A young man returned home to care for his mother. His final act helped six patients live—and exposes a deeper lesson about what healthcare gets right, and what it still gets wrong.
“There is an urgent need to fix what’s broken in health
care today—and it is not the doctor.” — Jack
Resneck Jr., MD, former President of the American Medical Association
One man died. Six patients received a chance to live. And
somewhere in between, healthcare demonstrated what it looks like when people,
information and systems actually work together.
A young man from Hanoi had been studying in Japan.
Then he learned his mother was ill.
So he came home.
He never returned.
In late August, he developed a sudden, severe headache and
neck pain. Doctors discovered a subarachnoid hemorrhage caused by a ruptured
aneurysm.
Despite intensive treatment at Bach Mai Hospital in Hanoi,
his brain injury became irreversible.
His mother had watched programs about organ donation before.
She had never imagined she would one day have to make that
decision herself.
She said her son had been taught from childhood to be kind
and generous.
So, in the middle of unimaginable grief, she agreed to
donate his organs.
His heart went to a 37-year-old woman with severe heart
failure.
His liver went to a six-year-old child who had waited
nearly a year for a transplant.
His two kidneys went to patients with end-stage kidney
disease.
His two corneas went to patients with severe corneal
damage.
The effort involved Bach Mai Hospital, Vietnam's National
Organ Transplant Coordination Center, Hue Central Hospital, 108 Military
Central Hospital and the National Children's Hospital.
The donor's name has not been publicly released, and neither
has his mother's.
And perhaps that is fitting.
Because this story is bigger than one name.
It is about what healthcare can become when human beings,
clinical expertise, information and operations are aligned around one purpose.
There is an uncomfortable lesson here for every physician
and clinic owner.
Healthcare can coordinate an extraordinarily complicated
chain of events in the middle of someone's worst day.
Yet in many ordinary practices, we still struggle to get the
patient's insurance information from the front desk to the billing team without
something breaking.
That is the paradox.
We can transplant a heart.
But we still fax things.
We can coordinate organs across hospitals.
But a physician may spend an afternoon chasing a prior
authorization.
We can perform extraordinary medicine.
Then spend Friday afternoon trying to figure out why a $900
claim was denied.
Something is wrong with that picture.
And I don't think the answer is another software dashboard.
The uncomfortable question
Here is my contrarian question:
What if physician burnout is not primarily a people
problem?
What if it is a systems design problem wearing a human
face?
We often tell physicians:
Manage your stress.
Practice resilience.
Take a vacation.
Set boundaries.
Protect your well-being.
All reasonable advice.
But imagine telling an airline pilot:
“Your cockpit has 400 unnecessary alarms. Maybe work on your
resilience.”
The pilot might reasonably ask:
“Or we could remove the alarms?”
Healthcare deserves the same honesty.
If a workflow repeatedly creates unnecessary work, telling
the physician to become better at tolerating the workflow is not innovation.
It is outsourcing the cost of bad design to the person with
the least spare capacity.
The real story is not organ donation
The organ donation is the emotional hook.
But the deeper story is coordination.
Think about what had to happen after the family said yes.
The medical team had to determine that the patient's brain
injury was irreversible.
The organs had to be assessed.
Potential recipients had to be identified.
Multiple hospitals had to coordinate.
Timing mattered.
Clinical information had to move.
Teams had to communicate.
Every minute mattered.
Dr. Nguyen Ngoc Hung, director of Bach Mai Hospital's
Center for Digestive Surgery, emphasized the urgency: every passing minute
represented a chance of survival for people waiting for transplantation.
That is a remarkable operational lesson.
The system did not say:
“Let's schedule a meeting about this next Tuesday.”
It moved.
Because the cost of delay was obvious.
Healthcare has thousands of other workflows where the cost
of delay is also real.
We just don't always see it.
A delayed claim becomes aging A/R.
A missing authorization becomes a postponed procedure.
An eligibility error becomes a denied claim.
A documentation gap becomes a physician query.
A payer response becomes another phone call.
A billing problem becomes another staff meeting.
Individually, each problem looks small.
Collectively, they become the operating system of the
practice.
We have an odd definition of innovation
Healthcare loves innovation.
We put the word everywhere.
Innovation center.
Innovation lab.
Innovation summit.
Innovation strategy.
