CFOs dove right into the tough conversations about the impact of accountability and care strategy at the HealthLeaders CFO Exchange.
In a time marked by rapid change and financial uncertainty, CFOs are gathered in Virginia at the HealthLeaders CFO Exchange to dissect and address the multifaceted challenges keeping them up at night.
A major theme that emerged during the discussions was the impact of accountability on hospital finances, organizational culture, and structure.
How CFOs are Navigating the Complexities of Accountability
CFOs voiced concerns over the complexities involved in aligning health system operations with systemwide financial accountability. One of the key challenges they identified is determining who is responsible for outcomes within an organization—whether it's managers or leaders. This lack of clarity can complicate decision-making and hinder the efficient allocation of resources.
Danielle Willis, CFO at LCMC Lakeview Hospital in Louisiana, highlighted a crucial perspective: “It’s less about metrics, more about setting expectations.” Her comment underscores the need for a shift away from rigid numerical targets toward a broader understanding of roles and responsibilities.
Moreover, CFOs stressed that mergers and acquisitions add another layer of complexity to accountability. These transactions can significantly affect job roles and necessitate a reevaluation of who is accountable for what within a newly merged organization.
The Role of Culture and Relationships
Beyond accountability, the discussions delved into the importance of organizational culture and the structure necessary to support financial goals.
CFOs emphasized that fostering strong relationships among leaders, vendors, payers, and the entire organization is essential for achieving successful outcomes, especially when adopting new technologies such as AI and automation.
The need for what some referred to as "role reversal" was also a topic of conversation. CFOs suggested that executive teams should strive to understand the day-to-day work at the ground level, which is crucial for comprehending how automation and other technological advancements can be effectively integrated.
Championing Change and Ensuring Alignment
Another significant point raised was the importance of identifying who is championing changes within the organization.
CFOs questioned whether CEOs and COOs are leading these shifts and whether they are promoting new ways of thinking and acting within their teams. Without strong leadership driving these changes, progress can stall, leaving health systems struggling to take the next step forward.
CFOs agreed that alignment across all facets of a health system is critical for moving forward. This alignment needs to encompass not just internal operations but also the overall strategy for patient care, from acute to ambulatory settings.
Acute Versus Ambulatory Care: A Strategic Discussion
A significant part of the discussion also focused on care strategy, particularly the differences between acute and ambulatory care.
CFOs noted that while these two sectors of care need to align, they should not simply mirror each other. “You want to own the patient journey, from acute to ambulatory,” one CFO remarked, emphasizing the importance of a seamless transition across care settings.
Kyle Wilcox, VP of Finance for MercyOne Medical Group, added, “The playbooks don’t overlap. They have to complement each other.” This highlights the necessity of crafting strategies that acknowledge the unique needs and operations of both acute and ambulatory care, while ensuring they work together to provide comprehensive patient care.
Simplicity in Strategy
As the discussions concluded, CFOs shared a final piece of advice: don’t overcomplicate strategies. In the face of complex challenges, it can be tempting to get bogged down in the minutiae. However, maintaining simplicity and focus is crucial for effective decision-making and implementation.
The HealthLeaders CFO Exchange underscored the importance of accountability, alignment, and organizational structure in overcoming the financial challenges facing healthcare. With a commitment to innovative strategies and fostering collaboration both within and outside of the health system, CFOs are well-positioned to navigate the obstacles ahead and continue advancing toward delivering exceptional patient care within an efficient, effective organizational framework.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
The EHR company put on its usually flashy show, and while groundbreaking announcements were minimal, there are signs that the industry is starting to look at the technology in a new light.
Epic’s annual User’s Group Meeting (UGM) last week was all that it promised to be: Flashy, upbeat and befitting of the nation’s biggest EHR company.
But for healthcare execs who are part of the Epic universe as well as those on the outside looking in, there wasn’t much that could be called newsworthy. The company and its powerhouse leader, Judy Faulkner, are notorious for playing things close to the vest.
That said, here are the four biggest takeaways:
The AI Hype Machine Rolls On. More than 100 AI-enabled tools are already in the Epic toolbox, according to Faulkner, and the company has an aggressive agenda to develop the technology for both providers and consumers. The announcement puts Epic smack in the middle of the AI race, alongside some of the tech titans with which it’s also collaborating. And with little more than a passing mention of working with others and developing open-source tools, it’s clear that the company is making AI its next big marketing feature.
