Latest / Becker’s Healthcare Podcast / Creating Capacity in Orthopedics: How AI Is Helping Practices Do More With Less

Transcript

Creating Capacity in Orthopedics: How AI Is Helping Practices Do More With Less · Becker’s Healthcare Podcast

• 0:00
  - Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  - Healthcare. Thanks so much for tuning in to
• 0:04
  - the Becker's Healthcare podcast series. It's great to
• 0:06
  - have you. Today, we're talking about creating capacity
• 0:09
  - in orthopedics,
• 0:11
  - how AI is helping practices do more with
• 0:14
  - less, and I'm so excited to be joined
• 0:16
  - by doctor David Klein. He's the partner and
• 0:18
  - doctor at Kennedy White Orthopedic Center. Doctor Klein,
• 0:21
  - it's so great to have you. Thanks for
• 0:22
  - being here and taking some time.
• 0:24
  - Absolutely. Thanks for having me on your show.
• 0:27
  - Absolutely.
• 0:28
  - Well,
• 0:29
  - I'm not a surgeon, so I don't know
• 0:33
  - what your what your day to day looks
• 0:35
  - like. And I wanna know more about
• 0:37
  - what your day to day looks like, specifically
• 0:40
  - as we're seeing
• 0:42
  - orthopedic practices
• 0:43
  - are are under increasing pressure to do more
• 0:46
  - with less. What does your typical day look
• 0:48
  - like, and where do you see today the
• 0:52
  - biggest operational bottlenecks?
• 0:55
  - So orthopedics is, a little different from many
• 0:58
  - different surgical specialties.
• 1:00
  - In orthopedics,
• 1:01
  - one thing is we're often called the, quote,
• 1:04
  - primary care of the musculoskeletal
• 1:06
  - system,
• 1:07
  - because the majority of the patients that we
• 1:09
  - see never have any surgery at any point
• 1:12
  - in their treatment.
• 1:13
  - We usually see people for specific things that
• 1:17
  - they come to us for new consultations,
• 1:19
  - and they may come back to us in
• 1:21
  - the future. And there are some people,
• 1:23
  - that get a more prolonged course like with
• 1:25
  - arthritis of their knees and their hips. But
• 1:28
  - for the most part, like my practice, I
• 1:30
  - have, three office days a week where I
• 1:33
  - may see between thirty and forty patients, and
• 1:35
  - then I have two operating room days a
• 1:37
  - week. And then, of course, there's the on
• 1:39
  - call stuff.
• 1:40
  - So there's a high throughput of patients.
• 1:43
  - Some are for very straightforward simple things. Some
• 1:45
  - are for more complex things.
• 1:47
  - And a lot of the bottlenecks
• 1:50
  - come from, like, literally getting,
• 1:52
  - the patients between scheduled to the office,
• 1:55
  - appointments to the office, seen in the office,
• 1:57
  - document their office notes.
• 1:59
  - And then for people that need,
• 2:01
  - certain other things like imaging studies like MRIs,
• 2:05
  - or,
• 2:06
  - simple treatments like people with, lumbar stenosis who
• 2:09
  - may need an epidural steroid injection
• 2:12
  - as well as full on surgeries like if
• 2:14
  - I do a total shoulder replacement or a
• 2:17
  - rotator cuff repair on down to a trigger
• 2:19
  - finger surgery,
• 2:20
  - then the insurance companies want certain hoops jumped
• 2:24
  - through,
• 2:25
  - so you can,
• 2:26
  - validate,
• 2:27
  - the severity of the person's problem to the
• 2:30
  - insurance company,
• 2:31
  - so that they'll authorize it.
• 2:33
  - Now some of the things you've just highlighted
• 2:35
  - come back to something that's been very prevalent
• 2:37
  - in health care, which is administrative
• 2:39
  - work. We were still talking about it in
• 2:42
  - 2026.
• 2:43
  - And, again, it does take valuable time away
• 2:46
  - from patient care. It can take valuable time
• 2:48
  - away from patient care. Again, as you're looking
• 2:51
  - at this
• 2:52
  - from a technology lens, for you personally, where
• 2:56
  - have you seen AI make the biggest difference
• 2:59
  - for your team and your practice?
• 3:02
  - Yeah. Our introduction
• 3:03
  - as an office to AI,
• 3:05
  - probably came through,
• 3:07
  - an AI phone answering system.
