Monday, August 31, 2026

Jeannie Guffey’s Final Wish Wasn’t Another Treatment. It Was a Baptism.

What three ICU nurses, a kiddie pool, and one dying patient can teach us about the future of healthcare



“Human judgment, empathy, and understanding of individual patient contexts remain essential.”Dr. Imamu “Mu” Tomlinson, emergency physician and CEO of Vituity

 

Jeannie Guffey was 74.

She had lung cancer.

She was in the Medical ICU at Huntsville Hospital, surrounded by monitors, IV poles, equipment, alarms, and the machinery of modern medicine.

She knew her time was short.

She was preparing to go home with hospice.

Then she told her family something she wanted to do before she left.

She wanted to be baptized.

Simple enough.

Except she was lying in an ICU bed.

There was no convenient church baptismal pool waiting downstairs.

No standard hospital protocol titled:

“Baptism for a Critically Ill Patient.”

No dropdown menu in the electronic health record.

No software workflow.

No committee meeting.

So three ICU nurses decided to figure it out.

Erin Powers. Kaitlin Swaim. Emily Owens.

They did some research.

Then they bought a kiddie pool from Walgreens with their own money.

They had it delivered to the hospital.

The family supplied an electric air pump.

The nurses figured out how to fill the pool with warm water using ventilator tubing.

The ICU team used the room's ceiling lift to lower Jeannie safely into the water.

Her son, Jody, performed the baptism.

Her family watched.

For a few minutes, that fourth-floor ICU room became something else.

Not just a place where medicine was being delivered.

A place where a family was saying goodbye.

And that is where this story gets uncomfortable.

Because we spend billions of dollars trying to make healthcare more efficient.

More digital.

More automated.

More intelligent.

More connected.

More AI-powered.

And yet three nurses still had to buy a kiddie pool to make a dying patient's final wish possible.

Maybe the problem isn't that healthcare needs more technology.

Maybe the problem is that healthcare has become very good at optimizing the wrong things.


The $20 Question Healthcare Doesn't Like to Ask

Here is my contrarian question:

What if the most important metric in healthcare isn't how much technology we deploy, but how much human attention we return?

We measure revenue.

We measure productivity.

We measure length of stay.

We measure readmissions.

We measure patient satisfaction.

We measure RVUs.

We measure denial rates.

We measure days in A/R.

We measure clicks.

We measure utilization.

We measure throughput.

We measure everything.

Except perhaps the thing patients actually experience:

Did their clinician have enough attention left for them?

That is a harder metric.

And inconveniently, it cuts across every department.

Because the physician who spends an hour fighting a payer isn't spending that hour with a patient.

The nurse completing another administrative task isn't standing at the bedside.

The practice manager reconciling three spreadsheets isn't solving the operational problem that actually matters.

The billing specialist chasing a preventable denial isn't working on the next claim.

And the patient?

The patient doesn't care which department caused the problem.

They just experience the friction.


We Have Confused Digitization With Progress

Healthcare has a strange habit.

We take an old manual process.

Put it on a computer.

Call it innovation.

Then add a dashboard.

Then an API.

Then an AI assistant.

Then another dashboard to monitor the first dashboard.

Eventually someone asks why everyone is exhausted.

This is not innovation.

It is digitized bureaucracy.

The computer is faster.

The bureaucracy is still bureaucracy.

The fax becomes a portal.

The portal becomes an inbox.

The inbox becomes a notification.

The notification becomes a task.

The task becomes a queue.

And the queue becomes someone's problem.

Congratulations.

We digitized the headache.

This is especially obvious in revenue cycle management.

A practice can have an EHR.

A billing system.

A clearinghouse.

A payer portal.

A claims scrubber.

A denial-management platform.

A patient-payment system.

A reporting dashboard.

And six browser tabs open on someone's monitor.

Yet the practice can still have bad data.

That should tell us something.

The problem isn't always the absence of software.

Sometimes the problem is the architecture between the software.


Jeannie Guffey Didn't Need Another App

This is what makes her story so powerful.

Jeannie didn't need another app.

She didn't need an AI chatbot.

She didn't need a predictive analytics dashboard.

She didn't need a patient engagement platform.

She needed three nurses to say:

“Let's find a way.”

And they did.

That phrase may be one of the most important phrases in healthcare.

Not:

“That's not our workflow.”

Not:

“That's outside the protocol.”

Not:

“The system won't allow it.”

Not:

“Submit a ticket.”

Not:

“Please call billing.”

Not:

“Please contact your insurance company.”

But:

“Let's find a way.”

Now ask yourself:

How much of modern healthcare prevents clinicians from saying those words?


The Administrative Tax on Medicine

The numbers are uncomfortable.

According to the American Medical Association's latest prior-authorization survey, physicians complete about 40 prior authorization requests per week.

The work consumes approximately 13 hours of physician and staff time each week.

94% of physicians surveyed said prior authorization contributes to burnout.

95% said it delays access to necessary care.

79% reported that patients abandon treatment because of authorization challenges.

And 26% reported that prior authorization had contributed to a serious adverse event, including hospitalization, permanent impairment, or death.

Those aren't technology statistics.

They're human statistics.

Thirteen hours is not an abstract administrative burden.

It's thirteen hours.

That is time.

Time that could have been spent seeing patients.

Calling a worried family.

Teaching a trainee.

Reviewing a difficult case.

Going home.

Sleeping.

Being with children.

Being a spouse.

Being a human being.

Healthcare keeps treating time as if it were an unlimited resource.

It isn't.


Here Is the Uncomfortable Part About AI

I'm a physician.

I'm also a healthcare technology entrepreneur.

I believe AI can be extremely useful in healthcare.

But I'm increasingly skeptical of the industry's obsession with saying:

“AI will solve healthcare.”

No.

AI will solve some problems.

If we are lucky, it will solve the right ones.

Because AI can make a bad workflow faster.

That's not necessarily progress.

Imagine giving a race car to someone driving in the wrong direction.

Congratulations.

You're now going the wrong way at 200 miles per hour.

The question isn't:

Can AI automate this?

The better question is:

Should this process exist in this form at all?

That distinction is everything.


Expert Insight #1: The Patient Comes Before the Workflow

Emily Owens' comment about Jeannie's baptism contains a profound lesson:

“This was a last wish that was very important to the patient and her family, so we had to find a way.”

Notice the order.

Patient.

Family.

Wish.

Then workflow.

Healthcare often reverses that order.

Workflow.

Policy.

Department.

Technology.

Billing.

Then patient.

We need to reverse it.

Start with:

What does the patient need?

Then:

What prevents us from delivering it?

Then:

How do we remove that barrier?

That is patient-centered design.

It is also good business.


Expert Insight #2: Technology Should Protect Human Judgment

This week's healthcare conversation around AI is increasingly moving toward a similar conclusion.

Medical AI is becoming more common in documentation, clinical decision support, information retrieval, and workflow management.

