Addressing SDOH comes down to knowing the community's needs, says this CNO.
On this episode of HL Shorts, we hear from Jess Almeida, chief nursing officer at Cedars-Sinai Marina del Rey Hospital, about how health systems can address social determinants of health to improve patient care. Tune in to hear her insights.
Supporters say the extension merely kicks the can down the road and they may soon urge either Congress or the White House to step in and create a permanent rule.
Healthcare providers will be able to prescribe scheduled drugs via telemedicine for at least one more year, thanks to a last-minute extension of a pandemic-era waiver by the U.S. Drug Enforcement Administration (DEA).
The announcement late Friday may have been met with relief by advocates, but it’s little more than a stopgap measure. The federal agency has been tasked with creating a special registration process for prescribing via telemedicine since the passage of the Ryan Haight Online Pharmacy Consumer Protection Act in 2008, but has resisted calls from advocates and lawmakers to do so.
Nevertheless, the latest announcement garnered some praise.
“We are pleased to see the DEA act to ensure patient care is not interrupted next month,” Chris Adamec, executive director of the Alliance for Connected Care, which spearheaded a letter signed by more than 300 organizations urging Congress to take action, said in a press release issued Friday. “We look forward to working with the Trump Administration next year to finish the work they started in 2020 through a permanent rulemaking that creates access to comprehensive medical care, including a controlled substance when necessary, through telemedicine.”
“The DEA’s extension of telehealth flexibilities of controlled substances is a lifeline for many mental health and substance use disorder patients,” Debbie Witchey, president and CEO of the Association for Behavioral Health and Wellness (ABHW), said in a separate release. “Buprenorphine, in particular, is very safe and one of the gold standards of care for opioid use disorders (OUD). The option to provide buprenorphine-based treatment via telemedicine will enhance access to care and address health disparities. ABHW strongly supports removing the in-person requirement permanently for tele-prescribing buprenorphine as this requirement hinders access to care.”
Supporters, including many health systems and hospitals, say the ability to prescribe controlled medications via telemedicine is critical to improving treatment and access to care for substance abuse and behavioral health issues, as patients often can’t or are reluctant to seek in-person treatment. They also worry that ending the waiver will disrupt and potentially end treatment for patients who have relied on virtual prescriptions for the past few years.
According to the DEA, the extension “ensure(s) a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions.” It also gives the DEA and the Health and Human Services Department (HHS) more time to come up with a final rule, and for providers to be ready for that rule when it goes into effect.
That hasn’t worked out too well in the past.
In 2023, the DEA unveiled a proposal for a final rule, but advocates quickly criticized the proposal as being too complex and restrictive, leading the agency to shelve the plan and extend the waiver. Earlier this year, the DEA floated another draft of a final rule, but a leaked copy of the plan was deemed by supporters to be “a significant blow to the telemedicine industry.”
The one-year extension isn’t a surprise. Those familiar with the process have been anticipating either a one- or two-year continuance for some time. But there’s a growing concern among telehealth advocates that the DEA won’t come up with a final rule that meets their concerns, and that they will have to put extra pressure on either Congress or the White House to bypass the DEA and create a permanent rule that is amendable to everyone.
That may be why advocates like the American Telemedicine Association (ATA) were quick to praise not only the DEA but HHS, Congress and the White House for the waiver.
“As we close out this year and prepare for 2025, we will remain actively engaged with the incoming Trump administration, the DEA, the Department of Health and Human Services (HHS), interagency partners, and other key stakeholders to establish a permanent framework that ensures appropriate and necessary access to care for millions of Americans,” Kyle Zebley, the ATA’s senior vice president of public policy and executive director of ATA Action, the organization’s lobbying arm, said in a press release last week.
“We remain grateful to the Biden Administration, the DEA and other key agencies, and our bipartisan, bicameral Congressional telehealth champions, as well as President-elect Trump and his first Administration, for their staunch support,” he added. “However, our work is far from over. We are buoyed by this important ruling and will continue to pursue permanent access to essential virtual care services on behalf of healthcare providers and the millions of patients who have come to rely on telehealth.”
Health systems should be careful to avoid misclassification of nurses as independent contractors, according to this law professional.
