CMOs and other healthcare leaders need to employ several strategies to restore trust, such as pushing back on misinformation about who profits from vaccines.

Trust in physicians and hospitals fell from 71.5% in April 2020 to 40.1% in January 2024, according to a new research article.

The trust patients place in physicians and hospitals is an important concern for CMOs and public health officials. If patients do not trust physicians and hospitals, they are less likely to follow their recommendations.

The coronavirus pandemic marks a turning point for trust in physicians and hospitals, says the lead author of the research article, Roy Perlis, MD, MSc, associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital.

"Prior to the pandemic, many physicians took it for granted that people would trust them," Perlis says. "Unfortunately, because there was so much misinformation and politicalization of healthcare during the pandemic, a lot of the initial trust in physicians and hospitals was squandered. What we have realized is that we need to rebuild trust if we are going to support public health in the future."

The loss of trust during the pandemic was not a surprise for the researchers, according to Perlis.

"Unfortunately, during the course of the pandemic, especially with the spread of misinformation about COVID and the vaccine, trust declined substantially," Perlis says. "We were not surprised that trust declined, but we were surprised by the magnitude of the drop."

The research article is based on survey data collected from more than 440,000 U.S. adults. In addition to the finding that trust in physicians and hospitals dropped 31%, the study, which was published in JAMA Network Open, includes three key results:

• Higher levels of trust were associated with a higher chance of vaccination for COVID-19 (adjusted odds ratio 4.94) or influenza (adjusted odds ratio 5.09), as well as getting a COVID-19 booster (adjusted odds ratio 3.62).
   
• Characteristics linked to decreased trust included being 25 to 64 years of age, female, lower educational level, lower income, Black, and living in a rural area.
   
• When survey respondents were asked why they had lower levels of trust, the reasons cited included financial motives over patient care, poor quality of care and negligence, influence of external entities and agendas, and discrimination and bias.

Roy Perlis, MD, MSc, is associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital. Photo courtesy of Mass General Brigham.

Trust is essential to convince patients to follow recommendations such as vaccination, according to Perlis.

"If your doctor is telling you to do something either directly or through the hospital where you get your care, there is no reason to follow the recommendations if you do not trust what you are being told about something like vaccination," Perlis says. "That is one of the reasons why it is imperative that we restore trust."

Loss of trust is different for different groups, according to Perlis.

"Some of them may be more likely to have had bad experiences with healthcare. Historically, we know that we have not necessarily treated all groups equally well," Perlis says. "Unfortunately, public health became politicized during the pandemic, and some of the groups that were associated with less trust had more exposure to the politicization of healthcare."

For survey respondents, the reasons for loss of trust broke down into several categories, according to Perlis:

• One reason was bad experiences in terms of their own care or the care of a family member.
   
• There were concerns about conflicts of interest.
   
• People were worried that doctors or hospitals may have financial motives rather than simply being focused on providing the best care.
   
• There was concern that doctors or hospitals might be influenced by outside entities or outside agendas.
   
• There was a subset of survey respondents who had experienced discrimination or bias in their interaction with the healthcare system.

Restoring trust in doctors and hospitals

There are several steps that CMOs and other healthcare leaders can take to restore trust, according to Perlis.

"It is one thing to say trust is down," Perlis says. "It is another thing to think about how we can repair trust, which we will need for all kinds of public health initiatives, including the next pandemic and anything that involves intervening to improve public health. We absolutely must prioritize restoring trust."

Strategies to restore trust will have to be crafted with the reasons why trust has eroded.

"The strategies to restore trust probably aren't a one-size-fits-all response," Perlis says. "They need to address some of the underlying concerns."

There are several ways that CMOs and other healthcare leaders can show people that conflict of interest does not drive decision-making.

"For example, we have transparency laws that make it easy for people to see whether their doctor is being paid by someone other than the hospital," Perlis says.

CMOs and other healthcare leaders need to push back on misinformation about who profits from things such as vaccines or medications.

"Simply clarifying who pays for these things and who benefits from them financially is important," Perlis says.

For people who have had bad experiences with healthcare or feel they were not treated well, that is more difficult to address.

"We need to find ways to re-engage with these people," Perlis says. "One way to do that is to listen. We can get people in to see their doctor and find out why they had bad experiences."

