Apr 03rd 2020

How Artificial Intelligence Can Make Hospital Administration More Efficient

The role of artificial intelligence (AI) is moving from a novelty to a necessity in the healthcare arsenal. Many healthcare organizations see the value of AI for a variety of applications, from support of better clinical decision-making to improving operational efficiencies to extracting key meaning and insights buried in big data files.

In a recent Market Insights report, the American Hospital Association said that within 5 years, the application of AI technologies will markedly change how work is done inside forward-looking hospitals. In addition, research by HIMSS Media shows that 59% of healthcare organizations are or will be leveraging AI specifically for resolving operational inefficiencies, and 48% for optimizing administrative and clinical workflows.

With revenue margins for hospitals expected to tighten even further, achieving administrative and operational efficiency is more important than ever. The capabilities of AI-powered tools and AI-enhanced robotic process automation can enhance productivity, reduce errors, improve operational and clinical efficiency, and reduce operating costs for hospitals and healthcare practices. 

Automating repetitive tasks


The Brookings Institution estimates that 40% of tasks performed by healthcare support staff and 33% of tasks performed by healthcare practitioners have the potential to be automated.

For example, robotic process automation (RPA)—software robots that have machine-learning capabilities—can be used to automate functions ranging from admissions to billing. And natural language processing (NLP)—a branch of AI that helps computers understand and process human language—can automate workflows for administrative documentation, including the creation of transcripts and patient-case summaries. 

Top uses of AI in healthcare administration


Accenture predicts that the healthcare AI market will grow more than tenfold between 2014 and 2021, from $600 million to $6.6 billion. Within that, administrative workflow assistance is a top-third application (valued at $18 billion by 2026). 

AI can make administrative workflows more efficient in areas such as:

Prior authorization: A recent survey of healthcare executives identified automation of prior authorizations as the AI application with the most potential. Considering that 88% of physicians report this administrative burden increasing in the last 5 years—it stands to reason that healthcare administrators target this area as a top priority.

The tasks involved in prior authorization include:

·       Identifying the patient’s health plan as well as medical and drug benefits

·       Identifying exactly which services or medications require prior authorization for each patient’s individual health plan benefits

·       Collecting and providing documentation—such as patient history, referral information, and medical necessity justification—for approval.

Most hospitals and providers are dealing multiple prior authorizations each day. Many of these steps could be automated with AI-fueled RPA and NLP.

Billing and claims processing: Handling claims is costly and time-consuming. The Center for American Progress estimates that billing and insurance-related costs make up 13% of physician-care spending and 8.5% of hospital-care spending. Denied claims are also expensive, with some estimates showing a price tag of $118 per claim

Using RPA to enter, process, and adjust claims both streamlines the process and makes it more reliable. EY has found that in the insurance industry overall, RPA can reduce turnaround time for routine claims by as much as 85%, while eliminating as much as 70% of repetitive tasks. Additionally, NLP is well-suited for processes such as converting physicians' notes into standardized codes.

Provider productivity: The back office is not the only one burdened by administrative tasks. Documenting chart notes and patient summaries, writing testing orders and prescriptions, and similar responsibilities in increasingly complex electronic health record systems take providers away from direct patient care. 

AI shows promise in making providers more productive by eliminating those types of manual tasks. Accenture estimated that administrative workflow assistance can result in 51% of time savings for nurses and 17% for physicians. Using AI to boost productivity not only improves patient care but also makes providers more efficient and cuts administrative costs.

AI is a smart investment for healthcare organizations


Healthcare is in the early stages of exploring the applications and benefits of AI, both for patient care and back-office operations. The industry has worked diligently to digitally capture data; now the next step is to use that data intelligently to improve outcomes.