CVS Health is identifying at-risk members of Aetna health plans of upcoming heat waves and connecting them with resources for care management.
CVS Health has launched a digital health program aimed at consumers affected by heat waves and other extreme weather events.
The company is using a data analytics platform to identify at-risk patients, such as those with chronic health conditions, when an excessive weather event is expected to occur in their area. The service is currently available to members of Aetna health plans, with plans to expand to CVS Pharmacy and Minute Clinic locations.
“Extreme heat kills more Americans each year than all other weather events combined,” Dan Knecht, vice president and chief clinical innovation officer for CVS Caremark, said in a press release. “In addition to fatalities driven by heat strokes, extreme heat can worsen chronic conditions such as cardiovascular disease, asthma and chronic obstructive pulmonary disease.”
With more health systems and hospitals using digital health tools to connect with patients outside the hospital or doctor’s office and boost engagement, strategies like this could become more popular. Healthcare organizations need these types of outreach to improve care management and coordination and address preventive health and public health issues.
Technology plays a key role in these programs. Data analytics and AI tools can help care providers quickly identify at-risk patients and even send tailored e-mail, text, or phone messages. They can also alert primary and emergency care providers, including hospital emergency departments and clinics, to prepare for increased traffic.
Looking even further, these platforms could be used to synch in police, fire, ambulance and EMS departments as well as telehealth programs.
Through the CVS Health program, Aetna care teams can identify and contact at-risk members as many as seven days ahead of an extreme weather event and connect them to the appropriate resources, such as Oak Street Health clinics and other urgent care clinics, cooling centers, and pharmacies.
The company is first focusing on heat waves, with excessive heat alerts and pargeted outreach for those affected by hot weather. It plans to expand the platform in the fall to patients susceptible to reduced lung function, asthma and cardiac problems caused by excessive exposure to air pollution.
This type of program could also be expanded to cover extreme cold weather, smog alerts (or other alerts tied to air quality), wildfires, floods, dangerous storms, even epidemics and other outbreaks.
The Bipartisan Policy Center is recommending that Congress extend the CMS model for five years and study whether the innovative program is cutting costs and improving care outcomes.
The Bipartisan Policy Center is recommending that the Centers for Medicare & Medicaid Services extend the Acute Hospital Care at Home (AHCaH) program for another five years while launching a study to determine whether the innovative program is reducing costs and improving care outcomes.
The Washington-based think tank’s report comes at a crucial time for supporters of the Hospital at Home strategy. The November 2020 waiver issued by CMS for its AHCaH model, which relaxes rules on providing home-based acute care and enables hospitals and health systems to seek Medicare reimbursement, is set to expire at the end of this year, a move that could threaten the sustainability of many programs.
Currently CMS has authorized 331 health systems and hospitals to operate an ACHaH program, though not all are doing so; others are running or developing variations of the acute care at home model.
“Research shows that hospital at home models yield positive health outcomes,” the BPC report states, citing a small study which found that the program led to shorter hospital stays, lower readmission rates, fewer diagnostic tests, and lower costs compared to patients admitted to the hospital for the same health concerns.
“Initial data show promise, including the potential for cost savings,” the report added. “But more research is needed on patient and caregiver experiences, access and patient selection, the cost impact on Medicare and Medicaid, hospital expenses, and service delivery across diverse populations. Research is also needed on whether the relatively small number of hospitals participating is nonrepresentative and unique. … Congress needs more clarity about the likely financial effects of the model if it were to move from a model with low uptake, which is the case today, to something that would be implemented on a larger scale.”
An Alternate Take on the Hospital at Home Model
While the model has drawn a lot of support, including a users group of healthcare organizations lobbying to make the model permanent, it has its detractors. Some have said the program is too complex and costly, drawing on too many resources for patients who should be hospitalized.
Jain argues that the model should be re-evaluated to filter out what he calls the “toxic positivity that has defined the hospital-at-home movement.” In certain cases the program will work, he adds, but there has to be “a definable cost advantage and sound, scalable, highly reliable underlying logistics.”
