No doubt, artificial intelligence (AI) has been one of the most talked about topics of the year, especially with the release of Chat-GPT-4 in March.

Suddenly, it seemed everyone became aware of the very real possibility of AI replacing humans in a variety of professions, prompting a plethora of discussions about everything from ethics and global regulations to societal impacts and future industry disruption.

While the initial hype has evolved into an ongoing drumbeat of multi-faceted discussions, AI is moving forward and when it comes to healthcare, there are opportunities to transform virtually every aspect of the industry. Now, governments worldwide are stepping up to address how AI will be monitored and regulated.

On December 8, European Union officials announced a provisional deal finalizing what will become the world’s first comprehensive laws regulating artificial intelligence. Called the AI Act, it seeks to regulate uses for AI rather than the technology itself. It also strives to protect democracy and uphold the law and fundamental rights, while encouraging innovation and investment.

The Act’s rules work along a risk spectrum, with lighter rules for low-risk applications like content recommendations and stricter rules for high-risk applications, like medical devices. Violations could result in fines up to the equivalent of $38 million or 7% of a company’s global revenue.

The Act won’t take effect until two years after final approval, which is expected early next year.  Still, many believe it will serve as a global framework for classifying risks, ensuring transparency, and penalizing non-compliance.

What about the U.S.? On October 30, President Biden issued an Executive Order (EO) on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. Its purpose, as noted in Section 1, is as follows:

“Artificial intelligence (AI) holds extraordinary potential for both promise and peril. Responsible AI use has the potential to help solve urgent challenges while making our world more prosperous, productive, innovative, and secure. At the same time, irresponsible use could exacerbate societal harms such as fraud, discrimination, bias, and disinformation; displace and disempower workers; stifle competition; and pose risks to national security. Harnessing AI for good and realizing its myriad benefits requires mitigating its substantial risks. This endeavor demands a society-wide effort that includes government, the private sector, academia, and civil society.”

Interestingly, within the EO, an entire section (Section 8) is devoted to safe, responsible deployment and use of AI in healthcare, public health, and human services. Among other things, it includes key deadlines and deliverables (mostly driven by the Secretary of Health and Human Services):

• Within 90 days of the EO, create an HHS AI Task Force. Within 365 of creating the task force, develop a strategic plan including policies and frameworks, and possible regulations, on AI and AI-enabled technologies in the HHS sector, including research, discovery, drug and device safety, healthcare delivery, finance, and public health.
• Within 180 days of the EO, develop an AI assurance policy to evaluate important aspects of AI-enabled healthcare tools’ performance, as well as infrastructure needed for pre-market and post-market oversight of algorithmic system performance against real-world data.
• Within 180 days of the EO, consider actions to advance understanding of and compliance with Federal nondiscrimination laws related to AI by HHS providers receiving Federal financial assistance.
• Within 365 days of the EO, establish an AI safety program with a common way to identify and capture clinical errors resulting from AI in healthcare settings. Create a central repository for incidents that cause harm – including through bias or discrimination. Analyze data and outcomes to create recommendations and best practices for avoiding harm, and processes for disseminating them to stakeholders.
• Within 365 days of the EO, develop a strategy to regulate the use of AI or AI-enabled tools in drug development processes.
• Ongoing: create incentives under grantmaking authority to promote responsible AI development and use.

So, it looks like 2024 is going to be a landmark year for AI frameworks, potential regulations, and more. Stay tuned. As you consider what AI and related applications may mean to your organization, please remember RBT CPAs is here to provide accounting, audit, tax, and business advisory services. Interested in learning more? Give us a call today.

RBT CPAs is proud to say 100% of its work is prepared in America. Our company does not offshore work, so you always know who is handling your confidential financial data.

Value-based care is being trumpeted as the panacea to cure all of the healthcare systems’ ills, and while it’s picking up momentum, to say there are a lot of different perspectives to this story is a gross understatement.

From medical and political organizations to investors and technology companies, value-based care is the talk of the town.

Value-based care was first introduced by Michael Porter and Elizabeth Olmsted Teisberg in their 2006 book, Redefining Health Care: Creating Value-Based Competition on Results. Since then, it has been embraced by some; criticized by others. Still, after almost 17 years, the discussion continues. In scouring numerous publications from several months, here’s a sampling of the discussions…

December 16, 2022. American Psychological Association

“The National Academies of Science, Engineering, and Medicine issued a report on implementing high-quality primary care stating that we should ‘pay for primary care teams to care for people, not doctors to deliver services.’ The report recommends a shift towards a hybrid model of payment; part fee-for-service and part capitated (per member, per month) as the default method to pay prospectively for interprofessional, integrated, team-based care rather than the fee-based system that undervalues the work reflected in primary care and behavioral health services.” (“APA advocates for value-based payment models.” December 16, 2022. APAServices.org.)