CNOs everywhere are strategizing how to fill workforce gaps left by the nursing shortage.
While navigating recruitment and staffing challenges, it’s important to look at how nurses will be brought on and integrated into the workforce. Part of this process involves making sure nurses fall under the proper worker classification, and ensuring that the hospital or health system remains in compliance with legal requirements for classification.
While nurses are often classified as full-time employees, some are designated as independent contractors, which depends on several factors, according to Richard Reibstein, head of Locke Lord's New York labor and employment practice and co-head of the firm’s independent contractor compliance and misclassification practice.
"There is no one particular situation where nurses can be legitimately classified as independent contractors," Reibstein said. "Rather, there are many different situations, and the facts are critical in determining if you are in sync with the law or out of compliance and facing IC misclassification liability."
Why independent contractors?
According to Reibstein, a nurse could be classified as an IC if their work is unsupervised or unassigned, they are not told how to perform services, they can determine their own schedule, negotiate their pay, and incur their own expenses.
Other factors include whether the nurse is free to accept or decline engagements and whether they have the right to work with multiple agencies or health systems. However, Reibstein explained, some states have more restrictive law tests for ICs than others.
"What is most important is a state-of-the-art analysis of these and other factors in view of applicable law," Reibstein said. "We look at more than 48 different factors to assess whether a worker is likely to be properly classified."
Reibstein emphasized that there are both upsides and downsides to classifying nurses as ICs, depending on the needs of a health system. The upside for IC classification, according to Reibstein, is that health systems need to worry less about compliance with the applicable federal, state, and municipal labor and employment laws that apply to employees.
However, the downside of IC classification has the potential to impact standards of care delivery.
"The downside is that the health care system engaging a nurse as an independent contractor cannot direct or control the manner in which the nursing services are being performed," Reibstein said, "if direction and control [are] important."
What about misclassification?
It’s critical that CNOs and other healthcare executives ensure that any nurses or clinicians treated as ICs must be classified properly, or there can be steep consequences.
According to Reibstein, health systems can face investigations and litigation in situations where misclassification occurs.
"They can be subjected to class action lawsuits as well as audits and investigations by state or federal workforce and tax agencies,” Reibstein said, "all leading to considerable legal exposure and liability."
To avoid these issues, Reibstein said health systems should structure their relationships with ICs in a manner that maximizes compliance with the applicable IC laws, and they should strive to meet as many as two or three dozen criteria for IC compliance.
Health systems must also document and implement the IC relationship in a compliant manner, Reibstein explained, and customize the IC relationships to meet their business model and objectives, so that the outcomes are sustainable.
"One-size-fits-all approaches are usually ill-fitting," Reibstein said, "and what may work for one health care system may not work effectively for another."
Deciphering value in new tools and strategies is a constant challenge for healthcare leaders. At the HealthLeaders RevTech Exchange, they came togetheer to discuss the best strategies and biggest hangups.
New technologies like AI may have a bright future in healthcare, but many revenue cycle executives say the ROI just isn’t there yet. And they’re having some tough conversations with vendors and their own staff about how to move forward with new ideas.
At this week’s HealthLeaders RevTech Exchange in Nashville, some 30-40 healthcare leaders discussed a variety of strategies for embracing new tech. Those strategies almost always focus on defining and seeing ROI, and that factor alone can make or break a new technology contract or scuttle a promising program before it begins.
“Some very good products don’t justify the expense” said Jonathan Davis, Executive Director of Patient Access and Revenue Cycle Analytics at Yale New Haven Health. RCM execs may not have the budget or the time and resources to spend on new ideas that take too much time to develop value or don’t have clear value to begin with.
RCM executives are in a tough spot right now, caught between the value-based care movement and business strategies that still adhere to episodic care. Their definition of value often clashes with clinical leadership, and it’s in technology that those differences hit the spotlight. ROI for a new tool that improves clinical outcomes is far different than the ROI for a tool that improves administrative efficiency.
At the same time, a new tool that greatly improves clinical outcomes won’t be useful to a hospital that can’t keep its door open because of unsustainable revenues. So the delicate balance of priorities continues.