Immediate and Long-Term Recommendations
The BPC report offers several immediate policy recommendations, including:
Congress should extend the AHCaH model for five years to maintain participation, support investment from payers and providers and gather additional evidence on the program’s value. “A temporary reauthorization of five years would likely increase participation in AHCaH and incentivize state Medicaid investment, improving the diversity of participation,” the report said. “It would also allow policymakers to collect data on the model to guide future reauthorizations and make informed programmatic and financial decisions.”
Congress should provide funding for and direct CMS to provide technical support for health systems and states launching the ACHaH model, especially to improve access for Medicaid members.
Congress should also provide funding for a CMS-initiated study of the cost and quality of the ACHaH model, with a report submitted back to Congress by September 2028.
Congress should direct CMS to strengthen regulatory guidance for health systems and hospitals that include evidence-based protocols for the use of telehealth and remote patient monitoring (RPM), infectious prevention practices, fall prevention and escalation for clinical deterioration.
Congress should direct CMS to create quality measures for the ACHaH model, covering functions like tracking adverse events beyond mortality, a patient’s ability to connect with the care team after hours, and care team response times to escalations.
Congress should direct CMS to develop evidence-based, standardized language for health systems and hospitals to use when offering the program to patients.
The report also identifies key issues that federal policymakers will need to address when deciding the future of the program beyond five years. They include whether to make the program permanent, extend it further or end it; whether to modify the model to ensure sustainability; and how to ensure safety and program integrity as more health systems and hospitals adopt the model.
The Orlando-based nonprofit OneBlood says it's still operating but at "a significantly reduced capacity."
Orlando-based OneBlood is recovering from a "ransomware event" discovered on Monday and it's asking the more than 250 hospitals it supplies to "activate critical blood shortage protocols" as cybersecurity teams determine the extent of the attack.
Spokeswoman Susan Forbes says the nonprofit blood center is still operating and collecting and distributing blood but "at a significantly reduced capacity."
"We have implemented manual processes and procedures to remain operational," Forbes says, adding that these stopgap measures "take significantly longer to perform and impact inventory availability."
"In an effort to further manage the blood supply we have asked the more than 250 hospitals we serve to activate their critical blood shortage protocols and to remain in that status for the time being," Forbes says.
OneBlood did not say what the hackers were demanding or if a ransom was paid.
This week's attack on OneBlood is the latest in a string of high-profile cyberattacks targeting healthcare-related entities. The Change Healthcare hack in March paralyzed large swaths of the nation's care delivery system and cost parent UnitedHealth about $2.5 billion, including $22 million in ransom payoffs.
'A National Security Concern'
Mary Mayhew, president and CEO of the Florida Hospital Association, says OneBlood became aware of the hack on Monday, which investigators, including the Federal Bureau of Investigation, have traced back to Russia.
Mayhew says OneBlood handles about 80% of the blood supply for Florida hospitals and also supplies three other southeastern states. The blood center "was completely shut down" in the hours after the attack but has gradually brought services back on-line, Mayhew says.
"What we've heard is that they now have control over all their systems taken back from the cybercriminal," Mayhew says. "They are optimistic day-over-day, that their capacity will continue to increase as they are able to bring their systems back online.
"They are unable to give a date certain, but they believe it's a matter of days, not weeks. But we could continue to operate well below 100% of what a hospital typically receives and depends on for blood supply for at least another three to five days."
To compensate, Mayhew says the National Blood Task Force has been activated.
"They are drawing from the Red Cross and other blood centers and other national resources to try to get some blood into Florida," she says. "The biggest major concern is platelets. Platelets have a very short shelf life by days, and it's important to understand that for transplant surgeries, for open-heart surgeries, for certain cancer treatments, platelets are absolutely critical."
Mayhew says the OneBlood attack "really reinforces a focus on this as a national security concern."