But physicians remain concerned about accuracy, context, accountability, and what happens when automated systems make mistakes.

Stanford physician-computer scientist Dr. Jonathan Chen, featured this week by Science Friday, discussed the growing use of AI by physicians while emphasizing the tension between its usefulness and clinicians' concerns about its limitations.

The lesson isn't:

Reject AI.

It is:

Don't surrender judgment to it.

A useful system should make the physician smarter.

It should not make the physician less responsible.


Expert Insight #3: Interoperability Is Really About Time

The AMA is working on an initiative to improve electronic prior authorization by connecting clinical terminology with administrative coding.

Why does that matter?

Because the clinical system and payer system often speak different languages.

Someone has to translate.

Usually a person.

The AMA's initiative aims to bridge SNOMED CT clinical concepts and CPT coding so electronic prior authorization can become more seamless.

This sounds technical.

It isn't.

It is about time.

Interoperability is a human-time problem disguised as a software problem.

Every disconnected system creates another translation job.

Every translation job creates another opportunity for error.

Every error creates another phone call.

Every phone call consumes another minute.

Multiply that across thousands of patients.

Now you have an industry.


The Revenue Cycle Has the Same Problem

This is exactly why I think medical billing deserves a different conversation.

The traditional question is:

“How do we collect more money?”

Important.

But incomplete.

The better question is:

“Why did the information fail to move correctly from the patient encounter to the payment?”

That changes everything.

A claim is not born as a claim.

It begins as information.

Patient information.

Insurance information.

Clinical information.

Documentation.

Orders.

Procedures.

Diagnoses.

Codes.

Charges.

Modifiers.

Authorizations.

Then all of that gets translated into a financial transaction.

Every translation is a potential failure point.

So when a claim gets denied, the denial is often the last symptom of an earlier problem.

The industry frequently attacks the symptom.

Work the denial.

Appeal it.

Resubmit it.

Call the payer.

Repeat.

Repeat.

Repeat.

That is expensive.

And frankly, a little ridiculous.

If your refrigerator leaks every Tuesday, hiring someone to mop the floor every Wednesday is not a business strategy.

Fix the refrigerator.


The Revenue-Cycle Thesis

Here is my thesis:

Medical billing is not primarily a billing problem.

It is a data-quality and workflow problem.

Billing is where the problem becomes visible.

By then, it is already expensive.

That means the real opportunity is upstream.

Capture better information.

Connect information.

Validate information.

Identify exceptions early.

Prevent avoidable errors.

Then send the cleanest possible transaction downstream.

This is fundamentally different from building a bigger denial factory.


The Denial Factory

Healthcare has built an enormous industry around correcting problems after they happen.

Claim denied?

Work it.

Authorization denied?

Appeal it.

Documentation incomplete?

Send it back.

Coding wrong?

Correct it.

Eligibility wrong?

Call.

Information missing?

Search.

Payer changed its rules?

Update the spreadsheet.

Someone somewhere eventually fixes the problem.

But we rarely ask:

Why are humans repeatedly fixing the same class of error?

That is the question founders should obsess over.


The Five-Minute Test

Here's a simple exercise for every clinic owner.

Pick one repetitive administrative task.

Now ask:

Why does a human have to do this?

If the answer is:

“Because that's how we've always done it.”

Congratulations.

You found a candidate for redesign.

If the answer is:

“Because the systems don't talk to each other.”

You found an interoperability problem.

If the answer is:

“Because someone has to check whether the information is correct.”

You found a validation problem.

If the answer is:

“Because the payer requires it.”

Ask whether the requirement can be automated, standardized, or integrated.

If the answer is:

“Because it requires judgment.”

Keep the human.

That last answer matters.

Not everything should be automated.


A Better Division of Labor

I believe the future healthcare operating model should look something like this:

Machines handle repetition.

Eligibility checks.

Data matching.

Pattern recognition.

Sorting.

Classification.

Routine validation.

Work queues.

Status monitoring.

Humans handle judgment.

Clinical decisions.

Exceptions.

Ambiguity.

Sensitive conversations.

Escalations.

Relationships.

Ethical decisions.

Complex patient situations.

That sounds obvious.

Yet much of healthcare does the opposite.

We ask humans to perform repetitive administrative work.

Then we ask machines to summarize the humans.

Maybe we should switch the arrangement.


What Small and Midsize Practices Should Do Tomorrow

You don't need a $20 million transformation program.

Start smaller.

Step 1: Follow one patient

Take one patient from:

Appointment → Visit → Documentation → Coding → Claim → Payment.

Write down every handoff.

Don't theorize.

Watch what actually happens.

 

Step 2: Circle every duplicate entry

If someone enters the same information twice, circle it.

Three times?

Circle it twice.

Ten times?

You may have found your next technology project.

 

Step 3: Find the first failure

Don't start with the denial.

Find where the information first became wrong.

That is the upstream problem.

 

Step 4: Measure the human cost

Ask:

How many minutes?

How many employees?

How many interruptions?

How many calls?

How many corrections?

How many follow-ups?

How many claims?

How much cash?

Then calculate the cost.

 

Step 5: Automate only after simplifying

This is important.

Simplify first. Automate second.

Otherwise you may simply automate a bad process.


Five Metrics I Would Watch

Forget the 37-tab dashboard.

Start with five numbers.

1. First-Pass Yield

How much work succeeds without rework?

2. Denial Rate

How much submitted revenue fails?

3. Days in A/R

How long does earned revenue remain trapped?

4. Administrative Hours

How many human hours are spent moving information around?

5. Revenue Leakage

How much legitimate revenue fails to become cash?

And I would add a sixth:

6. Minutes Returned to Clinicians

This is the metric most healthcare dashboards don't show.

It should.


Why “Minutes Returned” May Be the Best ROI Metric in Healthcare

Imagine your technology saves a physician 30 minutes a day.

That's 2.5 hours a week.

More than 100 hours a year.

Now imagine that physician uses those hours to:

See patients.

Call families.

Teach.

Review charts.

Take a breath.

Leave the office earlier.

That is ROI.

Not just financial ROI.

Human ROI.

We need to start measuring it.


A Funny Thing About Healthcare

We have spent years trying to calculate the value of a physician's time.

RVUs.

Collections.

Visits per day.

Revenue per physician.

Productivity.

But we rarely calculate the value of a physician not doing administrative work.

That's strange.

If a surgeon spent an afternoon repairing the office plumbing, we'd recognize the absurdity.

But if a physician spends an afternoon fighting an insurance portal?

Somehow that's called healthcare.

It isn't.

It is a systems failure.


What Jeannie Guffey's Nurses Did Right

Let's return to Jeannie.

Erin Powers.

Kaitlin Swaim.

Emily Owens.

They didn't have perfect information.

They didn't have a perfect workflow.

They didn't have a perfect solution.

They had a patient.

They had a problem.

They had limited time.

And they improvised.

That's healthcare at its best.

The important lesson isn't that every nurse should personally buy a kiddie pool.

