Monday, August 17, 2026

THE OTHER 166 HOURS

ONE WIFE, ONE PATIENT, AND THE HIDDEN LABOR OF AMERICAN HEALTHCARE



“Our care is better for patients when we don't feel burned out. We make fewer mistakes when we don't feel burned out.” — Christine Sinsky, MD, American Medical Association

Source: American Medical Association, Addressing the rapid rise in physician burnout revealed by a new study.


There is a sentence in healthcare that sounds comforting until you actually have to live with it:

“You're going home with services.”

Sounds good.

Almost luxurious.

Services.

Plural.

It has the ring of a concierge package.

Then you get home.

And discover that “services” may mean a nurse comes once a week.

A physical therapist comes once a week.

And your spouse becomes the rest of the healthcare system.

That is the story of an unnamed husband and wife featured in a recent 24/7 Wall St. report.

The husband went home needing help with wound care, medications, mobility, meals, bathing and the ordinary things that suddenly become extraordinarily difficult when someone is sick.

A home-health nurse came once a week.

A physical therapist came once a week.

Everything else belonged to his wife.

The article put the arithmetic bluntly:

168 hours in a week.

Professional home-health visits covered roughly two.

His wife was effectively responsible for the other 166 hours.

No dramatic operating room.

No billionaire startup.

No breakthrough drug.

No shiny AI robot.

Just a husband.

A wife.

A walker.

A medication schedule.

A 3 a.m. bathroom trip.

And a healthcare system that technically did what it promised.

That last part is what interests me.

Because the system wasn't necessarily lying.

It was simply defining “care” much more narrowly than the family experienced it.

And that should make every physician and clinic owner stop for a moment.

Because we have our own version of the Other 166 Hours Problem.

It happens after the patient leaves the exam room.


THE PATIENT LEFT.

THE WORK DIDN'T.

A physician sees a patient.

Maybe 15 minutes.

Maybe 30.

Maybe an hour for a complicated visit.

The patient leaves.

The door closes.

The physician moves to the next patient.

But somewhere behind the scenes, another patient is born.

The administrative patient.

This one has an insurance ID.

A CPT code.

An ICD-10 code.

A modifier.

A payer.

A claim number.

A status.

A denial code.

A deadline.

And eventually, perhaps, an appeal.

Nobody invited this patient.

But suddenly your staff is spending 20 minutes taking care of it.

Then 40.

Then an hour.

Sometimes the physician gets involved.

Someone says:

“Doctor, the insurance company wants more information.”

You sigh.

You open the chart.

You look at the note.

You wonder why the payer couldn't simply read what you already documented.

Then you remember:

Because apparently the healthcare system has invented a second patient who exists entirely inside the billing department.

And that patient needs care too.


HERE'S MY CONTRARIAN TAKE

We don't have a physician productivity problem.

We have a system design problem disguised as a productivity problem.

That distinction matters.

For years, healthcare has responded to administrative overload by telling clinicians to:

Work faster.

Document better.

Learn the new rule.

Use the new portal.

Check another box.

Hire another staff member.

Try another vendor.

Download another app.

Attend another training.

And, naturally, take care of yourself.

Because nothing says “wellness” quite like another mandatory 45-minute webinar.

We keep asking:

How can physicians become more efficient?

I think the better question is:

Why are physicians being asked to perform so much work that should have been prevented upstream?

That is a different question.

And it leads to a different kind of healthcare technology.


THE OTHER 166 HOURS EXISTS INSIDE YOUR PRACTICE

The caregiver story is powerful because the wife became the invisible infrastructure.

The healthcare system provided professional services.

She provided continuity.

She provided context.

She noticed changes.

She managed the ordinary moments.

She was there when nobody else was.

The same phenomenon happens in physician practices.

Your staff becomes the invisible infrastructure.

They remember payer quirks.

They know which claims are always problematic.

They know which physicians document differently.

They know which payer portal is broken.

They know which authorization department never answers the phone.

They know which denial code means:

“Good luck.”

They compensate.

They improvise.

They create workarounds.

They keep the practice moving.

And because they are good at their jobs, leadership sometimes assumes everything is fine.

That is one of the most dangerous illusions in healthcare.

A system can look functional because excellent people are constantly repairing it.


THE HUMAN COST OF “MAKING IT WORK”

Think about that phrase:

“We make it work.”

It sounds positive.

In medicine, it can be a warning sign.

“We make the schedule work.”

“We make the staffing work.”

“We make the billing work.”

“We make the payer work.”

“We make the old software work.”

“We make the new regulation work.”

“We make the denial process work.”

Translation:

Humans are absorbing the defects of the system.

And humans have limits.

That is where burnout enters the conversation.

The AMA's latest data show that 41.9% of physicians reported at least one symptom of burnout in 2025. That is an improvement from 43.2% in 2024 and 48.2% in 2023.

Improvement is good.

But 41.9% is still roughly four out of ten physicians.

That is not a rounding error.

And here's the part I find interesting:

We often talk about burnout as if it were an emotional problem.

Sometimes it is.

But much of the time, burnout is also an operations problem.

If the system generates unnecessary work every day, eventually somebody pays for it.

Usually with time.

Sometimes with money.

Often with both.


THE RCM MACHINE HAS A STRANGE BUSINESS MODEL

Let's imagine another industry.

A customer buys something.

The company delivers it.

Then the company intentionally creates paperwork that prevents itself from getting paid.

The customer says:

“Please prove you delivered it.”

The company provides proof.

The customer says:

“Please provide it in another format.”

The company does that.

Then the customer says:

“We still can't process it.”

The company hires 14 people to investigate.

Eventually everyone celebrates because the company successfully received payment for the thing it already delivered.

We would call that business model insane.

In healthcare, we call it:

Revenue Cycle Management.

I'm not saying billing is inherently broken.

I'm saying we've normalized an astonishing amount of post-service administrative friction.

And then we built an entire industry around cleaning it up.

That should make us uncomfortable.


THE DENIAL IS NOT THE PROBLEM

Here's another contrarian idea:

A denial is often not the problem.

It is the symptom.

The real problem happened earlier.

Maybe eligibility wasn't verified.

Maybe an authorization requirement wasn't identified.

Maybe documentation wasn't structured properly.

Maybe coding didn't reflect the clinical work.

Maybe the claim failed a payer-specific rule.

Maybe information was lost between systems.

Maybe nobody knew the rule had changed.

By the time the denial arrives, the system is essentially saying:

“Congratulations. We found your problem.”

Thank you.

Could we have known this yesterday?

That is the question.


DOWNSTREAM HEALTHCARE IS EXPENSIVE

The traditional revenue-cycle model is largely reactive.

Something happens.