Playing With Payers? The Epic Payer Platform isn’t revolutionary, nor is it new. But it does address a consistent concern in healthcare: How to get providers and payers to sit at the same table to trade data and tackle key pain points in connecting care with compensation. Faulkner said roughly half of the Epic health system and medical group customers and seven of the nation’s largest payers are connected to the platform, with the goal of reducing denials and improving the prior authorization process. But will payers want to play in this sandbox? And what incentives could Epic offer to get them interested?
Looking to the Little Guys. Epic has long been focused on the biggest health systems and hospitals, to the point that some competitors have changed their approach to focus on smaller providers, from rural hospitals to medical practices, even FQHCs, Rural Health Clinics and specialty practices. Faulkner’s mention of the Washington State Health Care Authority, a collaboration between the state and Epic launched several years ago to support EHR adoption for smaller providers, may be an indication that the company has its sights set on expanding its reach.
Paying Attention to the Patient. From plans to make MyChart a more interactive tool for patients to the grand designs for Cosmos, it’s clear that Epic wants to get more involved with patient-centered care. Cynics will say they’re giving patients that same opportunity to experience the frustration with technology that doctors experienced a few decades back, but this strategy may be the most impactful of all to come out of the UGM. It recognizes that the EHR, for all its perceived faults, has evolved. If patients can draw as much value as clinicians from this platform, the opportunities for care collaboration and—yes, we’ll say it—value-based care are pretty good.
One strategy for recruiting specialty nurses is growing your own, according to this CNO.
On this episode of HL Shorts, we hear from Jesus Cepero, CNO at Stanford Medicine Children's Health, about how nurse leaders should implement recruiting and retention strategies to recruit specialty nurses. Tune in to hear his insights.
AI is now one of the biggest disruptors in healthcare as it works its way into all corners of the industry.
Many nurses have ethical concerns about generative AI, along with worries about job displacement and the potential loss of human touch and connection with patients. For CNOs and other nurse leaders, implementation is another big concern.
It's critical that CNOs incorporate AI into workflows in a way that will help nurses and patients, and not become a hinderance. According to Robbie Freeman, vice president of digital experience and the chief nursing informatics officer at Mount Sinai Health System, nurses need to have a seat at the table during decision making to make implementation go smoothly.
"One of the things that I think will be important as we start to see AI make its way into patient care is that our care team members, our nurses, have a seat at the table," Freeman said, "and that their voice is included in how we design these AI products, understand how they work, and then implement and ensure that it's a seamless experience."
At Mount Sinai, Freeman said they take a co-design approach to decision-making surrounding AI products, meaning that everyone sits down together at the table, including data scientists, engineers, and frontline team members, to design the best product that will work for everyone.
"Some of our best ideas come from our frontline team and our nurses," Freeman said. "Anyone in our organization can submit a request for an AI concept or idea, and we have many examples where the frontline team has sent us an idea, we would scope it out together, and where it makes sense, we would partner, develop, and bring it to life."
The goal is to help reduce the burden of documentation and improve the ability to keep patients safe while delivering high quality care, Freeman explained.
"I think when done in the right way, we can do a lot," Freeman said, "but we want to make sure that the key is having the nursing voice at the table along the way."
"It was inspired by the five rights for medications," Freeman said, "so we took that, and we wanted to look at it through the lens of AI."
Freeman said the authors came up with five things that are important to consider while implementing AI. Leaders should first identify the right objective, meaning the problem they want to solve with AI.
"[Make] sure that [it's] really clear why you're using the tool and the problem that you're solving," Freeman said.
Second, CNOs need to consider the right approach, while making sure that the AI will be integrated into the workflow and that the approach makes sense. Third, CNOs must have the right competency on the team that will be using the AI, and make sure that the team members understand the "why."
"We don't want to just blindly follow the output of an AI model," Freeman said, "because we really look at this as an augmented intelligence tool and it's not going to ever replace our clinical decision-making."
Fourth, the right data is critical. CNOs need to understand how the data is sourced and interpreted by asking questions about how the AI was trained. Fifth, any implemented AI tool must have the proper safeguards.