CMOs and other healthcare leaders need to make it easier for people to interact with the healthcare system.

"There are many reasons people get frustrated such as long wait times to see doctors," Perlis says. "We need more outreach and more accessibility."

Sanford Health's Dane Hudelson, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and finance, says his team of data analysts and tech experts does the behind-the-scenes work that improves all aspects of the health system.

AI programs for revenue cycle and financial operations may not directly affect a healthcare organization's clinical outcomes, but they do play a crucial role in creating a healthy health system. And that'll make everyone smile.

"When you have nurses that are spending the first week of every month, putting schedules together, creating Excel documents, that's not what they signed up for," says Dane Hudelson, enterprise director of data & analytics at Sanford Health. "So when we're able to kind of step in and say, ‘You know, let us help you take care of that, we'll handle it digitally and give it back to you in a couple hours and you go back to doing what you enjoy doing.' … My employees definitely enjoy … knowing that they're impacting patient care."

Hudelson, a participant in the HealthLeaders Mastermind program on the use of AI in revenue cycles and financial operations, spoke during a HealthLeaders podcast this week on Sanford Health's AI strategy. He noted that the South Dakota-based health system, the largest rural heath network in the country, developed its AI strategy in-house, drawing from an enterprise data and analytics team created in 2015.

"We are well versed," he noted. "We create tools, but also have the foundational knowledge and unique understanding of the patients we serve, so our projects are tailored to Sanford patients and Sanford as an organization."

Their first AI project, which went live some 18 months ago, focused on intelligent automation scripting.

"With a little over 160 facilities, our first project was aligning with their operational groups to hopefully make life a little easier on some of the processes that they were having to do for each of their facilities for the month-end closing process," Hudelson said. This "historically required a team of five individuals that would invest, give or take, 80 to 100 hours in some instances, even a little bit longer."

The solution, a "digital employee" leveraged on the Python platform, saves revenue cycle staff at least 100 hours per month—the key metric used in determining the value of an AI-based rev cycle/finance tool. Saved time, Hudelson said, translates to reduced expenses and more efficient processes as rev cycle staff can focus on "recurring processes that are inefficient, time-consuming [and] labor-intensive."

Like, say, creating a more efficient way for nurses to schedule their shifts.

Sanford Health has launched roughly 20 rev cycle AI programs over the past 18 months, Hudelson said, saving the health system roughly 7,500 hours of manual labor.

Hudelson takes great pride in his enterprise data & analytics team, which comprises some 70 people—including mathematics experts, Epic-certified report developers, statisticians, even a research nuclear physicist and some psychology folks.

"A lot of these kids--I call them my kids-- enjoy doing this because they can understand we might not be a patient-facing department, but they understand," he said. ‘And it's very easy for them to see how their work impacts patients on a day-to-day basis, whether we're dealing with nurse schedules or one of the other projects that's not so much rev cycle oriented as it is [making people more efficient at what they do.]"

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

The retail primary care market may be struggling, but some see an opportunity to meet the healthcare needs of the fastest growing population in the nation.

Disruptors looking for the secret sauce for success in the primary care market are setting their sights on a new strategy: Senior care.

CVS Health recently announced plans to open 25 new Oak Street Health Centers this year alongside CVS pharmacies and another 11 stores next year, with the new stores focusing on senior care.

“By coupling these two powerful CVS Health assets, it advances the company’s strategy to deliver [a] personalized healthcare experience in a more integrated way, especially for senior patients with complex or chronic health conditions,” Mike Pykosz, Oak Street’s co-founder and EVP and president of healthcare delivery for CVS Health, recently told Forbes.

Just last month, Humana announced that it would open 23 new senior primary care centers, operating under the CenterWell Senior Primary Care and Conviva Care Centers brands, in select Walmart Supercenters.

“These nearly two dozen primary care centers are specifically designed for seniors, and each location’s design, including dedicated entrances and easy parking, offers patients the access that they have come to expect at our clinics across the nation,” CenterWell President Sanjay Shetty, MD, said in a press release. “We are eager to expand on our mission to help patients lead happier, healthier lives.”

