As physician salaries soar amid a worsening shortage, healthcare executives are grappling with whether these costs are sustainable or if alternative care team models can ease the financial strain.
Welcome to our HealthLeaders January 2025 cover story. Each month, our editors dive into the topics that matter most—such as healthcare innovation, leadership strategies, payer/provider wars, and patient care—delivered in a dynamic, engaging format.
What did we look at this month? It’s all about physicians.
The escalating costs of employing physicians have become a financial fault line in healthcare. As doctor salaries climb ever higher—driven by an unrelenting physician shortage and skyrocketing demand—healthcare executives are facing a critical dilemma: Are these massive expenditures truly sustainable?
While these high salaries reflect the critical role physicians play in patient care, they also raise difficult questions about sustainability and the viability of other solutions.
Could advanced practice providers, technology-driven efficiencies, or new team-based care models help offset the escalating costs? If not, what's the solution?
This month, our CMO editor Chris Cheney explores the financial and operational dilemmas at the heart of modern healthcare, and the tough decisions leaders must make to balance quality care with fiscal responsibility.
In the high-stakes world of healthcare revenue cycle management, few issues cast as long a shadow as claim denials.
For revenue cycle leaders, the challenge of denials is both urgent and complex, representing a persistent pain point that threatens financial stability, operational efficiency, and patient satisfaction.
Denials are not just a numbers game, and addressing them isn’t merely a matter of firefighting—it’s about building proactive strategies to prevent them from occurring in the first place.
Why Denials Matter
As rev cycle leaders know, denials are a drain on resources. When a claim is denied, it triggers a cascade of consequences: delayed payments, increased administrative workloads, and, in some cases, unrecoverable revenue.
But the cost isn’t just financial.
Denials create friction for patients, who may find themselves navigating confusing bills or facing unexpected out-of-pocket expenses. For care providers, denials can feel like a betrayal of their efforts to deliver high-quality care. Revenue cycle teams often bear the brunt of this frustration, forced into reactive workflows that drain morale and divert attention from higher-value activities.
The urgency to address denials goes beyond operational efficiency; it’s a matter of organizational sustainability. In an era where margins are razor-thin and the push toward value-based care adds layers of complexity, revenue cycle leaders cannot afford to treat denials as a mere operational inconvenience. They are a strategic imperative.
Unpacking the Drama: Why Denials Persist
The root causes of denials are multifaceted, reflecting the intricate web of payer requirements, coding guidelines, and documentation standards that govern healthcare reimbursement. While each denial represents a unique failure point, common culprits include:
Coding Errors: Incorrect or incomplete coding remains a leading cause of denials. Despite advances in technology, human error and gaps in training continue to fuel this issue.
Prior Authorization Problems: Many claims are denied because the required prior authorization was not obtained or was incorrectly documented. The burden of navigating payer-specific requirements falls disproportionately on revenue cycle teams.
Lack of Documentation: Insufficient or inconsistent documentation can leave claims vulnerable to denials, particularly in specialties where clinical nuance matters.
Payer Preferences: Each payer has its own labyrinthine set of rules, and failure to comply with these idiosyncrasies can lead to denials, even when the care provided was medically necessary.
Timely Filing Issues: Missed deadlines for submitting claims or responding to requests for additional information can result in automatic denials, further compounding the issue.
These problems are exacerbated by the lack of visibility into real-time claim status, fragmented communication channels, and siloed data systems.
The result? A reactive posture that keeps revenue cycle leaders perpetually on the back foot.
The Path Forward: Prevention Over Reaction
The key to solving the denial dilemma lies in shifting from a reactive to a proactive approach.
This requires leveraging technology and streamlining processes to anticipate issues before they arise. The good news is that innovative solutions are emerging to help revenue cycle leaders take control.
But how?
For revenue cycle leaders grappling with the high stakes of denials, actionable insights are not a luxury; they are a necessity. That’s why we’re bringing together industry experts for a game-changing webinar designed to tackle this issue head-on.
