William H. Morris, MD, MBA

I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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Rural health. Is the one we’re we need to see improvement not in care, but in operational efficiency. So nice to see implementation of AI methodologies. I have been a bit of a sceptic, AI tool tries to save physican and care provider time, but than they are over burdened with administrative tasks. So glad to see AI Grand Rounds giving a realistic picture of what is happening by in the field and not just hype. If we want real victories, we need to tackle at multiple levels, AI is absolutely a yes these days, but organizations should adapt and want to make provider lives better. AI Grand Rounds Dallas AI #RuralHealth #healthequity

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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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The new healthcare AI arms race: Using AI to empower clinicans and patients to push back on health insurers: Anomaly ➡️ Uses machine learning to parse health insurers' policies and historical claims data to help clinicians predict and prevent claims denials. Anterior ➡️ provides tech to clinicians working inside health insurers to automate prior authorizations for covered medical care Claimable ➡️ analyzes a range of data, including clinical research, insurer policies, and existing appeals data, to generate a personalized letter for $40 Cofactor AI ➡️ Platform analyzes medical records, insurer policies, and claims data, to help hospitals appeal claims denials Cohere Health ➡️ reduces the number of unnecessary prior authorization denials to help patients get the care they need faster Goodbill ➡️ works with patients and employers to reduce medical costs by cross-referencing medical records with incoming hospital bills to identify potential errors and overcharges. Humata Health ➡️ works with hospitals to automate the collection of documents included in requests for prior authorizations sent to insurers and flag likely denials. Guardian AI ➡️ provides hospitals and physician groups with tools to analyze insurance reimbursement patterns and automate the handling of unpaid medical claims and denials Time will tell what needles are moved by these companies - what firms would you add to the list?

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Radiologists are achieving payments 500% above the Qualified Payment Amount (QPA) in surprise billing disputes, thanks to the No Surprises Act. This figure is staggering and highlights an important reality: many providers might not realize the tremendous potential of this opportunity. When the No Surprises Act (NSA) was enacted in 2022, the rates at which providers were reimbursed took a major hit, often cut in half. Payors exploited the QPA to justify lower payments, essentially giving themselves the green light to underpay claims. If a provider disagreed with the payment, they had to navigate the cumbersome claims process to recover what they deserved. But here’s the good news: By participating in the IDR process, radiologists are claiming up to 5 times their initial payments. This result is a powerful incentive for payers to engage in a meaningful negotiation and ensure fair compensation. Providers should leverage the NSA to their advantage - and capture every dollar they’re owed.

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Sharing key takeaways on the CMS Hospital Inpatient Quality Reporting program for FY2025. - Seven new measures are added (which are welcome, with the caveat of let's see how they work out) -> Patient Safety Structural Measure beginning CY 2025 with payment determination in FY 2027 -> Age Friendly Hospital CY 2025/FY 2027 -> Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations (CAUTI- Onc) CY 2026/FY 2028 -> Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations (CLABSI-Onc) CY 2026/FY 2028 -> Hospital Harm – Falls with Injury (eCQM) CY 2026/FY 2028 -> Hospital Harm – Postoperative Respiratory Failure (eCQM) CY 2026/FY 2028 -> Thirty-day Risk-Standardized Death Rate Among Surgical Inpatients with Complications July 1, 2023–June 30, 2025/ FY 2027 - Five existing measures are removed (which is a breath of fresh air) - the unpopular PSI-04, and measures related to 30-day episode payments for acute myocardial infarction, pneumonia, total hip/ knee arthroplasty, heart failure - Two existing measures are modified (Global malnutrition composite score expanded from seniors over 65 to anyone older than 18 - this is very positive; and Refined HCAHPS measure - will post details on this next week.)

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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SCAN Health plan's successful suit of the CMS over an obscure provision (Tukey outlier detection) in the regulations will result in ~250 million dollars changing hands from the CMS to SCAN health plan. Got me wondering about what the healthcare system is getting out of measuring quality. So I took a look at two of the common healthcare quality measurement systems, HEDIS and STARs. I broke all the measures into six categories: *Screening/Assessment/Evaluation *Survey *Immunization/Vaccine *Medication/Adherence *Biometric Control *Non-Screening Procedure or Service The first two are obviously pure process measures (did you screen a patient or provide a follow-up visit). The next two reflect clinical patterns but do not measure outcomes (e.g. are the medications working). I would argue the last two reflect actual clinical outcomes or impacts. HEDIS MY 2024 broke out as: *Screening/Assessment/Evaluation - 43% *Survey - 6% *Immunization/Vaccine - 3% *Medication/Adherence - 25% *Biometric Control 6% *Non-Screening Procedure or Service - 16% STARS: *Screening/Assessment/Evaluation - 28% *Survey - 44% *Immunization/Vaccine - 2% *Medication/Adherence - 19% *Biometric Control 5% *Non-Screening Procedure or Service - 2% Most of what the healthcare system pays for in terms of quality is Medication Adherence and Screening. I have long advocated for using episodes of care to help improve both financial incentives and quality. Quality is easier to measure within a specific episode of care, especially when using Patient-Reported Outcomes. As a comparison below is how the new Enhancing Oncology Model Quality Measures break out: *Screening/Assessment/Evaluation - 14% *Survey - 29% *Immunization/Vaccine - 0% *Medication/Adherence - 14% *Biometric Control - 0% *Non-Screening Procedure or Service - 43% Still room for improvement. I've seen some very interesting work done by Patient Discovery and others around patient reported outcomes for cancer. I'd like to see more of this implemented in both CMS programs and private ACO initiatives. Important to think about what we are paying for in quality measurement.

