Category: 2024

Artificial Intellegence

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BY KATHRYN RUSCITTO, ADVISOR

We are planning a Heritage trip and have spent hours doing research. My daughter pulled up Chat GPT, gave it a few directions and in 30 seconds it listed an itinerary, things to visit, and lots of other info for consideration.

In a moment it became clear to me how Artificial Intelligence can augment my work. I still had to decide who, what, where, and when, but AI took the data that exists, boiled it down and gave me options to start with. It saved time, and while not perfect, gave me info I had not looked at prior.

Can AI do the same thing in health care? From chronic illness , to assisting in the development of new devices and drugs, can AI supplement clinicians work flow? Can it review charts and data, predict at risk patients, and match patients to treatments?

The current use of AI in some phone processes, has proven to be a barrier when a question did not fit the algorithms. In time, those early designs will be improved. For AI to work in health care, it needs to be integrated into clinician workflows, not added as yet another step. The debate about AI replacing human decisions is concerning and deserves consideration. But more likely it will free the workforce from analytical tasks and move to higher level thinking. In addition, other concerns relate to the bias of the data. But the advancement of AI will likely be similar to the integration of computers, smart phones and laptops into our daily lives. They didn’t replace humans, but a human without a smart phone or laptop does not have the advantages in easily accessing info and education. If AI can improve care for patients, by adding to the analytical knowledge of clinicians in an era of accelerated information and inventions, it will advance care.

I looked for some examples where AI is integrated in health care and found specialists are using AI in nephrology and cancer treatments. “Penny” at UPenn is helping clinicians with complex patients between visits, “The technology has the potential to improve patient health by guiding them through complex medication schedules, keeping clinicians routinely updated about a patient’s condition, and enabling clinicians to step in at early signs of trouble.” h t t p s : / / w w w. a a m c . o r g / n e w s / how-ai-helping-doctors communicate- patients.

Additionally there are many applications already in use for detecting disease through programs that analyze bacteria, and other disease criteria to lead to diagnosis and treatment in radiology, pathology and cancer treatments.

For clinicians to be comfortable with machine learning, or language learning that reads patient records and integrates info to recommend treatment, they will want a clear understanding of the quality of the ap’s learning. Also, it’s track record in making accurate diagnosis, and their ability to integrate their own clinical history and knowledge. The AMA cautions clinicians about bias and inaccuracy in todays AI algorithms, but notes it will continue to improve and tomorrows physicians will see a reduction in paperwork burden and back room operations from chart reviews to billing. https://www.ama assn.org/practice management/ digital/why generative-ai-chatgpt cannot- replace-physicians

In the past 100 years we have moved from an agrarian society, to an industrial society, to an age of information. We have now entered what is being called the age of knowledge, or the creative age. Understanding AI’s potential is our best advantage to adapting it in applications for health care.

Resources: https://www.jnj.com/inno ation/artificial-intelligence- in-healthcare &utm_source=goog

AI Won’t Replace Humans https://hbr.org/2023/08/a -wont-replace-humans- but-humans-with-ai-will replace-humans- without-ai

The Current State of AI in Healthcare: https://healthtechmagazin .net/article/2022/12/ ai-healthcare-2023-ml-nlp more-perfco

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynru citto or at krusct@gmail.com

 

Corporate Transparency Act

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On January 1, 2024, a new federal law, the Corporate Transparency Act (“CTA”), will go into effect. The main purpose of the CTA is to crack down on the proliferation of shell companies used as shields in money laundering, tax avoidance, and similar activities. However, the new reporting requirements will also compel most businesses created by filing documents with the Secretary of State to provide the information outlined in the CTA. Any business entity that must report to FinCEN is called a “reporting company” in the language of the CTA. The information will have to be reported to the Financial Crime Enforcement Network (“FinCEN”), which is part of the Department of Treasury.

There are three main parts to the new reporting requirements: beneficial ownership information (“BOI”), company applicants, and information about the reporting company itself. Reporting companies must submit the information of everyone possessing beneficial ownership. A beneficial owner is defined in the CTA as an “individual who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, exercises substantial control over the entity, or owns or controls 25 percent or more of the ownership interests of the entity or receives substantial economic benefits from the assets of the entity.1” While owning or controlling over 25 percent of the business entity is fairly straightforward, the definition of “substantial control” is less obvious. Within the CTA, the definition of substantial control is expansive. It includes, but is not limited to, any senior officers of the company, persons having authority over the appointment or removal of any senior officer or a majority of board members, persons who direct or have substantial influence over important decisions made by the entity or have control over an intermediary entity that exercises substantial control over a reporting company. Since the definition of a beneficial owner is expansive, careful consideration will have to be given to make sure everyone who meets the definition of a beneficial owner has their BOI entered into the FinCEN site.

A “company applicant” is the individual who files the application with the Secretary of State and, in addition, the person who directs or controls the filing if more than one individual is involved. However, at least at this point in time, there can only be two company applicants. The company applicants might not be anyone who works  for or controls the reporting company in question. The company applicant could, for instance, be the lawyer and paralegal hired to help bring the entity into existence. The company applicant information will only have to be submitted once.