Innovation officer.
But sometimes I wonder whether we have made innovation
unnecessarily glamorous.
Because some of the most valuable innovation in healthcare
is incredibly boring.
It looks like:
The claim didn't fail.
The patient didn't have to call twice.
The nurse didn't have to enter the same information three
times.
The physician wasn't interrupted.
The staff member didn't have to call the payer again.
The bill was correct the first time.
Nobody puts that on a conference stage.
But patients notice.
Physicians notice.
Staff notice.
And owners notice it in the financial statements.
The administrative tax nobody puts on the menu
The American Medical Association's latest prior
authorization survey gives us a sense of the scale.
Physicians report completing approximately 40 prior
authorization requests every week.
The process consumes about 13 hours of physician and
staff time per week.
94% say prior authorization contributes to burnout.
95% say it delays access to necessary care.
79% report that patients abandon treatment because of
authorization challenges.
And 26% report that prior authorization has
contributed to a serious adverse event, including hospitalization, permanent
impairment or death.
Read that again.
Forty requests.
Thirteen hours.
Every week.
For a process that is supposed to make healthcare more
efficient.
That is where the irony becomes difficult to ignore.
A process designed to control healthcare spending can
create more healthcare work.
And sometimes more healthcare utilization.
The AMA reports that 88% of physicians surveyed said
prior authorization increases overall healthcare utilization, citing
additional office visits, ineffective initial treatments, urgent care and
hospitalizations among the consequences.
That is not efficiency.
That's bureaucracy doing cardio.
The physician is not the workflow
One of the biggest mistakes healthcare organizations make is
treating physicians as if they are simply another step in a workflow.
They're not.
A physician has a scarce resource that software cannot
manufacture:
clinical judgment.
When a physician spends 20 minutes correcting an
administrative problem that could have been prevented upstream, the cost is not
merely 20 minutes of payroll.
The opportunity cost may be:
Another patient.
A conversation with a family.
A complex diagnosis reviewed more carefully.
A trainee taught.
A nurse supported.
A physician leaving the office at 6:30 instead of 5:00.
And eventually:
A physician who decides they don't want to practice this
way anymore.
AMA data show that physician burnout has improved
nationally, with 41.9% of physicians reporting at least one burnout symptom
in 2025, down from 48.2% in 2023. But the AMA also notes persistent
variation driven by workload, administrative burden, staffing and the realities
of day-to-day practice.
Improvement is good news.
But it should not become an excuse to stop fixing the
system.
Three experts. One uncomfortable conclusion.
Christine Sinsky, MD: stop treating burnout like a
personality defect
Christine Sinsky and the AMA have consistently emphasized
the role of system-level factors in physician burnout.
That matters.
Because there is a subtle but dangerous shift that happens
when organizations focus too heavily on individual resilience.
The question becomes:
“How can we make physicians better at handling this?”
Instead ask:
“Why are physicians handling this at all?”
That's the better operational question.
Atul Gawande: checklists are useful because systems fail
Atul Gawande's work has repeatedly examined a simple truth:
Human beings are brilliant and fallible.
Good systems acknowledge both.
That is particularly relevant to billing.
If a workflow depends on everyone remembering everything,
eventually something gets missed.
Not because people are careless.
Because people are people.
Good systems make the right behavior easier.
They catch predictable errors.
They create visibility.
They make exceptions obvious.
They don't rely on heroic memory.
Abraham Verghese: technology cannot replace the encounter
Abraham Verghese has spent much of his career emphasizing
the importance of the human relationship in medicine.
That gives us an important technology principle:
The more technology we introduce, the more aggressively
we should protect the human encounter.
If the software makes the physician look at the screen more
and the patient less, we need to ask what problem we solved.
Technology should create more room for listening.
Not less.
The billing problem starts before billing
This is where I have become increasingly contrarian.
I don't believe healthcare billing is primarily a billing
problem.
I believe it is often a data-quality problem.
The claim is simply where the problem becomes visible.
Consider the chain:
Patient registration.
Eligibility.
Scheduling.
Authorization.
Clinical documentation.
Diagnosis.
Procedure.
Coding.
Claim creation.
Claim submission.
Payer adjudication.
Payment.
Every step depends on information from the step before it.
If the information is wrong at the beginning, someone
downstream inherits the problem.
