Episodi

  • TP510 - The Connectivity Tax

    TP510 - The Connectivity Tax
    Oct 21 2026
    For a small hospital, staying independent now comes with a technology bill. Federal survey data shows the hospitals least able to trade records with the rest of healthcare share one trait more than any other. They stand alone. Independent hospitals routinely send, receive, look up and use outside patient records at less than half the rate of hospitals inside a system. Geography matters less than affiliation does. Money alone doesn't close that gap. A modern EHR costs millions to put in, and running one takes a team most small hospitals can't hire. The federal Rural Health Transformation Program is sending states billions for rural care, but it caps spending on replacing an EHR at 5% of each state's yearly award. The money can connect old systems. It mostly can't buy new ones. So small hospitals rent. Epic's Community Connect lets a larger system host a smaller hospital on its own instance, and Oracle Health and MEDITECH sell their own routes to a modern record. For many hospitals that arrangement is a lifeline: current software and real support at a price they can manage, with their own board still in place. It also puts order sets, upgrade schedules and the patient's history inside someone else's system. Chris Boyer and Reed Smith leave one question open. When a hosted hospital's future changes and a different system acquires it, who keeps the patient relationship? The portal login, the contact preferences and the consent records all sit with the host. Allen Cooper wants small hospitals to stay independent, and he sees software as part of how they get there. His company, Ancilla Ventures, builds for systems with a dozen hospitals and for single critical access hospitals, so he sees the gap from both sides. His test for any tool is plain. If the digital version takes a patient longer than the paper did, it didn't help. He also asks the question interoperability keeps running into: who pays for it? If your hospital rents its record from a neighbor, what happens to your patients when the lease ends? Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes, plugged in the open: https://www.touchpointpodcastbook.com Allen Cooper on LinkedIn: https://www.linkedin.com/in/allen-c00per/ Ancilla Ventures: https://ancillaventures.com/ MN Community Measurement: https://mncm.org/ ASTP Health IT Data Brief 71, "Interoperable Exchange of Patient Health Information Among U.S. Hospitals: 2023,": https://www.ncbi.nlm.nih.gov/books/NBK606033/ ASTPs: https://www.healthit.gov/data/quickstats/electronic-health-information-exchange-hospitals ASTP: https://www.healthit.gov/sites/default/files/2025-01/A-Decade-of-Data-Examined-The-Evolution-of-Health_508.pdf Chartis, "2026 Rural Health State of the State," February 2026: https://www.chartis.com/insights/2026-rural-health-state-state KFF Health News, "Can a federal lifeline keep rural hospitals open?," August 3: 2026https://civicmedia.us/news/2026/08/03/can-a-federal-lifeline-keep-rural-hospitals-open CMS, Rural Emergency Hospitals: https://www.cms.gov/medicare/health-safety-standards/certification-compliance/rural-emergency-hospitals Flex Monitoring Team, "Trends in Inpatient Revenue and Volume Among Critical Access Hospitals," April 2026: https://www.flexmonitoring.org/publication/trends-inpatient-revenue-and-volume-among-critical-access-hospitals CMS, Rural Health Transformation Program awards: https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states Bipartisan Policy Center: https://bipartisanpolicy.org/explainer/rural-health-transformation-program-notice-of-funding-opportunity/ Paul Keckley, The Keckley Report, "It's March Madness for Hospitals," March 22 2026: https://paulkeckley.com/the-keckley-report/2026/3/22/its-march-madness-for-hospitals/ Becker's, "Epic Community Connect, explained," June 11 2026: https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/epic-community-connect-explained-what-small-hospitals-get/ Becker's, "Which EHRs do small hospitals prefer?," October 31 2024l: https://www.beckershospitalreview.com/ehrs/what-ehrs-do-small-hospitals-prefer/ Oracle: https://www.oracle.com/news/announcement/critical-access-hospitals-select-oracle-health-communityworks-to-enhance-clinical-and-financial-operations-2024-09-24/ MEDITECH, "MEDITECH Signs 100th Expanse MaaS Customer," January 2024. MEDITECH as a Service is a cloud subscription MEDITECH runs itself: https://ehr.meditech.com/news/meditech-signs-100th-expanse-maas-customer Gunnison Valley Health, "Gunnison Valley Health Adopts Epic," January 2025, on joining UCHealth's Community Connect program: https://www.gunnisonvalleyhealth.org/news/2025/january/gunnison-valley-health-adopts-epic-the-gold-stan/ Gunnison Valley Health, EHR transition page, May 2025 go-live and legacy portals kept for past records: https://www.gunnisonvalleyhealth.org/patient-resources/gvh-electronic-health-record-transition/ Becker's, "'No ...