Quite the opposite.

Healthcare organizations should build systems where clinicians don't have to become heroes just to do the right thing.

That's the real lesson.

Heroic work is inspiring.

But it is not scalable.


The Dangerous Myth of Heroic Healthcare

Healthcare loves stories about extraordinary clinicians.

The nurse who stays late.

The doctor who makes the impossible diagnosis.

The surgeon who works through the night.

The staff member who personally calls every patient.

We celebrate them.

We should.

But then we should ask:

Why did the system require heroism?

A heroic workaround can hide a broken process.

If one nurse staying late saves a patient, that's compassion.

If every nurse must stay late because the system is broken, that's an operational problem.

There is a difference.


Best Practice Isn't Always Best

Here's another uncomfortable opinion.

“Best practice” can become an excuse for not thinking.

A process can be standardized and still be terrible.

A workflow can be compliant and still be inefficient.

A dashboard can be accurate and still be useless.

A billing company can process millions of claims and still create unnecessary friction.

A software platform can have 400 features and still solve the wrong problem.

The real question isn't:

“Is this industry standard?”

It is:

“Does this work?”


Pitfalls Healthcare Leaders Should Avoid

Pitfall 1: Buying software before understanding the workflow

Technology cannot diagnose a problem you haven't defined.

Pitfall 2: Measuring activity instead of outcomes

Claims processed aren't cash collected.

Denials worked aren't denials prevented.

Clicks reduced aren't necessarily time saved.

Pitfall 3: Automating everything

Some decisions require humans.

Pitfall 4: Ignoring staff

The people who actually perform the workflow know where it breaks.

Listen to them.

Pitfall 5: Treating billing as a back-office problem

Billing affects cash flow.

Cash flow affects staffing.

Staffing affects access.

Access affects patients.

Everything connects.

Pitfall 6: Creating another silo

If your new tool creates another login, another dashboard, another inbox, and another reconciliation process, ask whether you actually solved anything.

Pitfall 7: Assuming AI equals intelligence

AI can be powerful.

It can also confidently be wrong.

Healthcare needs auditable intelligence, not magic.


Legal and Compliance Reality

Automation does not eliminate responsibility.

A practice remains responsible for the accuracy of its claims and appropriate handling of patient information.

Any technology touching protected health information should be evaluated for:

Privacy

Security

HIPAA obligations

Business associate arrangements

Auditability

Access controls

Data retention

Vendor responsibilities

Coding accuracy

Payer requirements

Human oversight

The key principle:

Automate the work. Don't automate away accountability.

For specific compliance, legal, coding, or reimbursement questions, practices should consult qualified professionals.


Ethical Question: Who Gets the Time?

This may be the most important question in healthcare automation.

Suppose technology saves 10 hours a week.

Who gets those 10 hours?

The corporation?

The payer?

The practice?

The physician?

The patient?

The staff?

There isn't one universal answer.

But we should at least ask.

Because if automation simply means:

“Great. Now you can see three more patients.”

We may have missed the point.

Maybe the physician needed those minutes to think.

Maybe the nurse needed them to recover.

Maybe the patient needed them for a conversation.

Efficiency without humanity can become another form of exhaustion.


What OnnX Is Trying to Change

This is the philosophy behind my work with OnnX.

OnnX is an AI-powered medical billing SaaS built around a simple idea:

Small and midsize practices should not need unnecessary layers of middlemen and administrative friction to get paid for the care they already delivered.

The objective isn't “AI for AI's sake.”

The objective is better information flow.

Better workflow.

Earlier detection.

Less avoidable rework.

More transparency.

More control.

And ultimately:

More time returned to the people doing the actual work of healthcare.

That's the north star.


But Let's Be Honest About What Technology Cannot Do

Technology cannot make every payer policy reasonable.

It cannot eliminate every denial.

It cannot replace clinical judgment.

It cannot fix every broken incentive in American healthcare.

It cannot make difficult patients easy.

It cannot eliminate every administrative requirement.

And it certainly cannot make healthcare human by itself.

Technology is a tool.

The system around the tool matters more.

The incentives matter.

The workflow matters.

The people matter.

The culture matters.


The Future Isn't “AI Replaces Doctors”

That headline gets clicks.

I think it misses the point.

The more interesting future is:

AI removes work that doctors shouldn't have been doing.

That's a much better story.

A physician should be thinking about the patient.

Not whether an insurance number was copied correctly three screens ago.

A nurse should be thinking about the bedside.

Not which portal contains the authorization status.

A practice manager should be thinking about the health of the practice.

Not manually reconciling three spreadsheets.

A billing specialist should be solving complex exceptions.

Not repeatedly correcting predictable errors.

That's where intelligent automation becomes useful.


Recent News: The Same Story Keeps Appearing

The healthcare news cycle this week has been remarkably consistent.

The technology gets smarter.

The administrative problem remains.

A recent Science Friday discussion featured Stanford physician-computer scientist Jonathan Chen, examining how doctors are using AI for documentation, diagnosis-related tasks, and staying current while wrestling with accuracy and trust.

The AMA continues to report serious physician concern about prior authorization.

And a recent physician commentary described the broader payment and administrative environment as a structural problem for independent practices.

The lesson?

The industry doesn't simply need smarter tools.

It needs better systems.


Three Questions for Every Healthcare Founder

Before building another healthcare product, ask:

Question 1

What human task are we eliminating?

If the answer is unclear, keep digging.

Question 2

What decision becomes easier?

Automation without better decisions is just faster activity.

Question 3

What happens to the time we save?

That is where the human value lives.


Three Questions for Every Physician

Ask yourself:

What administrative task makes me think, “Why am I doing this?”

That's your first target.

Then:

What information do I repeatedly have to hunt for?

That's your data problem.

Finally:

What would I do with five extra hours a week?

That's your ROI.


Three Questions for Every Practice Owner

Where is revenue leaking?

Where is staff time disappearing?

Where does information break between clinical care and payment?

Don't solve all three at once.

Pick one.

Fix it.

Measure it.

Then move.


The 30-Day Challenge

If I were running a small medical practice, here's what I would do.

Days 1–7

Track every administrative interruption.

No judgment.

Just count them.

Days 8–14

Group them.

Billing.

Eligibility.

Prior authorization.

Documentation.

Payer communication.

Patient billing.

Days 15–21

Identify the largest source of wasted time.

Find the root cause.

Days 22–30

Automate, eliminate, or redesign one process.

Then measure the difference.

Not six months later.

Now.


Myth Busters

Myth: More automation always means better healthcare.

False.

Bad automation can create faster bad decisions.

Myth: Denials are simply a billing department problem.

False.

Many denials originate upstream in registration, eligibility, documentation, coding, authorization, or data exchange.

Myth: Bigger RCM vendors automatically perform better.

False.

Scale doesn't guarantee alignment with a practice's workflow.

Myth: AI should replace human review.

False.

AI should make human review more focused and useful.

Myth: Technology saves time automatically.

