The Hospital Finance Podcast

In this episode, Dr. William Padula, Health Economist and Professor at the University of Southern California, and Martin Burns, CEO at Bruin Biometrics discuss the financial burden of pressure injuries.

← Back to All Podcasts Understanding the Escalating Costs of Musculoskeletal Care In this episode, Scott Linthorst, Senior Vice President of Value-Based Care for TailorCare, discusses understanding the escalating costs of musculoskeletal care. Highlights of this episode include: Why musculoskeletal care is such a major financial challenge in healthcare Where costs escalate in MSK episodes What role early navigation plays in controlling costs What role data or predictive analytics play Predictive analytics results What metrics hospital/health plan leaders should track Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Scott Linthorst. Scott is the Senior Vice President of Value-Based Care for TailorCare, a leading provider of specialty value-based care solutions focused on improving patient outcomes for joint, back, and muscle conditions. Scott leads the organization’s efforts to optimize outcomes under value-based care arrangements. He oversees the actuary, medical economics, and analytics teams to drive a data-informed strategy that improves clinical, financial, and operational performance. Scott has a diverse background in finance, patient engagement, and healthcare services. In his previous role at Babylon, he led the Value-Based Care Finance Function, managing over $1 billion in deals from contracting to forecasting and ongoing performance management. Prior to that, he spent eight years at CVS Aetna and also served as the CFO of an internal startup that empowered physician-led organizations to assume medical cost risk and led FP&A teams focusing on digital health, member engagement, and virtual care initiatives. Scott also has a decade of experience as a management consultant, enhancing his strategic and analytical capabilities. He earned a Bachelor of Science in Engineering from Columbia University. In this episode, we’re discussing understanding the escalating costs of musculoskeletal care. Welcome, and thank you for joining us, Scott. Scott Linthorst: Hey, Kelly, great to be here with you. Kelly: Well, let’s go ahead and jump in. So why is musculoskeletal care such a major financial challenge in healthcare? Scott: Well, I think there are a couple things. I mean, first, musculoskeletal conditions affect about half of all adults. And in the United States, it’s about $420 billion in annual spend, the single largest specialty, more than cardiology, cancer, kidney, and it’s really closely aligned with a lot of other comorbidities, cardiovascular health, metabolic health, behavioral health. I think one of the big challenges is that it’s a mix of both chronic, think degenerative arthritis and hip or knee, and episodic costs, think acute injuries from falls or lifting something too heavy. And for patients, often the biggest challenge is just knowing where to start. Patients begin their journeys in a variety of different places. It might be their PCP, it might be with a physical therapist, it might be with other downstream specialists. And so, it’s just really fragmented and hard to figure out where the costs start and where they escalate.Kelly: Yeah, no, that makes sense. The chronic and episodic costs that you talked about, that makes sense with this particular care that we’re discussing. So where do you typically see costs escalate in MSK episodes? Scott: Well, the anecdote I often hear from orthopedic specialists is that patients will suffer a functional decline in silence, think you’ll put your salt shaker on the counter instead of up on a shelf. But when they get to pain, that’s what really begins to motivate action. What we see in the data is there’s little consistency across different patients’ care journeys. There’s imaging. There are specialist visits. And especially when those come before conservative care treatment options are attempted, they predispose patients towards surgery at a much higher rate than if you start with some of those conservative care options. And if there isn’t some form of clinical triage that starts at the beginning, some guidance to those patients, they often end up on the most intensive care pathways as opposed to those that might work best for them. Kelly: No, that makes a lot of sense. Thanks for explaining that for us, Scott. So, what role does early navigation play in controlling costs? Scott: I think there’s several things that influence cost. I think the first is just educating patients about their conditions, spending time with them, really understanding not just what is the diagnosis, but what are the functional constraints? What is the impact? And then talking to them about what are their goals, what do you want to accomplish? Are you trying to walk your grandchild down the aisle? Do you want to get back to your gardening habit? What is the thing that you want to be empowered to do? And then really exploring what are the different treatment options and modalities, and what has worked for patients similar to you? Going through that kind of shared decision-making process and navigating patients to the best providers downstream can really help control costs. When patients go through that type of navigation, they’re more likely to start with physical therapy or exercise programs, and those may help them avoid those more invasive procedures downstream. Kelly: Yeah, no, I love what you said about shared decision-making. That totally makes a lot of sense in this particular instance. So, Scott, what role does data or predictive analytics play here? Scott: Because there are such a different variety of places that people will start in their care journeys, try to identify patients early and before they get to some of those escalated care modalities is really important. You can identify, using predictive analytics, those patients that are just more likely to have surgery. And if you can look at those patterns and engage those patients early, sometimes you can engage them even before they get to those places that they were likely to get to downstream. Kelly: I’m always so fascinated by predictive analytics. And I think engaging patients early, that also makes a lot of sense to me. So, what results have you seen from this model? Scott: When we see patients that begin with that kind of structured evaluation that I talked about, when it’s clear to those patients what are the pathways that they could choose, what we frequently see is that patients choose to start on conservative care pathways, conservative treatment options, exercise programs, physical therapy before they would then continue on to more invasive or more escalated options. And I think when they do that, what we typically see is a decent number of those patients stick to those pathways and report really meaningful improvements in pain and in their function. And they also report a lot higher satisfaction. When patients feel informed, they feel supported through the process, they generally just have a more warm, fuzzy ...

