UCSF is launching a remote patient monitoring program aimed at identifying arrhythmias in expectant mothers and improving detection, treatment and long-term care.

Researchers at the University of California San Francisco (UCSF) are enrolling mothers-to-be in a remote patient monitoring study aimed at analyzing how pregnancy affects heart health.

The San Francisco-based university and affiliated health system is partnering with digital health company Vivalink in the BRITE-MOM study, which will use wearable ECG monitors to track participants in real time. The study aims to monitor women with congenital heart disease and pre-eclampsia through pregnancy and six months after delivery to identify signs of arrhythmia.

"Women with congenital heart disease and pre-eclampsia face a significantly elevated risk of arrhythmia during pregnancy, yet data on how and when these arrhythmias occur remain limited," Nicky Herrick, MD, a cardiology fellow at UCSF and one of the study’s principal investigators, said in a press release. "Our goal is to generate a detailed picture of the types, frequency, and symptoms of arrhythmias in pregnancy using wearable technology that allows us to monitor participants safely and remotely."

[Read also: New Study: RPM Reimbursement Needs a Reset.]

Healthcare providers are embracing RPM at a rapid pace, with an eye toward tracking their patients outside the hospital, doctor’s office or clinic and understanding how daily life may affect their health. In this particular case the focus is on identifying cardiac complications and reducing maternal mortality, which caused almost 33 deaths per 100,000 live births in the U.S. in 2021, according to the Centers for Disease Control and Prevention.

The study will collect round-the-clock data on heart rate variability, arrhythmia episodes and early indicators of cardiac stress. Often these indicators won’t show up in an office exam, either through testing or talking with patients, so it’s crucial to gather that data as the patient goes through her day.

UCSF says the study will help clinicians better understand arrhythmia patterns that can help guide early detection, clinical intervention and long-term care management.

"By incorporating wearable devices for long-term use, we are able to better capture arrhythmia episodes and early signs of cardiac stress that could otherwise go undetected," added Anushree Agarwal, MD, a UCSF Health cardiologist and co-principal investigator, in the press release.

CNOs must be equipped with the skills to advocate for policies that will improve the lives of their nurses and help them deliver the best quality care to patients.

Nurses across the country are faced with many challenges, such as workplace violence and staffing ratios, that have potential legislative components.

In a discussion about advocacy and policy at the 2025 HealthLeaders CNO Exchange, the participating CNOs had several areas of focus for nurse leaders wanting to get involved in the legislative process.

Here is a checklist of what CNOs can do to get involved in political advocacy. 

Click here to read the accompanying article. 

The research facilitated by the Buckeye Paws program aims to discover the impact of the program on nurses and the therapy dogs, says this nurse leader.

On this episode of HL Shorts, we hear from Beth Steinberg, associate director of research at the OSU Center for Integrative Health and program director for Buckeye Paws, about the additional research being done on nurse wellbeing in the Buckeye Paws program. Tune in to hear her insights.

PPEC programs like Spark Pediatrics give healthcare providers a resource to manage and coordinate care for children with complex care needs. They also give parents a chance to relax a bit, and enable these children to be kids.

Health systems and hospitals play an important role in coordinating care for small children with complex medical needs, who often transfer out of the NICU and into a chaotic and uncertain world.

A model of care called PPEC (Prescribed Pediatric Extended Care) aims to make that process easier for providers, patients and their families.

A concept that’s been around for roughly 40 years, PPEC centers are gaining momentum as the number of “medically complex” children surpasses 3 million in the U.S., straining the resources of both healthcare providers and families. The center-based model, likened to a day care, aims to give these children the care they need alongside the childhood they’re often missing out on.

“We’re helping kids [with complex medical conditions] get access to skilled nursing care,” says Jeffrey Soffen, CEO of Spark Pediatrics, a Florida-based PPEC provider that is working with more than a dozen health systems across three states. “We promote socialization. We promote respite for the families so that they can either have time to themselves or time to go to work or whatever it might be. I'd say right now that's really important.”

There are roughly 180 PPECs in the U.S., located in the 15 states whose Medicaid programs permit the centers (Medicaid requires a prescription for care from the child’s primary pediatrician). Several states, including Missouri, are debating amending their Medicaid program to permit PPECs, but the path forward is slow and uncertain, especially considering the current political climate.