December 16, 2022. McKinsey & Company

“Providers specializing in value-based care have become attractive to investors because of the distinctive quality of care that they can provide and the investable opportunity they present, with a diversity of risk levels and business models. By building on a decade of increasing value-based payment adoption—combined with enhanced value-based capabilities across payers, providers, employers, and other healthcare stakeholders—continued traction in the value-based care market could lead to a valuation of $1 trillion in enterprise value for payers, providers, and investors.” (Abou-Atme, Zahy; Alterman, Rob; Khanna, Gunjan; and Levine, Edward. “Investing in the New Era of Value-Based Care. December 16, 2022. Mckinsey.com.)

February 7, 2023. The Commonwealthfund.org

“Studies of value-based care programs so far suggest that they can reduce costs and improve quality of care, although results have often been mixed and impact modest….Although participation in value-based care programs is on the rise in the U.S., many healthcare providers are still not in one. To encourage participation, future models in both the public and private sector would likely benefit from being more accessible and financially rewarding, particularly to those serving disadvantaged or rural populations. Moreover, further research is needed about how these programs impact patients, providers, and the health care system overall, as well as which factors are associated with success.” (Lewis, Corinne; Horstman, Celli; Blumenthal, David; Abrams, Melinda K. “Value-Based Care: What It Is and Why It’s Needed.” February 7, 2023. Thecommonwealthfund.org.)

Feb 10, 2023. Healthcare Dive

“With 48% of the eligible Medicare population enrolled in Medicare Advantage plans and, the CMS committed to having 100% of enrollees in a value-based care program by 2030, the tailwinds are pushing at-risk arrangements forward in a big way.” (Kirk, Liz. “Tipping point is in sight: Value-based care is driving meaningful financial results.” February 10, 2023. Healthcaredive.com.)

March 14, 2023. BenefitsPro

“Employers and their benefits consultants are increasingly embracing value-based reimbursement models as they – along with provider organizations, commercial payers, and government programs – seek more ways to improve health outcomes while reducing costs.” (Sharma, Rahul and Caroll, Lynn. Implementing value-based health care: Key trends shaping 2023.” March 14, 2023. Benefitspro.com.)

April 10, 2023. Bain.com

“There is still ample headroom for growth in value-based care adoption in the PCP space. As of 2021, nearly 60% of healthcare payments had at least some linkage to quality and value, but less than 20% incorporated two-sided risk (and capitated models are still under 8% of spending)…Our analysis suggests fee-for-value arrangements will capture 15%–20% market share from traditional FFS providers in primary care by 2030, creating strong macro tailwinds and supporting further investment in the space.” (Fry, Sharon; Nierenberg, Dave; Wynn, Grace; Murphy, Kara; and Jain, Nirad. “Value-Based Care: Opportunities Expand.” April 10, 2023. Bain.com.)

April 29, 2023. The American Journal of Managed Care

“…there have been many iterations of value-based programs sponsored by both government insurers and private companies… Among other challenges, a main issue that arises in value-based care surrounds attribution, meaning a patient is attributed to a provider and that provider is reimbursed based on the contract. But what is attribution? If a patient sees 2 primary care providers within a year, which provider is paid for their care?” (McNulty, Rose. “Value-Based Care: Is It Possible for All Providers to Succeed?” April 29, 2023. AJMC.)

May 8, 2023. The New York Times

“Large health insurers and other companies are especially keen on doctors’ groups that care for patients in private Medicare plans…Now, nearly seven in 10 of all doctors are either employed by a hospital or a corporation, according to a recent analysis from the Physicians Advocacy Institute…Insurers say their purchase of medical practices is a step toward what is called value-based care…” (Abelson, Reed. “Corporate Giants Buy Up Primary Care Practices at Rapid Pace.” May 8, 2023. NYtimes.com.)

May 23, 2024. Beckers ASC Review

“Three key driving forces behind the shift to value-based care are government programs and incentives, advancements in technology, and the use of data to gather information. The model has piqued the interest of companies such as CVS Health, Optum, and Amazon, as well as physician groups…Though value-based care’s popularity is growing, just 14 percent of physicians participate in the payment model, according to Medscape’s 2023 ‘Physician Compensation Report.’ The fee-for-service model is still the most popular payment model by a long shot, with 46 percent of physicians participating in it.”  (Hatton, Riz. “How value-based care is squeezing its way into every corner of healthcare.” May 23, 2024. Bekersasc.com.)