Then somebody fixes it.

Claim denied.

Work denial.

Missing documentation.

Chase physician.

Wrong code.

Correct code.

Payer requests information.

Find information.

Authorization missing.

Start calling.

This is the healthcare equivalent of waiting for the smoke alarm before installing a fire extinguisher.

We need to move upstream.

Instead of:

Denial → correction

we should aim for:

Clinical encounter → validation → clean claim

Instead of:

Missing information → physician interruption

we should aim for:

Missing information → early identification

Instead of:

Payer rejection → investigation

we should aim for:

Payer requirements → pre-submission intelligence

That is the difference between reactive RCM and preventive RCM.


AND THE DATA ARE GETTING HARDER TO IGNORE

MGMA's 2026 Regulatory Burden Report found that approximately 95% of medical groups reported increased regulatory burden over the previous three years.

The report identified audits and appeals as the leading burden, while Medicare Advantage prior authorization, denials and automatic downcoding were also among the top issues.

That isn't a technology problem alone.

It is a workflow problem.

A staffing problem.

A financial problem.

And eventually, a patient-access problem.

MGMA explicitly connects rising administrative burden and declining reimbursement with physician burnout, consolidation and difficulty maintaining patient access.

So when we talk about medical billing, we need to stop treating it as the boring corner of healthcare.

It isn't boring.

It is infrastructure.


THE BILLING DEPARTMENT IS PART OF CLINICAL CAPACITY

This may sound strange.

But hear me out.

Suppose your billing team spends hundreds of hours every month correcting avoidable claims.

That is labor.

If your physicians spend evenings answering documentation queries, that is labor.

If your practice manager spends Friday afternoon fighting payer portals, that is labor.

If your medical assistant spends 30 minutes tracking an authorization, that is labor.

Every administrative task consumes capacity.

And capacity is finite.

Which means:

Administrative friction is a clinical resource problem.

Every hour spent fighting a preventable denial is an hour that cannot be spent improving the practice somewhere else.

Maybe with patients.

Maybe with staff.

Maybe with growth.

Maybe with quality.

Maybe with sleep.

Yes.

Sleep.

We don't put that on the balance sheet.

Perhaps we should.


WHAT I BELIEVE ABOUT AI

I am a physician.

I am also building a healthcare technology company.

So naturally I have an opinion about AI.

Here it is:

AI is not magic.

Sorry.

There goes the keynote.

AI will not eliminate payer policies.

It will not make every claim payable.

It will not replace clinical judgment.

It will not automatically make a poorly designed workflow intelligent.

And it certainly should not be used as an excuse to put more work onto physicians.

The real opportunity is much less glamorous.

And much more valuable.

Use AI to prevent humans from having to do repetitive work in the first place.

That's it.

Not sexy.

Very useful.


THE BEST AI MAY BE THE AI YOU NEVER NOTICE

Imagine an AI system that quietly notices:

“This documentation may not support the selected code.”

“Eligibility changed.”

“This payer requires additional information.”

“This claim has a pattern associated with previous denials.”

“This modifier combination deserves review.”

“This physician consistently encounters the same denial.”

That is not science fiction.

It is workflow intelligence.

And the best version of it does not shout:

LOOK WHAT AI CAN DO!

It quietly prevents the problem.

That is the kind of AI healthcare needs.

Less theater.

More infrastructure.


THIS IS WHY I BUILT ONNX

The thesis behind OnnX is simple.

The healthcare industry has spent enormous energy optimizing what happens after the claim fails.

I believe we should spend more energy asking:

Why did the claim become vulnerable in the first place?

That moves the conversation upstream.

From billing to clinical-to-claims intelligence.

From correction to prevention.

From manual work to intelligent workflow.

From:

“Who can fix this?”

to:

“Why did we create this problem?”

That is a much more interesting question.

And frankly, it is the question I think healthcare technology has avoided for too long.


THE THREE QUESTIONS EVERY PRACTICE OWNER SHOULD ASK

Forget the vendor demo for a minute.

Ask these first.

QUESTION ONE:

Where are we losing money?

Not theoretically.

Show me the last 90 days.

 

QUESTION TWO:

Why are we losing it?

Group the denials.

Look for patterns.

Do not accept:

“Insurance denied it.”

That's not a root cause.

That's a sentence.

 

QUESTION THREE:

Where was the problem first created?

This is the big one.

Because the place where you discover a problem is often not the place where you created it.


A DENIAL DASHBOARD IS NOT ENOUGH

This is another industry habit I would challenge.

A practice installs a dashboard.

Beautiful charts.

Green arrows.

Red arrows.

Trend lines.

Someone presents it at the monthly meeting.

Everyone nods.

Then the same denial happens next month.

And the month after.

Congratulations.

You have successfully visualized the problem.

You have not solved it.

Analytics without intervention is expensive wallpaper.

The dashboard needs to lead somewhere.

A root cause.

An owner.

An intervention.

A measurable change.


FIVE METRICS I WOULD WATCH

1. CLEAN CLAIM RATE

How often does the claim get through the first time?

Simple.

Important.

 

2. DENIAL RATE

But don't stop there.

Break it down by:

payer, provider, procedure, diagnosis, modifier and denial reason.

Patterns matter.

 

3. DENIAL TOUCHES

How many people touch the claim before it is resolved?

One?

Three?

Six?

If a $100 claim requires $200 worth of human labor to recover, you have discovered something important.

 

4. PHYSICIAN ADMINISTRATIVE TIME

How many minutes per week do physicians spend dealing with billing-related questions?

Track it.

You may not like the answer.

That's okay.

Bad information is still better than comfortable assumptions.

 

5. DAYS IN A/R

Watch the trend.

Not just the number.

A rising A/R curve can be the smoke before the fire.


THE 30-DAY PRACTICE EXPERIMENT

Don't overhaul everything.

Pick one problem.

Just one.

DAYS 1–5

Pull 90 days of claims.

Find your top three denial categories.

DAYS 6–10

Choose the largest category.

Trace it backward.

Where did it begin?

DAYS 11–15

Interview the people who actually touch the workflow.

Not just executives.

Ask the person who fixes the problem every day.

They usually know more than the dashboard.

DAYS 16–20

Change one upstream step.

DAYS 21–30

Measure the result.

Did the denial rate fall?

Did staff touches fall?

Did physician interruptions fall?

Did A/R improve?

If yes, keep going.

If no, congratulations again.

You learned something.

That is better than pretending the first solution worked.


WHAT NOT TO AUTOMATE

This is important.

Do not automate everything simply because you can.

Clinical judgment should remain with clinicians.

Compliance decisions need appropriate oversight.

Exceptions need human review.

High-risk decisions need escalation.

