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Many doctors who run their own practices spend hours on work someone else could do. One practice owner who charges $300 an hour was his own receptionist, verifying insurance all night and stepping away from a family dinner to take a patient’s call. Central AI and Wing Assistant CEO Karan Kanwar discusses his KevinMD article “The physician opportunity cost nobody puts on a bill.” He argues that this time, along with the revenue lost when calls go unanswered, never shows up on a profit and loss statement. You’ll hear why practices hesitate, from reluctance to let go of tasks to worries about HIPAA compliance and connecting to the EHR. He walks through the easiest places to start, including phone calls, payer calls, billing and test result questions, and non-clinical questions about medical equipment. He also shares how to judge whether an AI vendor will still be around. Stay for a simple exercise: look at everything you do in a day and decide what you can give away.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Karan Kanwar. He’s a health care executive, and today’s KevinMD article is “The physician opportunity cost nobody puts on a bill.” Karan, welcome to the show.
Karan Kanwar: Hello, Kevin. Thank you so much for having me.
Kevin Pho: All right, let’s start by briefly sharing your story, and then we’ll jump right into your KevinMD article.
Karan Kanwar: For sure. I started a company called Wing Assistant back in college. It grew really fast, and we ended up building a company that does $35 million in revenue. For the last couple of years, we’ve been really focusing on the health care niche. We’ve been working with health execs, with clinicians, and with folks who own and operate their own clinics. Over the last couple of years, we’ve served thousands of them around the country and, broadly speaking, the world. We’ve been able to help folks all across the gamut of their clinical operations improve everything that they do.
That’s a big part of why we started our second company, which is called Central. We’re essentially building out health care agents that help at the front desk, in RCM, and in all sorts of parts of that health care journey. So those are the two companies that I’ve built. Along the way, we’ve learned so much about the health care industry, how we can help, and the kinds of problems that health care execs face today. Honestly, that’s really where we saw the opportunity to make a big difference. The tools that folks use are so stuck in the early 2000s, and we really saw an opportunity to change that. So that’s a little bit about us and the companies that we run.
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Kevin Pho: All right. Just give us a little bit of context. You mentioned things like agents, and how technology and AI today can help with a lot of the administrative and front-desk work physician offices do. Give us a lay of the land. Where are we in terms of health care, and how quickly, or not, is health care adopting some of these tools?
Karan Kanwar: Health care is a very interesting market, because folks are really thirsty to improve the quality of their clinical operations and the patient care experience, but the tools they’re using just don’t let them. It’s really hard for you to integrate the various EHRs that you use into anything modern. I see it every single day: Folks have these request-an-appointment pages, and it’s ridiculous. It’s a very early 2000s experience.
But that’s really where there’s some magic to it as well, because a lot of the folks who are in this industry today are looking to break that mold. We spend a lot of time trying to resolve those difficult things, like EMR connections, and partnering up with all those folks to make sure that it’s a really seamless experience. We find that they’re really excited, but a lot of them just don’t believe it can be done, because these EHRs have been such a big blocker to adopting these kinds of technologies.
We see folks really excited about the kinds of things you can deploy in health care these days, whether that’s remote talent or AI technology. We see the health care industry really wanting to adopt this technology. It’s just a matter of getting over the industrial hurdles you have in this sector, which are the technology stack, of course, but also the compliance aspects, right? We’ve been in business for a really long time, so we’ve had the opportunity to learn everything about this industry and how difficult it is to navigate things like HIPAA compliance. That’s really where we see it: Folks are really excited, but they want to make sure all those hurdles are covered.
Kevin Pho: Your KevinMD article is titled “The physician opportunity cost nobody puts on a bill.” For those who didn’t get a chance to read your article, tell us what it’s about.
Karan Kanwar: For sure. The premise of the article is health care folks who run their own clinics, especially owner-operators, but at every level, even up to MSOs and larger practices as well. At 9 p.m., I’ve seen folks doing their own insurance verification. I’ve seen folks waking up early and getting to the office to make sure they have their recalls done. It’s crazy, right? You’re obviously very talented clinicians, doing God’s work and saving the world here, but you’re putting in all these extra hours that bring down your hourly wage. That’s an expense that you and many folks don’t see when you look at a balance sheet or a P&L.
As a result, there’s a ton more optimization you could potentially be doing, both in seeing more patients and in improving your business, and frankly, just living your lives. That was really the argument we were trying to make: Despite how much you’re able to do professionally in your careers, there’s just so much waste. We’ve seen this firsthand. So we really encourage folks to take a closer look at how much time they’re putting into all the things that, as health care professionals, they frankly just shouldn’t be doing. There are cheaper and better ways to take this stuff off your shoulders.
Kevin Pho: Give us an example of how it works in a practical setting.