The two announcements may point to a trend: Developing retail healthcare clinics for the fastest growing segment of the nation’s population.

In a recent HealthLeaders podcast Chris Palmieri, president and CEO of the Commonwealth Care Alliance, said the primary care space is still considered the entry point for consumer access to care.

“Long gone are the days of people walking into and sitting in their physician’s office,” he pointed out. That’s especially true of seniors who might have difficulties getting to their doctor’s office.

Palmieri says the aging population—by 2030, he notes, the nation will have more seniors than people under age 18—represents a fertile market for healthcare, not only in helping seniors stay in their homes and out of long-term care facilities but in helping them access care.

“Our system today is not built for this demographic shift,” he said. “As an industry we need to find ways to effectively and efficiently serve this population. The winners are going to be those that can adapt, that truly be effective and friendly and meet those individuals’ changing needs.”

Palmieri says the healthcare industry is coming to grips with the growing popularity of consumer-driven healthcare, and the idea that consumers—in this case seniors—are starting to dictate how, when and where they want their care.

The focus going forward will be on how these senior care clinics are developed, and how they’d be different from primary care clinics open to people of any age.

Repetitive needlesticks are impacting patient care, according to this survey. 

Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective.

A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.

These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have. 

Here's what you need to know about the reality of repetitive needlesticks. 

Click here to read the accompanying article. 

A new study by the Cleveland Clinic finds that clinicians tend to prescribe more antibiotics in virtual care visits than they do in person. Researchers say it's the fault of the platform, not the provider.

Healthcare organizations with robust virtual care programs should invest in antibiotic stewardship resources to prevent overprescribing, according to the results of a recent study.

The study, conducted by researchers at the Cleveland Clinic Health Systems and published in Oxford Academic, found that urgent care virtual visits for treatment of respiratory tract infections were far more likely to result in antibiotic prescriptions than the same visits conducted in person.

It's not the first study to suggest that providers using telehealth are more likely to prescribe medications. Some place the blame on providers, particularly those contracted by direct-to-consumer telehealth providers, saying they're more likely to prescribe to save time and seek higher reimbursements.

Others are disputing that suggestion, and the Cleveland Clinic study follows that route. Researchers there say the telemedicine platform may be at fault, as clinicians don't have the ability to see a patient in person to conduct a thorough analysis, which might rule out antibiotics or lead to a different treatment.

"To our knowledge, this is the first to attempt to isolate the role of the platform in antibiotic prescribing," the Cleveland Clinic team reported. "That we found higher prescribing in virtual care suggests that it is the limitations of the platform, and not the clinicians or the health system, that drive higher antibiotic prescribing."

The Cleveland Clinic team used EHR data to analyze 69,189 in-person visits and 19,003 virtual care visits for RTI treatment conducted by the health system between 2018 and 2022, with COVID-19 visits excluded. According to that data, 58% of the virtual visits led to an antibiotic prescription, compared to 43% of in-person visits. More specifically, 34% of the virtual care visits were diagnosed as sinusitis, and 95% of those led to a prescription, while only 13% of the in-person visits led to a sinusitis diagnosis, and 91% of those resulted in a prescription for antibiotics.

Many hospitals and health systems already include special training for clinicians who use virtual care. Studies like that conducted by the Cleveland Clinic are evidence that those programs should include protocols for virtual prescribing, monitoring of virtual prescribing habits, and antibiotic stewardship tools.

Despite the slight bump, rural and underserved facilities may see significant decreases in their reimbursement payments.

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule increasing Medicare inpatient prospective payment system rates by 2.9% for FY2025.

According to the agency, the update reflects a hospital market basket increase of 3.4%, and a productivity cut of 0.5%. Payments are expected to increase by $2.9 billion and new medical technology payments to increase by $300 million.

However, rural health payments could decrease by $400 million, should legislators decide not to extend the Medicare-dependent hospital and enhanced low-volume adjustment programs. Disproportionate share hospital payments are expected to decrease by $200 million, which is attributed to a decrease in the uninsured rate.

The finalized rate is 0.3% higher than the previously proposed 2.6% increase, which providers have criticized for being too low. Despite the slight bump, their feelings remain unchanged.