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    58 min
  • TP509: The Smart Intern Problem

    TP509: The Smart Intern Problem
    Oct 14 2026
    Somewhere right now, a survey is being answered by someone who does not exist. Sometimes that is fraud. Sometimes it is the product. Synthetic respondents, digital twins and AI personas all start from real human data. None of them is a real person answering your question today. The ideas themselves are old. Personas came out of software design in the late 1990s, and digital twins came out of engineering. What changed is that both are now pointed at people, and the AI answers on their behalf. The early tests lean one way. Synthetic answers drift toward the most common response, and the unusual answers get smoothed out. In one vendor's test of coffee habits, the people who never drink coffee disappeared from the synthetic sample entirely. In healthcare, that missing group is the rural patient, the person with a rare condition and the person who has never used your health system. Those are often the questions that matter most. Follow that drift far enough and it becomes a loop. Cheaper research means less real research gets fielded. That thins the data the models learn from, and it thins the experience junior researchers need to recognize a wrong answer. Human data carries its own risk too. Federal prosecutors charged people tied to two research firms with selling fabricated survey responses for years. Bad data goes in, and clean-looking synthetic data comes out. Chris Boyer and Reed Smith leave one question open: can a new researcher build judgment by grading AI output, or does that instinct only come from reading thousands of real answers? Rob Klein and Eva Gott make the case for a hybrid approach anchored in real respondents. Synthetic panels can stretch a small market or a niche audience and give a quick read on creative. Understanding how a cancer patient feels during treatment still takes a person who can explain why. Rob puts the limit plainly. AI has no peripheral vision. It sees only the data in front of it, which makes it smart and naive at the same time. If your health system stopped paying for real respondents tomorrow, who would notice first? Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes, plugged in the open: https://www.touchpointpodcastbook.com Klein & Partners, Rob Klein's national healthcare market research firm: https://www.kleinandpartners.com thinqinsights, Eva Gott's custom market research firm and a strategic partner of Klein & Partners since January 2024: https://www.thinqinsights.com Eva Gott, author profile on Greenbook listing her as Head of Research at thinqinsights: https://www.greenbook.org/insights/authors/eva-gott Klein & Partners and thinqinsights partnership announcement, January 2024: https://www.mrweb.com/drno/news36191.htm HCIC 2026, the Healthcare Interactive Conference, October 25 to 28 2026 at the Omni Orlando ChampionsGate. Rob is presenting on the website journey and AI with a colleague from Virtua Health: https://hcic-prod.enqbator.com/ Argyle and colleagues at Brigham Young University, "Out of One, Many: Using Language Models to Simulate Human Samples," Political Analysis, 2023. The paper that named silicon sampling: https://www.cambridge.org/core/product/035D7C8A55B237942FB6DBAD7CAA4E49 Shumailov and colleagues, "AI models collapse when trained on recursively generated data," Nature, July 2024. The model collapse study cited in Segment 2: https://www.nature.com/articles/s41586-024-07566-y U.S. Department of Justice, District of New Hampshire. Indictment of eight defendants in a scheme to bill about $10 million in fraudulent market survey data through Op4G and Slice, April 15 2025: https://www.justice.gov/usao-nh/pr/eight-defendants-indicted-international-conspiracy-bill-10-million-fraudulent-market U.S. Department of Justice, third guilty plea in the same case, March 5 2026. Source of the figure that fabricated data drove about 90% of the two firms' revenue: https://www.justice.gov/usao-nh/pr/third-man-pleads-guilty-role-10-million-international-fraudulent-market-survey Jang, Lee and Kim at KAIST, "Instruction-Tuned Language Models Cannot Sample from Distributions They Can Describe," preprint, July 2026. Not yet peer reviewed: https://arxiv.org/abs/2607.25292 Verasight, "Synthetic Sampling Report for Market Research," October 2025. GPT-5 personas took a coffee survey alongside 1,519 real US adults. Verasight sells human survey panels: https://www.verasight.io/reports/coffee-llm Prolific study of 996 real US adults against AI personas, preprint dated August 2026, as reported by Research Live. Prolific sells access to human research participants: https://www.research-live.com/article/news/synthetic-respondents-cant-replace-human-measurement-finds-prolific-study/id/5152227 Kelly McKnight of VERVE, "Entry-Level Careers in Research Aren't Dead, They're Different," Researchworld, April 2026. The argument behind the view that junior researchers can learn by judging AI output: https://researchworld.com/articles/...