And guess who often gets to clean it up?
A person.
Usually someone who already has too much to do.
The industry's favorite game: whack-a-mole
A claim is denied.
Someone fixes it.
Another claim is denied.
Someone fixes that one.
Another authorization fails.
Someone calls.
Another eligibility issue appears.
Someone opens a spreadsheet.
Then someone creates a second spreadsheet to manage the
first spreadsheet.
Eventually someone says:
“We need a dashboard.”
So you buy a dashboard.
Congratulations.
You now have a beautifully visualized problem.
This is one of the traps of modern healthcare technology.
Visibility is not the same as prevention.
A dashboard can tell you that 17% of claims failed.
That is useful.
But the better system asks:
Why did they fail before we submitted them?
The upstream principle
This is the core idea behind the way I think about
healthcare technology:
Move intelligence upstream.
Don't wait for the denial.
Predict it.
Don't wait for the eligibility problem.
Catch it.
Don't wait for missing information to become a claim
failure.
Validate it earlier.
Don't wait for A/R to become old.
Understand why revenue is slowing.
Don't wait for the physician to become frustrated.
Measure how much administrative work is reaching the
physician.
This is the difference between a reactive revenue cycle
and a predictive revenue cycle.
What small practices should actually measure
You do not need 47 dashboards.
You need a few numbers that tell you whether the system is
getting healthier.
1. First-pass yield
How many claims are accepted without correction?
This is one of the clearest indicators of upstream quality.
2. Days in A/R
MGMA identifies 30–40 days as an optimal benchmark
for days in A/R, while emphasizing the importance of understanding the
underlying drivers and practice context.
Don't just ask:
“What's our A/R?”
Ask:
“Why is it there?”
3. A/R over 90 days
Old money is increasingly difficult money.
Track it.
Understand it.
Work it.
But more importantly:
Prevent new balances from joining the pile.
4. Denial rate
Useful.
But incomplete.
A denial rate without denial reasons is like knowing you
have a fever without checking the temperature.
You know something is wrong.
You don't know what.
5. Administrative touches per claim
This is one of my favorite metrics.
How many humans touch a claim before payment?
One?
Two?
Five?
Eight?
Every additional touch represents potential cost, delay and
error.
6. Physician administrative interruptions
Track how often physicians are pulled into:
Coding questions.
Billing questions.
Prior authorization.
Documentation clarification.
Payer disputes.
This metric is rarely on a revenue-cycle dashboard.
It should be.
The metric I wish more practices tracked
Human minutes per encounter.
Not dollars.
Not claims.
Not clicks.
Minutes.
How many minutes of staff attention does one encounter
generate outside direct patient care?
If that number keeps climbing, your system is getting
heavier.
If it falls while quality remains stable, you're creating
leverage.
That is real operational improvement.
A five-step practice audit
You can do this without buying another software platform.
Step 1: Take 100 recent claims
Don't analyze everything.
Start small.
Step 2: Categorize the failures
Eligibility.
Authorization.
Documentation.
Coding.
Payer.
Patient responsibility.
Step 3: Trace each failure backward
Don't ask:
“Who made the mistake?”
Ask:
“Where did the system first allow this mistake to
happen?”
That distinction is enormous.
Blame produces defensiveness.
Root-cause analysis produces improvement.
Step 4: Calculate the human cost
For each category estimate:
Staff time.
Physician time.
Number of touches.
Number of calls.
Days delayed.
Dollars delayed.
Step 5: Fix the earliest failure
This is where most practices can become more proactive.
If the problem begins with eligibility, improve eligibility.
If it begins with documentation, improve documentation.
If it begins with coding, improve the clinical-to-coding
interface.
Don't build a bigger cleanup crew for a problem you could
prevent.
Do not automate chaos
This deserves its own section.
Because AI has made this mistake easier to make.
A company can take a broken workflow, put an AI layer on top
and call it transformation.
It isn't.
AI + chaos = faster chaos.
If your process is broken, first simplify it.
Then standardize it.
Then automate the predictable parts.
Then use AI where judgment and pattern recognition actually
add value.
That sequence matters.
Where AI actually belongs
AI should not simply become a faster denial worker.
That is backward.
Useful AI can help identify:
Claims likely to fail.
Missing documentation.
Eligibility inconsistencies.
Unusual coding patterns.