In this episode, Dave Trier, CEO of ModelOp, discusses why AI ROI becomes guesswork once systems scale.

Fixing the Systems Professionals Depend On--The Hidden Operational Drivers of Hospital Financial Performance

In this episode, Tony Paquin, Co-founder, Chairman, and CEO at iRemedy Healthcare Companies, here to discuss the hidden costs of healthcare distribution, what hospital CFOs need to know.

← Back to All Podcasts Medicare Cost Report Appeals and Reopenings–What You Need to Know Webinar In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, presented live on Wednesday, May 13, at 1 PM ET. Highlights of this episode include: What is this webinar about? Who would benefit most from this webinar and why? Key takeaways Best practices Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ first webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, live on Wednesday, May 13, at 1 PM Eastern Time. This is our first in our Medicare Cost Report Appeals and Reopenings Series. Welcome back and thank you for joining us, Kristin. Kristin DeGroat: Well, thank you for having me back. Kelly: Well, let’s go ahead and jump in today. So can you tell us what’s this webinar about? Kristin: So, we’re going to talk about the Provider Reimbursement Review Board, at least a background of that. And then we’re really going to focus on what you need to do to preserve your appeal rights as well as your reopening rights, which are different and are handled differently. And we’ll get into a little bit of the differences and provide some best practices. Kelly: Awesome. Sounds like it’s going to be a great webinar. So, who would benefit most from this webinar and why? Kristin: So, most people immediately think, “Oh, this is just for reimbursement people.” But actually, people in patient financial services, even executives that maybe don’t deal with the cost report and appeals and reopenings and really don’t get into the depth. But there are data elements that we need, which usually come from patient financial services. There are cost report elements needed. And again, you need the buy-in at the top so that they understand what it takes and maybe the costs associated with filing appeals and/or reopenings. Kelly: Well, that makes a lot of sense. So, what will be some of the key takeaways from the webinar? Kristin: So, the key takeaway, I think, really will be, “I can have an appeal that preserves my rights, and I can have a reopening at the same time.” Most people don’t realize that. And so, I think that’s beneficial where it’s an issue that can be settled. So, the problem we’ve got with the board, right, in filing appeals is that they often take a number of years. And so, the reopening may be the faster route, not always, but maybe the faster route to getting the dollars. Kelly: That makes sense. And yeah, I didn’t know that you could do an appeal and a reopening at the same time, so I’m sure others don’t know that as well. So, what best practices do you have for those going through an appeal or reopening? Kristin: So don’t take any chances. Don’t just assume you’re going to be able to appeal or reopen. You need to understand the specifics of those rules and how they apply to your cost report. Protest, protest, protest, protest, that is the key. And again, file your reopenings, even if you have an appeal. Kelly: Those are some great best practices. Thanks for sharing those with us. So why is having an external partner important for this very complex and often long process? Kristin: The change in rules between the cost report rules, the reopening rules, the board’s rules. There are many pitfalls. And if you don’t understand how they fit together, you could lose your right to appeal or reopen. So, you’ve got to understand how that comes together. And having an external partner that focuses on the rules, the changes, ensuring that everything is filed properly, that you have the right tools to ensure that your appeal rights are protected. Kelly: No, that makes a lot of sense. Sounds like finding the right partner is important for this process. Well, thank you– Kristin: Definitely. Kelly: Yeah, so thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know.  Join us live on Wednesday, May 13th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristen. Kristin: You’re welcome. Looking forward to seeing everyone Wednesday. Kelly: Sounds great. And thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time… [music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings. If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at [email protected]. Subscribe Today! 945.237.1009
