Tuesday, September 29, 2026

Kev Rands Got a New Heart. Fourteen Years Later, He Has Something Healthcare Rarely Talks About: An Ordinary Life

Kev Rands' “fantastic, mundane” life raises a bigger question: If healthcare is supposed to give people their lives back, why are we using AI to create more activity instead of removing the work that gets in the way?



“We will have to decide not only which parts of medicine can be automated, but which parts we want to automate.” — John Whyte, MD, MPH, CEO, American Medical Association, STAT, September 9, 2026

 

The most extraordinary thing about a heart transplant may be what happens when the patient no longer needs to think about the heart transplant.

Kev Rands was just 10 days old when he underwent his first open-heart surgery.

His mother noticed he wasn't feeding properly.

She called the midwife.

The midwife called the GP.

The GP sent him to hospital.

And suddenly, a newborn baby's life became a medical emergency.

Rands had a rare congenital heart condition called double inlet left ventricle.

Doctors operated.

Then they operated again.

Throughout his childhood and adolescence, he underwent six open-heart surgeries, along with numerous other procedures involving coils, stents, pacemakers and heart valves.

Hospital became part of childhood.

At school, he was frequently absent.

Sometimes he spent five or six weeks in hospital.

His medication made him feel unwell.

He developed blood clots.

His baby teeth turned black and fell out.

It was, by almost any definition, an extraordinary medical life.

But eventually the doctors reached the point where another repair wasn't enough.

At 23, Rands was placed on the heart-transplant waiting list.

Then he waited.

For five years.

There were phone calls.

A heart might be available.

He would prepare.

Then another call:

The cross-match wasn't right.

The heart wasn't suitable.

Try again.

Eventually, after two years of this emotional roller coaster, he asked to come off the transplant list.

“It was all too much.”

Then his condition deteriorated.

He went back on the list.

At 27, the call finally came.

Rands received the heart of an unknown young man.

The donor's name has not been publicly disclosed.

The operation took place at Freeman Hospital in Newcastle, after hospitals in London, Bristol and Leeds reportedly declined his case because of its complexity.

And then something remarkable happened.

Nothing.

No more dramatic medical plot twist.

No blockbuster ending.

No miracle montage.

Instead, Kev Rands got to live.

Fourteen years later, he is 41 years old, married, and the father of an 11-year-old daughter and a 4-year-old son.

He works as a van salesman.

He goes to the gym.

He takes family photographs.

He has birthdays, errands, shopping trips and ordinary mornings.

And he describes his life with two words that seem almost hilariously understated after everything he has survived:

“Fantastic, mundane.”

Think about that.

Six open-heart surgeries.

Years on a transplant waiting list.

Cancelled transplant calls.

A complex operation involving a stranger's heart.

And the reward?

A boring Tuesday.

A family dinner.

A trip to the gym.

A child's birthday.

A normal life.

Mundane.

And perhaps that is the most profound thing about the story.


Maybe Healthcare Has Been Measuring the Wrong Thing

Healthcare loves extraordinary outcomes.

We celebrate the surgery.

The breakthrough drug.

The new device.

The transplant.

The AI model.

The number of patients treated.

The number of claims processed.

The number of denials overturned.

The number of notes generated.

The number of tasks completed.

We love numbers.

Numbers make excellent dashboards.

They also make excellent hiding places.

Because patients don't necessarily want more healthcare.

They want more life.

Kev Rands didn't need a heart transplant so he could become an excellent long-term heart-transplant patient.

He needed one so he could stop being a patient.

That distinction matters.

The best outcome of healthcare may sometimes be the moment healthcare becomes irrelevant to someone's everyday life.

A successful transplant eventually becomes:

“Dad is going to the gym.”

A successful cancer treatment eventually becomes:

“Mom is going to work.”

A successful pediatric intervention eventually becomes:

“She's going to school.”

The medical intervention disappears into the background.

Life takes over.

That may be the real definition of success.

And it raises a rather uncomfortable question for healthcare technology:

What if technology should be judged by what it allows people to stop doing?


We Have an Odd Obsession With Making Healthcare More Efficient

Healthcare has spent decades trying to make things faster.

Faster documentation.

Faster coding.

Faster claims.

Faster authorizations.

Faster scheduling.

Faster eligibility checks.

Faster appeals.

Faster communication.

Now we have AI to make many of those things even faster.

Wonderful.

But faster is not automatically better.

If I give you a faster way to dig a hole you don't need, congratulations.

You are now an extremely efficient hole digger.

Healthcare may occasionally resemble this.

We build a workflow.

The workflow creates administrative work.

Then we build software to automate the administrative work.

Then we add AI to automate the software.

Then we create a dashboard to measure how efficiently the AI automated the software that automated the work created by the workflow.

At some point, someone should probably ask:

Why are we digging the hole?


The New Question for AI

This is why a recent comment from John Whyte, MD, MPH, CEO of the American Medical Association, caught my attention.

Writing in STAT this month about AI and medicine, Whyte made an important distinction:

“We should not confuse the automation of medical tasks with the automation of medicine itself.”

That's a much more interesting AI conversation.

Because the question isn't simply:

What can AI automate?

AI can automate a lot.

The better question is:

What should we automate?

And I would add a third:

What should we eliminate altogether?

Those are three very different questions.


Automation Is Not the Same as Improvement

Imagine a physician practice with a recurring problem.

A claim keeps getting rejected because some piece of information is missing or inconsistent.

The traditional response is:

  1. Find the denial.
  2. Identify the problem.
  3. Contact someone.
  4. Correct the information.
  5. Resubmit.
  6. Monitor.
  7. Repeat.

Now introduce AI.

AI can potentially:

  1. Find the denial.
  2. Identify the problem.
  3. Draft the correction.
  4. Generate the appeal.
  5. Route the task.
  6. Monitor the status.
  7. Repeat.

That sounds impressive.

And it may be useful.

But here's the annoying question:

Why did the problem reach the claim in the first place?

We have automated the repair.

We haven't necessarily fixed the cause.

That's the difference between automating a broken workflow and redesigning the system that created the workflow.


Healthcare Has an Activity Addiction

Look at the language we use.

Claim submitted.

Authorization requested.

Appeal filed.

Task assigned.

Message sent.

Chart closed.

Account worked.

Case escalated.

Everything sounds busy.

Very little tells us whether anything actually happened.

A submitted claim is not payment.

An authorization request is not authorization.

A referral is not an appointment.

An appeal is not a successful appeal.

A message is not communication until someone receives it and acts on it.

A task marked “complete” is not necessarily a problem solved.

Healthcare has developed a strange substitute for progress:

activity that looks like progress.

And AI is extraordinarily good at producing activity.


The Billion-Dollar Question May Be: What Work Should Disappear?

Recent healthcare technology discussions are increasingly moving in this direction.

