Thursday, October 22, 2026

Katherine Elkins Survived a Devastating Accident. Why Is Healthcare Still Making Recovery So Hard?

The best workflow is the one you never needed. Through Katherine Elkins’s journey from nurse to patient and back, we confront healthcare’s overlooked challenge: preventing unnecessary work before it reaches the people who can least afford it.

 


“I can ensure they have dignity, and that their death is a phenomenal, beautiful thing.” — Courtney, a hospice nurse practitioner, interviewed by Madeleine Aggeler for The Guardian.

 

The Nurse Who Became the Patient

Imagine spending your career helping people navigate some of the most vulnerable moments of their lives—then suddenly finding yourself on the other side of the hospital bed.

That is what happened to Katherine Elkins, a nurse at Touro in New Orleans.

In 2023, Elkins was riding her bicycle with friends to attend Jazz Fest when a car struck her at an intersection. Her next clear memory was waking up at University Medical Center New Orleans. Her family had been warned that she might not survive the night.

She survived. But survival was only the beginning.

The accident left her with a traumatic brain injury, brain hemorrhaging, fractures, a collapsed lung, severe nerve damage and other serious injuries. Her recovery required intensive rehabilitation, physical and occupational therapy, speech therapy, additional procedures and countless medical appointments.

Everyday tasks became difficult. Concentrating was harder. Multitasking became a challenge. Even managing routine responsibilities could feel overwhelming.

Then came the bills.

Elkins described how the brain injury made it difficult to manage the administrative responsibilities that accompanied her recovery. Medical bills arriving in the mail became a source of anxiety. Tasks that might once have seemed ordinary could suddenly feel impossible.

Think about that for a moment.

A person who had spent years caring for patients now had to navigate the system as a patient herself—while recovering from an injury that made complex tasks harder to manage.

Fortunately, she was not alone.

Elkins recalled a nurse who learned that she loved Dippin’ Dots and brought them to her. Another caregiver, identified in the published account only as Jesse, helped her get outside to experience the campus fountain.

Small gestures. Enormous meaning.

In April 2026, three years after the accident, Elkins returned to nursing at Touro with workplace accommodations and support from her colleagues.

Her story is one of survival, rehabilitation, human connection and determination.

But it also raises a question healthcare leaders should be willing to confront:

Why can receiving care sometimes create a second job for the person who is already struggling to recover?

The first job is getting better.

The second can involve understanding bills, organizing documents, coordinating appointments, responding to insurance requests and figuring out what to do when information is missing or confusing.

Nobody puts “unpaid administrative project manager” on a patient’s discharge paperwork.

Yet patients and families can find themselves doing exactly that.


The Contrarian Truth: More Automation Is Not Always More Progress

Healthcare technology has a compelling promise: automate the workflow, save time, reduce costs and improve efficiency.

There is genuine value in that ambition. Automation can reduce repetitive work, improve consistency and free staff to focus on tasks that require human judgment.

But the industry has a blind spot.

We are getting better at automating work without always asking whether the work should exist in the first place.

Consider a hypothetical physician-owned practice.

A patient arrives for an appointment. Staff enter information into the electronic health record. Another employee checks the practice management system. Someone notices a missing field. A message is sent to request clarification. The information is entered again.

Later, a claim is submitted.

The payer rejects it because the original information was incomplete or inconsistent.

Now the practice has a new workflow:

  • Investigate the rejection.
  • Identify the missing information.
  • Contact the appropriate person.
  • Wait for a response.
  • Correct the record.
  • Resubmit the claim.
  • Monitor its status.
  • Repeat the process if the correction does not solve the problem.

An automation vendor may offer to accelerate several of these steps.

That could help.

But what if the information could have been captured correctly at the beginning?

What if the missing requirement could have been identified before submission?

What if the handoff had been designed to prevent the error rather than discover it weeks later?

The most valuable workflow might be the one that never needed to happen.

Automating rework can make rework faster. It does not necessarily make rework disappear.

A beautifully automated mistake is still a mistake. It simply arrives with better formatting and a more impressive dashboard.

And a claim that has been submitted is not the same as a claim that has been paid.

Activity is not completion. Processing is not resolution. A task marked complete is not proof that the underlying problem has been solved.

Healthcare can become extraordinarily efficient at managing the consequences of poor information while leaving the source of the problem untouched.

That is not necessarily progress. Sometimes it is just expensive repetition at scale.


What Katherine Elkins’s Story Actually Teaches Us

We should be careful not to turn Elkins’s experience into a convenient technology sales pitch.

Her accident was not caused by medical billing. Her story does not establish that billing inefficiencies caused her recovery challenges, nor does it prove that a particular software platform could have prevented her anxiety.

Her recovery involved medical professionals, rehabilitation specialists, colleagues, family and community members. Their contributions mattered in different ways.

But her experience illustrates a broader human reality:

Administrative tasks do not become less demanding simply because someone has more important things to deal with.

They may become more difficult.

A person recovering from a brain injury may struggle with concentration and complex tasks. Someone undergoing cancer treatment may have limited energy. A caregiver may be balancing work, family responsibilities and a loved one’s appointments.

Even people who are generally organized can find administrative work overwhelming during a crisis.

The problem is not necessarily that people lack discipline.

It is that systems often assume everyone has unlimited time, attention, organizational capacity and emotional energy.

They do not.

Neither do clinicians.

A physician who spends an evening resolving documentation discrepancies is not spending that time with a patient. A medical assistant repeatedly chasing missing information has less capacity for other work. A billing specialist correcting preventable errors cannot devote the same attention to more complex reimbursement problems.

The cost is not merely the time spent fixing something.

It is the opportunity cost of everything that could have been accomplished instead.

A problem may begin at the point of care, become a staff follow-up task, turn into a claim delay and eventually require attention from a patient or family member.

The person who experiences the final inconvenience may be far removed from the process where the problem began.

That is why healthcare leaders should ask two questions:

  1. How quickly did we resolve the problem?
  2. Why did the problem need to exist in the first place?

The first question measures operational response.

The second opens the door to prevention.