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In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, presented live on Wednesday, May 13, at 1 PM ET. Highlights of this episode include: What is this webinar about? Who would benefit most from this webinar and why? Key takeaways Best practices Kelly Wisness: Hi, this is Kelly Wisness. We&#8217;re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ first webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, live on Wednesday, May 13, at 1 PM Eastern Time. This is our first in our Medicare Cost Report Appeals and Reopenings Series. Welcome back and thank you for joining us, Kristin. Kristin DeGroat: Well, thank you for having me back. Kelly: Well, let&#8217;s go ahead and jump in today. So can you tell us what&#8217;s this webinar about? Kristin: So, we&#8217;re going to talk about the Provider Reimbursement Review Board, at least a background of that. And then we&#8217;re really going to focus on what you need to do to preserve your appeal rights as well as your reopening rights, which are different and are handled differently. And we&#8217;ll get into a little bit of the differences and provide some best practices. Kelly: Awesome. Sounds like it&#8217;s going to be a great webinar. So, who would benefit most from this webinar and why? Kristin: So, most people immediately think, &#8220;Oh, this is just for reimbursement people.&#8221; But actually, people in patient financial services, even executives that maybe don&#8217;t deal with the cost report and appeals and reopenings and really don&#8217;t get into the depth. But there are data elements that we need, which usually come from patient financial services. There are cost report elements needed. And again, you need the buy-in at the top so that they understand what it takes and maybe the costs associated with filing appeals and/or reopenings. Kelly: Well, that makes a lot of sense. So, what will be some of the key takeaways from the webinar? Kristin: So, the key takeaway, I think, really will be, &#8220;I can have an appeal that preserves my rights, and I can have a reopening at the same time.&#8221; Most people don&#8217;t realize that. And so, I think that&#8217;s beneficial where it&#8217;s an issue that can be settled. So, the problem we&#8217;ve got with the board, right, in filing appeals is that they often take a number of years. And so, the reopening may be the faster route, not always, but maybe the faster route to getting the dollars. Kelly: That makes sense. And yeah, I didn&#8217;t know that you could do an appeal and a reopening at the same time, so I&#8217;m sure others don&#8217;t know that as well. So, what best practices do you have for those going through an appeal or reopening? Kristin: So don&#8217;t take any chances. Don&#8217;t just assume you&#8217;re going to be able to appeal or reopen. You need to understand the specifics of those rules and how they apply to your cost report. Protest, protest, protest, protest, that is the key. And again, file your reopenings, even if you have an appeal. Kelly: Those are some great best practices. Thanks for sharing those with us. So why is having an external partner important for this very complex and often long process? Kristin: The change in rules between the cost report rules, the reopening rules, the board&#8217;s rules. There are many pitfalls. And if you don&#8217;t understand how they fit together, you could lose your right to appeal or reopen. So, you&#8217;ve got to understand how that comes together. And having an external partner that focuses on the rules, the changes, ensuring that everything is filed properly, that you have the right tools to ensure that your appeal rights are protected. Kelly: No, that makes a lot of sense. Sounds like finding the right partner is important for this process. Well, thank you&#8211; Kristin: Definitely. Kelly: Yeah, so thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings&#8217; free webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know. &nbsp;Join us live on Wednesday, May 13th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristen. Kristin: You&#8217;re welcome. Looking forward to seeing everyone Wednesday. Kelly: Sounds great. And thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time… [music] This concludes today&#8217;s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings. If you have a topic that you&#8217;d like us to discuss on The Hospital Finance Podcast or if you&#8217;d like to be a guest, drop us a line at [email protected]. The post Medicare Cost Report Appeals and Reopenings&#8211;What You Need to Know Webinar [PODCAST] appeared first on Besler Holdings.