And automated coding should never become a license to inflate reimbursement.

The ethical goal is:

accurate representation of care.

Not:

maximum possible reimbursement.

Those are not synonyms.


THE LEGAL AND ETHICAL LINE

Healthcare technology lives in a world of privacy, compliance and accountability.

If your system handles protected health information, appropriate safeguards matter.

If AI influences coding or billing, auditability matters.

If a vendor touches sensitive data, contracts and responsibilities matter.

If automation produces recommendations, someone must be accountable for reviewing them when appropriate.

And if a system encourages unsupported documentation or coding, that's not innovation.

That's a problem.

Technology should help practices become more accurate, not merely more aggressive.

The best revenue-cycle system is not the one that finds the most money.

It is the one that helps the practice accurately capture the value of legitimate care it already provided.


HERE'S ANOTHER UNCOMFORTABLE TRUTH

Small practices are often told they need to behave like large health systems.

More software.

More processes.

More dashboards.

More departments.

More infrastructure.

I'm not convinced.

Small practices have an advantage large organizations often envy:

They can move quickly.

The problem is that they have less room for waste.

A large system can hide inefficiency inside a giant organization.

A five-physician practice cannot.

If one employee spends half a day every week fixing the same problem, you feel it.

If the physician spends two hours every Friday dealing with claims, you feel it.

If $100,000 sits in avoidable A/R, you feel it.

The smaller the practice, the more valuable operational clarity becomes.


THE REAL COMPETITIVE ADVANTAGE

I don't think the future belongs to the practice with the most technology.

I think it belongs to the practice with the least unnecessary work.

Think about that.

Not:

Who has the most AI?

Who has the newest EHR?

Who has the biggest billing department?

Who has the fanciest dashboard?

Instead:

Who can deliver excellent care with the least administrative friction?

That's a better competitive question.


THE CAREGIVER WASN'T THE BILLING DEPARTMENT

Let's be clear.

The wife in the original story was not dealing with claims.

She was caring for her husband.

Her story is not proof that RCM causes caregiver burden.

That would be a ridiculous leap.

But her story illustrates something important:

Healthcare systems often count formal services while families experience the total workload.

That distinction matters.

A nurse's visit is counted.

The spouse's midnight work often isn't.

A physical therapy session is documented.

The hours of supervision between visits aren't.

Healthcare measures encounters extremely well.

It is often much worse at measuring everything that happens between encounters.

And that is exactly where a huge amount of healthcare work lives.


BETWEEN THE VISITS

Healthcare happens between visits.

Between appointments.

Between claims.

Between payer decisions.

Between authorization requests.

Between phone calls.

Between portal messages.

Between discharge and follow-up.

Between documentation and reimbursement.

Those gaps are where friction hides.

And wherever friction hides, opportunity usually follows.

That's where healthcare founders should look.

Not necessarily at another flashy front-end app.

Look at the spaces between systems.

Look at the handoffs.

Look at the moments where information gets lost.

Look at the places where humans repeatedly compensate.

That's where the real infrastructure opportunity may be.


THE NEXT GENERATION OF HEALTHCARE TECHNOLOGY

I think we are moving toward a different model.

The first generation of healthcare software digitized paperwork.

The second generation automated workflows.

The next generation should understand context.

It should know:

What happened clinically.

What needs to happen operationally.

What the payer expects.

What historically goes wrong.

What requires human judgment.

And what can safely happen automatically.

That's more than automation.

That's workflow intelligence.


THE FUTURE IS NOT “NO HUMANS”

That's the wrong goal.

Healthcare is human.

Always will be.

The goal should be:

fewer humans doing unnecessary work.

More humans doing work that requires judgment.

More physician attention where it matters.

More staff attention where it matters.

Less clicking.

Less chasing.

Less duplicate entry.

Less “Can you resend that?”

Less “The payer says they never received it.”

Less Friday-afternoon claims archaeology.

And, ideally:

fewer reasons for a physician to stare at a billing portal after seeing patients all day.


THE QUESTION I WOULD ASK EVERY PHYSICIAN-OWNER

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

Prior authorization?

Denials?

Eligibility?

Documentation queries?

Claim status?

Coding?

Payer portals?

Something else?

And here's the more important question:

Why does that task exist in the first place?

That second question is where innovation begins.


THREE THINGS I WOULD DO THIS MONTH

ONE: Find your most expensive recurring denial.

Not your most annoying one.

Your most expensive one.

TWO: Calculate the human labor required to fix it.

Staff time.

Physician time.

Manager time.

THREE: Move the intervention upstream.

Don't simply hire someone to work the denial faster.

Ask whether the next denial can be prevented.

That is the difference between scaling labor and scaling intelligence.


THE BIGGEST MYTH IN MEDICAL BILLING

The myth is that the solution to administrative burden is more administrative capacity.

Sometimes it is.

But not always.

If the system creates 1,000 unnecessary tasks and you hire people to complete those 1,000 tasks, you have not solved the problem.

You've just become better at tolerating it.

Efficiency is not doing more work faster.

Sometimes efficiency means making the work disappear.


FINAL THOUGHTS

The husband in this story went home.

His wife stayed on call.

The healthcare system provided professional services.

She provided the rest.

There is something uncomfortable about that.

Not because the system necessarily failed.

But because the system's definition of “care” was smaller than the family's reality.

Physician practices face a similar challenge.

The patient encounter may be 20 minutes.

But the administrative life of that encounter can stretch for days.

The work doesn't disappear because the patient walked out the door.

Someone carries it.

A biller.

A medical assistant.

A practice manager.

A physician.

Someone.

So perhaps the question isn't:

“How do we get our staff to work harder?”

Perhaps it is:

“How much of this work should exist at all?”

That is the question I want healthcare leaders to ask.

Because the future of healthcare won't be built simply by adding more people to broken workflows.

It will be built by designing workflows that need fewer unnecessary interventions in the first place.


THREE SENTENCES TO REMEMBER

Stop measuring how much unnecessary work your people can tolerate.

Start measuring how much unnecessary work your system can eliminate.

Give healthcare professionals their most valuable resource back: attention.


GET INVOLVED

Now I want to hear from physicians and clinic owners.

What is the one administrative task in your practice that makes absolutely no sense anymore—but everyone has simply learned to live with it?

Tell me in the comments.

Don't give me the polished executive answer.

Give me the real one.

The annoying one.

The absurd one.

The task your staff complains about every Friday.

Share this article with another physician or practice owner who has ever wondered why healthcare requires so much work to get paid for work already completed.

And if you're building something better in healthcare, join the conversation.

Question the workflow.

Challenge the “best practice.”

Measure the friction.

Fix the source.