Several exchange attendees said they follow a technology ROI threshold of 3:1, meaning a new product or program has to produce in revenue three times what it cost to launch the project. No one touches anything with a 1:1 return, and a 2:1 return won’t hold up against unexpected and additional costs.
So the technology has have an immediate and impactful ROI, particularly at a time when so many health systems and hospitals are skating on thin margins. One of the first places to cut expenses is in innovation, putting the pressure on executives to be sure they’re finding the right vendors with which to partner.
Lynn Ansley, Vice President of Revenue Cycle Management at the Moffitt Cancer Center, says healthcare executives are becoming more critical in their evaluation of vendors. They’re asking for more details about products and avoiding ambiguity at all costs, and they’re looking at shorter contracts—three years was mentioned more than once—so that they can back out if the ROI isn’t there.
In many instances, RCM executives are asking for a detailed proof of concept from vendors, requiring them to map out how their product will benefit the health system and even asking for assurances or guarantees. That’s not unlike the shared risk that we see in arrangements between payers and providers.
And if there are multiple vendors vying for the same contract? How about a “bake-off,” in which they put their products up against each other to determine who’s better at proving ROI. Some health systems are even working with two vendors that offer the same tools, so that both are accountable and giving their best effort.
This is crucial, exchange attendees said, because payers often seem to be ahead of the game in tech adoption, particularly with AI. Some even said their health systems are moving fast to adopt AI just to stay in the game with payers.
“You show up at the contract table with any payer and they know more about your business than you do,” one executive pointed out.
In terms of staffing, which is a sore spot at every health system and hospital, RCM execs are defining ROI in automation and AI tools not by how technology can replace humans, but by how it frees up staff to handle more important tasks.
“There are other things that we need smart people for,” notes Ansley.
And they’re countering staff concerns that AI will replace them by pointing out that those upskilling opportunities often come with salary increases. That, in turn, helps with staff retention and hiring.
Finally, RCM execs are looking at a future that sees them playing more of a role in the patient’s healthcare journey. That means not only collaborating with clinicians to advance the right technology purchases but highlighting the role that revenue cycle staff can play in helping patients understand and fulfill their financial obligations.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
The fight to retain a multigenerational workforce has been a losing battle for healthcare CEOs. Is one generation in particular to blame?
Welcome to our November 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year.
What did we look at this month? In the intense, ever-evolving landscape of healthcare, a perfect storm is brewing.
Retaining workers in hospitals and health systems has become a near-impossible task. The factors behind this crisis are complex, but one looming culprit stands out: generational clash. CEOs are not only struggling to keep people on board; they’re fighting against rapidly shifting priorities driven by a multi-generational workforce that seems to have conflicting demands.
Meeting those demands is getting harder, not easier, largely due to the youngest generation’s relationship with work. Gen Z is the workforce of tomorrow, but its fit in the grueling environment of healthcare, which can often feel like a square peg in a round hole, is something hospital decision-makers are attempting solve for.
It’s a challenge that threatens to destabilize an industry already reeling from the aftershocks of the pandemic.
But what's the solution? Our CEO editor Jay Asser explains that while cutting out an entire generation of workforce isn't feasible–or necessary–the truth is, healthcare is fighting a multigenerational war within its own walls, and healthcare leaders need to strike back.
The key to success is getting to know your team, according to this CNO.
Jessica “Jess” Almeida’s background in nursing leadership spans a variety of patient care and nonclinical areas. Almeida earned her doctorate in nursing practice and her master’s in nursing from Capella University in Minneapolis, and professionally, she has led hospital-wide initiatives focused on improving communication, interdisciplinary care and operational efficiency.
Almeida joined Cedars-Sinai Marina del Rey Hospital in 2023 as associate director of Nursing Operations, and she now serves as chief nursing officer. She honed her nursing expertise over more than two decades and has extensive clinical experience working with patients in neonatal intensive care units, emergency departments and medical-surgical divisions.
Prior to joining Marina del Rey Hospital, Almeida served as the executive director of operations at Cedars-Sinai Providence Tarzana Medical Center, where she focused on quality improvement projects related to patient flow, work processes, clinical informatics and construction of the hospital’s new patient tower.
