If you’re concerned about revenue at your hospital, then The Hospital Finance podcast is your go-to source for information and insights that can help you protect and enhance the revenue your hospital has earned. From regulatory changes to revenue cycle optimization, readmissions to bundled payments, you’ll get important perspectives, news and strategies from leading experts in healthcare finance. For show notes and additional resources from Besler Holdings, visit https://www.besler.holdings/podcasts.
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The Hidden Cost of Healthcare Distribution--What Hospital CFOs Need to Know
Episode 543
Wednesday, May 13, 2026 • Duration 23:34
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.
Medicare Cost Report Appeals and Reopenings--What You Need to Know Webinar
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.
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 update@besler.com.
Medicare Cost Report Appeals and Reopenings--What You Need to Know Webinar
Episode 535
Wednesday, May 6, 2026 • Duration 05:07
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’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?
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.
Using Tech to Boost Patient Care and Streamline Operations
Using Tech to Boost Patient Care and Streamline Operations
In this episode, Beth Raboin, Founder & 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?
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome . 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.
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Using Tech to Boost Patient Care and Streamline Operations
Episode 541
Wednesday, April 29, 2026 • Duration 12:21
In this episode, Beth Raboin, Founder & 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?
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.
The AI Security Blind Spot That Healthcare Can't Afford to Ignore
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.
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The AI Security Blind Spot That Healthcare Can't Afford to Ignore
Episode 540
Wednesday, April 22, 2026 • Duration 17:59
In this episode, Vrajesh Bhavsar, CEO & Co-founder at Operant AI, discusses the AI security blind spot that healthcare can’t afford to ignore.
Highlights of this episode include:
What’s the AI risk that most hospital leaders still don’t fully appreciate
Zero-click vulnerability
How autonomous AI fundamentally can challenge the compliance model healthcare
Why traditional security tools struggle to keep pace with the way AI actually moves data inside a health system
What the real financial and reputational costs are when a healthcare AI deployment goes wrong
What the first steps are to take to understand their actual exposure
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.
Personalizing Healthcare: Strategies to Drive Patient Engagement and Financial Impact
Episode 537
Wednesday, April 15, 2026 • Duration 20:00
In this episode, Casey Williams, SVP of Patient Engagement at RevSpring, discusses personalizing healthcare, strategies to drive patient engagement, and financial impact.
Highlights of this episode include:
What RevSpring does and the difference it makes for healthcare organizations
Biggest challenges healthcare organizations face when trying to protect their finances while also helping patients
Personalization and how it impacts patients and providers
Practical strategies for meeting patients where they are financially
RevSpring’s approach
What trends or innovations that will shape healthcare communications and finance
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Casey Williams. Casey leads solution consulting and sales efforts for new direct healthcare customers at RevSpring. He has 20 years of experience in developing customized patient engagement and payment solutions for over 100 healthcare revenue cycle clients. His knowledge of patient engagement strategies, including self-service optimization, has made him an advocate for change for RevSpring clients and the wide healthcare revenue cycle market.
In this episode, we’re discussing personalizing healthcare, strategies to drive patient engagement, and financial impact. Welcome, and thank you for joining us, Casey.
Casey Williams: Kelly, thanks for having us. We appreciate it.
Kelly: Yeah, we’re glad to have you here. So, let’s go ahead and jump in. So, Casey, can you tell us about your background? And how did you end up in your position at RevSpring?
: Yeah, it’s a great question, Kelly. I think by default is probably the most honest answer. Coming out of Bowling Green State University, studying interpersonal communication, there was nothing that screamed healthcare finance from that background. But actually, I think kind of started as most people start their jobs or their careers where I had a friend working in a company, a smaller company, at that time called Data Image. And they had just had some transition in their sales environment. And the owner, founder had asked me to join. And that kind of began the path into communication, payments, and engagement overall. And really started at that smaller company involved in the hospitals in and around central Ohio and then expanded into the greater Midwest. But really got a great appreciation for when you’re a small company at that time, you not only position what the value is, but when you do that successfully, then you actually do the setup or the implementation, and then you service it. And then when there’s a billing question, you’re actually the finance arm as well. So, I was very blessed to be able to have such exposure at such a young time in my career to where I got a lot of different experiences within that and have just enjoyed it ever since. And we at RevSpring, which Data Image then sold into what then became RevSpring in 2010– and we’ve continued to acquire value across the market in how we are trying to build our technology stack today. So, by happenstance, I got into it, but I have been fully immersed and fully engaged ever since.
From Inventory to Insight--Rethinking Medication Management for Clinical and Operational Performance
Episode 538
Wednesday, April 8, 2026 • Duration 23:37
In this episode, Randall Lipps Founder, Chairman, President, and CEO of Omnicell, discusses from inventory to insight, rethinking medication management for clinical and operational performance.
Highlights of this episode include:
How to reduce costs within medication management
How system wide visibility can change decision making for health system leaders
Centralized medication distribution and automation
AI-driven analytics
Efficiency and caregiver support
How to drive enterprise-wide cost optimization
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Randall Lipps. Randy is the founder, chairman, president, and CEO of Omnicell, a company transforming pharmacy care delivery with a comprehensive portfolio of medication management solutions. Inspired by inefficiencies he observed during his daughter’s birth and his experience in airline operations, he founded Omnicell in 1992, growing it into a publicly traded company in 2001 that now serves healthcare systems worldwide. Recognized for his industry leadership, he was elected to the Bellwether League Hall of Fame in 2014 and has served on the American Nurses Foundation Board of Trustees. Randy and his wife, Kathy, actively support a range of charitable endeavors, while Omnicell fosters volunteerism and charitable initiatives through its Omnicell Cares program. He holds bachelor’s degrees in economics and business administration from Southern Methodist University.
In this episode, we’re discussing, from inventory to insight, rethinking medication management for clinical and operational performance.
Welcome, and thank you for joining us, Randy.
Well, Kelly, thank you so much for having me here today. It’s always fun to talk about the numbers, especially with folks who are thinking about the numbers all the time.
The Role of Remote Work in Healthcare and Its Impact on Patient Care
Episode 537
Wednesday, April 1, 2026 • Duration 14:38
In this episode, Chris McShanag, Founder and CEO of Virtual Teammate, discusses the role of remote work in healthcare and its impact on patient care.
Highlights of this episode include:
What operational intelligence is
How it changes the way hospitals function day-to-day
How AI can be applied in hospitals
Examples where operational improvements directly impacted patient care
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Chris McShanag. Chris is the founder and CEO of Virtual Teammate, which has helped more than 2,500 talented virtual professionals find their place in organizations worldwide, supporting over 600 clients along the way. His mission is simple but bold to reshape the virtual assistant industry by creating an experience that feels seamless, supportive, and genuinely valuable for both clients and assistants. At Virtual Teammate, culture comes first. Chris makes sure every assistant blends effortlessly into client teams, delivering immediate impact and dependable support. Many of these professionals are registered nurses and HIPAA certified, a testament to the company’s dedication to excellence in healthcare and beyond. Chris is passionate about building real relationships. His drive to help clients succeed and streamline operations is setting fresh standards in the world of virtual staffing.
In this episode, we’re discussing the role of remote work in healthcare and its impact on patient care.