• 3:09
  - Because in our practice,
• 3:12
  - we had prior to COVID, I think we
• 3:14
  - had about, 13 people in our call center,
• 3:18
  - in house,
• 3:19
  - that made office appointments for people. And on
• 3:21
  - a typical Monday morning, they would get more
• 3:23
  - than,
• 3:25
  - 1,100
• 3:26
  - phone calls to answer,
• 3:28
  - from people over the weekend and stuff like
• 3:30
  - that. With with COVID, we lost a lot
• 3:32
  - of employees. We actually went down to about
• 3:35
  - seven. And since then, we've had trouble maintaining
• 3:37
  - people in the phone room. So that's where
• 3:39
  - we first looked to AI
• 3:40
  - is how do you handle a case where
• 3:43
  - somebody says that they waited on the phone
• 3:45
  - fifty minutes to even speak to a human.
• 3:48
  - So we found,
• 3:50
  - an AI phone answering system,
• 3:52
  - that basically took over for the initial calls.
• 3:55
  - Like people call in, they get the call
• 3:57
  - answered immediately.
• 3:59
  - As long as they don't have certain
• 4:02
  - characteristics with respect to why they're calling,
• 4:04
  - then they can get the computer to set
• 4:06
  - them up with a simple office appointment. And
• 4:09
  - that also means if they fall out of
• 4:10
  - that stack, then they can talk to a
• 4:12
  - human who then has more time to talk
• 4:14
  - to them because the human's not dealing with
• 4:16
  - the simple stuff anymore,
• 4:18
  - and the humans can take care of the
• 4:20
  - more difficult things. So that was our first
• 4:22
  - introduction to AI. Our second introduction
• 4:25
  - was with AI transcription using Heidi Health.
• 4:28
  - And, that was something that we didn't even
• 4:31
  - realize how good it was
• 4:33
  - until we actually started using it. We actually
• 4:35
  - started with that more for a cost saving
• 4:38
  - approach,
• 4:39
  - because we were paying human transcriptionists,
• 4:42
  - to do all our transcription that took two
• 4:45
  - to three days to get it back and
• 4:46
  - put in our medical records, but sometimes with
• 4:49
  - errors just like, you know, any other thing.
• 4:51
  - So that was very awkward. And then with
• 4:53
  - Heidi, we got notes in under thirty seconds
• 4:56
  - that are available immediately to be used or
• 4:58
  - given to the patient, and we actually had
• 5:00
  - a 13 to 15 times cost savings that
• 5:03
  - way that we had no idea that it
• 5:05
  - would get that, much, of a cost savings.
• 5:09
  - And, again, it it eventually also trickles down
• 5:11
  - to the patient. It improves the patient experience,
• 5:13
  - which is so crucial.
• 5:15
  - I wanted to ask too. You've touched on
• 5:17
  - some of the issues. Like, again, we have
• 5:19
  - the referrals and authorizations
• 5:21
  - and
• 5:22
  - scheduling, all of these things that need to
• 5:24
  - happen.
• 5:26
  - How does this affect the patient experience when
• 5:29
  - it's not done correctly, when it's not optimized?
• 5:33
  - Well, I mean, you may have been in
• 5:35
  - this situation, and I know I've been in
• 5:36
  - this situation before. You get denials, you get
• 5:39
  - cancellations,
• 5:40
  - you get callbacks where the patients call the
• 5:43
  - insurance company, the patients call the office, they
• 5:46
  - use office time to complain that the insurance
• 5:48
  - company has denied them.
• 5:51
  - Patient demands that, you know, you call the
• 5:53
  - insurance company to do the peer reviews. The
• 5:56
  - The peer review physicians
• 5:57
  - only have limited availability to talk to you,
• 6:00
  - which is during your office hours. So then
• 6:01
  - you step out of seeing patients
• 6:04
  - to talk to a peer review person who
• 6:05
  - might just say, as one of my partners
• 6:07
  - a few minutes just said on the phone,
• 6:09
  - just like as soon as I spoke with
• 6:10
  - a peer reviewer, she's like, I don't know
• 6:12
  - why this wasn't approved. It's approved. But that
• 6:14
  - took
• 6:15
  - days and time and effort,
• 6:18
  - and it's very arduous,
• 6:20
  - and especially
• 6:21
  - cancellations.
• 6:22
  - I mean, if I have,
• 6:24
  - you know, three shoulder replacements in a day
• 6:26
  - and one gets canceled because of insurance approval
• 6:29
  - a day or two before,
• 6:31
  - you know, that's a huge hole in the
• 6:32
  - schedule that could be filled by other patients.
• 6:34
  - But because other people need preapproval and other
• 6:37
  - stuff, they can't just drop into that space.