False.

Only workflow redesign converts technology into actual time savings.

Myth: Patient-centered care is only clinical.

False.

Every administrative interaction can affect access, trust, cost, and continuity.


The Question Nobody Puts on the Dashboard

Here is the metric I want healthcare leaders to consider adding:

Human Attention Returned.

How many hours did we give back?

Not hours that disappeared into another task.

Hours that actually became:

More patient conversations.

More clinical thinking.

More family communication.

More teaching.

More rest.

More presence.

Because that's what technology is supposed to buy us.

Not more software.

More humanity.


Final Thoughts: Jeannie Guffey Didn't Need the Future of Healthcare

She needed three nurses.

Erin Powers.

Kaitlin Swaim.

Emily Owens.

She needed a kiddie pool.

She needed her son, Jody, to baptize her.

She needed her family.

And she needed a healthcare team willing to say:

“We have to find a way.”

That story should make us proud.

It should also make us uncomfortable.

Because we shouldn't build a healthcare system that depends on extraordinary people overcoming ordinary administrative obstacles.

We should build systems that remove those obstacles.

We shouldn't ask:

How can we make doctors more productive?

We should sometimes ask:

How can we stop wasting their time?

We shouldn't ask:

How much AI can we put into healthcare?

We should ask:

How much unnecessary work can we take out of healthcare?

And we shouldn't define innovation simply as doing more with less.

Maybe innovation is:

Doing less unnecessary work so humans can do more meaningful work.

That is a different vision of healthcare.

And I think it is the better one.


Get Involved: Your Turn

Here is my question for physicians, practice owners, nurses, healthcare executives, and founders:

If you could permanently eliminate one administrative task from your practice tomorrow, what would it be?

Don't give me the polished answer.

Give me the annoying one.

The task that makes you sigh.

The task you have explained to five different people.

The task that exists because “that's how the system works.”

Tell me in the comments.

I want to know what healthcare professionals are actually fighting every day.

If this article made you rethink the relationship between technology, administrative burden, medical billing, and patient care, share it with another physician or practice owner.

And if you believe healthcare technology should create more room for human care rather than simply more room for software, join the conversation, raise your voice, and help shape what comes next.

The future of healthcare should not be measured by how many clicks we automate.

It should be measured by how much human attention we return.

Let's build systems that give clinicians more time to do what only humans can do.


References

1. Huntsville Hospital Health System — the original account of Jeannie Guffey's final wish and the three Medical ICU nurses who helped make her baptism possible.
Read the Huntsville Hospital account

2. American Medical Association — 2026 physician survey documenting the continuing burden of prior authorization, including time consumption, delays, denials, and burnout.
Read the AMA report

3. Science Friday — August 28 discussion with Stanford physician-computer scientist Jonathan Chen on physicians' growing use of AI and their concerns about the technology.
Listen to the Science Friday discussion


Continue the Conversation

Healthcare changes quickly.

The harder question is whether we are changing it in the right direction.

I share practical perspectives on healthcare operations, medical billing, physician experience, healthcare technology, AI, and the business of medicine.

Explore the ideas, challenge them, and bring your own experience into the conversation.

Visit Dr. Cham's website

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Knowledge drives progress. But knowledge becomes useful only when we turn it into better decisions, better systems, and better care.


About the Author

Dr. Daniel Cham is a physician and medical consultant working at the intersection of medical technology, healthcare management, medical billing, and practice operations.

His work focuses on practical ways healthcare professionals can reduce administrative friction, improve operational performance, and use technology without losing sight of the human experience of medicine.

Connect with Dr. Cham on LinkedIn


Disclaimer / Note

This article is intended for general educational and informational purposes. It should not be interpreted as medical, legal, coding, compliance, reimbursement, financial, or professional advice. Healthcare organizations should seek guidance from appropriately qualified professionals regarding their individual clinical, operational, contractual, regulatory, privacy, and legal circumstances.


One Last Thought

The best healthcare technology may not be the technology patients notice.

It may be the technology that quietly removes the work standing between a clinician and a patient.

Jeannie Guffey's story gives us a surprisingly simple test:

Did we create more room for people?

If the answer is yes, we're probably building something worthwhile.


Free Resource

Looking for practical healthcare operations and medical-billing insights?

Check the Featured section of my LinkedIn profile for a free resource. No signup required.

And if this perspective resonates with you, repost it so another physician, clinic owner, nurse, or healthcare founder can join the conversation.

#Healthcare #HealthcareTechnology #MedicalBilling #RevenueCycleManagement #PhysicianLeadership #HealthcareInnovation #MedicalPractice #PhysicianBurnout #AdministrativeBurden #HealthTech #HealthcareAI #PracticeManagement #IndependentPractice #PatientCenteredCare #DigitalHealth #HealthcareOperations #PhysicianEntrepreneur #MedicalBillingAutomation #OnnX

 

Sunday, August 30, 2026

Giovanni “Gio” Cruz Was Playing Baseball. Then a Rare Disease Changed Everything.

What one family’s journey through medical uncertainty can teach physicians, clinic owners, and healthcare leaders about the human cost of fragmented care—and why better information may be healthcare’s most overlooked innovation.



“The relationship between a patient and their primary care doctor is, at its best, one of the most protective forces in human health – and, right now, we’re systematically dismantling it.” Lucy McBride, MD, The Guardian, How do you define good health – and achieve it in a broken US medical system?

 

There is a sentence in a recent healthcare story that I cannot stop thinking about.

Not because it involves artificial intelligence.

Not because it involves a billion-dollar healthcare company.

Not because another payer announced another policy.

It is much simpler than that.

It is about an 11-year-old boy named Giovanni “Gio” Cruz.

In May, Gio was dancing, smiling and playing baseball.

A few weeks later, he was in a children's hospital fighting a rare disease.

His mother, Patricia Cruz, was trying to understand what was happening to her son.

Gio developed severe chest pain. His symptoms escalated. He experienced sweating, back pain and vomiting. He was hospitalized, underwent testing and was eventually transferred to Banner Diamond Children's Medical Center.

Specialists diagnosed him with idiopathic multicentric Castleman disease, a rare immune disorder that can cause widespread inflammation and affect multiple organs.

He is reportedly receiving intensive treatment, including IL-6-directed therapy, high-dose steroids and dialysis.

But the part that stayed with me was not the name of the disease.

It was Patricia's description of uncertainty.

“They want answers from me when I don’t even know what to say or what’s going on.”

Think about that sentence.

Now think about your medical practice.

Because here is my contrarian view:

Healthcare does not have a billing problem.

Healthcare has an information problem.

Billing is simply where the problem becomes expensive.


The patient can live with uncertainty. Your revenue cycle shouldn't have to.

Medicine is complicated.

Rare diseases are complicated.

Patients do not always read the textbook.

Symptoms do not always arrive in neat diagnostic categories.

Sometimes the first test does not solve the mystery.

Sometimes the second test doesn't either.

