Rock Health reports that US digital health startups raised $6.4 billion in the first half of 2025, which represents a modest increase over the same period last year. AI-enabled companies captured 62% of that total, raising average round sizes that were nearly double those of non-AI startups. Nine of the 11 funding rounds of greater than $100 million went to companies that offer AI-driven products, including two mega-rounds for Abridge within just four months.
An AI cybersecurity company says that its average health system audit uncovers 70 active AI applications, many of them embedded in tools from Microsoft, Salesforce, Google, and LinkedIn. It notes that while healthcare organizations often believe that they have limited AI use by blocking tools like ChatGPT and Gemini, they often overlook AI features that are contained in vendor-provided technology.
Cleveland Clinic Abu Dhabi appoints Peng Xiao, the CEO of Emirates-based AI development company G42, as its board chair.
John Snow Labs spins off Martlet.ai, which will apply AI to HCC coding.
FDA grants Breakthrough Device Designation to Artera’s precision medicine tool for prostate cancer.
UCLA researchers create an AI tool that turns structured EHR data into “pseudo-notes” that can be used by clinical decision support systems without EHR integration.
Mayo Clinic develops an AI tool that diagnoses surgical site infections by analyzing patient-taken photos of wounds after surgery.
University of South Florida researchers develop an AI system that assesses pain in NICU babies in real time by analyzing data from cameras and sensors.
Huntsville Hospital (AL) upgrades its campus security system with 1,800 AI-powered cameras that employ facial recognition and license plate detection.
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Samsung Electronics Acquires Xealth, Bridging the Gap Between Wellness and Medical Care
Samsung Electronics will acquire digital health integration company Xealth.
Gallion Health launches out of University of Maryland Medical System’s IHarbor Innovation Center to offer providers cloud-based digital supply chain capabilities.
Naviant Acquires Amitech Solutions to Expand Healthcare and Intelligent Automation Capabilities
Intelligent automation and process consulting company Naviant acquires healthcare services firm Amitech Solutions.
Samsung Electronics will acquire digital health integration company Xealth.
Xealth announced an undisclosed amount of funding from Morningside Ventures earlier this year. The company spun out of Providence in 2017 to sell its platform that allows providers to prescribe digital health programs and tools.
Samsung says the acquisition will help it reach more health systems and digital partners through connected care.
From Abacab: “Re: the VA. They posted an RFI on July 3 titled ‘Electronic Health Record Modernization (EHRM) Systems Integration Support to the EHRM Integration Office.’ If they proceed, it most likely strips Oracle Health of the prime integration responsibility and shifts it to a traditional government systems integrator. Oracle has had notable failures with its Oracle Health rollout. Shifting it to an SI who has similar experience at least brings risk down substantially.”The RFI seeks input on selecting a system integrator to support the VA’s enterprise-wide rollout of Oracle Health, covering implementation, integration, management, and sustainment. My initial, non-expert assumption was that Oracle Health would remain the prime contractor, with funding and operational responsibility shifting to the integrator. Leidos seems to be a likely frontrunner given its role as prime contractor for the DoD’s Oracle Health rollout. However, a reader who has deep federal contracting experience believes that the VA may actually be looking to replace Oracle Health as the prime, not just add an integrator. They noted it never made sense for Cerner – who had never installed its system for the government and never served as prime contractor on a big federal project as far as I know — to receive a no-bid contract for both software and responsibility as prime, which of course let it keep most of the money.
From Dropsy: “Re: Becker’s Health IT & CIO Report. Amenities Health founder and CEO Aasim Saeed, MD, MPA rips them on LinkedIn for running an Epic blog post as its lead story.” I agree that it’s not real journalism to run a lead story that summarizes a vendor CEO’s company blog post. News is always sparse right after a holiday, but surely this was the most questionable choice from the 10 stories listed.