Welcome, and thank you for joining us, Chris.
Chris McShanag: Thank you, Kelly. It’s a pleasure to spend some time with you today and excited to kind of share some important information about this topic and ever-evolving capabilities it provides for healthcare providers to really buy back their time.
Kristin:
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 contact@besler.holdings.
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.
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’ve really become a specialist in. What we do is the onboarding of our services can be– that’s where you have more skin in the game, and there’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’s where really that’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– 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’s time, they were like, “Wow, this is really working out amazing.” And they’ve already scaled up over 75. And so we’re able to be able to do that for them and really kind of keep up with the pace of what’s necessary and intending to bring in really great talent to be able to do and meet the service level agreements that we’ve come up with along with our client to make sure that we’re bringing nothing but the best in terms of patient service. So yeah, it’s been an interesting, fun business model. I love the scaling piece of it. It’s one of the things that we’ve I’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’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’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– any one of us would want to start is where we can make an immediate impact to the bottom line, so whether that’s patient balances, whether that’s following up on denied claims, whether it’s submittal of claims. As we become more and more infiltrated into some of the hospital systems, we’re learning that there’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’s where we can make an immediate impact. How we are different than other outsourced companies is we don’t take a fee for that. That’s not how we function. We don’t get a percentage of what is collected. That’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’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’re going through, whether it’s in neurology or it’s the cardiac unit or it’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’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’d love you. Just go right to our website. You can find so much information. So, it’s https://gmva.com/, and that’s Global Medical Virtual Assistants dot com. And we’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’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’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 update@besler.com.
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.
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’ve really become a specialist in. What we do is the onboarding of our services can be– that’s where you have more skin in the game, and there’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’s where really that’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– 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’s time, they were like, “Wow, this is really working out amazing.” And they’ve already scaled up over 75. And so we’re able to be able to do that for them and really kind of keep up with the pace of what’s necessary and intending to bring in really great talent to be able to do and meet the service level agreements that we’ve come up with along with our client to make sure that we’re bringing nothing but the best in terms of patient service. So yeah, it’s been an interesting, fun business model. I love the scaling piece of it. It’s one of the things that we’ve I’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’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’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– any one of us would want to start is where we can make an immediate impact to the bottom line, so whether that’s patient balances, whether that’s following up on denied claims, whether it’s submittal of claims. As we become more and more infiltrated into some of the hospital systems, we’re learning that there’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’s where we can make an immediate impact. How we are different than other outsourced companies is we don’t take a fee for that. That’s not how we function. We don’t get a percentage of what is collected. That’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’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’re going through, whether it’s in neurology or it’s the cardiac unit or it’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’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’d love you. Just go right to our website. You can find so much information. So, it’s https://gmva.com/, and that’s Global Medical Virtual Assistants dot com. And we’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’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’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 contact@besler.holdings.
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.
Kelly: Yeah, there’s definitely a lot of things happening right now, and I know HIPAA complicates things as well. So why do traditional security tools struggle to keep pace with the way AI actually moves data inside a health system?
VJ: Yeah, this is where we have gone through such massive waves in the last 30, 40, 50 years, right? And AI agents, and that’s a big, big one, that is going to completely change how security tooling and security requirements would work. But as you think about when cloud came about, there was a very bare bones kind of understanding of, okay, how am I protecting different network systems and databases? And this is very, very early on when you had your data centers, and firewalls came about to actually stop access to different parts of the data system, where different parts of the data center where you might have databases or critical data that you want to protect from different attacks. And over the years, we had usage of mobile and now usage of APIs, and there are so many different technologies have come into play, and you need a different approach for all these different technology adoptions that are going on.
And so, as you think about what is happening in the layers of APIs, in the layers of AI, in the layers of agent, you kind of need a very different AI layer firewall, right? The traditional things that used to be at the network layer, just trying to make sure that computer A doesn’t talk to computer B, it now needs to translate in the way that, hey, agent A cannot talk to agent B or agent A cannot talk to the patient record systems, or it needs to get permission from a human before it does that. And all those things are happening at such scale. We see so many stats about thousands of agents running and doing all these things every day in every enterprise. And so, when such speed and scale is at play, you’re going to need a different tool, a different system to tackle these systems, and it cannot be just a manual process. That’s kind of where a lot of the traditional tools fall apart because they relied on kind of checking the external boundaries, but they don’t know what is going on inside these environments. The tools used to be, oh, I’m going to scan code and try to make sure there is no threat lurking inside.
But when the code is being generated in real time by these agents, they’re coming up with new API endpoints on their own. They’re coming up with MCP servers on their own. And so, what do you do when this new code is getting generated on the fly? What do you do when intent and instructions can drift and can change over time? And that’s where you need something that is understanding what kind of actions are going on and make sure that you’re going to stay compliant as well as not bring more threats and risks into your system.
Kelly: Makes a lot of sense. Thanks for explaining all that for us. Beyond regulatory exposure, what’s the real financial and reputational cost when a healthcare AI deployment goes wrong? And is the industry pricing that risk correctly?
VJ: Look, there are a lot of people trying to understand a lot around pricing the risk and what to do in care of the benefits and kind of threats that come through. And I feel like we’ll learn a lot over the coming couple of years that how this translates in practical life, but definitely there’s a big shift needed, right? With the scale at which these agents can access the number of records, that’s really scary to be honest. There are different types of compliance rules and regulations around like, “Hey, XYZ number of records breached results in XYZ kind of fine.” Well, but also when you have the loss of trust, let’s say patients were trusting some EHR system or some hospitals and other systems with their private information that now suddenly when you have a massive scale breach, that trust is lost, there will be a lot of questions around like, well, do I want to be passing on all my data to the system that has a lot of security risks. But beyond that, there were a year or two ago, a couple of years ago now, where there was a massive outage at airports and airlines where some cybersecurity vendor was not able to deploy things properly.
And those type of operational risks that come in that can really bring down some of these systems and healthcare being such a critical infrastructure requires a level of kind of risk analysis before you put in AI into these environments where if something goes wrong, it can terribly, terribly bring down the entire infrastructure. And I mean, I think those things are obviously questions that a lot of the leaders are thinking through. A lot of the security teams that we talk to, the legal, financial teams that we interface with. And so those are things that are still kind of in flux and hopefully we’ll find ways to keep bringing innovation while also kind of bringing in the right guardrails and safety measures along the way.
Kelly: Yeah, no, definitely agree with all that. And what you were talking about, the lost trust really resonated with me because it seems like once that trust is lost, it’s hard to regain. VJ, for a CCO or Chief Compliance Officer who has already deployed AI across their organization, what are the first steps they should take to understand their actual exposure?
VJ: There’s a classic saying: You can’t secure what you can’t see, right? And I think in the world of AI and agents and APIs, I think a lot of leaders are realizing that discovery means a completely different thing at this point. A lot of teams have had engineering observability tools or some form of access visibility and all that. But I think what we are seeing is that as teams try to understand like, “What is going on? Okay. My teams have already deployed all this AI. They are using all these AI tools, or they have deployed agents in certain ways. Just getting visibility into what’s going on. That’s where everyone has to start.”