June 8, 2023. Center for Medicare and Medicaid Services

“Today, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states… Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.” (“CMS Announces Multi-State Initiative to Strengthen Primary Care.” June 8, 2023. CMS.gov.)

No doubt, this discussion is to be continued. While you are following the latest headlines shaping the future of healthcare in America, you can count on RBT CPAs to take care of your accounting, tax, audit, and advisory needs with the highest ethical and professional standards. To learn more, give us a call today.

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In today’s media, it’s hard to tell the difference between news and marketing. Take 5G and healthcare as an example. Talk of the revolutionary nature of this next generation of wireless technology has been around for years, but in truth the uptake has been slow. So, I set out to see what I could learn about whether and how 5G is transforming health care. Here’s what I found…

First, what is 5G? It stands for the fifth generation of cellular wireless technology (1G allowed for voice; 2G – digital voice; 3G – data; 4G – streaming; and 4GLTE encompasses everything up to 4G, faster and better than ever).  5G will transmit data 20x faster than 4G; handle 100x more traffic so more devices can be connected and work more reliably; support wireless operations; speed up how quick data can be uploaded and transported; and dramatically increase the amount of data available for decision-making.

While Wi-Fi doesn’t have the bandwidth to support all of the leading-edge technologies – like the IoMT, edge computing, robots, augmented and virtual reality (AR/VR), and more – 5G can. It’s expected to transform how work gets done, driving productivity, competitiveness, quality, cost savings, profitability, smart decision-making, data security, and more.

As reported by ManagedHealthcareExecutive.com, the Cleveland Clinic Mentor Hospital – scheduled to open its doors to patients on July 11 – is the first U.S. hospital built with a private 5G network via a partnership with Verizon Communications, providing “an opportunity to explore how private 5G networks can help enable digital transformations in hospital settings.”

According to InsiderIntelligence.com, the Cleveland Clinic is already ranked fourth by Newsweek’s World’s Best Smart Hospitals 2023 (Mayo Clinic, Massachusetts General and John Hopkins take the top three spots). With 5G at Mentor Hospital, the clinic will be exploring potential use cases for asset tracking, digital displays, entertainment, check-in kiosks, AR/VR for education/assisted surgery/imaging, and more.

While looking forward to the learnings that will come from Mentor Hospital’s 5G capabilities, Samsung Medical Center (SMC) in Seoul, South Korea is already experiencing the benefits of integrating 5G with digital pathology.

HealthcareITNews.com reports 5G is helping to cut pathology time at SMC in half. They have three diagnostic reading rooms that received numerous “requests for frozen section tests.” It would take 15 to 20 minutes for someone to get to the rooms, until a scanner, analysis and interpretation software, a desktop computer, and 5G enabled access via mobile devices, reducing response time to 10 minutes. The result is quicker diagnosis and fewer surgical delays.

In April, The Wall Street Journal reported on how another hospital in Seoul is using AR technology to promote precision during surgery thanks to its private 5G network which can upload and transmit tremendous amounts of data without lags. The Ewha Womans University Mokdong Hospital’s 5G-enabled AR technology helps surgeons see the exact location of tissues and tumors when a tablet is placed above a patient’s chest. This replaces a surgeon making incisions based on CT scans.

The hospital also tested the system for a recent surgery where surgeons in different locations were able to join a procedure and exchange advice, setting the stage for remote surgeries and even physician training.

(FYI: The AR technology was developed by SKIA Co. which is applying for regulatory approval in South Korea for widespread use and subsequently plans to apply for approval from the U.S. Food and Drug Administration.)

No doubt, this is just the beginning. As The Wall Street Journal reported, “The 5G healthcare market—encompassing 5G-supported augmented-reality and virtual-reality technology services, virtual consultations, remote patient monitoring and more—was valued at $2.5 billion in 2021 and is expected to grow an average of more than 35% annually from 2022 to 2030, according to Global Market Insights, a market research firm.”

While you may be thinking about where and how 5G will impact your healthcare organization’s future strategy, please know that RBT CPAs can help free you up by handling all of your accounting, tax, audit, and business advisory needs. To learn more, visit us at RBTCPAs.com or give us a call today.