July 22 (Tuesday) 1 ET. “Innovating the Consumer Experience Beyond the EMR with Open Standards.” Sponsor: Praia Health. Presenters: Ryan Howells, principal, Leavitt Partners and program manager, The CARIN Alliance; David LaBine, VP of software engineering, Providence Digital Innovation Group; Robin Monks, CTO, Praia Health; Kristen Valdes, CEO, b.well. As healthcare faces rising consumer expectations and tighter regulations, the high cost of maintaining fragmented, proprietary systems is no longer sustainable. While patient data access has improved, the lack of open standards continues to hinder innovation, drive up integration costs, and limit the potential of digital health beyond the EHR. This webinar will discuss how open standards like OIDC, HL7 FHIR, and open technology requirements are essential for reducing integration burdens, accelerating development, and lowering maintenance costs. Panelists will describe how every closed integration represents a lost opportunity and will offer practical strategies for leveraging open technology as a competitive advantage that improves efficiency, ensures compliance, and strengthens patient trust.
Contact Lorre to have your resource listed.
Health and human services technology company VitalHub acquires patient flow software vendor Novari Health for $32 million. Canada-based VitalHub’s recent acquisitions include Induction Healthcare (patient engagement and virtual care), MedCurrent (clinical decision support), and Strata Health (care coordination).
PointClickCare promotes James Yersh to president.
Kumar Murukurthy, MBBS (Altais) joins Optimum Healthcare IT as chief clinical officer.
La Paz Regional Hospital (AZ) goes live on Meditech Expanse.
Lifepoint Health and Community Health Systems implements Cadence’s new Proactive Care Engine for Advanced Primary Care Management of Medicare patients.
Hannibal Regional Healthcare System (MO) will go live on Epic this week.
Black Book Research surveys clinicians to measure how their input shapes AI product design, using eight qualitative KPIs that are tied to workflow fit, usability, and trust. Top-scoring vendors are Epic, Signal 1, Aidoc, Suki AI, Notable, and Viz.ai.
A new KLAS report on EHR clinical optimization names Nordic and Chartis as the top-performing firms.
KLAS surveys 169 health system executives to understand how they are dealing with the uncertainty of federal policy, with the largest expected impact being cuts in Medicare and Medicaid. It concludes that financial pressures are forcing the organizations to “plan through the fog” by taking action now even without clear direction. A summary:
The New Jersey Department of Health and Department of Human Services works with RWJBarnabas Health and the New Jersey Health Information Network on a pilot project that automates the filing and creation of birth certificates via data exchange between hospital EHRs and the state’s Vital Statistics Birth Registry.
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CDC data chief announces departure from agency
CDC Chief Data Officer Alan Sim announces his departure from the agency after nearly five years in the role.
VitalHub Announces Acquisition of Novari Health Inc.
Health and human services technology company VitalHub acquires patient flow software vendor Novari Health for $32 million.
VA to reduce staff by nearly 30K by end of FY2025
The VA announces that it is on track to reduce its staff by 30,000 by the end of the year without the need for a reduction in force.
I’ve spent a lot of my career working on the “softer” side of clinical informatics, such as change management, governance, adoption, and optimization. Although I’ve implemented a couple of technologies in my career that have been dramatic, most of the time I’m working on projects that are a little more subtle.
I’m appreciative of projects like that when I have to gain buy-in from difficult stakeholders. When they don’t feel like you’re yanking the carpet out from under them, they are more likely to align with the goals and objectives. On the other hand, sometimes when projects are too low-key they’re not perceived as valuable. It’s a fine line that has to be walked.
I can’t even count the number of practices where I’ve helped implement EHRs over the years. I’ve worked with people ranging from those who have never used computers prior to the EHR to those who have been using them since birth.
In the early days of EHR, people used to talk about the “older” physicians being resistant. Fortunately, I had a good story to counter that after meeting a curmudgeonly colleague who informed me that he had been “advocating for electronic charting since long before you were born, young lady.” He and I actually competed for the first EHR-related role in our health system. I think he was a little grumpy that he didn’t get the position. I grew to appreciate his point of view as he pushed back on some of the things we were trying to do, because he always wanted to make things just a little bit better.