On our latest installment of The Exec, HealthLeaders sat down with Almeida to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
The company behind the stylish, AI-enabled CarePod has abruptly closed, following a similar spiral as the HealthSpot more than a decade ago. The news proves that healthcare innovators shouldn’t just be trying to recreate the doctor’s office.
Another kiosk-based telehealth company has shut down, proving once again that a high-tech virtual care platform isn’t the successful business model that disruptors think it can be.
Forward, which launched in 2016 with a cash-based model and unveiled the stylish, AI-enabled CarePod just last year, announced its abrupt demise in a company post this week, putting some 200 employees out of work. The company said it was immediately discontinuing its app, cancelling all scheduled visits and shutting down all operations, while keeping a support team available for about a month.
The collapse is reminiscent of the HealthSpot, a similarly-styled kiosk that debuted at the CES show in Las Vegas in 2012. The company behind the kiosk raised almost $50 million, built close to 200 kiosks and had deals in place with Rite-Aid, the Mayo Clinic, Cleveland Clinic and Kaiser Permanente before going bankrupt in 2016.
The lesson to be learned in these closures is that technology alone won’t solve anything, and that consumers and business owners are looking past all the bells and whistles for convenient, no-frills healthcare connections. A kiosk that can replicate a complete visit to the doctor’s office may look and sound great, but it’s still a healthcare visit to a different location. If consumers want the experience to look that much like a doctor’s office, they’ll go to their doctor’s office.
To be fair, the kiosk concept is still enticing. Pursuant Health, which began as SoloHealth in 2007 with the EyeSite vision kiosk, now has more than 4,600 health kiosks in high-traffic retail and grocery stores across the country. And Canada-based UniDoc Health Group, which unveiled its H3 Cube Virtual Care Simulations Model (VCSM) at the American Telemedicine Association conference in 2022, rolled out the first commercial shipment this week, and is pursuing an international “AI-focused eHealth” strategy that would out its kiosks in remote and resource-thin regions around the globe.
Health systems and hospitals are also interested in the form factor. Rochester University Medical Center has partnered with Five Star Bank to locate smaller telehealth kiosks in several bank branches, eyeing a strategy that that improves access in rural upstate New York. And several healthcare organizations across the US have located smaller kiosks--some no more than a laptop and connected devices in a cubicle—in libraries, malls, community centers and other locations with the goal of giving consumers quick and easy access to virtual care providers for small health concerns.
As Forward and HealthSpot have proven, bigger isn’t better and telehealth companies, care providers and disruptors who are looking to recreate the doctor’s office in other settings are missing the point. Small, quick and easy may be the key to sustainability.
As the HealthLeaders 2024 RevTech Exchange kicked into action this week in Nashville, executives from dozens of health systems discussed how they're managing new technology like AI
Today's revenue cycle management leaders need to be agile. The healthcare industry is going through a significant period of change, buffeted by costs and quality concerns and workforce shortages and buffered by new technologies like AI. That's a challenging environment for any leader to navigate.
Roughly 40 RCM leaders from health systems across the country gathered in Nashville this week at the HealthLeaders 2024 RevTech Exchange to talk about those challenges and opportunities.
Here are a few key plot points from the first day of the Exchange:
Train, train, and train some more. And don't stop training. Due in large part to the advances in automation and the potential of AI, the revenue cycle workforce is evolving. Managers need to develop a strategy that prepares staff for that evolution. They need to address that worry that AI is taking people's jobs by pointing out that jobs aren't disappearing, but they are changing. RCM staff will become monitors, overseers and auditors, keeping a close eye on the technology that is doing all the manual tasks they used to do.
And that training won't stop. A key element of generative and predictive AI is that it keeps on learning, and RCM staff will need to keep on learning alongside those tools.
That goes for leaders as well. New technologies like AI are new to everyone, including those in the C-Suite. Healthcare leaders need to have a clear understanding not only of these new opportunities, but how they'll affect staff and workflows. Be ready to talk to people who are worried that AI will replace them, as well as staff who are perhaps a bit too eager to try something new.
Technology isn't the answer. "We look at technology like it's going to solve all our problems," says Derek Dudley, VP of Revenue Cycle Operations at Tidelands Health. "But a $200 hammer isn't going to make you a better carpenter."