Karan Kanwar: For sure. Like I mentioned, at Wing, as an example, just last week I was speaking to a health care practice owner. He runs twenty-two clinics himself. Obviously he has physicians and so on, but he’s still doing so much of the admin himself. He’s going from practice to practice, trying to improve operations on the ground. Every single day, he’s going through a list of patients across his practices who have complained about patient access, as an example. What that means in practice is folks calling at 9 p.m. and just hitting a wall, not being able to get to anybody, and nobody calling them back, right? Those kinds of complaints compound. They turn into bad ratings, and they turn into patients choosing other options.
That’s one example I saw at Wing Assistant last week, and it doesn’t have to be that way. There are two kinds of solutions you can implement there, right? One is that you can have staff available 24/7. You can have an AI that picks up your phone after hours, or you can have a big staff through any kind of answering service, right? But somebody like this, a person who owns twenty-two clinics, does not need to be spending time on these kinds of things, right? The problem is being created unnecessarily.
Beyond that, I saw another example last week of a guy who runs his own practice. He is the receptionist himself. He’s doing insurance verification all night long. He was telling us how he had to step away from a dinner with his family because a patient called. He told us about another time he had to come in early to do that insurance verification work himself, to make sure the patients were covered. This is the kind of thing we see all the time. He charges $300 an hour while he’s doing work that somebody could do for five bucks an hour, ten bucks an hour. So it’s quite an interesting experience. These are just some of the places where we see that it makes so much sense to deploy a better solution.
Kevin Pho: In terms of the obstacles to implementing these solutions, why aren’t more practices adopting solutions like these?
Karan Kanwar: I think it’s a couple of things. I’m a business owner myself, and I always think I can do things better. That’s just a human thing, right? Folks aren’t willing to let go of the things they think they can do best. But you have to let go at some point; otherwise, you’re just going to be working all your life.
Then, on the other side of things, there are the more practical limitations. Obviously, people are worried about compliance. They’re worried about patient health care data. These are things you probably should be worried about, of course. But you can work with folks, and with technology, in such a way that you’re going in with HIPAA compliance, business associate agreements, and data secured in a way where it’s all stored in the United States and encrypted at all levels. There are so many things that most modern companies do today to ensure health care data is completely secure.
The last one, of course, is the bane of everyone’s existence: connecting into these systems of record. They make it very hard, and rightly so, of course; patient health care data has to be safeguarded. But there are plenty of ways these days for folks to find safe and effective ways to access those EHRs. A lot of folks I’ve seen still don’t believe they can have their EHR connected to something else, but it’s definitely possible.
So these are the practical limitations we hear from our clients every single day as to why they feel a little uncomfortable about adopting any kind of solution to their problems. That first one, though, I think is doing a lot of the heavy lifting. But I think there are also some other very simple ones that most folks don’t realize we can get over today.
Kevin Pho: As you know, and as we talked about before, there are a lot of these technological solutions and AI solutions that practices are being bombarded with. Tell us the types of questions they need to ask these companies to evaluate whether they’re going to be around, how robust they are, and whether it’s the right solution for them. Because, as you know, a lot of these startups don’t last, right? So I think a lot of hospitals and clinics are wary of that.
Karan Kanwar: Exactly. I’m not going to say any names, but we worked with a practice in New York, a pretty big one, that was using a medical scribe that started to put out a new voice solution. They were really excited about it, and then just, poof, one day it disappeared. So it’s interesting. It’s always worrisome, even when you work with a bigger company. Bigger companies have the ability to spin up something very quickly, try it out, see if it works, and then shutter it really quickly. On the other side, you have smaller companies springing up every day. We actually just had this experience with one of our own vendors at Wing Assistant. We started building a lot of stuff with them, a lot of key infrastructure, and they just disappeared.
So being able to understand whether these folks will still be around is obviously a big one. In our case, as an example, when we evaluate vendors, we look for either some kind of really large institutional backing or a long track record. That’s the first part: Will they disappear? It’s very hard to judge that in AI, because a lot of the companies deploying AI solutions have only been around for about two years. But when you look at a company that has, for example, a larger portfolio of services and is trying something new, that’s always a good sign to an extent.
Of course, you want to understand how big that operation is and whether it’s still a priority for that company’s leadership. Especially if you’re a larger medical group or a hospital, that’s the kind of thing you really want to get into. I would recommend speaking to the CEO directly to figure out what their priorities are around keeping this line of business going.
For us at Wing Assistant, as an example, we have a much larger company that has been around for over a decade, doing this for the health care industry for a really long time. This new product we’ve created has been around for a couple of years already, and for us it’s a really important line of business, because we see the opportunity not just in health care but in building general-purpose technology. As a result, despite whatever shortcomings we might face in the short term, it’s a very, very good place to be for the long term. That’s how we present ourselves, but it can really depend from company to company. So I would always recommend speaking with the CEO, especially if you’re a larger organization that can get a CEO on a call. That’s the easiest way to figure out what their motivations are for being around.
Kevin Pho: When it comes to adopting AI solutions, as you know, these features are being implemented by larger EMRs like Epic, right? And sometimes that makes them less reliant on these smaller startups. As a company in the AI space, how do you navigate that landscape, when a lot of the things you do may eventually be integrated by larger conglomerates like Epic?