"By that, I mean this is affecting our public health infrastructure when you are threatening the life-saving resource of the supply of blood," she says. "Just as we would have a national security response if there was an attack to our electrical grid or any other infrastructure that we depend on, this is obviously life and death when they jeopardize and undermine the supply of blood in our country."
Supported by a CMS alternative payment program, Illinois-based Egyptian Health is actively addressing SDOH and other barriers and helping kids get the care they need.
Rural healthcare organizations are getting serious about identifying and addressing the barriers that are keeping children and young adults from accessing the care they need—especially behavioral healthcare.
Many organizations, from health systems and hospitals to local clinics and public health groups, are screening for social determinants of health the moment someone comes through their door, if not sooner. Through surveys, interviews and digital health tools that can sift through claims and EHR data, they’re spotting barriers early on, including issues with housing, families, food, schooling and transportation.
“When kids come in and they have all of these other needs, basic needs, that if those aren’t met first, it’s really hard [for them to] to receive the more specialized services that they need,” says Angie Hampton, CEO of the Egyptian Health Department. “We were seeing that across the board.”
Founded in 1951 as a public health department, Egyptian Health serves a wide swath of rural Illinois known as Little Egypt. Based in Fairfield, the organization added behavioral health services in 1972; it’s now their fastest growing service, as more and more kids show up with behavioral healthcare needs that aren’t being addressed.
Hampton estimates some 11,000 children and their families rely on Egyptian Health for care. Any child under the age of 21 who is enrolled in Medicare or CHIP is eligible for those services.
And many are having problems accessing those services.
Egyptian Health was one of eight healthcare organizations selected in 2020 to enroll in the Centers for Medicare & Medicaid Services’ Integrated Care for Kids (InCK) Model, an alternative payment model borne out of the CMS Innovation Center that aims to reduce healthcare expenses and boost quality of care for children. The seven-year project, for which CMS has set aside almost $126 million, will reward providers who develop programs that identify and address barriers to access for at-risk children, putting them in front of the right care teams and keeping them out of the Emergency Room.
Hampton says Egyptian Health, like so many other healthcare organizations, was often reacting to SDOH and other barriers before developing a strategy to proactively identify and address them. Without that strategy, she says, kids were falling through the cracks, either ending up in the local hospital or avoiding care altogether.
Working with Solventum, a health management company spun off earlier this year from 3M, Egyptian Health began combing through claims data and other information to get a better picture of the youth population in their coverage area. They then created a strategy for surveying these youths on SDOH and other barriers and creating connections with the right resources to address those barriers.
A key element to this program, Hampton says, is primary care. Alongside the partnership with the state’s Medicaid program, Egyptian Health is coordinating care with a network of local hospitals, federally qualified health centers (FQHCs) and clinics. Under the CMS InCK model, participating providers will receive inventive payments based on the success of the program in meeting performance metrics, such as reduced ED visits and admissions and increased well child visits and follow-ups.
“Honestly it allows us … many additional opportunities,” Hampton says of the program, now in its fifth year and ready to report on outcomes and issue its first payouts this fall. She says Egyptian Health is “really focusing on what those interventions can be” and moving toward a time when they can focus more on care and less on the obstacles.
She says the program should also help the region’s schools, where teachers and other staff are spending more time addressing healthcare concerns and less time teaching.
One barrier that Hampton is seeing among providers is a lack of experience with alternative payment models. That has slowed adoption as providers learn what they should be doing to qualify for reimbursements.
She also sees a need to emphasize whole-family care and care for adults, which spurred Egyptian Health to expand the program to address those populations as well. The idea, she says, is that by resolving the barriers to care that one person or one family experiences, the door may open to affect and improve care for others.
Hampton says she’s eager to see the first results come out in August, which will provide concrete examples of how the program is working and give providers the incentive to keep addressing SDOH. And she’s working on new partnerships and grant opportunities to keep that momentum going when the InCK program ends in two years.