I’ve also worked with younger physicians who were incredibly resistant to adopting technology, particularly anything other than the one that they personally felt was the best. There’s nothing quite as entertaining as watching an Apple devotee argue with the IT team about how he absolutely, positively cannot use the PCs that are present in every shared workspace in the hospital. Folks like that were especially fun during the early days of “bring your own device” programs. They demanded to be able to use hardware that didn’t comply with the published standards.
I’ve worked with ER physicians who complained about how long it took them to do their charts, yet were found to be spending a good chunk of their day on the Zappos website.
These examples show how differing perspectives and experiences can have a tremendous impact on the success of a project. In turn, how those outcomes can ultimately influence the patient experience. When you have one physician in a practice who refuses to do the recommended workflow, it can cause extra work for the staff. It can also result in confusion and delays for patients who are waiting for their results or for a response from the physician.
I’ve long wondered what makes one person think a new solution is awesome and another one thinks it’s awful when they are doing the same work and caring for the same patients. An informatics colleague and I were talking about this over a recent round of cocktails. She brought up a recent study from the Proceedings of the National Academy of Sciences that looked at how different people perceive works of art.
Although I lived with an art history major for a number of years, I hadn’t heard of the concept of the “Beholder’s Share,” where a portion of a work of art is created by the memories and associations of the person viewing or experiencing it. I suppose it’s a more academic rendering of the idea that beauty is in the eye of the beholder.
The researchers behind the article employed high tech means to look at it, however, using functional MRI (fMRI) imaging to identify how people used their brains differently when viewing different types of art. Apparently abstract art results in more person-specific activity patterns, where realistic art delivers lass variable patterns. They also noted activity in different parts of the brain when looking at abstract art.
I’d love to see how different end user brains would react to differences in EHR screens and workflows. Maybe we could use that information to better predict how users will perform with different tools. Instead of looking at a subject’s brain activity while looking at a Mondrian painting, as the study did, we could see how their brains perform when confronted with different user interface paradigms.
I’ve seen EHR and clinical solution designs over the years that were jarring in color or layout. I’ve seen those that were so vanilla that nothing seemed to catch the user’s attention.
Another concept in the art world is that of shared taste. It explains why some groups of people prefer the same things, where others might find them objectionable. People typically know if they prefer art from classical times, the Renaissance, the Impressionists, or from abstract or modern artists, I would bet that we can create groupings around different types of clinical data visualization and how they can best be used in patient care.
Similarly, I would be interested to see if users who have certain sentiments about a given piece of technology can be grouped in a particular way, such as by specialty, user demographics, location, or tone of the program where they completed their training. Similar to the concept of precision medicine, I wonder if we could use that information to create precision training or a precision technology adoption curriculum that could help users adapt to new tools that end up in their workflows.
Even without the expense and risk of something like fMRI scans, I would bet that we could do a lot in clinical informatics to better understand our users and the learners with whom we are engaging. I’ve seen quite a few surveys that ask new employees about their experience with electronic documentation or technology in general, but they are fairly superficial. They usually have questions like, “Which of the following systems have you used?” with a list of vendor names. They don’t recognize if the user was on a heavily customized version or an out-of-the-box configuration. Most users wouldn’t know anyway unless they have experience behind the informatics curtain.
Institutions have come a long way recognizing different learning styles and whether people prefer classroom, asynchronous, or hybrid learning methods. I don’t doubt that the training and adoption efforts that we see today might be supplanted by other paradigms in the future.
Is the beauty of the EHR in the mind of the beholder, or is it something with which users simply have to cope? Is one platform more abstract than the other? Will we ever see an EHR with a classical sense of style? Leave a comment or email me.
Email Dr. Jayne.