Healthcare Has Made Progress. So Why Is There Still So Much Friction?

The healthcare industry is not standing still.

The 2025 CAQH Index, released in February 2026, estimated that electronic transactions and improved data exchange helped U.S. healthcare avoid $258 billion in administrative costs during 2024. The report also identified an estimated $21 billion in additional annual savings potential from fully automating remaining manual and partially manual administrative transactions.

These are national industry estimates, not a guarantee of savings for any individual practice.

They nevertheless highlight an important point: automation has created substantial value, but administrative inefficiency remains.

The wrong conclusion would be that automation has failed.

The more useful question is whether the next phase of improvement should focus only on automating more transactions—or also on reducing the errors, omissions and handoff failures that create avoidable transactions in the first place.

Automation is a means, not the outcome.

The desired outcome is less unnecessary work, more reliable information, fewer avoidable delays and more time for people to do work that genuinely requires their expertise.

A clinic should not have to celebrate how quickly it corrected a recurring error if the same error could have been prevented.

It should investigate why the error keeps happening.

That may sound less exciting than announcing another artificial intelligence initiative. It is also more likely to produce a useful operational question.

The next breakthrough may not be doing the same work faster. It may be discovering how much of that work was unnecessary.


The Hidden Cost of “Just One More Follow-Up”

Administrative problems often look small when viewed individually.

A missing date. An incomplete field. A discrepancy between systems. A document that was not attached. An authorization request that needs clarification.

Each issue may take only a few minutes to address.

But those minutes rarely tell the whole story.

Someone must notice the problem, understand it, locate the relevant information, determine who can resolve it, make contact, wait for a response and verify that the correction worked.

The process may involve several employees and multiple systems.

There is also the cost of interruption. A staff member who stops one task to chase missing information must later return to the original task and reconstruct their train of thought.

Multiply this across a busy practice, and seemingly minor issues can fragment an entire day.

The pattern is familiar:

Incomplete information → follow-up → delay → correction → resubmission → more follow-up.

It is tempting to treat this cycle as an unavoidable feature of healthcare.

Some administrative complexity is unavoidable. Clinical decisions require judgment. Payer rules differ. Unusual cases require investigation. Not every denial is preventable.

But other work exists because information was not captured clearly, expectations were not aligned, responsibilities were ambiguous or systems failed to communicate.

Those are different problems. They deserve different solutions.

A workflow automation tool may help move a task from one person to another.

A well-designed upstream process may eliminate the need for the task altogether.

That is the difference between managing the burden and reducing its source.


The Real Bottleneck May Be Data Quality, Not Staff Productivity

When a practice experiences recurring billing problems, the first instinct is often to look at the billing team.

Can staff process claims faster? Should another employee be hired? Would an AI-powered denial-management tool help?

These are reasonable questions.

But they can begin too far downstream.

Consider a claim rejected because essential information is missing or inconsistent.

The billing team may have performed its work correctly. The rejection may originate in an earlier handoff, an incomplete field, conflicting information across systems or a process that failed to make a requirement clear.

Giving the billing team a faster tool may help it detect and resolve the problem. It may not prevent the same issue from appearing again tomorrow.

This is why healthcare billing should be examined as a data-quality problem as well as a workflow problem.

The question is not simply whether information exists somewhere in the organization.

It is whether the right information is accurate, complete, consistent and available to the right person at the right point in the process.

Information buried in a document, trapped in another system or discovered only after a claim is rejected may technically exist.

Operationally, it may be almost as useful as information that does not exist.

The goal should be to make the correct action easier when information is first captured.

That can involve clearer requirements, better validation, consistent terminology, defined handoffs and earlier identification of missing details.

It also means avoiding the temptation to treat every failure as a staff-performance problem.

If several competent employees repeatedly encounter the same issue, the process deserves scrutiny before the people do.

A recurring error is not just a recurring task. It may be evidence that something upstream needs to change.


Artificial Intelligence Cannot Magically Repair a Broken Process

Artificial intelligence is increasingly being applied to healthcare administration, including documentation, coding support, claims operations and revenue-cycle workflows.

Used appropriately, it can be valuable. AI can help identify patterns, summarize information, flag inconsistencies and reduce repetitive tasks.

But there is a limitation that deserves more attention:

AI cannot reliably turn missing or incorrect source information into truth simply by processing it more elegantly.

If the original record is incomplete, an AI system may identify the gap—or it may produce an output that still requires careful verification.

If two systems contain conflicting details, the technology needs a reliable way to identify which information is authoritative.

If staff members use inconsistent definitions, an algorithm may inherit that inconsistency.

The problem is not that AI is useless.

The problem is expecting intelligence downstream to compensate indefinitely for poor information upstream.

Imagine asking an exceptionally capable assistant to prepare a financial report using three spreadsheets that disagree.

The assistant may produce an attractive report in seconds.

That does not make the underlying numbers correct.

Healthcare faces the same principle, with additional stakes involving privacy, compliance, patient care and reimbursement.

A more sensible sequence is:

  1. Define the information required.
  2. Capture it as close as practical to its source.
  3. Validate it against appropriate rules.
  4. Identify missing or conflicting information early.
  5. Route exceptions to the right person.
  6. Use AI and automation where they genuinely add value.
  7. Measure whether the underlying problem actually decreases.

This is not an argument against AI.

It is an argument against asking AI to become a permanent cleanup crew for a process nobody has redesigned.

Or, to put it less politely: buying a smarter mop is not always the same as fixing the leaking pipe.


What Physician-Owned Practices Can Do Differently

Small and medium-sized practices often operate with limited staffing, tight margins and little appetite for another complicated implementation.

They cannot redesign everything overnight.

They can, however, start with a focused review of recurring administrative work.

The objective is to distinguish necessary work from work caused by preventable failure.

Step 1: Identify the recurring problems

Look at the issues that repeatedly consume staff attention.

Examples include incomplete insurance information, missing documentation, avoidable claim corrections, repeated eligibility checks, unclear authorization status and information that must be entered into multiple systems.

Do not begin with the most technologically exciting problem.