FREQUENTLY ASKED QUESTIONS

Is the “Other 166 Hours” story about a real patient?

Yes. The August 16, 2026 24/7 Wall St. story describes an unnamed husband discharged home with intermittent home-health services and his wife providing the majority of his ongoing care. The publication does not identify the couple by name.

Why use this story in an article about medical billing?

Because it illustrates the broader concept of hidden healthcare labor. The caregiver experiences the full workload of care even when the formal healthcare system measures only specific professional services.

The RCM connection is an analogy, not a claim that the two situations are identical.

Is physician burnout improving?

Yes, according to the AMA's latest data. But 41.9% of physicians reported at least one symptom of burnout in 2025, so the problem remains substantial.

What is currently one of the biggest administrative burdens for medical groups?

MGMA's 2026 Regulatory Burden Report identifies audits and appeals as the leading burden and lists Medicare Advantage prior authorization, denials and automatic downcoding among the major burdens.

Does AI eliminate denials?

No.

AI can help identify patterns, flag potential problems and automate repetitive workflows.

But payer policies, clinical judgment, documentation and human oversight remain essential.

Should physicians be responsible for billing?

Physicians should understand the connection between clinical documentation, coding and reimbursement.

They should not have to become billing specialists.

The objective should be to make the system work better around clinical care.

What should a practice measure first?

Start with:

clean claim rate, denial rate by root cause, denial touches, days in A/R and physician administrative time.

Is outsourcing medical billing a bad idea?

Not necessarily.

The problem is outsourcing without visibility.

A practice should still understand its denial patterns, collections, A/R, vendor performance, contracts and escalation processes.

What is upstream RCM?

Upstream RCM means identifying and preventing revenue-cycle problems before they become denials, rework or delayed payment.


EXPERT PERSPECTIVES

CHRISTINE SINSKY, MD

Dr. Sinsky's work on physician well-being has emphasized the relationship between clinician burnout and the systems in which physicians practice.

The lesson for practice owners is straightforward:

Don't treat a system problem as a resilience problem.

If the workflow generates unnecessary administrative work, redesign the workflow.


ANDERS GILBERG, MGMA

MGMA's senior vice president of government affairs has highlighted the growing burden that regulatory requirements, Medicare Advantage processes, denials and other administrative demands place on medical practices.

The broader lesson:

Administrative burden is no longer a side issue. It is a practice sustainability issue.


THE AMA'S PHYSICIAN WELL-BEING RESEARCH

The AMA's current data show that physician burnout is moving in the right direction, but remains widespread.

The lesson is not that healthcare can declare victory.

It is that system-level improvements can matter—and that continued work is necessary.


THREE REFERENCES

MGMA — 2026 Regulatory Burden Report

MGMA's report documents the growing administrative burden experienced by medical groups, including audits, appeals and Medicare Advantage-related processes.

Read the MGMA 2026 Regulatory Burden Report

American Medical Association — Physician Burnout

The AMA's latest data show 41.9% of physicians reported at least one burnout symptom in 2025.

Read the AMA physician burnout report

24/7 Wall St. — The Other 166 Hours

The original human-interest story that inspired this article describes the gap between intermittent professional home-health visits and the family's ongoing caregiving responsibilities.

Read the original caregiver story


ABOUT THE AUTHOR

Dr. Daniel Cham is a physician, medical consultant and healthcare entrepreneur focused on the intersection of medical technology, healthcare operations, medical billing and practice sustainability.

He is the founder of OnnX, an AI-powered medical billing platform focused on helping small and medium-sized medical practices reduce administrative friction and improve the connection between clinical documentation, coding, claims and reimbursement.

His work centers on a simple question:

What if healthcare technology stopped asking physicians to work around broken systems—and started making those systems work around physicians?

Connect with Dr. Daniel Cham on LinkedIn


DISCLAIMER

This article is intended for general educational and informational purposes and should not be interpreted as medical, legal, compliance, coding or reimbursement advice.

Healthcare requirements, payer policies, contracts and regulations vary.

Physicians, practice owners and healthcare organizations should obtain advice from appropriately qualified professionals regarding their individual circumstances.


CONTINUE THE CONVERSATION

The healthcare conversation should not end with the article.

Explore more perspectives on healthcare operations, physician entrepreneurship, medical technology, revenue-cycle management and healthcare innovation:

Visit Dr. Cham's website

Listen to the podcast on Spotify

Watch on YouTube

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Follow Dr. Cham on Facebook

Knowledge creates leverage.

Better questions create better systems.

Better systems give healthcare professionals more time to do the work only they can do.

Start there.


FREE RESOURCE

PS: A free resource is available in the Featured section of my LinkedIn profile. No additional signup is required. If you are working to improve your practice operations, take a look.

If this article made you think differently about administrative work, repost it.

Another physician may need to see it.

Another practice owner may recognize their own Friday-afternoon billing nightmare in it.

And maybe the next healthcare innovation won't be another tool that adds work.

Maybe it will be the tool that finally removes some.

#Healthcare #Physicians #MedicalBilling #RevenueCycleManagement #HealthcareInnovation #PhysicianBurnout #MedicalPractice #PracticeManagement #HealthTech #HealthcareTechnology #MedicalCoding #ClaimsManagement #DenialManagement #HealthcareLeadership #PhysicianEntrepreneur #IndependentPractice #ClinicalOperations #AIinHealthcare #OnnX

 

Sunday, August 16, 2026

Robert Carradine Asked for Help. What Happens When Healthcare Systems Fail the People Who Trust Them?

What his story reveals about patient trust, system reliability, administrative burden, and why healthcare technology should give physicians back the attention patients need.



“The relentless focus on productivity metrics has been associated with physician burnout, emotional exhaustion, moral distress and workforce attrition, all of which may threaten patient access to timely, high-quality care.”American Medical Association, 2026


A physician's contrarian take on patient trust, administrative burden, medical billing and the systems we ask clinicians to depend on

The uncomfortable question

What if the biggest problem in healthcare isn't that physicians aren't working hard enough?

What if they're working inside systems that require them to work too hard?

That distinction matters.

And a recent story involving actor Robert Carradine makes that distinction impossible to ignore.

Carradine, known for Revenge of the Nerds and Lizzie McGuire, voluntarily entered UCLA's Resnick Neuropsychiatric Hospital in January 2026 after experiencing suicidal thoughts.

He went there because he needed help.

He trusted a healthcare institution to provide it.

Carradine later died on February 23, 2026, at age 71.

His children — Ever Carradine, Marika Reed Carradine and Ian Alexander Carradine — have filed a lawsuit against The Regents of the University of California, alleging wrongful death, elder abuse and neglect.