The next webinar in our Winning Edge series will explore cutting-edge technologies and proven strategies to reduce denials, featuring success stories from leading healthcare organizations.
Our distinguished panel includes:
Beth Carlson, VP of Revenue Cycle at WVU Medicine.
Michael Mercurio, VP of Revenue Cycle Operations at Mass General Brigham.
Eric Sulivant, Solution Strategist at Waystar.
Eric Wicklund, Event moderator and HealthLeaders content manager.
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately.
Join us as we unravel the drama, share solutions, and help you reclaim control over your revenue cycle.
Financial decision-makers are learning that AI will turn revenue cycle management upside down, but it might also save the day.
The promise of AI in healthcare is nothing short of revolutionary, but when it comes to the revenue cycle, the path forward is still challenging.
Revenue cycle leaders are finding that the technology, which expands on automation with generative and predictive capabilities, has been good so far at reducing and improving administrative tasks. But ROI is fleeting, and the true test of AI will come when it’s used to improve payer relations and patient financial engagement.
The 2024 HealthLeaders AI in Finance and Revenue Cycle Mastermind program brought together revenue cycle leaders who are advancing AI in their health systems. Through virtual meetings and an in-person roundtable, the participating executives combined their knowledge and experience to provide a framework from which other health systems might chart their RCM path in the future.
What did we learn? Well, AI in the revenue cycle is a story of slow, gradual improvements and incremental wins. And while the technology has been used to make data-crunching more efficient and ease the workloads of coders and RCM staff, there are still concerns around the unpredictable nature of augmented intelligence, from security concerns to the occasional hallucinations and drift to the ever-present chance of bias.
Those concerns will remain front and center as the technology evolves and the industry learns how to use it.
In this robust report, sponsored by Flywire, we examine how prominent revenue cycle leaders who stand on the brink of advancing AI find themselves caught between the enormous potential for efficiency and cost savings and the perilous task of navigating a labyrinth of challenges.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs and is sponsored by Flywire.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
Urged on by COVID-era successes, hundreds of health systems and hospitals across the country are delivering hospital-level care at home. But questions about cost, complexity, and culture are threatening a promising strategy and its 'toxic positivity.' Is it time to abandon ship and return care to the hospital?
Welcome to our December 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year (and we have even bigger plans for 2025).
What did we look into this month? Hospital at home.
The hospital and the home could not be more different, yet a bold strategy is trying to merge the two. It’s a gamble that could reshape healthcare—or collapse under its own complexity.
The Hospital at Home strategy, borne out of the chaos of the COVID-19 pandemic, was meant to alleviate overcrowded hospitals and offer patients a more comfortable setting to heal. But as it expands, cracks are beginning to show in its ambitious foundation.
On paper, the model combines the best of in-person and virtual care. In practice, it’s a high-stakes balancing act that some argue is teetering dangerously close to failure.
Supporters hail it as a revolution, pointing to studies showing improved outcomes and cost savings. But critics warn of the risks: patients with serious conditions treated far from the safety net of a fully equipped hospital, escalating costs, and a healthcare system strain-ing to adapt.
At a time when more execs are buying in to hospital at home, is it actually time time retreat? Eric Wicklund tries to find out in this month's cover story.
One way or another, Medicare Advantage is in for a change in 2025.
November has been a busy month as President-elect Donald Trump began rolling out his cabinet picks. From Dr. Mehmet Oz taking over CMS to RFK Jr. spearheading HHS, there has been no shortage of reactions to the newly appointed.
While all important, the most recent nomination of Dr. Mehmet Oz as the next Administrator of CMS has ignited healthcare leadership discussions about one topic in particular: the future of Medicare Advantage (MA).
Dr. Oz’s history of media prominence and his evolving views on healthcare policy may foreshadow significant changes for MA, a program long under scrutiny by hospitals and health systems for its poor reimbursement practices and administrative hurdles.
HealthLeaders knows well the strife MA causes for hospital and health system leaders, so digging into what Dr. Oz could mean for the future of the program is warranted.
Medicare Advantage: A system forever under fire?
