Gen Z is looking for purpose at work, says this CNE.
HealthLeaders spoke to Jean Putnam, chief nurse executive at Baptist Health South Florida and HealthLeaders Exchange member, about workforce challenges in nursing and innovative ways to recruit and retain Gen Z nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
The agency is eliminating copayments for all telehealth encounters and putting more money into a controversial program that creates telehealth stations for veterans in remote and rural areas.
The largest telehealth provider in the country is proposing to eliminate copayments and expand a controversial program that provides access to care in rural and remote regions through telehealth stations.
The U.S. Department of Veterans Affairs announced on Veterans Day that it aims to amend the Commander John Scott Hannon Veterans Mental Healthcare Improvement Act of 2019 to end all copayment obligations for veterans, greatly expanding a decision earlier this year to waive copayments for a veteran’s first three outpatient mental healthcare visits per year through 2027.
In addition, the VA plans to establish a grant program to support new telehealth access points in non-VA facilities. The funding would bolster The Accessing Telehealth through Local Area Stations (ATLAS) program, which launched in 2019, by supporting organizations, such as non-profits and businesses, to create and maintain telehealth stations where veterans could access VA care services.
The idea behind the program is to create a network of locations that would enable veterans to access care outside of VA hospitals and care sites, giving veterans more convenient options for care. Current sites are located in Walmart stores, American legion posts and Veterans of Foreign Wars posts.
Interestingly, the ATLAS program so far hasn’t performed up to expectations. Just a month ago, the Government Accountability Office (GAO) issued a report that found that 14 of the 24 sites supported by the program weren’t used at all in FY 2022 or 2023.
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in an October interview. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
VA officials said the two new announcements aim to build on a successful platform for veterans, and an understanding that many veterans either can’t or won’t visit VA centers or other VA-affiliated care sites.
“Waiving copays for telehealth services and launching this grant program are both major steps forward in ensuring Veterans can access healthcare where and when they need it,” VA Secretary Denis McDonough said in a press release. “VA is the best and most affordable care in America for veterans. With these steps, we can make it easier for veterans to access their earned VA healthcare.”
The announcement continues a growth trend for the nation’s largest health system, which serves more than 16.2 million veterans. In fiscal year 2023, more than 2.4 million veterans, or 12% of that total, were treated through more than 11.6 million virtual care encounters, including some 9.4 million on the VA Video Connect platform.
Also last month, the VA expanded its tele-emergency care (tele-EC) platform to veterans across the country, after the success of pilot programs in selected regions. Veterans can now use a smartphone and associated app to access emergency care at any time and from any location.
Chief among the system's drivers of ROI is a coding automation platform grown close to home.
Let's face it: We're not getting any younger.
"Our population [is] getting older, more complex, more challenging, so there's always going to be more volume than we can keep up with," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.
For revenue cycle teams, it means the pressure is on "to not only perform well and bring in as much cash as we can as effectively, compliantly, and quickly as we can, but [to] do it at a cost that isn't burdensome to the organization," he explains. "Because every dollar that they spend on me is one dollar [that] they don't spend on a clinician or on research or on community assistance or on direct patient care."
To help those dollars more readily reach their intended targets, Mercurio has half a dozen "bot builders" implementing robotic process automation (RPA). "We're looking to continue to expand that as quickly as we can," he explains.
Ahead, more ways Mercurio taps tech to keep pace with RCM's ever-upping ante.
Cracking the CAC code
Today, Mass General Brigham's rev cycle team is automating more than 80% of their radiology-related coding activity with CodaMetrix's platform, which Mercurio helped launch in 2019 to commercialize the computer-assisted coding (CAC) solution developed by the system's physician organization billing office.
This focus has paid off big, Mercurio says. "The quality is excellent, and we've seen a reduction in denials and therefore a reduction in cost on the backend, which we've been able to pass on to our practices or reinvest in ourselves by redeploying staff to areas [that] need it as opposed to working things that would have been denied."