According to the complaint, the family alleges that UCLA staff failed to follow important safety procedures, including allegations concerning a belt, required observation checks and the accuracy of medical documentation.

Those are allegations, not established facts.

The case will have to be decided through the legal process.

UCLA Health has not publicly accepted the family's account.

But the story raises a question much bigger than the lawsuit:

What happens when a patient trusts a healthcare system to do the small things correctly?

Because that is what healthcare ultimately is.

Not one heroic physician.

Not one brilliant diagnosis.

Not one extraordinary surgeon.

A system of thousands of small things.

A medication is reconciled.

A result is reviewed.

A referral is transmitted.

A patient is observed.

A note is documented.

A claim is submitted.

A denial is investigated.

A payment is reconciled.

A follow-up happens.

And another human being assumes someone else did the thing that needed to be done.

That is where healthcare becomes interesting.

And dangerous.

Because systems don't fail only when people don't care.

They also fail when good people are forced to work inside bad systems.

That is the part of this story I want physicians and clinic owners to think about.

Not the celebrity.

Not the lawsuit.

The system.


The healthcare industry has a strange obsession

We love asking:

How can physicians become more efficient?

We ask doctors to see more patients.

Document faster.

Code accurately.

Complete prior authorizations.

Respond to messages.

Review results.

Meet quality measures.

Close charts.

Fight denials.

Monitor inboxes.

Stay current.

Avoid burnout.

And somehow remain fully present with every patient.

Then we act surprised when physicians say:

"I don't have enough time."

Maybe the problem isn't physician productivity.

Maybe the problem is system productivity.

That is a very different conversation.

And it is one healthcare leaders should be having.


Here's my hot take

Healthcare doesn't have a physician shortage nearly as much as it has a physician-attention shortage.

We have doctors.

We have nurses.

We have medical assistants.

We have practice managers.

We have billing professionals.

What we don't have is unlimited human attention.

And healthcare keeps spending that attention on work that often shouldn't require it.

A physician spends five minutes on a payer issue.

A nurse spends ten minutes finding a missing authorization.

An office manager spends thirty minutes reconciling a claim.

A biller spends twenty minutes correcting data that already existed somewhere else.

Nobody thinks much about any individual event.

But multiply it by:

100 patients.

1,000 claims.

10,000 encounters.

12 months.

Suddenly we're not talking about administrative "tasks."

We're talking about a second healthcare workforce whose job is fixing the first workforce's infrastructure.

That is expensive.


The Carradine story isn't really about celebrities

That's what makes it useful.

Robert Carradine could have been almost anyone.

A father.

A grandfather.

A teacher.

A factory worker.

A retired engineer.

A physician.

A patient.

The emotional core is not his celebrity.

It is this:

A human being recognized that he needed help and walked into a healthcare institution expecting the institution to help him.

That is an extraordinary act of trust.

Patients do this every day.

They trust the medication list.

They trust the lab result.

They trust the referral.

They trust the diagnosis.

They trust the nurse.

They trust the physician.

They trust the hospital.

They trust that somebody is watching.

And they trust that if something goes wrong, somebody will notice.

Healthcare therefore has an unusual responsibility.

The patient should not have to understand the system in order to be safe inside it.


Now bring that idea into your medical practice

Your patient doesn't care which billing vendor you use.

They don't care which clearinghouse processes the claim.

They don't care which payer portal your staff logs into.

They don't care which spreadsheet contains the A/R.

They don't care which employee is responsible for eligibility verification.

They care about whether their care works.

But here is where things become uncomfortable.

The financial health of the practice affects the care environment.

If claims are repeatedly denied:

Cash flow suffers.

If cash flow suffers:

Hiring becomes harder.

If hiring becomes harder:

Staffing becomes tighter.

If staffing becomes tighter:

Workload rises.

If workload rises:

Administrative burden rises.

If administrative burden rises:

Physician attention gets fragmented.

And when physician attention gets fragmented, the quality of the entire practice environment can suffer.

This isn't a theoretical connection.

It is a systems problem.

Revenue cycle management is part of care infrastructure.

Most physicians were never taught to think about it that way.


The $1,000 problem physicians don't see

Here's an example.

Suppose a practice loses $1,000 because of a preventable denial.

The obvious question is:

"How do we recover the $1,000?"

The better question is:

"Why did the $1,000 become recoverable in the first place?"

Maybe the claim lacked authorization.

Maybe eligibility was wrong.

Maybe documentation didn't support the service.

Maybe the payer changed its policy.

Maybe the claim was submitted incorrectly.

Maybe information existed in the EHR but didn't flow into the billing system.

Maybe somebody simply missed a step.

The denial is the visible symptom.

The actual problem happened earlier.

That is one of the most important concepts in revenue-cycle management.

The denial is often not the failure. It is the notification that the failure already happened.


This changes how we should think about medical billing

Traditional billing asks:

Did we get paid?

Better billing asks:

Why didn't we get paid?

Intelligent revenue-cycle management asks:

Why did this claim become vulnerable in the first place?

And truly preventive revenue-cycle management asks:

How do we stop the next 500 claims from becoming vulnerable for the same reason?

That is the evolution.

From:

collection

to

recovery

to

prevention

to

prediction

That is where AI can become genuinely useful.


But here's the contrarian part about AI

I am a physician entrepreneur building healthcare technology.

So I have every reason to tell you that AI is the answer.

I'm not going to.

Because sometimes AI is not the answer.

Sometimes the problem is a bad workflow.

Sometimes the problem is missing data.

Sometimes the problem is a payer rule.

Sometimes the problem is poor interoperability.

Sometimes the problem is simply that nobody owns the handoff.

And if you automate a broken workflow, you don't necessarily get an intelligent workflow.

You may simply get:

a faster broken workflow.

That is one of the most dangerous misconceptions in healthcare technology.


Faster isn't necessarily better

Imagine a billing system that can process 100,000 claims an hour.

Sounds impressive.

Now imagine it makes the same mistake on 10 percent of those claims.

Congratulations.

You've automated your mistake.

Healthcare needs to stop treating speed as synonymous with intelligence.

The better question is:

How reliably does the system know when it is right?

And more importantly:

How reliably does it know when it may be wrong?

That second question is enormously important.

A trustworthy healthcare AI system needs an exception strategy.

It needs to know when to stop.

When to escalate.

When to ask.

When to defer.

When to show its reasoning.

When to bring a human into the loop.


Three expert lessons healthcare leaders should pay attention to

Expert perspective #1: Atul Gawande — don't confuse expertise with immunity to error

Surgeon and writer Atul Gawande helped popularize the medical checklist not because physicians are unintelligent.

Quite the opposite.

Checklists recognize a fundamental truth:

Complex systems exceed human memory.