England-based healthcare software vendor Agilio acquires Blue Stream Academy, which offers healthcare e-learning services.
The Villages Health Announces Strategic Restructuring and Agreement to be Acquired by CenterWell
The Villages Health, which offers healthcare services to the 150,000 residents of The Villages retirement community in Florida, files Chapter 11 bankruptcy and will sell itself to Humana’s CenterWell health services business.
Complete Family Medicine to launch Epic EHR System
Complete Family Medicine, a part of Hannibal Regional Healthcare System (MO), will implement Epic July 9.
Island Health lays off VP, ‘several’ executives, citing financial pressures
In Canada, Island Health lays off a number of executives amidst an organizational restructuring that has also eliminated IT positions related to the health system’s 300-site EHR implementation.
Symplr acquires the Smart Square staff scheduling system from AMN Healthcare for $75 million.
A majority of poll respondents attribute Best Buy’s exit from its Current Health business as being due to its underestimation of healthcare’s complexity.
New poll to your right or here: Will insurers follow through on their pledge to streamline prior authorization? My take: only if it makes them more money. What I expect:
July 22 (Tuesday) 1 ET. “Innovating the Consumer Experience Beyond the EMR with Open Standards.” Sponsor: Praia Health. Presenters: Ryan Howells, principal, Leavitt Partners and program manager, The CARIN Alliance; David LaBine, VP of software engineering, Providence Digital Innovation Group; Robin Monks, CTO, Praia Health; Kristen Valdes, CEO, b.well. As healthcare faces rising consumer expectations and tighter regulations, the high cost of maintaining fragmented, proprietary systems is no longer sustainable. While patient data access has improved, the lack of open standards continues to hinder innovation, drive up integration costs, and limit the potential of digital health beyond the EHR. This webinar will discuss how open standards like OIDC, HL7 FHIR, and open technology requirements are essential for reducing integration burdens, accelerating development, and lowering maintenance costs. Panelists will describe how every closed integration represents a lost opportunity and will offer practical strategies for leveraging open technology as a competitive advantage that improves efficiency, ensures compliance, and strengthens patient trust.
Contact Lorre to have your resource listed.
England-based healthcare software vendor Agilio acquires Blue Stream Academy, which offers healthcare e-learning services.
The Villages Health, which offers healthcare services to the 150,000 residents of The Villages retirement community in Florida, files Chapter 11 bankruptcy and will sell itself to Humana’s CenterWell health services business. TVH reportedly owes the federal government nearly $400 million in Medicare overpayments.
Franciscan Alliance promotes Joseph Schnecker, MD, MMM to CMIO.
I missed this earlier. Nebraska Medicine promotes Michael Ash, MD to CEO. Ash, who is also a pharmacist, was chief medical officer for Cerner for 11 years and chief transformation officer of the health system for eight years.
Researchers find that prescription costs for Medicare Advantage beneficiaries didn’t go down following implementation of a real-time prescription benefit tool.
OpenAI hires a forensic psychiatrist to assess the emotional impact of ChatGPT use. Mental health experts have raised concerns about people relying on AI as a therapist, pointing to cases in which chatbots were linked to mental breakdowns and suicides.
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I’m not a superfan of The Joint Commission, but I was interested to see their press release about partnering with the Coalition for Health AI (CHAI) to create AI best practices for the US healthcare system. The partnership plans to develop AI tools, playbooks, and it wouldn’t be The Joint Commission without a certification program as one of the offerings.
If anyone wants to lay odds on the cost of such a program, I’m happy to run the betting pool. Initial guidance will be issued in the fall, with AI certification to follow. I’ve done consulting work around patient-centered medical home recognition, EHR certification, and other compliance-type efforts, so I’ll be looking for the devil in the details as they are released.
