Diversity should inform your strategy, according to this CNE.
On this episode of HL Shorts, we hear from Claire Zangerle, CEO of the American Organization of Nursing Leadership (AONL), and senior vice president and CNE at the American Hospital Association (AHA), about how CNOs can incorporate DEI into strategy. Tune in to hear her insights.
The Memorial Hermann Health System is partnering with a digital health company to make sure patients undergoing cancer treatment have a care team around them at all times—especially at home.
Health systems looking to maximize care for patients undergoing cancer treatment are finding value in innovative partnerships that focus on care management and monitoring at home.
"At 3:00 in the morning when a patient is awake and afraid and has pain that they've never felt before, or a nausea that is unceasing, and they've maybe forgotten [to] take that medication, they can pick up the phone," says Sandra Miller, MHSM, RN, NE-BC, VP of the oncology service line at Houston's Memorial Hermann Health System. "They can call, they can talk to someone right away, who can then help them to deescalate and think clearly about what next steps would be."
Those patients aren't necessarily calling the hospital. They're calling a care team employed by Reimagine Care, a Nashville-based company that focuses on cancer care services in the home. That team, which includes oncology nurses and advanced practitioners, enables patients to access care on-demand, while giving Memorial Hermann a platform on which to integrate its clinical team.
"It's a good model for this type of program because we know that cancer patients are terrified," Miller says. "Their levels of anxiety and depression are very high. They need a very strong support team … as an additional component to their family members and their clinical teams that see them regularly."
Partnerships like this are a crucial factor to improving care management and coordination at a time when health systems and hospitals are dealing with workforce shortages and inpatient care stresses and embracing concepts like remote patient monitoring (RPM) and home-based care. Through programs like collaborative or connected care, they can create programs around patients with complex care needs.
And they'll become more important as healthcare innovation leaders develop the Hospital at Home concept and look at improving care coordination for patient groups, such as those with chronic conditions.
Miller points out the partnership enables Memorial Hermann to focus on inpatient and acute care—care for which patients either need to be in a hospital or need to be seen by a clinician—while separating the tasks and services that fill up their workflows but could be handled by other members of the care team.
"It relieves the burden of late nights and overtime and late hours for providers and for nurses," she says.
Reimagine Care is one of dozens (if not more) of companies that have sprung up over the past two decades to tackle care management outside the hospital, offering 24/7 services and the ability to hand off to the hospital when the need is escalated.
The company's CEO, Dan Nardi, says Reimagine Care focuses on cancer care and targets a pervasive pain point for hospitals: Managing care outside the hospital or doctor's office and in between the visits. He cites research conducted in 2023 that found that 82% of patients want to be treated as much as possible at home, and more than 90% want to be able to connect with a member of their care team on demand, whenever they need to make that connection.
Without this type of partnership, a patient might call a doctor's office or hospital and find there's no one to talk to at that moment, and then they might decide to go to the Emergency Department.
The ER "is the last place they want to be," says Miller. She notes that in the year and a half that Memorial Hermann has worked with Reimagine Care, unplanned ER visits have dropped below the national average, while patient satisfaction has improved.
Miller says the platform is proving especially valuable to younger patients and those with families and jobs—patients who are balancing the demands of everyday life with their care routines and having little time to spend on trips to the doctor's office or ED beyond their scheduled visits.
And by creating a care team bolstered by Reimagine Care, Memorial Hermann is able to create room for more patients, especially those facing barriers to accessing care.
"This creates capacity for new patients," Miller says. "There are always patients waiting. There's always a wait time to see a new provider and we don't want patients to wait who have cancer. By being able to triage patients to home care or home support, we're able to see new patients who are waiting, who are sick, who need the attention and time of a medical oncologist. So creating capacity for new patients is paramount in this relationship."
Nurse practitioners may soon be able to classify chest radiographs, according to the CDC.
Nurse practitioners' (NPs) scope of practice will potentially be expanded once again as the Centers for Disease Control and Prevention (CDC) considers allowing NPs to try their hand at reading a specific type of X-ray.
The CDC's National Institute for Occupational Safety and Health (NIOSH) submitted a request for information regarding the B Reader Program from interested parties to determine whether or not they should allow nurse practitioners and physician assistants (PAs) to become B Readers.
The goal is to grant nurse practitioners and physician assistants eligibility to take and pass the NIOSH B Reader exam and become certified B Readers. According to the information request, the interested parties include experts in occupational respiratory health surveillance and radiology, nurse practitioners, physician assistants, and workers unions who represent workers exposed to mineral dust, and/or the workers themselves.
What is a B Reader?
According to NIOSH, the B Reader program "trains and certifies physicians in the International Labour Organization (ILO) International Classification of Radiographs of Pneumoconiosis." In simpler terms, B Readers classify chest radiographs of employees participating in health surveillance programs, such as the NIOSH Coal Worker's Health Surveillance Program.