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    1 ora e 5 min
  • TP508: Marketing Beyond the Megaphone

    TP508: Marketing Beyond the Megaphone
    Oct 7 2026
    The American Marketing Association took promotion out of its definition of marketing in 2008. Inside most health systems, marketing still means advertising. Part of the reason is simple: impressions and clicks are easy to count, and the rest of the job is not. That habit is about to cost patients. Adults covered through Medicaid expansion now have to document work, school or community service hours to keep their coverage, and prove eligibility twice a year instead of once. Most states start in January, and a few already have. The last time renewals piled up, during the unwinding after the pandemic, most people who lost Medicaid lost it to paperwork. The state had an old address. The notice was confusing. The deadline passed. Those are communication failures. Health system marketing already owns the tools that address them: contact data, plain-language writing, patient messaging, the web path from a confusing letter to a person who can help and relationships with trusted voices in the community. None of it is promotion, and almost none of it shows up in a board report. The natural partner sits down the hall. Every nonprofit health system has a team responsible for community benefit, and the IRS rules that team works under exclude activities done mainly for marketing purposes. That sets up the open question between Chris Boyer and Reed Smith. Should marketing power coverage outreach from behind the scenes and measure renewals instead of impressions? Or should the hospital's name go on it, because patients open a message from their own doctor before one from the state? Chris Bevolo takes the argument further. After 25 years in health system marketing, he launched ServingOverSelling, a call for health systems to move promotional spend into access, patient experience and community work. He is candid that cutting ads will not fix healthcare affordability, which he places mostly with insurers, PBMs and pharma. His case is stewardship. When patients cannot afford care, a dollar spent on self-promotion is hard to defend at any scale. If a patient loses coverage in January over a letter they never understood, which department owned that letter? Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com ServingOverSelling, Chris Bevolo's movement asking health systems to reallocate promotional marketing spend toward serving patients and communities. The pledge, the serving and selling definitions and the private community signup are on the site: https://www.serveoversell.com Chris Bevolo, founder of Bearing 287, on LinkedIn: https://www.linkedin.com/in/chrisbevolo/ ServingOverSelling launch announcement, September 27 2026: https://www.einpresswire.com/article/944590118/industry-veteran-launches-servingoverselling-movement-to-encourage-health-systems-to-curb-promotional-marketing The Reallocation, Chris Bevolo's weekly LinkedIn newsletter. Find it from his LinkedIn profile. No direct link verified Joe Public Doesn't Care About Your Hospital, Chris Bevolo's book on transforming health system marketing. No link verified American Marketing Association definition of marketing, released January 2008. The 1985 definition it replaced named pricing, promotion and distribution. The current one covers creating, communicating, delivering and exchanging offerings that have value for customers, clients, partners and society at large One Big Beautiful Bill Act (Public Law 119-21), signed July 4 2025. KFF's summary of the Medicaid work requirement provisions: https://www.kff.org/medicaid/a-closer-look-at-the-work-requirement-provisions-in-the-2025-federal-budget-reconciliation-law/ KFF, "An Early Look at Policy Decisions as States Get Ready to Implement Work Requirements." 43 states including DC must implement. Nebraska began enforcing May 1 2026, Montana July 1 and Iowa December 1. Arkansas began checking compliance July 1 without disenrolling anyone before January 2027. States showing a good-faith effort can get extensions no later than December 31 2028: https://www.kff.org/medicaid/an-early-look-at-policy-decisions-as-states-get-ready-to-implement-work-requirements/ healthinsurance.org summary of the law's coverage changes, including six-month eligibility checks for expansion adults starting in 2027: https://www.healthinsurance.org/blog/one-big-beautiful-bill-act-brings-sweeping-changes-to-health-coverage/ KFF Medicaid Enrollment and Unwinding Tracker. As of September 2024, at least 25.2 million people disenrolled, 69% for procedural reasons and 31% found ineligible: https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/ Congressional Budget Office estimate of the Medicaid provisions of Public Law 119-21, 7.5 million more uninsured in 2034 out of about 10 million for the law overall: https://www.cbo.gov/publication/61837 IRS Instructions for Schedule H (Form 990), 2025. Defines community benefit reporting for nonprofit hospitals and ...