← Back to All Podcasts Using Tech to Boost Patient Care and Streamline Operations In this episode, Beth Raboin, Founder &amp; CEO of Global Medical Virtual Assistants, discusses using tech to boost patient care and streamline operations. Highlights of this episode include: What is a medical virtual assistant? Where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs? How GMVA ensures medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely How the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices Where’s the best place to start to ensure long-term ROI? What other hospital departments are a good fit for medical virtual assistance? Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Beth Raboin. Beth is leading GMVA in vision in the day-to-day business operations securing the functionality of the business to drive extensive and sustainable growth. Combining her strong leadership and determination with over 22 years of corporate experience in the private and public sector of surgical device, pharmaceutical, and specialty pharmacy industries, she keeps the company moving forward with high-level strategy while understanding the details of day-to-day execution to ensure steadfast success. Prior to Beth’s corporate and entrepreneur experience, she competed as a full athletic scholarship athlete as a Division 1 gymnast at the University of Florida, where she graduated with a Bachelor of Science in Health Sciences. In this episode, we’re discussing using tech to boost patient care and streamline operations. Welcome, and thank you for joining us, Beth. Beth Raboin: Oh, thank you so much for having me, Kelly. I’m so excited to be here. Kelly: We’re excited to have you. So, let’s go ahead and jump in. So, for listeners who may be newer to the concept, what exactly is a medical virtual assistant? And how do they differ from traditional outsourcing models? Beth: Yeah, oh thank you so much. Starting with a big question there, Kelly. So, first of all, medical virtual assistants are additional staff that you can bring into your hospital or medical practice to help facilitate some of the back office work that needs to happen. So, we do not do clinical care. Medical virtual assistants do all of the clerical and/or administrative patient care that happens behind the scenes. So that’s the differentiator between your typical in-hospital setting versus bringing in a medical virtual assistant. And how we’re different from other models is you’re not outsourcing. You’re not sending and outsourcing all of the work elsewhere. That’s not how it works. We are actually more like an insource. We’re additional staffing that’s brought into your medical practice and/or hospital to do the work that needs to get done within your tools, within your systems, within your workflows. And so, we’re actually integrated as part of the team. Kelly: I love that. It’s so intriguing. From a financial standpoint, where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs? Beth: Oh, gosh. Well, so we’re a fraction of the cost of what it would be to hire someone here in– within the hospital system within the United States. We are outside of the United States, so we’re mainly in the Philippines where the cost of living is lower. So therefore, the cost structure for our business model is also lower. And where they can utilize our services is just, it’s endless. Where we’re seeing where we’re a huge asset– for example, we just were onboarded this past year with a huge healthcare hospital system on the West Coast. They brought us just in to do patient access to fill in some open appointments, making sure patients are going to show up to their appointments, and then backfilling the appointments within the schedule that those patients were not going to show up to. And they saw an immediate, an immediate, I think it was like $2 or $3 million difference in their bottom line just within two quarters. So that’s just one simple example. We’ve also been brought in heavily within the hospital systems, within revenue cycle management. Collecting dollars is critical for hospital systems, making sure that denied claims are in fact paid. And so the resubmittal of claims, following up on denied claims, making sure that patient balances are paid, all of that. So that also is a really big– a really great place to be able to bring in our staff to help and augment the way things are being done within that hospital. Kelly: Wow, I mean, so some significant savings there. That’s awesome. So how does GMVA ensure medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely? Beth: Yeah, well, so there’s a few different ways we do that. Number one, we’re hiring professionals, right? We’re hiring people who have a bachelor’s degree, a bachelor’s degree, typically in nursing. They understand healthcare. They understand HIPAA and PHI. And so, they’re put through obviously a HIPAA certification class, so they’re HIPAA-certified, but that’s not enough. That’s just not enough to ensure patient information is– it’s just not enough to make sure patient information is protected, right? So, we put in additional safeguards and everyone works remotely, they’re not working within a call center, they’re working from their home. So, we’ve put additional software security on their computer systems to make sure that they’ve got a closed network that they’re working within. So, they’re logging directly into the client’s EMRs, directly into the client’s tools, and we need to make sure that there’s no nefarious actors or viruses are able to penetrate the system. So, we’ve got a pretty substantial, what we call a blue box on their computer, and they’re working within the safeguards of that system. It’s amazing. It’s been one of the things that we heavily invested in just to ensure that we’re protecting patient information. But beyond that, we’re also protecting the tools of our clients because we all know that viruses and/or nefarious actors are working consistently to try to break into hospital systems, break into hospitality, break into banks, and any possible way that they can try to penetrate a closed off system. So, we do everything within our power to make sure that we’re keeping patient information protected. Kelly: Yeah, I know HIPAA compliance is so important. And for lack of a better term, it’s an epidemic that we’re just kind of hitting. We’re being hit with all these bad actors all the time. So, it’s just a constant issue, isn’t it? Beth: Oh, constantly. So, I mean, we’re all getting them even into our private email addresses, work email addresses, people sending over what you think looks like a real invoice, but it’s not a real invoice. You click on it, before you know, you’re in trouble. So yeah, we’re trying to do the absolute best we can to keep up to date on protecting any and all software that we’re logging into. <p class="has-text-color has-lin...