Earlier this year Spark Pediatrics raised $15 million in new investments, with funding from Pittsburgh’s UPMC Enterprises and the Houston’s Memorial Hermann Health System. Soffen says the funds will enable Spark to establish new partnerships in Pennsylvania and Texas, the next step in a plan to expand across the country.

“Spark is creating a new model of care delivery for children with medical complexities that is aimed at improving quality of care and the family experience for this often-overlooked population,” Mary Beth Navarra-Sirio, Vice President of Market Development at UPMC Enterprises, the innovation, commercialization, and venture capital arm of UPMC, said in a January 2025 press release on the funding round. “This aligns well with our focus on creating innovations that impact the lives of patients in meaningful, lasting ways.”

Soffen says medically complex children often begin their lives in the hospital NICU, move through other departments in the hospital, then need care from a wide range of doctors, nurses and specialists when they go home—tasks that often fall on stressed parents. On top of that, there are often delays, some as long as a year, in accessing specialists.

"We Should Be Locking Arms"

That’s where care coordination becomes a necessity.

“Our kids are born in their NICU, they're going back to their hospitals, they're seeing their pediatricians,” Soffen says. “It feels like we should be locking arms, right?”

Spark uses a patient-centered medical home strategy at about half the cost of in-home care, he says. Through a care team that collaborates with specialists, the center offers up to 12 hours of care seven days a week, with a patient-to-staff ratio of 1:3.

“My biggest thing that I want to do is make these kids’ lives easier,” Soffen says. “If you think about a child that we serve, they might have 12-13 specialists. They might have an appointment every week with a different doctor. [Parents] also have to coordinate therapies. So if you have a feeding tube, you've got to be working on swallowing in order [to make] progress and eventually get this feeding tube out.”

“We need to do as many of those things in our center as possible, but we also need to understand who we are and who we are not,” he adds. That means the center focuses on a small care team and coordinates specialist visits, taking the pressure off of parents who would otherwise be scheduling specialist visits at home or transporting their children to doctor’s offices and clinics.

For that reason, Spark Pediatrics—like most PPEC providers—needs to be located near large population centers.

“The more kids that we serve in a center, the more we can do for them, and that's the really powerful thing,” Soffen says. “So if I have 30 kids in my center instead of 10, my ability to attract providers to do virtual visits or come into the center to do a wellness check is a totally different scenario. If they can see 20 kids instead of five kids, that makes it worthwhile.”

That’s why Spark Pediatrics started in Florida and is targeting heavily populated states like Texas and Pennsylvania. Medicaid support is crucial, Soffen says, as almost all of their patients are on Medicaid, and Spark is working with legislators in states like Missouri to expand the number of states they can work in. They’re also talking to private payers about the value of the program.

The UPMC partnership, meanwhile, has an added benefit of an associated health plan, offering opportunities for innovative care arrangements like an ACO.

“An ACO is a is a way for providers to come together to produce better outcomes for their patients and to do it in a cost-effective manner than incentivizes them to do that,” Soffen says. “Why shouldn't we be a part of that if we're able to help them achieve that goal?”

"Why Shouldn't They Have That Chance to Just Be a Kid?"

Soffen says they’ve had good conversations with pediatric hospitals (their partners include Nemours, Joe DiMaggio Children’s Hospital, Orlando Health’s Arnold Palmer Hospital, Palm Beach Children’s Hospital, Baptist Health Jacksonville’s Wolfson Children’s Hospital and Texas Children’s Hospital). But the wider strategy is to partner with any health system that treats medically complex children.

“A big part of our job is to educate, in particular, the hospitals, the discharge coordinators, the care managers, the case managers, the pediatricians, the specialists, the pediatric specialists,” he says. “Those are who our kids are going to every day and they're the ones that put their trust in those institutions to recommend what is best for them.”

The biggest barrier, of course, is funding, and the ongoing chaos in Washington DC over Medicare and Medicaid sustainability casts a shadow over the growth of any PPEC.

That’s why Soffen wants healthcare providers and lawmakers to see not only the financial and clinical value to these centers, but what these facilities can offer to children and their parents.

“You want these kids to have the childhood that you dream about, where they come home from friend's houses or birthday parties or doing arts and crafts, and you put [their artwork] on your window and you're so proud of them,” he says. “Why shouldn’t they have that chance to just be a kid.”

