| Michael Dowling, president and CEO of New York’s largest provider, Northwell Health, says the hospital industry’s reliance on Medicare and Medicaid has left it in financial peril. Medicare slashed reimbursement rates by 3.4 percent on Jan. 1, and states, which share Medicaid costs with the federal government, are looking for savings — including New York. Dowling sees technology, specifically artificial intelligence, as one way to reap the efficiencies needed to handle the shortfalls. He talked with Daniel about the future of care delivery and what he’s focused on in 2024. This interview has been edited for length and clarity. How’s business? The reimbursement is getting tougher. The payer relationships are getting harder. The government payers — Medicare and Medicaid — don’t provide you enough to cover your expenses. Providers are basically focused on the following: Everybody’s trying to figure out how to improve operational efficiency. If you’re a large system, you try to make sure you consolidate services as much as possible. The other thing that every organization is looking at today is how to continue to grow and expand. Expansion in the outpatient-ambulatory space is huge. Everybody’s focused on gaining new business — and especially new commercial business, which pays you a little bit better than noncommercial. How does AI play into these challenges? Everybody’s focused on figuring out how to maximize and optimize the use of technology — especially now with artificial intelligence and its potential. I think that we can use AI to dramatically reduce a lot of the labor-intensive things: documentation, predicting future outcomes and more. We have created inside Northwell a center of excellence in AI, and we’re going to be spending an awful lot of time trying to figure out what parts of our business can become more efficient. It has the potential to dramatically improve a lot of things. We just have to be careful when the machine brain becomes smarter than the human brain — and we can’t figure out what the machine brain is doing. Is this as challenging a business environment as you’ve seen? It’s more challenging today, though I look at every challenge as an opportunity. You’re dealt your hand and you have to deal with it. Many hospitals in New York are in terrible, terrible shape, mainly because that primary source of income is from government payers. I was in government for 12 years. We had that problem, but today, the problem is much larger. Many government officials want places like Northwell that are doing relatively OK to take over the places that are doing poorly. And I’ve done a lot of that, but I can’t take all of the hospitals doing poorly because then I will be in that situation myself.
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