A brilliant surgeon can forget a step.

An experienced nurse can miss something during a chaotic shift.

An excellent biller can overlook a payer-specific requirement.

A physician can document something perfectly and still have the information fail to reach the billing workflow.

The lesson isn't:

"Train people harder."

The lesson is:

Design systems that support people when human attention is inevitably imperfect.


Expert perspective #2: Don Berwick — stop treating every failure as an individual failure

Healthcare quality leader Donald Berwick has spent decades arguing for systems-based improvement.

This matters because healthcare has a deeply ingrained habit:

Something goes wrong.

Find the person.

Retrain the person.

Write a policy.

Move on.

But what if the person wasn't the real problem?

Suppose an authorization is missed.

The traditional response:

"The staff needs to remember."

A systems response:

"Why did the workflow depend on someone remembering?"

That is a much better question.

If the same mistake happens repeatedly, you shouldn't keep blaming the person.

Fix the environment that produces the mistake.


Expert perspective #3: Lucian Leape — human error is often predictable

Patient-safety pioneer Lucian Leape helped move medicine away from the simplistic idea that errors are primarily the result of bad individuals.

The deeper insight is that predictable failures often emerge from predictable environments.

That has enormous relevance to healthcare operations.

If a claim fails repeatedly because information is trapped in another system, don't keep telling employees to "be more careful."

If a payer requirement changes and nobody knows, don't simply blame the biller.

If a practice has five different systems that contain five different versions of patient information, don't blame the person who accidentally chooses the wrong one.

Ask:

Why was the wrong choice so easy to make?


What these three experts have in common

Gawande.

Berwick.

Leape.

Different careers.

Different approaches.

Same fundamental lesson:

Good people need good systems.

That should be printed above every healthcare operations department in America.


The administrative burden problem is getting harder to ignore

MGMA's 2026 Regulatory Burden Report surveyed more than 230 medical groups, with 60% of respondents identifying as independent practices. The organization highlights prior authorization, Medicare Advantage requirements and quality reporting among the major burdens diverting resources away from patient care.

That matters because independent practices have less room for waste.

A giant health system can sometimes absorb another administrative layer.

A six-physician practice cannot.

Every unnecessary process has a real human cost.

Every duplicated task consumes time.

Every preventable denial consumes staff capacity.

Every payer portal creates another login.

Every disconnected system creates another handoff.

Every handoff creates another opportunity for information to disappear.

And every disappearing piece of information eventually becomes someone's problem.

Usually the person closest to the patient.


The physician becomes the middleware

Here's a phrase I wish healthcare leaders would use more often:

Human middleware.

Middleware is software that connects systems.

But healthcare has created another kind.

Humans.

A medical assistant takes information from one system and puts it into another.

A nurse interprets a message and translates it into a task.

A physician rewrites documentation because a payer requires something different.

A billing specialist searches multiple systems to reconstruct what happened.

An office manager reconciles conflicting numbers.

These people aren't necessarily doing high-value clinical work.

They're connecting broken infrastructure.

We are paying humans to perform integrations that technology should increasingly perform.

That is a massive opportunity.


What OnnX is trying to change

This is the philosophy behind OnnX.

Not:

"Let's replace the biller."

Not:

"Let's put an AI chatbot on your revenue cycle."

Not:

"Let's make claims move faster."

The larger idea is:

What if a medical practice could understand its revenue cycle as clearly as it understands its patient schedule?

What if the practice could see:

Where claims are failing.

Why they're failing.

Which problems are recurring.

Which problems are preventable.

Which claims need human attention.

Which payer behaviors are changing.

Where money is sitting.

Where staff time is being consumed.

And what should happen next.

That's not simply automation.

That's visibility.


The real enemy isn't the billing company

This is another place where I want to challenge conventional thinking.

Physicians sometimes say:

"Our billing company is the problem."

Sometimes it is.

But not always.

There are excellent billing companies staffed by talented professionals.

The deeper problem is often that nobody has end-to-end visibility.

The billing company sees the claim.

The EHR sees the encounter.

The payer sees the adjudication.

The physician sees the patient.

The practice manager sees the bank account.

Everybody sees a piece.

Nobody sees the whole picture.

Fragmentation is the problem.


And fragmentation is where money disappears

Think about what happens to one claim.

The patient schedules.

Eligibility is checked.

The encounter occurs.

The physician documents.

Coding happens.

The claim is created.

The claim goes to a clearinghouse.

The payer adjudicates.

A response returns.

Someone posts the payment.

A denial enters a queue.

Someone investigates.

Someone appeals.

Someone follows up.

That is not one process.

It is a chain.

And every chain has weak links.

The question isn't:

"Who made the mistake?"

The better question is:

"Where did information lose fidelity?"


The overlooked metric: rework

Physicians know revenue.

Administrators know collections.

Billing companies know claims.

But one of the most revealing metrics is often ignored:

Rework.

How many times did someone touch the same claim?

How many times did someone reopen the same account?

How many times did someone enter the same information?

How many times did someone call the payer?

How many times did someone correct something that should have been correct the first time?

Rework is expensive.

And unlike a salary, it often doesn't appear as a separate line item.

It hides inside payroll.

It hides inside overtime.

It hides inside physician frustration.

It hides inside delayed collections.

It hides inside burnout.

Rework is the shadow cost of bad infrastructure.


Five questions every clinic owner should ask this month

1. Where are we losing money before we even know there is a problem?

Look upstream.

 

2. What are our five largest recurring denial categories?

Not the five largest individual denials.

The five largest patterns.

 

3. How much staff time is spent fixing preventable problems?

Actually estimate it.

 

4. Which information is being entered more than once?

Duplicate entry is a signal.

 

5. What does our billing vendor know that we don't?

If the answer is "almost everything," you have a visibility problem.


The 30-day physician practice challenge

You don't need a multimillion-dollar transformation project.

Try this.

Week 1: Observe

Choose one claim type.

Follow 20 claims.

Document every handoff.

Don't judge.

Just observe.


Week 2: Categorize

Put every failure into one of these categories:

Data

Eligibility

Authorization

Documentation

Coding

Payer

Submission

Payment

Follow-up

Unknown

You will probably find a pattern.


Week 3: Fix one upstream cause

Pick the largest preventable category.

Don't try to solve everything.

Solve one thing.


Week 4: Measure

Compare:

denial rate

days to submission

days to payment

staff touches

rework

A/R

Then ask:

Did the workflow actually improve?

If yes, scale it.

If not, learn why.


Don't automate until you understand the workflow

This may be the most important practical advice in the article.

Map first.

Measure second.

Automate third.

Too many healthcare organizations reverse the order.

They buy software.

Then ask:

"What are we going to do with it?"