When considering automation, Mercurio recommends starting with higher-volume service lines where notes typically follow a standard template or format, such as radiology or pathology. "There's significant volumes of those, so the machines can learn very well on past history and do a really good job predicting the future," he explains.
Making humans happier
Apart from creating economies of scale in house through CAC and RPA, Mercurio sees an opportunity for tech advances to make work more joyful for the humans in the loop.
"Our providers are severely overburdened and that's causing a lot of challenges clinically from an access perspective and doctors losing the joy of medicine. So AI is going to help there," Mercurio says. "From our [RCM] perspective, it's really making us think, ‘do we really want to do X if technology is going to maybe potentially give us a boost or a lift or resolve this problem for us?'"
He points to new AI tools on the horizon, along with companies offering tech that tees up appeals to denials likeliest to get overturned based on a payer's policies and historical activity.
Laying the groundwork
Though such possibilities are ripe for ROI, they risk being waylaid by waning budgets and bandwidths. "There are so many companies and technologies and opportunities out there," Mercurio says. Though there's no silver bullet for these "killer bees," the following strategies are some worthy repellants.
Talk shop
"I rely heavily on my network," Mercurio says. "If someone's already using a vendor or a process, that's a good head start to narrow it down." He recommends asking peers which partners and solutions they've chosen and/or shortlisted, and based on what criteria, "so we don't have to do that market scan ourselves."
Avoid vaporware
Tapping your network also means you can learn from their mistakes. Mercurio recalls a peer who ran into early misunderstandings about an AI product they were purchasing that, one full year after implementation, left them where they thought they'd be on day one.
"It's so new, and there's a lot of hype, and people are quick to jump on to that," Mercurio explains. "If you're not asking the right questions or doing the right reference checks, and really digging in to understand the full breadth and depth and scope of your potential partner—which you should do for anything, not just AI—then you could end up getting bitten."
To sniff out potential snake oil, he recommends connecting with a peer organization already using a prospective solution to discuss how implementation went. "There's a very big difference between selling and installing," he notes.
Empower teams
System leadership is generally supportive of tech-enabled experimentation to "drive more value at a lower cost and a higher quality," Mercurio says.
As for staff whose roles might be directly impacted, such as coders, buy-in "comes down to the communication and the trust that your team has in you as a leader and your leadership team," he explains. The objective, he tells his staff, is to elevate team performance so members can build capabilities and take on more valuable work—not lose their jobs.
"We're not looking to eliminate any of the coders on our teams because of technology. We have more volume than we can keep up with," he says. "We want to make sure that we have the right coders who are trained in various subspecialties and are experts in their field and can really provide the value to our overall organization."
Put value over cost
Though price is "obviously important," Mercurio is "more interested in the quality of the outcome of the service we're buying, the relationship that we're going to have with that vendor," he explains. "We want them to be sticky. It's not a great idea to save 60% and then have seven times as many problems and constant turnover with account managers or teams where you're then managing more than you were to begin with and you're spending more than you were to begin with."
See the vision
"I like to try to find the companies that are really trying to do something different and special," Mercurio says. "That's who we would want to partner with to see if we can elevate our game and provide more value to our patients and our providers and our practices."
Nurse leaders should take a deliberate and disciplined approach to workplace violence, says this CNO.
On this episode of HL Shorts, we hear from Michele Szkolnicki, senior vice president and chief nursing officer at Penn State Health Milton S. Hershey Medical Center, about how CNOs can help keep their nurses safe in the face of rising workplace violence incidents. Tune in to hear her insights.
CNOs should pay attention to these nurse leaders in the new year.
2024 was a prosperous year for new nurse leadership.
This year, HealthLeaders spoke to several new CNOs, CNEs, and other nurse leaders for the Exec. Each leader shared their insights on the hottest trends and challenges in nursing, and left pieces of advice for their peers. As all of them thrive in their positions, they will continue to grow in their leadership and have great impacts on the industry.
Here are eight nurse leaders that you should watch in 2025.
Click below to view each executive's full interview.
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.