“We’re here now and it will only get better,” she says.
There are many different ways to demonstrate the value of nursing, according to these nurse leaders.
What is the value of nursing?
It’s an age-old question that circulates throughout C-suite meeting rooms in health systems across the country. And as of now, nursing often does not have a separate line item on many budgets, despite making up a large portion of the healthcare workforce.
Here are some ways that health systems could show the value of nursing on paper, according to To Katie Boston-Leary, director of nursing programs at the American Nurses Association (ANA), and Rudy Jackson, senior vice president and chief nurse executive at UW Health. Both Boston-Leary and Jackson are also HealthLeaders Exchange members.
During a recent HealthLeaders AI NOW panel, nursing leaders said the technology can help improve patient handoffs and scheduling.
Nurses face many headaches during their shift, including figuring out their schedules and making sure patient handoffs are done right. Could AI help them out?
Their bosses think so.
"We've been talking about nursing for a long time, about bringing back joy and practice," says Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy. "And I think done correctly, augmented intelligence … can really help us get there faster."
Rocchio participated in a panel at the recent HealthLeaders AI NOW summit that focused on how AI is figuring into a healthcare organization's nursing strategy. The panel, sponsored by Collette Health, included Jon McManus, Vice President and Chief Data, AI and Software Development Officer at Sharp HealthCare, and Nicholas Luthy, Collette Health's Chief Product Officer.
AI is the topic du jour in the healthcare space these days, and while a lot of the talk has centered on using the technology to improve back-office functions and give doctors more time in front of their patients, nursing leaders are eager to claim some of that spotlight.
The AI NOW discussion centered on how hospitals and health systems can use AI to improve nursing workflows and nurse well-being, critical factors at a time when many organizations are dealing with stress and burnout and a depleted nurse workforce.
McManus said San Diego-based Sharp HealthCare wants to "empower the nursing workforce with mobile-based technology so that they can document more at ease on the fly."
"The more that we can reduce some of the information worker burden that is attached to the modern nursing discipline is a key step toward coming back to top of licensure and why someone wanted to become a nurse in the first place," he noted.
"We've added the technology, we've added the electronic health record, we've added disparate technologies into the workflows of nurses, but what we haven't done is [understand] how we could literally integrate all of this to clean up the work environment and workflows," she said.
Nurses spend the most time in the EHR, she added, "and we're left at the bedside to have to go through all those amounts of information to get to what we need to make good decisions."
That includes patient handoffs. Rocchio said Mercy targeted that pain point with an AI tool, aiming to improve an often confusing process that accounts for roughly 80% of documentation errors. ED nurses often have to pull together disparate data, such as physician orders and EHR information, then pick up the phone and relay that information to the next member of the patient's care team.
Much like hospitals and health systems are using AI tools to summarize a physician's encounter with a patient, Rocchio said the technology can be used to help summarize a patient's ED stay. She said the tool has helped Mercy reduce charting errors by some 60%--and helped to identify breakdowns in care coordination.
"We didn't anticipate that unless the doctor signs their note in the emergency department, the items that we were pulling from that field weren't always coming across correctly," Rocchio said.
Aside from AI tools to improve interactions with the EHR and give nurses the patient data they need at the bedside, nursing leaders said they'd like to see the technology applied to the complex process of scheduling nurse shifts. A key factor in improving nurse workflows is giving them shifts that fit their work-life routine and aren't overwhelming. That includes factoring in vacations and time off requests and breaks.
"There's a lot of opportunity there to support improvements," McManus pointed out.
McManus, who's a member of the non-profit Coalition for Health AI (CHAI), which aims to establish standards for the safe and ethical use of AI in healthcare, said AI needs to be carefully planned and tested be health system leadership.
"You really need to practice micro to macro," he said. "You have to do pilot-based work. You have to do integrated feedback loops with your care teams. You have to kind of grow these disciplines."
He also said AI programs should be developed to improve existing workflows, not create new ones, and protocols should be based on facts.
