As 2024 continues to unfold, healthcare executives are paying close attention to several key trends that are shaping the future of the industry.
It’s no secret that these are trying times for hospital and health system leaders. As we have learned from our interviews, research, and virtual and in-person events, there is no shortage of challenges from every facet of healthcare organizations from CEOs to revenue cycle executives.
From financial pressures to workforce challenges, these developments are set to impact how hospitals and health systems operate in the coming years.
Here are the top eight trends that our healthcare leaders have been monitoring most this year.
1. Mounting Financial Pressures
Healthcare systems are grappling with significant financial strain as costs continue to surge. Labor expenses increased by over $42.5 billion between 2021 and 2023, largely driven by workforce shortages.
The U.S. healthcare system is facing a critical shortage of doctors and nurses. Projections suggest a shortfall of up to 124,000 physicians and 450,000 nurses by next year. This shortage poses a significant threat to the quality and accessibility of care.
Negotiations over reimbursements are becoming tougher, with hospitals facing delayed payments and tighter reimbursement policies. Healthcare executives are trying to keep their heads above water in this complex payer landscape—and all while trying to ensure sustainable financial performance.
4. Regulatory and Policy Changes
Shifting regulations are reshaping the healthcare industry.
All of these shifts require hospital leaders to adapt quickly, ensuring compliance while exploring opportunities for improved care delivery and cost efficiency.
As hospitals face rising costs and competitive pressures, many are looking to consolidate to improve operational efficiencies and strengthen their financial position. M&A activity is expected to continue at a rapid pace, with health systems increasingly pursuing cross-geographic deals to share resources and create synergies in an evolving market.
These disruptors are capitalizing on new patient preferences for more convenient, cost-effective care. With the ability to offer targeted services and significant capital at their disposal, these non-traditional players are reducing inpatient utilization and attracting valuable patient segments.
Hospital executives must adapt to this competitive landscape by improving their own offerings and patient experience.
Attracting and retaining healthcare workers is an ongoing challenge for hospitals, particularly in light of the current shortages in both clinical and non-clinical roles.
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In this episode of the HealthLeaders podcast, finance Editor Marie DeFreitas is joined by Kyle Wilcox, who is the vice president of finance for MercyOne Medical Group and a HealthLeaders Exchange member. Wilcox chats about how a health system's financial structure could be adding to burnout, as well as the need for cost cutting, revenue cycle optimization, and maintaining financial stability—all of which will be discussion points at the upcoming HealthLeaders CFO Exchange this month.
Mass General Brigham is using a state grant to test an advanced care at home model for patients in need of skilled nursing facility services.
Mass General Brigham is testing a variation of the advanced care at home strategy on SNF care.
The health system is using a $4.6 million grant from the Massachusetts Executive Office of Health and Human Services to develop a short-term rehabilitation program that would be an alternative to traditional skilled nursing facilities, to which roughly 25% of Medicare patients are transferred after a hospital stay.
Health system officials say the program, which will follow the acute hospital care at home strategy, would help alleviate the lack of SNF and rehabilitation beds in Massachusetts, which is causing a logjam in hospitals. A recent report from the Massachusetts Health & Hospital Association indicates almost 2,000 hospital patients in the commonwealth are waiting—some for months--to be discharged into SNF care.
“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home program and principal investigator of the trial, said in a press release. “There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians.”
Advanced care at home programs, sometimes called hospital at home, gained attention during the COVID-19 pandemic as a strategy to reduce hospital overcrowding and give selected patients the opportunity to receive care at home. The typical blueprint includes telehealth and remote patient monitoring services alongside in-home visits, often daily, by a care team.
More than 300 health systems and hospitals across the country are using some form of hospital at home service, many of them following a model developed by the Centers for Medicare & Medicaid Services (CMS), which includes a waiver to meet federal guidelines and be eligible for Medicare reimbursement. That waiver is scheduled to end this year, putting many programs that rely on the reimbursement in jeopardy.
Advocates say the program reduces hospital costs and patient length of stay, while improving clinical outcomes and patient and provider satisfaction. Critics say the program is complex and costly and adds to stress on caregivers and care teams.
