EPtalk by Dr. Jayne 4/11/24

I recently saw an article talking about the creation of chief AI officer roles at several organizations. Artificial Intelligence is here to stay and we need to be proactive about its consequences. Politico ran a great article recently that looked at the intersection of AI and medical malpractice. It cites comments from AMA President Jesse Ehrenfeld, who says that lawsuits are already being filed about the use of AI in healthcare. In speaking with some of my friends who are attorneys, they noted that there will be some interesting case law created over the coming years. Tech vendors will be pointing fingers at the clinical end users who leverage AI in patient care, and those practitioners will be pointing their fingers right back at the AI technology’s creators. Physicians are already left holding the bag for a variety of things, including patients who refuse recommended care and patients who get caught in the crossfire when insurers won’t cover recommended care. What’s one more point of liability?

From Madge in HR: “Thanks for mentioning employee handbooks last week. I think the majority of people just sign them blindly and don’t read them. It’s always interesting to me when a company deploys a new policy to the wild, but especially so when you know that the policy is the result of a recent event. My company just announced our new ‘Professional Behavior Policy.’ While it’s shocking to me that we need such a policy in place, it’s reassuring to know that the company values professionalism and is willing to require it of every employee. The prohibited behaviors that stuck out to me included: slamming doors; refusal to communicate or communicating dishonestly about business matters; obstructing, undermining, or preventing another employee’s work performance; and possession of objects that are sexual in nature. Long story short: Be nice to each other. Don’t throw a tantrum. Don’t lie. Don’t keep others down. And for the love of all that’s good and right, keep your bedroom toys out of view when you’re on a Teams meeting.” Although I agree with the intent behind these, I don’t envy those that have to handle complaints on some of the more subjective issues. Most of us have at least some experience at companies where people stretch the truth to varying degrees and where politics and blocking are a daily event. It’s sad given the fact that we’re all in an industry where the ultimate use case is about helping people.

The US Food and Drug Administration has cleared its first AI tool for sepsis detection. Developed by Prenosis, the Sepsis ImmunoScore tool was approved through the FDA’s De Novo pathway. Sepsis is a serious health condition, leading to more than 350,000 deaths annually. The tool looks at more than 20 clinical parameters including vital signs and laboratory results to help identify sepsis risk. Although other organizations, including Johns Hopkins University and Epic have built sepsis detection systems, this is the first one to receive FDA approval. The Prenosis tool sorts patients into four different risk categories but is not considered an alert system. Testing was performed on a dataset that included more than 25,000 patients.

Having spent a good chunk of my career working in emergency department and urgent care settings, a recent article about “rat snacking” really resonated with me. Although the headline was mostly about physicians, the piece applies to anyone whose work schedules disrupt traditional mealtimes. The authors define “rat snacking” as when “people consume whatever type of food they can scavenge.” Anyone who has ever subsisted on graham crackers and apple juice swiped from a hospital unit’s floor stock feels this in their bones. A local hospital recently curtailed the availability of what one nurse describes as “real food” on the night shift, citing cost control measures. Maybe they should be more aware of the literature that shows that disordered eating can lead to nutritional deficits and excess consumption. Of course, the answer is planning ahead and packing your own food, but that only goes so far when your eight-hour shift suddenly becomes 12 or 14.

The Change Healthcare ransomware debacle continues to be a thorn in the side of many physicians, as they await claims and payments to catch up. Several of my local colleagues have had to take out lines of credit or personal loans to cover office payroll and they’re eager to eventually reach resolution with their revenue cycles. Change Healthcare’s parent company, Optum, isn’t winning any friends with recent headlines about practice acquisitions that leave patients without physicians as theirs jump ship. This particular story includes a vignette of a patient who has been part of the practice for more than two decades but cannot be accommodated after the departure of his physician. The patient panels carried by primary care providers these days are more than twice the size of those that existed when I was in a traditional family medicine practice, and those bloated panels make it difficult to recruit replacement physicians.

The happenings going on at this particular organization, Oregon Medical Group, have led to the introduction of legislation designed to slow the influx of corporations into healthcare in the state. The reality of the entry of these parties into the healthcare ecosystem is that their goals are not the same as the owners they replace – often physicians. Where physician-owned organizations will generally continue to participate with low-paying payers, such as Medicaid, many corporate entities move quickly to try to push those patients out of the practice. Non-physician owners that have shareholders are motivated primarily to deliver profit to those shareholders, which can increase provider burnout and place patients at risk.

Given the challenges facing primary care physicians, I was surprised to see the number of medical students who requested to participate in my local medical society’s “Coffee with a Doc” program. I took a first-year medical student to lunch and was surprised to learn that her school is incorporating classes on “the business of medicine” as early as year one. She had some good questions about RVUs and physician payment, and I introduced her to the concept of Direct Primary Care, which apparently wasn’t included in her curriculum. I’m seeing increasing numbers of my family medicine colleagues moving in this direction, so I’m glad the topic came up. Kudos to her school for adding information to the curriculum that can help students learn more specifics about what they’re getting themselves into.

From Stage Mom: “Given your previous comments about health systems sponsoring stadiums and other facilities, I thought you would appreciate this article about a $5.4 million theater naming deal.” BayCare Health System, based in Clearwater, FL, will pay the amount over a 10-year period in exchange for naming rights at the BayCare Sound amphitheater. The agreement has an option for a 10-year renewal in 2034. BayCare also has a ballpark under its belt. According to ChatGPT, that amount of money would pay for more than a quarter million influenza vaccines, or more than a hundred thousand cervical cancer screening tests, or more than 36,000 mammograms. I wonder which the community would rather have?

Will health systems keep slapping their name on everything, or will they start to put their non-profit profits to better use? Leave a comment or email me.

Email Dr. Jayne.