A September 25 HealthLeaders analysis reported that healthcare leaders looking at AI and clinician burden emphasized workflow redesign alongside technology, rather than treating technology alone as the solution.

That distinction is crucial.

Because adding technology to a bad workflow can simply give the bad workflow a faster engine.

The real opportunity is different:

Use technology to make the bad workflow unnecessary.

That is much harder.

It is also much more valuable.


The Most Expensive Software in Healthcare Might Be a Person

Consider what happens inside a physician-owned practice.

A patient's information is incomplete.

Someone notices.

A medical assistant sends a message.

The physician responds.

The scheduler checks something.

The billing team discovers another problem.

Someone logs into a payer portal.

Someone makes a phone call.

Someone waits on hold.

Someone documents the phone call.

Someone follows up.

Someone checks again.

Someone asks:

“Did anyone ever hear back?”

This is not a software stack.

This is a human stack.

And humans are incredibly expensive middleware.

We don't usually call them middleware, of course.

We call them:

“Staff.”

“Care coordinators.”

“Practice managers.”

“Billing specialists.”

“Administrative support.”

And they are often extraordinarily good at compensating for broken processes.

That is exactly why broken processes survive.

Humans are too good at rescuing them.


The Healthcare System's Secret Superpower Is Human Compensation

Think about how many healthcare workflows function because somebody remembers.

Someone remembers to call the patient.

Someone remembers to check eligibility.

Someone remembers the authorization expires Friday.

Someone notices the payer changed.

Someone recognizes that the diagnosis doesn't match the procedure.

Someone catches the missing documentation.

Someone says:

“Wait. That doesn't look right.”

That human vigilance saves healthcare every day.

But it is not scalable infrastructure.

If the process depends on one exceptionally attentive person catching the same error 400 times a month, the organization hasn't solved the problem.

It has hired a hero.

Heroes are wonderful.

Systems are better.


Most of the Problem Starts Upstream

This is where the medical billing problem becomes more interesting.

We tend to treat billing as something that happens after care.

The patient is seen.

The claim is created.

The payer responds.

Then the revenue cycle team goes to work.

But the billing problem often begins much earlier.

At intake.

During scheduling.

At registration.

During documentation.

When insurance information changes.

When an authorization is requested.

When clinical and operational information don't line up.

The downstream claim is simply where the problem becomes visible.

That is different.

The claim may be the messenger.

And we have a habit of shooting the messenger.


Healthcare Billing Is a Data Problem Before It Is a Workflow Problem

This is the central idea behind OnnX:

Healthcare billing is a data-quality problem, not simply a tooling problem.

The industry has become extremely sophisticated at managing downstream uncertainty.

Denial management.

A/R management.

Appeal management.

Claim scrubbing.

Coding review.

Payment reconciliation.

All valuable.

But what if we spend less time asking:

“How do we process the problem?”

and more time asking:

“Why did the problem exist?”

That is a different operating philosophy.

Instead of:

More downstream intervention.

Think:

Better upstream structure.

Instead of:

More follow-up.

Think:

Fewer reasons to follow up.

Instead of:

More automation.

Think:

Less work.


The Difference Between “Submitted” and “Solved”

This may sound like semantics.

It isn't.

Suppose a clinic submits 10,000 claims.

That's impressive.

Unless 1,500 require intervention.

Then the real question becomes:

What happened to those 1,500?

Suppose the practice processes 2,000 denials.

Great.

Unless 1,300 were caused by the same three recurring problems.

Then the achievement isn't really “2,000 denials managed.”

It may be:

“We discovered three problems we haven't eliminated.”

That's a completely different way of looking at revenue cycle management.

And potentially a much more productive one.


The Prior Authorization Machine

Prior authorization makes this especially visible.

The American Medical Association's 2025 physician survey reported that physicians complete an average of 40 prior authorizations per week, consuming about 13 hours of physician and staff time weekly. The survey also found that 94% of physicians said prior authorization contributes to burnout, while 95% said it delays access to necessary care.

The obvious response is:

“Let's build better AI for prior authorization.”

And perhaps we should.

But the deeper question is:

Why does the healthcare system require so much human labor to move information that often already exists somewhere inside the healthcare ecosystem?

The answer is often fragmentation.

The information exists.

But it may be sitting in different systems.

Different formats.

Different fields.

Different workflows.

Different people's heads.

So humans become the bridge.

Again.


AI Can Be the Bridge—or It Can Become Another Toll Booth

AI can absolutely reduce administrative burden.

But AI itself is not the strategy.

That's an important distinction.

We could deploy AI everywhere and still have a terrible healthcare system.

Why?

Because AI can optimize a bad process.

It can also create new work.

New alerts.

New outputs.

New exceptions.

New things to review.

New dashboards.

New “AI-generated recommendations” someone must approve.

Suddenly we have:

AI creating work for humans to supervise the AI that was supposed to reduce human work.

That would be a magnificent joke if it weren't happening.


“Human in the Loop” Shouldn't Mean “Human Doing Everything”

There is a reasonable argument for human oversight.

Healthcare involves risk.

Clinical judgment matters.

Patients are not spreadsheets.

AI should not casually make consequential decisions without appropriate oversight.

John Whyte makes this point in his recent STAT essay: AI can help physicians search information, document care and reduce administrative work, but medicine still requires judgment, relationships, values and human responsibility.

But there is a difference between:

human oversight

and

human participation in every tiny administrative step.

A physician should review a clinically meaningful recommendation.

A physician should not necessarily be required to rescue a missing demographic field.

A practice manager should oversee operations.

They should not spend Friday afternoon hunting through payer portals for information that should have been structured automatically.

A biller should exercise judgment.

They should not spend half the day repeatedly correcting the same preventable error.

Human-in-the-loop should mean:

humans handle what requires humans.

Not:

humans remain trapped inside every workflow because nobody redesigned it.


What If We Stopped Asking “What Can AI Do?”

Try this instead.

Question 1:

What work is genuinely necessary?

Question 2:

What work exists because the system is poorly designed?

Question 3:

What work exists because information is incomplete?

Question 4:

What work exists because of unnecessary handoffs?

Question 5:

What work should be automated?

Question 6:

What work should simply disappear?

That last question is the one healthcare technology doesn't ask often enough.


The Handoff Tax

Every handoff introduces risk.

Patient → front desk.

Front desk → clinical team.

Clinical team → authorization team.

Authorization team → payer.

Payer → practice.

Practice → billing.

Billing → payer.

Payer → billing.

Billing → physician.

Physician → staff.

Staff → patient.

At every transition, information can be:

  • lost
  • delayed
  • reinterpreted
  • duplicated
  • mistyped
  • misunderstood
  • forgotten

We then hire people to coordinate the handoffs.

Then we buy software to coordinate the coordinators.

Then we add AI to coordinate the software.

