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.
Nurse manager turnover is highest within the first four years of leadership, so CNOs must focus on how to retain them, according to this CNO.
On this episode of HL Shorts, we hear from Robyn Begley, CEO of the American Organization of Nursing Leadership (AONL), and senior vice president and CNO at the American Hospital Association (AHA), about how CNOs can improve nurse manager retention. Tune in to hear her insights.
In the high-stakes world of healthcare revenue cycle management, few issues cast as long a shadow as claim denials.
For revenue cycle leaders, the challenge of denials is both urgent and complex, representing a persistent pain point that threatens financial stability, operational efficiency, and patient satisfaction.
Denials are not just a numbers game, and addressing them isn’t merely a matter of firefighting—it’s about building proactive strategies to prevent them from occurring in the first place.
Why Denials Matter
As rev cycle leaders know, denials are a drain on resources. When a claim is denied, it triggers a cascade of consequences: delayed payments, increased administrative workloads, and, in some cases, unrecoverable revenue.
But the cost isn’t just financial.
Denials create friction for patients, who may find themselves navigating confusing bills or facing unexpected out-of-pocket expenses. For care providers, denials can feel like a betrayal of their efforts to deliver high-quality care. Revenue cycle teams often bear the brunt of this frustration, forced into reactive workflows that drain morale and divert attention from higher-value activities.
The urgency to address denials goes beyond operational efficiency; it’s a matter of organizational sustainability. In an era where margins are razor-thin and the push toward value-based care adds layers of complexity, revenue cycle leaders cannot afford to treat denials as a mere operational inconvenience. They are a strategic imperative.
Unpacking the Drama: Why Denials Persist
The root causes of denials are multifaceted, reflecting the intricate web of payer requirements, coding guidelines, and documentation standards that govern healthcare reimbursement. While each denial represents a unique failure point, common culprits include:
Coding Errors: Incorrect or incomplete coding remains a leading cause of denials. Despite advances in technology, human error and gaps in training continue to fuel this issue.
Prior Authorization Problems: Many claims are denied because the required prior authorization was not obtained or was incorrectly documented. The burden of navigating payer-specific requirements falls disproportionately on revenue cycle teams.
Lack of Documentation: Insufficient or inconsistent documentation can leave claims vulnerable to denials, particularly in specialties where clinical nuance matters.
Payer Preferences: Each payer has its own labyrinthine set of rules, and failure to comply with these idiosyncrasies can lead to denials, even when the care provided was medically necessary.
Timely Filing Issues: Missed deadlines for submitting claims or responding to requests for additional information can result in automatic denials, further compounding the issue.
These problems are exacerbated by the lack of visibility into real-time claim status, fragmented communication channels, and siloed data systems.
The result? A reactive posture that keeps revenue cycle leaders perpetually on the back foot.
The Path Forward: Prevention Over Reaction
The key to solving the denial dilemma lies in shifting from a reactive to a proactive approach.
This requires leveraging technology and streamlining processes to anticipate issues before they arise. The good news is that innovative solutions are emerging to help revenue cycle leaders take control.
But how?
For revenue cycle leaders grappling with the high stakes of denials, actionable insights are not a luxury; they are a necessity. That’s why we’re bringing together industry experts for a game-changing webinar designed to tackle this issue head-on.
The next webinar in our Winning Edge series will explore cutting-edge technologies and proven strategies to reduce denials, featuring success stories from leading healthcare organizations.
Our distinguished panel includes:
Beth Carlson, VP of Revenue Cycle at WVU Medicine.
Michael Mercurio, VP of Revenue Cycle Operations at Mass General Brigham.
Eric Sulivant, Solution Strategist at Waystar.
Eric Wicklund, Event moderator and HealthLeaders content manager.
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately.
Join us as we unravel the drama, share solutions, and help you reclaim control over your revenue cycle.
CNOs must keep an open mind and try new things in the new year, according to this nurse leader.
As the saying goes, "new year, new beginnings."
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.
Looking ahead
Begley emphasized that workplace violence will continue to be a challenge as CNOs continue to work diligently at strategies to protect patients and staff.
"Healthcare is not isolated from society," Begley said, "mitigating workplace violence and promoting workplace safety is really important."
Work-life balance and wellbeing will stay a priority in 2025 for nurse leaders, according to Begley. These challenges go hand in hand with staffing hurdles as well.
"Retirements and newly licensed nurses leaving the profession are things that we are actively working on," Begley said.
Begley predicts that health systems will continue having financial challenges.
"We know that many hospitals and health systems in our country are facing grave financial constraints," Begley said, "so that is also a challenge."
Additionally, Begley pointed out that the speedy implementation of new technologies and innovations presents both a challenge and an opportunity.
"The introduction of technology and innovation into care delivery settings is a challenge," Begley said, "but also [it's] really an opportunity for us to dig in and participate and get things right."
Working together
CNOs and nurse managers will have to work together to address these issues going into 2025, and according to Begley, communication is key.
"Communication, communication, communication," Begley said. "[Have] regular check-ins that are scheduled, that aren't just catch-as-catch-can, but really rise to the top from the perspective of importance."
Begley emphasized communication is critical at all levels of nursing, not just for nurse managers.
"We need opportunities for nurses to provide feedback," Begley said. "Policies have to be and are best set when they're developed jointly."
CNOs should develop policies and procedures with staff and managerial input while using data and analytics.
"We have the data…to make informed decisions," Begley said, "not just 'this is what we sort of intuitively know,' but what are those things that we have data and analytics to support?"
Advice for CNOs
CNOs should remember they won't get things right the first time, Begley emphasized.
"Perfect is the enemy of good," Begley said. "Many times, we want to roll out an initiative that we think we have accounted for all the possibilities, [and] we just want it to be perfect, and we know in life that that's not what happens."
In this digital age where technology is advancing so rapidly, Begley recommends keeping an open mind.
"I think we have to be open to the idea that this is going to be iterative and we're not going to…just hit the home run and everything's going to be perfect," Begley said, "and that's hard for nurses."
Begley suggested starting with small changes and seeing how they work, and collecting the input of frontline staff and nurse managers. CNOs should also partner with colleagues in digital transformation and IT.
Nurses will have to learn new competencies to keep up with changing technologies and change the way they think about delivering and experiencing healthcare.
"We have to remember what the impact is on our patients and their families," Begley said. "We have to embrace new technology, [and] embrace making care more patient-centric."
An ever-changing environment is placing greater importance on pursuing integration and getting it right, say hospital CEOs.
In the first webinar of HealthLeaders' The Winning Edge series, Aspirus Health CEO Matt Heywood and University Health CEO Ed Banos discuss how health systems can pursue M&A to achieve growth in several areas, from reaching new markets to advancing technology.
Tune in to hear the panelists offer their insight on trends driving dealmaking and what M&A strategies have allowed their organizations to grow.
