Latest / Becker’s Healthcare Digital Health + Health IT / Transforming Healthcare: AI's Role in Hospital Revenue Cycle

Transcript

Transforming Healthcare: AI's Role in Hospital Revenue Cycle · Becker’s Healthcare Digital Health + Health IT

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  Hello, everyone, and thank you for tuning in
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  to the Becker's Healthcare Podcast. We are thrilled
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  to be joined on-site here at Becker's Health
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  IT Digital Health RCM Conference in Chicago.
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  Today, I'm pleased to be joined with William
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  Chan, CEO and cofounder, Iodine Software.
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  We're gonna discuss how AI driven solutions are
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  transforming health care in the hospital revenue cycle
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  space. William, thank you for being here. Thank
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  you, Brian. It's a pleasure to be here.
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  So so can you tell us just to
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  get going here how the use of AI
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  in the hospital mid revenue cycle has transformed
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  over the past 3 to 5 years? I
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  think it's been a pretty pretty,
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  wild time in that regard. It it has
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  been very transformative. Yes. I'll I'll say there
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  there are probably
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  three things that kinda lead up to this.
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  One, I'd say, is that
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  documentation
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  and the
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  the need for accurate documentation has kind of
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  risen to the level of being a critical
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  set of data in health care, specifically RCM.
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  2nd is
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  the recognition by health systems and and the
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  like that
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  the old ways of doing things, I. E.
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  Just throwing labor at it, just Mhmm. Doesn't
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  work. Right? COVID pooped that out to a
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  great deal.
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  Hence, it's brought us to this point where
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  alternate solutions have to take place, and that
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  alternate solution is AI. And then within the
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  past 3 to 5 years,
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  it's been the transformational
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  evolution
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  of AI
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  from something that is more just of about
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  general automation,
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  that robotic process automation, RPA and all that
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  kind of stuff, NLP,
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  to something that is more
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  transformative,
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  gen AI, machine learning.
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  And that's where the real change has occurred.
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  And that continues to evolve. Right? Starting out
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  with gen AI, you're talking about things where
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  you can now summarize. You can now generate
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  information
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  accurately.
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  Right? Right? You can summarize documentation. You can
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  you can generate documentation
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  effectively.
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  The next level is really
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  predicting.
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  Mhmm. And,
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  this is where AI needs to get to
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  evolve. But you're not just predicting
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  things in general. You're predicting things within a
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  clinical context.
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  And AI has evolved to that point where
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  I think, it's starting to understand the clinical
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  context.
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  And that, I think, is the big game
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  changer for health care in general, certainly for
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  RCM.
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  Yeah. That's that's huge. That's a huge difference
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  for AI to be understanding clinical context,
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  has implications, of course, for RCM brought more
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  broadly as well. Can you talk a little
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  bit about just because this is such a
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  transformative time and there's so much happening,
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  What do you see where do you see
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  this going in the future? A little bit
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  more details there. But but importantly, how can
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  hospitals and health systems kinda keep up here?
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  Yeah. Because I do think there's probably a
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  bit of a challenge in terms
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  of where they're going to make investments, where
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  they're paying attention, what's gonna yield the the
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  greatest benefits to them. So can you share
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  some more details on that? Yeah. I think
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  the first part of it is that
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  AI is gonna lead to better and better
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  predictive
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  results.
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  Around RCM, I'm I'm not talking about the
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  clinical aspect of a c
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  of AI. That's a separate thing. Around
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  RCM, the ability to predict,
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  what will be an outcome from an administrative
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  perspective.
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  Should I admit the patient? Should I discharge
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  the patient? Does this patient have the right
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  level of care? Does this patient have the
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  most accurate documentation?
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  I think AI is going to be able
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  to transform that
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  and make the human practitioners of this so
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  much more efficient. Mhmm. How then do hospitals
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  keep up with all of this?
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  I think
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  it's it's akin to the public private partnership,
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  I I would say. Right? You want hospitals
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  or I think hospitals would desire to be
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  in partnership
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  with vendors, with software developers.
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  Because,
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  quite frankly,
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  it's the vendors who are 1,
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  innovating,
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  and 2, they're trying to keep track and
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  stay on top of the latest technology. That's
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  what vendors do.
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  Hospitals,
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  they have the source of the data.
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  And so that's how that's gonna feed into
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  the large language models and machine language models.
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  And they also have the clinical context that
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  the vendors need to understand.
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  So I think it's this partnership between the
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  vendor
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  and the hospital that will really allow
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  hospitals to kinda keep up to date, if
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  not stay at the forefront of this changing