And being able to do that in all these different use cases and areas, so whether it’s employees using AI clients and talking to different AI systems and trying to, whether it’s private or public kind of exposure, there is a lot to be done in just understanding that exposure. When you have your EHR information or EHR systems as well as your other cloud environments, whether they are running on hybrid, private, there are a lot of different systems. People have to start with what are the AI models running? What are the agents running? And we’ve come across teams that feel like, “Oh, yeah, I have XYZ tool that gives me AI, SPM, and I know the five models that I’m running.” And when we actually go show them like, well, actually it’s not five. It’s like 97.
That really shocks people. And that type of sprawl has happened so fast in the last year or two that getting access to the telemetry that gives you that type of visibility, it’s something that is actually available, right? It’s such a daunting task to know what is going to come through. With kind of full visibility, we call it discovery. We talk about getting the right telemetry from the layers at which AI operates, layers at which agents talk to different agents and systems over APIs and MCPs. And if the leaders are uncomfortable kind of knowing like, “Do I really know how many things are running?” and that’s kind of the big gap that you have to start closing, and from there, you can set up the right processes around detecting the risks and then defending and controlling and governing all these different systems that are in your purview.
Kelly: Well, thank you so much for providing all that great information and for sharing your insights with us, VJ, on the AI security blind spot that healthcare can’t afford to ignore. If a listener wants to learn more, contact you to discuss this topic further, how best can they do that?
VJ: You can reach us on our website, operant.ai, and I’m also reachable on email directly, vrajesh@operant.ai. Thank you so much.
Kelly: Awesome. Thank you for providing that. 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 update@besler.com.
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.
Kelly: Yeah, there’s definitely a lot of things happening right now, and I know HIPAA complicates things as well. So why do traditional security tools struggle to keep pace with the way AI actually moves data inside a health system?
VJ: Yeah, this is where we have gone through such massive waves in the last 30, 40, 50 years, right? And AI agents, and that’s a big, big one, that is going to completely change how security tooling and security requirements would work. But as you think about when cloud came about, there was a very bare bones kind of understanding of, okay, how am I protecting different network systems and databases? And this is very, very early on when you had your data centers, and firewalls came about to actually stop access to different parts of the data system, where different parts of the data center where you might have databases or critical data that you want to protect from different attacks. And over the years, we had usage of mobile and now usage of APIs, and there are so many different technologies have come into play, and you need a different approach for all these different technology adoptions that are going on.
And so, as you think about what is happening in the layers of APIs, in the layers of AI, in the layers of agent, you kind of need a very different AI layer firewall, right? The traditional things that used to be at the network layer, just trying to make sure that computer A doesn’t talk to computer B, it now needs to translate in the way that, hey, agent A cannot talk to agent B or agent A cannot talk to the patient record systems, or it needs to get permission from a human before it does that. And all those things are happening at such scale. We see so many stats about thousands of agents running and doing all these things every day in every enterprise. And so, when such speed and scale is at play, you’re going to need a different tool, a different system to tackle these systems, and it cannot be just a manual process. That’s kind of where a lot of the traditional tools fall apart because they relied on kind of checking the external boundaries, but they don’t know what is going on inside these environments. The tools used to be, oh, I’m going to scan code and try to make sure there is no threat lurking inside.
But when the code is being generated in real time by these agents, they’re coming up with new API endpoints on their own. They’re coming up with MCP servers on their own. And so, what do you do when this new code is getting generated on the fly? What do you do when intent and instructions can drift and can change over time? And that’s where you need something that is understanding what kind of actions are going on and make sure that you’re going to stay compliant as well as not bring more threats and risks into your system.
Kelly: Makes a lot of sense. Thanks for explaining all that for us. Beyond regulatory exposure, what’s the real financial and reputational cost when a healthcare AI deployment goes wrong? And is the industry pricing that risk correctly?
VJ: Look, there are a lot of people trying to understand a lot around pricing the risk and what to do in care of the benefits and kind of threats that come through. And I feel like we’ll learn a lot over the coming couple of years that how this translates in practical life, but definitely there’s a big shift needed, right? With the scale at which these agents can access the number of records, that’s really scary to be honest. There are different types of compliance rules and regulations around like, “Hey, XYZ number of records breached results in XYZ kind of fine.” Well, but also when you have the loss of trust, let’s say patients were trusting some EHR system or some hospitals and other systems with their private information that now suddenly when you have a massive scale breach, that trust is lost, there will be a lot of questions around like, well, do I want to be passing on all my data to the system that has a lot of security risks. But beyond that, there were a year or two ago, a couple of years ago now, where there was a massive outage at airports and airlines where some cybersecurity vendor was not able to deploy things properly.
And those type of operational risks that come in that can really bring down some of these systems and healthcare being such a critical infrastructure requires a level of kind of risk analysis before you put in AI into these environments where if something goes wrong, it can terribly, terribly bring down the entire infrastructure. And I mean, I think those things are obviously questions that a lot of the leaders are thinking through. A lot of the security teams that we talk to, the legal, financial teams that we interface with. And so those are things that are still kind of in flux and hopefully we’ll find ways to keep bringing innovation while also kind of bringing in the right guardrails and safety measures along the way.
Kelly: Yeah, no, definitely agree with all that. And what you were talking about, the lost trust really resonated with me because it seems like once that trust is lost, it’s hard to regain. VJ, for a CCO or Chief Compliance Officer who has already deployed AI across their organization, what are the first steps they should take to understand their actual exposure?
VJ: There’s a classic saying: You can’t secure what you can’t see, right? And I think in the world of AI and agents and APIs, I think a lot of leaders are realizing that discovery means a completely different thing at this point. A lot of teams have had engineering observability tools or some form of access visibility and all that. But I think what we are seeing is that as teams try to understand like, “What is going on? Okay. My teams have already deployed all this AI. They are using all these AI tools, or they have deployed agents in certain ways. Just getting visibility into what’s going on. That’s where everyone has to start.”
And being able to do that in all these different use cases and areas, so whether it’s employees using AI clients and talking to different AI systems and trying to, whether it’s private or public kind of exposure, there is a lot to be done in just understanding that exposure. When you have your EHR information or EHR systems as well as your other cloud environments, whether they are running on hybrid, private, there are a lot of different systems. People have to start with what are the AI models running? What are the agents running? And we’ve come across teams that feel like, “Oh, yeah, I have XYZ tool that gives me AI, SPM, and I know the five models that I’m running.” And when we actually go show them like, well, actually it’s not five. It’s like 97.
That really shocks people. And that type of sprawl has happened so fast in the last year or two that getting access to the telemetry that gives you that type of visibility, it’s something that is actually available, right? It’s such a daunting task to know what is going to come through. With kind of full visibility, we call it discovery. We talk about getting the right telemetry from the layers at which AI operates, layers at which agents talk to different agents and systems over APIs and MCPs. And if the leaders are uncomfortable kind of knowing like, “Do I really know how many things are running?” and that’s kind of the big gap that you have to start closing, and from there, you can set up the right processes around detecting the risks and then defending and controlling and governing all these different systems that are in your purview.
Kelly: Well, thank you so much for providing all that great information and for sharing your insights with us, VJ, on the AI security blind spot that healthcare can’t afford to ignore. If a listener wants to learn more, contact you to discuss this topic further, how best can they do that?