As we know, MA plans, operated by private insurers under CMS oversight, offer an alternative to traditional Medicare.
While beneficiaries often enjoy lower premiums, additional benefits like vision and dental care, and out-of-pocket cost caps, providers have voiced strong concerns about the program's operational challenges.
One case in point is Scripps Health. Two medical groups within the system canceled their MA contracts for 2024 because of low reimbursement rates, denials, and administrative costs to manage high utilization and out of network care.
“We’re unfortunately on the vanguard of what I think is going to be a very ugly few years between hospitals and commercial insurance companies,” Chris Van Gorder, president and CEO of Scripps, told USA Today.
And Scripps has the resources to better manage these burdens, meaning these burdens are even more exacerbated for smaller systems.
An example of this is Samaritan Health Services. It recently terminated its commercial and MA contracts with UnitedHealthcare.
The five-hospital, nonprofit health system cited slow processing of requests and claims that have made it difficult to provide appropriate care to UnitedHealth's members, according to a news release from Samaritan.
“This, along with other factors, is not in alignment with our mission of building healthier communities together,” the health system said.
Another example is St. Charles Health System, a four-hospital network and healthcare company in Central Oregon, which terminated its MA contracts in 2023.
Steve Gordon, president and CEO of St. Charles, said great thought went into the decision to reevaluate MA participation, and it was done only after years of concerns piled up not just at St. Charles, but at health systems throughout the country.
“The reality of Medicare Advantage in central Oregon is that it just hasn’t lived up to the promise,” he said in a press release. “A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials, and frustrations. The sicker you are, the more hurdles you and your care teams face. Our insurance partners need to do better, especially when nurses, physicians and other caregivers are reporting high levels of burnout and job dissatisfaction.”
These issues have led some healthcare leaders to question the sustainability of MA in its current form, even as enrollment continues to climb.
Oz’s stance on Medicare Advantage
While Dr. Oz has yet to explicitly outline his policy priorities as CMS Administrator, his past commentary provides clues about his approach.
The proposal sought to extend MA beyond older adults to include all Americans not already enrolled in Medicaid. They suggested rebranding the program as “Medical Advantage” and funding it through a 20% payroll tax.
In the article, Dr. Oz and Halvorson argued that this system would eliminate Medicare fraud as a government expense and significantly reduce administrative burdens. The duo also emphasized that consolidating the U.S. payment system under MA would simplify healthcare delivery, reducing administrative costs by a third.
“Once instituted, the universal Medicare Advantage plans should be obligated to reduce excess administrative costs by a third,” they wrote.
As a Pennsylvanian, I was front and center when Dr. Oz revisited these ideas during his Senate campaign in 2022, branding the proposal as “Medicare Advantage Plus.” A campaign spokesperson described the plan as expanding access to “high-quality, low-cost” healthcare, which “is beloved by seniors and should be available to everyone who wants it.”
As a physician and public figure, Dr. Oz has extolled the virtues of prevention and patient-centric care, themes consistent with MA’s emphasis on managing chronic conditions and promoting wellness.
Should hospitals and health systems brace for impact?
Hospital and health system leaders are likely to approach Oz’s nomination with caution, given the stakes for their financial stability.
Excessive administrative burdens, driven largely by MA policies, have led to soaring operational costs. A study published in Health Affairs found that hospitals spend billions annually on administrative tasks related to MA disputes, highlighting the need for systemic reform.
Oz’s appointment represents a marked departure from the technocratic leadership of the Biden administration. Current CMS Administrator Chiquita Brooks-LaSure, a policy expert with a focus on equity and access, has championed measures to address MA plan denials and streamline processes for providers.
For example, under Brooks-LaSure, CMS finalized new rules aimed at reducing “prior authorization” burdens—a frequent source of friction between insurers and providers.
Dr. Oz’s background, by contrast, suggests a more consumer-oriented approach, potentially at the expense of provider-centric reforms. This shift could exacerbate tensions with hospitals and health systems unless Oz works to balance patient access with provider sustainability.