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  technology. Yeah. It's not realistic, I imagine, for
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  for a hospital to be able to do
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  what a vendor does in terms of keeping
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  up with the advancement of technology. Yeah. I
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  I think there'd be very few hospitals that
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  would be able to do that. Right? I
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  think first and foremost, I think, it's my
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  belief that a hospital is there to take
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  care of patients Correct. And to provide the
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  best level of care you can. And technology
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  is certainly a part of that. But I
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  think that that partnership with a vendor will
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  elevate
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  the hospital's ability to
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  deploy the most recent and most advanced technology
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  to do that. Mhmm. I wanna get into
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  sort of, clinical documentation integrity here. Can you
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  talk a little bit about how
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  you think organizations should be integrating CDI and
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  What what what can you can you expand
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  on that for our listeners? Sure. I I
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  think the the interesting about clinical documentation and
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  utilization management is that it's all really a
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  part of the same continuum across
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  rev cycle. And, you know, you can look
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  at it from a mid rev cycle perspective,
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  but it's really a part of the entire
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  rev cycle. Documentation,
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  the collection of information about the patient,
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  is required to ensure
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  proper utilization management.
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  Has the patient got the right level of
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  care? Should the patient be admitted, discharged? Where
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  should the patient be placed? And then you've
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  got to make sure that the documentation of
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  patient while they are in the hospital is
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  accurate, 1st and foremost, in order to have
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  good patient care, better have good documentation quality.
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  And of course, there's the reimbursement aspect of
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  it. But I think all of this, from
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  a hospital perspective, all of this ties to
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  outcome.
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  And there are 2 things here, right? 1
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  is you want to be able to deliver
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  the best care for the patient possible.
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  And 2 is you want to be able
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  to get paid
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  accurately for the care that you delivered. And
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  I think
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  it's the combination
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  of
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  plus CDI
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  that will
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  collect all the information that is needed
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  to ensure that the patient is getting the
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  best care. It will also ensure that the
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  hospital is then getting reimbursed
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  at the right level for everything that they
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  have done with the patient
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  from admission all the way to discharge. And
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  and, you know, it just strikes me that
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  this sits in such a this this intersection
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  between the the right care, the right care
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  for patients, and also the the financial health
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  of an organization.
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  Curious if you could expand upon sort of
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  what doing this, sort of what benefits it
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  yields to to patients in the the organization,
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  but also I think
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  to staff. Right?
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  Clinicians, I I imagine too if this is
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  done appropriately, it can change their experience how
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  how they, show up to work. Can you
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  expand on that? Yeah. Definitely. That's that's very
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  true. I think there there are few things
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  that are,
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  top of mind here. First off, it's the
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  ability to collaborate.
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  The information that is collected
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  from a nurse during the process,
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  the information that is collected or needed by
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  the CDI specialist,
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  it's all the same type of information. So
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  a collaboration between those two departments
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  is critical.
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  The better they collaborate, the more transparent
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  the information is going to be, the better
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  the care, the better the reimbursement, so on
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  and so forth. The second part of it
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  is that all this information also needs to
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  be put in front of the physician, whether
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  it's a physician advisor managing the utilization management
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  process or a physician managing the patient during
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  the inpatient stay.
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  Again, the collaborative aspect allows all this information
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  to flow directly to the physician and back
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  in a much smoother manner.
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  And then the transparency
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  of all of this information
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  will allow things to be resolved a lot
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  quicker. Any issues will be resolved. You don't
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  want to have all this information in silos.
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  And that's what's been happening. All of this
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  information, you know, you got the silo. You
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  got a CDI silo. You got a physician
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  care silo. Right? All of these need to
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  be combined and information has to
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  flow
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  smoothly between all of these entities.
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  Yeah. And it it stands to reason that
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  if you achieve that, that's gonna change the
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  game for a lot of a lot of
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  different Exactly. Right. Right. You you expect
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  that once you are able to do that,
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  better patient care because everyone's talking. Mhmm. Right?
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  And better reimbursement because everyone's got the right
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  information that ultimately flows into the bill that
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  gets dropped. Excellent. Well, William, I think that's
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  a great place for us to conclude. It's
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  been a pleasure speaking with you today. Alright.
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  Thank you, Brian. I also wanna thank our
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  podcast sponsor, Iodine Software. You can tune into
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  more podcasts from Becker's Healthcare by visiting our
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  podcast page at beckershospitalreview.com/podcast.