"We [need to] make sure that we've tested it prospectively, we understand how it works, we've checked for bias, and that we've ensured that those steps were taken before it gets used for clinical care," Freeman said.
For nurse leaders
The goal of this framework is to empower nurse leaders with a set of high-level questions to ask before they implement an AI product, according to Freeman.
"If this was written for an audience of data science experts, we may get into some more technical discussions on hyperparameter tuning, or the way things are working under the hood," Freeman said, "but we tried to keep it at the business leader [and] clinical leader perspective to make sure we're at least addressing those big boulders."
However, health systems still should utilize those teams to work on the details, Freeman recommended.
"[As organizations] think about their AI governance structure, they need to have teams that can do that deeper dive into the very technical evaluations around the model," Freeman said, "like performance and how you're going to measure that over time, and watch for performance drift, and other considerations."
"This was really through the lens of a nurse manager or nurse leader," Freeman said, "and it's not meant to replace organization-wide, overarching, robust governance processes that are also critical."
Taking action
To move forward with AI implementation, Freeman recommended that CNOs ask about AI governance and make sure that nurses have a voice at that table. Nurse leaders should have a voice in any tools that are used at the point of care by the frontline nursing team.
"I think the CNO plays a really important role there advocating for the nursing team, advocating for the safe and ethical use from the patient perspective as a patient advocate, and ensuring that they have a voice within the governance process," Freeman said. "I think that organizations who do that well are going to be really well positioned to realize a lot of value from their use of AI."
CNIOs can also be a great partner for CNOs, Freeman explained, since they can help with communication between the technology teams and the clinical teams.
"I would encourage our CNOS and chief nurse executives to lean on their CNIOs and their nursing informatics team members who can play a really important role here," Freeman said.
The INN Between offers a wide range of services for homeless patients and those in unsafe living conditions. Health systems and hospitals should take notice.
A unique program in Salt Lake City is managing care for underserved patients who live on the street or in an unsafe location, and helping hospitals reduce ED crowding, improve care coordination and reduce costs in the process.
The INN Between is a nine-year-old program that began as a 16-bed Catholic convent and is now an 80-bed “assisted living facility” of sorts, offering everything from hospice care to rehabilitation and care management services.
The organization addresses a significant care gap for health systems and hospitals who see these patients in their Emergency Departments and ICUs—and who often discharge them to an uncertain care landscape.
“How can they continue to care for the individual if they’re not going to a home?” notes Jillian Olmsted, The INN Between’s CEO and executive director. “And how can they make sure they’re getting back to those appointments?”
Seeking Support from Providers
When the organization first opened its doors, Olmsted says, Salt Lake City’s two main health systems, Intermountain and the University of Utah Health’s Huntsman Cancer Institute, paid a per-bed per-night fee to house discharged patients, but that arrangement soon ended. Intermountain now provides a charitable donation, and The INN Between, which operates year-to-year on a budget of $1.6 million (recently cut down from $2 million), exists on a mishmash of charitable donations, grants, and the occasional federal or state subsidy.
According to Olmsted, an independent study found The INN Between has helped local hospitals reduce the average yearly length of stay for this population by 13.49 days from admission to discharge, representing a 91.44% decrease in hospital utilization and about $47,000 in annual savings per patient.
Olmsted is hoping to present this study to health system executives this fall.
Jillian Olmsted, CEO and executive director of The INN Between. Photo courtesy The INN Between.
“They are the primary beneficiaries of this program aside from the patient,” she notes, and hospitals “are extremely motivated to discharge to someplace other than a shelter.”
She says the organization serves a variety of needs, including hospice and medical respite care. It also acts as a temporary home for patients with complex care issues, such as transplants, recent surgeries and those undergoing cancer treatment, patients with chronic care issues like uncontrolled diabetes, all of which might need a safe home environment in order to qualify for medical care.
“So we help clear up all those barriers for them, maybe help get them on Social Security, get their ID, Social Security card, all the things that prevent them from getting into some sort of housing,” she says.
“We're helping individuals just learn about their medical condition and treatment plans, helping them get that one medical home because oftentimes they've gone from ER to ER or clinic or pain doctor and they don't know where to fill their prescriptions,” she adds. “They don't know how to get their medical records, so we help get them one primary care doctor so that they can be more successful.”