At some point, maybe the boldest innovation isn't better coordination.

Maybe it is:

fewer handoffs.


A Referral Is Not Treatment

A referral is not treatment.

An authorization request is not approval.

A submitted claim is not payment.

A denial appeal is not resolution.

A message sent is not a completed communication.

A task assigned is not a completed task.

This distinction sounds obvious.

Yet healthcare workflows routinely measure the first thing because it is easier to measure.

Activity is visible.

Completion is harder.

The future of healthcare operations should move toward measuring what actually matters.

Not:

“How many tasks did we touch?”

But:

“How many problems disappeared?”


The Real ROI Isn't Always Dollars

Healthcare executives understandably ask:

How much money did the technology save?

Good question.

But there is another question.

How much human attention did it return?

Suppose technology saves a practice 100 administrative hours per month.

Where did those hours go?

If they simply became 100 more hours of administrative work, the system hasn't created much human freedom.

If they become:

  • more patient time
  • fewer late evenings
  • better staff retention
  • fewer interruptions
  • faster resolution
  • more time for practice improvement
  • less physician inbox time

then the return is different.

It is operational.

Financial.

And human.


What Should Physicians Get Back?

This is the question I care about most.

Not:

How much more can physicians do?

But:

What should physicians no longer have to do?

Should a physician have to chase documentation because a downstream process can't determine what's missing?

Should a physician have to repeatedly answer administrative questions caused by disconnected systems?

Should a practice owner personally intervene because staff cannot see where a claim stalled?

Should highly trained clinicians spend their attention on work that a well-designed system could prevent?

The answer isn't “automate everything.”

The answer is:

protect human attention.

Because attention is one of the scarcest resources in healthcare.

And unlike software licenses, you cannot renew it.


The Goal Isn't to Replace Humans

This matters.

The interesting future isn't:

AI replaces the biller.

It is:

AI removes the repetitive work that prevents the biller from using judgment.

It isn't:

AI replaces the physician.

It is:

AI removes administrative noise so the physician can spend more attention on the patient.

It isn't:

AI eliminates staff.

It is:

AI eliminates unnecessary work.

That distinction changes everything.

The goal isn't fewer humans.

The goal is fewer humans doing work that machines should have prevented them from needing to do.


Kev Rands Gives Us the Best Test

Here's the test I'd apply to almost every healthcare technology:

What does the human get back?

Kev Rands received a donor heart.

What did he get back?

Not another medical procedure.

Not another complicated care pathway.

He got:

A wife.

Two children.

A gym.

A job.

Family photographs.

Ordinary mornings.

Ordinary problems.

Ordinary life.

He got to become something more interesting than a patient.

He got to become Kev.

And that is why his phrase sticks:

“Fantastic, mundane.”

The mundane wasn't the consolation prize.

It was the outcome.


Maybe “Boring” Is the Future of Healthcare

Healthcare technology companies love words like:

Transformative.

Revolutionary.

Disruptive.

Autonomous.

Generative.

Predictive.

Intelligent.

But the best technology may produce none of those feelings.

It may feel boring.

The authorization is already there.

The insurance information is correct.

The claim doesn't need fixing.

The staff member doesn't need to call.

The physician doesn't receive another notification.

The patient doesn't have to explain the same thing twice.

The account gets paid.

Nobody celebrates.

Nobody writes a press release.

Nobody posts a LinkedIn announcement.

It just worked.

That may be the highest compliment healthcare technology can receive.


The Best AI May Be the AI Nobody Talks About

We tend to evaluate AI by what it produces.

A note.

A summary.

A prediction.

A recommendation.

A claim.

An appeal.

But perhaps we should also evaluate AI by what it prevents.

A phone call.

A denial.

A duplicate entry.

A missing field.

A needless handoff.

A repeated question.

A physician interruption.

A staff escalation.

A patient delay.

That changes the scoreboard.

Instead of:

“Look how much AI did.”

We could say:

“Look how much unnecessary work disappeared.”

That is much harder to market.

It may also be much more valuable.


The Future of Medical Billing Might Be Less Billing

That sounds ridiculous.

It may actually be the point.

If we improve the quality of information at the source, fewer claims should require intervention.

If we reduce ambiguity, fewer people should need to clarify it.

If we reduce handoffs, fewer things should get lost.

If we improve consistency, fewer exceptions should occur.

If we eliminate preventable problems, fewer staff hours should be spent fixing them.

So perhaps the future of revenue cycle management isn't:

more sophisticated billing.

Perhaps it is:

less unnecessary billing work.

The best revenue-cycle department may not be the one that handles the most problems.

It may be the one that creates the fewest problems for itself.


A Simple Practice Audit

You can test this tomorrow without buying anything.

Ask your team five questions.

1. What do you repeatedly fix?

Not occasionally.

Repeatedly.

2. What information do you repeatedly chase?

If the answer is “the same information,” you've probably found an upstream problem.

3. Where do the most handoffs occur?

Map them.

Don't assume they're necessary.

4. Which tasks are “completed” but not actually resolved?

This is where activity metrics become dangerous.

5. If we could permanently delete one administrative task, what would it be?

Don't ask leadership first.

Ask the people doing the work.

They know where the bodies are buried.


Then Ask the More Interesting Question

Once you've identified the annoying task, don't immediately ask:

“Which software can automate it?”

Ask:

“Why does this task exist?”

Then:

“What information would have prevented it?”

Then:

“Where should that information have been captured?”

Then:

“Why wasn't it?”

That takes you upstream.

And once you're upstream, you're no longer simply doing workflow optimization.

You're doing system design.


Healthcare Doesn't Need More Digital Busywork

The industry already has enough software.

Enough dashboards.

Enough alerts.

Enough portals.

Enough passwords.

Enough notifications.

Enough “action required” messages.

Enough systems that promise to simplify healthcare while adding another login.

The next generation of healthcare technology should have a more difficult mission:

remove complexity rather than decorate it.

Don't make the maze prettier.

Make the maze smaller.

Don't make the paperwork faster.

Ask why the paperwork exists.

Don't make physicians better at administrative work.

Give administrative work less access to physicians.

Don't automate every problem.

Prevent more problems from becoming problems.


That Is the Difference Between Automation and Design

Automation asks:

“How can we make this task faster?”

Design asks:

“Why are we doing this task?”

Automation improves the process.

Design questions the process.

Automation can save minutes.

Design can eliminate the need for the minutes.

That distinction is easy to miss because automation produces impressive demos.

Design produces fewer things to demo.

And fewer things happening is sometimes the whole point.


The Strange Lesson of an Anonymous Heart

There is something deeply human about Kev Rands' story.

He doesn't know the donor's name.

The donor's family doesn't appear to know him personally.

There is no neat Hollywood ending.

No reunion.

No handshake.

No photograph of the two families together.

There is simply a decision made by strangers.

Someone said yes.

