Artificial intelligence has been leveraged at orthopedic practices nationwide, and Philadelphia-based Rothman Orthopaedic Institute is using it to manage billing efficiencies, Alex Vaccaro, MD, PhD, said.
Dr. Vaccaro, president of Rothman, spoke with Becker's about the advancements the practice made with its AI strategy along with updates about the group's research.
Note: This conversation was lightly edited for clarity.
Question: Can you elaborate about some of the work you're doing with your CIO and with AI? What's been working?
Dr. Alex Vaccaro: I'll give you a hard example. We did a lot of things by hand in our billing office. We would send the insurance company a bill and when we eventually got paid we were never really sure if we got paid according to the explanation of benefits. We would then have to go back on each claim and hand adjudicate. The volume of surgeries we do each year is incredible. In Florida alone it is 11,000 cases a year. We automated that with a single-platform electronic revenue cycle management system. Now our claims are accepted, rejected or modified and we receive this information in a much shorter time period. We now can see if the claims were paid as per our contractual agreements. You could just imagine with the volume of surgeries performed at Rothman it is so easy to be underpaid or not paid at all. This risk is now mitigated through technology as a medical care provider only has a limited time period to get reimbursed.
We have exploited AI through tireless bots that check and ensure a surgeon's bills are placed on the date of surgery and are billed according to the accepted pre-authorized schedule. If I used a code that wasn't pre-authorized, AI technology would notify the surgical team appropriately, and the pre-authorization would be updated and submitted to the insurance company.
Unless it's a trauma case, you have to obtain pre-authorization for most surgeries with the majority of insurance companies. This technology has assisted in this arduous task.
Q: I spoke with a couple of Rothman surgeons about some of the research going on earlier this year. What are some of the other interesting research projects going on at Rothman and what kinds of findings can you reveal?
AV: From a spine perspective, we try to participate in all clinical trials related to spinal cord regeneration. Our institution is researching the safety and efficacy of implantable electrode leads that bypass the level of spinal cord injury, allowing the brain to control appendicular movement. As long as you have an intact nerve end muscle connection, hopefully useful movement will be obtained. Our end goal is to re-create useful hand and lower limb motion without relying on an adjunctive exoskeleton, which is cost prohibitive and not available to the vast majority of those with a spinal cord injury.
We're also doing research with robotic technology better understanding its use in minimally invasive spinal procedures. An exciting area of research is stem cell regeneration of the nuclear pulposus. Our end goal here is to figure out a way of intervening early and avoiding the natural aging cascade, which may result in pain and dysfunction.
In total joint arthroplasty. We're looking at methods of monitoring for early onset joint infection and intervening early. On average we publish between 230 and 290 peer-reviewed manuscripts a year. The Rothman Institute has an amazing group of physicians dedicated to education, research and clinical care.