Sometimes the physician has to say:

“We don't know yet.”

That is not necessarily bad medicine.

Sometimes it is honest medicine.

But imagine the administrative side of the practice saying:

“We don't know why this claim failed.”

Then:

“We don't know where the documentation went.”

Then:

“We don't know who is working on it.”

Then:

“We don't know why the payer didn't pay it.”

Then, six weeks later:

“Let's have a meeting about it.”

That is not clinical uncertainty.

That is operational failure.

And there is a difference.

A very expensive difference.


Here's the uncomfortable question

If a physician can manage a rare disease with a differential diagnosis, why can't the revenue cycle manage a claim with a risk score?

Think about it.

A physician doesn't look at a complex patient and say:

“Everything looks normal. Good luck.”

The physician asks:

What do we know?

What don't we know?

What is most likely?

What could be dangerous?

What information do we need next?

What should we do now?

What requires specialist input?

That is clinical reasoning.

Why shouldn't revenue-cycle technology work the same way?

Instead of:

Claim denied.

Imagine:

Potential authorization problem detected.

Documentation may not support the submitted service.

Payer-specific rule identified.

Missing information detected.

High-risk claim. Human review recommended.

That's a very different philosophy.

It moves billing from:

react → repair

to:

detect → prevent → learn

And that is where I believe healthcare technology is heading.


The great billing myth: “We just need to collect more.”

No.

We need to create fewer problems to collect in the first place.

This is where the healthcare industry sometimes makes me smile.

We build enormous machinery to repair mistakes we could have prevented.

A claim gets denied.

Someone opens it.

Someone researches it.

Someone calls someone.

Someone sends something.

Someone documents the phone call.

Someone updates the account.

Someone resubmits it.

Someone waits.

Someone checks again.

And then someone asks:

“Why is billing so expensive?”

Well...

Look at what we just did.

We turned one preventable problem into a small administrative opera.

Five people.

Three systems.

Two phone calls.

One spreadsheet.

And a partridge in a pear tree.

That's not innovation.

That's organized rework.


The hidden cost isn't the denial

This is the part I wish more physician-owners would measure.

The denial itself is not always the biggest problem.

The bigger problem can be everything surrounding it.

Staff time.

Rework.

Delayed cash.

Management attention.

Payer follow-up.

Appeals.

Patient confusion.

Employee frustration.

Opportunity cost.

And sometimes, the claim is never recovered.

Recent healthcare revenue-cycle analysis has continued to show pressure from denials and revenue leakage. Kodiak Solutions reported that provider organizations experienced a 25% increase in net revenue losses from final denials and bad debt in 2025 in its proprietary analysis.

The precise financial impact varies by organization.

But the direction is hard to ignore.

Revenue leakage is not merely a finance problem.

It is an operational problem.


And here's where small practices get hurt

A large health system can have departments for:

Revenue cycle.

Compliance.

Coding.

Analytics.

IT.

Contracting.

Denials.

Payer relations.

Authorization.

Data science.

A physician-owned clinic?

Maybe it has:

One office manager.

Two billers.

A front-desk team.

A physician who is already seeing patients.

And someone named Linda who somehow knows how the entire practice works.

Every practice has a Linda.

And when Linda leaves?

Suddenly everybody discovers that Linda was the EHR administrator, billing expert, payer encyclopedia, compliance historian and keeper of the sacred spreadsheet.

This is not a technology strategy.

It's institutional memory held together by one exhausted human being.


The future of medical billing isn't about hiring more people to chase more claims.

It is about building systems that require fewer people to chase preventable problems.

That is a very different goal.

And it changes what we should expect from software.

Traditional billing software asks:

What happened?

Modern systems should ask:

What is happening?

The next generation should ask:

What is likely to happen next?

And the really useful system should tell you:

What should we do about it?

That's the difference between a reporting system and an intelligent operating system.


Three experts. One surprisingly consistent lesson.

The most interesting part of the Gio Cruz story is not just the disease.

It is what rare disease teaches us about information.

1. David Fajgenbaum, MD: collaboration changes what is possible

Dr. David Fajgenbaum is a physician-scientist whose personal experience with Castleman disease helped drive the development of the Castleman Disease Collaborative Network.

His work illustrates a powerful principle:

Complex problems improve when information stops living in isolated silos.

Patients.

Physicians.

Researchers.

Families.

Clinical data.

Research data.

The goal is not simply to collect information.

It is to make the information useful to the people who need it.

That lesson translates directly to medical practices.

If your EHR knows something your billing system doesn't...

If your scheduling system knows something your authorization workflow doesn't...

If your billing system knows something your physician-owner doesn't...

You don't have an information system.

You have information islands.

And islands are beautiful on vacation.

They're terrible for healthcare operations.


2. Frits van Rhee, MD, PhD: complexity demands structure

Dr. Frits van Rhee is another major figure in Castleman disease research.

The broader lesson from rare-disease medicine is that complex clinical problems require structured approaches to diagnosis, treatment and collaboration.

The same principle applies to revenue cycle.

A complex claim should not simply be dumped into the same queue as everything else.

It should be recognized as complex.

It should receive appropriate attention.

It should be prioritized.

And, when appropriate, it should be escalated to a human.

Complexity should trigger intelligence, not confusion.


3. Andrew Knight and colleagues: you don't need perfect certainty to act

Recent rare-disease guidance emphasizes practical coordination and support for clinicians caring for patients with uncommon conditions.

That principle is important.

Healthcare often operates before complete certainty exists.

That's normal.

The mistake is believing that uncertainty means the system should become disorganized.

It doesn't.

A good system says:

We don't know everything yet.

But we know what we know.

We know what we don't know.

And we know what we're doing next.

That is exactly how good clinical teams operate.

It should also be how good administrative systems operate.


The lesson hidden inside Gio Cruz's story

Gio's physicians faced a difficult clinical problem.

The disease was rare.

His symptoms were serious.

The diagnosis was not immediately obvious.

The family was frightened.

Nobody could simply press a button and make certainty appear.

But there was still a process.

Evaluation.

Testing.

Specialist involvement.

Diagnosis.

Treatment.

Monitoring.

Adjustment.

That process matters.

Now compare that with a typical denied claim.

What happens?

Usually:

Denial.

Queue.

Research.

Correction.

Resubmission.

Wait.

Maybe payment.

Maybe another denial.

Where is the learning?

Often, it is buried somewhere in a report.

That is the missed opportunity.


A denial should be a teacher

This is one of my favorite contrarian ideas.

Stop treating every denial as a task.

Treat it as a lesson.

If one claim is denied because authorization was missing, that's a task.

If 37 claims are denied because authorization was missing, that's a process failure.

If the same payer creates the same authorization problem every month, that's a systems problem.

And if you continue fixing each claim individually?

Congratulations.

You have built a very efficient machine for repeating the same mistake.

The real question is:

Where did the error begin?

Maybe it started at scheduling.

Maybe eligibility.

Maybe authorization.

Maybe documentation.