"If you cannot ground in fact-based work, you're not going to be able to build any type of trust in those workflows," he said.
And as with any innovative idea, nurses should be included in planning and governance. Nurses need to be included in the deign of any new process or tool that they'll be using, and they need to understand how to spot problems and react quickly to correct them.
"I'm not sitting in a boardroom deciding what this looks like for our nurses," Rocchio noted. "I have an entire nursing informatics team that's on the ground, at the elbow, with our nurses, developing."
"Having our senior nurse leadership engaged in the topic, in the oversight, in the strategy development … is paramount," McManus added.
He added that AI literacy is taught throughout the health system.
"We're developing these foundational skills so that when we introduce specific features, we're supporting the readiness to use, the readiness to understand and the expectation of transparency and feedback loops," he said.
Addressing a common concern in healthcare that AI might replace jobs, both McManus and Rocchio pointed out that AI, to them, stands for augmented intelligence, and that the technology is a tool to be used by and for care providers, not instead of them.
"AI will never replace critical judgment," Rocchio noted.
Nurses should be burning bright, not burning out, says this nurse leader.
On this episode of HL Shorts, we hear from Dr. Shakira Henderson, Dean, Chief Administrative Officer, and Associate Vice President for Nursing Education, Practice and Research at the University of Florida College of Nursing, and System Chief Nurse Executive of UF Health, about how nurse leaders should implement recruiting and retention strategies that address burnout as well as the nursing shortage. Tune in to hear her insights.
A new survey from Carta Healthcare finds that almost half have found inaccuracies in their medical records, and more than half say AI can be used to improve accuracy.
Some 45% of consumers in a new survey say they’ve found inaccuracies in their medical records, and many feel that AI can be used to correct them.
The survey of more than 1,000 consumers, conducted by Propeller Insights for healthcare tech company Carta Healthcare earlier this month, finds an American public intrigued by the potential of AI, but also wary of its effects. For while 60% feel that the technology can improve the accuracy of medical records, more than half have concerns about security and more than 40% worry about accuracy.
“The integration of AI in healthcare record management shows promise, though trust issues need to be addressed,” company co-founder Matt Hollingsworth said in a press release. “As the healthcare industry continues to digitize, ensuring the accessibility and accuracy of medical records and addressing public concerns about AI integration will be paramount to improving patient care and trust in the system.”
Back-end functions like data entry and processing have been the low-hanging fruit for AI in healthcare, with numerous hospitals and health systems using the technology to relieve doctors and nurses of those administrative tasks. But a more savvy consumer population is keeping an eye on how that technology works.
That may be because younger generations, who are growing up with AI, are paying more attention to their medical records than their parents and grandparents.
Indeed, according to the survey, almost 61% of Gen Z and 52% of Millennials have had to correct a mistake in their records, compared to only 32.5% of older generations. All of the generations blame human error for those mistakes, with the Baby Boomers, at 60%, being the most critical. And at 84%, they also have the highest confidence that AI can help with the accuracy of healthcare data.
Accessibility, on the other hand, is not a big issue. Among those surveyed, 83% feel their medical records are accessible when needed, 74% know how to get to them, and 76% know how to request them from providers or payers.
And while they are finding errors, 86% believe their records are accurate and 67% say they don’t believe those errors have affected their current treatment. The errors, they report, are most often in personal information (33%), allergies or aversions (23%), and treatment history (22%).
According to the survey, 46% use e-mail to ask for their records, while 37% now do that through online portals. That said, only 28% of those surveyed have had to ask for their medical records.
Finally, 73% of those surveyed say the healthcare industry has the processes in place to ensure data accuracy, and 72% should play a part in ensuring the accuracy of their healthcare data through AI tools.
The survey should help healthcare executives to understand that while AI holds promise to address some of the industry’s biggest pain points, they should take care to ensure that the technology is monitored for accuracy. And because their patients and others are becoming increasingly knowledgeable around the use of AI, they can also use this as a marketing tool.