As a primary care physician at heart, I’m sensitive to the multitude of recommendations that we give to our patients, often all at one time. For example, a patient who is newly diagnosed with diabetes may need to have labs drawn, see a diabetic educator, visit an ophthalmologist, consult with a podiatrist, and manage prescriptions from a retail pharmacy and a mail order pharmacy. Health systems are investing in solutions to reach patients via patient portal, text, interactive voice calls, paper mail, and email, which has resulted in patients being overwhelmed. I’m intrigued by Lirio’s concept of “Precision Nudging” (they have trademarked the term) to help manage this problem.
AI is involved via their large behavior model that aims to use elements of behavioral science along the way. It pulls together engagement and outcomes data with consumer understanding to identify the most appropriate channel to reach a given patient. Interventions are modified based on patient response and are tweaked along the way.
I have followed other companies like this over time, but Lirio seems to get it better than others, going beyond vague concepts like “wellness” and “engagement” to actually talk about specific screening programs and revenue-generating interventions that can boost patient quality and deliver a solid return on investment. They do have a bit of a revenue cycle background, so I’m sure that helps.
I was also geeked to learn that the company’s name actually has meaning rather than being something that either just sounded good or hadn’t been registered yet, as one commonly sees in younger companies. It’s actually named after Liriodendron tulipifera (the tulip tree), which apparently is the state tree of Tennessee. Props to the marketing team for its use of the phrase “lustrous branchlets” to describe the company’s strengths. This wordsmith salutes you.
Mr. H already mentioned this, but I wasn’t surprised to see that Best Buy has sold Current Health, returning the company to its former CEO and co-founder. A Best Buy executive said that growing its home care business has “been harder and taken longer to develop than we initially thought.”
I can understand that given the performance of their booth team at HIMSS25. On one of my booth crawls, my companions and I stood in their large booth for probably 5-7 minutes chatting before anyone approached us, despite there being multiple employees in the booth staring at their phones. I didn’t mind it too much because we were enjoying their extra-thick carpet, but if they were looking to capture leads, they were falling down on the job. Once a rep finally approached, the conversation was passable, but negative first impressions are hard to undo.
As much as I think I’m with it as far as keeping up with healthcare IT news and trends, I still rely on HIStalk for information on a regular basis. There’s always some tidbit that I haven’t gotten to yet, which is not surprising given the calamitous state of my inbox these days. HIStalk was the first place I learned about the new CMS prior authorization program for traditional Medicare. I’m all for catching bad actors, such as the durable medical equipment companies that cold-call patients offering knee braces and other questionable interventions, then rely on relatively clueless physicians who have rented out their medical licenses to enable a high-volume prescription mill situation.
However, I feel like the majority of physicians caring for our nation’s seniors aren’t committing fraud. They are negotiating the complex interplay between evidence-based medicine, the costs of various treatments, and patient beliefs and preferences. Sometimes the “best” treatment is unaffordable for a given patient, or you’re working with patients who can barely afford food, let alone their medications.
They’re going after specific procedures, including knee arthroscopy for arthritis, along with skin and tissue substitutes and nerve stimulator implants. You know what else would help reduce these unneeded procedures? Greater health literacy and patient education campaigns, which are parts of public health that we continue to neglect in this country. Hopefully the program will remain with these high-dollar, low-benefit procedures and won’t creep into primary care on the whole.
Given the amount of data that CMS has on every prescriber’s habits, they should be able to hire some clinical informatics folks to find those who are practicing inappropriately and go after them rather than putting processes in place that annoy those who are trying to do the right thing.
I recently had a rough travel day with significant delays. As I was waiting for my inbound aircraft to arrive, I noticed two fire trucks pull up on the tarmac. They did a quick test that I recognized as preparing to deliver a water salute. I’ve seen it for Honor Flights that were returning to the airport and for a pilot retirement.