Maybe coding.

Maybe charge capture.

The denial is simply where the problem became visible.

Visibility is not origin.

That distinction is crucial.


The billing equivalent of a differential diagnosis

Here is a framework I think physician-owned practices should adopt.

Instead of looking at a denial as:

“Why didn't they pay?”

Ask:

1. What happened?

The claim was denied.

2. What are the possible causes?

Eligibility?

Authorization?

Coding?

Documentation?

Payer policy?

Timely filing?

Technical rejection?

3. What evidence supports each possibility?

Look at the data.

4. What is the most likely root cause?

Find the pattern.

5. What action should happen next?

Assign responsibility.

6. How do we prevent recurrence?

Fix the upstream process.

That's basically clinical reasoning applied to operations.

And frankly, healthcare should be better at this than almost any other industry.

We invented the differential diagnosis.

Why are we still treating billing problems like random acts of nature?


Statistics: don't fall in love with the dashboard

Healthcare leaders love dashboards.

I understand why.

Dashboards look intelligent.

Lots of numbers.

Lots of graphs.

Lots of green.

Very reassuring.

Until the cash doesn't arrive.

A dashboard should not exist to make executives feel informed.

It should exist to help someone make a better decision.

For a physician-owned practice, I would focus on a relatively small group of operational signals:

First-pass acceptance

Denial rate

Denial reason

Days in A/R

A/R aging

Net collection rate

Charge lag

Payment lag

Underpayments

Rework hours

Exception volume

And I would add one more:

Preventable error rate

Because that's where the future is.

Not:

“How many problems did we fix?”

But:

“How many problems did we prevent?”


The metric nobody puts on the wall

Here's another contrarian metric:

Human touches per claim.

How many times does a human have to touch a claim?

One?

Two?

Five?

Ten?

Twenty?

Nobody celebrates this number.

Maybe we should.

Because every human touch has a cost.

Not just payroll.

Attention.

Context switching.

Fatigue.

Opportunity cost.

And error risk.

If a routine claim requires six human touches, don't immediately ask:

“How can we make our staff faster?”

Ask:

“Why does this claim need six human touches?”

That's a better question.


AI is not the answer

Now I am going to disappoint the AI crowd.

AI is not the answer.

There.

I said it.

AI is a tool.

A potentially powerful one.

But if you put AI on top of a broken workflow, you may simply create a faster broken workflow.

That's not transformation.

That's turbocharged dysfunction.

The useful question is:

Where does intelligence actually belong?

AI can help with:

Pattern recognition

Anomaly detection

Claim validation

Risk prediction

Denial classification

Work prioritization

Documentation comparison

Payer-rule analysis

Workflow recommendations

But AI should not become an excuse to remove human accountability.

The ideal relationship is simple:

AI finds.

AI explains.

AI prioritizes.

Human validates.

Human decides when judgment matters.


The most dangerous AI in healthcare

It isn't necessarily the hallucinating chatbot.

It's the AI that looks confident.

Imagine a system that says:

“This claim is fine.”

And everyone believes it.

That's dangerous.

A better system might say:

“This claim appears low risk based on the available information. Here are the validation checks completed.”

And:

“These two elements remain uncertain.”

That's much more useful.

Healthcare does not need artificial confidence.

It needs transparent assistance.


Why I built OnnX

This is the problem that led me to build OnnX.

I am a physician.

I have spent enough time around healthcare to see how often good clinicians are forced to operate inside bad administrative systems.

The problem is not that people don't care.

Usually, they care enormously.

The problem is that the workflow asks them to compensate for system weaknesses manually.

My philosophy is simple:

Capture better information.

Validate earlier.

Surface risk sooner.

Reduce repetitive work.

Give physicians visibility.

Keep people involved where judgment matters.

OnnX is being built around that idea.

Not:

“Let's put AI on billing.”

But:

“Let's rethink what billing should have been doing all along.”

That's a much bigger ambition.


The industry asks the wrong question

The usual question is:

“How do we get more claims paid?”

I think the better question is:

“Why are we creating claims that need fixing?”

That sounds like a small difference.

It isn't.

The first question creates a reactive organization.

The second creates a preventive organization.

The first rewards recovery.

The second rewards learning.

The first measures output.

The second measures system quality.

And that is a fundamental shift.


Five “best practices” I would challenge

Best practice #1: “Denials are inevitable.”

Some are.

Many patterns are not.

If the same preventable denial happens repeatedly, calling it “inevitable” is just a polite way of saying we stopped looking for the cause.

 

Best practice #2: “Just hire another biller.”

Sometimes staffing is absolutely necessary.

But if the workflow is broken, adding people can hide the problem.

Before adding labor, ask:

Can we eliminate the work?

Then:

Can we automate the work?

Then:

Can we simplify the work?

Only then:

Do we need more people?

 

Best practice #3: “Billing starts after the encounter.”

No.

Billing starts when information enters the system.

Registration matters.

Eligibility matters.

Scheduling matters.

Authorization matters.

Documentation matters.

Coding matters.

Charge capture matters.

The claim is the final product of a much larger information chain.

 

Best practice #4: “The physician doesn't need to know.”

The physician doesn't need to know every claim.

But the physician-owner needs to know whether the practice is leaking money.

That's not micromanagement.

That's ownership.

 

Best practice #5: “More software means better technology.”

Absolutely not.

Sometimes the best technology is the technology that removes a screen.

Or removes a spreadsheet.

Or removes a phone call.

Or removes a manual handoff.

The best workflow is often the one you no longer need.


The front desk may be your most important revenue-cycle department

Here's another uncomfortable truth.

Some billing problems are born before the biller ever sees the claim.

An incorrect demographic field.

An outdated insurance card.

A missing authorization.

A scheduling mismatch.

A payer-specific requirement nobody noticed.

By the time the biller receives the claim, the mistake has already matured.

The biller is now asked to perform archaeology.

This is why I believe revenue-cycle technology needs to move upstream.

Don't wait until the claim becomes a problem.

Catch the problem when it is still cheap to fix.


Fix problems where they begin

This principle is simple:

The farther downstream a mistake travels, the more expensive it becomes.

Consider a missing authorization.

At scheduling:

Easy to correct.

At check-in:

Still manageable.

After the encounter:

More complicated.

After claim submission:

More expensive.

After denial:

Now someone has a work queue.

After appeal:

Now management may be involved.

After timely filing expires:

Maybe the revenue is simply gone.

Same mistake.

Different price.

That's why prevention is so powerful.


The 20-minute physician-owner audit

You don't need a consulting firm.

Start with 20 minutes.

Ask your team:

Question 1

What are our three most common denials?

Question 2

Where does each one actually begin?

Question 3

How many staff hours do we spend fixing them?

Question 4

Which one could we prevent first?

Question 5

What information would have allowed us to catch it earlier?

Question 6

Can technology help us catch it?

Question 7

Who owns the fix?

That's it.

You don't need a 74-slide PowerPoint.