That is backwards.

Technology should enter the workflow after the problem is understood.


The AI hierarchy I would use

Not every task deserves the same level of automation.

Level 1: Automate

Use software when the rule is clear.

Examples:

Eligibility checks.

Duplicate detection.

Data validation.

Basic claim status.

 

Level 2: Assist

Use AI when interpretation is useful but human oversight remains important.

Examples:

Denial categorization.

Documentation comparison.

Payer-rule summarization.

Work-queue prioritization.

 

Level 3: Escalate

Use AI to identify cases that need expert review.

Examples:

Conflicting documentation.

Unusual payer behavior.

Potential compliance issues.

Ambiguous coding.

 

Level 4: Human decision

Keep the final decision with an accountable professional when the stakes or uncertainty warrant it.

That is not an AI failure.

That is good system design.


The myth of the "fully automated" practice

I don't believe in it.

At least not in the way the phrase is often marketed.

Healthcare is not Amazon checkout.

Patients aren't products.

Clinical documentation isn't a shipping label.

Payers aren't uniform.

Rules change.

People make exceptions.

Contracts differ.

Clinical circumstances matter.

There will always be edge cases.

The goal isn't to eliminate humans.

The goal is to stop wasting humans on predictable work.

That is a much more realistic vision.


Myth buster: "More technology means less work"

Not automatically.

Poorly implemented technology can create more work.

Another login.

Another dashboard.

Another notification.

Another queue.

Another integration.

Another system that requires training.

Technology can reduce administrative burden.

Or it can digitize administrative burden.

Those are very different outcomes.


Myth buster: "Our denial rate tells us everything"

It doesn't.

You can have a low denial rate and still have substantial leakage through:

underpayments,

missed charges,

incorrect contracts,

slow payment,

credentialing problems,

coding gaps,

patient balances,

or services never submitted.

Look beyond denials.


Myth buster: "The physician shouldn't care about billing"

Physicians don't need to become billers.

But they should understand the economics of their practice.

Why?

Because the economics eventually influence:

staffing,

access,

hours,

technology,

services,

and sustainability.

Financial literacy is not selling out.

It is stewardship.


Myth buster: "Independent practice can't compete"

I disagree.

Independent practices have one enormous advantage:

They can move faster.

A small practice can change a workflow in a week.

A giant system may need six committees.

The opportunity is to use that agility intelligently.

Don't imitate the bureaucracy of large systems.

Build a lean operating system.


What does patient safety have to do with billing?

Everything and nothing.

Let's be precise.

A billing error is not equivalent to a clinical safety event.

We should never trivialize patient harm by making that comparison.

But both reveal a common systems principle:

When healthcare depends on humans remembering, transferring and documenting critical information perfectly across complex workflows, failures become inevitable.

The solution isn't to blame the human.

The solution is to improve the system.

That is the bridge.


Legal considerations

Healthcare automation creates real legal responsibilities.

Practices need to think about:

HIPAA

privacy

security

Business Associate Agreements

coding compliance

documentation integrity

payer contracts

audit trails

access controls

records retention

fraud and abuse risk

false claims exposure

And one issue deserves special attention:

Do not allow automation to manufacture certainty.

An AI system should never invent clinical documentation to support a claim.

It should never encourage inappropriate upcoding.

It should never conceal uncertainty.

And it should never make it impossible to determine who approved an important action.

The more automation you introduce, the more important governance becomes.


Ethical considerations

The ethical question isn't:

"Can we automate this?"

It is:

"What happens to the patient if we automate this badly?"

That changes the conversation.

A billing system can affect patient statements.

A documentation system can affect reimbursement.

A scheduling system can affect access.

A denial system can affect whether a patient receives a service.

So operational technology is not morally neutral.

The closer technology gets to patient access, the higher the standard should be.


The economics of physician attention

Let's make this concrete.

Suppose a physician spends just 30 minutes per day dealing with administrative problems that could reasonably be reduced.

That's 2.5 hours a week.

Approximately 10 hours a month.

More than 120 hours a year.

For one physician.

Now imagine a ten-physician practice.

That's more than 1,200 physician hours a year.

Those hours have economic value.

But their clinical value may be even greater.

What could those physicians have done with that time?

Seen patients.

Called families.

Reviewed complex cases.

Mentored staff.

Taken a break.

Gone home.

Been with their children.

Sometimes the most valuable ROI from healthcare technology is not another dollar collected.

It is an hour of human attention returned to a physician.


The question I want healthcare founders to answer

Not:

"How intelligent is your AI?"

Ask:

"How much human attention does your product return?"

That is a much harder question.

And a much more meaningful one.

If your technology saves 30 seconds but creates three new workflows, it failed.

If it processes a million transactions but nobody understands the exceptions, it failed.

If it generates recommendations but increases cognitive load, it failed.

Technology should make the healthcare worker's job simpler, not merely more digital.


What I would measure if I were evaluating OnnX

I wouldn't start with the AI model.

I'd start with outcomes.

Reduction in preventable denials

Reduction in rework

Reduction in manual touches

Reduction in days to submission

Reduction in days to payment

Improvement in first-pass acceptance

Improvement in net collection rate

Staff time recovered

Physician time protected

Exception accuracy

Auditability

Those are the numbers that matter.

Not how many AI agents you have.

Not how many tokens you process.

Not how impressive the demo looks.


A better definition of healthcare innovation

Healthcare innovation is often presented as:

new technology + old workflow.

I think that is insufficient.

Real innovation is:

new technology + redesigned workflow + measurable outcome + human accountability.

Take away any one of those pieces and you may have a product.

You don't necessarily have an improvement.


The future isn't AI replacing physicians

It is more interesting than that.

The future is AI removing the administrative obstacles that prevent physicians from practicing medicine well.

That means:

Less searching.

Less copying.

Less re-entering.

Less chasing.

Less guessing.

Less waiting.

Less repetitive documentation.

Less manual reconciliation.

More attention.

More judgment.

More conversation.

More care.

That is the future I want.


What healthcare leaders may be missing

Everyone is racing to build the smartest AI.

I think we should also race to build the most trustworthy systems.

Because healthcare doesn't have a shortage of information.

It has a shortage of:

reliable information flow.

The data exists.

It is just scattered.

The authorization is somewhere.

The documentation is somewhere.

The claim is somewhere.

The payer response is somewhere.

The payment is somewhere.

The problem isn't always intelligence.

Sometimes it is coordination.

That is why the next generation of healthcare technology may look less like a brilliant robot and more like extremely good infrastructure.

Quiet.

Invisible.

Reliable.

Boring.

And incredibly valuable.


The most provocative idea in this article

Here it is:

The best healthcare technology may be technology nobody notices.

