Thank you for these thoughts. I think billing inefficiencies caused by documentation make both hospitals and insures lose - one will get paid later, one will pay anyway, but the process is costly for patients who finance both, in the end of the day :(
My friend who works now as an engineer at Apple interviewed with Epic 6 years ago - he got a guidance from a fellow to make a few mistakes in test tasks to increase chance of getting a job offer, and it worked - he got the offer
Whatever Epic has been doing from a hiring perspective seems to work pretty well. They are highly profitable, have a near zero customer churn rate, and many employees have been there for decades. The software might not be ideal from a usability or interoperability perspective but it's reliable, secure, and gets the job done. We could all learn something from how they operate.
An EMR will necessarily have low churn rate because the cost of switching is tremendous. I've been doing this a long time, and Epic is kind of the "EMR of the day". No doubt a new one will come along, solving the UI problems, offering new capabilities, and hospitals will switch over.
Eventually Epic may be replaced but it's really hard to break into the hospital market. Any new competitor would have to meet all of the ONC Health IT Certification requirements, plus a bunch of other checklist requirements imposed by hospital purchasing departments. It doesn't matter whether they solve the UI problems or offer new capabilities if they don't have the basics finished first, and that takes many person years of work.
The only way a startup might be able to eventually replace Epic is to target a niche ambulatory care specialty first where meeting all the checklist requirements is less important than really nailing an optimal clinician workflow. Then gradually expand out from that foothold by adding the features that hospitals need.
Thank you for the insights, I believe the challenge they have is related to CPT coding - not mistakes or errors, but the completeness' of clinical picture fro m the billing/insurance standpoint. A lot of this coding knowledge is tribal and resides in the head of clinicians. We can help, would greatly appreciate an introduction to your wife's colleagues at [email protected] (Dmitry Karpov), thank you!
Thanks, I will ask my wife to ask the guy who gives the talks (their internal expert in billing matters) if he is interested and send him your email. Personally, I really think your solution has potential to help them, in the sense that they don’t have a sustainable/automated process for training clinicians to write notes in the correct way, or to detect issues when the clinicians don’t know or remember to do so. I know that meeting wasn’t perfectly attended, but even if it had been, they add like 8 new people at the beginning of July, and those people won’t attend the billing meeting until the next one happens in a year. The push for more revenue has been within the last month or so (I think maybe due to Trump related cuts to grant funding and concerns about Medicaid), so it’s an issue that is currently on the mind of leadership.
Very insightful, thank you! A comment on claim-amplifying customers - optimizing for the insurance payouts actually forces providers to adopt certain standards of compliance for medical records - here we are not talking about mistakes but about depth of CPT coding (the biggest for value-based care providers), etc. And it is not about claim but the underlying documentation of care
Not only US, e.g. the whole clinical world is now moving into AI-powered scribing of doctor visits, it really depends on the deployment model - where are LLMs, how they comply with local regulations. But access of AI to medical charts is a solved questions in general.
Great questions, indeed this is a kingdom of red tape. We realized that our fist users likely will be small providers but who currently lose $$ on denied/delayed claims. Talked to the first cohort of them - rehabs, allergy clinic, men's health clinic, nursing home, etc. We signed the first rehab just 2 weeks after meeting them because we offered to solve their problem in the same way as their 3rd party billing provider does (manually finds mistakes and circles them back to clinicians) for 2x lower price tag. Then we realize this is common situation for many rehabs.
My FIL ran his own prosthetics and orthotics business for a couple decades and then had to shutter his doors due to all the insurance provider red tape. If all the Ts weren't crossed, or Is not dotted - denied. And the appeals/resubmission process was, IMHO, deliberately drawn out to deter anyone from doing it. US healthcare and insurance is such a shit show, but I digress. He now works for the VA, making much less - but at least he's still helping people and working in his field.
Glad to see something like that taking shape, and hopefully helping other small businesses (and larger too) get a leg up on these insurance companies. As well, of course, avoiding real-world medical dangers as you've mentioned.
Thank you, human stories like this made us passionate about solving this issue! Talked today to a behavioral health clinic that has 65 different payors, all with own set of billing rules and documentation standards!