And years later, another family is living because of it.

Rands has sent photographs to the donor's relatives through the NHS.

He hasn't received a response.

Still, he wanted them to know:

“I didn't waste it.”

That may be one of the most powerful measures of healthcare.

Not how much happened.

But what happened because someone cared enough to make the right thing possible.


The Ultimate Healthcare Metric Might Be Life Outside Healthcare

Maybe we have been looking at the healthcare system from the wrong direction.

We measure:

hospitalizations.

visits.

procedures.

claims.

codes.

denials.

payments.

workflows.

tasks.

Maybe we should also measure something much simpler:

How much life happens outside the system because the system worked?

For Kev Rands, that life is a family.

For a physician, it might be dinner at home.

For a nurse, it might be leaving on time.

For a practice manager, it might be one afternoon without a fire.

For a patient, it might be never having to call the billing office.

These aren't small outcomes.

They're the reason the system exists.


The Contrarian Future

The healthcare industry is asking:

How can AI help us do more?

I think there is a better question:

How can AI help us need less?

Less rework.

Less chasing.

Less duplication.

Less manual reconciliation.

Less administrative noise.

Less handoff.

Less uncertainty.

Less time spent fixing predictable problems.

Less time spent asking:

“Who was supposed to do this?”

And more time doing what only humans can do.

Care.

Judgment.

Conversation.

Empathy.

Relationships.

Life.


Final Thoughts

1. Stop confusing activity with outcomes.

A submitted claim is not revenue. A requested authorization is not approval. A closed task is not necessarily a solved problem. Measure completion, not motion.

2. Move upstream.

When the same problem repeatedly appears downstream, don't merely automate the repair. Find where the information first became unreliable and fix the source.

3. Protect human attention.

The purpose of healthcare AI should not be to make physicians, staff and administrators capable of doing an infinite amount of administrative work.

It should be to make that work require less of them.

Kev Rands received a stranger's heart.

Fourteen years later, his greatest achievement isn't another medical milestone.

It's that he has an ordinary life.

A wife.

Two children.

A gym.

A job.

A Tuesday.

He calls it:

“Fantastic, mundane.”

Maybe that is what healthcare should aspire to more often.

Not extraordinary healthcare experiences.

Not endless healthcare activity.

Not more technology for technology's sake.

But a system that quietly works well enough that people can get back to the thing they came for in the first place:

their lives.

And perhaps the best healthcare technology isn't the technology that makes healthcare more impressive.

It's the technology that makes healthcare less necessary in the moments when it doesn't need to be there.


One Question for Physicians, Practice Owners and Healthcare Operators

What is one administrative task your team performs every week that should probably not exist at all?

Not the task you'd like to automate.

The task you'd like to delete.

What is it?

Why does it exist?

And what would have to change upstream for it to disappear?

Tell me in the comments.

Then share this with the person in your organization who spends too much of their day fixing problems that should have been prevented upstream.

Because perhaps the next healthcare breakthrough isn't another thing we can automate.

Perhaps it's something we no longer need to do.


About the Author

Dr. Daniel Cham is a physician and medical consultant with expertise in medical technology consulting, healthcare management, and medical billing. He focuses on practical insights that help healthcare professionals navigate complex challenges at the intersection of healthcare, technology and medical practice.

Connect with Dr. Cham on LinkedIn to learn more.

PS: A free resource is available in the Featured section of my LinkedIn profile—no signup needed.


Continue the Conversation

Healthcare is changing quickly. But the most important question isn't simply what technology comes next.

It's what that technology makes possible for patients, physicians and healthcare teams.

Knowledge drives progress. Start your journey here.

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Sources & Further Reading

1.     NHS Blood and Transplant — Kev Rands' story
The official NHS account of Kev Rands, including his rare congenital heart condition, six open-heart surgeries, first surgery at 10 days old, transplant, and life after receiving an anonymous donor heart.
NHS Blood and Transplant: Kev Rands' story

2.      John Whyte, MD, MPH — STAT
The AMA CEO's September 9, 2026 essay examining AI in medicine and the distinction between automating medical tasks and replacing the broader practice of medicine.
STAT: “AI can master medical tasks. Practicing medicine is much more than that”

3.     American Medical Association — Prior Authorization Survey
The AMA's 2026 report on its 2025 physician survey, including the findings that physicians complete an average of 40 prior authorizations per week, that the process consumes about 13 hours of physician and staff time weekly, and that 94% say prior authorization contributes to burnout.
AMA: Prior authorization reform survey

4.     HealthLeaders — Clinician burden and workflow redesign
A September 25, 2026 analysis examining why technology alone may not reduce clinician burden and highlighting the importance of workflow redesign and clinician involvement in AI implementation.
HealthLeaders: “Is the Answer to Reducing Clinician Burden Just Technology?”

5.     NHS Blood and Transplant — Heart transplantation
Official NHS information on heart transplantation, including the transplant process, waiting, donor matching and life after transplantation.
NHS Blood and Transplant: Heart transplantation


Disclaimer

This article is intended for educational and informational purposes only. It does not constitute medical, legal, financial, coding, billing, compliance or other professional advice. Healthcare regulations, payer requirements and reimbursement policies vary and change over time. Readers should consult appropriate qualified professionals and authoritative sources when making clinical, operational, financial or business decisions.

Hashtags

#Healthcare #HealthcareTechnology #HealthcareAI #MedicalBilling #RevenueCycleManagement #HealthTech #PhysicianEntrepreneur #MedicalPractice #PracticeManagement #AdministrativeBurden #PhysicianBurnout #PatientCare #HealthcareInnovation #ArtificialIntelligence #HealthcareLeadership #OnnX

 

Monday, September 28, 2026

The Most Important Healthcare Outcome Was Never Measured

What Brooklyn Dotson, Michael Waters, and Noah Waters can teach us about medical billing, invisible outcomes, and why healthcare keeps fixing problems after they happen



“Moral agency is getting eroded.” — Kayvan Haddadan, MD

 

Brooklyn Dotson received Michael Waters’s liver. Years later, she fell in love with his brother, Noah. What can their extraordinary story teach us about the problems we discover too late in medical billing?

In a September 27, 2026 essay, physician Kayvan Haddadan, MD, argued that declining reimbursement, increasing patient volume, documentation demands, payer audits, denials, and clawbacks can create a cycle that steadily squeezes the time and autonomy physicians have to practice medicine.

That observation got my attention.

But another healthcare story had been sitting in the back of my mind.

It starts with a little girl named Brooklyn Dotson.

It includes a 10-year-old boy named Michael Waters.

And it eventually brings us to Noah Waters, Michael's younger brother.

The story sounds almost too improbable to be true.

But it is.

In 2003, Brooklyn Dotson was a toddler in Kentucky with alpha-1 antitrypsin deficiency. Her liver was failing. Her mother, Ashley Baker, was told that without a transplant, Brooklyn might have only days to live.