VJ: You can reach us on our website, operant.ai, and I’m also reachable on email directly, vrajesh@operant.ai. Thank you so much.
Kelly: Awesome. Thank you for providing that. 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 contact@besler.holdings.
Kelly: That’s awesome. It’s great how those things happen. For someone who isn’t– for someone who isn’t familiar, how would you describe what RevSpring does and the difference it makes for healthcare organizations?
Casey: Yeah, Kelly, it’s a great question. I think the most simplistic answer to that question and one that I get from my kids all the time is they see me going into hospitals and thought for many years that I was a doctor. And then at one time, we had an office inside a bank, and then they thought I was a banker. So, I practiced this answer a lot over the years. But primarily, we are a patient engagement and communication company with an emphasis on payments. And the sense of this is that when patients need services, we handle everything from the intake to the scheduling to the registration at time of service to estimating the balance that that patient would owe, do our absolute very best in terms of trying to capture payment at that time or a method of payment so that autopay could be performed. Once that individual service, if not collected in full at time of service, goes to be billed from an insurance standpoint and that amount is adjudicated, then there’s a self-pay after insurance balance. We are then engaging within that patient population to let them know that there is a balance to meet them where they are, meaning that if they are unable to pay that balance in full, we have predictive analytics that address how much that patient can afford to pay on a monthly basis.
And so, whether that engagement is print, we produce about a billion and a half communications a year from that standpoint, or we engage digitally within that to be able to facilitate payment and those outcomes. And so, I think that’s probably the simplistic answer to that question. And I think why that matters is…is you look at healthcare in terms of the ecosystem in which everything is operating today, there’s a great strain in healthcare. As high-deductible healthcare plans continue to progress, patients continue to pay more for the health insurance, continue to be pushed off from their employers of having to pay more themselves within that. That then puts a strain within healthcare, is that 20, 25% now of the receivables that are within the total revenues of healthcare are now to the patient, meaning self-pay/self-pay after insurance. And so, without our technologies, without our sophistication, without our intelligence, it becomes very tough to engage, as well as getting patients to respond to what they owe.
Kelly: Wow, that’s very fascinating. Thanks for sharing that with us, Casey. Yeah. So, what are some of the biggest challenges healthcare organizations face when trying to protect their finances while also helping patients?
Casey: Yeah, that’s another great follow-up to that, Kelly. And I think probably the number one answer you would get within a healthcare finance type of roundtable would be insurance denials. And so when you, when you look at the ecosystem and the landscape of healthcare, about 75, 80 percent of all revenue that comes into an IDN/hospital provider is generally on the commercial Medicare and Medicaid side. And then about 20 to 25 percent of that revenue comes in on the patient responsibility. And what that means is, is after their insurance is paid, what is their responsibility? Or if they’re uninsured, what is their responsibility? And so, denials continue to play a large part in that 80% of the revenue stream. But if we’re looking at the 20, 25% of revenue, it is around the patients continue to owe more, but yet the wages have not continued to go up at the same levels in which they’re either paying for their healthcare or their healthcare insurance. And so that creates kind of that massive strain that I was mentioning in terms of how do they collect? How do they give pathways for those individual patients to be able to engage in order to pay their balances? And if that doesn’t happen, we look at rural healthcare as an example, continued consolidation, even closures within that environment, when that doesn’t happen.
Kelly: Well, yeah, there are quite a few challenges in healthcare right now, that’s for sure. We hear a lot about personalization these days, but how does it actually impact patients and providers in terms of engagement and financial outcomes?
Casey: I oftentimes give bad examples or metaphors. And for those of you that are old enough listening to this, know the old TV show Cheers is that kind of the opening song is, “Everybody wants to know your name.” I think it’s a…I think it’s a really good illustration in the sense of what personalization means to any commercial engagement that we have as a patient, as a human, from a commerce perspective. And the more that the business knows about me and can perfect that engagement, can perfect that pathway, to where I don’t have to continue to repeat myself. Once I’ve answered a question, I don’t have to answer it again, or meeting me where I am, meaning that if I if I don’t have $1,000 in my bank or if I’m like 50% of Americans that do not have $500 in their account to pay for a surprise bill, that you’re not just sticking a $2,500 bill in my face and saying, “Pay me.” So, the personalization really gets down to meeting the patient where they are. To give you a couple of practical examples of that is if I am a patient, let’s even say I’m a millennial to where I do not like to receive paper and all I receive is paper. But if you send me a text, I’m going to pay within 15 seconds as long as I can afford that. That’s a good example of meeting the patient where they are, as well as personalizing that.
If you have, let’s say a person like me that is midlife, I think 47 is midlife. Maybe that’s on the older side of the life. I’m not sure. But I actually still like paper. Now maybe that’s because we print and mail a billion and a half communications. But let’s say I’m one of those individual patients that cannot afford $2,500. So am I receiving a communication in printed form to where I can touch, feel, and interact with that, but yet see a pathway to where I can potentially hit a QR code taken into a payment application where it’s giving me the option of 10 payments of $250. That is where the dynamic of patient engagement is massively changing and it has been massively changing over the last two to three years to where we can utilize intelligence and technology to meet patients where they are and then give them pathways to engage and respond.
Kelly: Yeah, I mean, personalization is key. I think in all industries now, as a marketer, it’s important for me too. And I really loved what you said about meeting the patient where they are, because that is so true. When it comes to meeting patients where they are financially, what are some practical strategies or tools that you see work really well?
Casey: It’s a great question, and this is probably a little bit challenging, hopefully, for the audience that you have. So, if you’re a healthcare executive within the revenue cycle or in finance as a whole, I think the number one thing to understand is what is the affordability of your demographic? So I give you a great example of this is that when we look to healthcare is as healthcare is continuing to go from the towers out to the strip malls in terms of urgent cares, pop up health clinics and all of these pieces, you’re starting to see kind of the retail experience happening within healthcare. And what retail does better than anybody else does is that they truly understand their customer. And so, when we look at standalone IDNs, large health systems, is there an understanding of the affordability within their customer market? The answer to that generally is no. If you were to say, what is the affordability of our patients or my patients within my individual demographic? I don’t think there’s an understanding of that, nor is there any kind of view into that?
And here’s the example that I’ll give in terms of explaining that. If you are a not-for-profit, large IDN or health system or even rule, for that matter, and you have a financial assistance policy, is that meeting your needs of your community? Furthermore, if you have a payment or collections policy that says we do not accept payment plans greater than 12 months, but yet your patient population with their accounts receivable, meaning the AR that is actually outstanding, many times we get into these data studies. And the answer to that question is that greater than 60% of all their patient AR, meaning accounts receivables or balances do, cannot engage within their collections policy. So just stop and think about that for a second. Greater than 60% of your customer base cannot afford to pay you. Now, if you’re a retail environment, if you’re a dollars and cents type of business, maybe even brick and mortar, I don’t think you would go into business for that. And so, the opportunity that you have by understanding what your actual demographic is, what your affordability is, and what your reality is, is now our policies or their policies can actually bend themselves to actually meeting the needs of that demographic.