In this episode, Beth Raboin, Founder &amp; CEO of Global Medical Virtual Assistants, discusses using tech to boost patient care and streamline operations. Highlights of this episode include: What is a medical virtual assistant? Where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs? How GMVA ensures medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely How the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices Where&#8217;s the best place to start to ensure long-term ROI? What other hospital departments are a good fit for medical virtual assistance? Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We&#8217;re pleased to welcome Beth Raboin. Beth is leading GMVA in vision in the day-to-day business operations securing the functionality of the business to drive extensive and sustainable growth. Combining her strong leadership and determination with over 22 years of corporate experience in the private and public sector of surgical device, pharmaceutical, and specialty pharmacy industries, she keeps the company moving forward with high-level strategy while understanding the details of day-to-day execution to ensure steadfast success. Prior to Beth&#8217;s corporate and entrepreneur experience, she competed as a full athletic scholarship athlete as a Division 1 gymnast at the University of Florida, where she graduated with a Bachelor of Science in Health Sciences. In this episode, we&#8217;re discussing using tech to boost patient care and streamline operations. Welcome, and thank you for joining us, Beth. Beth Raboin: Oh, thank you so much for having me, Kelly. I&#8217;m so excited to be here. Kelly: We&#8217;re excited to have you. So, let&#8217;s go ahead and jump in. So, for listeners who may be newer to the concept, what exactly is a medical virtual assistant? And how do they differ from traditional outsourcing models? Beth: Yeah, oh thank you so much. Starting with a big question there, Kelly. So, first of all, medical virtual assistants are additional staff that you can bring into your hospital or medical practice to help facilitate some of the back office work that needs to happen. So, we do not do clinical care. Medical virtual assistants do all of the clerical and/or administrative patient care that happens behind the scenes. So that&#8217;s the differentiator between your typical in-hospital setting versus bringing in a medical virtual assistant. And how we&#8217;re different from other models is you&#8217;re not outsourcing. You&#8217;re not sending and outsourcing all of the work elsewhere. That&#8217;s not how it works. We are actually more like an insource. We&#8217;re additional staffing that&#8217;s brought into your medical practice and/or hospital to do the work that needs to get done within your tools, within your systems, within your workflows. And so, we&#8217;re actually integrated as part of the team. Kelly: I love that. It&#8217;s so intriguing. From a financial standpoint, where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs? Beth: Oh, gosh. Well, so we&#8217;re a fraction of the cost of what it would be to hire someone here in&#8211; within the hospital system within the United States. We are outside of the United States, so we&#8217;re mainly in the Philippines where the cost of living is lower. So therefore, the cost structure for our business model is also lower. And where they can utilize our services is just, it&#8217;s endless. Where we&#8217;re seeing where we&#8217;re a huge asset&#8211; for example, we just were onboarded this past year with a huge healthcare hospital system on the West Coast. They brought us just in to do patient access to fill in some open appointments, making sure patients are going to show up to their appointments, and then backfilling the appointments within the schedule that those patients were not going to show up to. And they saw an immediate, an immediate, I think it was like $2 or $3 million difference in their bottom line just within two quarters. So that&#8217;s just one simple example. We&#8217;ve also been brought in heavily within the hospital systems, within revenue cycle management. Collecting dollars is critical for hospital systems, making sure that denied claims are in fact paid. And so the resubmittal of claims, following up on denied claims, making sure that patient balances are paid, all of that. So that also is a really big&#8211; a really great place to be able to bring in our staff to help and augment the way things are being done within that hospital. Kelly: Wow, I mean, so some significant savings there. That&#8217;s awesome. So how does GMVA ensure medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely? Beth: Yeah, well, so there&#8217;s a few different ways we do that. Number one, we&#8217;re hiring professionals, right? We&#8217;re hiring people who have a bachelor&#8217;s degree, a bachelor&#8217;s degree, typically in nursing. They understand healthcare. They understand HIPAA and PHI. And so, they&#8217;re put through obviously a HIPAA certification class, so they&#8217;re HIPAA-certified, but that&#8217;s not enough. That&#8217;s just not enough to ensure patient information is&#8211; it&#8217;s just not enough to make sure patient information is protected, right? So, we put in additional safeguards and everyone works remotely, they&#8217;re not working within a call center, they&#8217;re working from their home. So, we&#8217;ve put additional software security on their computer systems to make sure that they&#8217;ve got a closed network that they&#8217;re working within. So, they&#8217;re logging directly into the client&#8217;s EMRs, directly into the client&#8217;s tools, and we need to make sure that there&#8217;s no nefarious actors or viruses are able to penetrate the system. So, we&#8217;ve got a pretty substantial, what we call a blue box on their computer, and they&#8217;re working within the safeguards of that system. It&#8217;s amazing. It&#8217;s been one of the things that we heavily invested in just to ensure that we&#8217;re protecting patient information. But beyond that, we&#8217;re also protecting the tools of our clients because we all know that viruses and/or nefarious actors are working consistently to try to break into hospital systems, break into hospitality, break into banks, and any possible way that they can try to penetrate a closed off system. So, we do everything within our power to make sure that we&#8217;re keeping patient information protected. Kelly: Yeah, I know HIPAA compliance is so important. And for lack of a better term, it&#8217;s an epidemic that we&#8217;re just kind of hitting. We&#8217;re being hit with all these bad actors all the time. So, it&#8217;s just a constant issue, isn&#8217;t it? Beth: Oh, constantly. So, I mean, we&#8217;re all getting them even into our private email addresses, work email addresses, people sending over what you think looks like a real invoice, but it&#8217;s not a real invoice. You click on it, before you know, you&#8217;re in trouble. So yeah, we&#8217;re trying to do the absolute best we can to keep up to date on protecting any and all software that we&#8217;re logging into. Kelly: Definitely, yeah. So how does the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices? Beth: Yeah, I mean, the scaling is one of the things that we&#8217;ve really become a specialist in. What we do is the onboarding of our services can be&#8211; that&#8217;s where you have more skin in the game, and there&#8217;s a good six to eight weeks of training us on your tools, your systems, your strategies, your service level agreements that we work out with you. That&#8217;s where really that&#8217;s some of the hurdles you need to get over in the beginning. Once we do that, we have all the training materials necessary to then scale with you, so your team is no longer having to do the training, right? So, scaling has really been one of the wonderful things that we can do really quickly and efficiently. And hospital systems for sure&#8211; like I said, I had mentioned one particular hospital system. We had another hospital system we also started with last year that just wanted to start with 10 medical virtual assistants. And within a month&#8217;s time, they were like, &#8220;Wow, this is really working out amazing.&#8221; And they&#8217;ve already scaled up over 75. And so we&#8217;re able to be able to do that for them and really kind of keep up with the pace of what&#8217;s necessary and intending to bring in really great talent to be able to do and meet the service level agreements that we&#8217;ve come up with along with our client to make sure that we&#8217;re bringing nothing but the best in terms of patient service. So yeah, it&#8217;s been an interesting, fun business model. I love the scaling piece of it. It&#8217;s one of the things that we&#8217;ve I&#8217;m really great at. And it is different for a large practice or a large medical system versus a smaller practice. Smaller practices, they just don&#8217;t see the huge patient