The next challenge for virtual nursing will be growing to scale, says this virtual care leader. 

Health systems have made significant strides in virtual nursing over the past few years as technology opens the door to new possibilities.

Stephanie Johnson, executive director of virtual care for UnityPoint Health, recently gave HealthLeaders an update on the health system's virtual nursing progress over the past year.

Johnson is part of the HealthLeaders Virtual Nursing Mastermind program, which brings together several health systems to discuss the ins and outs of their virtual nursing programs and what their goals are now and for the future.

What's changed?

Last year, according to Sarah Brown, UnityPoint's CNO, the goal of the virtual nursing program was to improve the nurses' experience by offloading burdens and giving them time back at the bedside.

In the past year, Johnson explained that the biggest evolution is the shift from a decentralized, market-based model to a centralized leadership structure, with standardized workflows.

"Standardization of workflows is happening in parallel with the centralization," Johnson said.

The biggest challenge going forward, according to Johnson, is the investment in growing to scale. In terms of equipment, UnityPoint is adding in-room technology this year.

"This is happening on a single unit as proof of concept, with the intent to scale the technology system-wide," Johnson said.

Currently, the health system uses a separate vendor solution for their software platform. However, as offerings evolve, Johnson expects that to shift to the EHR.

"We anticipate more collaboration with Epic as their service offerings continue to develop in the future," Johnson said.

UnityPoint is measuring outcomes using a virtual nursing dashboard to track several quality and process measures.

"Some of the data, such as first-year turnover, is yielding the results we anticipated," Johnson said.

Future of care delivery

In terms of the program's impact on staffing, Johnson said their strategy is still in the infancy stages as they continue to focus on building strong foundations.

"The future will focus on a growth strategy where we can continue to support the bedside and in-house nursing staff," Johnson said, "by assessing new opportunities across a variety of care settings including the ED, L&D, and transfer center."

As for what comes next, Johnson said there might be some opportunities for integration into care programs that extend beyond the hospital.

"[We are] starting to consider opportunities to collaborate with bed placement and care coordination," Johnson said.

Lastly, Johnson is most surprised by UnityPoint's progress in virtual nursing as measured by nurse and patient reactions.

"The patient and nursing adoption and satisfaction has been overwhelmingly positive once given the opportunity," Johnson said.

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

The Charleston-based health center, participating in HealthLeaders’ Virtual Nursing Mastermind program, is ready to move beyond med/surg units and put virtual nurses in the ED, ICU and specialty care programs.

It’s an “exciting time for nursing transformation,” says Emily Warr, Administrator for the Center of Telehealth at the Medical University of South Carolina (MUSC). And that means it’s time for the health system to scale its Virtual Nursing program beyond their med/surg units.

“We have grown significantly, are planning to pilot in room equipment this quarter, and are making great progress with quality and finance metric improvements,” says Warr, a participant in the HealthLeaders Virtual Nursing Mastermind program.

MUSC, which has taken part in the Mastermind program the past two years, is seeing growth at a time when many health systems and hospitals are ramping up their virtual nursing programs to meet a rising demand for effective care transformation. Many are looking to move beyond the initial ROI of improving nurse workflows and well-being and are looking for clear clinical value, such as improved patient outcomes or administrative metrics such as patient length of stay or admission/discharge times.

In a May 2024 HealthLeaders interview, Warr said MUSC had launched an earlier version of virtual nursing that didn’t succeed because it wasn’t sustainable. That led to a second iteration, which focused on specific pain points and targeted tasks in which success could be measured and proven.

“We needed to focus on something that we felt we could impact and choose to measure,” she said, such as “very specific, task-oriented things.”

Fast-forward to today, and Warr says they’ll soon be expanding the program beyond med/surg to the Emergency Department, ICU and other specialty care units.

“We can’t expand fast enough,” she says. “Nursing units across the system are demanding the service and are eager to see the benefits in their work area. I think the specialty units will be interesting to explore and will present scalability challenges, but we look forward to problem-solving those while maintaining a focus on outcomes and efficiency.”

MUSC’s program tracks several metrics, beginning with nursing satisfaction and turnover rates and patient satisfaction scores, all of which have improved with the program. They’re also charting pressure injuries and hospital-acquired infections, time to discharge, quality of information given to patients upon discharge, quality of patient-nurse communications and even time given back to nurses.