Then a liver became available.

It came from Michael Waters, a 10-year-old boy from Dayton, Ohio, who had been struck by a car and died near his home.

Michael's family honored his wishes.

Two years before his death, Michael had learned about organ donation and told his parents that if something happened to him, he wanted his organs donated.

His mother, Tina Poteet, later said:

“It was Michael’s gift.”

Michael's liver saved Brooklyn's life.

But that was only the beginning.

A few months later, the two families connected.

Brooklyn's mother, Ashley Baker, and Michael's mother, Tina Poteet, exchanged letters.

The families eventually met.

Brooklyn and Noah Waters met when Noah was about six.

They became friends.

The families stayed connected for years.

Brooklyn grew up.

Noah grew up.

They lived separate lives.

They dated other people.

They went to college.

They started careers.

Then something neither family could have predicted happened.

The friendship became a relationship.

Noah proposed to Brooklyn in December 2025.

The little girl who received Michael Waters' liver was now engaged to Michael's younger brother.

The story is extraordinary because nobody could have predicted the outcome when the transplant took place.

Nobody knew where the chain of events would eventually lead.

A donor.

A grieving family.

A liver.

A transplant.

A child surviving.

Two families meeting.

Two children becoming friends.

Two adults falling in love.

One healthcare event.

Decades of consequences.

The Washington Post reported that Brooklyn and Noah were scheduled to marry on September 26, 2026.

Think about that.

The most important outcome of that transplant wasn't necessarily the outcome anyone could have measured at the time.

It was everything that happened afterward.

And that is where this beautiful human story connects to something much less beautiful:

medical billing.

Because healthcare has a habit of measuring the last thing that happened.

The payment.

The denial.

The readmission.

The authorization.

The audit.

The appeal.

The clawback.

The missed appointment.

The incomplete note.

But the event we see at the end often started much earlier.

And sometimes, by the time we see it, we are already too late to prevent it.

That is the problem I think healthcare needs to talk about.

Not just better billing.

Not just faster billing.

Not just more automation.

Better upstream information.


The Question I Would Ask Every Physician Owner

Here is my deliberately uncomfortable question:

What if your denial is not the problem?

What if it is merely the first place the problem becomes visible?

That sounds like semantics.

It isn't.

Imagine a claim gets denied because the documentation does not support the billed service.

The billing department sees the denial.

So the billing department works the denial.

Reasonable.

But now go backward.

Why was the documentation incomplete?

Maybe the physician was seeing 30 patients.

Why 30?

Because reimbursement is under pressure.

Why does that matter?

Because higher volume can compress the time available for documentation.

Why does documentation matter?

Because the payer evaluates the record retrospectively.

Why does that matter?

Because a clinical decision made under time pressure may later be judged through a very different administrative lens.

Now we have a much bigger story.

The denial wasn't born in the billing office.

It may have started with time.

And the time problem may have started with economics.

And the economics may have started with reimbursement pressure.

And suddenly the denial has become the final visible symptom of a much larger system.

That is why simply asking, "How do we appeal this?" can be intellectually lazy.

Sometimes the better question is:

"Where did this problem actually begin?"


Healthcare Loves Firefighters

Healthcare has a strange relationship with heroism.

We love the person who stays late.

The nurse who catches the problem.

The physician who calls the insurer.

The biller who rescues the account.

The practice manager who fixes the mess.

The employee who knows the payer rule nobody else knows.

We call these people indispensable.

And they often are.

But there is a hidden danger.

A great firefighter can make a terrible fire-prevention program look successful.

If your best biller rescues 300 claims every month, that is not necessarily evidence that your revenue cycle is healthy.

It may be evidence that your biller is extraordinary.

Those are very different things.


The Billing Department May Be the Emergency Department of Your Revenue Cycle

Think about that analogy.

The emergency department doesn't create every illness.

It receives the consequences.

Something happened earlier.

A disease developed.

An injury occurred.

A symptom was ignored.

An infection progressed.

Then the patient arrives at the emergency department.

The emergency team responds.

Billing can work the same way.

The billing team receives:

  • Incorrect demographic information
  • Coverage problems
  • Missing authorization
  • Documentation gaps
  • Coding inconsistencies
  • Payer edits
  • Claim rejections
  • Denials
  • Underpayments

Then billing responds.

But what if we stopped thinking of billing as the place where problems are solved?

What if we treated it as the place where system failures are diagnosed?

That would change everything.


The Revenue Cycle Is Not a Billing Department

This may be the most important sentence in the article:

The revenue cycle begins before the claim exists.

It begins when someone schedules the patient.

It continues when eligibility is checked.

It continues when the referral is processed.

It continues when prior authorization is evaluated.

It continues when the patient is registered.

It continues when the physician documents the encounter.

It continues when the diagnosis is captured.

It continues when the procedure is coded.

Only then does the claim enter the billing process.

So why do we act as though billing owns the entire revenue cycle?

Because the biller is the person holding the bag when something goes wrong.

That's not ownership.

That's inheritance.


The Information Chain

Consider a typical patient journey:

Patient → Scheduling → Registration → Eligibility → Referral → Authorization → Clinical Encounter → Documentation → Coding → Claim → Payer → Payment

Now imagine every arrow represents a handoff.

Every handoff introduces potential variation.

A name can be entered differently.

An insurance number can be wrong.

A referral can be missing.

An authorization can expire.

A diagnosis can be documented differently.

A clinical note can lack a required element.

A payer rule can change.

A code can be selected incorrectly.

Then the claim gets denied.

And someone asks:

"Why did the payer do that?"

Maybe the payer did exactly what the information they received told them to do.

That does not necessarily mean the payer is right.

It means the interesting question is earlier:

What information reached the payer, and how did it get there?


The Hidden Cost Nobody Puts on the P&L

Physician owners usually see billing costs.

They see the billing company's invoice.

They see payroll.

They see software subscriptions.

They see clearinghouse fees.

They see collection percentages.

But there is another cost.

It is hiding inside everyone's job.

The nurse spends 20 minutes dealing with an authorization.

The front desk spends 15 minutes correcting eligibility.

The physician spends 10 minutes answering a documentation question.

The biller spends 30 minutes fixing a claim.

The practice manager spends an hour investigating why payment is delayed.

Individually, none looks catastrophic.

Together?

That is a staffing model.

You may not have hired another full-time employee.

But your practice may be behaving as though you did.

I call this the 1.2 FTE problem.

The practice has an invisible employee whose job is:

Fixing things that should not have broken.

That employee never gets a badge.

Never gets a performance review.

Never appears on the organizational chart.

But you are paying for them.


The Numbers Behind the Friction

The administrative burden is not theoretical.