Since the airport was small, I could see my inbound plane taxiing at a slow speed, which was unusual given the airline’s propensity to get planes to the gate quickly, especially after delays. A few minutes later, a Marine Corps Honor Guard arrived and I realized this flight was carrying a deceased service member. The waiting passengers in the terminal gradually fell silent and stood to show their respect, with hardly anyone moving until the transfer was complete. It was a sobering reminder that no matter how bad I felt my day was, steps away from me was a family that was having one of the worst days of their lives.
As we approach the Independence Day holiday, I’m grateful for everyone who has put on a uniform and sworn an oath to protect and defend our country. Freedom comes at a high price. Thank you to all current and former service members and their families for being willing to make that sacrifice.
Email Dr. Jayne.
Healthcare operations software vendor Symplr acquires AMN Healthcare’s Smart Square workforce scheduling software.
Feeling sick? Use ‘ChatGPT of the NHS’ first, patients to be told
England’s NHS will enhance its patient app with an AI-powered assistant called My Companion that helps users review their health information and explore care options.
Mayo Clinic’s AI tool identifies 9 dementia types, including Alzheimer’s, with one scan
Mayo Clinic researchers develop an AI tool that can identify the brain activity patterns of nine types of dementia, including Alzheimer’s disease, from a single PET scan.
England’s NHS will enhance its patient app with an AI-powered assistant called My Companion, which it describes as a “ChatGPT for the NHS,” that helps users review their health information and explore care options. A separate feature, My Choices, will let patients compare providers based on wait times, clinical outcomes, and satisfaction scores.
Duke Medicine Chief Health Information Officer Eric Poon, MD, MPH says that ambient scribing is being used in 70% of Duke’s primary care visits. He notes that the technology saves him two hours on his own clinic days and admits that he hadn’t realized how much of his focus had been consumed by acting as a “courtroom transcriptionist.”
China-based Ant Group launches AQ, an AI app that lets users consult with AI avatars of real physicians before receiving priority access to care scheduling. The company says that AQ stands for “answer your question,” an English-focused name that suggests plans for a wider rollout. Ant, which is affiliated with Alibaba, operates Alipay, one of the country’s two major mobile payment systems. The company is increasingly focused on offering health-related services that it says are used by 800 million people.
CMS announces WISeR, a pilot project that will use technologies such as AI to expedite Medicare prior authorization for services that are vulnerable to fraud, waste, or inappropriate use.
Sweden-based startup Tandem Health raises $50 million in a Series A funding round to further develop its Europe-focused ambient documentation system.
Website protection vendor Cloudflare is testing a pay-per-crawl system that allows content owners to either block AI training web crawlers entirely or charge them a fee for access.
AI-powered drug discovery and design advances from theoretical to actual, as an AI-designed drug reaches phase 2a clinical trials. Rentosertib shows safety and efficacy in the treatment of idiopathic pulmonary fibrosis. AI was also used to generate the target before designing the molecule itself.
Mayo Clinic researchers develop an AI tool that can identify the brain activity patterns of nine types of dementia, including Alzheimer’s disease, from a single PET scan.
Bioinformatics researchers at Vanderbilt University Medical Center find that rural US medical centers face significant barriers to adopting AI. They conclude that limited data availability, lack of infrastructure, and inadequate staffing could create an AI divide between urban and rural hospitals that can be addressed through research, partnerships, and policies.
People are seeking advice from ChatGPT on how to inject themselves with facial filler at home to puff up their lips and cheeks.
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RCM technology vendor VisiQuate acquires Etyon, whose technology optimizes revenue cycle workflows.
More than 300 employees cut in Sharp HealthCare layoffs
Sharp HealthCare (CA) lays off 315 employees, with several media outlets reporting IT staff among those affected.
Nordic Capital partners with Arcadia to drive data-focused healthcare innovation
Nordic Capital takes a majority stake in health data insights vendor Arcadia.
RCM technology vendor VisiQuate acquires Etyon, whose technology optimizes revenue cycle workflows.