The health system is reporting a 10% reduction in nurse time spent in the EMR, a 5% improvement if patient experience tied to communication with nurses at admission, and a 10% improvement in patient throughput, or timeliness to discharge.

Perhaps the only drawback at the moment to expansion, Warr says, is a hiring pause on virtual nurses, which she says is necessary for MUSC to catch up on workflow efficiencies and investigate productivity.

With the transition to other departments within the hospital, she expects to see some new challenges. That includes creating workflows for virtual nurses in the ED that don’t conflict with floor nurses and the many different challenges that influence nursing care in the ICU, including drug administration, sedation, ventilator management and documentation.

And that’s where Warr is focusing her excitement. The expansion of virtual nursing to other departments not only poses new challenges, but opens up the model to new ideas for care management and new outcomes for improvement. That the program has worked so well in med/surg doesn’t mean it will thrive in other environments, but MUSC has the experience and the data to build off of those early gains.

That includes, eventually, new care pathways that extend outside the hospital, even into the home.

“We have virtual nursing roles in all areas of our virtual ecosystem,” she points out.

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on accelerating your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com

CMS spent almost $200 million on remote patient monitoring in 2023, and more providers are embracing the technology to track patient biometrics. That’s why the time is right to align payer policies and reimbursement on high-performing programs.

Healthcare providers are finding increasing value in remote patient monitoring (RPM), and that ROI is tied to Medicare and Medicaid reimbursement. But those payments are limited, and some providers are saying they don’t get enough back to justify the investment in new technology and workflows.

With that in mind, a new report says the time is right to rewrite RPM policy, improving reimbursements and giving providers more opportunities to embrace innovative tools that can improve clinical outcomes.

The report, from the Peterson Center on Healthcare, finds that Medicare expenditures on RPM have grown from $6.8 million in 2019 to $194.5 million in 2023, but that’s still just a small part of overall Medicare spending. The growth is driven by CPT codes approved by the Centers for Medicare & Medicaid Services (CMS) for some remote physiological monitoring (RPM) and remote therapeutic monitoring (RTM) services, as well as a growing number of vendors offering RPM devices and management services and a general desire among clinicians and care teams to track their patients’ biometrics outside of the doctor’s office, hospital or clinic.

CMS reimbursement began in 2019 and was expanded in 2023,and as of September 2024, 42 states now have some form of reimbursement through Medicaid for certain RPM services. But the report notes those rules are limited and commercial payer adoption is inconsistent.

That’s why, the report says, policy-makers, providers and payers should come together to improve reimbursement opportunities. The report lists three recommendations:

• Align coverage and reimbursement for RPM services to clinical value.
• Ensure access to high-impact RPM services.
• Improve data collection in RPM tools and programs.

“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”

A Service Ripe for Expansion and Improvement

The report lists four takeaways from a review of CMS data:

• Only about 1% of Medicare patients are in remote physiological monitoring programs, and even less are using remote therapeutic monitoring. But those numbers are growing, from 44,500 in 2019 to 451,000 in 2023 for RPM and roughly 52,500 in 2023 for RTM.
• Providers are billing RPM services for longer periods of time, from an average of 1.7 months in 2019 to 5.2 months in 2023.
• More than half (57%) of all Medicare spending on remote physiological monitoring services focuses on hypertension, while 13% addresses diabetes and 6% targets sleep and waking disorders. For remote therapeutic monitoring, almost 60% targets musculoskeletal disorders, while 5% addresses either respiratory disorders or hypertension.
• In 2023, traditional Medicare spent $194.5 million on remote physiological monitoring services and another $10.4 million on remote therapeutic monitoring services, which comes out to an increase per-patient from $154 in 2019 to $431 in 2023.

The report suggests that RPM reimbursement be tied to those specific programs that show the most value.

“Coverage and payment policies should be aligned with this evidence to encourage adoption of solutions that deliver clinical benefits and limit payment for monitoring that is not driving meaningful clinical improvements,” the report states.

Why Are Doctors Embracing RPM?

The report also revealed three key takeaways to clinical value for RPM programs:

• The clinical impact of RPM varies by condition.
• Clinical benefits from RPM depend on provider engagement with the data collected and the ability to act on that data to improve outcomes.
• RPM programs are time-limited, and clinical effectiveness varies depending on the condition.