So whether that is, hey, we’re going from a 6-month policy to a 36-month policy, whether that is we’re going to create intelligence to be able to meet patients where they are, or whether that is we’re going to offer up additional relief valves to patients that are not necessarily qualifying for financial assistance, but yet we’re not just pushing them into bad debt because our policies do not meet them where they are. So I think that is something that I highly encourage in terms of any healthcare executive that is sitting in a position of authority or power, actually having that data to be able to guide decisions versus just what our gut opinion is or what our experience has been over the last 20 years because our experiences over the last 20 years are not indicative of what today’s market is.
Kelly: Definitely not. Thanks for sharing all of those strategies and tools. Those were great. Can you share a story or example of a healthcare organization that saw results using RevSpring’s approach?
Casey: Yeah, I think from just, again, vast experiences within our client base, a little bit nuanced in terms of demographic. If you’re a safety net hospital, it’s not like somebody’s going to wave a magic wand and suddenly change the demographic in terms of the ability to pay, but I can tell you countless times when technology is utilized, when intelligence is utilized. And what I mean by that is, is going back to understanding how do we know as much as we possibly can about an individual patient, a guarantor, and then utilizing technology to then convey what we know and then a pathway around that. You are talking about increases in the patient pay rate, or better stated maybe as yield, of no less than 3%. We’ve had individual customers that have modified their pay rate in the low teens. And you start to think about that as people might be listening to this podcast and saying, “Well, what does that mean?” It’s a very simple math equation. If you were to take your amount billed, meaning the total dollars that you billed out to your patient population on an annual basis, and then multiply that by 3%, that is the worst-case lift that we have seen within the market when intelligence and technology have been deployed. And then, if you want to get really excited, go to the small teams and then multiply that by 11, 12, 13, 14%, then become art of the possible, right, in terms of what those response rates have been.
And then, kind of the icing on the cake or the cherry on top is that you then have these different value levers, maybe otherwise defined as cost. Postage is number two when it comes to cost centers within a revenue cycle. Labor is generally number one. Another large cost center within finance is merchant processing and that cost. Those are three mechanisms that potentially you can pull to not only increase the outcome from a yield, but also decrease your cost to collect so that maybe your two largest KPIs, you can have dramatic impacts on. And not to say that you can get rid of labor. Nobody wants to do that. But if you can increase patient self-service by utilizing intelligence and technology, then you can bring down the inbound call center. If you can allow pre-check in and take care of the intake process and the forms environment before a patient ever walks in your door, then you’re taking down the labor needs and those experiences. If you can convert to digital, not necessarily just to reduce cost, but actually reduce cost and increase yield and eliminate some postage. You’re never going to eliminate postage. Anybody tells you that you want to do a digital-only environment doesn’t understand yield. But if you can have a 40, 50, 60% reduction within postage, it’s a great outcome.
Kelly: Definitely. I think my key takeaways there were the labor, the postage, and the merchant processing are the biggest kind of expenses there. And thank you for sharing that story. That was a great one. So, Casey, what trends or innovations do you think will shape healthcare communications and finance over the next few years?
Casey: Yeah, I think that just fear is the mother of all innovation. And right now, there’s a lot of fear. There’s a lot of fear in rural healthcare, which I grew up in rural America in eastern Ohio. And so, to see hospitals on the edge of closing, to see mass consolidation where someone having a child has to drive an hour and a half to receive services, none of that is good. And then you stack whatever your political views are, not to get into any of that. But with the big, beautiful bill, there is some fear out there, right, in terms of what reimbursements are going to look like going into 2027. And so that fear is perpetuating cost reductions within healthcare today that everybody’s experiencing. If there’s any partners or vendors on the phone, whether a web or radio listening to the podcast, they know this, they’re getting calls every single day from their clients saying, “We need you to reduce cost.” And that fear is perpetuating that need for cost reduction in allowing these systems to kind of prepare for the unknown. I think that that is driving innovation. And that’s the exciting part out of any type of market change, is that it’s exciting to sit back and see the innovation work, because not all the time can you cost your way out of situations. And so, where we’re seeing the market is, how do you utilize? And again, just back to technology and intelligence, how do you utilize those two value levers to be able to increase the outcomes while pulling the other three cost levers, such as merchant labor and postage within that.
And that’s where we’re seeing breakthrough innovation and how you’re looking at how do we gain as much information in terms of a patient to truly know me, create this know-me based experience, and then to be able to guide patients through the process from a self-service perspective to where they’re not having to interact with individual labor as much as they possibly can. I know going through COVID, based on a retail experience dealing with Kroger in the Little Clinic, I had a complete check-in experience at the Little Clinic and saw a salesperson who actually had to be the or was the healthcare provider. I didn’t see a receptionist. I didn’t see a registrar. I didn’t see a customer service rep. I simply interacted in a kiosk. I sat down and a clinician came and got me. I received the testing needed to go to a conference. And I walked out, and I paid my bill. The learnings from retail, as it is extending itself into the brick-and-mortar type of healthcare, along with the fear of reimbursements and what that cash crunch is going to be in the future, is creating mass change. And it’s exciting to be in the middle of it.
Kelly: Yeah, definitely exciting times. Lots of innovation happening, too. Well, thank you, Casey, for sharing your insights with us on personalizing healthcare, strategies to drive patient engagement and financial impact. So, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Casey: Yeah, our website is always a plethora of information in terms of revspringinc.com. Certainly able to reach out on our socials, whether that’s LinkedIn, Facebook, Instagram, within that environment in terms of Rev Spring. And as always, happy to find any associate that is willing to help and engage.
Kelly: Awesome. Thank you for providing that. 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 contact@besler.holdings.
Kelly: Yeah, exactly. Well, let’s go ahead and jump in. So, Randy, as I read your bio, you don’t have a healthcare background initially, so what drove you into healthcare from the airline industry? It must be an interesting story there. [laughter]
Randy: Yeah, when I got out of school, I went to work for the airlines, and the airlines had a ton of numbers, kind of like healthcare, I guess. And it had some of the same profile: it had a lot of employees in order to run an airline, a lot of capital, and a lot of regulation, things you will also find in healthcare. And in order for us to survive in the airline industry – at that time, it was American Airlines – we had to lower our cost. There was no other mandate other than to lower our cost, and we had to do that by eliminating work that we didn’t really have to do, minimizing the necessary work, centralizing it so that we could then really get a good perspective on it, and then eventually automating it. As I experienced healthcare through my own daughter’s long-term stay in a hospital, I realized there were some of the same opportunities that existed in the airline that there is in healthcare, so some Stanford students and I launched a venture to go find out ways to make things more efficient and easier, particularly for nurses and pharmacies to do their jobs with less cost. I mean, what was ingrained with that thought process when I entered the airline is it’s great to think about soft costs, but you’ve got to save hard dollars when you come up with new technology and new automation, and so that’s always been on the front of my mind in the way I think and we move the company forward.
Kelly: I love that story. I mean, it’s just so interesting that you’re kind of sharing those commonalities between two industries that we wouldn’t think have anything in common but seemingly do. With U.S. healthcare spending nearing $5 trillion, where do hospitals have the biggest untapped opportunity to reduce costs within medication management?