Nursing is often undervalued on paper. Some believe that reimbursement is the answer.
What is the value of nursing?
It’s an age-old question that circulates throughout C-suite meeting rooms in health systems across the country. And as of now, nursing often does not have a separate line item on many budgets, despite making up a large portion of the healthcare workforce.
To Katie Boston-Leary, director of nursing programs at the American Nurses Association (ANA), and a HealthLeaders Exchange member, that is a big part of why nursing is seemingly undervalued.
"I think a lot of it has to do with the fact that we're invisible in terms of how we contribute to the bottom line, particularly the financial well-being of institutions," Boston-Leary said. "We don't have a separate line item on the claim side and also on the reimbursement side."
In recent years, the idea of direct reimbursement for nurses has been making some headway.
The concept
According to the ANA, nursing costs are grouped in with patient room costs, and when the time comes for budget cuts, nursing is often the first to go. Direct-Reimbursement Nursing Model pilots "expand nursing practice and elevate the value of nursing through direct reimbursement for nursing care delivery, management, and coordination outcomes," says the ANA.
Anne Dabrow Woods, nurse practitioner and chief nurse of health learning, research and practice at Wolters Kluwer, says this model would impact both nurses and nurse practitioners, who provide primary care services but are not reimbursed in the same way that physicians are.
"They don't tend to see [nurse practitioners'] value as great as what a physician is, and all the research clearly shows that a lot of our care is equal to that of a physician," Woods said. "We're not saying we want to replace physicians, but we are saying we want to work collaboratively with them."
In terms of nursing, Woods argued that the lack of reimbursement communicates the lack of value for the work nurses do.
"Now as a nurse, it becomes really problematic if you're not getting reimbursed for the care you deliver … and you're lumped into that room and board charge," Woods said, "because it's very difficult to articulate the value that nurses bring to patient care in acute care settings or other settings if you can't reimburse."
Boston-Leary explained how in her experience as a chief nursing officer, she found that nursing was seen as an expense, which means it’s a liability and a cost that needs to be reduced.
"The way the system is set up, if organizations can reduce labor, particularly with nursing … and achieve excellent patient outcomes, that's the win," Boston-Leary said, "which doesn't help, because … nurses, in some cases, are going along with working [in] unhealthy work environments [with] unimaginable workloads."
"The harm is happening in the middle, which subsequently leads to issues with retention and ultimately recruitment," Boston-Leary said, "because word of mouth is a powerful thing."
Whether reimbursement is in the cards, Boston-Leary said, health systems are not properly valuing nursing.
"I think it's every institution's duty," Boston-Leary said, "it's more about the fact that there's a responsibility for every organization to understand how nurses contribute to the bottom line, because they do."
Reimbursement in practice
Many different reimbursement models could potentially be put in place if health systems decide to follow this strategy.
Woods said the first step is to look at nurses' impact on care and nurse-specific quality indicators. Some of the factors could include fall prevention, infections, and readmission rates.
The reimbursement process could be based on the model that physical therapists and occupational therapists use, according to Woods.
"They look at the overall patient acuity and they look at the time that is spent with the patient," Woods said.
Woods also suggested using the nurse equivalent to national provider numbers that others use to bill for their services.
"[Nurses] have a thing called a nurse's number, and you get that number when you pass your boards," Woods said. "If we could start associating the work of the nurse with their nurse's number, then you can start to really make a case for allowing nurses to bill for their services."
For payers, Woods said, change would likely begin at the federal level with the Centers for Medicare and Medicaid Services (CMS). This would provide a model for other payers.
"If we can get CMS to change, and there's been a lot of hesitancy for them to change up to this point," Woods said, "we would have a chance of changing other third-party payers."
Boston-Leary said there might be a pathway toward reimbursement in models that already exist for advanced practice nurses. However, Boston-Leary said, the system would have to undergo a total overhaul to make reimbursement a reality.
