When it comes to looming economic challenges, most hospital CFOs or practice managers are wary of the future. A combination of inflation, rising wages and drug costs is just the beginning of the industry’s woes. Staffing shortages, and more aggressive payers such as health insurers, Medicare, and Medicaid are also helping put new pressures on an industry struggling to perform. As a result, healthcare costs are projected to increase 7% in 2024.[1]
What options do healthcare providers have in the face of this challenging prognosis? The treatment plan for many is a combination of cutting costs, upping reimbursements, and finding new ways to significantly boost productivity, even as they strive to improve patient outcomes.
One solution gaining momentum comes from new advances in both augmented and generative artificial intelligence (AI). While augmented intelligence supplements human intelligence in certain roles, artificial intelligence is a self-learning technology that replaces it in select applications. Shana Peterson-Sheptak, PNC Bank’s Head of Business Banking, notes that a host of applications are now coming online, both clinical and administrative. And many organizations are looking closely at the promise of new technology to both improve their financial picture and boost patient satisfaction.
“When people talk about augmented intelligence and AI in the healthcare environment, they tend to focus on how it can improve things on the clinical side. This new technology can help reduce human errors and support treatment decision through efforts such as analyzing diagnostic imaging. In addition, it is evolving to better provide certain types of patient services 24/7 and gain administrative efficiencies. But depending on how well it is harnessed—while making very certain that the accuracy of output lives up to the technology’s promise—it could affect other areas of healthcare, leading to profound and transformative benefits.”
Is It Smart For Your Organization?
So, what are the ways that this new technology may be part of healthcare’s future?
In broad terms, AI and augmented intelligence has the potential to make substantial impacts on the industry’s productivity and expenses. Many players could benefit, ranging from sprawling healthcare systems to private practices, and everyone in between. Brian Kelly, Head of PNC Healthcare, offers insights.
“There’s no one-size-fits-all solution. In terms of specific benefits, it really depends on the provider’s scope of operations. For example, a hospital may realize significant savings from improved clinical operations, such as maximizing scheduling of surgical suites, as well as ensuring quality and safety.”
The effect of this new technology could prove extensive, transforming every aspect of the patient experience. Chatbots now sometimes act as first patient contact responding to the most frequently asked questions. Further, AI-powered analysis of medical imaging is expected to provide a powerful assist to radiologists during diagnosis.
This new technology is also projected to assist with the development of treatment plans[2] or handle some non-clinical care duties such as visit planning, patient information summaries, and ensure ongoing patient contact for follow-up care.[3]
Then there’s the all-important matter of reimbursement. AI may help with accurate coding, payer engagement, and screening out fraud and abuse. As a result, powerful software could offer numerous avenues to reduce the administrative costs that currently make up 25% of all healthcare spending.[4]
As one example, PNC has developed its own software, PNC Claim Predictor. PNC Claim Predictor uses AI and machine learning to identify inaccurate or insufficiently populated insurance claims prior to submission for payment. In turn, that creates the potential for significant improvements in cash flow by reducing claim rejections and streamlining payment cycles.
Sounds Great. But How To Finance It?
Regardless of an organization’s size, the fundamental question is one of paying for implementation. With high upfront costs, what is the expected return on investment? How soon can this fast-developing technology deliver results for the bottom line? With no hard and fast answers, financial savvy becomes just as crucial as technical expertise.
“We work with a range of healthcare providers because of our industry-specific expertise,” Peterson-Sheptak continues. “As one example, we have advisors who are certified in practice management, equipping us with working knowledge that extends well beyond the theoretical.”
Kelly agrees. “As a result, when a client comes to us about financing this highly specialized investment, we see it as a collaboration. Together, we look at the overall financial picture of the organization, any expected productivity gains from implementation, and determine how likely those investments will be to pay off in both the short- and long-term. We also strive to ensure a well-defined strategy for making the implementation as efficient as possible, driving down costs.”
And, of course, how to pay for AI and augmented intelligence becomes the paramount question. If these advances make sense for your practice, what financial tools come into play? Peterson-Sheptak points out how important it becomes to have the fullest range of financial options from a lender who fully understands the industry.
“More than thirty years ago, PNC realized the need for a dedicated healthcare finance operation for both non-profit and for-profit providers. Over time, we’ve come to serve every sector of the industry with both integrated solutions and strategic services. Because we understand the complex realm of capital requirements in healthcare, we’ve developed a full range of solutions from maximizing working capital. Those solutions range from treasury management to improving revenue cycles.”
Are There Side Effects?
The good news? The potential is one of enhanced savings and productivity over time. Yet, depending on the extent of the investment, implementing AI and augmented intelligence is no simple matter. An ill-considered leap could result in headaches and stress for your organization and your staff.
“We often see a strong business case for our healthcare clients when it comes to this kind of investment,” Kelly offers. “At the same time, our extensive background in healthcare management informs us that it will prove a sustained, ongoing effort. That requires both capital and the commitment of leadership throughout the organization.”
What are the hallmarks of a successful implementation? New hardware and software to support upgraded systems, as well as storage platforms and network infrastructure. Bolstered security measures to ensure the safety of sensitive patient data and HIPAA compliance. Seamless integration with existing health record systems. Development and customization to suit the unique needs of the healthcare provider. Ongoing data collection so that a system can continually learn and make accurate predictions. And, finally, the ongoing maintenance and upgrades that every sophisticated system demands.
In other words, many gears need to mesh for this new technology to live up to its expectations. That requires a wide range of experts, including healthcare attorneys, healthcare automation pros, and a host of others to keep the process moving ahead smoothly.
“Obviously a large health system will make a more substantial investment in AI and augmented intelligence than, say, a private practice,” Kelly continues. “But regardless of how ambitious your efforts are, it requires fully understanding how it will be applied to any organization, then beginning a meticulous planning effort. While most healthcare organizations are appropriately focused on the clinical benefits, a key portion of the decision-making process should be dedicated to determining what makes financial sense and does the investment generate the appropriate return.”
What does it take to ensure a smooth process? A wide range of experts is key. As Peterson-Sheptak puts it, “Don’t rely purely on one vendor or organization for the solution. How you get there is highly important to the ultimate outcome.” And don’t take lightly the need for risk management. While AI isn’t necessarily new, it is a technology that is evolving and can introduce risk if introduced without the right controls in place to govern data responsibly.
The only constant is change, and the world of healthcare is no exception. To ensure the best overall patient care, it then becomes crucial to fully grasp the opportunities provided by technology. With the right strategy, the right commitment, and the right financial toolbox, artificial intelligence may prove the catalyst to help your healthcare organization enjoy renewed vitality and fiscal health.[5]