As with clinicians, RCM managers need to understand that technology is a tool that will help them become better, but it won't solve all the pressing problems of healthcare on its own. Managers and staff need to understand how to use those tools to improve rev cycle performance.
For example, Beth Carlson, VP of Revenue Cycle at the West Virginia University Health System (WVU Medicine), noted her health system developed a tool to predict denials from a certain payer. The tool was wildly successful—but it was scrapped, because the denials were still happening. In other words, they'd created a great tool, but it didn't have any value.
Look for proactive solutions. Taking the WVU Medicine example one step further, what the health system needed was a tool that would identify the root causes of those denials, and develop a strategy for preventing denials in the first place.
Several health system executives at the Exchange emphasized the need to develop new tools and programs that tackle key pain points in RCM, such as denials, appeals and prior authorization hangups, before they happen. The appeal of AI lies in gathering all the data at hand and predicting when those issues occur, then using that data to plot the best way to avoid them.
Collaborate with IT and especially clinicians. Revenue cycle departments shouldn't exist in their own silos, and yet they sometimes think they do. Because of this, and because many of the sexy new AI tools address clinical care, RCM staff may be feeling a bit inferior to their medical counterparts.
That's a load of baloney. Successful health systems and hospitals thrive on collaboration, and it's important that executives look for those opportunities to collaborate on new tech and programs. Lynn Ansley, VP of Revenue Cycle Management at the Moffitt Cancer Center, said revenue cycle leaders should even go on rounds with clinicians to understand their workflows and see where RCM technology intersects.
In fact, revenue cycle managers should even find clinician champions, much like CIOs and CNOs will do to support the rollout of new clinical technology. Having clinician support and have clinicians understand how RCM technology benefits their workflows will go a long way toward establishing that elusive ROI.
Find that elusive ROI. This is the biggest challenge in healthcare technology today. New tools like AI may look great and even produce amazing results in pilots, but they need to prove long-term value, and that hasn't been easy so far. With health systems and hospitals on razor-thin margins and reluctant to spend money on new ideas (especially something as pricey as AI), there has to be a proven ROI attached.
Balance established tech with new tech. Many healthcare organizations don't have the resources to develop new technology like AI, so they outsource, looking for a company with a good background and product or even a startup that they support. On the other hand, EHR companies are developing their own tools that integrate into the medical record. Is it better to wait for that tool or spend money on an outsourced product that may have to be bolted onto the EHR?
It's not an easy question to answer. Some Exchange participants said they don't want to wait for their EHR provider to develop a tool they need now and are willing to look for help. Others are against bolted-on functionality and are willing to wait. And then there are those who would consider buying a new tool or capability and then switching over when the EHR provider comes along with that tool.
Look at RCM from the outside. Many of the new ideas coming into healthcare have proven themselves in other industries, like retail, banking and travel. And while the healthcare sandbox is a difficult place in which to play with new concepts, savvy leaders will look for ways to adopt them and adapt to the changes. Part of that process includes understanding how these ideas worked in other industries and learning how they might fit in.
Beyond that, RCM leaders also need to look at their departments from the perspective of other parts of the healthcare ecosystem. How does IT see the RCM process? How do doctors and nurses view those operations? This is particularly important when developing a culture of collaboration.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Workforce concerns go far beyond just recruitment and retention, according to HealthLeaders Exchange members.
Today's CNOs, CMOs, and other industry leaders are confronting AI, breaking down barriers to entry in education, and cultivating a sense safety in the workplace, all in an effort to create the most sustainable workforce possible. However, this work doesn't come without major challenges.
The 2024 HealthLeaders Workforce Decision Makers Exchange wrapped up last week in Washington D.C. after two days of insightful idea-sharing and compelling discussion about the most difficult obstacles in building a workforce.
Here are three key takeaways that leaders should know about workforce challenges.
The standard workforce challenges persist while others continue to pop up, according to this nurse leader.
On this episode of HL Shorts, we hear from Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Association (ANA), and HealthLeaders Exchange member, about the hottest workforce challenges that CNOs are facing right now. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