Key questions moving forward
So, all that being said, there are several critical questions that will shape MA under Oz’s leadership:
Will reimbursement rates improve? Providers hope for policies that narrow the gap between MA and traditional Medicare payments.
Can prior authorization reform advance? Hospitals will closely watch for signs that CMS will tackle administrative inefficiencies.
How will enrollment growth be managed? As more beneficiaries choose MA, ensuring adequate funding and oversight will become increasingly urgent.
Dr. Mehmet Oz’s nomination to lead CMS has injected uncertainty into the future of MA. For hospital and health system leaders, his tenure could either herald long-awaited reforms to address reimbursement and administrative challenges—or deepen existing frustrations with the program.
While his tenure remains an open question, one thing is clear: the future of MA will remain a critical issue for America’s healthcare system.
The fight to retain a multigenerational workforce has been a losing battle for healthcare CEOs. Is one generation in particular to blame?
Welcome to our November 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year.
What did we look at this month? In the intense, ever-evolving landscape of healthcare, a perfect storm is brewing.
Retaining workers in hospitals and health systems has become a near-impossible task. The factors behind this crisis are complex, but one looming culprit stands out: generational clash. CEOs are not only struggling to keep people on board; they’re fighting against rapidly shifting priorities driven by a multi-generational workforce that seems to have conflicting demands.
Meeting those demands is getting harder, not easier, largely due to the youngest generation’s relationship with work. Gen Z is the workforce of tomorrow, but its fit in the grueling environment of healthcare, which can often feel like a square peg in a round hole, is something hospital decision-makers are attempting solve for.
It’s a challenge that threatens to destabilize an industry already reeling from the aftershocks of the pandemic.
But what's the solution? Our CEO editor Jay Asser explains that while cutting out an entire generation of workforce isn't feasible–or necessary–the truth is, healthcare is fighting a multigenerational war within its own walls, and healthcare leaders need to strike back.
There are four key technology trends that revenue cycle leaders are prioritizing to boost efficiency, strengthen vendor management, and support staff transformation.
As hospitals and health systems face increasing financial pressure, revenue cycle leaders are doubling down on advanced technology to streamline operations, increase payment efficiency, and navigate workforce challenges—but they can’t do it alone.
HealthLeaders' upcoming RevTech Exchange, from November 11-13, 2024, in Nashville, is bringing these leaders together to discuss the latest trends reshaping revenue cycle technology with hands-on discussions led by industry innovators from organizations like Stanford Healthcare and WVU Medicine.
So, what are rev cycle leaders actually spotlighting? Let’s dive into the four technology trends that revenue cycle leaders are prioritizing—and why they matter now more than ever.
Strengthening Vendor Contracts
In today’s complex healthcare landscape, effective vendor management has become essential for revenue cycle success. As organizations increasingly depend on vendors for crucial automation, AI-driven tools, and data analytics, clear, well-structured contracts and accountability metrics are critical.
Leaders are recognizing the importance of establishing precise service-level agreements that define performance expectations, timelines, and accountability measures to protect against issues like service disruptions and cyberattacks.
“If we’re not able to implement [it] on time, and it’s because [the vendor’s] team wasn’t ready to go, then maybe our first payment doesn’t start till six weeks later than we planned,” Shannan Bolton, vice president of revenue cycle optimization for Stanford Health, and RevTech attendee explained. “These are the commitments that I’m going to build into those service line agreements.”
Building robust vendor partnerships with clearly defined standards and proactive communication ensures that external solutions genuinely support operational goals, helping to prevent dependency or service shortfalls.
Building Proactive Operations
AI and automation are reshaping revenue cycle operations, pushing organizations to shift from reactive problem-solving to proactive operational strategies.
“[Let’s say] there’s a tool that we have in place, but its [performance] is stagnant. I’m looking for continuous optimization,” Bolton said. “So, I’d look at it holistically: What are they offering or doing for other organizations that our current vendor hasn’t thought of or isn’t moving towards even if the changes are small or in a focused area.”
Pictured: Revenue cycle leaders talk shop at our spring 2024 Revenue Cycle Exchange.