• 6:40
  - That's a big deal. And in our office,
• 6:42
  - we've actually now hired a specific person to
• 6:45
  - do insurance authorizations
• 6:47
  - just for epidural steroid injections for my partners
• 6:49
  - that do that via pain management to feed
• 6:52
  - our spine spine surgery patients
• 6:55
  - that need it
• 6:56
  - because that takes a tremendous amount of time
• 6:59
  - because there are just so many of them.
• 7:02
  - You mentioned the tremendous ROI that some of
• 7:05
  - these technology investments have brought to your practice,
• 7:08
  - certainly, when it comes to improving just the
• 7:10
  - day to day improving workflows. But, again, you've
• 7:12
  - also mentioned the financial aspect, which is crucial.
• 7:15
  - As
• 7:16
  - the colleagues some of your colleagues, many of
• 7:18
  - your colleagues listening,
• 7:21
  - they're evaluating this. They're evaluating AI solutions. They're
• 7:24
  - looking at what they can do based on
• 7:25
  - your experience. What advice would you give them,
• 7:29
  - and what outcomes should they be measuring to
• 7:32
  - determine, okay. This AI investment makes sense for
• 7:35
  - me today?
• 7:37
  - Well,
• 7:38
  - some things are very straightforward, like our substitution
• 7:41
  - of going from human transcriptionist,
• 7:43
  - which is almost like the old days where
• 7:45
  - I had a tape recorder and recorded on
• 7:47
  - tapes and sent them off to somebody across
• 7:50
  - town to,
• 7:51
  - type up. So that that's a pretty simple
• 7:53
  - one to figure out.
• 7:55
  - The other is the insurance denials. If you
• 7:57
  - can figure out how to quantitize,
• 7:59
  - say,
• 8:00
  - you know, how many epidural steroid injections
• 8:04
  - get approved on a first time basis versus,
• 8:08
  - have denials,
• 8:09
  - how many MRIs that you send out get
• 8:12
  - approved versus denied. That's actually the stuff that's
• 8:16
  - a little more important than,
• 8:18
  - or or at least certainly,
• 8:20
  - it it's it's more measurable
• 8:22
  - than a physician writing a note because the
• 8:24
  - physician
• 8:25
  - is always gonna document whether the physician has
• 8:28
  - a pen
• 8:30
  - or, a talking device or a computer doing
• 8:33
  - it. There's always gonna be a way to
• 8:34
  - do the documentation.
• 8:37
  - But I I know a lot of other
• 8:38
  - people, like, I always did my documents during
• 8:40
  - the day. A lot of these companies talk
• 8:42
  - about, quote, pajama time. I didn't know that
• 8:45
  - term before, but I understand it because I
• 8:47
  - had some partners that they would go home
• 8:49
  - and they would dictate their notes after dinner
• 8:51
  - until 10:00 at night when their kids and
• 8:53
  - their wife were asleep.
• 8:55
  - So that's another thing that, from the note
• 8:58
  - taking perspective, certainly improves the physician's happiness and
• 9:01
  - may make it easier for them the next
• 9:03
  - day. And you may get to see a
• 9:05
  - few other patients that way too. But it
• 9:07
  - it's,
• 9:08
  - for us, it hasn't been a huge volumetric
• 9:10
  - improvement,
• 9:11
  - but it it's been a, quality of life
• 9:14
  - improvement and allow us to focus better even
• 9:16
  - when it comes to just looking patients in
• 9:18
  - the eye instead of looking at your pad
• 9:20
  - and writing with a pen.
• 9:23
  - Just as a quick follow-up to this too,
• 9:25
  - you've mentioned the tape recorders.
• 9:27
  - I think we I still remember using those
• 9:29
  - at some at some point in time.
• 9:31
  - How
• 9:32
  - personally, for you, how has your own approach
• 9:35
  - evolved
• 9:35
  - with AI? Right? Have you have you personally
• 9:39
  - felt those
• 9:40
  - that value that it brings to you from
• 9:42
  - a time savings perspective?
• 9:44
  - From my personal perspective, I would say I
• 9:46
  - actually spend a little more time per visit
• 9:48
  - with people, so I think that makes people
• 9:50
  - happier.
• 9:51
  - And also, you know, I I will frequently
• 9:54
  - give them,
• 9:55
  - an office summary to read, which I think
• 9:58
  - makes it happier, especially when people would previously
• 10:00
  - say, oh, could you write that down for
• 10:02
  - me because my wife's not here and, she's
• 10:04
  - gonna wanna know and she should be here.