Currently in the United States, only licensed physicians can become B Readers, and as of October 2024, only 184 U.S.-based physicians in 35 states are licensed B Readers, according to the information request.
The CDC's goal is to increase access to B Readers across the country.
"NIOSH is interested in ensuring that B Readers are available to classify chest radiographs obtained in all states and territories," the information request says.
What does NIOSH want to know?
NIOSH specifically is inquiring about the following questions from the interested parties, according to the information request:
What is the current demand for B Readers, and would expanding the program to include nurse practitioners and physician assistants help meet this demand?
Are there specific geographic areas or populations that might benefit from having nurse practitioners and physician assistants certified as B Readers?
Are there any potential risks associated with expanding the B Reader certification to nurse practitioners and physician assistants and, if so, how can those risks be mitigated?
ILO classification of chest radiographs is not the same as clinical interpretation. Are there states where scope of practice and standards of care allow nurse practitioners and physician assistants to perform clinical interpretation of chest radiographs without physician oversight? In states where physician oversight is required for clinical interpretation, is it also required for ILO classification? What would be the best approach to ensuring that appropriate clinical interpretations are obtained for all contemporary chest radiographs undergoing ILO classification by nurse practitioners and physician assistants?
How do you anticipate different interested parties (e.g., physicians, nurse practitioners and physician assistants, industry representatives, workers, health profession boards) would view the potential expansion of the B Reader program to include non-physicians?
What challenges might arise during the implementation of this expansion, and how could they be effectively managed?
Do you have any other information or comments relevant to whether nurse practitioners and physician assistants should be able to become B Readers and, if so, the best way to implement that expansion?
The request's comment period ends March 17, 2025.
Moving forward
If nurse practitioners become eligible to take the B Reader exam and become licensed B Readers once they pass, that will once again expand the role that nurse practitioners play in care delivery.
According to a 2024 report from the Association of American Medical Colleges (AAMC), the United States will face a shortage of 86,000 physicians by 2036. An increase in nurse practitioners and physician assistants will help fill that gap.
There are over 385,000 nurse practitioners across the country, according to the American Association of Nurse Practitioners (AANP). If all of them have the potential to get B Reader certified, that will be a significant step toward NIOSH's goal of expanding access.
Denials are a major pain point for revenue cycle leaders. Here’s how to manage—and perhaps even prevent—them.
In the latest installment of HealthLeaders’ The Winning Edge webinar series, Beth Carlson, VP of Revenue Cycle at WVU Medicine, explained how denials are impacting the entire health system, from RCM down through provider to patients. That’s why denials management, she says, requires a collaborative approach.
Carlson says she’s working with the financial, legal and clinician departments to not only better understand why denials happen and what to do when they happen, but to move upstream and identify how to prevent them in the first place. She’s also using new technology, like AI, to understand payer and provider trends and patient financial options and collaborate with payers to integrate clinical care pathways with payer policies.
Tune in below to hear how Carlson is addressing denials management.
At age 28, Zangerle was working in clinical exercise physiology in cardiac rehab, and was inspired by what the nurses were doing.
"I can do that, I can educate, I can do all these great things the nurses are doing," Zangerle said, "I can take the clinical knowledge that I learned in exercise physiology and elevate that into nursing."
After receiving a Bachelor of of Science in Exercise Physiology from Texas A&M University, Zangerle went on to get a master's in nursing administration from Kent State University, a master's in business administration with a focus in healthcare from Lake Erie College, and a Doctor of Nursing Practice from Texas Christian University.
Zangerle previously served as principle of CMZ Strategies, LLC, offering nurse leader coaching and nursing organization strategy. She is the former chief nurse executive at Allegheny Health Network and CEO of the Visiting Nurse Association of Ohio. Zangerle spent several years at the Cleveland Clinic where she served in a variety of roles, including as chief nursing officer, director of quality and accreditation and director of preventive cardiology.
Now, Zangerle serves as chief executive officer of the American Organization for Nursing Leadership (AONL), and senior vice president, chief nurse executive of the American Hospital Association (AHA). In her role at AONL, she leads a membership organization of more than 12,000 nurse leaders whose strategic focus is excellence in nursing leadership. In addition, she works collaboratively with the AHA to ensure the perspective and needs of nurse leaders are heard and addressed in public policy issues related to nursing and patient care.
On our latest installment of The Exec, HealthLeaders sat down with Zangerle to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
Here's what RCM leaders should be doing to tackle this pervasive pain point
Payer denials are, to put it mildly, a pain. In this week’s The Winning Edge webinar on defeating denials, WVU Medicine’s Beth Carlson lays out the groundwork for an effective—and forward-thinking—denials management strategy.