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    58 min
  • TP508: Schooled by AI: Faster Work, Thinner Judgment?

    TP508: Schooled by AI: Faster Work, Thinner Judgment?
    Sep 30 2026
    The first draft a new hire used to write badly, and learn from, now arrives finished. Healthcare marketing never had a residency. It had the entry-level job, and AI is absorbing that job one task at a time. Judgment in this field is tacit knowledge. It is knowing when a quote will land wrong with physicians, or when a headline will read as spin. It comes from repetition with feedback, and those repetitions lived inside the lowest-value work: the rewritten press release and the service line page that came back covered in red. That is the work AI now handles first. Stanford's payroll research suggests the change is arriving quietly, as junior roles that never get posted rather than people shown the door. The case for AI as a faster apprenticeship is real. A tool can put the patterns of the best people in the building in front of a beginner at the moment of need. The trouble starts when the tool leaves the room. In one field experiment, high school students who practiced math with an unguarded chatbot scored better in practice and worse on the exam than students who never had it. They looked finished before they had learned anything. Experience is what protects senior people for now, and Chris Boyer and Reed Smith question how long that holds. Workers who trust AI more tend to check its output less. Experienced endoscopists in Poland found fewer precancerous growths on their own after routine AI use, though a three-year Japanese study found no such decline. Most AI-drafted patient messages still pass through a human reviewer. That safeguard works only while the reviewer's judgment stays sharp. Rose Glenn and David Jarrard argue that communication education was already teaching theory without application, and that the gap widens once AI takes over the tasks where application used to happen. Their answer runs through internships, relationships with compliance and physician leaders built before a crisis, and a new textbook for students and early-career professionals. David's sharpest point is that as more skills become AI-integrated, real-world experience becomes worth more. If no one on your team has written a discharge instruction from scratch this year, who will notice when the AI gets one wrong? Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Jarrard Inc: https://jarrardinc.com/ David Jarrard, executive chairman, Jarrard Inc.: https://jarrardinc.com/team/david-jarrard/ Rose Glenn, lecturer in the Department of Communication & Media at the University of Michigan: https://prod.lsa.umich.edu/comm/people/regular-faculty/rmglenn.html Stanford Digital Economy Lab, "Canaries in the Coal Mine?": https://digitaleconomy.stanford.edu/news/canariesaug26/ Brynjolfsson, Li and Raymond, "Generative AI at Work," The Quarterly Journal of Economics: s: https://nber.org/papers/w31161 PNAS, 2025: : https://doi.org/10.1073/pnas.2422633122 "The Impact of Generative AI on Critical Thinking," CHI 2025: https://www.microsoft.com/en-us/research/uploads/prod/2025/01/lee_2025_ai_critical_thinking_survey.pdf Budzyń et al., "Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy," The Lancet Gastroenterology & Hepatology, 2025l: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(25)00133-5/abstract Okumura et al., "Long-term impact of computer-aided adenoma detection," Endoscopy, 2025: https://www.thieme-connect.com/products/all/doi/10.1055/a-2661-2624 Fortune, Shopify CEO Tobias Lütke on "slop grenades,": https://fortune.com/2026/09/17/shopify-tobias-lutke-ai-slop-grenades/ TP506, "Who Hears the Patient Now," with Amy Brown of Authenticx, on AI voice agents in access centers TP464, "The AI Loop Problem (Where Humans Still Matter Most)," on human-in-the-loop and human-out-of-the-loop models Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social From the cold open: Hidden Valley Spooky Ranch: https://finviz.com/news/395227/hidden-valley-introduces-spooky-ranch-the-iconic-dressing-takes-on-a-haunting-hue-for-halloween Recommendations from this episode: Chris: Visit an apple orchard this fall Reed: Neagley on Prime Video https://www.joblo.com/reacher-season-four-neagley-spin-off/amp/ MENTIONS FROM THE SHOW Learn more about your ad choices. Visit megaphone.fm/adchoices
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    1 ora e 7 min
  • TP506 - Who Hears the Patient Now

    TP506 - Who Hears the Patient Now
    Sep 23 2026
