
• 11:38
  the machine handles the machinery.
• 11:41
  It sounds like it's just talking in a
• 11:43
  circle.
• 11:44
  I think it's a really beautiful sentence,
• 11:45
  but I want you to help me unpack
• 11:46
  it.
• 11:47
  What does that look like in a clinic
• 11:49
  where it's working the way it should,
• 11:51
  the way you hope the machine handles the
• 11:54
  machinery?
• 11:55
  Yeah.
• 11:56
  So if you remember last week,
• 11:59
  we talked about Sarah and how she's
• 12:02
  working.
• 12:03
  And the reality is she finishes an
• 12:05
  evaluation, she signs the note,
• 12:07
  and that's the end of her involvement with
• 12:09
  the administrative aspect of the patient.
• 12:13
  She doesn't touch code strings if this AI
• 12:15
  agent does its job.
• 12:16
  She doesn't choose a prior app.
• 12:18
  She doesn't get pulled out of a session
• 12:21
  because an authorization disagreed with it
• 12:23
  or an edit bouncing back from something
• 12:26
  you programmed into the EMR.
• 12:28
  I remember when that was really big.
• 12:30
  The system already did it.
• 12:32
  The AI agent already did it with the
• 12:34
  right functional data pulled from her
• 12:36
  nodes.
• 12:37
  The billing happens, the pre-cert happens.
• 12:39
  The payer gets honored.
• 12:42
  The payer gets what they get.
• 12:44
  They just get it from a non-human.
• 12:45
  They get it from an AI agent who
• 12:47
  doesn't typically have a bad day.
• 12:49
  But it happens, I would say,
• 12:53
  the same way that plumbing happens.
• 12:54
  It's in the walls, out of sight.
• 12:57
  She trusts that it's there and that it
• 12:59
  just happens.
• 13:00
  And so she's got presence and now she's
• 13:02
  had clinical judgment all at the same
• 13:04
  time.
• 13:04
  So what the difference is,
• 13:05
  is that Sarah spends her cognitive budget
• 13:09
  The hours that she's meant thinking on
• 13:11
  patients in front of her,
• 13:12
  not on billable units, not on pre-op,
• 13:15
  not on is it covered.
• 13:17
  She spends all of her time doing what
• 13:19
  she's paid to do.
• 13:21
  Not a clinic with fewer patients,
• 13:22
  a clinic where the therapist's brain is
• 13:24
  finally pointed at patients.
• 13:27
  at the right problem.
• 13:28
  And I would say it this way,
• 13:30
  good machinery is like good plumbing,
• 13:32
  right?
• 13:33
  A good agent would be like good plumbing,
• 13:35
  you don't admire it,
• 13:36
  you just you just stop thinking about it.
• 13:39
  And that silences the whole point.
• 13:41
  So when it breaks down, like plumbing,
• 13:43
  you would get concerned about it.
• 13:45
  Right.
• 13:46
  So and hopefully the AI won't break down.
• 13:49
  You only notice it when there's an issue.
• 13:50
  And every other time you just it's it's
• 13:52
  in the walls.
• 13:54
  Another line I liked,
• 13:54
  verification is the product.
• 13:56
  This one sort of stings a little bit
• 13:59
  because it feels a little true.
• 14:01
  That sounds more like more than an AI
• 14:05
  principle, though.
• 14:06
  That sounds more like a systemic issue.
• 14:08
  It almost sounds philosophical if you want
• 14:10
  to get it to.
• 14:11
  So what does verification is the product
• 14:14
  mean?
• 14:15
  Yeah, it's a philosophy.
• 14:17
  It's the one that keeps this from really
• 14:20
  going wrong here.
• 14:21
  So here's the trap with AI in healthcare.
• 14:23
  People think that the output is the
• 14:25
  product, the generated note,
• 14:27
  the auto-selected code, the prior auth,
• 14:31
  the compliance check.
• 14:32
  Any tool could generate an output.
• 14:35
  The thing you're actually buying,
• 14:37
  the one thing that makes safe
• 14:40
  is that it is checkable,
• 14:41
  that a human being can look at every
• 14:44
  one of those decisions, re-understand it,
• 14:46
  and in theory, override it, right?
• 14:48
  The agent doesn't get to be a black
• 14:50
  box that quietly decides how to get paid.
• 14:52
  It does the legwork,
• 14:54
  and it shows the work.
• 14:55
  The clinician stays accountable.
• 14:58
  The audit trail is the product.
• 14:59
  The verifiability is the product.