volume that a large system would see. And so, but we can still manage and handhold them through bringing on one, two, three virtual assistants. But in a hospital system, we can bring in 25, 50, 75, 150 virtual assistants and scale and keep them and manage them. Kelly: Yeah, that sounds pretty awesome. I mean, I love what you said about scaling with you. That seems like something that you got that is very valuable. So, for a CFO or revenue cycle leader considering medical virtual assistance for the first time, where&#8217;s the best place to start to ensure long-term ROI? Beth: Yeah. I mean, of course, one of the first places you would want to start&#8211; any one of us would want to start is where we can make an immediate impact to the bottom line, so whether that&#8217;s patient balances, whether that&#8217;s following up on denied claims, whether it&#8217;s submittal of claims. As we become more and more infiltrated into some of the hospital systems, we&#8217;re learning that there&#8217;s large amounts of balances that are still not on the balance sheet, that just have not been paid to the bottom line yet. That&#8217;s where we can make an immediate impact. How we are different than other outsourced companies is we don&#8217;t take a fee for that. That&#8217;s not how we function. We don&#8217;t get a percentage of what is collected. That&#8217;s just not what we do. We are additional staffing. We are butts in seats to do the actual work. And so that also is a really great benefit to the hospital or medical system because then they&#8217;re not losing part of that revenue to an outside source. And so that also is an additional part of the way we function in terms of bringing an additional asset to the team without getting a part of what those payouts would look like or a percentage of those fees. Kelly: That sounds pretty awesome. Beyond those revenue cycle teams, what other hospital departments are a good fit for medical virtual assistance? Beth: Most definitely anything within specialties. Specialties are really where we shine. We have extensive training internally for particular specialties. So, our medical virtual assistants are very well versed in the types of procedures that they&#8217;re going through, whether it&#8217;s in neurology or it&#8217;s the cardiac unit or it&#8217;s in the fertility space. We become quite versed in being able to have those conversations with patients or internally with the existing staff, knowing the medical terminology is there. We understand the patient journey. We understand the procedures that are taking place. We understand the medications that the patients are being given. So, when it comes to be doing prior authorizations for patient medication or prior authorizations for getting diagnostic care or getting the procedures done, we can do all of that. So, we really fit really nicely in every piece of the model within revenue cycle management, if you include prior auths and insurance verification as part of that journey. We can do all of that. But patient facing, patient access is also something we&#8217;re really, really fantastic, and we have a great fit within models of the patient access. Kelly: Yeah, that makes a lot of sense. Well, thank you so much, Beth, for sharing your insights with us on using tech to boost patient care and streamline operations. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that? Beth: Yeah, we&#8217;d love you. Just go right to our website. You can find so much information. So, it&#8217;s https://gmva.com/, and that&#8217;s Global Medical Virtual Assistants dot com. And we&#8217;ve got voice recordings there of what our virtual assistants sound like. We have podcasts like yours, Kelly, will be on there kind of listening to hear what we&#8217;ve done or what we do, as well as a whole host of other resources, and also a way to be able to quickly schedule a strategy session to have a meeting with us and have a Zoom call with us to get a better understanding of how we can fit into your model. Kelly: Great. Well, thank you for providing that for us, Beth. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time… [music] This concludes today&#8217;s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings. If you have a topic that you&#8217;d like us to discuss on The Hospital Finance Podcast or if you&#8217;d like to be a guest, drop us a line at [email protected]. The post Using Tech to Boost Patient Care and Streamline Operations [PODCAST] appeared first on Besler Holdings.