Begin with the one that repeatedly wastes time or delays resolution.

Step 2: Trace each problem backward

When a claim is rejected or a staff member must chase information, ask:

  • What was missing, incorrect or inconsistent?
  • At what point should the information have been captured?
  • Who had access to it?
  • Was the requirement clear?
  • Did the relevant systems communicate?
  • Could the problem have been detected before the claim was submitted?

The objective is to find the earliest preventable point—not simply the last person who touched the file.

Step 3: Separate human judgment from repetitive administration

Some tasks require clinical expertise, negotiation, interpretation or a conversation with a patient.

Others involve repeatedly transferring information, checking predictable requirements or tracking a status that should already be visible.

Automate repetitive work where it is safe and appropriate. Preserve human oversight for exceptions and decisions that require it.

The goal is not to remove people from healthcare.

It is to stop consuming their attention on tasks that do not need their judgment.

Step 4: Make completeness visible

Staff should not have to discover a missing requirement weeks after the original encounter.

Where possible, build checks into the point at which information is created or received. Make it clear what is complete, what is missing and what needs human review.

A useful system does not merely store information. It helps people determine whether that information is ready for the next step.

Step 5: Fix the process, not just the individual case

When a problem is corrected, record why it happened.

If the same issue appears repeatedly, review the underlying process.

A corrected claim is a useful result. A corrected process is a more durable one.

Step 6: Measure outcomes rather than clicks

Do not judge success solely by how many tasks a system processes or how quickly it completes a workflow.

Consider tracking:

  • First-pass claim acceptance.
  • Rework and correction rates.
  • Time spent on repetitive follow-up.
  • Days in accounts receivable.
  • Frequency of recurring documentation gaps.
  • Time from identifying a problem to resolving its cause.
  • Staff-reported administrative burden.

Choose metrics that reflect the practice’s priorities and establish a baseline before introducing a new tool.

A dashboard full of completed tasks can look impressive.

A declining number of unnecessary tasks is more persuasive.

Step 7: Listen to the people closest to the problem

Billing specialists, front-desk staff, medical assistants, clinicians and patients often experience different parts of the same broken process.

Ask where information gets lost, which requests repeatedly arrive too late and what work people perform only because another step failed.

They may already know where the system is leaking time.

The challenge is to convert those observations into improvements rather than expecting everyone to keep working around the same defects.


Five Metrics That Tell a More Honest Story

If a practice wants to understand whether administrative improvement is real, it should look beyond the number of automated transactions.

First-pass claim acceptance

How often are claims accepted without preventable correction or resubmission? Define the metric consistently and distinguish submission-level acceptance from payer adjudication outcomes.

Rework rate

How frequently must staff revisit work because information was missing, inaccurate or inconsistent? Categorize the causes so the practice can distinguish preventable errors from legitimate payer or case complexity.

Administrative touches per claim

How many separate staff actions are required to move a claim through the process? A reduction may indicate a simpler workflow, although fewer touches alone do not prove better outcomes.

Time to resolution

When an issue occurs, how long does it take to resolve it—and how much of that time is spent waiting for information, clarifying responsibility or repeating work?

Recurrence of known errors

After a problem is corrected, does it return? If the same error keeps appearing, the organization may be treating individual symptoms without correcting the underlying cause.

These metrics should be interpreted together. No single measure explains every revenue-cycle problem, and improvements should never come at the expense of accuracy, compliance or patient access.

The principle is straightforward: measure the friction, identify its source and verify that the intervention reduces it.


The Patient Experience Is Part of the Administrative Workflow

Healthcare administration is often discussed as an internal operational issue.

But the boundaries are not as neat as organizational charts suggest.

A patient may be asked to repeat information already provided. A family member may need to clarify an unexplained bill. Someone recovering from a serious illness may receive confusing communications from different departments.

Not every such experience is preventable. Healthcare is complicated, and some cases genuinely require multiple steps.

But administrative friction should not be assumed harmless simply because it happens outside the examination room.

For patients, confusion can create uncertainty. Repeated requests can erode confidence. Unclear bills can become a source of anxiety. For people already dealing with serious health challenges, the burden can feel disproportionate.

Elkins described how receiving medical bills became overwhelming during her recovery from a traumatic brain injury. Her account is an individual experience, not a population-level study. It should not be used to claim that every patient responds the same way.

Its value is that it makes a familiar administrative process visible through one person's experience.

A bill is a document to an organization.

To a patient, it may represent uncertainty about money, coverage, responsibility and what happens next.

The difference matters.

A process can be technically compliant and still be unnecessarily difficult to navigate. A claim can be operationally complete while a patient remains confused about the financial outcome.

The goal should be accurate administration and clear communication—not merely a completed transaction.


The Future of Healthcare AI Should Be Measured by What Disappears

The next stage of healthcare AI should not be judged solely by how many administrative tasks it can perform.

It should also be judged by how many unnecessary tasks it helps prevent.

That requires moving beyond the assumption that every problem deserves a new workflow.

Sometimes the right intervention is a better integration. Sometimes it is clearer data standards. Sometimes it is improved training. Sometimes it is a change to the way information is captured. And sometimes an AI tool is the right answer.

The important thing is to diagnose the problem before choosing the technology.

A mature healthcare AI strategy should ask:

  • Can we detect incomplete or inconsistent information earlier?
  • Can we prevent a predictable error before it becomes a denial or delay?
  • Can we reduce repeated data entry without compromising accuracy?
  • Can we make responsibility for the next step clear?
  • Can we identify the root cause of recurring rework?
  • Can we show that the change improved outcomes rather than merely increasing activity?

This is less glamorous than announcing that AI will automate an entire department.

It is also more practical.

Healthcare does not need technology for technology’s sake. It needs systems that make reliable work easier, exceptions more visible and preventable errors less common.

The most valuable AI may sometimes be the AI that helps a task disappear—not because it performs the task faster, but because the process no longer requires the task.


The OnnX Perspective: Move Upstream

This is the operational question behind my work with OnnX.