Addressing a Societal Concern
Without a resource like The INN Between, it’s likely a lot of these patients would fall through the cracks. They’d return to the streets or another unsafe living situation, ignore follow-up appointments and prescriptions, and eventually show up in the ED with a more serious health concern, repeating the ED-to-ED cycle.
According to Greendoors, which develops community partnership programs to help the homeless, each visit to an ED costs $3,700; at an average of five ED visits a year, that’s at least $18,500, with much higher costs for frequent users. In addition, homeless patients often spend at least three days in the hospital, at a cost of more than $9,000.
Continuing that thread, roughly 80% of ED visits by the homeless are for medical issues that could have been prevented through preventative care, and the homeless are at a far higher risk of developing chronic health concerns. Little data is available on the cost to the healthcare industry for missed care appointments or unfilled prescriptions. Finally, these costs are usually not recouped by health systems and hospitals.
The national effort to identify and address social determinants of health (SDOH) has in some ways put this issue in the spotlight, and many healthcare organizations are taking a look at how to address these costs and this population. But progress is slow.
Providing a Place to Stay
Olmsted says The INN Between is staffed by some nurses and CNAs, care coordinators and case managers, a wide assortment of volunteers, including chaplains, representatives from Mental Health America, and occasionally social workers or people on internships or some other arranged program. Hospice care is coordinated through the hospice care provider of the patient’s choice. And through the national No One Dies Alone (NODA) program, volunteers are on hand to sit at a patient’s bedside during their final days.
“It's just an extra set of eyes and ears for maybe when someone's no longer able to push the call button,” Olmsted says, adding that each patient who passes away is remembered in a house meeting later on.
She says there are plenty of stories about the people who stay there.
“People come in with rough exteriors, not willing to accept help,” she says. “They've lost trust in healthcare. They've lost trust in homeless services, but here they have their own room and a TV. And they get to choose when they eat, and they have a dresser, and I think it just helps people change and think, ‘Maybe there’s something different for me. Maybe I don't need to just stay in the cycle of homelessness and, you know, in and out of the shelter.’”
The INN Between can’t currently bill payers for its services. Olmsted is working with a lobbyist to push passage of state legislation that would enable them to qualify for a Medicaid waiver that would allow health plans to pay for medical respite care and housing support for homeless beneficiaries as medical expenses.
The push for permanent source of funding is crucial, as is the quest for support from the healthcare industry, including hospitals and health systems. Olmsted says The INN Between serves an important role in the healthcare ecosystem that is often overlooked or addressed by small groups, charities, and the likes of the Ronald McDonald House.
“My hope would just be that if we can have a sustainable funding stream that we would just be a really good model for different states to follow,” she says.
The standard care model for nursing will be highly comprehensive, due to the integration of virtual nursing.
HealthLeaders spoke to Steve Klahn, system clinical director for virtual medicine at Houston Methodist, about the widespread impacts of virtual nursing on the healthcare industry. Tune in to hear his insights.
A pilot project coordinated by the Michigan Health Information Network aims to help hospitals share critical patient data with EMS providers and ambulances.
Hospitals often face difficulties accessing data on patients coming into their Emergency Departments. A new health information exchange project in Michigan could help.
The Michigan Health Information Network (MIHIN) recently conducted a pilot with Hillsdale Hospital, Reading Emergency Unit, and Beyond Lucid Technologies to create a secure pathway for information exchange between the EMS provider and the hospital, using MIHIN’s secure network and Beyond Lucid’s technology platform.
During the pilot, an REU ambulance transporting a patient to Hillsdale Hospital was able to send an electronic patient care record containing the patient’s vital signs and other clinical information, including medical history and social determinants of health, to Beyond Lucid’s tech platform. That platform converted the data to a Continuity of Care Document (CCD), which was securely transmitted over the MIHIN network to the hospital, enabling care providers to get an accurate assessment of the patient prior to arrival in the ED.
Secure data exchange in emergency care is a complex pain point for health systems and hospitals, many of which don’t have a secure or reliable pathway to exchange information with EMS providers, ambulances, police and fire departments and other mobile responders. With the advent of digital health technology and health information exchange networks, the push is on to create those pathways so that hospitals can coordinate care for ED patients.
