This episode is brought to you by r one RCM, a leading provider of technology driven solutions that transform the financial performance of hospitals, health systems, and medical groups. R one delivers proven, scalable operating models that power sustainable improvements to net patient revenue while reducing operating costs. To learn how you can transform your revenue cycle performance, visit us at www.ronercm.com/becchers. Hello, and welcome to the Becker's Healthcare podcast. My name is Will Riley from r one RCM. I'm joined today by Reuben Azekar. Reuben is VP for perioperative services at Beth Israel Deaconess Medical Center in Boston. Welcome to the podcast, Ruben. Good morning, and thank you for the kind invitation. Ruben, let's start, please, by learning a little bit more about you and tell us about Beth Israel. Well, I'm originally from Venezuela, and, I came to train at the states in the mid nineties. And, clinically, I'm anesthesiologist and critical care physician. And, I was prior to my arrival at the Beth Israel Deaconess, I was the chairman of the anesthesia department at Tufts Medical Center, just a mile away from the Beth Israel Deaconess Medical Center. The Beth Israel Deaconess, it's one of our tertiary quaternary academic medical centers affiliated to Harvard, and we're really looking for excellence in all the domains that relate to medicine. Patient care, education, research, but also more and more having a deep understanding and work hard to, financial stability on these difficult times in health care. Excellent. Thank you for that introduction. I'm looking forward to exploring some of the big trends shaping how health care providers are thinking about the years ahead with you, and getting your perspective on them. Right. So the the first one I'd like to talk about is cybersecurity. It's a topic that's been in the news a lot in 2024. From your vantage point, how do you think about cybersecurity? Well, definitely a big risk in health care, not only, because they can have access to your institution data, but to your patient's data. Also, it will affect your reputation as well. So it's a really, big risk that exist, and, we had to be prepared, to to prevent those things and also be prepared to respond if things were not to go the right way. And, the way to do that is probably have a continuous assessment of the risk, especially nowadays when you have updates of your different programs that might be opportunities to that. So have a very clear understanding of the risk that you might be facing, on that area. And, also, decide if you need to invest more on that. The ROI might not be tangible because it's risk, not a Mhmm. Revenue driven situation. And and lastly, I think very important is to educate the staff. I used to travel with my work computer. I stopped doing that. Mhmm. You know, I make sure people don't open emails that they don't recognize, because of phishing scare. So it is key. It's cardinal to have educational staff to understand the risk that they're placing themselves, their patients, and the institution. Yeah. Yeah. Yeah. Excellent. It starts with just on the ground awareness and common sense. Correct. Yeah. Yeah. Let's talk about another big area of focus for health care, artificial intelligence. I'm curious how are you looking at artificial intelligence in the work that you do? And in particular, perhaps, how are you thinking about managing some of the risks and potential, pitfalls of using the technology? Well, I I think, artificial intelligence is here to stay, and there are many domains on health care, where you can think about UCEDD. You know? From the clinical perspective, the whole area of diagnostics, is one that, you know, has impacted physicians and patients and institutions. If you look at the revenue cycle, you know, AI can help you detect, ahead of time where claims may be denied and help you, assess that, you know, in a prompt way. It can help you, predict your revenue cycle, and analyze your revenue cycle pitfalls, and also even, you know, predict the revenue with you know, on a more dynamic, real time that retrospective review as we currently do. Mhmm. So I think, and, again, in many, many domains, and I only mentioned 2, artificial intelligence is here to stay. It will not replace the humans, but definitely will help us. Yeah. Are you using it in the perioperative domain, very actively? We are, we just implemented Epic this year. Mhmm. And, we are looking to have a platform to help us, with our operating room utilization, because there is again, the human being can only see so much ahead. But with AI, we probably see trends and see changes and also create kettles, where allow us to minimize, loss of time in the operator room, and also maximize access to the surgeons. It seems like that's an area in which the technology has really strong potential for improving efficiency and throughput. It is. It is. And, and, again, you know, I I could see, our prior, director scheduling who had been at the at the Beth Israel for almost 50 years. She had a set of, stick pads on her computer trying to figure out how to do the schedule. And now if we get something that can do it for us on a more faster dynamic in a smart way, you know, that would be great. Yes. Yes. And is that just digging into that a little bit more, is that, you know, an