OnnX is being developed around a premise that deserves greater attention in healthcare billing: many downstream billing problems begin as upstream information problems.

Revenue-cycle tools can help practices manage claims, denials, coding and follow-up. Those functions matter.

But when a problem begins with incomplete, inconsistent or poorly structured information, the long-term opportunity may be to improve the information before it enters the downstream workflow.

That means asking different questions.

Not only: How do we process the claim?

But: Was the information ready when the claim was created?

Not only: How do we handle the denial?

But: Could the underlying issue have been identified earlier?

Not only: How do we make the staff member more productive?

But: Why is that staff member repeatedly doing work that should not be necessary?

This is not a claim that every denial can be prevented, every workflow automated or every reimbursement challenge solved by one platform.

It is a design principle: prevent what can reasonably be prevented, make exceptions easier to manage and use technology where it solves a clearly defined problem.

For small and medium-sized physician-owned practices, that distinction matters. Limited staff should not have to compensate indefinitely for disconnected systems and recurring information gaps.

The opportunity is not to add technology to every step.

It is to make the whole process require fewer avoidable steps.


A Human Story, Not a Technology Sales Pitch

Katherine Elkins’s story should not be reduced to a metaphor for billing software.

She is a nurse who survived a devastating accident, worked through a difficult recovery and returned to a profession she loves.

Her account also highlights the people who supported her: the clinicians who treated her, the rehabilitation team, the colleagues who helped her return and the individuals who offered small acts of kindness when she needed them.

The Dippin’ Dots mattered. The chance to go outside and touch the fountain water mattered. The support that helped her return to work mattered.

These details remind us that healthcare is not merely a collection of transactions. It is a human relationship carried out through a complex system.

Technology can help that system work better. But the measure of success should be whether it reduces unnecessary friction and allows people to direct more attention toward what matters.

For a patient, that may mean less confusion during recovery.

For a nurse, it may mean more time and energy for patient care.

For a physician-owned practice, it may mean fewer preventable corrections, more predictable revenue-cycle operations and less staff time spent chasing information.

These are connected goals, but they are not interchangeable. Each requires evidence, thoughtful design and attention to the people affected.

The lesson is not that technology can replace kindness.

It is that good systems should stop making people work so hard just to navigate the system.


Myth-Buster: “If We Automate It, We’ve Fixed It”

Myth: Administrative automation automatically means administrative improvement.

Reality: Automation can reduce repetitive work, but it can also make an inefficient process run faster without correcting the source of the inefficiency.

Myth: Every denial is a billing department problem.

Reality: Some problems originate earlier in the process, including missing or inconsistent information, unclear handoffs or requirements that were not identified in time. Others stem from payer rules, coverage limitations or factors requiring different interventions.

Myth: More dashboard activity means better performance.

Reality: Activity is not the same as resolution. Practices should also measure rework, recurrence, accuracy and outcomes that matter to patients and staff.

Myth: AI will automatically solve data-quality problems.

Reality: AI can help identify patterns and flag inconsistencies, but reliability depends on the information available, system design and appropriate human oversight.

Myth: The patient’s administrative experience is separate from care.

Reality: Administrative processes shape how patients understand bills, respond to requests and navigate the financial side of healthcare. They deserve attention to clarity and usability.


Frequently Asked Questions

Does Katherine Elkins’s experience prove that medical billing harms patients?

No. Her account describes the difficulty of managing medical bills during recovery from a traumatic brain injury. It is an individual story, not proof of a general causal relationship. It illustrates why administrative burden deserves attention, particularly when people are vulnerable.

Is automation a bad idea for healthcare practices?

No. Automation can improve consistency, reduce repetitive work and lower administrative costs. The argument is for choosing automation strategically and addressing preventable sources of rework rather than assuming every existing task should simply be automated.

What is upstream data quality in medical billing?

It means capturing and validating relevant information as close as practical to where it originates, so downstream processes receive information that is accurate, complete, consistent and usable. Requirements depend on the workflow, payer rules and clinical context.

Where should a small practice begin?

Start with one recurring problem that consumes staff time or delays claim resolution. Review a sample of cases, identify common causes, trace them back to the earliest preventable step and test a focused improvement. Measure results before expanding the intervention.

How should practices decide whether an AI tool is worthwhile?

Define the problem first, establish a baseline and specify the desired outcome. Assess accuracy, integration, privacy, compliance, usability and the human review required. Then evaluate whether the tool improves the chosen outcome in actual practice—not merely whether it performs well in a demonstration.


The Question Healthcare Should Be Asking

Katherine Elkins’s journey from nurse to patient and back to nursing is a story of resilience, human connection and the long road to recovery.

It also challenges healthcare leaders to think about the systems surrounding care.

We cannot eliminate every administrative task. We cannot prevent every denial. We cannot assume every problem begins with poor data. And we should never promise that technology will make a complicated healthcare system frictionless.

But we can be more deliberate about distinguishing necessary work from work created by preventable failures.

We can make information clearer at the point of capture. We can improve handoffs. We can examine recurring errors instead of repeatedly correcting them. We can measure whether automation reduces the burden rather than merely shifting it to another person.

And we can remember that every administrative workflow ultimately affects people—patients, families, clinicians and staff.

Here is the contrarian question I would put to every healthcare technology leader and practice owner:

What if the next big breakthrough in healthcare AI is not automating more work—but proving how much unnecessary work we can eliminate?

Because the future of healthcare should not be measured by how efficiently we make people navigate broken processes.

It should be measured by how many of those processes we no longer need.

And if your latest automation project has made the same mistake happen 30% faster, congratulations: you have built a very efficient way to be wrong.

Perhaps the next productivity breakthrough is not another dashboard.

Perhaps it is fewer reasons to open the dashboard in the first place.


About the Author

Dr. Daniel Cham is a physician and medical consultant with expertise in medical tech consulting, healthcare management and medical billing. He focuses on practical insights for professionals at the intersection of healthcare and medical practice. As the physician-led founder of OnnX, he is interested in improving upstream data quality to reduce avoidable billing friction for physician-owned practices.