From Dark Daze: “Re: Sharp HealthCare. Cut 315 FTEs yesterday, 150 of them from IT, which is a 25% haircut.” Unverified, although the local TV station reports that IT was one of the departments affected and Redditors claim that IT was the hardest-hit area.
From Isthmus: “Re: Sharp HealthCare. Laid off most of their Epic IT staff with plans to have their Epic system supported by a third party.” Unverified.
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Premier acquires IllumiCare, which adds a financial component to clinical decision support, and will market it under its Stanson Health brand.
Ralph Porpora (Grand View Health) joins Deborah Heart and Lung Center (NJ) as VP of IS/CIO.
Pager Health names Ken Yamaguchi, MD (Northwestern University’s Feinberg School of Medicine) chief medical officer.
BayCare (FL) names Patrick Brown, MD (Centra Health) VP/CMIO and Philip Karp, MS (NYU Langone Health) VP/CTO.
Medical error prevention pioneer Lucian Leape, MD died Monday at 94. He was involved in the Harvard study that resulted in the landmark 1999 report “To Err Is Human: Building a Safer Health System.”
Spartanburg Regional Healthcare System (SC) implements precision medicine technologies from 2bPrecise.
Microsoft’s AI team claims that one of the company’s diagnostic tools can outperform physicians in solving the toughest cases, correctly identifying 85% of 304 real-world cases that had been published weekly in the New England Journal of Medicine, four times the success rate of doctors. This is an interesting test, with these caveats:
CMS approves Eko Health’s Sensora digital stethoscopes cardiac algorithm for payment under the Hospital Outpatient Prospective Payment system.
The Washington Post provides details from court documents of the federal government’s Operation Gold Rush, a massive fraud takedown where Medicare was billed $10.6 billion for medical devices that were not medically necessary or actually delivered to patients:
Central Maine Healthcare restores its IT systems and resumes normal operations after a June 1 cyberattack forced it to downtime procedures.
In South Africa, the Gauteng health department denies reports that a hospital morgue was backed up with two weeks’ worth of bodies because it couldn’t print death certificates due to a shortage of printer cartridges.
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Premier, Inc. Expands Clinical Decision Support (CDS) Capabilities with Acquisition of IllumiCare
Premier, Inc. acquires IllumiCare, which adds a financial component to clinical decision support, and will market it under its Stanson Health brand.
NHS will use AI in warning system to catch potential safety scandals early
England’s NHS will deploy an AI-powered early warning system that will analyze near real-time data to look for patterns of problems that will trigger urgent inspections.
Steward Health Plans Litigation to Unwind Transfers to Cerberus, Other Insiders
An investigation by the bankrupt Steward Health Care System finds that its former private equity owner and former executive Ralph de la Torre improperly extracted $1 billion from the hospital chain during its insolvency.
The Journal of Graduate Medical Education published a thought-provoking article this week titled “A Eulogy for the Primary Care Physician.” It reflects on the original purpose of a primary care physician as the trusted physician “who knows their health inside and out, who guides them through the complexities of the medical system, and who fosters relationships not with charts, but with people.”
This is exactly the kind of old-timey family physician that many of my peers and I thought we would become. That’s what we were trained to be during our residency programs. Little did we know that the forces that would actually align against our being able to do that.
First, there were the turf wars. I was trained to perform a variety of procedures during residency, including minor office-based surgeries, biopsies, wound management and repair, and sigmoidoscopy. I was also trained to deliver prenatal care and perform non-operative deliveries in partnership with local OB/GYNs who served as backup.
I quickly found that I wasn’t able to do most of those things in my hospital-sponsored practice. Family physicians weren’t allowed obstetric privileges, full stop, even if we had an OB/GYN who agreed to back us up. One of the hospitals where I was forced to be on staff didn’t even have obstetrics, which somewhat limited my ability to recruit newborns to the practice.
After six months of appeals, I was allowed to seek newborn nursery privileges at a competitor hospital in an attempt to maintain that part of my skillset, although caring for infants became increasingly rare.