High-value denials.
Payer-specific patterns.
Recurring workflow failures.
Exceptions that need human attention.
The important word is:
before.
The most valuable AI in revenue cycle management may be the
AI that prevents a problem nobody ever sees.
That is difficult to market.
Because nobody celebrates the denial that never happened.
But clinic owners should.
What OnnX is trying to change
This is the philosophy behind OnnX.
I don't think small and medium-sized practices need another
layer of middlemen.
They need better infrastructure.
The goal isn't to remove humans.
It is to remove unnecessary human work.
That distinction matters.
A skilled billing professional should spend time on
difficult cases.
Not copying information between screens.
A physician should spend time making clinical decisions.
Not explaining to a billing department why the patient's
diagnosis supports what was already documented.
A practice owner should understand the economics of the
practice.
Not spend their evening hunting through spreadsheets.
The objective is simple:
Make the routine invisible. Make the exceptions visible.
Keep humans in control.
A confession from healthcare technology
Here's something the healthcare technology industry doesn't
always like to admit:
Software does not automatically create simplicity.
Sometimes it creates another password.
Another portal.
Another notification.
Another integration.
Another dashboard.
Another training session.
Another vendor meeting.
We have somehow managed to create technology designed to
reduce work that creates work explaining how to use the technology.
That's not a joke.
It's an industry problem.
The best technology should require less explanation over
time, not more.
Five questions before buying another healthcare platform
Ask the vendor:
1. What manual work disappears?
Not:
“What features do you have?”
Ask:
“What work disappears?”
2. What errors does the system prevent?
Not:
“What reports do I get?”
Ask:
“What goes wrong less often?”
3. How many human touches remain?
Automation that still requires five people is not very
automated.
4. What happens when the system is wrong?
This question is surprisingly important.
Good systems need exceptions.
5. How will we measure success?
If the answer is:
“Your staff will love it.”
Run.
The legal side nobody should ignore
Healthcare automation is not a free-for-all.
Practices need to consider:
HIPAA and data security.
Documentation integrity.
Coding accuracy.
Medical necessity.
Auditability.
Vendor contracts.
Business associate obligations where applicable.
Human oversight.
State and federal requirements.
Automation does not eliminate accountability.
It changes where accountability sits.
A practice should always understand:
Who made the decision?
What data was used?
Can the decision be reviewed?
Can the result be corrected?
Who is responsible if something goes wrong?
Those are not merely technical questions.
They are healthcare questions.
The ethical question
Here's the ethical test I would use:
Does this technology give the human being more agency, or
less?
For the patient?
For the physician?
For the nurse?
For the billing professional?
For the practice owner?
If technology makes the system more powerful but the people
inside it less capable of understanding what is happening, that's not
necessarily progress.
It's just complexity with better branding.
The patient eventually pays for bad operations
This is easy to miss.
A practice with broken operations may experience:
More denials.
More A/R.
More staff turnover.
More physician frustration.
More phone calls.
More billing complaints.
More delayed care.
More pressure to see more patients.
And eventually:
A worse patient experience.
Patients don't see your revenue-cycle architecture.
They experience the consequences.
They know when nobody calls them back.
They know when they receive a bill they don't understand.
They know when their appointment gets delayed.
They know when their physician seems exhausted.
Operational excellence is therefore not merely a business
function.
It is part of the patient experience.
What organ donation teaches us about operational
excellence
Return to the story.
The mother made an extraordinary decision.
But her decision alone could not save six people.
The system had to respond.
Clinicians.
Transplant specialists.
Coordinators.
Hospitals.
Laboratories.
Operating rooms.
Transportation.
Information.
Timing.
Every component had to work.
That's the part worth studying.
Compassion started the process. Coordination finished it.
Healthcare needs both.
A beautiful mission with broken operations still produces
frustration.
A highly efficient system without humanity produces
something worse.
The goal is the combination.
The contrarian definition of efficiency
We usually define efficiency as:
More output with fewer resources.
I would change it.
In healthcare:
Efficiency is more meaningful human work with less
unnecessary friction.
That is different.
If automation lets a billing employee process twice as many
claims but creates twice as many errors, that's not efficiency.
If a physician sees two additional patients but spends the
evening finishing charts, that's not necessarily efficiency.
