It’s a bit sad that there’s nothing in this post about actually wanting to improve patient care, but instead make money for hospitals and “enhance metrics.”
It's called upcoding. It's been happening with or without AI or SV's help for well over 40 years. [0]
Interestingly, whistleblowers can recoup a big chunk of the recovered funds in a False Claims Act suit when medical providers do this to defraud Medicaid / Medicare [1]. Could be a lucrative long-term play if you get employed at a company whose sole purpose is helping hospital chains bill for care that an AI thinks may have been provided.
American healthcare in a nutshell. All of these startups in the healthcare industry focusing on "upcoding", "dealing with insurance" would go bust if private health insurance no longer existed or at least existed in a much much smaller role.
I can relate to this reaction for a variety of startups. I still am interested in working for these light mission or neutral mission startups, rather than crypto or something empty, but I wish we had a lot of deep mission startups to choose from. I blame the diluted mission problem on VC + hypergrowth. If more startups could focus on less aggressive capital and growth goals and let the founders dream more, I think we would all be more excited.
Our models don't only suggest up-coding possibilities, but also chart quality improvements! As a result, patient's charts become more accurate, allowing for potentially better patient care in subsequent visits.
Also, the hospitals being able to bill more accurately allows them to have more resources to invest in patient care, and when you consider that a lot of hospitals operate on 1-3% profit margins while health insurance companies operate on a sometimes exponentially higher %, it's actually one of my favorite aspects of what we're building here.
dangerlibrary|10 months ago
Interestingly, whistleblowers can recoup a big chunk of the recovered funds in a False Claims Act suit when medical providers do this to defraud Medicaid / Medicare [1]. Could be a lucrative long-term play if you get employed at a company whose sole purpose is helping hospital chains bill for care that an AI thinks may have been provided.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10759668/ [1] https://en.wikipedia.org/wiki/False_Claims_Act_of_1863
xyst|10 months ago
unknown|10 months ago
[deleted]
aloof8723|10 months ago
justin_sdx|10 months ago
Also, the hospitals being able to bill more accurately allows them to have more resources to invest in patient care, and when you consider that a lot of hospitals operate on 1-3% profit margins while health insurance companies operate on a sometimes exponentially higher %, it's actually one of my favorite aspects of what we're building here.
To each their own though ¯\_(ツ)_/¯
dogtorwoof|10 months ago
numeromancer|10 months ago