Nobody celebrates a system because a claim didn't get denied.

Nobody posts on LinkedIn because an authorization was correctly identified before the patient arrived.

Nobody writes a press release because a billing workflow didn't require a human to re-enter information.

But those quiet successes matter.

The best infrastructure is often invisible.

You notice it when it fails.


And that brings us back to Robert Carradine

His story is painful precisely because healthcare is supposed to be a place of trust.

According to reporting on the lawsuit, Carradine's family alleges that he voluntarily sought care at UCLA's Resnick Neuropsychiatric Hospital and that critical safety processes were not followed.

Again:

Those allegations remain allegations.

But regardless of how the litigation ultimately resolves, the story forces healthcare leaders to confront an uncomfortable truth.

A policy sitting in a binder isn't safety.

A protocol nobody can reliably execute isn't safety.

A checkbox isn't safety.

A documented process that doesn't reflect reality isn't safety.

Reliability is safety.

And that principle extends throughout healthcare.


The same principle applies to your revenue cycle

A billing policy sitting in a manual isn't revenue-cycle control.

A payer rule nobody knows about isn't operational intelligence.

A denial report generated 60 days later isn't prevention.

A dashboard nobody reads isn't visibility.

A billing vendor you cannot audit isn't transparency.

A claim that gets paid after three appeals isn't necessarily a success.

Maybe it is.

Maybe it is evidence of a problem that should have been prevented.

The mature question is:

What happened upstream?


Your practice doesn't need more heroics

This is perhaps the most important message for physicians.

You don't need to become a better human.

You don't need your office manager to work another Saturday.

You don't need your biller to remember another 400 payer rules.

You don't need another heroic effort.

You need a system that makes heroic effort less necessary.

That's what good infrastructure does.


Start here

Tomorrow, ask your office manager one question:

"What is the most ridiculous thing your team has to do every day that you believe should be automated or eliminated?"

Then listen.

Don't defend the process.

Don't explain why it exists.

Don't say:

"That's just how healthcare works."

Write it down.

Then ask:

"How often does this happen?"

Then:

"What happens if we don't do it?"

Then:

"Why can't the system do it?"

That conversation may reveal more about your practice than another expensive consultant's report.


A simple operating philosophy for independent practices

I would summarize it this way:

Eliminate before automating.

Don't automate unnecessary work.

Automate before hiring.

If a predictable task can be safely automated, don't build a permanent manual process around it.

Measure before claiming improvement.

Baseline first.

Escalate uncertainty.

Don't force AI to guess.

Preserve human accountability.

Someone should always own the outcome.

Make data visible.

You should understand your own practice.

Fix upstream.

Don't spend all your energy cleaning up downstream failures.


What OnnX ultimately stands for

For me, this isn't really about medical billing.

Billing is simply where I started.

The larger idea is healthcare infrastructure that works for the people actually providing care.

Technology should not create another layer between physician and patient.

It should remove layers.

It should not hide complexity.

It should absorb complexity.

It should not require clinicians to become software engineers.

It should make the software adapt to the clinical environment.

And it should not replace judgment.

It should protect judgment for the moments when judgment matters most.


Final Thoughts: Stop Asking Physicians to Be the System

Maybe healthcare's biggest hidden problem isn't incompetence.

Maybe it's overdependence on human heroics.

We ask physicians to remember.

We ask nurses to catch.

We ask medical assistants to reconcile.

We ask office managers to chase.

We ask billers to appeal.

We ask patients to navigate.

Then we call the system "efficient."

It isn't.

A system that requires extraordinary people to compensate for ordinary failures is not a high-performing system.

It's a fragile one.

The better system is different.

It catches problems early.

It makes information visible.

It routes exceptions intelligently.

It automates predictable work.

It preserves human judgment.

And when something goes wrong, it makes the failure easier to understand.

That is what healthcare technology should aspire to.

Not replacing the people we trust.

Building systems worthy of their trust.


Get Involved

So here is the question I want to put directly to physicians and clinic owners:

What is the one administrative process in your practice that everyone has accepted as "normal" even though it makes absolutely no sense?

Don't give me the politically correct answer.

Give me the real one.

Tell me in the comments.

If this article made you think about a problem differently, share it with another physician or clinic owner who is dealing with the same friction.

And if you believe healthcare can be redesigned around clinicians rather than asking clinicians to constantly adapt to the system, join the conversation.

The future of healthcare isn't something that happens to physicians.

Physicians should help build it.

Raise your hand. Question the workflow. Start with one broken process.


About the Author

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

He is the founder of OnnX, an AI-powered medical billing platform focused on helping small and medium-sized medical practices reduce administrative friction, improve revenue-cycle visibility and spend less time navigating fragmented billing workflows.

His work focuses on a practical question:

How can technology give physicians more control over the systems surrounding patient care?

Connect with Dr. Cham on LinkedIn:

Dr. Daniel Cham on LinkedIn


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 their particular circumstances.

References to the Robert Carradine litigation describe allegations reported in publicly available sources. Those allegations have not been adjudicated and should not be interpreted as established findings of fact or liability.


Continue the Conversation

Healthcare is changing too quickly for any one discipline to solve its problems alone.

The most interesting work is happening where medicine, technology, operations, economics and human experience intersect.

I share practical observations, healthcare strategy and lessons from building at that intersection.

Knowledge starts the conversation. Practical insight moves it forward.

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Three references

1. Robert Carradine's family lawsuit against UCLA. The Los Angeles Times reports that Carradine's family filed a wrongful-death lawsuit against UCLA's governing body, alleging his death following psychiatric hospitalization was preventable.

Read the Los Angeles Times report

2. MGMA's 2026 Regulatory Burden Report. The report draws on responses from more than 230 medical groups and identifies prior authorization, Medicare Advantage requirements and quality reporting among major burdens diverting practice resources from patient care.

Read the MGMA 2026 Regulatory Burden Report

3. AMA analysis of 2026 physician payment and practice economics. The AMA reports that Medicare physician payment has risen only about 10% from 2001 to 2026 while the cost of running a medical practice increased 63%, illustrating the financial pressure facing physician practices.

Read the AMA analysis


One final thought

Robert Carradine's story is about a patient who trusted a healthcare system.

Your patients do the same thing every day.

They trust that the right information will be there.

They trust that someone will notice.

They trust that the system will work.

They trust you.

The question isn't whether healthcare has enough good people.

It is whether we have built systems good people can trust.

That is the healthcare technology challenge worth solving.

 

THE OTHER 166 HOURS

ONE WIFE, ONE PATIENT, AND THE HIDDEN LABOR OF AMERICAN HEALTHCARE “Our care is better for patients when we don't feel burned out. We ...