• 15:01
  So ultimately, the clinician always has
• 15:05
  you know the benevolent dictator right
• 15:07
  over a verification check of an ai it
• 15:09
  just doesn't again the output isn't the
• 15:11
  product the fact that a human can check
• 15:13
  it understand it and overrule it that's
• 15:17
  the problem it's the human that can
• 15:18
  overrule it verification you know is is is
• 15:22
  the whole ball game yeah well you
• 15:24
  described sort of shangri-la right which
• 15:26
  is a world where the clinician gets to
• 15:28
  asks
• 15:30
  what does this patient need instead of
• 15:32
  this little voice, this hum,
• 15:35
  will insurance approve this thing that I'm
• 15:37
  already thinking of?
• 15:38
  Do you think we've forgotten that those
• 15:40
  are supposed to happen in that order?
• 15:43
  Because I feel like it does happen.
• 15:45
  It just happens in the other order.
• 15:47
  Yeah,
• 15:47
  I would say that we haven't necessarily
• 15:49
  forgotten about it.
• 15:50
  We've been trained.
• 15:52
  We've been trained to learn helplessness.
• 15:54
  We were trained out of it.
• 15:55
  There's a difference.
• 15:56
  And the difference really does matter.
• 15:58
  You know, forgetting would be innocent.
• 16:00
  You know, this is an innocent.
• 16:01
  It's it's conditional behavior that we've
• 16:04
  been trained in to deny a clinician enough
• 16:06
  times.
• 16:07
  make them redo enough notes,
• 16:10
  claw back enough visits,
• 16:11
  and they'll start pre-checking their own
• 16:13
  judgment against the payer's rules.
• 16:15
  We've just been normalized into the
• 16:17
  payer's rules.
• 16:17
  And before they can say it out loud,
• 16:19
  it's a survival reflex, if you will.
• 16:22
  Those two questions are supposed to happen
• 16:24
  in that order.
• 16:25
  Need first, coverage second.
• 16:27
  What does the patient need?
• 16:29
  What does my clinical judgment tell me?
• 16:31
  You figure out what the human being
• 16:32
  requires,
• 16:33
  and then you go fight the administrative
• 16:35
  fight to deliver it.
• 16:36
  And it's okay to have adult conversations
• 16:38
  with patients about coverage issues and
• 16:40
  that that's not your bag,
• 16:42
  but this is what you need.
• 16:43
  Let them decide.
• 16:44
  And what happens is most patients will
• 16:47
  typically decide to do what's right,
• 16:49
  not what the insurance covers,
• 16:50
  at least in my experience.
• 16:51
  It's just that we've been conditioned
• 16:52
  elsewhere.
• 16:53
  And the whole point of the agent is
• 16:55
  to take the second question off the
• 16:57
  therapist's plate.
• 16:58
  So the first question gets the clinicians
• 17:00
  full and undivided attention,
• 17:02
  clinical judgment.
• 17:03
  Get the order right and everything sort of
• 17:05
  downstream.
• 17:07
  Everything downstream gets healthier.
• 17:09
  It's not that we forgot, you know,
• 17:11
  the right order.
• 17:12
  We got trained out of it one denial
• 17:14
  at a time.
• 17:14
  Need first, coverage, treatment second,
• 17:17
  or, you know,
• 17:18
  treatment coverage from the insurance
• 17:19
  company second.
• 17:19
  Flip those two and what you've done is
• 17:22
  you've given your judgment away.
• 17:24
  So you brought Sarah back from from week
• 17:27
  one from article one in this series,
• 17:29
  you bring her back at the end with
• 17:31
  something you call this clinical focus.
• 17:34
  How would she know she'd gotten it back?
• 17:36
  What would feel different about her day?
• 17:38
  Would it be the thought process,
• 17:39
  the order in which or what would it
• 17:41
  look and feel like?
• 17:43
  Yeah.
• 17:43
  And so you're a clinician, Jimmy.
• 17:44
  So you have to go back and reimagine
• 17:47
  this a bit.
• 17:48
  But she'd feel it in her body at
• 17:49
  the end of the day.
• 17:50
  That's specific.
• 17:51
  This, you know, hollow.
• 17:53
  We get the sort of hollow tiredness,
• 17:55
  the one that comes from fighting the
• 17:56
  system, this fighting and fighting.
• 17:59
  It's very, very stressful.
• 18:00
  And it doesn't come from treating
• 18:01
  patients.
• 18:02
  It comes from fighting.
• 18:03
  And you're tired.
• 18:04
  In this case, she's tired.
• 18:06
  Now she's tired from clinically treating a
• 18:09
  patient.
• 18:10
  It's a different type of field.
• 18:11
  The kind you earn from actual work.
• 18:14
  They say, like,
• 18:15
  honest sweat doesn't smell.
• 18:17
  Honest tired feels good.
• 18:21
  I work today helping patients get better,
• 18:23
  not fighting the system.