“Ambulance and fire services are often the first point of contact for patients suffering a medical emergency,” Tim Pletcher, MIHIN’s executive director, said in a recent press release on the pilot project. “In these time-sensitive situations, expedient access to accurate patient health information is critical for making informed decisions and providing effective care. The partnership between MIHIN, Reading, Hillsdale Hospital and Beyond Lucid Technologies offers a promising solution for improving access to patient data in pre-hospital settings by providing a more complete picture of a patient's health during critical moments and minimizes the risk of errors associated with incomplete or inaccurate information.”
In a 2023 interview with HealthLeaders, Jonathon Feit, MBA, MA, Beyond Lucid’s co-founder and chief executive, said the healthcare industry has been slow to embrace the idea of a common framework for data sharing in emergencies. He noted that in 2020 the Cleveland Clinic, Essentia and Sanford Health were all unable to integrate EMS-based data into their Epic EHR even though Epic had published the data import specifications on its website.
Secure data exchange in emergency and urgent care is crucial for a number of reasons, not just ED transports.
“Consider prescription medications and substance use challenges," Feit said. "Substance use challenges [can] fester into overdoses due to a lack of visibility into patients’ encounters with care settings across jurisdictional lines. If a patient in Ohio sees a doctor in West Virginia, Kentucky, or Indiana, there is presently no mechanism for the Ohio-based fire or ambulance crews, or hospitals, to know what medications the patient should have been taking, which makes it much harder to surmise what she or he likely took."
Feit said the MIHIN project is an important step forward for interoperability.
“Michigan is a complex prehospital and post-hospital medical transportation ecosystem, and the partners to this project sought to create an onramp for any mobile medical agency to enjoy the benefits of true interoperability across the state,” he said in the MIHIN press release. “It also proves something that deserves to be shouted from the rooftops: This isn’t about fire or EMS or public or private services. It is about continuity of patient care, and getting everyone on the same page so that responders can deliver the most informed care possible.”
While the first phase of the project demonstrated the ability to share date between the EMS provider and the hospital, a second phase targets a familiar idea: A portable patient record that goes with the patient and can be accessed by EMS providers and others.
According to MIHIN, the organization “will create a real-time active care relationship between the patient and the mobile medical agency, enabling it to receive future discharge medication reconciliation reports from participating hospitals, improving medication management for patients.” MIHIN would then be able to share that ambulatory CCD with the patient’s care team.
In addition, MIHIN plans to expand the project to include fire and rescue services in two nearby communities.
At its annual user's conference, the EHR giant unveils a strategy that includes hundreds of AI programs and plans to address inpatient monitoring
As healthcare organizations develop AI strategies that use both in-house talent and outside vendors, Epic is reminding the industry that most of those new tools will work best through the EHR.
And they're even better if you're part of the Epic universe.
The nation's largest EHR vendor launched its 45th annual User's Group Meeting (UGM) on Tuesday with an exposition from company founder and CEO Judy Faulkner and several top executives on past successes, current programs—including a glitzy accounting of health systems and hospitals switching over to the Epic platform--and future plans. And with more than 100 AI applications now in use, the company aims to keep the momentum going.
"Healthcare still has tons of problems and … challenges," she announced, and Epic's goal is to "try to make care better."
Epic's pitch to attendees from every state and 16 countries, both at the Verona, Wisconsin campus and online, was two-fold. The company wants to keep its customers in-house, embracing new services and opportunities rather than adding onto the platform from outside sources (what Faulkner called YOYO, or You're On Your Own). In addition, Epic is looking to establish its capabilities as an AI innovator, with hopes of using the technology as a springboard to more growth.
Faulkner spearheaded this strategy by noting Epic has scored early successes with AI in two clinical care programs currently in the spotlight: e-mail inboxes and the doctor-patient encounter.
According to Faulkner, some 186 healthcare organizations are now using Epic's AI Charting tool, which uses ambient technology to capture the conversation, produce a transcript almost immediately and, after clinician review, enter the data into the medical record.
"A click saved is a click earned," she said.
She and other executives said the company plans to enhance this service to include orders, ED notes, inpatient notes and charting for nurses (a feature that Baptist Health, Duke and Intermountain Health are already testing).