On top of this though, the complexity of implementing AI solutions requires careful planning around governance, decision-making, and collaboration between departments like IT and operations.
Defining governance structures and identifying which teams will drive technological initiatives are critical in aligning AI efforts with organizational goals.
Leaders are increasingly focusing on creating seamless integrations with platforms such as Epic, which enables staff to operate "at the top of their licenses," ensuring that AI and automation solutions bring measurable, sustainable value to the revenue cycle.
Identifying New Opportunities to Improve Efficiency
AI’s potential to streamline workflows and improve payment accuracy is significant, yet identifying high-impact opportunities is essential for success.
Revenue cycle leaders are increasingly using AI to address targeted processes, such as enhancing first-pass claim approval rates and automating account management to reduce manual burdens.
On top of this, a common misconception around AI is that it is self-sufficient once implemented, but there are limitations to the technology which require oversight. For example, Bolton notes that most AI solutions manage simpler tasks, but not middle revenue cycle tasks that require more detail and clinical knowledge.
“That space becomes more complex, and the rules can change often by payer, location, or specialty,” she said.
Technology managing the simpler, repetitive tasks leave staff available to handle more complex tasks, like denials management. However, you can’t successfully implement a new solution without staff support, and leaders must be open and transparent in their conversations and messaging.
“We want our staff to continuously perform at the top of their scale.” Bolton said. “This means proactively developing the staff to upskill them once we bring in AI to perform that more simplistic work.”
When applied thoughtfully, these AI-driven improvements not only boost cash flow but also allow teams to focus on more complex tasks, ultimately contributing to a smoother, more positive patient experience.
Supporting and Preparing Staff
Speaking of staff, as technology transforms revenue cycle processes, it is critical to ensure that employees are supported through this transition.
Automation and AI bring new opportunities, but they also shift traditional roles, making change management a key consideration for revenue cycle leaders.
Encouraging staff to embrace evolving responsibilities and highlighting career development rather than workforce reductions can create a culture of adaptability.
Leaders are focusing on communicating the benefits of these technological changes and holding managers accountable for making full use of new tools.
“From a humanity standpoint, it’s so important,” Bolton said. “Making sure that the staff know we have their best interests at heart, that we’re going to develop you, support your career development, even if that means it’s not in this organization.”
With a well-structured approach, organizations can harness technology to optimize revenue cycle processes while fostering growth and resilience among their teams.
TheHealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights. Please join the community at ourLinkedIn page.
To inquire about attending a HealthLeaders Revenue Cycle Exchange event and becoming a member, email us atexchange@healthleadersmedia.com.
A CFO's job is evolving and its mission impossible. What will it take to survive as a modern CFO as isolated decision-making isn't a part of the future?
Welcome to our October 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year.
So, what did our team look into this month? Well, the role of the healthcare CFO has reached a breaking point. No longer just the financial gatekeepers, today's CFOs are thrust into an unforgiving landscape where the stakes couldn’t be higher. With the entire fiscal health of their organization resting on their shoulders, they must make critical decisions in the face of economic turmoil, shrinking margins, and escalating labor costs.
Every misstep risks not just the bottom line but the clinical outcomes that patients depend on. In this high-pressure environment, failure is an option. In the rare cases when hospitals do fail, the CFO will be in the conversation about why.
This begs the question: is this responsibility too immense for one individual? Many healthcare CFOs are burning out, crushed by the weight of these ever-expanding expectations. On top of this, CEOs are now asking themselves if it’s too risky for the entire financial wellbeing of a healthcare organization to hinge on one person?
As the job description continues to grow, CFOs are now required to oversee everything from operational strategy to technology investments—all while navigating the daily pressures of shrinking margins, labor shortages, and payer disputes.
In this high-stakes environment, where every misstep can be costly, is the modern CFO’s role becoming unmanageable? Our finance editor Marie Defreitas found out.
Baptist Health is leading the AI charge to reduce costs, streamline operations, and improve patient care and satisfaction.