CMS says prior authorization requests can cost providers approximately $20–$50 per hour in staff time and take an average of 13 hours per week, which CMS estimates can amount to approximately 700 hours of administrative time per provider annually. CMS is moving toward electronic prior authorization beginning in 2027 for certain processes.

The AMA has also reported substantial physician concern about prior authorization burden and its relationship to delays and burnout.

Those numbers matter.

But I think they tell only half the story.

Because the real question isn't simply:

How many hours are we spending?

It is:

Why are we spending them?

That is a different question.

And a much more useful one.


Recent News: Healthcare Is Still Trying to Solve the Downstream Problem

This week's healthcare news provides several reminders that the pressure on physician practices is not disappearing.

The Medical Group Management Association is currently highlighting changes affecting physician payment, MIPS, prior authorization, Medicaid, and other federal issues facing practices in 2027.

Medical Economics is also reporting on physician productivity and the financial pressure created when operating costs rise faster than revenue.

And this week's healthcare technology conversation is increasingly shifting toward a more practical question about AI: not simply whether AI can produce impressive outputs, but whether it can improve care quality and return meaningful time to clinicians.

That is an important shift.

Because "AI can do this" is not a healthcare strategy.

The better question is:

"What unnecessary work disappears because AI exists?"

If the answer is "none," we have created another tool.

Not necessarily another solution.


Three Experts, Three Lessons

Atul Gawande: Complexity Is the Enemy Hiding in Plain Sight

Surgeon and author Atul Gawande has spent years examining complexity, checklists, systems, and the challenge of delivering reliable care when professionals operate inside complicated environments.

The billing lesson is straightforward:

Good people cannot reliably compensate for infinite complexity.

Eventually, complexity wins.

Not because your staff is incompetent.

Because humans have limits.

We forget.

We misunderstand.

We get interrupted.

We make assumptions.

We work under pressure.

The answer is not to demand superhuman performance.

The answer is to design systems that require less heroism.


Peter Pronovost: Standardization Can Protect Human Judgment

Patient-safety researcher Peter Pronovost became widely known for demonstrating how standardized processes can reduce preventable harm.

The lesson is not "make medicine robotic."

Quite the opposite.

The point is to standardize the predictable parts so professionals have more capacity for the unpredictable parts.

That applies to revenue cycle management.

Do not make physicians memorize payer rules.

Do not make nurses memorize authorization requirements.

Do not make billers compensate forever for missing information.

Standardize the predictable.

Protect human attention for the exceptional.


Don Berwick: Fix the System

Don Berwick's work in healthcare quality has repeatedly emphasized system improvement rather than simply demanding more from individuals.

This may be the most important lesson for independent practices.

When the same problem happens repeatedly, ask:

Is this really an employee problem?

Or is it a system problem?

If five different employees make the same mistake, maybe you don't have five bad employees.

Maybe you have one bad process.

That distinction can save a lot of money.

And a lot of blame.


A More Provocative Definition of "Efficiency"

Healthcare often defines efficiency as:

Doing more with less.

I think that definition is incomplete.

A better definition is:

Doing less unnecessary work.

Those are not the same thing.

Doing 40 patient visits instead of 30 may look efficient.

Unless it produces more documentation problems.

Unless staff spend more time on follow-up.

Unless denials increase.

Unless physician burnout increases.

Unless patients wait longer.

Unless the practice loses people.

You haven't necessarily improved the system.

You may simply have squeezed it harder.


The Productivity Trap

This week's healthcare discussion around physician productivity makes the tension especially visible.

When operating costs rise faster than revenue, the obvious response is:

See more patients.

More visits.

More volume.

More productivity.

It makes financial sense.

At least initially.

But every system has a carrying capacity.

At some point, more volume creates more:

  • Documentation
  • Orders
  • Messages
  • Authorizations
  • Claims
  • Corrections
  • Follow-up
  • Administrative work

And now the system is producing more work faster than people can absorb it.

The physician becomes more "productive."

The practice becomes less manageable.

That's an interesting definition of productivity.


What If Productivity Is the Wrong Metric?

Here's my contrarian question:

What if the most productive physician is not the physician who sees the most patients?

What if it is the physician whose practice creates the least unnecessary work per patient?

That would change the dashboard.

Instead of simply counting encounters, we could also look at:

Administrative friction per encounter.

How many touches?

How many corrections?

How many messages?

How many authorization loops?

How many documentation queries?

How many claim interventions?

How many minutes of physician time occur after the patient has already left?

Now we are measuring something physicians actually experience.


The Problem With "Best Practices"

Healthcare loves the phrase best practice.

Sometimes I think we use it because it sounds better than:

"This is how we have always done it."

A large health system may have a 25-person revenue-cycle department.

An independent practice may have one biller and a practice manager who also handles HR.

Those two organizations should not necessarily use the same workflow.

The question is not:

"What is the industry's best practice?"

Ask:

"What is the simplest reliable practice for our environment?"

Simple wins surprisingly often.


Myth Buster

Myth: More billing staff will solve the problem.

Maybe.

But if the workflow generates unnecessary work, you may simply be hiring people to process the consequences.

More capacity is not the same as less waste.


Myth: A low denial rate means the system is healthy.

Not necessarily.

You can have a low denial rate and still have:

  • Underpayments
  • Delayed claims
  • Excessive manual work
  • Authorization burden
  • Documentation queries
  • Missed charges
  • Poor cash flow

A metric is useful only in context.


Myth: A denial is a billing problem.

Sometimes.

But many denials are downstream manifestations of upstream information or workflow problems.

The right answer is to identify the actual cause rather than assume the department where the problem appeared caused it.


Myth: AI solves bad data.

No.

AI can process bad data very efficiently.

That is not the same as fixing it.

Bad data plus powerful automation can create very sophisticated mistakes.


Myth: Automation means removing humans.

Not necessarily.

Good automation should remove unnecessary human work.

It should not automatically remove human accountability.


What AI Should Actually Do

I am a physician.

I am also building a healthcare technology company.

So I have an obvious interest in AI.

But I am increasingly skeptical of the phrase:

"AI-powered."

Those two words can mean almost anything.

The better question is:

What exactly is the machine doing?

Is it extracting information?

Classifying information?

Detecting an exception?

Predicting a risk?

Applying deterministic rules?

Recommending an action?

Submitting something automatically?

Those are very different things.

For healthcare billing, I believe a useful architecture looks more like:

AI extracts.

Rules determine.

Humans oversee exceptions.

That is much easier to trust than:

AI decides everything.


The OnnX Thesis

This is the problem I am building around with OnnX.

My thesis is simple:

Healthcare billing is often a data-quality problem before it becomes a billing problem.

Most revenue-cycle activity happens after information has already moved through multiple hands and systems.

By then, the practice is reacting.

OnnX is designed around moving intelligence upstream.

That means helping practices identify problems earlier in the patient-to-claim journey.

The objective is not to create another dashboard.