Second was the pressure for primary care to support the volumes of all of the other specialties. If there was a procedure to be had, I was expected to send those patients to my proceduralist colleagues so that they would have adequate volumes.
Numerous procedures can be done by appropriately trained primary care physicians in a high-quality and cost effective manner. However, I was told that it was unseemly to hoard those procedures, and I needed to refer them out and show that I was a team player. It didn’t matter that patients would prefer not having to make a second appointment, take off work again, or pay a second co-pay.
The only thing I was able to hang onto were the skin biopsies, because I could do them relatively quickly and they didn’t have a significant supply need or cost therefore they were somewhat “invisible” to the medical group administrators who actually ran the show.
There were a hundred other things that steered my work as a family physician in a different direction from what I thought it would be. When I was offered the opportunity to work with the electronic health record project, I jumped at it. Maybe that would be the answer to regaining autonomy since I would be able to run reports and see data on my work without external support. Previously, I had to rely on the business office to do so via our green-screen practice management system.
Because of my protected time to work with the EHR, I was somewhat buffered by the pressures to constantly see more patients, although I was still juggling dozens of patient messages and requests on the days when I wasn’t in the office. In hindsight, I probably worked 1.25 FTEs during that time, despite being paid as a 1.0 FTE, but I was the only person in my position and I didn’t know how to push back given the pressures that were on the other primary care physicians in my group and which seemed worse at the time.
Although the Eulogy article cites burnout, declining reimbursement, and private equity as significant contributors to the demise of the primary care physician, I would add other elements. The consumerization of healthcare continues to be a major force, as physicians are incentivized around patient satisfaction, sometimes to the detriment of quality of care.
As an example, two areas on which physicians are incentivized are patient satisfaction and avoidance of unnecessary antibiotics. For every patient who calls wanting a Z-Pak for what is undoubtedly a viral illness but who “wants to get ahead of it” or says “I know my body and what I need,” there is only a lose-lose situation. I’ve been roasted via online review sites for refusing to call in antibiotics without seeing a patient. I’ve been threatened with complaints to the state board. I’ve been ripped in Press Ganey surveys.
My quality numbers remained high, but when you get bad reviews (justified or not), your paycheck suffers. Physicians should not be placed in these crosshairs, but we do it every day. I know it’s the proverbial dead horse, but educating patients about the risks of unwarranted antibiotic prescriptions is another public health intervention at which we’re not very good.
When I had the opportunity to expand my informatics work and change to a different environment for patient care, it was bittersweet. Although I missed the regular “continuity” patients with whom I had bonded over five years, I was glad to get out from under all the patient portal messages and communications that didn’t stop while I was out implementing the EHR, training peers who refused to work with non-physician trainers, and trying to figure out our group’s strategy for health information exchange.
I thought that would be the death of my career as a primary care physician, but little did I know that once I started working in the emergency department and urgent care settings, more than half of my work would be primary care anyway, since many of our community used those environments for their primary care services.
The Eulogy states, “The PCP is survived by the independent physician assistant, nurse practitioner, and generative artificial intelligence.” As someone who is starting to have more encounters with the patient side of the healthcare system than I would like, I worry quite seriously about how my generation will be cared for in the future.
Every time I see my own primary care physician, who is a few years older than I am, I don’t leave without asking the question of when he sees himself retiring so that I’m not caught in the lurch. Fortunately, most of my subspecialist physicians are younger than I am, so I’m less worried in those areas.
With regard to generative AI replacing primary care, I think we have many years of it augmenting rather than replacing. I’ve been unimpressed by many of the solutions that I’ve seen. I hope clinicians remain skeptical as developers work through issues with quality.
What do you think about the death of primary care in the US and how healthcare information technology might be able to resurrect it? Leave a comment or email me.
Email Dr. Jayne.
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I dont think anything will change until Dr Jayne and others take my approach of naming names, including how much…