You need answers.


A seven-step revenue-cycle reset

Step 1: Map the journey

Patient registration.

Scheduling.

Eligibility.

Authorization.

Encounter.

Documentation.

Coding.

Charge.

Claim.

Adjudication.

Payment.

Denial.

Appeal.

Do not assume everyone sees the same journey.

Map it.

 

Step 2: Identify the friction

Where are people copying information?

Where are they switching systems?

Where are they waiting?

Where are they calling?

Where are they manually checking?

Those are opportunities.

 

Step 3: Find the repeat offender

Which denial keeps coming back?

That's your first target.

 

Step 4: Trace it upstream

Find where the problem began.

Do not stop at the denial code.

 

Step 5: Create a rule

If a predictable problem can be identified before submission, create a validation rule.

 

Step 6: Create an exception path

Not every claim needs human attention.

Not every claim should bypass human review.

Build a smart middle.

 

Step 7: Measure prevention

Track whether the same problem actually declines.

If it doesn't, your intervention didn't work.

That's okay.

Learn.

Change it.

Try again.


Legal and compliance reality

Here is where enthusiasm needs a seatbelt.

Healthcare technology cannot turn compliance into a checkbox.

Practices must consider applicable requirements involving:

HIPAA

Privacy

Security

Coding

Documentation

Payer contracts

Fraud and abuse

False claims risk

Auditability

Vendor agreements

AI governance

AI does not transfer responsibility to the algorithm.

If an automated recommendation is wrong, the practice still needs appropriate controls.

That is why explainability, audit trails, access controls and human oversight matter.

The goal is not:

“The AI told us to do it.”

The goal is:

“The system identified an issue, showed us why, and the appropriate person made the decision.”

That's defensible.


Ethical question: what happens when revenue optimization wins?

This deserves more discussion.

Healthcare organizations have a legitimate responsibility to collect appropriate payment for services provided.

But optimization can become dangerous when the financial objective becomes more important than clinical truth.

Technology should never encourage:

Unsupported coding.

Misleading documentation.

Unnecessary services.

Aggressive interpretation of clinical facts.

Gaming payer rules.

The goal is not:

maximize the bill.

The goal is:

accurately represent the care that was provided and get appropriately reimbursed for it.

That's a very different philosophy.


Myth Buster

Myth: AI will eliminate billing staff.

Reality: The better objective is to eliminate unnecessary billing work.

 

Myth: A low denial rate means you're doing great.

Reality: Look at underpayments, aging, write-offs, rework and net collections too.

 

Myth: The billing department owns the revenue cycle.

Reality: Revenue-cycle performance is influenced by the entire practice.

 

Myth: Every denial should be appealed.

Reality: The right response depends on the reason, documentation, economics and likelihood of recovery.

 

Myth: Small practices can't use sophisticated technology.

Reality: Small practices may benefit disproportionately because they have less administrative capacity to absorb inefficiency.

 

Myth: AI makes billing objective.

Reality: AI reflects the data, rules and assumptions built around it. Human oversight still matters.


The future is not “AI billing”

I don't think that's the right phrase.

I think the future is:

Predictive revenue-cycle management.

The system should know enough to say:

“This looks normal.”

Or:

“This looks unusual.”

Or:

“This claim is likely to encounter a problem.”

Or:

“Here is the reason.”

Or:

“Here is what you should check.”

Or:

“This problem has happened 18 times this month. You should probably fix the process rather than the claims.”

Now we're getting somewhere.


The real competitive advantage for physician-owned practices

It won't necessarily be having the largest staff.

It won't necessarily be having the most software.

It won't necessarily be having the fanciest AI.

It may be something much less exciting:

Knowing what is happening sooner.

That sounds boring.

Good.

Boring is underrated.

Predictable cash flow is boring.

Accurate claims are boring.

Fewer denials are boring.

Employees not spending Friday afternoon fixing the same error for the 400th time is boring.

Boring is wonderful.

Healthcare has enough excitement.


What healthcare founders should learn

If you're building healthcare technology, here's my challenge.

Stop asking:

“Where can we add AI?”

Start asking:

“Where is a human repeatedly compensating for a system failure?”

That's the opportunity.

Find the spreadsheet.

Find the workaround.

Find the person everyone calls when something breaks.

Find the task employees complain about but have accepted as normal.

Find the process that requires three systems.

Find the task someone does every morning because “that's just how we've always done it.”

That's where the innovation is hiding.


A word about middlemen

I am deliberately provocative here.

Healthcare has accumulated layers.

EHR.

Practice management.

Clearinghouse.

Billing company.

Consultant.

RCM vendor.

Coding vendor.

Analytics platform.

Payer portal.

Another portal.

Another login.

Another spreadsheet.

Every layer may have a legitimate purpose.

But every layer also creates a question:

Who actually owns the outcome?

Physician-owned practices should have more visibility and control.

That does not mean every practice must insource everything.

It means outsourcing should not require surrendering intelligence.

If a vendor is managing your revenue cycle, you should still be able to understand:

What is happening.

Why it is happening.

What is being done.

What is being recovered.

What keeps recurring.

And what is being done to prevent it.

Transparency should not be an upgrade.

It should be the baseline.


The OnnX thesis

My thesis behind OnnX is simple:

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

Bad information creates bad claims.

Bad claims create denials.

Denials create rework.

Rework consumes labor.

Labor increases cost.

Delayed payment affects cash flow.

And the cycle repeats.

So why start at the end?

Start upstream.

Capture.

Validate.

Predict.

Submit.

Monitor.

Learn.

That's the loop.


What I would do if I owned a small practice tomorrow

Monday morning, I would ask for the last 90 days of denial data.

Not the dashboard.

The actual reasons.

Then I would sort them.

Top 10 causes.

Then I would ask:

Which three are preventable?

Then:

Which one costs us the most?

Then:

Where does it begin?

Then:

Can we catch it before the claim is submitted?

Then:

Can technology help?

And finally:

Who owns the change?

That's it.

No massive transformation project.

No six-month committee.

No 300-page strategy.

Just one problem.

Then another.

Then another.


The human lesson

Let's return to Gio.

Because this article should not lose the human being who started it.

Giovanni “Gio” Cruz is not a billing problem.

He is not a statistic.

He is not a workflow.

He is not a claim.

He is a child.

His mother, Patricia Cruz, is not a data point.

She is a mother trying to understand what is happening to her son.

The medical team is dealing with a rare and serious condition.

There is uncertainty.

There are questions.

There are decisions.

There is fear.

Healthcare cannot eliminate all of that.

But it can decide how much additional friction to create.

That matters.

Because every unnecessary administrative problem consumes someone's attention.

And attention is one of the most valuable resources in healthcare.


The bigger idea

Maybe the real measure of healthcare technology isn't how much technology we deploy.

Maybe it is how much unnecessary work disappears.

How many clicks?

How many calls?

How many spreadsheets?

How many duplicate entries?

How many preventable denials?

