Becker's Hospital Review

22 INNOVATION Marshfield's Cerner install led to revenue cycle issues, ratings downgrade By Laura Dyrda M arshfield (Wis.) Clinic Health System's IT standardization efforts over the last few years disrupted operations and were a contributing factor in Fitch's decision to issue a ratings downgrade from an "A-" to "BBB+" rating. e health system began implementing Cerner's platform in 2020 and aims to finish the install in the first quarter of 2023. e switch has come with some growing pains, especially with revenue cycle operations. "e IT implementation has negatively affected the system's revenue cycle, with aging receivables, throughput errors and lower collections, which is being addressed with ongoing training, process revisions and technical remediation," the report states. "Further, the IT implementation has caused an unexpected level of productivity disruption, which has affected top line revenue and resulted in additional operational costs to support the activations." Marshfield had multiple legacy systems to convert to Cerner, which further complicated the install. "While Fitch believes that MCHS's highly integrated and broad franchise and significant service area distribution enhances the issuer's capacity to meet its financial obligations, the current environment of constrained cash flow in conjunction with revenue cycle disruption from the IT implementation has resulted in liquidity distress," Fitch noted. e ratings agency expects Marshfield Clinic's operating challenges to continue at least through the first half of 2023 as the system finishes installing its new IT platform. When the IT challenges are fixed, the system's provider productivity will likely improve and Fitch sees meaningful cost savings through 2024 as a result of the switch. Fitch anticipates operating EBITDA margins will stabilize 6.5 percent to 7 percent by 2025, according to the report. e health system reported an operating EBITDA margin of -0.9 percent and operating loss of $179 million in 2022. Fitch also cited labor and wage pressures as a reason for the operational challenges and ratings downgrade. n A peek into healthcare's future? AI passes medical licensing exam By Erica Carbajal A n artificial intelligence chatbot that generates humanlike responses passed all three parts of the U.S. Medical Licensing Exam, according to findings published in the preprint server medRxiv. Researchers evaluated the performance of ChatGPT — a model launched by OpenAI in November — on the exam. For Part 1 of the comprehensive exam, second-year medical students typically spend 300 to 400 hours preparing. It covers didactic and problem-based learning, including basic science, pharmacology and pathophysiology. The final part is completed by post-graduate students. Researchers found ChatGPT "performed at or near the passing threshold for all three exams without any specialized training or reinforcement," according to the findings published Dec. 21. While it varies by year, the USMLE pass threshold is approximately 60 percent most years, study authors noted. ChatGPT performed above 50 percent accuracy across all examinations and exceeded 60 percent in most analyses. "These results suggest that large language models may have the potential to assist with medical education, and potentially, clinical decision-making," the researchers said. The study included a number of limitations and is awaiting peer review. n Trinity Health plans to institute virtual nurses across its 88 hospitals in 26 states By Giles Bruce L ivonia, Mich.-based Trinity Health plans to roll out virtual nurses at its hospitals around the state of Michigan — and nationwide. Trinity will debut them across Michigan soon after a successful pilot project at Trinity Health Oakland Hospital in Pontiac, Mich., the Grand Rapids Business Journal reported Jan. 12. The health system also intends to launch them across its 88 hospitals in 26 states in the next 12 to 17 months, CEO Mike Slubowski told Becker's recently. The initiative includes a floor nurse, either a certified nursing assistant or licensed practical nurse, and a virtual, on-screen nurse working together to support patients in the face of staffing shortages. "We've seen that [virtual nurses] don't just fill in the gaps, they are actually able to proactively anticipate the needs for the patient as opposed to the patient or the family having to initiate those questions," Christie Sansom, vice president and transformation officer at Trinity Health, told the Business Journal. "That's really the incredible benefit of this team model." n

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