The MGB program will enroll 300 patients from five Boston-area hospitals, half of which will receive care in a SNF and half of which will receive care at home. The home-based program will include 24-hour RPM and telehealth services through CNAs and physicians, on-demand care from home health aides and a paramedic-based mobile integrated health (MIH) team, and physical, occupational and speech therapy as needed.
Aside from the traditional metrics of cost of care, length of stay, patient and care provider satisfaction, and rehospitalization rates, this program will also evaluate the effect on family and caregivers.
MGB is one of the leaders in the acute care at home space, having launched an early prototype of the program in 2016. The health system has treated more than 3,000 patients in this program, including more than 1,000 in 2023, and received federal and state approval last year to expand the program to more hospitals.
“Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you’re tailoring their care plan to their personal environment,” Stephen Dorner, MD, MPH, MSc, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, said in a September 2023 press release announcing the expansion.
This past January, a team of MGB researchers led by Levine published results of a nationwide survey of hospital at home programs. That study found a lower mortality rate among patients treated in acute care at home programs when compared to patients who were instead hospitalized, as well as spending less time in a SNF.
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said when the study was released. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” He added. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
The SNF model isn’t without precedent. Nearby South Shore Health launched a SNF at home program in 2021, during the height of the pandemic, but pivoted to a more traditional acute care at home program because they couldn’t secure payer reimbursement.
"There's a difference between acute and critical care, and certain things we can't do at the home right now,” Kelly Lannutti, DO, the health system’s director of clinical transformation and co-medical director of MIH, told HealthLeaders in an April 2022 interview. “We eased back."
MGB tested its own SNF at home model in 2019, putting 10 patients through the program. Officials said the results “were promising and pointed toward lower cost and a better patient experience compared to traditional SNF care,” but the test was too small to draw more substantial conclusions.
“Now, thanks to this financial award …, we can test this innovative care delivery model that reimagines how we deliver post-acute care,” Levine said in the press release.
Repetitive needlesticks impact patients in the short and long term, says this CNO.
On this episode of HL Shorts, we hear from Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, about how repetitive needlesticks and other uncomfortable procedures impact care delivery and the patient experience. Tune in to hear her insights.
Nurse leaders know reducing span of control for nurse managers is crucial in addressing burnout and high turnover rates, but how?
Amid high burnout and turnover rates, nurse leaders should take a closer look at a key piece of the workforce puzzle: nurse managers.
Nurse managers need time and support from leadership to complete their tasks. According to a report published by the American Organization for Nursing Leadership and Laudio, this could be accomplished by lowering span of control.
But how can nurse leaders do it? Here are six key strategies:
1. Understand the Importance of Span of Control
Span of control refers to the number of employees a nurse manager supervises. High spans can overwhelm managers, leading to burnout and increased turnover. The median span is 46, but many managers handle over 78 staff members.
Reducing this load allows managers more time for leadership development, improving team morale, and enhancing patient care.
2. Assess and Adjust Workload
Start by evaluating the current workload of your nurse managers. Consider metrics like headcount per manager, the number of ongoing projects, and administrative tasks. Identify tasks that can be offloaded or automated.
For instance, Rudy Jackson, senior vice president and CNE at UW Health and a HealthLeaders Exchange member, says UW Health's approach involved studying time allocation to understand where managers spend their time and how to reduce unnecessary burdens.
3. Leverage Technology and Support Roles
Use technology to ease administrative burdens, such as scheduling and paperwork. Additionally, consider how existing roles like charge nurses or assistant nurse managers can be optimized to support nurse managers. At UW Health, they are exploring the use of care team leaders to reduce the load on nurse managers.
4. Customize Solutions to Your Organization
Each health system is unique. Tailor your approach to your organization's size and resources. For some, splitting departments or reallocating administrative tasks may be feasible.
For others, it may involve enhancing existing roles rather than creating new ones. Innovative solutions, like giving managers time off or using technology, should be balanced with cost considerations.
5. Engage Nurse Managers in the Process
Create forums, like nurse manager councils, to give managers a voice in developing and testing new solutions.