• 18:25
  when sixty seventy percent of your time is
• 18:26
  fighting fighting system that's that's
• 18:29
  that's you know that's a problem she
• 18:31
  noticed she stopped rehearsing denials in
• 18:33
  her head you know that this noise and
• 18:35
  this hum you know started to go away
• 18:36
  without these little internal
• 18:37
  investigations going on
• 18:41
  And here's the quiet one, you know,
• 18:44
  she went home and she didn't need to
• 18:46
  bring her clinic home with her.
• 18:48
  It's not the second job.
• 18:49
  I'm not talking about notes that you have
• 18:51
  to do, but, oh man, units per visit,
• 18:54
  what was my report card telling,
• 18:55
  all these kind of things, you know.
• 18:57
  So you know it not from a dashboard,
• 18:59
  but you know it from the feeling that
• 19:01
  you had.
• 19:02
  And you know you've got your focus back
• 19:04
  the day you're tired from the work,
• 19:07
  not from fighting the machinery around the
• 19:09
  work.
• 19:09
  And every healthcare provider knows the
• 19:11
  difference.
• 19:12
  They know the feeling of the difference.
• 19:14
  Well,
• 19:14
  let's give a little forward tease to next
• 19:17
  week and the next part of this series.
• 19:18
  And when people finish this series,
• 19:19
  what do you hope they'll never again
• 19:21
  accept as just part of healthcare or that
• 19:24
  hum?
• 19:25
  Yeah,
• 19:25
  so what you're going to see is continued
• 19:27
  emphasis on what I believe is the best
• 19:30
  use case for AI in health care.
• 19:32
  Week one is about presence.
• 19:35
  Week two is about clinical judgment.
• 19:37
  And week three will just take this to
• 19:39
  different levels, again,
• 19:40
  more agentic view of where we're going
• 19:42
  with AI.
• 19:43
  And hopefully, by the end,
• 19:45
  they'll get rid of that hum,
• 19:46
  the idea that the background dread,
• 19:49
  the cost of the job.
• 19:50
  I want a clinician to finish.
• 19:53
  reading this or looking at this and
• 19:54
  actually get a little bit angry,
• 19:55
  but in a good way,
• 19:56
  to stop treating the second voice in the
• 19:58
  room, the payer, the seven PM note,
• 20:01
  the revenue anxiety,
• 20:02
  the erosion of your own judgment,
• 20:04
  to stop treating any of that as weather.
• 20:08
  And it's just how it is,
• 20:11
  is the price of admission, right?
• 20:12
  I wanted a little anger there.
• 20:14
  None of this is natural,
• 20:15
  all of it was built.
• 20:17
  And by the way,
• 20:17
  I want the EMR companies to read this,
• 20:19
  because I'm going to be submitting,
• 20:20
  secondly,
• 20:21
  Tim Flynn and I tried to submit an
• 20:22
  article for a professional publication,
• 20:24
  peer-reviewed publication,
• 20:25
  on the use of AI agents.
• 20:27
  And it was along these themes.
• 20:29
  A little harder to explain in the academic
• 20:31
  sense.
• 20:32
  But really,
• 20:32
  the ultimate goal will be another position
• 20:35
  paper that EMR companies look at and say,
• 20:37
  this is really what I need to do
• 20:39
  for a clinician.
• 20:40
  So that's what the hope is here.
• 20:45
  If you think about it, Jimmy,
• 20:46
  nothing about our system is natural.
• 20:49
  It was all built.
• 20:50
  The forms, the denials,
• 20:51
  the second voice in the room,
• 20:53
  and anything built by people can be
• 20:55
  rebuilt by people.
• 20:57
  Stop calling it weather.
• 20:59
  Start calling it a choice and then say,
• 21:02
  can we really use something like AI to
• 21:05
  help us get there?
• 21:07
  That's the goal.
• 21:08
  All right.
• 21:09
  Look forward to this next week.
• 21:10
  Make sure to subscribe on Substack.
• 21:13
  This conversation around AI usually
• 21:14
  focuses on what technology can do.
• 21:17
  You've seen the ads.
• 21:19
  If you've somehow missed them,
• 21:20
  teach me how to do that.
• 21:21
  But we want to keep asking the different
• 21:23
  question, what can technology give back?
• 21:25
  Last week, it was presence.
• 21:27
  This week, it was clinical focus.
• 21:29
  What is the focus of next week?
• 21:31
  Oh, you're going to see.
• 21:32
  It's going to be a surprise to you.
• 21:33
  Spoiler alert.
• 21:35
  If you're enjoying this series called The
• 21:37
  Care of the Age of AI,
• 21:38
  subscribe to The Operator on Substack.
• 21:40
  We'll put that link in the show notes
• 21:41
  so you don't miss the next installment.
• 21:44
  Until next time, keep operating.
• 21:49
  And I'll send you...