The situation is particularly concerning for rural and underserved communities. A statement from the American Hospital Association says the update will “exacerbate” the difficulties hospitals are experiencing as they seek to stabilize their operating margins.

“We are troubled that the final long-term care hospital outlier threshold is nearly 30% higher than it is currently,” Molly Smith, group vice president for public policy, said in a statement.

“Since FY 2021, this figure has increased by more than 180%, which forces these hospitals to absorb hundreds of thousands of dollars in additional losses when caring for the sickest patients.”

Smith added that the increase will negatively impact healthcare access, putting more pressure on acute-care hospitals and other providers who don’t usually care for rural and underserved groups.

Providers and professional groups alike have long been vocal in their criticism of CMS’ low payment rates. Reimbursement payments not covering the cost of care is a continual issue.

In addition to the rates not keeping pace with inflation and rising labor costs, the payments themselves don’t cover the cost of care.

Demand for APPs grows as patients migrate from traditional care venues toward retail clinics, urgent care centers, and telemedicine.

Remember when we wrote about the rise of the advanced practice providers (APP) era? Well we were on to something. The nation's most-highly recruited clinicians are not physicians, but APPs.

Nurse practitioners, nurse anesthetists, and physician assistants represented nearly one-in-four (23%) of the 2,138 searches conducted from April 1, 2023, to March 31, 2024 by Texas-based recruiters AMN Healthcare.  

Family physicians topped AMN's physician searches for the 18th straight year, second only to APPs among all searches. The average starting salary for family physicians was up 6.27% year-over-year, from $255,000 in 2023 to $271,000 this year.

However, while primary care physicians remain very much in demand, that demand is cooling as the demand for APPs heats up. Only 14% of AMN's searches this year were for primary care physicians, down from 17% last year, while 23% of search engagements were for APPs, up from 19% last year.

AMN says the transition away from recruiting primary care doctors and toward APPs reflects the ongoing patient migration from traditional care venues.

"NPs are filling needs created by the physician shortage and are used to staff a growing number of urgent care centers, retail clinics, and telemedicine platforms. In addition, more specialty medical practices are employing them," AMN says in its 2024 Review of Physician and Advanced Practitioner Recruiting Incentives, breaks down salaries, signing bonuses, and relocation allowances.  

The high demand for NPs was reflected in starting salaries, which rose 8.6% year-over-year, from $158,000 2024 to $164,000 in 2024. By comparison, the rate of inflation in the U.S. economy as measured by the Consumer Price Index was 4.06% in 2023 and 3.2% in 2024, federal data show.

The review also found that:

• Starting salaries for physicians and APPs were up year-over-year, with increases seen in 13 of the 20 specialties.

• Orthopedic surgeons were paid the highest average starting salary ($686,000). Pediatricians were paid the lowest ($244,000).

• The average signing bonus for physicians was $31,473. The average bonus for APPs was $11,758.

• In addition to salary and signing bonuses, physicians and APPs often got relocation and continuing medical education allowances. The relocation allowance for physicians averaged $11,284, and the allowance for APPs was $7,910. The CME allowance for physicians averaged $3,969 and $3,195 for APPs.  

• Most AMN searches this year (63%) were for physician specialists, including OB-GYNs, gastroenterologists, radiologists, cardiologists and other specialists.

• OB/GYNs were 2nd on the list of AMN's most requested physician search engagements this year, up from 4th last year. Demand for OB/GYNs remains strong, but the supply may be inhibited by the U.S. Supreme Court's Dobbs vs. Jackson decision, which discouraged medical school graduates from pursuing OB/ GYN residencies.

 • Nearly three-quarters (71%) of searches were in communities of 100,000 people or more, which AMN says shows that demand for physicians and APPs is not limited to small and/or rural communities.  

If you remove nurses, it's "no man's land," says this nurse leader. 

On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, and HealthLeaders Exchange member, about different ways that health systems could reflect the value of nursing in their budgets. Tune in to hear her insights.

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. 

Repetitive needlesticks might no longer be necessary with new technology, say these nurse leaders.

Several new care delivery models are taking over the nursing industry and streamlining daily nursing practices, now including needlestick procedures.

Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective. A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.

Impact on patients

These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.

However, IV and blood draw procedures are a necessary part of the hospital stay, and according to Anna Kiger, system chief nurse officer at Sutter Health, they make the patient experience less positive.