It is not to add another inbox.

It is not to give physicians another piece of software to learn.

And it is certainly not to make physicians into part-time billers.

The objective is to reduce the correction loop.

Less rework.

Less ambiguity.

Less manual chasing.

Less dependence on tribal knowledge.

More predictable revenue-cycle operations.


The Correction Loop

Here is the loop I want to break:

Information enters.

Something is incomplete.

Nobody notices.

The encounter occurs.

The claim is generated.

The payer rejects it.

Someone discovers the problem.

Someone investigates.

Someone contacts someone else.

Someone fixes the data.

Someone resubmits the claim.

Someone follows up.

Someone waits.

Someone checks again.

Eventually, money arrives.

Everyone celebrates.

And then the same thing happens next Tuesday.

That is not a workflow.

That's a subscription to frustration.


The Upstream Alternative

Now imagine a different model.

The system sees the information earlier.

A potential problem is identified.

The appropriate person gets an actionable exception.

The issue is corrected before the claim exists.

The claim goes out with fewer avoidable problems.

The billing team focuses on actual exceptions rather than routine cleanup.

The physician is interrupted less often.

The patient experiences less administrative friction.

The practice gets paid with fewer correction loops.

That is the direction I believe healthcare technology should pursue.


The Five Questions Every Clinic Owner Should Ask

1. Where does information first enter our system?

Usually the front end.

That makes registration more important than many practices realize.

2. Where does information change?

Every transformation is a risk point.

3. Where does someone have to remember a rule?

That is a candidate for standardization or automation.

4. Where do humans repeatedly correct the same problem?

That is a root-cause signal.

5. How much physician time is consumed downstream?

This one gets overlooked.

The physician's time is not just a clinical resource.

It is the most expensive attention in many practices.


A Five-Day Upstream Audit

You do not need a consulting firm.

You do not need a six-month project.

Try this.

Day 1: Pull 10 recent denials

Don't choose only the biggest ones.

Choose a representative sample.

Day 2: Trace each denial backward

Ask:

Where did the problem begin?

Day 3: Group the causes

Use five categories:

Data

Workflow

Authorization

Documentation

Payer rule

Day 4: Find repetition

Which problem occurred more than once?

That's your signal.

Day 5: Change one upstream step

Not ten.

One.

Then measure the result.


Metrics Worth Watching

Traditional revenue-cycle metrics still matter.

Track:

Days in accounts receivable

Clean-claim rate

Denial rate

Net collection rate

Payment variance

Aging

But add:

Preventable denial rate

Manual touches per claim

Administrative touches per encounter

Staff minutes spent on rework

Documentation query rate

Authorization exception rate

Repeat-denial rate

Time from encounter to claim-ready status

These metrics tell a different story.

They tell you how hard the system is making people work.


The Metric I Want More Practices to Measure

If I could add one number to every physician practice dashboard, it would be:

Administrative Touches Per Encounter

How many people have to touch the information before the practice gets paid?

One?

Three?

Seven?

Ten?

Fifteen?

The number is revealing.

Because every touch creates an opportunity for:

  • Delay
  • Error
  • Duplication
  • Miscommunication
  • Cost

Reducing touches does not mean removing necessary human judgment.

It means removing unnecessary handoffs.


Legal and Compliance Considerations

Upstream automation does not remove compliance responsibilities.

It can actually make governance more important.

Practices should consider:

HIPAA privacy and security

Business associate requirements

Access controls

Audit trails

Documentation integrity

Coding compliance

Payer contracts

Medicare and Medicaid requirements

State requirements

Human oversight

Data retention

Security incident response

There is also a basic principle that should never disappear:

The practice remains accountable for what it submits.

Software does not become the legal owner of the claim simply because software touched it.

"The algorithm did it" is not a compliance strategy.


Ethical Considerations

Revenue-cycle technology deals with information about real people.

A claim represents a patient.

A diagnosis represents a patient.

A denial may delay care.

A documentation query consumes physician attention.

A prior authorization request can delay treatment.

That means optimization has an ethical dimension.

The goal should not be:

Maximum automation.

It should be:

Minimum unnecessary friction while preserving accuracy, accountability, privacy, and clinical judgment.

That distinction matters.


Tools and Resources

A practical revenue-cycle improvement toolkit can be surprisingly simple.

Root-Cause Log

Track:

  • Payer
  • Service
  • Denial
  • Cause
  • Origin
  • Preventability
  • Staff time
  • Resolution

Payer Rule Tracker

Record important changes in:

  • Authorization
  • Documentation
  • Coverage
  • Coding
  • Filing deadlines

Exception Queue

Surface only cases that need attention.

Process Map

Map the patient journey from scheduling through payment.

Monthly Friction Review

Ask:

Where did people spend time fixing something that should have been correct the first time?

That question alone can reveal a lot.


The Biggest Mistake Founders Make

Healthcare founders often start with the technology.

They ask:

What can AI do?

I think the better question is:

Where is the human being wasting time?

Then:

Why does that work exist?

Then:

Can the underlying problem be prevented?

Only then:

Can technology help?

That sequence matters.

Otherwise, we risk building very sophisticated solutions to very poorly understood problems.


The Biggest Mistake Physicians Make

Physicians often assume administrative complexity is simply part of practicing medicine.

It isn't necessarily.

Some complexity is unavoidable.

Some is useful.

Some is necessary for safety.

But some is simply accumulated history.

One payer added a rule.

Another added an exception.

The EHR created a field.

Someone created a spreadsheet.

A staff member developed a workaround.

The workaround became policy.

Five years later, everyone follows it.

Nobody remembers why.

Welcome to healthcare.


The Bigger Opportunity

The next generation of healthcare technology may not come from making every process more sophisticated.

It may come from making them simpler.

Fewer handoffs.

Cleaner information.

Earlier detection.

Better exception management.

Less tribal knowledge.

More reliable workflows.

That is not as flashy as an AI agent doing everything.

But it may be more useful.


What the Brooklyn Dotson Story Really Teaches Us

Let's go back to Brooklyn.

Michael Waters' family could not know what would happen after they honored his wish.

They knew only that they wanted to respect what Michael had told them.

His liver went to Brooklyn Dotson.

Brooklyn survived.

The families connected.

Noah and Brooklyn grew up.

Life continued.

And more than twenty years later, the original act of generosity had become part of a completely different story.

That is healthcare.

Not a transaction.

A chain of consequences.

Some measurable.

Some invisible.

Some immediate.

Some decades away.

The mistake we make is assuming the outcome is the last event.

It isn't.

The outcome is everything that happens afterward.


And That Is Also True of Medical Billing

A denial is not the end of a claim.

It creates work.

That work creates cost.

That cost consumes staff time.

That time can affect workload.

Workload can affect physician experience.

Physician experience can affect retention.

Retention can affect continuity.