In addition, Faulkner said more than 150 healthcare organizations now use In Basket ART (Automated Response Technology), which uses AI to sort through e-mail messages and, in some cases, provide responses. The tool, she said, saves clinicians about 30 seconds per message and, in many cases, offers patients a more empathetic response than one written by a stressed-out doctor or nurse.
"I think that's kind of funny: The machine is more human than the human," she added.
Proposed enhancements on that tool include meeting summaries, message drafts, conversational search and suggestions.
And while the company has more than 100 AI features now inn use, Faulkner and her executives noted many other possibilities for the technology, including bi-directional faxing, routing claims through the EHR without the need of a clearinghouse, personalized patient reminders and recommendations through MyChart, chronic disease management summaries, and billing code recommendations.
Two areas of particular interest are payers and inpatient services. Company executives said Epic will develop AI tools to help providers work with payers on everything from claims to appeals and billing, and will debut a Professional Billing Exchange this fall.
As the inpatient experience, Faulkner and executives said Epic is designing AI tools to help monitor patients and detect or even prevent falls, as well as tools to automatically identify staff when they enter a room, aid in virtual nursing, and help patients with communications and entertainment options.
As with any user's conference, the Epic presentation was meant to update healthcare organizations on the company's progress, but it also underscored the intense competition in the healthcare marketplace for AI. As Senior Vice President Sumit Rana noted, there will come a time when the health system C-Suite has "AI vs. AI" conversations.
"While AI might not be perfect, it is developing rapidly," he noted. "AI is a force multiplier."
Virtual care platforms have many benefits for nurses, patients, and their families, say these healthcare leaders.
Many organizations are turning to virtual nursing to address staffing and wellbeing, and with the current trajectory virtual care will be an integral part of the future of healthcare.
The use of telemedicine following the COVID-19 pandemic kick started the virtual nursing movement. And while some systems are just getting started, many have been utilizing virtual nursing for years and continue to expand.
Researchers at Brigham and Women’s Hospital used AI to help understand when radiation treatments can cause dangerous heart arrhythmias.
Healthcare researchers are now using AI to gain a better understanding of when patients should and should not receive radiation as part of their treatment.
In a study published in JACC: CardioOncology, a team from Brigham and Woman’s Hospital used an AI tool to better understand the risk of cardiac arrhythmia for patients undergoing radiation treatment for lung cancer. The results not only could lead to better treatment plans but also improve care for the estimated 1 in 6 patients who experience severe side effects, including death.
“Radiation exposure to the heart during lung cancer treatment can have very serious and immediate effects on a patient’s cardiovascular health,” Raymond Mak, MD, director of clinical innovation for the Department of Radiation Oncology at Brigham and Women’s and corresponding author for the study, said in a press release. “We are hoping to inform not only oncologists and cardiologists, but also patients receiving radiation treatment, about the risks to the heart when treating lung cancer tumors with radiation.”
The study is just the latest effort by health systems and hospitals to apply AI to clinical care pathways.
This research targets patients receiving radiation therapy to treat non-small cell lung cancer (NSCLC), for which arrhythmias can be a common side effect. Because NSCLC tumors and the treatment to eradicate them occur close to the heart, the heart can be affected by those doses of radiation.
The Brigham and Women’s team used AI to gain a more focused understanding of how the heart is affected by that radiation treatment. Researchers analyzed data from 748 patients who had been treated with radiation for locally advanced NSCLC to identify different types of arrhythmia that can occur. They found that 1 in 6 patients experience at least one grade 3 arrhythmia within roughly two years of treatment, and 1 of every 3 of those patients experienced “major adverse cardiac events.”
“An interesting part of what we did was leverage artificial intelligence algorithms to segment structures like the pulmonary vein and parts of the conduction system to measure the radiation dose exposure in over 700 patients,” Mak said in the press release. “This saved us many months of manual work. So, not only does this work have potential clinical impact, but it also opens the door for using AI in radiation oncology research to streamline discovery and create larger datasets.”
Mak and his team concluded that radiation oncologists should collaborate with cardiology specialists when developing radiation treatment plans, including embracing strategies that “actively sculpt radiation exposure” away from the areas of the heart that are susceptible to arrhythmias.