In the fast-paced world of healthcare, the adoption of artificial intelligence (AI) is no longer just a futuristic dream—it’s quickly becoming a key driver of operational efficiency.
Baptist Health, a Jacksonville, Florida-based health system, is at the forefront of this AI revolution, particularly in the realm of revenue cycle management. Leading the charge is Steven Kos, MSHCS, CHCIO, senior director of revenue cycle application support and a HealthLeaders’ AI in Finance Mastermind participant.
Under his guidance, Baptist Health has been able to leverage AI across multiple areas of the revenue cycle, leading to reduced administrative burdens, increased efficiency, and improved patient satisfaction.
“We primarily use AI in the front office space,” says Kos. “For example, we use it for prior authorization and reducing the administrative burden around retaining that authorization. It has made a significant difference in ensuring that the right coverage is in place for treatments and services.” Kos emphasizes that AI has streamlined tasks that were previously time-consuming and prone to human error.
AI’s Role in Improving Patient Scheduling and Reducing No-Shows
One area where Baptist Health has effectively implemented AI is in ambulatory scheduling. Kos explains that the health system has undertaken a major project to standardize and automate scheduling templates, which is crucial to automating these processes.
“It’s hard to automate something that’s not standardized. Once we standardized our templates, we are now able to automate around them. Centralization of process not only helps manual workflows but also provides capabilities for tools like OCR to be leveraged with AI, which we have done in ambulatory by automatically indexing documentation that is scanned into the medical record,” he says.
A notable use of AI in patient scheduling is predicting the likelihood of no-shows. Using rules-based tools like Fastpass with AI, Baptist Health can forecast the probability of a patient missing an appointment and fill a cancelation. “If we know a patient may be a no-show, we can reach out to the patient, confirm appoint cancelation and offer that spot to someone else,” Kos explains. This proactive approach not only maximizes appointment slots but also improves access to care for other patients.
Kos further highlights AI’s integration into OR scheduling, which has made a considerable impact. “We’re automating case scheduling and improving the access to care by reducing the time it takes to schedule an appointment and render that service,” he adds.
Enhancing Patient Experience with AI in the Contact Center
Beyond the administrative and clinical realms, Baptist Health has also deployed AI in its contact center to enhance patient experience.
According to Kos, conversational AI bots are being used to assist patients in navigating their healthcare journeys. “These bots help patients find where to go, whether it’s finding a physician or determining the most suitable provider for their care. It serves as a virtual assistant, improving patient experience significantly,” says Kos.
These AI tools can handle a range of tasks, including wayfinding and managing referrals. Baptist Health's AI-driven system can process faxed referrals, digitize them, and compare the information against the EHR to ensure that necessary orders are in place and create a referral shell to schedule against.
"We’ve seen good success with this, and as we roll out more solutions in the referral space, we anticipate saving time up to an equivalent of 10 full-time employees," Kos notes.
AI's Expanding Role in Clinical Documentation and Claims
Baptist Health is also exploring AI’s potential in clinical documentation and coding, albeit in pilot phases. The health system is employing ambient and generative AI to capture patient-physician conversations in real-time and generate clinical documentation; starting with small pilots.
“This reduces the documentation burden on physicians, allowing them to focus more on patient care,” Kos says. This technology has already shown promise in improving the accuracy of clinical documentation, which is crucial for supporting the revenue cycle.
In the claims submission and billing arena, AI is helping Baptist Health reduce manual intervention. “We use AI for tasks like claims attachment automation, billing, and coding. AI helps us rank claims based on their priority, so we’re not checking on claims unnecessarily,” Kos explains.
The result is a more efficient claims process, reducing the number of follow-ups and improving overall cash flow.
The Challenges of AI Implementation
While AI offers enormous potential, implementing it comes with its own set of challenges. Kos cautions against the tendency for vendors to “overpromise and underdeliver.” “Vendors can sometimes assume that successful implementations at other healthcare systems will be replicated at your healthcare system. There are a lot of factors to consider.”
“There’s often a lot of legwork on the provider’s part to get things working smoothly. It takes time to tune AI models, and they can sometimes be inconsistent at first,” he says.