    In March 2025, Gartner predicted that agentic AI would resolve 80 percent of common customer service problems on its own by 2029. This February, the same Gartner practice predicted that half the companies that cut service staff because of AI will hire people back into similar work by next year, under different job titles. Eleven months apart, same firm. Healthcare is buying the first forecast right now. Voice AI vendors claim their agents can handle most inbound calls, and the business case that follows fits on one slide. Count the calls. Convert them to positions. Book the salaries as savings. What the slide leaves out is the people who train the bot, test it, listen back to it and pick up the calls it cannot finish. Those roles arrive later, in compliance or quality or IT, and nobody sets them next to the number that got approved. The question to settle before approval is which project this is. A bot answering a call at two in the morning that would have gone to voicemail is a real gain, and that is a capacity project. A case built on fewer people is a different claim. Chris Boyer and Reed Smith leave that one open, because the honest answer depends on what the organization wrote down when it signed. The second cost is quieter. A voice agent is built to capture the caller's intent, confirm it and complete it, which leaves no home for the rest of the call. Texas and California now require providers to tell patients when AI sits in the middle of their care, so more patients will know, and some will start asking for a person before they say anything else. Every AI-handled call also leaves a full transcript, more patient conversation than most health systems have ever held, reported upward as one number about how many calls the bot kept. Amy Brown of Authenticx names the fallacy directly. Executives like to believe AI means immediate cost reduction, when putting AI in front of patients in a regulated environment is a commitment that takes people to keep it honest. Her company now evaluates AI-to-human conversations, and her read on those is not flattering. If your access center business case counted the calls the bot will answer and not the people who will read them, you approved a capacity project and called it a savings plan. MENTIONS FROM THE SHOW Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes, which features Amy Brown's earlier Touch Point interview: https://www.touchpointpodcastbook.com Authenticx, the healthcare conversational intelligence company Amy Brown founded in 2018: https://authenticx.com Amy Brown, founder and CEO of Authenticx, on LinkedIn: https://www.linkedin.com/in/amy-brown-84821210/ Gartner, March 5 2025. Predicted agentic AI would autonomously resolve 80% of common customer service issues by 2029, with a 30% cut in operating costs. Analyst forecast: https://www.gartner.com/en/newsroom/press-releases/2025-03-05-gartner-predicts-agentic-ai-will-autonomously-resolve-80-percent-of-common-customer-service-issues-without-human-intervention-by-20290 Gartner, June 10 2025. Predicted 50% of organizations planning significant customer service workforce cuts because of AI would abandon those plans by 2027. Based on a March 2025 poll of 163 service leaders: https://www.gartner.com/en/newsroom/press-releases/2025-06-10-gartner-predicts-50-percent-of-organizations-will-abandon-plans-to-reduce-customer-service-workforce-due-to-ai Gartner, January 26 2026. Predicted generative AI cost per resolution will exceed $3 by 2030, above many offshore human agents, and that regulations guaranteeing access to a human will raise assisted service volume 30% by 2028: https://www.gartner.com/en/newsroom/press-releases/2026-01-26-gartner-predicts-genai-cost-per-resolution-for-customer-service-will-exceed-offshore-human-agent-costs-by-2030 Gartner, February 3 2026. Predicted half of companies that attributed headcount reduction to AI will rehire for similar functions under different job titles by 2027. Its October 2025 survey of 321 service leaders found only 20% had actually reduced agent staffing because of AI: https://www.gartner.com/en/newsroom/press-releases/2026-02-03-gartner-predicts-half-of-companies-that-cut-customer-service-staff-due-to-ai-will-rehire-by-2027 Gartner, July 9 2024. Survey of 5,728 customers conducted in December 2023: 64% would prefer companies not use AI in customer service, and 60% worried AI would make it harder to reach a person. Cross-industry, not healthcare specific: https://www.gartner.com/en/newsroom/press-releases/2024-07-09-gartner-survey-finds-64-percent-of-customers-would-prefer-that-companies-didnt-use-ai-for-customer-service Klarna, February 2024. The company's own claim that its OpenAI-powered assistant was handling the work of roughly 700 agents: https://www.klarna.com/international/press/klarna-ai-assistant-handles-two-thirds-of-customer-service-chats-in-its-first-month/ Sebastian Siemiatkowski at SXSW London, June 4 2025, describing ...