Continue the Conversation

What is one recurring administrative task in your practice that should never have become a task in the first place?

I welcome perspectives from physicians, practice managers, billers, nurses and healthcare technology leaders. The people doing the work often know exactly where the system is creating unnecessary friction.

If this perspective resonates, repost it so more healthcare professionals can join the discussion.

♻️ Repost to challenge the assumption that automating a task is always the same as improving a process.

·       Visit Dr. Cham's website

·       Dr. Daniel Cham on LinkedIn

·       Subscribe and watch on YouTube


References and Further Reading

  1. LCMC Health, “From Nurse to Patient and Back: Touro Nurse Returns to Caring for Patients After Traumatic Brain Injury,” October 16, 2026.
  2. Madeleine Aggeler, The Guardian, “‘Don’t sweat the small stuff’: hospice workers share 12 lessons about life and death,” October 21, 2026. The opening quote is from Courtney, a hospice nurse practitioner in Missouri who asked that her surname be withheld.
  3. CAQH, “2025 CAQH Index Shows U.S. Healthcare Avoided $258 Billion and Accelerated Automation, Interoperability and AI Adoption,” February 19, 2026.


Disclaimer

This article is for educational and general informational purposes only. It does not constitute medical, legal, coding, reimbursement or financial advice. The human-interest narrative is based on publicly reported information; broader operational recommendations are commentary and should be adapted to each practice’s circumstances. Verify current payer requirements, applicable laws and professional guidance before making clinical, billing or compliance decisions.


#Healthcare #MedicalBilling #HealthcareAI #RevenueCycleManagement #PhysicianEntrepreneur #HealthcareInnovation #PracticeManagement #HealthTech #DataQuality #PatientExperience #AdministrativeBurden #ArtificialIntelligence

 

Wednesday, October 21, 2026

Stephanie Johnson and Marcus Brown: A Brother’s Liver Donation, a Sister’s Second Chance, and the Healthcare Problem Nobody Should Accept

One family’s extraordinary journey raises an uncomfortable question: If healthcare exists to help people reclaim their lives, why do we tolerate systems that repeatedly take physicians away from the people they are trying to help?



“They all go back to the importance of the patient-physician interaction, which is really just a human connection that's part of delivering good-quality care and getting good outcomes.” — Dr. Gary Price, President of The Physicians Foundation, speaking to Medical Economics


A brother stepped forward before his sister asked

Stephanie Johnson lived with polycystic liver disease. Her liver had enlarged so dramatically that everyday activities became difficult. Eating was uncomfortable. Climbing stairs left her breathless. Strangers sometimes mistook her enlarged abdomen for pregnancy.

Her younger brother, Marcus Brown, wanted to help.

Stephanie was reluctant to ask family members to donate an organ. She believed other people on the transplant waiting list might need a liver more urgently.

Marcus saw it differently.

He raised the possibility of donating part of his liver with their mother before Stephanie knew what he was considering.

In February 2026, Marcus donated part of his liver to his sister at VCU Health’s Hume-Lee Transplant Center in Richmond, Virginia.

The operation involved a multidisciplinary medical team, including transplant surgeon Dr. Seung Duk Lee, M.D., Ph.D., and Dr. David Bruno, M.D., FACS. During Stephanie’s recovery, doctors also discovered a cancerous growth in her colon. Surgical oncologist Dr. Leopoldo Fernandez subsequently removed it.

Stephanie endured a prolonged hospitalization before finally returning home.

Then came a small moment with enormous meaning.

She found herself running up the stairs.

Previously, climbing them had left her struggling for breath. Now, she could move more freely, eat more comfortably, and begin reclaiming ordinary parts of life.

She could buy clothes in her own size. She could focus more of her energy on her two sons.

The medical procedures were extraordinary. The victories that mattered to Stephanie were wonderfully ordinary.

Eating a meal. Climbing stairs. Wearing a shirt without trying to hide. Getting more of your life back.

Her story is about family, medical expertise, difficult decisions, and the possibility of recovery.

It is not a story about medical billing, and there is no evidence that billing problems caused or affected her outcome.

But it reminds us of a principle that should guide every part of healthcare:

The system exists to serve the patient. The patient does not exist to serve the system.

That sounds obvious.

So why is it so easy to lose sight of it?


The uncomfortable question: What is healthcare optimizing for?

Healthcare can perform extraordinarily complex operations. Surgeons can remove diseased organs and transplant donated tissue. Clinical teams coordinate medications, imaging, laboratory results, intensive monitoring, and recovery.

Yet many physicians and their staff still spend hours tracking down missing information, correcting preventable errors, checking authorization requirements, and trying to understand why a claim has become another administrative project.

We can perform miracles in the operating room and still struggle to get the right information to the right person at the right time.

That is not an argument against technology, administration, or necessary safeguards.

It is a question about priorities.

Are we optimizing healthcare for the delivery of care—or for the processing of everything that surrounds it?

There is a difference.

A system can become extremely efficient at processing paperwork while leaving the underlying reasons for that paperwork untouched.

It can generate a dashboard showing yesterday’s failures without preventing tomorrow’s.

It can automate a process that should have been simplified.

It can even use artificial intelligence to make a bad workflow faster.

Congratulations. We have successfully taught the machine to run in circles.

The harder question is whether the circle needed to exist.


The contrarian thesis: Some billing problems begin before billing

As a physician and founder of OnnX, I have become increasingly interested in a question that sits upstream of traditional revenue-cycle management.

What if some of the work we call billing is actually the work of reconstructing information that should have been complete, connected, and usable much earlier?

Consider a typical patient encounter.

A patient schedules an appointment. The practice collects demographic and insurance information. Staff check eligibility and determine whether a referral or authorization is required. The physician evaluates the patient and documents the encounter. Coding and charge capture follow, and a claim is submitted.

Each stage depends on information from earlier stages.

A missing detail may not be obvious when it first appears. The workflow continues. Someone else assumes the information is complete. The problem becomes visible only when the next step fails.

Now someone must investigate.