• 10:06
  - So that's really easy because then you can
• 10:08
  - give a transcript of everything that you would
• 10:10
  - put in the chart to, you know, to
• 10:12
  - the family members or to the patients to
• 10:14
  - take to the family members.
• 10:16
  - From my standpoint,
• 10:17
  - I I went through four different artificial intelligence
• 10:20
  - dictation programs before settling on Heidi. And the
• 10:23
  - thing that really sold me on Heidi
• 10:26
  - was two things. It was really good out
• 10:28
  - of the box. And what I mean by
• 10:30
  - that is
• 10:32
  - I immediately got great notes,
• 10:35
  - plus
• 10:36
  - it didn't miss a bit of physical examination.
• 10:39
  - So orthopedic surgery is extremely hands on physical
• 10:43
  - exam. Like, we don't do do it well
• 10:45
  - with telemedicine.
• 10:46
  - It's so, you know, I would go through
• 10:48
  - and verbalize
• 10:49
  - all of my, physical exam stuff and talk
• 10:52
  - about different signs like speed sign or Lhermitte's
• 10:55
  - sign or Finkelstein
• 10:57
  - sign
• 10:58
  - or, you know, talk about range of motion.
• 11:00
  - And the three other ones that I used
• 11:02
  - prior to this had physical exams that they
• 11:04
  - said physical exam and they had some stuff
• 11:06
  - in it, but then I would be like,
• 11:08
  - wait a second. This doesn't describe I did
• 11:10
  - Tinel sign for the median nerve and cubital
• 11:12
  - Tinel sign. It's nowhere in this note. And
• 11:15
  - as soon as I used Heidi, literally, I
• 11:17
  - can't think of any
• 11:19
  - missed physical exam finding,
• 11:22
  - as long as I audibleize the physical exam
• 11:24
  - findings. And some of them, I'll just do
• 11:26
  - casually now,
• 11:28
  - because, just like Heidi's working with me, I'm
• 11:30
  - working with Heidi. So if a patient's sitting
• 11:33
  - there with a cane and I say, oh,
• 11:35
  - yeah. I see you're walking with a cane.
• 11:36
  - Which hand do you use that in? Does
• 11:38
  - that be something used for instability?
• 11:40
  - Well, those kinda answers that patient fills out
• 11:42
  - will also get incorporated into the note, you
• 11:45
  - know, very fluidly both into physical exam and
• 11:48
  - into the subjective.
• 11:50
  - And then Heidi let me the second part
• 11:51
  - is Heidi let me do extremely
• 11:54
  - specific templates. I mean, I really love my
• 11:57
  - templates and other doctors I've given to like
• 11:59
  - them because I think they come out with
• 12:01
  - great notes from the orthopedic perspective
• 12:04
  - detailing out, you know, history,
• 12:06
  - physical,
• 12:07
  - you know, what we're thinking about,
• 12:10
  - possible problems,
• 12:12
  - future things. And then even simple stuff like
• 12:14
  - in the top of the note, we put
• 12:16
  - in a separate line for what our X
• 12:18
  - X-ray text should do when the patient comes
• 12:20
  - back for a follow-up
• 12:21
  - that's kind of automated right out of our
• 12:23
  - notes. And at the bottom, because my,
• 12:27
  - assessment and plans get long, I have now
• 12:29
  - a separate, like, just bulletized,
• 12:32
  - summary of assessment and plan. So if somebody
• 12:35
  - gets the note really quick, they can just
• 12:37
  - quick and see where we are with this
• 12:39
  - patient's treatment.
• 12:40
  - So it it's the combination of not missing
• 12:44
  - anything
• 12:45
  - from physical exam perspective,
• 12:47
  - as well as the
• 12:49
  - customization,
• 12:50
  - for the templates
• 12:51
  - that sold me on Heidi versus the three
• 12:53
  - others that I used prior to Heidi.
• 12:56
  - And you never have to rewind the tape,
• 12:59
  - which is also very important.
• 13:01
  - Yeah. That's tapes are gone. We were using
• 13:04
  - Olympus digital recorders for for well over a
• 13:07
  - decade after the tapes.
• 13:09
  - Doctor Klein, it's so great to have you.
• 13:10
  - Thanks so much for taking some time for
• 13:12
  - us. Absolutely.
• 13:13
  - And we also want to thank our podcast
• 13:15
  - sponsor, Heide Health. You can tune in to
• 13:16
  - more podcasts from Becker's Healthcare by visiting our
• 13:19
  - podcast page at beckershospitalreview.com.