Randy: Well, that is a great question, and medication management is really the– it’s a tale of two cities, right? One, it’s the cost side, particularly on inpatient, and the other side, of course, is the revenue opportunity or the earnings opportunity that you have with the outpatient side. And so, a good organization must take advantage of both of those, so let me just cover those. On the inpatient side where everything is a cost, it’s really important to eliminate unnecessary work. And this is clearly seen as you see the consolidation of providers and hospitals and sites, that there’s duplicate work done at these sites. So, first step, eliminate unnecessary work, and then minimize the necessary work. The things that you have to do, be sure that you don’t do– that you do them, but that you don’t exaggerate them. And here’s the key. And many of these organizations have already figured this out. You then centralize it. You bring that critical work that you’ve minimized into a central location. There you have the expertise, you have the enterprise mindset, and you can make better decisions because you’re not looking at an individual basis, but as an enterprise, and then you create standards and roll those out. And then of course, the final step is after you centralize, you automate. Then now you’re automating the processes that you centralize and really understand well. And we begin to see this happen with these consolidated service centers where hospitals with 20, 30, 40, 50 hospitals move their medication management process to a central site that’s automated, reducing headcount and processes at individual locations so that the deliveries can be done once a day at these sites through technology like ours, automated dispensing, and really reduce the burden and the need to run full out pharmacies at every location.
This is a huge savings in terms of inventory cost, huge savings in terms of people cost, and probably more importantly, it allows you to execute to a standard. Everybody’s running the same way and reducing the variance by which you run, and it can be measured. And so that opportunity is there. We’re starting to see the industry take more steps on that side, and it’s a game changer. The amount of savings we’ve seen in some cases has been a third of the total cost of onsite inventory, reduction in over half of wasted products, the reduction of shortages, which takes people and time to cover are reduced because you’re now managing those shortages from a central location. It’s just been a beautiful thing to watch and makes a lot of sense. But it’s a strategic move. It’s an investment, but it has very hard returns. And it is a scalable way to grow as well as you acquire more assets, whether they’re inpatient or outpatient. Servicing them from a centrally consolidated service center makes a lot of sense, and makes the scaling and tracking of those costs, and understanding what those costs will be as you scale, easy to understand.
Now the same thing is somewhat true on specialty. Today, we have crossed the threshold. Over half the drug spend in the United States now is specialty pharmacy. And 25% of that drug spend– as we go into ’26 and ’27, 25% of that specialty drug spend will be spent on outpatient infusion centers. In other words, a provider has to execute the delivery of that medication management. And if that’s true, then that’s an opportunity for these hospital and providers to gain and garner lots of revenue. You have to be an expert in those types of infusion outpatient situations. They’re new drugs, new protocols. They’re not easy to ontake. You have to get alignment with the manufacturer and the payer to do those, but those represent significant revenue and earnings opportunities for all systems and optimizing that. A lot of systems do have those, but the amount of influx of new opportunities in the next even 24 months is significant, and you don’t want to miss out on those because it’s revenue that should be in your P&L because they’re your patients, they’re passing through your hands, and it just makes sense for you to manage those specialty drugs.
Now, on the other side of, of course, the specialty drug management is the 340B. We continue to see a lot of changes, or small changes, in 340B and reimbursement, and you’ve got to keep up with those 340B changes are, but it is still a profitable program that you need to be executing in your institutions. And many of the institutions we see are doing a great job executing the 340B program, but there’s still another 10 or 20% they’re missing out on just because of the changes and the dynamic nature of these 340B reimbursements. So, you’ve got to be able to take advantage of the outpatient specialty pharmacy and outpatient mail order pharmacy opportunities, and you’ve got to be able to consolidate in the inpatient area in order to automate and centralize and minimize and eliminate the workload so that it turns out to be a beautiful picture.
Now, what we’re starting to see is that in some situations, institutions are putting their outpatient pharmacy and their inpatient pharmacy in the consolidation center together. In other words, they’re utilizing the space to both manage inpatient and outpatient. And one area that has been sort of poorly managed is clinics or ambulatory care sites, which are under the responsibility of the provider pharmacy in many cases, but there hasn’t been the tools or the technology to manage medication management out at these distant spaces that use a few drugs, maybe expensive, but don’t use a lot of drugs. And with the new technologies that we have and that are in the marketplace, suddenly these become part of the equation, to manage these fringe sites in order to get closer to perfection. One of the big things that’s hard to manage in these sites is vaccines. Vaccines have expiration dates. You need to sometimes have a lot in different locations. They’re expensive. How do you manage vaccines in these clinics in order to not have too many there, not have too few there? It’s important to understand the best approach on those.
So those are the strategic areas that you as a provider have the opportunity to manage. And the challenges I know that you have today are about the shortage of techs. And what happens when you have a shortage of techs? You say, “Well, I’m saving money. I don’t have as many techs,” but then the processes get very inefficient and the costs go up other places. And so having a shortage of techs is costing you money, more than a little overtime here and there. It’s costing you money because then the process is people over-order because there’s not enough people to process the orders that they should be processing. And the same thing is true as in any part of your institution where you don’t have enough labor. Inefficiencies and costs are pushed up higher in other locations.
Kelly: A lot there to take in and to kind of think through all of that. What’s the financial risk of managing medications and silos? And how does system wide visibility change decision making for health system leaders?
Randy: Well, I always say, if you can’t manage the medication in the healthcare process, you can’t manage the risk. You can’t determine the outcome with understanding that leads to the best outcome and at the lowest cost. So the medication piece of the curative part of the healthcare experience is costly enough in getting it right not just in the cost of the med, but in the ability to get it right for these patients because it’s going to save you money because you’re not going to have the patient returning back to your institution because they were in the hospital and returned less than 30 days, and it costs you money to take care of them that you don’t get reimbursed for. So, managing medication is extremely important and the right medication. It’s harder to get than you think. And so, I think if we look at medication management as a chief goal of the curative outcome process, it really lends itself to the right outcome in terms of both cost and quality and best health for the patient.
Kelly: Wow. Thanks for sharing that with us. So, drug shortages are widespread. How can centralized medication distribution and automation help hospitals protect access to critical drugs without increasing spend?
Randy: Yeah. One of the things that’s really critical when you have shortages is visibility. Visibility starts with understanding what your demand is, but also understanding, “How much drugs do I have on hand?” And so, when you look at the demand and the drugs I have on hand, I really don’t have a shortage. I have enough drugs for the demand, but I don’t have those drugs in the right location so that it doesn’t create a shortage. When you centralize in a central location, you get that visibility both to the demand and to what you have available, and that availability when you put it in a central site usually is 6 to 12 hours. You can move it around to whoever needs it as quickly as possible, allowing for you to really eliminate that shortage. Even though that drug might be on short, per se, you may not have a shortage enterprise wide. You probably have shortages in certain locations. Eliminate that through a consolidated service center.
Kelly: Yeah. It makes sense that visibility is key there. How are hospitals using AI-driven analytics today to better forecast medication demand and reduce waste or inefficiencies?