EMR based solution? Are you working with other partners? How do you how do you think about that? So Epic does have, a very basic platform, but we're considering, inviting vendor vendors. We put a hold because the whole Epic implementation, took all our IT resources, but we are exploring the possibility of doing this. And I have spoken with vendors in the past, and we probably we invite them again. Yeah. Okay. You mentioned, revenue cycle earlier on, as an area where AI can potentially add some value. One of the trends the 3rd trend that we want to talk about is around the payer dynamic. We've seen that become really quite challenging for many health systems over the last couple of years with increasing denial rates. Got it. Request for prior authorizations and and so on. Firstly, perhaps, how is that playing out in your world? Yeah. We we're seeing an increase on challenges with reimbursement. Probably the one I will mention would be the Medicare Advantage Programs have have become more complex to deal with. And, so and I think something with AI, could help us detect where would be the things that those payers will deny the claim on and react proactively and avoid that mistake, you know, if it is on our initial claim. Also, if the claim is denied, you know, probably I can help us understand, you know, or AI with, machine learning will start learning how or to what trends or what things are happening to have those claims denied. And, so I think that, and also give us introspection. How can we do better? Right? Because, we're only human again. Also, I I think AI in terms of, predicting your reimbursement projecting it forward instead of retrospectively based on trends that the machine may be seeing and, maybe something that is helpful in the future. Yeah. Yeah. Okay. Perfect. Let's talk about the regulatory environment. What does that look like for you, and how are you navigating that at the moment? We're we're happy that, we have our preannual review coming up with the joint commission, so we're all in preparation. Mhmm. But, yes, you know, every soft and and at times many times during the year, there'll be a new regulation coming our way. And, you know, a lot of times, you know, the initial reaction is not to react to it or, you know, put on a side. But I think the the proper reaction is to have make sure you're compliant at all times. And, at the Beth Israel, we have an excellent, cross team, that goes from legal, regulatory, clinical, and other areas of the hospital that work together and, analyzes, discusses, and implement action when these regulations come. Mhmm. And going back to kind of the first question we had, and then education is key. Mhmm. Right? Because at the end, when the joint commission shows up, they're gonna be talking to our staff. Mhmm. So that, you know, that multidisciplinary cross team can create, all the policies they want. But if those are not known and understand by the people on the front lines, at the time of the regulation, you you might face problems. How do you, I mean, how do you do that? How do you Yeah. Make make that really stick and work? I I think a little bit is a bit reactive because now we we know that your commission is coming. Right? And Mhmm. We implemented Epic, and a lot of our workflows have changed, and new poll probably have been modified. So now we are first making sure everything on paper looks good. And then it's a matter of, you know, go area by the area and highlight what are the aspects that would affect them, with these changes on the policies or changes in regulation to be sure they're prepared when the business come. Got it. Thank you. Let's end with a question about 2025. I'm curious about, partnerships, alliances, or ecosystem strategies that you're thinking about to help you expand or serve your patients better? Yeah. I I I think at at this point where we are looking, it's, internally is how to improve our finances. You know, that's a phrase that may be commonplace and, you know, hear hear many times that is no money, no mission. Uh-huh. So we want to keep, our hospital providing outstanding care to our patients. If we wanna keep providing the best education for our students, residents, and fellows, if we wanna keep doing, world class research, we need to make sure our finances are solid. So I think, what we're looking into is how to manage our operational expenses better. Mhmm. And that has different angles. In the operating room, we're looking at, higher efficiency. Also, I think programs that improve patient care might require an investment of time and sometimes money. But if you provide better care to your patient, that will help because you might decrease length of state. You might decrease readmissions. It might decrease complications. So it's good for the patients, but, ultimately, might pay us for us to, provide that better value based care while also keeping the balling up. So that balance and, so I think that's our our our this year, that's what we're doing, on how we can provide keep providing outstanding care, but at the same time, be more mindful of our operational expenses, our efficiency, so that we can do what we do and fulfill the mission of the hospital. Excellent. Ruben, thank you so much for sharing your thoughts with us today. Oh, it it was a pleasure. Thank you very much. Thank you.