Was the insurance information correct? Was authorization required? Did the referral arrive? Does the documentation support the intended service? Was a payer-specific requirement overlooked? Did the information exist in another system but fail to reach the person who needed it?

The claim becomes the crime scene.

The actual cause may be several steps away.

This is why I believe healthcare should investigate the origin of recurring errors, not simply optimize the department that discovers them.

A denial is an event. It is not always an explanation.

A coding query is a task. It does not automatically reveal why the documentation was unclear.

A delayed payment is an outcome. It does not tell us whether the original problem began with registration, coverage, authorization, documentation, coding, or payer processing.

The location where a problem appears is not necessarily where it began.

That distinction can change how a practice measures performance, allocates staff, selects technology, and decides which problems deserve attention first.


The hidden tax of administrative rework

Imagine a hypothetical physician-owned practice.

A physician sees a patient, makes a clinical decision, and documents the encounter. The practice expects to submit an appropriate claim.

But the insurance information is incomplete. A referral requirement was overlooked. The documentation needs clarification.

Each issue appears manageable.

Together, they create a chain of additional work.

A staff member must identify the problem, determine what is missing, contact someone, retrieve information, and correct the record. The physician may need to clarify documentation. The claim may be delayed, corrected, or denied.

The practice has now paid for the encounter in operational terms twice: once to deliver care and again to repair the process around it.

Sometimes more than twice.

There may be staff time, physician interruptions, additional communication, delayed cash flow, and patient frustration.

These costs are scattered across departments. Because no single line item captures the entire burden, the practice may underestimate what recurring information failures actually cost.

The hidden tax is the labor required to reconstruct information that was missing, disconnected, misunderstood, or not preserved in context.

Not every billing problem originates upstream. Some result from payer decisions, contractual disputes, changing rules, genuine coding disagreements, or other causes outside a practice’s direct control.

But that makes root-cause analysis more important, not less.

If the practice does not distinguish between problems it can prevent and problems it must resolve, it may spend money trying to fix the wrong thing.


The numbers: Administrative burden is not imaginary

The American Medical Association’s 2024 prior authorization survey reported that physicians and their staff spent an average of approximately 13 hours per week completing prior authorization work, with physicians completing an average of 43 prior authorizations weekly.

The survey also found that physicians overwhelmingly viewed prior authorization as contributing to burnout and delaying necessary care.

These figures describe a specific survey and should not be treated as universal measurements for every practice. But they illustrate the scale of the challenge.

Thirteen hours is not a rounding error.

It is more than a working day every week.

And the cost is not simply the salary of the person completing the authorization. It includes the opportunity cost of what that person could have done instead.

Could a coordinator have helped a patient understand the next step in treatment? Could a medical assistant have supported follow-up? Could a physician have reviewed a complex case without another interruption?

We should not assume that every saved administrative hour automatically becomes a clinical hour. Staffing, scheduling, and practice economics are complicated.

But we should ask a straightforward question:

If a process consumes hours every week, what evidence tells us that those hours are being spent in the best possible way?


A timely warning from Dr. Gary Price

In an interview published October 20, 2026, Medical Economics spoke with Dr. Gary Price, president of The Physicians Foundation, about misinformation, burnout, and declining trust between patients and physicians.

Price emphasized the importance of preserving time for the patient-physician relationship. He also discussed how fragmentation, insurance barriers, prior authorizations, and denials can interfere with that relationship.

His argument is important because it moves the conversation beyond physician dissatisfaction.

Time with patients is not a luxury feature of healthcare. It is part of how healthcare works.

A physician who has enough time to listen may discover something that changes a diagnosis or treatment plan. A physician who can explain uncertainty may help a patient make a better-informed decision. A physician who knows the patient's history may recognize a change that a fragmented encounter obscures.

The human connection is not separate from clinical quality.

Yet administrative systems can consume the very time that helps make clinical care effective.

This is not a call to eliminate every administrative requirement. Some protect patients, support appropriate utilization, and establish accountability.

The challenge is to distinguish necessary controls from avoidable friction—and then design the necessary controls as well as possible.

The objective should not be to eliminate administration at any cost. It should be to eliminate the administration that exists because the system repeatedly fails to work as intended.


Three perspectives that belong in the same conversation

1. Dr. Gary Price: Protect the human connection

Price’s recent comments emphasize that physician-patient interaction and trust are fundamental to good care.

The operational implication is clear: administrative processes should support the clinical relationship, not compete with it unnecessarily.

A technology that saves time is valuable only if it produces a meaningful improvement in the work or experience that matters.

2. The American Medical Association: Measure the administrative burden

The AMA’s prior authorization research gives physicians a way to discuss the burden using more than anecdotes.

The implication is that practices should measure the time spent on repetitive administrative tasks, identify where delays originate, and evaluate whether interventions actually reduce the burden.

“Everyone feels overwhelmed” is a reason to investigate.

It is not yet a diagnosis of the operational problem.

3. CMS: Improve information exchange and standardization

The Centers for Medicare & Medicaid Services has established interoperability and electronic prior authorization requirements for certain impacted payers through its CMS Interoperability and Prior Authorization Final Rule.

These changes aim to improve information exchange and make prior authorization processes more transparent and efficient. Requirements and implementation timelines vary by provision and organization.

The implication is that electronic exchange matters—but digitization alone is not the finish line.

An electronic form can still request redundant information. An automated process can still depend on incomplete data. A faster transaction can still fail if the underlying requirement is misunderstood.

Digitization changes the channel. Better information structure can change the quality of the exchange.

 

These perspectives are not endorsements of OnnX. They represent different parts of the healthcare landscape that converge on a common question: how do we make the system support care more effectively?


The OnnX thesis: Fix the signal before repairing the noise

OnnX is an upstream intelligence platform for healthcare, built by physicians and medical billers to reduce downstream administrative and billing noise so physicians can focus on clinical care.

Our premise is that some recurring billing problems begin with fragmented information, unclear requirements, or disconnected decisions before a claim is submitted.