How many hours spent searching?

How many times does a patient have to repeat the same information?

How many times does a physician have to explain something already documented?

How many times does a biller have to repair something that could have been prevented?

That is the technology scorecard I care about.

Not:

How intelligent does the software look?

But:

How much unnecessary friction did it remove?


The next healthcare advantage may be boring

Healthcare loves breakthroughs.

The new drug.

The new device.

The new AI model.

The new platform.

The new billion-dollar startup.

But some of the biggest improvements may look remarkably ordinary.

A claim that never becomes a denial.

A prior authorization caught before the appointment.

A missing field identified before submission.

A physician who can see the practice's financial health in five minutes.

A biller who no longer spends half the day fixing the same error.

A patient who receives a clear statement.

A small practice that keeps more of the revenue it legitimately earned.

None of that makes a flashy conference keynote.

But it matters.


Three questions every physician-owner should ask

1. What problem are we repeatedly fixing instead of preventing?

If you don't know, find out.

2. Where does that problem actually begin?

The denial may not be the origin.

3. What information would have allowed us to catch it earlier?

That question points directly toward better workflow and better technology.


Three actions for this week

Action 1: Find your most expensive recurring problem.

Not the most annoying.

The most expensive.

 

Action 2: Trace it upstream.

Find the first point where the problem could have been detected.

 

Action 3: Ask whether the next occurrence can be prevented.

If yes, build the rule.

If no, build the exception workflow.

Then measure what happens.


Final Thoughts: Medicine can tolerate uncertainty. Systems shouldn't manufacture it.

Gio Cruz's story began with uncertainty.

A child became sick.

His family needed answers.

The diagnosis was difficult.

The road ahead remained unclear.

That's medicine.

We should not pretend otherwise.

But there is another kind of uncertainty that physicians and clinic owners do not have to accept.

Where is the claim?

Why was it denied?

Who is fixing it?

Why does this keep happening?

How much money are we losing?

Which problem should we address first?

Those are not mysteries.

They are information problems.

And information problems can be designed better.

That's where I believe healthcare technology has an enormous opportunity.

Not to replace physicians.

Not to replace billers.

Not to make another dashboard.

Not to sprinkle AI dust over an old workflow and call it innovation.

But to make the right information available earlier, to the right person, with the right next action.

That is what intelligent healthcare operations should look like.

And if we get that right, something interesting happens.

The technology becomes almost invisible.

The physician gets more time.

The staff gets less rework.

The practice gets better visibility.

The patient gets a smoother experience.

And healthcare becomes just a little more human.

That is the kind of innovation worth building.


Get Involved: Don't Just Read This. Challenge It.

Here is my question for physicians and clinic owners:

If your practice could identify a preventable billing problem before the claim was submitted, why would you wait for the denial?

Maybe you disagree.

Good.

Tell me in the comments.

What is the biggest source of administrative friction in your practice today?

Denials?

Authorization?

Coding?

Eligibility?

Documentation?

Payer rules?

Or something nobody is talking about?

Leave a comment.

Share what you're seeing.

And if this perspective makes you think differently about medical billing, repost this article so another physician or clinic owner can join the conversation.

Because the future of healthcare will not be built by technology companies alone.

It will be shaped by the people actually delivering care.

Ask better questions.

Challenge the old workflow.

Build something better.

Then share what you learned.


About the Author

Dr. Daniel Cham, MD is a physician, medical consultant and healthcare technology entrepreneur with experience across medical technology, healthcare management and medical billing.

He is the founder of OnnX, an AI-powered medical billing SaaS focused on helping small and medium-sized physician-owned practices reduce administrative friction, improve revenue-cycle visibility and gain greater control over their billing operations.

Dr. Cham writes about the intersection of medicine, healthcare operations, technology, AI and physician entrepreneurship, with an emphasis on practical ideas that can be applied inside real medical practices.

Connect with Dr. Cham on LinkedIn:

Dr. Daniel Cham, MD


Disclaimer

This article is intended for general educational and informational purposes only. It does not constitute medical, legal, coding, compliance, financial or other professional advice. Healthcare professionals and organizations should consult appropriately qualified professionals regarding decisions specific to their circumstances.

The discussion of Giovanni “Gio” Cruz is based on publicly reported news coverage and is not intended to suggest negligence, malpractice or wrongdoing by any clinician or healthcare organization involved in his care.


Continue the Conversation

Healthcare is too complicated for one voice to explain.

The most useful ideas often emerge when physicians, patients, operators, technologists and entrepreneurs compare what they are seeing on the ground.

I share practical perspectives on healthcare operations, medical billing, technology, AI, entrepreneurship and the future of medical practice.

Explore more insights and practical strategies:

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Knowledge Drives Progress

You don't need to transform your entire practice tomorrow.

Start with one question.

Where are we creating unnecessary friction?

Then find the answer.

Then fix one piece.

Then measure it.

Then improve again.

Better healthcare starts with better questions.

Better questions lead to better systems.

Better systems give people more room to care.


Free Resource

Looking for practical healthcare and medical-billing resources?

Check the Featured section of my LinkedIn profile for a free resource available without a signup.

Start there.

Learn something useful.

Test it in your practice.

Then tell me what happened.


References & Further Reading”

1. Giovanni “Gio” Cruz — the human story

13 News/KOLD, August 28, 2026 — This is the primary local report about 11-year-old Giovanni “Gio” Cruz, his mother Patricia Cruz, his rapid change in health, and his diagnosis of idiopathic multicentric Castleman disease.

Read the 13 News/KOLD story: “Tucson boy diagnosed with rare disease”

2. Lucy McBride, MD — the human connection in medicine

The Guardian, August 27, 2026 — Dr. Lucy McBride discusses the increasingly episodic, transactional and impersonal nature of U.S. healthcare and argues for stronger doctor-patient relationships and more personalized care. This provides an excellent bridge from Gio's story to your argument that healthcare technology should support—not replace—the human relationship.

Read The Guardian interview with Dr. Lucy McBride

3. Medical billing and revenue-cycle management — the physician-owner connection

Medical Economics, August 30, 2026 — This current analysis examines where AI can actually help medical billing and revenue-cycle management, while highlighting how claim denials can quietly erode independent-practice margins and how an error at the front desk can become a costly problem weeks later.

Read the Medical Economics analysis on AI, billing and RCM


One Last Thought

If this article resonated with you, repost it.

Not to promote a product.

To start a conversation.

Because somewhere right now, a physician is treating patients while worrying about cash flow.

A biller is fixing a claim that should never have needed fixing.

An office manager is searching through three systems for one piece of information.

And a patient is waiting for healthcare to feel a little less complicated.

Let's make the systems better.

Let's make the work simpler.

And let's keep the human being at the center of it.

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Jeannie Guffey’s Final Wish Wasn’t Another Treatment. It Was a Baptism.

What three ICU nurses, a kiddie pool, and one dying patient can teach us about the future of healthcare “Human judgment, empathy, and unde...