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100% satisfaction in birth metrics! What is the secret? Cleveland Clinic achieved 100% satisfaction across five birth metrics, a notable feat that Becker's Hospital Review highlighted. Cleveland Clinic adopted TeamBirth in October 2022. TeamBirth is a care delivery model jointly created in 2021 by Harvard Pilgrim Health Care, Ariadne Labs and UMass Memorial Health. It emphasizes routine check-ins with all patient care team members and family at key points to streamline communication about birth preferences and patient status, using a whiteboard as a key tool. Since adopting it, the health system saw the rate of C-sections for Black mothers go down from 41% to 22%. Rates also improved for white mothers, dropping from 27% to 23%, bringing the outcomes for its patient populations to a more equitable level. ▶ Satisfaction went up across five categories in 2022 to a perfect 100% for: ➡ Friendliness/courtesy of the unit — up 10% from 2022. ➡ Staff concern, information about progress and baby’s condition — up 12% from 2022. ➡ Nurse promptness in responding to patient call — up 12% from 2022. ➡ Nurse's attitude toward patient requests — up 13% from 2022. ➡ Doctor and staff working together during birth — up 15% from 2022. Patient satisfaction grew by 23% — from 72% in 2022 to 95% in 2024 — for how well they felt Cleveland Clinic managed their pain during labour. Transparent communication is important to promoting safety and reliability in high-risk organizations. ♻ How is the communication in your organization? #healthcare #communication #reliability

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If you're passionate about keeping a pulse on things that seek to advance the healthcare industry, tune in to the podcast TRADEOFFS! This week's episode delves into CMS's new pilot program, GUIDE (Guiding an Improved Dementia Experience), which starts 7/1. The 8-year initiative aims to support caregivers of individuals with dementia, and anticipates it will: 1) Reduce caregiver stress 2) Enhancing the patients quality of life 3) Avoid the use of nursing facilities. This is more than a 1-800 support number. It's a game-changer beyond traditional support services. My key insight? We must recognize and empower caregivers for their unique, invaluable role. Their personalized, impactful care is unparalleled. It's crucial to rally behind caregivers. Some companies like Careforth are already seizing this opportunity for Medicaid patients, with more likely to follow suit as CMS backs this model. Remember, where CMS leads, the nation follows. #healthcare #caregivers #CMS #podcast #TRADEOFFS

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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View of U.S. Healthcare Quality Declines to 24-Year Low Americans' rating of U.S. healthcare coverage is below average; most say the system has major problems This is not surprising, maybe there will be some improvement in 2025 #healthcarequality, #opinionofhealthcare, #sentimentofhealthcare https://lnkd.in/eRJAFgSh

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Very important points about hospital consolidation. ⏺ Has led to the majority of physicians now being employed by a system. ⏺ A hospital system may have different priorities than physicians (in private practice). ⏺A system in which physicians have very little leverage to negotiate or change factors important to patients and clinical care. The real reason highlighted around 2 minutes 50 seconds. Short interview with beneficial insight. ⏺Physicians have joined unions not for wage negotiation but to focus on changes that affect clinical care. We as physicians do not have a unified voice. We have not organized ourselves well to create a unified voice. I am not sure that a union is the right path, but uniting to have a common voice, leverage, and negotiation power is needed. At 9 minutes Kevin Schulman highlights how this could be done without creation of a union (we need a system clinical strategy, not a market strategy) based on thoughts by @atul gawande. #UsingWhatWeHaveBetter https://lnkd.in/g5YTjFbD

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Any mention of physician shortage, these days, gets linked to the problem of burnout and stress, which in turn gets connected to the documentation burden ("pyjama time"), which then takes us to the problems of #EHRs. As a result, ambient AI scribing, has become one of the fastest emerging use cases of generative AI in healthcare. An ambient AI scribing tool "listens" in the background during the physician-patient encounter and automatically produces the physician's note without the need for the physician to write anything. This is the promise of ambient AI scribing: by eliminating the need to write a note after the visit, physicians will have more time for patients or for themselves/families. I often wonder if the writing of the note is purely "wasted" time. Is note-writing not integral to our cognitive process and therefore to our ability to learn from each patient encounter and improve our 'practice' of medicine? To get some answers, I listened to this 1971 grand rounds by Larry Weed MD who invented the problem-oriented medical record: https://lnkd.in/g-WftXvi. Dr. Weed says at the beginning of the video: "...this record cannot be separated from the caring of the patient. This is not something.....the practice of medicine over here and the record over there. It is intertwined with it. It determines what you do in the long run." Therefore, in addition to studying the accuracy, evidence, and benefits (time, productivity, cost etc.) of these AI scribing tools, we should also consider the impact of the elimination of note-writing on physician's cognitive processes especially trainees - students and residents. #AI #generativeAI #ambientAIscribing #EHR #cognition #medicaleducation

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