The long-awaited proposal for a special registration would help providers with virtual treatment programs for addiction and behavioral health concerns. Critics, however, say the proposed rule isn't what they hoped it would be.
Healthcare providers will finally get a special registration to dispense controlled drugs via telemedicine, a kay part of virtual care treatment for patients in substance abuse and behavioral health treatment.
But the proposed rule, unveiled Wednesday by the U.S. Drug Enforcement Administration (DEA) and expected to be published on Friday, isn’t necessarily sitting well with telehealth advocates.
The proposed rule creates three tiers of providers who could prescribe controlled drugs. The first tier comprises clinicians wanting to prescribe Schedule III-V level drugs; the second would apply to specialists, such as pediatricians, psychiatrists and those in hospice or palliative care, who want to prescribe Schedule II drugs. The third tier would comprise clinicians wishing to prescribe Schedule II-V medications via telemedicine and would require that they register with the DEA through Form 224S.
“The rise of DTC online telemedicine platforms in recent years has further transformed healthcare delivery, but it has also introduced new challenges and heightened risks of diversion due to the remote nature of care delivery,” the DEA noted. “The proposed registration requirements for telemedicine-based prescribing and dispensing create a new business activity within DEA’s overarching registration framework, distinguishing it from the traditional modes of dispensing under a 21 U.S.C. 823(g) registration.”
Among the restrictions included in the proposed policy: Providers wishing to prescribe controlled medications via telemedicine must be located physically in the same state as their patients, and they must issue at least half of their prescriptions after in-person appointments.
In addition, providers seeking a special registration to virtually prescribe controlled substances must check prescription drug monitoring databases in all 50 states and U.S. territories (the one exception is buprenorphine, or Suboxone, for which providers would only have to check the database in the state where the patient is located). That provision would take effect three years after the proposed rule becomes law.
The DEA announcement comes after the agency extended a pandemic-era waiver three times that allowed providers to prescribe via telemedicine, and comes 17 years after the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 mandated that the agency create a special registration process.
Telehealth advocates, led by the American Telemedicine Association, and several lawmakers have criticized the DEA’s efforts for years, first for ignoring the mandate to create a special registration, then for proposing mandates that they say are restrictive or convoluted.
“It is clear that these updates carry significant implications for the telehealth community,” Kyle Zebley, the ATA’s senior vice president of public policy and executive director of the organization’s lobbying arm, ATA Action, said in a press release. “Early indications suggest the proposed rule includes elements that represent significant operational challenges. All stakeholders need time to carefully review this important proposal, which appears to incorporate valuable elements and other potentially unworkable restrictions that focus on maintaining compliance with patient verification, electronic recordkeeping, and ongoing monitoring.”
“We are pleased to see the DEA propose a special registration, as required by statute, to allow comprehensive medical care through telemedicine, including Schedule II medications,” the Alliance for Connected Care said in a release issued shortly after the DEA’s notice of proposed rulemaking. “These treatments are important in providing mental health, end-of-life care, substance use treatment, and many other services. Telemedicine has proven to be an effective tool in bridging the gap between patients and providers, reducing barriers to care, and supporting those most in need.”
“However, the alliance is very concerned to see language in the proposed rulemaking mandating what portion of patient care can be offered through telemedicine, as this is not an appropriate guardrail for a telehealth service,” the organization continued. “Similarly, restricting the geography in which telemedicine can be offered undermines the value of creating virtual access for those patients who need it most. Restricting access to telemedicine will lead to harsh consequences for many Americans relying on telehealth for mental health, substance use disorder, sleep disorders, terminal illness, and many other medical issues.”
The Foley & Lardner law firm, whose Telemedicine & Digital Health Industry team has long monitored the quest for a special registration, also panned the new proposal.
“The DEA published these rules, not because they were fully ready for implementation, but to ensure they were not abandoned by the incoming Trump administration,” Marika Miller, a telehealth and regulatory attorney with the firm, told STAT News. “The long-awaited special registration process falls flat with stakeholders, and it is anticipated that the associated rule will undergo yet another round of notice-and-comment rulemaking. Among other concerns, a key issue for stakeholders with both rules is the nationwide prescription drug monitoring program check requirement, a burden the DEA still appears to underestimate.”
The proposed rule, which will now face public comments through March 15, isn’t guaranteed. The incoming Trump Administration, which hasn’t yet named someone to lead the DEA, could drop or ignore the rule, reinstating the policy in place prior to the COVID-19 pandemic.
In HealthLeaders' latest The Winning Edge webinar, WVU Medicine’s Beth Carlson explains how revenue cycle management leaders can improve denials management to not only prompt better and quicker resolutions, but reduce denials before they even occur.