Randy: Yeah. AI is a great tool. And one of the best tools that AI is helpful for is administration. We see a heavy burden in pharmacy for administrative tasks, and many of these administrative tasks are helpful in managing pharmacy better. But today, in our last study that I’ve seen, it’s about 76% of activities done in pharmacy are for administrative tasks versus only 24% for clinical work. So, AI being applied to this administrative workload, delivering the reports that you need, being able to manage regulatory compliance that you need, and being able to just use AI to query where I am I on these compliance issues, where am I on these reporting issues? And then being able to actually, in some cases, deliver those reports with the AI with supervision, obviously. And so today we have people totally dedicated to many of these functions and we can really minimize the amount of time and workload it takes to probably even get a better answer. Now, we do have a tall task in medication management, particularly on big providers. And that is the task of managing many, many discrete inventory locations. So even if we take one of the top 300 largest providers in the United States, each of those has over a million discrete locations where they’re managing inventory. That’s on every floor, and that could be at remote pharmacies that could be in OR rooms, that could be in doctor’s offices. That’s everywhere. That’s a million locations of discrete inventory. How do you manage that so that you don’t have too much in any of these 1 million locations, or you don’t have too little? And so today we do that with spreadsheets and pieces that really give us suboptimal results. And now with the advent of AI, how do we really consume all that data to get us this, I would say, perfect answer for each one location? AI is the engine that’s delivering much, much better results. We have a great new inventory management process that’s driven by AI that we’re doing with King’s College in the UK. And it’s just delivering phenomenal results. And so, we’re going to see more of that in the marketplace where the expectation is that we can do a lot more with a lot less inventory, but have it in the right places.
Kelly: Yeah, it does seem that AI-driven analytics is a game changer for sure. From a finance lens, medication inventory ties up significant capital. What does modern inventory management unlock for hospital balance sheets?
Randy: Well, that’s a great question. I hope that many of your listeners will see a significant drop in inventory. I don’t mean 10%. I mean a third or more drop in inventory because many of the legacy processes and systems that are in place are really creating these inefficient buckets for additional inventory. And it adds up. It adds up in cost not only in capital toward these inventories, but because the meds tend to expire on the shelf. They’re perishable. They can’t last forever. And so, one of the key indicators that I’m sure many of these institutions are following is understanding what their expiration of on-shelf products and drugs are and what those costs are. So that’s a key indicator of how well you’re managing your inventories and what the opportunities are to really eliminate those. And I believe these consolidated centers, this approach to automation, which gives you much more visibility on exactly where you have it and what you have leads to the confidence, right? Because it takes confidence to lower your inventory to know that you’re going to have the right things where you need them. But you need to lean into the systems to give you that confidence to do that.
Kelly: That makes a lot of sense, Randy. Your personal experience as a founder shaped on [Micelle’s?] mission. How does that perspective influence the way you approach efficiency and caregiver support today?
Randy: Well, I had been on the nursing foundation board as well as on the pharmacy foundation board. And it’s these clinicians that are on the front line. These clinicians have the healing hands, if you will. If you look at inpatient, nursing is doing all the palliative care, and then pharmacy is delivering all of the drugs that mostly are used in the curative session of those hospital stays. So if you look at the function that they’re providing, you give them the right tools to allow them to administer effectively and clearly, they’re going to enjoy their jobs more because they know they’re providing those good outcomes for those patients, and they can see it, seeing the impact of automation and technology and the outcome of your job, not just making it easier, but making it better for others. And I think that’s kind of how we think these days, right? I certainly think that if I can do something for others, it’s more satisfying to me than just doing something for myself. And so, these tools, these solution sets, we believe, really empower these clinical folks to give more to patients that deliver better outcomes.
Kelly: I love that, Randy. I mean, caregivers are key in our healthcare system, for sure. So, what’s one question that CFOs should be asking their pharmacy teams right now if they want to drive enterprise-wide cost optimization?
Randy: Well, I’d ask first, do you have a consolidated service center strategy or not? That should be on your strategic plan for pharmacy. And secondly, how do we know what our specialty in 340B is? Are they optimized? Can we optimize them more? What are our opportunities over the next two years to get positioned to fundamentally make a big impact on our P&L? Those are the two biggest impacts on the P&L is consolidated service center strategy, secondly, on the specialty pharmacy, how can we get prepared to do more outpatient infusions with a specialty drug lineup that’s coming out in the next two years?
Kelly: Yep. That makes a lot of sense. Well, thank you, Randy, for sharing your insights with us on from inventory to insight, rethinking medication management for clinical and operational performance. Randy, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Randy: Oh, just send me an email, randyl@omnicell.com. Just do it. And I’d love to hear from you.
Kelly: Great. Thank you for providing that. 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 contact@besler.holdings.
Kelly: Great. Well, let’s go ahead and jump in. So, what shifted in the industry that made remote work not just possible, but necessary?
Chris: Well, what’s really shifted really in the last 10 years, we’ve gone from a workforce that 5% of the time was remote to well over 50%. And of course, we had a bump through COVID, but what we realized very quickly, particularly in the healthcare space, is there’s so many tasks that don’t involve touching a patient that can really be leveraged at a better pace and a better capacity and the right resources. And so, what we focus on at Virtual Teammate is really helping our customers and our clients and the clinic owners focus on the highest and best use of their time, which is patient care, and really delegating those tasks that don’t require their technical expertise or the technical expertise and capability of those in the office. And so, for us, it’s really been a game changer to have healthcare providers catch up with the insurance industry that for the longest period of time has been leveraging remote team members to really support their ongoing operations.
Kelly: Yeah, I know remote work is just so prevalent right now in healthcare and in other industries. Which healthcare roles are truly optimized for remote work, like medical scribes, billers, or admin support, and why?
Chris: Really, I mean, they’re optimized because they’re very much consistent, what I would like to refer to as kind of rinse, repeat the same process, the same task over and over. And that’s where our team accelerates is, as you mentioned, 80 to 90 percent of our folks are RNs healthcare trained. They’re all HIPAA certified, and a lot of them have come from the insurance industry. And so they have that deep experience from insurance verification, eligibility, precerts, billing claims. And so really, it’s about buying the clinics’ time back of the providers, but also getting reimbursed in a timely fashion for the work they do, and I know that’s what your company specializes in as well. And that’s where we really come alongside to support that and be intentional to really optimize the workflows for our clinics. And we leverage technology to really support that. So, it’s not just about a person or virtual assistants, a virtual assistant that’s enabled by technology to really improve and optimize the productivity. And because of that, we can confidently say that our team is about 47% more productive than having somebody in the office and allows for, yeah, exceptional revenue growth.
Kelly: Wow, no, that makes a lot of sense. So, I know some practice owners worried that remote staff might reduce the quality of care. What would you say to those who fear that outsourcing admin work affects the patient experience?
Chris: I would really challenge them to think about the patient experience starts when they come to the office, right? But it starts well before that. It’s when they interact with somebody. So many of my doctors and clients will say, “I love you, doctor, but I can never get in touch with you.” And so, by leveraging our teammates handling phone calls, handling scheduling, that really starts to enhance that patient experience well before they come in to the clinic. And so being able to connect with your doctor, being able to interact with them, that’s where our team takes a lot of that administrative support, phone calls, scheduling, off the doctor’s hands and those in the office so they can enhance the patient experience when they’re in front of them. And they can enhance that experience of feeling like they’re being heard and they’re connected and they have the necessary information, thereby allowing the doctors to spend more time with their patients. And what’s driven a lot of this is reimbursement has really declined, but costs have grown. And so, our team can really allow that opportunity for doctors to be intentionally spending time with their patients, particularly on the medical scribe side, where we’re real-time updating documentation while the doctor is spending time with the patient, instead of spending time in front of a computer.