The reporting company will need to disclose its 1) legal name, 2) DBA names, 3) business address, 4) state of formation, and 5) Taxpayer Identification Number. The beneficial owners of the reporting company will have to disclose their 1) legal name, 2) date of birth, 3) residential address, 4) unique number from an acceptable document such as a U.S. passport, state ID, or driver’s license, and 5) an image of that document.

The company applicants will need to disclose the same information as the beneficial owners with one potential difference: if the company applicant is registering the company in the course of the applicant’s business, such as lawyers, paralegals, or others, then the business address of the law firm will be substituted for the residential address. Also, the company applicant information will be required only for business entities that are formed on or after Jan. 1, 2024. The BOI will be required of all entities that are reporting companies regardless of their date of formation.

Businesses already in existence on Jan. 1, 2024, will have one year to file an initial report. For Businesses formed on or after Jan. 1, 2024, and before Jan. 1, 2025, an initial report must be provided to FinCEN within ninety days of formation. On and after Jan. 1, 2025, businesses will have to submit the required information within thirty days of formation. Another thing to note is that changes in beneficial ownership will need to be filed. Any changes in ownership or changes in organizational structure will require subsequent filings to keep the BOI up-to-date. Certain businesses are exempt from the reporting requirement, but most of these businesses are those in heavily regulated areas of finance. Otherwise, the important exemption to note is the “large operating company.” To qualify as such, a company needs 1) more than 20 full-time employees, 2) more than 5 million dollars in gross receipts/sales in the US, and 3) a commercial, physical street address in the US. All three of these elements must be met. For example, a business that]  operates online with no commercial, physical street address will not qualify for the exemption even if it has more than 20 employees and over 5 million dollars in gross receipts or sales. The other exemptions will be listed at the end of this post. While this legislation has mostly flown under the radar and might come as a surprise to many business owners, there is still time to prepare the necessary information. CCBLaw is here to help answer any questions and assist your business to ensure compliance with the CTA. In the meantime, to avoid potential civil and criminal penalties, entities that will qualify as reporting companies should make determinations as to who will be considered a beneficial owner under the CTA and gather the necessary information to submit to the FinCEN portal once it is active. Importantly, reporting companies will also want to consider who will have the responsibility of updating any changes in BOI to FinCEN because, as addressed above, as beneficial ownership changes, BOI is required to be updated within 30 days of any such change.

More links:
FinCEN website Small Entity Compliance Guide FinCEN contact page

Benjamin Goldberg is an associate at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6214 or bgoldberg@ccblaw.com.

 

Physician Burnout A Healthcare Crisis Impacting Quality Of Care And Driving Medical Errors

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Although physician burnout is not a new phenomenon, it has been put in the spotlight recently due to its rise in frequency. A 2021 survey by the Mayo Clinic and Stanford Medicine noted that 62.8% of physicians experienced symptoms of burnout, up from 38% in the previous year.

While the crisis of COVID has dissipated and was a leading stressor, one could argue the effects are still lingering. For one, the continued questioning of science and proliferation of misinformation around medicine in general has created a rift in the physician-patient relationship. Additionally, physicians often point to the administrative obstacles brought on by changing governmental requirements as a key component to their increase in job dissatisfaction. The AMA
recently spoke out on the topic of prior authorization, noting it as an antiquated system that must be reformed and a key point of frustration for doctors.

Burnout can occur in any workplace, but for physicians and health networks, its impact on patient safety sparks a need for additional concern. For some time, the focus on patient safety has been placed on a system approach, but this ignores a key component. While putting these systems in place has clearly shown to be beneficial, one could argue these benefits are derailed by overwhelmed providers suffering the fatigue of burnout.

Dr. Daniel Tawfik, a lead author of a study published in the Mayo Clinic Proceedings, looked at systems versus physician burnout in contributing to errors. What he found was “…rates of medical errors tripled in medical work units, even those ranked as extremely safe if physicians working on that unit had high levels of burnout. “The correlation between physician burnout and potential errors is not surprising, and with the significant increase in physicians reporting struggles as noted above, we must support physicians in the functions of their daily practice to make an impact on decreasing medical errors. We all have a personal stake in setting up the structures to support our physicians, as the impact goes beyond staffing or financial concern, and to the heart of the quality of care goal that every provider and health system strives for daily. It is incumbent on administrators to encourage an open dialogue on mental health that supports colleagues checking in with each other. These efforts must go beyond a pat on the back, to a review of the systems in place cultivating the accelerated rates of burnout.

Multiple pain points contributed to the issue at hand that must be addressed. Solving this requires actions from the government, insurance carriers, the tech sector, and health systems to change workflow responsibilities, increase reimbursement, and eliminate redundant administrative tasks, allowing physicians to do what they are trained to do. The first thing we must do is listen to what our providers are telling us they need. I believe Jack Resineck, Jr., MD, former President of the AMA, said it best in speaking out for his fellow colleagues: “Physicians haven’t lost the will to do our jobs – we are just frustrated that our health care system is putting too many obstacles in the way.” This is a fixable problem that cannot be ignored.

Connect with Jenn Negley, Vice President, National Healthcare Practice at Risk Strategies at 267-251-2233 or jnegley@ risk-strategies.com