Another significant challenge Baptist Health has faced is maintaining trust in AI systems. “If clinicians see that AI isn’t perfect, they lose trust, and adoption slows down,” Kos explains.
Additionally, external factors, such as system upgrades or security changes, can destabilize AI solutions, creating disruptions in automation and undermining confidence in the technology. “Unplugging an underperforming AI system can be worse than living with it, so you must weigh the pros and cons carefully. It is always good to think about what an off- ramp looks like,” Kos advises.
AI’s Potential in Coding and Denials Management
Baptist Health is cautiously optimistic about expanding AI’s role in coding, particularly for simple visit coding. "We already use auto-suggested coding, and we’re piloting further AI integration into the coding process," says Kos.
By incorporating AI earlier in the process, Baptist Health hopes to reduce the number of documentation queries sent to physicians, which would further streamline operations.
However, Kos acknowledges that AI in coding is still a work in progress, particularly for more complex areas like oncology. “Coding in certain specialties requires extreme precision, and AI takes time to learn those nuances,” he says.
The ultimate goal is to reduce denial rates by improving documentation and coding accuracy. Although it’s still too early to quantify the exact impact, Kos is confident that AI will play a pivotal role in reducing payer-related issues.
Repurposing Staff and Enhancing Patient Care
One of the benefits Baptist Health has seen from its AI initiatives is the ability to repurpose staff, particularly in administrative roles to support patient experience.
“When you implement an AI solution, you can often repurpose staff to focus on patient care and customer service. We’re training our staff to become patient advocates, guiding patients through their care and ensuring they get that ‘white glove’ treatment whenever possible,” Kos explains.
Baptist Health is also fostering a culture of continuous learning, encouraging its staff to develop new skill sets around AI and automation.
“We’re training individuals to take on roles that are more supportive of technology, helping to improve workflows and even becoming part of the solution,” Kos says. This focus on upskilling has created opportunities for staff to advance their careers while also improving operational efficiency.
The Importance of Governance in AI Implementation
As AI becomes more integrated into Baptist Health’s operations, the organization has established an “AI Institute” to ensure that new solutions are thoroughly vetted.
“It starts with a business case, then we dive into the details around the AI—how it will work with our environment, the risks involved, and what metrics we’ll track,” Kos explains.
This governance process has been crucial in ensuring that AI investments are aligned with Baptist Health’s broader goals and that resources are allocated effectively.
Looking Ahead
For Baptist Health, AI is more than just a technological innovation—it’s a transformative tool that is reshaping how the health system operates.
“We’re still early in the process, but AI is already helping us reduce administrative burdens, improve efficiency, and enhance patient care,” Kos says.
As AI continues to evolve, Baptist Health is poised to remain at the cutting edge, leveraging technology to drive better outcomes for both patients and providers.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
TGH and CEO John Couris successfully navigated Hurricane Helene using lessons learned from Hurricane Ian.
Editor’s note: On October 10, Tampa General Hospital was hit by Hurricane Milton. The system remained open as emergency response teams were activated to support communities impacted by the storm. “Preparing for Hurricane Milton was an incredible effort by the entire team and a true test of our resources, but it ensured we could continue to provide exceptional care for our patients in a high-quality, safe and uninterrupted environment before, during and after the storm,” John Couris, president and CEO of Tampa General Hospital said on its website. “Tampa General is open to support communities impacted and particularly our first responders. Working together, we will come back from Milton stronger than ever.”
When it comes to preparing for hurricanes and other natural disasters, hospitals must be ready to protect patients, staff, and facilities.
Tampa General Hospital (TGH) successfully navigated Hurricane Ian in 2022, avoiding damage despite being in the storm's path. Unfortunately, history repeated itself this year.
On September 26, Hurricane Helene made landfall in Perry, Florida, and caused flash flooding in the western part of the state, but luckily, the hospital's vulnerable Level 1 trauma center remained dry and unscathed.
