The HIMSS theme this year: "Health that Connects, Tech that Cares," highlights the importance of patient-centered practices that connect information, technology, and policy, emphasizing human-centeredness, quality, and interoperability. As forward-thinking tech companies proudly show off their achievements in chatGPT and generative AI, conservative healthcare providers are taking a more introspective attitude, assessing potential impacts and necessary responses. What breakthroughs can we expect at the intersection of these perspectives in the following years?
Medical Coding and Payment in Digital Health
Due to the pandemic, the U.S. has expanded digital healthcare payment coverage to include telemedicine, remote physiologic monitoring (RPM), remote therapeutic monitoring (RTM), remote assessments, and medical AI.
In addition, Medicare is implementing a new Physician Fee Schedule (PFS) and influencing policies that promote medical quality and performance evaluation, such as the Traditional Merit-based Incentive Payment System (MIPS), the new MIPS Values Pathway (MVPs) framework, Alternative Payment Models (APMs), and Accountable Care Organizations (ACOs).
As the industry focuses on digital, remote, and quality care, on-demand access to in-demand healthcare services is expected to create new business opportunities supported by more flexible and diverse coding and payment systems.
Revenue Relates To Record Quality, Backed By Thorough Analysis And Documentation
U.S. hospitals are struggling with prolonged revenue cycles, rising denial rates, and changing reimbursement regulations after the pandemic. To overcome financial challenges, many hospitals are turning to AI and analytics tools to improve the quality of medical records, address workforce shortages and burnout, and ensure both clinical and financial performance. Administrators, physician assistants, specialists, and clinical supervisors must collaborate in their clinical documentation integrity (CDI) efforts to capture missing data from various analyses. Traditional computer-assisted physician documentation (CAPD) systems are no longer sufficient; only proactive physician nudges and documentation assistance can effectively eliminate gaps in the medical record.
For example, systems that flag hemoglobin or iron abnormality in lab data or identify brain lesions in scattered notes can actively remind physicians and expedite accurate diagnoses. While major vendors such as EPIC, 3M, and Optum offer these features, most are rule-based rather than AI-driven. Hospitals like Pediatrics still need to create their own rules and analyze data under the constraints of the system architecture to develop automated, customized nudge applications.
Technology in Healthcare: Balancing Quality and Economic Benefits
Speakers from UNC Health and Mayo Clinic revealed that their institutions have approximately 35,000-40,000 and 130,000 connected medical devices, respectively. Despite cybersecurity concerns, the medical data generated by these devices must be linked to medical records and utilized effectively. The vast amount of medical information can be standardized and coordinated only through analytics and AI tools that support medical record documentation, allowing healthcare professionals to access critical insights.
Telemedicine policy has experienced profound reform in the wake of COVID-19. The recovering healthcare industry must adapt to the new digital era at its own pace. It may be too early for the widespread use of NLP and ChatGPT in clinical practice. Instead of blindly pursuing the latest technology trends, hospitals are more focused on adopting new approaches that effectively utilize various generations of technology to tackle both new and existing problems while balancing medical quality and economic benefits to improve patient outcomes and resource allocation.
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