Karan Kanwar: It’s an interesting question. I’m actually friends with another CEO who was able to navigate a very similar challenge, I’d say, in a past era. What was really interesting is that a lot of the EMR companies that integrated the kind of feature set he had actually ended up white-labeling his product. I’m not really sure what the limitations are, or why so many of them tend to do this, but the gist is that usually these companies are not that innovative. Epic is one of the few exceptions. They go out, they buy startups, and they integrate their products very quickly. Right now, if you’ve heard, I think they have a mega partnership with ChatGPT directly, where they’re doing a lot of interesting things with hospitals.
But in terms of how we navigate it, we see the opportunity as exploiting your larger competitor’s advantage. In the case of Epic, they are going to put something in, and it’s going to be a bolt-on for the most part, if I were to guess correctly. In doing so, it’s going to leave more to be desired. So one of the things we’ve really prioritized is that whenever we get customer feedback, it’s usually implemented within a week. What that really drives is that kind of user love: When people use the product, something they ask for is there the next week. A bigger company cannot match that. A company like Epic, which is just experimenting with this and has a smaller AI team, is just bolting stuff on, right?
We’ve been given a lot of compliments, I’d say, for the kind of depth and the level of detail in the customization of the experience. For example, you can tune even the speed of the voices, the accents, all sorts of things, because users have asked for these kinds of things. It’s very hard for a larger company to match that. I think a lot of people have said this about the AI space in general, but speed is the moat. That really is quite true from my experience so far. Being able to stay ahead of the competition and move faster than them is really what moves things today.
Kevin Pho: In general, after surveying what medical practices are going through and what they need, what do you see as some of the lowest-hanging fruit, the workflows that can be adopted or incorporated?
Karan Kanwar: That’s a great question. We obviously see a couple of different things, and we’ve tried to address all of them in the things we’re building. But for the most part, we see taking phone calls as obviously the most important one. People are dealing with so much in the clinic. If you’re not picking up the phone at all, that’s definitely revenue that you’re letting walk out the door. That’s one aspect.
The other aspect, of course, is everything that comes after that phone call. Typically, that means picking up the phone and sometimes having to dial a third-party payer like Blue Shield. They have a big call center that makes you wait half an hour. That’s stuff people are wasting hours on every day. Then you have clearinghouses. That’s minutes per day, but it’s still a very annoying task, where you have to go in and make sure every patient is verified against Availity or something like that.
Then there are other things, right? People call in asking about their bill. People call in asking about things like, “Where are my test results?” They’re all very similar answers, right? Regarding your bill, staff click into the EHR, look at any billing alerts that might be there, and check out the bill. It’s all a lot of things that people don’t have to be doing.
Those are all the different kinds of use cases we see, but we’ve also seen some really interesting ones. For example, there’s a sleep center we work with. They have over 300 devices of varying types: masks, machines, CPAP machines, and tubes. Their folks have to pick up the phone, look into manuals, and give the correct answer. That’s nonclinical advice, things like, “My respirator is fogging up,” or “It’s too tight. What do I do?” Those nonclinical things are also things you can essentially give away.
So pretty much, as long as it’s a workflow that requires somebody to do something and is nonclinical for the most part, we’ve been able to successfully work with a lot of practices on a lot of these things. But the ones I just mentioned, right, appointment booking and appointment logistics and billing, there’s just so much in that world that’s capable of being automated. Going past the phone, automating work in the EHR, using a mixture of computer vision, RPA, and basically computer-use agents, is all so possible today, and a lot of folks just aren’t taking advantage of it. So these are the lowest-hanging fruit that we see.
Kevin Pho: We’re talking to Karan Kanwar. He’s a health care executive, and today’s KevinMD article is “The physician opportunity cost nobody puts on a bill.” Karan, let’s end with the take-home messages that you want to leave with the KevinMD audience.
Karan Kanwar: For sure. I would definitely recommend, again, the theme of the article: Really sit down and take a closer look at the kinds of things you’re doing. I had to do this exercise myself recently. Despite running such a large executive assistant company, I didn’t have one for the longest time. I recently got one, so I really sat down and took a look at everything I was doing on a daily basis, and it’s not a pretty picture.
So I really recommend taking a moment. Your time is valuable. Take a moment, look at what you’re doing every single day, and see what you can give away. I’m not even saying to us or to anybody that you should hire an assistant. You should think about what you can take off your plate. Beyond that, in areas where you have folks but you’re not able to hit the mark, right, you’re just letting revenue walk out the door as well. You’re not going to see either of these things on a P&L, but both of them could really make a large change in your business and in your life.
These are some of the things that I think are really important, especially, again, having dedicated my life to starting companies in this space. But even from my own personal perspective, I think it’s a really important thing to do, to make sure that you’re not burning yourself out on all this work that you just don’t have to do yourself. That’s really the message I wanted to leave behind today. Thank you so much for having me, Kevin. Great to meet you.
Kevin Pho: All right, Karan, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Karan Kanwar: Sure.
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