If a clinic collects more money but burns out the people
generating the revenue, that isn't sustainable efficiency.
We need a more human definition.
Human ROI
Healthcare loves financial ROI.
Revenue.
Margin.
Collections.
Cost per claim.
Days in A/R.
All important.
But there is another ROI:
Human ROI.
How many physician hours returned?
How many staff hours returned?
How many patient calls eliminated?
How many unnecessary touches removed?
How many frustrating exceptions prevented?
How many evenings no longer spent cleaning up administrative
work?
That is value.
And unlike a dashboard metric, people actually feel it.
Three tactical changes you can make this week
1. Find your most expensive recurring mistake
Not your biggest problem.
Your most repetitive expensive problem.
Fix that first.
2. Measure physician administrative time
Ask:
“How many hours last week did you spend doing something that
could have been handled elsewhere?”
Don't judge the answer.
Measure it.
You can't improve what you refuse to see.
3. Pick one upstream metric
Choose one problem you currently discover too late.
Then create a measure that detects it earlier.
That is the beginning of predictive operations.
What physician leadership should look like
Physician leadership is not becoming the best administrator
in the building.
It is knowing enough about the system to redesign it.
You don't need to personally work every denial.
You need to know:
Why are we getting them?
How much are they costing us?
What causes them?
Who owns the process?
Can we prevent them?
That's leadership.
The future of medical billing is not "more AI"
That's my hot take.
The future is better information flow.
AI will matter.
Automation will matter.
Interoperability will matter.
Real-time eligibility will matter.
Better payer connectivity will matter.
But all of those technologies depend on something less
exciting:
good data.
If the information entering the system is wrong, intelligent
software simply becomes an extremely sophisticated way to be wrong.
The future revenue cycle should therefore work more like a
feedback loop.
Capture.
Validate.
Predict.
Prevent.
Submit.
Monitor.
Learn.
Improve.
Repeat.
What I think healthcare founders should build
Stop asking:
“Where can we put AI?”
Ask:
“Where is valuable human attention being wasted?”
That question is more interesting.
Because wasted attention is everywhere.
Physicians.
Nurses.
Medical assistants.
Schedulers.
Billers.
Practice managers.
Patients.
And attention is one resource healthcare cannot manufacture.
Once an hour is gone, it's gone.
The boring problems may be the biggest opportunities
Everyone wants to build the next breakthrough clinical
platform.
Few people want to build the infrastructure that makes
ordinary healthcare work.
That's precisely why there is opportunity.
Make scheduling less painful.
Make eligibility cleaner.
Make claims more accurate.
Make denials less mysterious.
Make A/R more predictable.
Make patient billing understandable.
Make physician workflows lighter.
Make small practices operationally stronger.
None of these problems sounds glamorous.
But healthcare doesn't need more glamour.
It needs fewer headaches.
The bigger healthcare lesson
The story from Bach Mai Hospital is ultimately about
something simple.
A mother lost her son.
She chose to give.
Clinicians coordinated.
Multiple patients received another chance.
The tragedy did not disappear.
But the healthcare system helped transform what could be
done with it.
That is what good healthcare does.
It cannot always change the outcome.
But it can change what happens next.
That principle applies to everything from transplantation to
medical billing.
A denial has already happened.
Fine.
What happens next?
A physician is overwhelmed.
What happens next?
A patient receives a confusing bill.
What happens next?
A practice has declining cash flow.
What happens next?
The answer should not always be:
Hire another person to clean it up.
Sometimes the answer should be:
Redesign the system that created the mess.
Frequently Asked Questions
What is the central lesson of this story?
Healthcare is a coordination business before it is a
technology business.
Technology is valuable when it helps people coordinate
better.
What does this have to do with physician burnout?
Administrative work consumes finite physician and staff
capacity.
Current AMA data show that prior authorization alone
requires roughly 13 hours of physician and staff time per week and is
reported as a burnout contributor by 94% of physicians surveyed.
Is medical billing really a clinical issue?
It is not clinical care itself, but it is tightly connected
to the information generated by clinical care.
Errors in upstream clinical and operational information can
become downstream billing problems.
Should practices eliminate billing staff?
No.
The better objective is to eliminate unnecessary manual work
so skilled people can focus on judgment, exceptions and complex cases.
Is AI the answer?
AI can be part of the answer.