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    58 min
  • TP505 - Who Is Consenting For This?

    TP505 - Who Is Consenting For This?
    Sep 16 2026
    Healthcare marketing spent four years settling on one answer to the tracking problem. Get consent, log it and honor it. It rests on an assumption nobody checked, which is that a person is on the other side of the banner reading the question. Software answers that question now. AI browsers do the browsing for people, and when one meets a consent modal it clears the modal as an obstacle. The decision gets logged. Nobody made it. The record a health system would produce to show it honored patient choice is turning into a record of machine behavior. But patients were not reading the banner either. They clicked to make it go away. What changed is who is clicking, which raises a real question about what the consent ever documented. It gets worse at the portal. A patient can hand their own record to an AI tool, and the moment they do, the law protecting it stops applying. HIPAA gives them that right and does not let a provider refuse because the destination is unwise. A health system must complete a handoff it would be sued for making on its own. Marketing owns the door the agent arrives at, and inherits a problem it did not create and cannot fix with a banner. Underneath both sits a question about authority. No regulator drew this line. The federal guidance that set off the panic was vacated in court and never replaced, and the rule meant to succeed it keeps moving further out. The working standards came from settlements instead, which produce a price rather than a principle, and the patient whose information was disclosed collects about twenty dollars. Chris Boyer and Reed Smith work through whether calibrating to litigation risk is honest risk management or an industry declining to decide what right looks like. Jessica Holton, co-founder of Ours Privacy, brings the view from inside that constraint. She was buying media for a telehealth platform when the pixel guidance landed, pulled her tracking, and watched acquisition costs climb. Her argument is that privacy becomes an asset once the whole organization owns it. Her survey names the blind spot. Nearly everyone believes their stack is compliant, and a majority describe that same stack as pieced together. If software declined tracking on a patient's behalf this morning, your consent log recorded a decision nobody made. MENTIONS FROM THE SHOW Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Ours Privacy, the HIPAA-compliant customer data platform Jessica Holton co-founded, including the free web scanner she describes in the interview: https://oursprivacy.com/ Ours Privacy, $15M Series A announcement, August 2026. Founders Jessica Holton, Adam Putterman and Tyler Zey launched the platform in 2024 after running the telehealth company Ours: https://oursprivacy.com/blog/oursprivacy-series-a-announcement-growth-marketing-data-infrastructure-healthcare HHS Office for Civil Rights, guidance on the individual right of access, health apps and APIs. The source for the point that information sent to a third-party app at the patient's direction falls outside HIPAA: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access-right-health-apps-apis/index.html HIPAA Security Rule Notice of Proposed Rulemaking, published in the Federal Register January 6 2025 at 90 FR 898. Final action now listed in the OMB Unified Agenda under RIN 0945-AA22 HIPAA Journal on the delay of the Security Rule final rule, now pencilled for 2027, and the Privacy Rule final rule status: https://www.hipaajournal.com/final-rule-implementing-hipaa-security-rule-updates-edges-closer/ New York Attorney General settlement with NewYork-Presbyterian, December 2024, $300,000 plus corrective actions covering third-party online tools, pre-deployment testing and deletion of collected patient information: https://www.healthcareitnews.com/news/newyork-presbyterian-pays-300k-settle-ny-pixel-tracking-case Banner Health and LifeStance Health Group tracking technology settlements, including the Banner class of roughly 1,028,000 MyBanner portal users: https://www.hipaajournal.com/banner-health-lifestance-health-group-pixel-settlements/ Five healthcare providers settle pixel class actions, including Bayhealth Medical Center with a class period running through December 31 2025: https://www.hipaajournal.com/five-healthcare-providers-pixel-class-action-settlements/ Atrium Health $1.8 million pixel settlement, preliminary approval May 2026, covering MyAtriumHealth and MyCarolinas portal accounts: https://www.classaction.org/news/1.8m-atrium-health-pixel-settlement-ends-class-action-lawsuit-over-alleged-patient-data-tracking The effect of AI browsers on tracking and attribution, including Atlas auto-rejecting consent banners and stripping referrers: https://taggrs.io/ai-browsers-tracking-attribution/ Prompt injection in AI browsers, and the position from OpenAI and the UK National Cyber Security Centre that it likely cannot be fully solved: ...