← Back to All Podcasts The AI Security Blind Spot That Healthcare Can’t Afford to Ignore In this episode, Tom Furr, CEO and Founder of PatientPay, discusses how the Shift in ACA enrollment is driving more high deductible health plans. Highlights of this episode include: How the reduction in ACA enrollment numbers are affecting out-of-pocket payments How should providers prepare for this change in coverage Long-term projections Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Vrajesh Bhavsar. VJ is an engineer with a Master’s in Computer Science from USC and over 20 years of experience building hardware and software products. VJ built core technologies for iOS and Mac OS, including dynamic tracing, data protection, and secure enclave at Apple. He holds eight patents in distributed systems, data, and security. He is passionate about building technology-first businesses that drive positive human impact at scale. In this episode, we’re discussing the AI security blind spot that healthcare can’t afford to ignore. Welcome, and thank you for joining us, VJ. Vrajesh Bhavsar: Hey, thank you for having me. Kelly: Well, let’s go ahead and jump in. So, AI is being deployed across healthcare at a remarkable pace. From a cybersecurity standpoint, what’s the risk that most hospital leaders still don’t fully appreciate? VJ: That’s a great question. And it’s such an exciting time that we are living in. There are so many new innovations coming to the entire space. And the impact of AI in so many different areas gets really exciting for a lot of industries where this kind of innovation is needed. And, of course, healthcare has so many different areas where AI can be applied, but also there are a lot of risks that come in when you are exposing this kind of critical area of safety and care to this kind of new innovation. And so the big risks that we see in a lot of interactions we are having is how when you have a lot of kind of new innovation getting sprinkled across use cases and areas where you didn’t really understand the full scope and things are operating without a lot of visibility, especially in the deep areas where sensitive data is in question and you have patient information as well as ways that a lot of the third party systems are going to interface with these things. That’s where there are so many risks that it’s not fully understood and appreciated. And the thing that really gets people is that we are used to kind of operating with these innovative systems in kind of traditional systematic ways, that A plus B results in something. But in the world of non-determinism, where there are a lot of new attacks coming in, the level of risk really, really goes to the roof. And the kind of attacks that have come through in terms of prompt injection or zero-click, and a lot of things that have been reported across the industry, and we have done some of the work ourselves. It really throws people back into like, “Oh, wow, I didn’t realize that this can really exfiltrate the data at such scale and such speed.” And the level of protections and defenses that people had through traditional tools are now out of question. Kelly: Yeah, it’s definitely an interesting time in healthcare and AI, and there’s a lot to consider there. You recently discovered a zero-click vulnerability that can silently extract complete patient records without leaving a trace. What does that mean in plain terms, and why is it a signal of a much larger industry problem? VJ: That’s a very interesting question. And I think as an industry, we have been trying to get everyone to kind of understand that, “Hey, don’t respond to random emails, don’t share credentials, don’t go chase random links and all that, right? But what’s happening in the world of AI is that without users taking any of such risky actions, now you can have a massive exposure and that’s what zero click refers to. And what we discovered is that a lot of these AI systems as they are interfacing with so many different data sources and all the records and all that, they can actually go take the credentials and access that you have given them and try to be helpful in ways that can actually result in data exfiltration and leakage at a massive scale. And so, what we are finding is there are the kind of attacks that come through in AI systems that are prompt injection or jailbreak attempts. And those things are getting embedded in documents, in ways that are invisible to the human eye, but those instructions mean a lot to what an AI system or an agent bot is going to do. And that’s where, now, you are bringing– you have so many, so much intelligence baked into these AI stacks that they are trying to be super helpful and trying to kind of take all these instructions that are embedded and the users didn’t do anything wrong, but this is where some of the attacks that are coming through. Some of the ones that we have discovered and the industry has discovered, even Anthropic reported several different types of attacks. And there is a lot of education needed in the industry to really kind of understand the scale and scope of what these intelligent, non-deterministic systems bring in these critical environments. Kelly: Completely agree. There’s definitely a lot of education required for us. VJ, HIPAA was built for predictable human-reviewed workflows. How does autonomous AI fundamentally challenge the compliance model healthcare has spent decades building? VJ: I know. This is where we are really passionate about like there is so much to be done, and I know HIPAA is trying to catch up on a lot of the new innovation. But at the end of the day, there is kind of like an inert way in which HIPAA assumes there are human accountability layers behind all the different decisions that are getting made. And I think that’s the thing that gets thrown out the window when you bring in agentic AI. And in these environments where you are passing responsibility, you’re passing autonomy, you’re passing decision-making capabilities to agents and at a speed of machine speed at which you can access so many different systems all at once and try to be helpful. That’s where there is no mechanism in place to even understand what these systems are trying to do. And beyond understanding, you need to actually govern and bring controls into these environments, right? And I think that’s kind of the core to a lot of the challenges and what we refer to it as runtime visibility and runtime controls. And when these agents are getting born and they are trying to figure out, like, “Okay, what are the instructions given to me?” And I’m going to try to make sense of that. I’m trying to access the systems that are available to me, and sometimes they overreach. And that’s when these breaches happen. That’s when, kind of, unexpected consequences happen. That’s when you end up with a non-compliant system. So, I think there is a lot to be done. I think the industry was still just catching up on what was happening in the world of microservices and all the API ecosystem. And now we have leaped directly into agentic environments. And I think that requires a full depth understanding of what all things are happening to stay compliant. <p...