But AI is not the strategy.
The strategy is improving the workflow.
What should a small practice measure first?
Start with:
First-pass yield.
Denial rate and denial reasons.
Days in A/R.
A/R over 90 days.
Administrative touches per claim.
Physician administrative interruptions.
What does "move intelligence upstream" mean?
It means identifying and preventing predictable problems before
they become denials, delays, rework or patient complaints.
How can a practice begin without buying new software?
Take 100 recent claims.
Categorize the failures.
Trace each failure to its earliest cause.
Calculate the staff and physician time consumed.
Fix the most repetitive upstream problem.
Then measure again.
You may learn more from that exercise than from another
software demo.
Final Thoughts: Stop Making Physicians Pay for Broken
Systems
The young man from Hanoi came home because his mother was
sick.
His story ended in tragedy.
But his mother made a decision that allowed his heart,
liver, kidneys and corneas to help other people continue living.
The physicians and hospitals then did something equally
important:
They coordinated.
That word is easy to overlook.
But coordination is what healthcare does when it is working.
The patient should not have to coordinate the entire
healthcare system.
The physician should not have to coordinate the billing
system.
The billing staff should not have to reconstruct information
that already exists somewhere else.
The practice owner should not need five spreadsheets to
understand where the money went.
And nobody should confuse more software with better
healthcare.
The best system is the one that quietly removes friction
while keeping humans in control.
That's the standard I believe healthcare technology should
be held to.
Not more clicks.
Not more dashboards.
Not more portals.
Not more AI for the sake of saying we have AI.
More time for patients.
Less preventable work for physicians and staff.
Better information moving through the system.
Fewer problems discovered after they become expensive.
That is what operational innovation should mean.
Get Involved
Here's the question I want to leave with you:
If you could eliminate one administrative task from a
physician's day tomorrow, what would it be?
Tell me in the comments.
Not the polished answer.
The real answer.
The task that makes you think, Why are we still doing
this?
If you're a physician, clinic owner, practice manager or
healthcare operator, share what your practice is struggling with.
And if this perspective resonates, repost this article
so another physician or clinic owner can join the conversation.
Because healthcare does not need another lecture about
working harder.
It needs better systems.
Raise your hand. Add your experience. Challenge the
conventional wisdom.
Let's make the boring parts of healthcare work better so
the human parts can matter more.
About the Author
Dr. Daniel Cham is a physician, medical consultant
and healthcare technology entrepreneur focused on the intersection of healthcare
management, medical technology, medical billing and practice operations.
As founder of OnnX, he is working to help small and
medium-sized medical practices reduce unnecessary administrative friction,
improve revenue-cycle performance and build more sustainable operating systems.
His focus is practical:
Better data.
Better workflows.
Less administrative waste.
More capacity for patient care.
Connect with Dr. Cham on LinkedIn:
Disclaimer
This article is intended for general educational and
informational purposes only. It does not constitute medical, legal, compliance,
coding, billing or financial advice.
Healthcare regulations, payer policies and individual
circumstances differ. Practices should consult appropriately qualified
professionals for guidance regarding specific clinical, legal, regulatory,
coding or financial situations.
Continue the Conversation
Healthcare improves when people share what they learn.
I explore the intersection of medicine, healthcare
operations, technology, entrepreneurship and innovation — with an emphasis
on practical ideas that can be applied in the real world.
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Knowledge creates leverage. Start with one problem,
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If you work in healthcare, don't just consume the
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free resource. No signup required.
Use it with your team.
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If this article made you rethink how your practice handles
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References
1. The human story — Bach Mai Hospital / Tuoi Tre News
A young Hanoi man returned from Japan to care for his sick mother, died after a
catastrophic brain hemorrhage, and became an organ donor whose heart, liver,
kidneys and corneas helped multiple patients.
Read
the Tuoi Tre report
2. Physician administrative burden — American Medical
Association
The AMA's latest prior-authorization survey documents approximately 40
requests per physician per week, roughly 13 hours of physician and staff
time, and major reported effects on access, outcomes and burnout.
Read
the AMA findings
3. Revenue-cycle benchmark — MGMA
MGMA identifies 30–40 days as an optimal benchmark for days in A/R and
emphasizes analyzing aging and workflow causes rather than relying on a single
number.
Read
the MGMA A/R guidance
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