"It is one of the most frequent tasks that a nurse or phlebotomist does," Kiger said, "so if you come for healthcare, it's a high probability we're going to stick you at least once, if not more."

There are several factors that can also make needlestick procedures more difficult, Kiger explained.

"Whether it's in the emergency department or later on in the acute care setting, we do need to obtain blood samples from them for a variety of reasons," Kiger said, "and unfortunately, due to the acuity of their diagnosis and their age, obtaining a clean single needlestick to get the blood can be very difficult."

According to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, repetitive needlesticks impact patients in both the short and long term. Not only do needlesticks increase anxiety and pain among patients, but incorrect vascular access practices in general can impact health literacy and lead to potential rehospitalizations or disease progression.

"When patients are more anxious, they're less likely to understand the procedures that are being explained to them," Acito said. "Short term, they're not hearing about their care, about their needs, about their diagnosis, and long term, they're not hearing about the things they need to do upon discharge."

Needlestick alternatives

Luckily, alternatives to repetitive needlesticks are on the horizon.

According to Kiger, there is now a device that can provide needleless blood draws.

"This particular technology, which allows a nurse to obtain a direct blood draw through an IV catheter, does eliminate the need for a needlestick," Kiger said, "and that particular device can be used in the ED or in the inpatient setting."

This new technology is called the PIVO™ device, currently owned by BD, which essentially enables a small tube to enter the blood vessel through the IV to avoid an additional needlestick when blood draws are necessary.

"It's an IV with a tail essentially coming out of it," Acito said. "The patient should expect one stick when they come into the hospital and they have the IV inserted, unless they need a special test like blood cultures, then this PIVO™ device would be used."

In patients Kiger has observed, the experience with the device is painless and the blood samples taken with it are of the same quality as those obtained through a needle aspiration.

"If you can remove the needle and obtain a quality blood sample and get to the test result that is required for a physician to make a decision, then I'm all in favor of doing that," Kiger said, "because it's one less penetration of the skin, which is our protection from infections, and the patient gets an entirely different experience, a painless experience for most, obtaining blood."

Acito said they oftentimes employ licensed practical nurses (LPNs) to do the blood draws with the device, which can greatly benefit them as well as the patient.

"This allows [the LPNs] to work at the top of their license, while reinforcing education that has already been provided to the patient, interacting with the patient, providing other needs while they're in the room," Acito said.

In addition to the PIVO™ device, Acito emphasized the importance of good IV care to help decrease repetitive needlesticks.

"Once you put in the IV, if you maintain it well and you choose the site properly, you can use devices that help you find the vein so that there's a decrease in the number of sticks," Acito said. "How many blood draws you get is really determined by your diagnosis and the number of tests that need to be run to find [it] or to see if the treatment is working."

There have already been positive outcomes from using this device as well, according to Acito.

"The positive outcome is that you don't waste more resources trying to find a vein, [and] trying to stick the patient," Acito said. "When you walk in, no longer do you have to check this arm and check that arm and find that vein. You already have access."

The bottom line is that it's better for the patient, Acito explained, because it decreases exposure to excessive bleeding, bruising, or infection.

"They know when they come in and they get that PIVO™ device because of education from the nurse that this is going to be the site where [they] get [their] medications [and] IV fluids, and it's also where we're going to draw [their] blood from," Acito said.

Training and education

Both nurses and patients need to be educated about needlesticks and vascular access procedures and their alternatives.

CNOs must ensure that nurses receive the proper training on how to make patients feel more comfortable during a needlestick experience.

"I think it's really important for the nurse to always recall for themselves what it would be like or even a personal experience with having had an IV," Acito said. "Completely engage the patient, distract them, [and] make sure that the patient is fully educated on what to expect."

Kiger said the most important thing leaders can do is educate other nursing and hospital leaders about the new technology alternatives that do allow for successful needleless blood draws, like the PIVO™ device.

"First of all, basic education, getting more literature out, getting more published research out, getting the experiences of those who actually use a device like this in clinical practice, and then also getting the patient's perspective out there," Kiger said. "Then I think it becomes a matter of showing that over time, this is actually an easier way to draw blood."