Continuity can affect the patient experience.

The chain continues.

So perhaps the right way to think about revenue cycle is not:

"How much money did we collect?"

But:

"How much unnecessary friction did it take to collect it?"

That is a very different metric.


Three Things I Would Change Tomorrow

First: Stop treating every denial as an isolated event.

Look for patterns.

Second: Stop measuring only recovery.

Measure prevention.

Third: Stop asking employees to compensate for broken workflows.

Fix the workflow.

That sounds simple.

It isn't always easy.

But it is where the leverage is.


A Challenge for Physicians and Clinic Owners

Take your last ten denials.

Don't open the payer portal yet.

Don't call the billing company.

Don't blame the payer.

Don't blame the biller.

Instead ask:

Where did this problem first become possible?

You might be surprised by the answer.

It may not be in billing.

It may be in scheduling.

Registration.

Eligibility.

Documentation.

Authorization.

Communication.

Or simply a rule nobody knew had changed.

That is the point.

The visible problem is often not the original problem.


The Future of Revenue-Cycle Management

I don't think the future is humans versus AI.

That's an unnecessarily dramatic framing.

The future is more likely:

Humans doing the work that requires judgment.

Machines handling predictable information processing.

Rules enforcing deterministic requirements.

Systems identifying exceptions earlier.

People intervening when context matters.

And perhaps most importantly:

Data becoming useful before it becomes a claim.

That is where healthcare technology becomes interesting.


Final Thoughts: Look Upstream

The story of Brooklyn Dotson, Michael Waters, and Noah Waters is extraordinary because it reminds us that the consequences of a healthcare decision can extend far beyond the moment in which the decision was made.

A 10-year-old boy's decision about organ donation became a liver transplant.

The transplant became survival.

Survival became a childhood.

The childhood became a life.

That life eventually became a relationship.

And that relationship became a marriage.

No dashboard captured the entire chain.

No metric predicted it.

No one could see the final outcome at the beginning.

Healthcare is full of chains like this.

We simply don't always notice them.

The same is true in the revenue cycle.

The denial we see today may have started weeks earlier.

The payment delay may have started at registration.

The documentation problem may have started with time pressure.

The authorization problem may have started with a rule nobody knew had changed.

The revenue leakage may have started with information that was never structured correctly.

So perhaps the most important question for physician practices is not:

"How do we get better at fixing denials?"

It is:

"How do we get better at preventing the conditions that create them?"

That is the difference between reacting to the revenue cycle and designing it.

And that is where I believe healthcare technology has an opportunity to become genuinely useful.

Not by adding another layer.

Not by replacing physicians.

Not by creating another dashboard nobody opens.

But by making the information that matters available before the problem becomes expensive.

Look upstream.

Fix the information before you fix the claim.

And measure how much unnecessary work your system creates before asking your people to work harder.


Get Involved: Continue the Conversation

Here is the question I want to leave with physicians, practice owners, administrators, and medical billers:

What is the most expensive problem in your revenue cycle that everyone has simply learned to live with?

Is it prior authorization?

Eligibility?

Documentation?

Coding?

Payer changes?

Denials?

Underpayments?

Or something nobody has named yet?

Leave a comment and tell me where the friction begins in your practice.

If you've seen the same problem repeatedly, share your experience. Someone reading this may be dealing with exactly the same issue.

And if this perspective resonates, repost the article so another physician or clinic owner can rethink the assumption that every billing problem belongs to the billing department.

The conversation should move upstream.

The opportunity is there.

Let's start looking for it.


About the Author

Dr. Daniel Cham is a physician, healthcare strategist, and founder of OnnX, an AI-powered medical billing SaaS focused on helping small and medium-sized physician practices reduce administrative friction and address revenue-cycle problems upstream.

His work explores the intersection of clinical workflows, healthcare operations, medical billing, data quality, and practical healthcare technology.

His perspective is straightforward:

Healthcare technology should reduce friction rather than create another layer of it.

Connect with Dr. Daniel Cham on LinkedIn


Disclaimer / Note

This article is provided for general educational and informational purposes. It discusses healthcare operations, medical billing, technology, and administrative processes at a general level and does not constitute medical, legal, coding, compliance, reimbursement, or financial advice.

Specific requirements can vary according to specialty, payer, contract, jurisdiction, patient circumstances, and organizational policy. Readers should obtain appropriate professional guidance before making decisions concerning their individual practices or organizations.


Continue Exploring

The healthcare conversation does not stop at the claim.

I share practical observations about healthcare operations, physician entrepreneurship, medical technology, medical billing, workflow design, and innovation.

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Knowledge becomes useful when it changes what we do. Start here, keep learning, and help shape a more practical and human-centered healthcare system.


Free Resource

PS: Check the Featured section of my LinkedIn profile for a free resource designed for physicians and clinic owners. No signup is required.

If you are trying to understand where revenue-cycle friction actually begins, start there.


Three References

1. Kayvan Haddadan, MD — “Moral agency in medicine is being squeezed by payer audits.”
Published September 27, 2026, this physician perspective examines the relationship among reimbursement pressure, physician volume, documentation, payer audits, denials, and professional autonomy.
Read the physician commentary

2. Healthcare IT News — “What it will take for AI to deliver better clinical decisions.”
Published September 28, 2026, this analysis focuses on the practical value of healthcare AI, including care quality and time returned to clinicians rather than technology for its own sake.
Read the Healthcare IT News article

3. CMS — Electronic Prior Authorization.
CMS outlines the administrative burden associated with prior authorization and its work toward electronic prior authorization, including implementation steps for providers and health IT vendors.
Read the CMS guidance


The Human Story Behind the Argument

For readers who want to understand where this article began, the story of Brooklyn Dotson, Michael Waters, Noah Waters, Ashley Baker, and Tina Poteet was reported by The Washington Post.

Brooklyn received Michael's liver after he died at age 10. His mother, Tina Poteet, had learned that Michael wanted to be an organ donor. Poteet later connected with Brooklyn's mother, Ashley Baker, and the two families remained close. Brooklyn and Noah Waters eventually developed a romantic relationship and became engaged.

It is worth reading the original story because the details matter.

The healthcare lesson is not that organ donation is somehow equivalent to medical billing.

It isn't.

The connection is more fundamental:

We rarely know the full consequence of a healthcare decision when we make it.

That is precisely why upstream decisions deserve more attention.


Hashtags

#MedicalBilling #RevenueCycleManagement #HealthcareOperations #PhysicianPractice #IndependentPractice #MedicalPracticeManagement #HealthcareTechnology #HealthcareAI #PriorAuthorization #DenialManagement #PhysicianEntrepreneur #HealthTech #ClinicalWorkflow #HealthcareInnovation #DataQuality #OnnX

If this perspective resonates, consider reposting it to help other physicians and clinic owners rethink how billing problems begin.

 

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