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    59 min
  • TP504 - The Disposition Code

    TP504 - The Disposition Code
    Sep 9 2026
    Somewhere in every access center there is a drop-down menu. No answer. Left message. Refused. Not interested. Wrong number. The person choosing from it has the least context in the building and the most pressure on the clock, and the choice takes about four seconds. That code then leaves the work queue, enters a report and becomes the evidence for not spending on those patients again. Chris Boyer and Reed Smith open episode 504 by pulling apart two things health systems routinely treat as one. Capacity utilization measures whether you sold the inventory. It says nothing about who could not get in. Reed puts the distinction plainly. Capacity is the view from the provider's side of the desk and access is the view from the patient's. Marrying the two is the work. Then the evidence. A cluster randomized trial across 44 primary care practices and roughly 12,000 patients found that electronic health record reminders alone moved nothing at all. Completion of overdue follow-up ran 22.7% with reminders against 22.9% for usual care. Adding a letter and a phone call took it to 31%. Ordinary contact, twice, with no technology in it. Chris keeps the ceiling in front of the audience for the rest of the episode, because even in the strongest arm roughly two thirds of patients still did not complete. The second segment asks what a person is actually for. Medicare answered part of this in 2024 when it started paying for patient navigation, and the answer it gave is clinical severity, with a cancer diagnosis qualifying automatically. Patients owe 20% of the cost, which is one of the reasons practices report they have not started using the codes. Chris and Reed then sit with the finding that argues against them. In that same trial, adding a navigator on top of the letter and the phone call moved the number four tenths of one point. They work through what that does and does not prove, and land on three jobs a person can do that a letter cannot. Only one of them changes the system instead of recovering a patient, and it is the one nobody puts in a financial model. Jessica Walker of Care Sherpa closes the episode with the case. A health system handed her a list of oncology screening patients its access team had marked unreachable after the auto-dialer sequence ran out. What she found in that list was almost never disinterest. Wrong orders, wrong referring physician, wrong location. Phone numbers and addresses that no longer worked. Carrier blocking. Patients in hospice, deceased or no longer eligible while the order sat and expired. Patients who would have had to cross a river. Her description of it is that the health system was asking people to pick up a part-time job to fix their own referral. The most useful moment comes later. Her team heard the same thing from more than one patient, that the nearest location's hours did not work for a shift worker. The system added Wednesday evenings and recovered those patients. She also describes a referring physician who had quietly stopped sending patients because his patients were never getting their screenings done, and what it took to turn that back on. If you cannot say what your people do that a letter cannot, you have bought a service tier rather than an answer. Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com Atlas SJ, Tosteson ANA, Burdick TE, et al. A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results: A Cluster Randomized Clinical Trial. JAMA. 2023;330(14):1348-1358. 44 practices, 11,980 patients: https://jamanetwork.com/journals/jama/fullarticle/2810508 Atlas SJ, Tosteson ANA, Burdick TE, et al. Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results. JAMA Netw Open. 2022;5(9):e2234194. Survey of 275 primary care practitioners across three health systems: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796828 CMS, Health Equity Services in the 2024 Physician Fee Schedule Final Rule. Principal Illness Navigation codes G0023 and G0024, plus the peer support codes, effective January 1 2024: https://www.cms.gov/files/document/mln9201074-health-equity-services-2024-physician-fee-schedule-final-rule.pdf-0 Pratt-Chapman ML. Navigation Refresh: Updates to Principal Illness Navigation Billing. Journal of Oncology Navigation & Survivorship. May 2026;17(3). Source for the 20% patient coinsurance as a reported barrier to adoption: https://www.jons-online.com/issues/2026/may-2026-vol-17-no-3/navigation-refresh-updates-to-principal-illness-navigation-billing Care Sherpa: https://caresherpa.com Jessica Walker on LinkedIn: https://www.linkedin.com/in/jessicawalkercaresherpa/ Eternal, the longevity startup founded by Alex Mather of The Athletic, which now generates a weekly AI audio recap of a user's own lab and wearable data. Fast Company, June 9 2026: https://www.fastcompany.com/91555441/...