"Largely for all nurses, every single nurse getting directly reimbursed, I don’t know that the system itself and the people within the system have a tolerance for all that and the capacity for all that," Boston-Leary said, "because being set up for that in itself takes a lot."
To Rudy Jackson, senior vice president and chief nurse executive at UW Health, and a HealthLeaders Exchange member, the issue lies with making the concept a reality, especially in a time where the goal of many healthcare executives is to cut costs.
"Conceptually, the ability to recognize the care provided by nurses as a mechanism in reimbursement is incredibly interesting," Jackson said. "The challenge is [that] operationalizing a model such as this would require a complete restructuring of our entire healthcare reimbursement model."
Jackson also pointed out that there are already areas where nurses do get reimbursed.
"There are, in fact, certain skills completed by registered nurses that are reimbursable, such as Vascular Access Teams, however, not many," Jackson said. "There is an opportunity to look more aggressively at other skills provided by nurses."
Reimbursement would involve one process for submitting invoices or claims and getting reimbursed and another for denials and resubmissions.
“There's not much tolerance and ability and capacity for the system and the people within the system to make this happen," Boston-Leary said. "Not to mention, it's going to take a major reversal of the current processes and change for this to happen."
What about the cost?
As with any new program in healthcare, the first question on everyone's mind is how to pay for it.
According to Woods, the direct reimbursement process would not be taking money out of health systems.
"What we're saying is allow the nurses to get reimbursed for their work that they do,” Woods said. “And if they are employed by the healthcare organization, essentially that reimbursement goes back to that healthcare organization."
Reimbursement could act as a reinvestment in the health system, Woods explained, which would improve patient care along with recruitment and retention. If hospitals put a cost to the value of nursing, they would be in a better position to focus on developing nurses.
"If a nurse gets into a work situation and the situation is unsafe … the nurse is going to leave because its an uncertain work situation," Woods said. "If we can invest in our nurses and really articulate the value they bring, you're going to see better nurse retention."
To Boston-Leary, nurses do not always feel as respected as other members of the care team, and health systems need to understand how direct care nurses contribute to the bottom line.
"Understanding that piece, particularly when we do have to be more financially savvy as nurses and understand what things cost and how systems get reimbursed," Boston-Leary said, " adds to that piece of matter for nurses where they feel as if they are adding to the bottom line."
The alternatives
There are alternatives to reimbursement that could also demonstrate the value of nursing on paper.
To Jackson, the answer is that hospitals need to invest in nursing.
"Offer appropriate staffing ratios based on nursing's assessment of the care needed," Jackson said. "Leverage technology to support administrative tasks nurses are faced with."
Nursing is the single largest workforce in any hospital, according to Jackson, and so nurses must be included in leadership and decision-making processes.
"Nursing leadership should always be part of the senior leadership team with reporting responsibilities to the highest level of the organization,” Jackson said. "This ensures accountability and support."
Boston-Leary recommended looking at nurse-sensitive indicators, since nurses do have duties that directly impact outcomes. Health systems could look at the ROI when hiring new nurses in a similar way that they look at ROI when hiring new physicians.
"This is also a place where we can't afford to couch it in the space of soft dollars," Boston-Leary said, "because people hardly pay attention to soft dollars. It's more about hard numbers.”
CNOs should advocate for bringing in a finance partner who can crunch numbers and show how nurses are contributing to the bottom line, Boston-Leary said. Some health systems have even hired a nurse in the finance department to give input.
"I know this is going to be a struggle for most small critical access hospitals," Boston-Leary said, "but for the ones that can, they can lead the way to help set up the methodology for the smaller institutions and community hospitals that can't afford it."
Boston-Leary also recommended revisiting the metrics that health systems use to determine value.
One example is the average daily census, which only captures a certain number at a certain point in the day and doesn’t provide the full story. Another is productivity, which, according to Boston-Leary, is not the measure that people think it is.