The working process is:

Capture → Structure → Preserve → Propagate → Act → Learn

  • Capture: Collect relevant information where it first becomes available.
  • Structure: Organize the information so its meaning and relationships are clear.
  • Preserve: Retain the context needed to interpret it correctly.
  • Propagate: Make the relevant information available to the next appropriate step.
  • Act: Identify gaps, inconsistencies, or requirements that need attention.
  • Learn: Review outcomes and use verified patterns to improve future decisions.

The objective is not to replace medical billers or promise that every denial will disappear.

It is to test whether better information continuity and earlier decision support can prevent some of the rework that practices currently resolve downstream.

Think of a recurring billing error as a smoke alarm.

One option is to hire someone to reset it every time it sounds.

Another is to investigate whether something is repeatedly causing the alarm to activate.

The first task may still be necessary. But if nobody investigates the cause, the practice has created a very efficient alarm-resetting department.

That is not the same as solving the problem.


Seven practical steps for physician-owned practices

A practice does not need to purchase another platform tomorrow to start improving its information quality.

Begin with one recurring problem.

1. Pick a specific failure.
Choose something measurable, such as recurring eligibility errors, missing authorization information, documentation clarification requests, or claims returned for incomplete data. “Fix billing” is not a useful project definition.

2. Map the information journey.
Document where the information originates, who handles it, where it is stored, and when it is needed. Ask frontline staff where the process repeatedly breaks down.

3. Identify the earliest controllable cause.
Separate missing information from misunderstood requirements, unclear responsibilities, software limitations, and payer-side constraints. These problems require different interventions.

4. Establish a baseline.
Measure frequency, staff time, recurrence, and impact on claims or patient services. Without a baseline, a team can mistake a busy month for an improvement.

5. Fix the source where possible.
Improve the relevant registration field, documentation prompt, authorization process, responsibility assignment, or information exchange. Do not automatically send every problem to billing for repair.

6. Use technology for a defined purpose.
Automation may help flag missing fields, compare information, route exceptions, or surface relevant requirements. It should not invent clinical facts or silently make consequential decisions without appropriate oversight.

7. Evaluate honestly.
Check whether the intervention reduced the original problem, created new work, increased false alerts, or shifted the burden to another department. Expand only when the evidence supports it.

This approach is less glamorous than buying a platform with a futuristic name.

It is also more likely to reveal what the practice actually needs.


Metrics that matter more than a shiny dashboard

A useful operational improvement should be measurable.

Depending on the problem, consider tracking:

  • First-pass claim acceptance: The proportion of claims accepted without correction, using a clearly defined measure.
  • Preventable denial rate: The share of denials linked to causes the practice can reasonably address.
  • Rework time: Staff time spent investigating, correcting, resubmitting, or escalating recurring issues.
  • Missing-information rate: How often a workflow reaches a point where required information is absent or inaccessible.
  • Authorization turnaround: The time required for practice-side processing, distinguished from payer processing time.
  • Repeat-error rate: How frequently the same underlying issue returns after it has been corrected.
  • Exception rate: How often an automated process needs human intervention.
  • Patient communication burden: How often patients must contact the practice to clarify an administrative delay.

No single metric tells the whole story.

A lower denial rate might coincide with slower claim submission. An automated system might appear efficient because it fails to identify difficult cases. A new checking process might improve accuracy while increasing staff workload.

Pair efficiency measures with quality, safety, and workload measures.

The goal is not to make the dashboard green.

The goal is to make the underlying work better.


Five myths worth challenging

Myth 1: We just need better billers.

Good medical billers are essential. But even excellent staff cannot reliably compensate for every upstream information gap. When the same error recurs, investigate the process as well as the performance of the people working within it.

Myth 2: More automation means less work.

Automation can move work from one department to another, generate false alerts, or create new exception queues. Measure the entire workflow before and after implementation.

Myth 3: AI can solve documentation problems by generating more text.

More text does not necessarily mean better documentation. Accurate, relevant, clinically appropriate information matters more than note length. Clinicians remain responsible for ensuring that the record reflects the encounter truthfully.

Myth 4: Denials are simply part of doing business.

Some disputes and denials are unavoidable. That does not make every recurring denial inevitable. Classify the reasons, investigate the preventable portion, and track whether interventions reduce recurrence.

Myth 5: The newest platform must be the best solution.

Sometimes the right answer is software. Sometimes it is clearer training, a better template, a defined responsibility, or a simpler process. Buy technology to address a demonstrated problem—not to avoid diagnosing it.


The risks of getting it wrong

An upstream intelligence platform can create value, but it can also introduce new risks.

Clinical integrity: Never fabricate symptoms, findings, medical necessity, or other clinical information to satisfy a billing requirement.

Human oversight: Make recommendations understandable and provide a clear process for review, correction, and escalation.

Privacy and security: Apply appropriate safeguards, access controls, auditability, and agreements governing the use of patient information.

Bias and reliability: Test performance across specialties, payer arrangements, practice sizes, and patient populations. A system that works in one setting may fail in another.

Transparency: Users should understand why a system raised an alert and what evidence supports its recommendation.

Compliance: Practices should assess applicable HIPAA obligations, business associate arrangements, coding standards, payer contracts, and other requirements with qualified advisers.

Appropriate incentives: Do not encourage unnecessary services, unsupported diagnoses, or inflated coding in pursuit of better reimbursement.

There is a subtler risk: a system can make a bad process harder to question because it now has an algorithm.

An automated recommendation is not automatically correct. A workflow is not automatically appropriate because it is digital.

Technology should help people make better decisions—not obscure responsibility for those decisions.


A 30-day experiment

For a physician-owned practice, meaningful improvement can begin with a small, disciplined test.

Week 1 — Find the recurring problem. Choose one issue, gather examples, interview the staff handling it, and measure the baseline.

Week 2 — Trace it upstream. Identify where the information first becomes incomplete, inconsistent, inaccessible, or misunderstood. Separate internal causes from external constraints.

Week 3 — Test one intervention. Change a specific step, train the affected team, and define who handles exceptions. Keep the experiment limited enough to monitor safely.

Week 4 — Evaluate the evidence. Compare results with the baseline. Did the problem decline? Did workload actually fall? Did another error increase? Should the practice expand, modify, or abandon the intervention?