Kelly: No, definitely. So how does removing administrative burden from doctors and clinicians directly impact patient outcomes and satisfaction?
Chris: So, I mean, I think it buys back their time. So, they spend more time doing what they do best and are educated to do is interact with the patient, get to understand the patient’s needs, where their struggles are, and really be able to respond in an empathetic manner, where they’re not overburdened. And we’re seeing such a burnout in the healthcare industry of doctors, dentists, veterinary folks really burning out because they’re spending the majority of their time, whether during the office hours or after hours, doing unnecessary paperwork that’s not the best for them. And then that has direct impact on the customer satisfaction in regards to their mood and how they feel and how they present themselves to work. And then, of course, the outcomes, they’re not getting that one-on-one interaction with the doctor because the doctor’s too distracted by making sure they update the notes, making sure they do all that information, or they’re following up on billing and things like that. And it also improves the satisfaction outcomes by streamlining the scheduling process and making sure that your patients can get in touch with the doctor’s office and get the care that they need and deserve.
Kelly: No, I love that. It’s so important to keep those doctors focused on what they really should be spending their time on. So, Chris, what measurable improvements have you seen in practices that embraced remote healthcare support, financially, operationally, or clinically?
Chris: So financially, and really clinically, on the financial side, we’ve seen huge bumps. And so a number of our clients have reported 40-50% increase in the number of claims and precerts that can get completed in a day, thereby really accelerating their reimbursement. And so being paid for the services. If you think about it, healthcare is one of the only industry that extends credit with the hope of payment, right? We deliver the services, but we don’t get paid at that exact time for the services. We have to go kind of chase that down. And so, for us, it’s really about enhancing that experience so the doctors can get the money that they’re paid or owed. Follow up with the insurance company, work through denials, and really reduce the AR days, which is such a burden for practices because they’re incurring all this cost with the hope of payment down the line. And so, for me, I’m really passionate about the little bit I can do to give back to doctors so they feel like they’re getting compensated for the work they’re doing, but also not spending all their time on paperwork, but being able to really invest in nurturing the relationships with their patients.
Kelly: No, I love that so much. Chris, looking ahead, 5 to 10 years, do you see remote staffing becoming the norm in private practices? And what happens to clinics that resist this shift?
Chris: Yeah, I definitely do see this continually being embraced because, on the provider side, we’re probably 5 to 10 years behind the insurance companies and other areas. I really see it embraced because, as we move more to technology and more to kind of some of these online visits, particularly we’re seeing a lot of growth in the behavioral health, mental health space with our clients. I think that’s definitely the trend is going to continue. But I think on top of that is not just having remote team members. It’s having remote team members like what we’ve put in place with Virtual Teammate, because the focus of Virtual Teammate isn’t just giving you an assistant. It’s a teammate. And because the definition of a team is a group of individuals that’s working together to a common goal.
And our teams have changed. As I mentioned previously, our teams were all in the office. Now our teams are what I like to refer to as here, near, and far. Here, physically in your office. Near, working remotely, maybe in the same geographical space within the US, for example. And then far, leveraging folks like myself, my team that’s in the Philippines, Latin America, across the globe, forming one team and really coming together and driving engagement. Because that’s where the workforce is going. And that’s where the optimization and efficiency is going because of the continued growth in technology. A lot of my clients will come to me and say, “Hey, but won’t AI replace all of that?” Well, healthcare is such unstructured data that AI is not going to really embrace that completely in the next 5 to 10 years. But instead, I see technology and AI enabling our remote team members to be more efficient and effective, thereby allowing doctors more time to spend with their patients and less time having to deal with unnecessary paperwork because with an executive assistant, you’re not just getting the work done, but it’s also monitored to make sure it’s accuracy. And that’s hugely important, of course, when you’re working in the healthcare space, data accuracy and data privacy.
Kelly: Oh, definitely, that data accuracy and data privacy is certainly key. If a healthcare practice owner is still overwhelmed, burned out, and buried in admin work today, what’s the real cost of not embracing remote support for both their business and their patients?
Chris: I mean, I think the cost really is mental burnout for our physicians. And so, we’re seeing about a 40% burnout of physicians. Rather get out of this business that they’re so passionate and loved and did education and spent so much time in their life into because it’s just overwhelming, right? The reimbursements are coming down. So, I think for those that don’t embrace it are going to kind of get swept over because costs continue to rise. Obviously, minimum wage and other things continue to rise. And really what we come alongside is, we take care of that heavy lifting to give you highly capable folks that can perform the work administratively in the back office. So, it allows to free you up time to do what you do best, take care of patients, but also buy back some of your time so you get to spend time with loved ones and others to really refresh. And if you don’t do that, then I think that those kind of physicians and practices are going to get rolled over because it’s just too much work, and they’ll get sucked up into some of these larger corporations.
And so, for me, I’m just passionate about how do I keep those one to two, three physician doctor offices sustaining? Because I think that’s a legacy they have to leave to future generations. And so, 95% to 97% of my clients are all one to five practitioners. I don’t do a lot of work with the hospitals because I think the uncapped capability and ability within this country is really those small to medium sized healthcare practices that have that opportunity to do personal care. And if they don’t embrace remote team members like the larger hospitals and insurance companies, they’re just going to get burnt out and rolled over.
Kelly: Well, Chris, I love all your passion for this topic. And we really appreciate you sharing your insights with us on the role of remote work and healthcare and its impact on patient care. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Chris: The best way is via LinkedIn. I love getting messages via LinkedIn. Also, you can go to our website, virtualteammate.com and book a call to kind of schedule to meet with me. I love sitting down with our clients and just kind of strategizing on how we can help them because my main focus in building this organization and really is to have an impact in the healthcare space. As I like to say, kind of I’ve been in the healthcare for about 30 years. And my focus has always been on delivering technology, whether it be meaningful use or large technology systems. But I realized really quickly that I could deliver all the technology, but that’s taking doctors away from their patients. And so, for me, I’m very passionate about Virtual Teammate and what we can do to make a difference to enhance clients leveraging remote team members, which is super important. And that’s creating that opportunity, but also the opportunity to enhance the virtual teammate experience working for fantastic doctors and clients and allowing them the opportunity to earn a living wage and really making that connection and then leveraging technology for frictionless growth and automation so that doctors can do the best they can do and we can really optimize their operations and segments. And so, the best way would be reach out via LinkedIn or reach out via our website, where I’m always happy to take your emails from our folks at cmcshaneick@virtualteammate.com. And I always love talking to doctors and learning more about how we can really help them be more successful because they go to work each and every day taking care of us. And I want to do our best to take care of them because I recently became a grandparent. I’m now a grandparent of three. And I want to have a legacy where I can at least contribute to having healthy, successful doctors and clinics when I pass on.
Kelly: Well, love that. Well, thank you so much, Chris, for providing that. 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 contact@besler.holdings.