"We should not be celebrating when nursing has 98% to 120% productivity," Boston-Leary said, "especially if you have a department that's not fully staffed. It may mean that you're overextending your people and it's impacting their wellness and overall health."
Health systems should also pay attention to the positions that tend to get cut when times get tough, since many of them are still necessary for a strong and resilient workforce, Boston-Leary said.
"I think these are all the things that require some research that CNOs can lead with the proper resources," Boston-Leary said, "and get the message out there, so that everyone sees it and understands how that could be applicable to where they are as well."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
HHS Secretary Javier Becerra says the changes highlight federal efforts to take a more active role in defining AI and data policy and address cybersecurity concerns.
ONC Chief Micky Tripathi will be Washington’s current point man for AI governance under an ambitious reorganization unveiled this week by the U.S. Department of Health and Human Services.
The reshuffling sharpens federal leadership around data governance and policy as well as AI policy, which has been an ongoing concern in light of the rapid adoption of AI in healthcare and other industries. The changes also highlight federal leadership on cybersecurity, a key pain point at a time when ransomware attacks and cybersecurity outages are happening almost weekly.
Tripathi, formerly head of the Office of the National Coordinator for Health IT (ONC), will become the Assistant Secretary for Technology Policy/National Coordinator for Health Information Technology (ASTP/ONC), as well as the Acting Chief AI Officer.
Just a few weeks ago, Tripathi and Troy Tazbaz, director of the U.S. Food and Drug Administration's digital health center of excellence, ended their participation as non-votring members of the board of directors of the Coalition for Health AI (CHAI), an organization of more than 1,000 health systems, vendors and others working to develop AI standards and governance. That move, along with this reorganization, signals that the federal government may be distancing itself from collaborating with the healthcare industry.
Alongside AI policy, oversight over technology and data will also shift from the Assistant Secretary for Administration (ASA) to the ASTP/ONC, and the Chief Technology Officer and Chief Data Officer will join Tripathi in that department.
In addition, the Administration for Strategic Preparedness and Response (ASPR) will take over the so-called 405(d) Program, a public-private collaboration between the healthcare industry and the federal government addressing cybersecurity.
“Cybersecurity, data, and artificial intelligence are some of the most pressing issues facing the health care space today,” HHs Secretary Xavier Becerra said in a press release issued Thursday morning. “As a department, HHS must be agile, accountable, and strategic to meet the needs of this moment. For decades, HHS has worked across the organization to ensure appropriate and safe use of technology, data, and AI to advance the health and well-being of the American people. This reorganization builds on that success and prepares the department for the challenges that lie ahead.”
“Under the vision and leadership of Secretary Becerra and Deputy Secretary [Andrea} Palm, HHS is fully embracing the importance of information technology to the department’s mission, and consolidating organizational resources accordingly, to lead and shape technology policy across the department’s broad array of external and internal activities,” Tripathi said in a blog.
“For some time, and especially over the last few years, ONC has played an informal role shaping technology and data policy across HHS,” he continued. “This move formalizes this function, which will allow us to build synergies with the work that we’ll continue to do in health IT, and stand-up dedicated organizational capacity to ensure that HHS is making the best use of technology and data across all operating and staff divisions.”
According to HHS, the Chief AI Officer will:
Set AI policy and strategy for the department;
Establish internal governance, policies, and risk management approaches for uses of AI internal to HHS;
Coordinate HHS’ AI approach in the health and human services sectors;
Support the safe and appropriate use of AI technologies and tools across the department; and
Coordinate AI-related talent and training initiatives.
Tripathi will fill that role until the federal government concludes its search to fill that role as well as the roles of Chief Data Officer and Chief Technology Officer.
The Chief Data Officer, meanwhile, will:
Continue to oversee data governance and policy development;
Drive data literacy and data talent initiatives;
Manage HHS data strategy;
Support data collaboration and exchange; and
Manage HHS’ data as a strategic asset for the department.