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    59 min
  • TP503 - The Person Who Wasn't Part of the Plan

    TP503 - The Person Who Wasn't Part of the Plan
    Sep 2 2026
    Healthcare marketing has had a caregiver persona for fifteen years. She was worried, researching options, wanting a second opinion. That was a fair description of the job in 2010. Today most family caregivers help with bathing, dressing and mobility, and many now handle injections, wound care, catheters and oxygen equipment at home. Eleven percent were trained for any of it. Chris Boyer and Reed Smith open on new research projecting how much bigger this population gets by 2040, and on why the explanation everyone reaches for turns out to be wrong. The rest of the first half is about why none of this reaches anyone's numbers. One caregiver arrives in a health system as three unlinked records. The one tool built to let her in goes unmarketed and almost unused, and the workaround hospital staff recommend instead would get a marketer fired. Then Chris turns to why every fix built for her quietly stops working around week three. Jessica Hulter and Lamarque Polvado of CareStarter built software that asked a clinic checkout desk for sixty seconds. Staff used it for two weeks, then stopped, and nobody could make them start again. What they did in response put the human somewhere other than where healthcare usually puts her, and Jessica is that human. If your organization has a caregiver persona, go find out what year the data underneath it came from. Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com The Future Availability of Family Caregivers: Implications for Late-Life Care Gaps, Population Research and Policy Review, volume 45, article 33, published online June 1 2026. Pairs the National Health and Aging Trends Study with kinship projections through 2040: https://link.springer.com/article/10.1007/s11113-026-10016-4 AARP Public Policy Institute, The Aging of the Baby Boom and the Growing Care Gap, 2013. Source of the caregiver support ratio, 6.6 in 1990, 7.2 in 2010, projected near 4 by 2030: https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/baby-boom-and-the-growing-care-gap-insight-AARP-ppi-ltc.pdf AARP and the National Alliance for Caregiving, Caregiving in the US 2025. Fielded in 2024, published July 2025, 6,858 family caregivers on a nationally representative online survey: https://www.caregivingintheus.org/wp-content/uploads/2026/03/caregiving-in-us-2025.doi_.10.26419-2fppi.00373.001.pdf Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals, JAMA Network Open, 2020. Survey of 102 US hospitals on proxy account availability: https://pubmed.ncbi.nlm.nih.gov/32364562/ Administrative burden as an organizational design problem, narrative review, The Healthcare Executive, August 2026. Source of the argument that burden work moves rather than disappears: https://www.thehealthcareexecutive.net/article/operations-quality-safety/administrative-burden-workflow-redesign-hospitals/ CareStarter: https://carestarter.co PIC6, the innovation unit: https://pic6.co PCSI, whose mission is to enhance the lives of people with disabilities: https://www.pcsi.org Jessica Hulter on LinkedIn, where she invited listeners to reach out directly: https://www.linkedin.com/in/jessica-hulter/ AFWERX, the Air Force innovation arm whose SBIR program funded the Travis Air Force Base work: https://afwerx.com/ Exceptional Family Member Program, Military OneSource overview: https://www.militaryonesource.mil/family-relationships/special-needs/exceptional-family-member-program/ GAO-18-348, DoD Should Improve Its Oversight of the Exceptional Family Member Program, May 2018: https://www.gao.gov/products/gao-18-348 Montclair Police Department cargo theft investigation, two pickups about an hour apart on August 17 at the Anheuser-Busch distribution center on Brooks Street in Montclair California, roughly $70,000 in product including about 40,000 pounds of Pabst Blue Ribbon. Pabst posted a reward and a return deadline on Instagram: https://ktla.com/news/california/40000-pounds-of-pabst-blue-ribbon-stolen-in-massive-california-beer-heist/ TP499, "The Experience Ends Where the Bill Begins," the Cassandra Skinner episode Chris calls back to on what looks like noncompliance TP482, "The Pilot That Never Graduates," the episode Chris calls back to on initiatives that never survive past the trial Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Recommendations from this episode: Chris: Ted Lasso season four on Apple TV+. Ten episodes, premiered August 5 2026 with new episodes weekly on Wednesdays through October 7. Jason Sudeikis, Hannah Waddingham, Juno Temple, Brett Goldstein and Brendan Hunt return, with Ted taking over AFC Richmond's second division ...
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    1 ora e 4 min