“We are pleased to share that our Tampa General Hospital health system stood strong against the storm. In the wake of the hurricane, we remain focused on providing world-class care to our patients and supporting emergency response efforts across our community,” the health system’s website says.
How did they do it? Well, CEO John Couris was prepared.
Here’s how to prepare your facility for an emergency storm, based on TGH’s experiences with Hurrican Ian:
1. Start Early: Preparation Begins Well Before the Storm
TGH started preparing for Hurricane Ian a week before it made landfall. This included stockpiling critical supplies like food, water, and medical resources.
According to Couris, “[We] began bringing in our emergency supplies, med-surge supplies, and emergency water about a week out. We also set up our AquaFence, which can push back about 15 feet of storm surge.”
Actionable Steps:
Review emergency supply stockpiles well ahead of time.
Secure critical infrastructure, such as flood barriers or AquaFences.
Test backup systems like emergency generators to ensure functionality.
Three days before Ian, TGH activated its emergency command center, part of a larger 8,000-square-foot facility that uses AI and predictive analytics. “We have a dedicated emergency management team that takes over, with leadership staying on-site to make real-time decisions,” Couris explained.
Actionable Steps:
Establish a centralized command center to coordinate response efforts.
Ensure your leadership team stays on-site during the storm for fast decision-making.
Create a two-tier staffing model (Team A for the storm, Team B for post-storm relief).
3. Practice Disaster Drills Year-Round
A key to TGH’s success was regular disaster training. Couris emphasized, “All critical elements worked because we practice this stuff all year long. We conduct mass casualty drills and review standard procedures constantly.”
Actionable Steps:
Conduct regular disaster preparedness drills, including mass casualty simulations.
Train staff on emergency protocols and refine procedures through tabletop exercises.
Make emergency readiness part of routine operations.
4. Plan for Water Shortages
A major lesson learned from Ian was the critical importance of water. At the time, several hospitals had to evacuate due to a lack of water pressure, even though their facilities withstood the storm.
Couris pointed out that during Ian, “Water was the primary reason why patients had to be transferred. We are developing plans to ensure TGH has its own emergency water supply.”
Actionable Steps:
Evaluate your facility’s water usage and plan for emergency water storage.
Consider tanker trucks or alternative water sources in the event of supply interruptions.
Develop contingency plans to maintain fire suppression and sanitation systems if municipal water is compromised.
5. Make Sleeping Arrangements for Staff a Priority
TGH had 2,000 staff members caring for nearly 900 patients during Hurricane Ian. Couris noted that while their emergency plan worked, sleeping arrangements for staff always pose a challenge. “Hospitals aren’t designed to house thousands of staff for days, so we’re always learning how to do that better.”
Actionable Steps:
Designate sleeping areas and provide adequate bedding for on-site staff.
Anticipate long stays and ensure facilities are equipped with basic amenities like showers and meals.
Continually refine staff accommodation plans based on feedback from previous events.
6. Collaborate with Other Hospitals for Patient Transfers
After the Ian, TGH played a crucial role in assisting hospitals to the south, transferring over 50 patients from affected areas. Couris explained, “We had five helicopters and ambulances running patients from Fort Myers up to Tampa.”
Actionable Steps:
Establish relationships with nearby hospitals for mutual aid agreements.
Plan for patient transfers, including air and ground transportation logistics.
Ensure your hospital is prepared to accept patients from neighboring facilities in case of evacuations.
7. Constantly Review and Improve Your Disaster Plan
Couris’s final piece of advice is to make disaster preparedness an ongoing effort. “My advice to people is practice, practice, practice. Review your processes and systems consistently. The only way to stay ready is to make this part of your routine operations.”
Actionable Steps:
Regularly review and update emergency plans based on new insights and lessons learned.
Involve all levels of staff in disaster preparedness to build a culture of readiness.
Keep refining your plans to ensure your hospital is ready for the next storm.
By following these strategies, hospitals can better prepare for the impact of natural disasters, ensuring the safety of patients, staff, and facilities.
Pictured: Revenue cycle leaders talk shop at our spring 2024 Revenue Cycle Exchange.