“These clinical findings suggest that reimbursement for remote monitoring solutions should reflect effectiveness and vary by duration,” the report said. “CMS and other payers should consider developing condition-specific billing guidelines that match the periods of highest effectiveness as evidenced by clinical benefit for each condition.”

“Once an evidence-based time limit for remote monitoring services is reached, continued coverage of these services should require additional clinical justification,” the report continues. “Medical necessity is already a standard in Medicare and Medicaid; this would be a step toward defining medical necessity criteria for remote monitoring technologies.”

As an aside, the report notes that providers currently have no limits on how long they can use RPM for a specific patient, and can be reimbursed “on a monthly basis in perpetuity for anyone with a diagnosed chronic condition, even if they are already well-managed.”

This points to the need for more detailed data on how providers are billing for RPM services and how these variations in the duration and effectiveness of treatment may impact healthcare spending.

The report also gives health system and hospital leaders a blueprint for developing an RPM strategy that makes the most out of available reimbursements. It can also be used to develop more effective programs, either by fine-tuning devices and care pathways for common conditions are creating new treatments to address gaps in clinical care.

Dogs provide a safe space for nurses to share how they're actually doing, says this nurse leader.

On this episode of HL Shorts, we hear from Beth Steinberg, associate director of research at the OSU Center for Integrative Health and program director for Buckeye Paws, about the benefits that therapy dogs have on nurse mental health and wellbeing. Tune in to hear her insights.

 

Nurses should be the ones advocating for nursing, say these CNOs.

Nurses across the country are faced with many challenges, such as workplace violence and staffing ratios, that have potential legislative components.

CNOs must be equipped with the skills to advocate for policies that will improve the lives of their nurses and help them deliver the best quality care to patients.

The HealthLeaders CNO Exchange is well on its way in Nashville as the participating members discuss everything from succession planning, leadership development, virtual nursing and AI, to workplace violence and nursing policy. On a panel about advocacy and policy, the participating CNOs had three areas of focus for nurse leaders wanting to get involved in the legislative process.

Issues to prioritize

According to the panelists, there are several key issues that CNOs should be prioritizing, with workplace violence policy at the top of the list. There has been a national push towards further penalizing those who assault healthcare workers, specifically with the Safety From Violence for Healthcare Employees Act, or the SAVE Act. Many have come to expect workplace violence in nursing, and CNOs need to counter that narrative and push for more legal protection for nurses.

The panelists made it clear that regardless of the viewpoint, mandated staffing ratio legislation is something CNOs must pay attention to. Reimbursement and full practice authority policies are also critical, especially for nurse practitioners, to demonstrate the value of nursing.

On a national level, nurse leaders now find themselves needing to defend Medicare and Medicaid, according to the panelists. There are several policies coming out of HHS that the panelists are concerned about and it's important that CNOs stay up to date with the newest proposals from legislative bodies at all levels.

Getting involved

The list of policies goes on and on, but the key takeaway from the panelists is that CNOs must be at the table during legislative discussions. Many policymakers do not understand the inner workings of the healthcare ecosystem, and by developing strong relationships with legislators, nurse leaders have the ability to make a real impact.

The panelists recommended that CNOs make appointments with local, state, and federal legislators outside of session, and make it clear that they can be a point of contact for when the legislator needs an expert. When the legislative bodies are in session, CNOs should make their presence known and engage as constituents.

CNOs should also develop relationships with their government relations teams at their organizations. Ultimately, the panelists emphasized that now is the time for nurses to advocate for nursing, rather than letting others do it for them.

Skills to employ

While advocacy might be new for some CNOs, it's necessary to take part in, and according to the panelists, there are a few key skills to work on that will improve advocacy efforts.

First, engage in storytelling. Everyone has been touched by a nurse or by the healthcare industry at some point in their lives, and by sharing those stories, CNOs can make nursing policies feel more personal to legislators who can prioritize them.

The panelists recommended following up with data to support the storytelling and emphasizing numbers that will stand out, such as vacancy rates. Nurse leaders should also get to know legislative aids and staffers who are doing a lot of the heavy lifting for the legislators as part of their team. Despite the overwhelming nature of politics and the constant change, CNOs should try to stay educated and be selective about where they can affect the most change.

The CNO Exchange continues, so stay tuned for more coverage.

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 CNO Exchange event, email us at exchange@healthleadersmedia.com.