Leveraging AI For Surgery In A World Dominated By Others

Mar 30, 2024 | by Brad Bichey

If AI is rapidly transforming many sectors of our economy…

why is it not revolutionizing surgery?

I had this question raised to me at the Health 2.0 Conference held recently in Las Vegas. In reality, where it is correctly applied, Artificial Intelligence (AI) has indeed been transforming the surgical marketplace for years.

How has AI transformed patient search, influenced consumers, and disrupted prior authorizations?

Patient search and the growth of consumerism:

The efficacy of artificial intelligence (AI) in surgery is a nuanced subject, recognizing that AI has indeed been transformative for certain sectors that have adeptly integrated it into their operations. Over the past five years, AI’s application has become ubiquitous with large corporations like Google. Not only has AI influenced our daily interactions on the internet, but many patients who use social media for medical knowledge are influenced by algorithms that are predominantly AI-driven.

The COVID-19 pandemic accelerated the digital migration of patients away from phones and traditional referrals, marking a significant shift in how healthcare services are accessed and delivered. The majority of patient journeys now commence online, influenced heavily by AI, which has been instrumental in refining search algorithms to provide personalized and optimized online experiences.

Better search is one goal of Google. Another is optimizing charges for its services and ads, as these are its primary source of revenue. AI with its technological leverage has not only enhanced user engagement but has also been a significant driver of revenue growth for search engines in general, particularly in the context of healthcare search optimization.

Major insurance companies have secretly been using AI for years:

Unfortunately, the adoption and understanding of AI’s potential within the healthcare sector, especially among physicians and healthcare executives, remains limited. Unbeknownst to many, major insurance companies have been leveraging AI for several years to streamline their operations, particularly in the processing of surgical claims.

The conventional practice of manual review of surgical notes for prior authorizations has largely been supplanted by AI-driven scoring systems, designed to assess and determine the approval of claims with high efficiency.

There have been problems:

This shift was highlighted by recent incidents, such as Cigna’s notable denial of over 300,000 claims in an exceedingly short timeframe. This unfortunate lack of transparency has given insurers an advantage, increased profits, made it harder for patients to obtain care, and increased provider burnout.

Cigna is being sued over its insurance claims algorithm.CORBIS VIA GETTY IMAGES

The software system allows claim rejections without doctors ever opening patient medical records, according to the lawsuit.

Accuracy with these systems has been suspect, as they have only had oversight by the insurers themselves. More recently, many have questioned the high rate of reversals when humans actually get involved. Despite the high rate of claim denials being overturned upon human review, a significant portion of denials remain uncontested, pointing to a systemic issue of AI use within the insurance claims process.

How has AI been used successfully by health insurers to their own end?

These companies have primarily used AI in a framework to recognize patterns of care and make coverage decisions based on predictive models. This situation reflects the broad trend where AI has been utilized  to forecast health-related concerns and outcomes, often without the full awareness or participation of the surgical community. To the benefit of their shareholders, large insurance companies have profited greatly by these systems.

It is a major discrepancy that underscores the critical need for greater engagement and understanding of AI’s capabilities and implications in the healthcare sector, particularly among practitioners, healthcare administrators, and medical device executives as a whole.

In 2023, UnitedHealth Group’s revenue grew to $371.6 billion, an increase of 14.6% from 2022. 2023 earnings from operations were $32.4 billion, an increase of 13.8%.

How is AI currently being utilized by surgeons?

The integration of Artificial Intelligence (AI) in the medical field can be categorized into three primary functions:

As a Co-pilot, serving as an assistive tool for practitioners by verifying their work and offering recommendations.

In Automation, where AI undertakes routine tasks such as documentation, image analysis, narrative summaries, etc.

In Predictive Health, which applies the principles of predictive analytics to forecast patient outcomes based on extensive data analysis.

Currently, the predominant AI applications available to surgeons and healthcare professionals focus on the Co-pilot and Automation models, because they are the easiest to develop. These tools, while beneficial, will not significantly revolutionize patient care or surgical outcomes. They will only improve existing workflows.

Offering a greater opportunity, is the complexity of developing and implementing effective Predictive Health models, which require analyzing vast datasets to accurately predict individual patient outcomes. These predictive health models will transform surgery on a scale equivalent to the rise of Google, AWS, and United Health Group.

AI has not revolutionized the lives of surgeons and patients because adoption is years behind big tech and big insurance.

The limited impact of AI in transforming surgical practices and the lives they treat can be attributed to the competitive disadvantage surgeons face against well-established corporations that have been leveraging Predictive Health AI for years. Companies like Google, United Health Group, and Anthem have realized considerable revenue growth by incorporating AI-driven predictive analytics, while many surgical practices and healthcare systems are experiencing dwindling profit margins as a result.

For AI to truly enhance surgical care, it is imperative that surgeons begin to employ AI solutions rooted in PREDICTIVE HEALTH frameworks. These advanced AI systems will level the playing field, enabling surgeons to effectively navigate and counteract existing systems that currently restrict patient access to innovative surgical treatments.

These Solutions Are Not Found On ChatGPT

The disparity in growth and profitability between big tech/insurance giants and surgical practices/health systems underscores a crucial gap in the adoption and effective application of AI in surgery. The potential for AI to revolutionize surgery lies in the development and adoption of predictive health models that can rival the advanced systems already employed by many corporations, thereby facilitating a more strategic approach to patient care and surgical planning.

In summary, the question isn’t about the capability of AI to revolutionize surgery but rather about how surgeons, healthcare systems, and medical device companies can harness AI’s potential in predictive health to enhance patient care, improve outcomes, and streamline surgical processes.

The future of AI in surgery is promising, contingent upon the development and integration of sophisticated AI tools tailored to the unique demands and intricacies of surgical care.

Fire up!