No giant transformation budget is required.

No presentation needs the phrase “paradigm shift.”

Just a real problem, a measurable test, and the willingness to discover that the original assumption may have been wrong.


What the future should look like

The future should not be a clinic where every employee spends the day supervising an endless parade of alerts.

Nor should it be a clinic where AI makes consequential decisions that nobody understands or checks.

A better future would allow relevant information to be captured appropriately, structured consistently, preserved with context, and made available to the people who need it.

Missing information would be identified earlier. Exceptions would reach the right person. Physicians would not repeatedly reconstruct details that already existed elsewhere. Medical billers could spend more time applying their expertise and less time chasing basic information.

Automation would handle appropriate routine tasks while people retained responsibility for decisions requiring judgment.

Success would be measured not by how many tasks software completed, but by whether accuracy improved, rework declined, operations became more predictable, and patients and staff had a better experience.

That is the direction behind OnnX: upstream billing intelligence.

The ambition is to investigate whether better information continuity and earlier decision support can reduce preventable downstream problems for physician-owned practices.

That is a hypothesis to validate through real workflows, measurable outcomes, and honest testing—not a promise that one platform can eliminate every problem.

Healthcare needs fewer confident promises and more disciplined investigations into where its problems begin.


The lesson Stephanie and Marcus leave us

Stephanie Johnson’s recovery is measured in things many healthy people rarely think about: eating a full meal, climbing stairs, buying clothes in her own size, and having more energy for her children.

Marcus Brown made an extraordinary personal decision to help his sister regain those ordinary freedoms.

Their family relied on a specialized medical team whose work demanded precision, coordination, and careful attention to both donor and recipient.

Their story reminds us that the purpose of healthcare is not merely to complete procedures, submit claims, or close tasks.

It is to help people live healthier lives.

Complex medicine will always require expertise, safeguards, and coordination. Not every administrative requirement can or should disappear.

But we should question avoidable friction wherever it repeatedly consumes the time, attention, and resources that patient care requires.

If a process is necessary, make it reliable.

If information is needed, make it available.

If an error keeps recurring, investigate its origin.

If technology is introduced, measure whether it improves the outcome.

And if physicians and staff are repeatedly asked to reconstruct information that was lost, duplicated, or poorly structured, ask whether the process needs to work that way at all.

The future of healthcare may depend not only on what we teach machines to do, but also on what we finally stop asking people to do over and over again.


A question for physicians, practice owners, and healthcare operators

If you could eliminate one recurring administrative problem from your practice tomorrow, which would give your team the most time back for patient care?

Prior authorization? Missing information? Documentation rework? Eligibility errors? Preventable denials?

Tell me in the comments. The most useful answers may come from the people who encounter these problems every day.

If this perspective resonates with you, share or repost it so more physicians and practice teams can join the conversation.

The goal is not to make administration disappear. It is to make unnecessary administration harder to justify.


Frequently asked questions

1. What is upstream billing intelligence?
It focuses on information quality, context, and decisions before a claim is submitted, with the aim of identifying gaps early enough to reduce avoidable downstream rework.

2. Is every medical billing denial preventable?
No. Denials can result from coverage limitations, payer decisions, contractual disputes, coding issues, incomplete information, and other causes. Practices should distinguish preventable problems from those requiring appeal or external resolution.

3. Does better documentation guarantee reimbursement?
No. Reimbursement also depends on coverage, applicable rules, authorization requirements, coding, contracts, and payer adjudication. Documentation must remain accurate and clinically appropriate.

4. Can AI eliminate prior authorization?
AI may help organize information, identify requirements, prepare submissions, and support status monitoring. It cannot eliminate payer requirements or guarantee approval.

5. How can a small practice begin reducing administrative burden?
Choose one recurring problem, measure its frequency and impact, trace it to its earliest controllable cause, and test a targeted improvement before expanding.

6. What should a practice measure?
Depending on the problem, measures may include first-pass claim acceptance, preventable denial rate, rework time, missing-information rate, authorization turnaround, repeat-error rate, and staff workload.

7. Does upstream intelligence replace medical billers?
It should not be framed as a replacement for billing expertise. Better information systems can help billers spend less time repairing avoidable gaps and more time applying their knowledge.

8. How is OnnX different from a traditional revenue-cycle management service?
OnnX is being developed around an upstream intelligence thesis: improve how information is captured, structured, preserved, and acted upon before it creates downstream billing problems.

9. Should every administrative process be automated?
No. Some processes protect safety, accountability, and compliance. The goal is to reduce unnecessary friction while preserving accuracy, privacy, appropriate review, and patient protections.

10. What is the first question to ask about recurring errors?
Where did this problem first become possible, and what information or decision would have prevented it?


About the author

Dr. Daniel Cham, MD, is a physician, entrepreneur, and founder working at the intersection of clinical care, healthcare operations, and technology. Through OnnX, he is exploring how upstream information quality and decision support can reduce administrative and billing friction for physician-owned practices.

Connect with Dr. Cham on LinkedIn.

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Disclaimer

This article is for general educational and informational purposes. It is not medical, legal, coding, reimbursement, compliance, or financial advice. Requirements vary by payer, jurisdiction, specialty, and practice. Consult qualified professionals for guidance on specific circumstances.


References and further reading

  1. VCU Health: A brother’s liver donation gives his sister a new lease on life — the original account of Stephanie Johnson and Marcus Brown.
  2. Medical Economics: Misinformation, burnout and lost trust are “incredibly interrelated” — October 20, 2026, interview with Dr. Gary Price.
  3. American Medical Association: Prior Authorization — research and resources on prior authorization and physician burden.
  4. Centers for Medicare & Medicaid Services: CMS Interoperability and Prior Authorization Final Rule — federal requirements and implementation information.

#Healthcare #MedicalBilling #PhysicianEntrepreneur #HealthcareInnovation #PracticeManagement #HealthTech #PriorAuthorization #RevenueCycle #PhysicianOwnedPractices #PatientCenteredCare #OnnX

 

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