Denials are a key pain point for revenue cycle leaders, and a problem that affects the entire organization, from patients on through to providers. But today’s RCM executives don’t have to go it alone in addressing this problem.
Through collaboration with other departments, such as clinical, and the use of technology like AI, RCM leaders can move upstream and proactively address denials even before they occur. They can also better prepare for when denials do occur, and work with payers to understand and improve the process, reducing expensive and time-consuming appeals and ensuring that patients receive the care they need.
In this week’s HealthLeaders The Winning Edge webinar for defeating denials, Beth Carlson, VP of Revenue Cycle at WVU Medicine, explains how today’s RCM departments aren’t just a back-office function of the healthcare enterprise, and that they’re much more involved in helping patients get the care they need by addressing and improving denials.
To fully embrace this strategy, Carlson offers three pieces of advice:
Establish a Strong Denials Management Process. Create a framework not only for addressing denials, she says, but also understanding why they happen and how they might be avoided. Study payers to understand when and why they issue denials, even spotting trends with certain payers and delaying tactics; work with providers to examine medical necessity and care pathways, helping them to understand when a certain procedure or process might go against a payer’s policies; and even work with patients so that they understand their benefits and options for care.
When denials do occur, start with a root cause analysis to understand all the factors of that particular denial, and be ready to to establish a “triage escalation capability” if a denial is particularly complex. Make sure service lines—clinical, financial, legal—review them as well, so that everyone understands why they happened.
Collaboration is Key. RCM can’t happen in a vacuum any more, Carlson says. It’s crucial that RCM leaders work with other departments to both understand denials and address them after they happen.
Working with clinicians will help both RCM staff and clinicians to better understand how denials happen. Clinicians can then develop care pathways for their patients that steer clear of procedures that would be denied by payers, and RCM staff can identify and work with clinicians who cause frequent denials. In addition, there are occasions when a doctor can prove to RCM leaders and even a payer that a certain policy isn’t working, and can help to have that payer change the policy to reduce denials.
Looping in the legal department is important as well. They can help RCM leaders develop strategies to speed up the denial resolution process, including understanding when a case is too complex to pursue.
And finally, working with patients at the earliest point in the healthcare journey—before the patient even comes into the hospital—can benefit everyone. Educating patients on their financial responsibilities, health plan coverage and other details of the care experience can reduce the chances of an unexpected or surprising cost down the road. This also gives RCM leaders and staff and opportunity to better understand the patient’s care journey, and to work with patients on a care plan that synchs with their insurance coverage and policies and reducing the chances of a denial.
It's All About the Data. As with almost any facet of the healthcare enterprise, data is the key to improved performance and outcomes, and with today’s technology (especially AI), there are many more opportunities to access, manage and find value in data. With denials, this means gathering all the necessary information ahead of time on payers, providers and patients.
Carlson says RCM leaders need to understand the data and how they can use it—and how to use AI tools to get the most out of that information. They can better understand payer policies and trends, identify coding mistakes and opportunities, and gain insight into provider tendencies and care pathways that lead to denials.
That data comes in handy when dealing with payers as well. RCM leaders who are armed with the right information can not only smooth the denial resolution process, but work with payers to identify improvements (in either provider practices or payer policies) that can reduce denials and improve patient care and outcomes.
As physician salaries soar amid a worsening shortage, healthcare executives are grappling with whether these costs are sustainable or if alternative care team models can ease the financial strain.
Welcome to our HealthLeaders January 2025 cover story. Each month, our editors dive into the topics that matter most—such as healthcare innovation, leadership strategies, payer/provider wars, and patient care—delivered in a dynamic, engaging format.
What did we look at this month? It’s all about physicians.
The escalating costs of employing physicians have become a financial fault line in healthcare. As doctor salaries climb ever higher—driven by an unrelenting physician shortage and skyrocketing demand—healthcare executives are facing a critical dilemma: Are these massive expenditures truly sustainable?
While these high salaries reflect the critical role physicians play in patient care, they also raise difficult questions about sustainability and the viability of other solutions.
Could advanced practice providers, technology-driven efficiencies, or new team-based care models help offset the escalating costs? If not, what's the solution?
This month, our CMO editor Chris Cheney explores the financial and operational dilemmas at the heart of modern healthcare, and the tough decisions leaders must make to balance quality care with fiscal responsibility.
CNOs will continue to focus on workplace violence, wellbeing, and digital transformation, according to this nurse leader.
It's 2025, and while there will be many new beginnings in healthcare, CNOs will also face some perpetual challenges that continue to rear their heads.
According to Robyn Begley, CEO of American Organization of Nursing Leadership (AONL), and senior vice president and CNO at the American Hospital Association (AHA), several of the biggest issues going into 2025 will be the same that the industry has seen for the past couple years.
Here is the 2025 forecast of challenges that CNOs should keep tabs on.