Their insights can lead to practical, effective changes that genuinely reduce their span of control and improve job satisfaction.
6. Monitor and Adjust
Implement time studies and other assessments to continually monitor the impact of reduced span of control.
This data-driven approach will help in refining strategies and ensuring that the changes lead to positive outcomes like reduced turnover and improved patient care.
By focusing on these steps, nurse leaders can create a more manageable and supportive environment for nurse managers, ultimately leading to better outcomes for staff and patients alike.
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 CNO Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Nurse leaders must determine what staffing model works best for both patients and nurses, says this CNO.
The nursing shortage continues to be one of the biggest concerns for CNOs across the country, and many are brainstorming creative staffing models to recruit and retain more nurses.
When implementing new staffing models, there are several factors to consider. CNOs must prioritize what works best for patients while also meeting the needs of their nurses.
According to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children's Healthcare, there are several innovative staffing models that CNOs could implement at their health systems.
Innovative staffing models
Staffing models have recently been expanding to include more specialized roles and nurses of different designations, Tilton explained. Leveraging advanced practice nurses can help enhance care delivery while filling gaps in the workforce.
"Contingency labor and role specialization to ensure operational efficiency and adaptability in meeting patient care demands are being leveraged as well," Tilton said.
There are four examples of new staffing models that Tilton emphasized, the first being team-based care, which promotes collaboration between nurses, nurse practitioners, physicians, physician assistants, pharmacists, social workers, and other healthcare professionals. This model empowers nurses to be more autonomous, Tilton explained, and to participate in decision-making by contributing their expertise.
"Team-based care enhances coordination, communication, and efficiency in healthcare delivery," Tilton said, "leading to improved patient outcomes and satisfaction."
The second model is flexible staffing, which, can help health systems adapt to fluctuations in patient volume and acuity as well as staffing shortages, according to Tilton.
"These strategies may include the use of float pools, cross-training programs, per diem staffing, and contingency staff," Tilton said. "Implementation of innovative scheduling practices such as self-scheduling, shift bidding, and predictive analytics-based staffing algorithms are being considered to optimize staffing levels and match resources with patient needs."
Care continuity models are also necessary to promote patient safety, reduce medical errors, and enhance the patient experience, Tilton emphasized.
"Care continuity models aim to maintain consistent nurse-patient relationships across care transitions and settings," Tilton said. "These models may involve assigning care coordinators or a primary nurse to patients throughout their healthcare journey."
The last innovative staffing model is telehealth nursing. Virtual care has revolutionized nursing and other aspects of healthcare in general, by providing new opportunities for nurses to work remotely and flexibly, while still providing patients with quality care. According to Tilton, nurses in telehealth roles can provide direct patient care, health education, counseling, and support through virtual consultations, remote patient monitoring, and tele-triage.
"Telehealth nursing enables greater access to care, especially for underserved populations," Tilton said. "It improves care coordination and enhances patient convenience and satisfaction."
Choosing for patients
The second piece of the puzzle is choosing which staffing model works best for patients. According to Tilton, there are several factors regarding patient needs, nursing practice, organizational resources, and external details that CNOs must consider when making the right decision.
First, CNOs need to assess the demographics, acuity levels, and care needs of their patient population, Tilton recommended, while working with their teams to make sure their workforce is experienced and competent to address those needs.
"This assessment helps CNOs determine the appropriate nurse-to-patient ratios, skill mix, and expertise needed to deliver safe and effective care," Tilton said.
Next, CNOs must remain in compliance with regulatory requirements, accreditation standards, professional staffing, and patient care guidelines, according to Tilton.
"They need to stay informed about state regulations, nurse licensure laws, staffing ratios mandated by regulatory agencies," Tilton said, "and recommendations from professional organizations such as the American Nurses Association and the National Council of State Boards of Nursing."
Then, CNOs should assess their health system's financial resources, budget constraints, and reimbursement mechanisms to decide a staffing model's feasibility.
"Analyze staffing costs, productive metrics, revenue generation opportunities, and return on investment associated with each model," Tilton said.
Finally, Tilton recommended that CNOs engage with key stakeholders during the decision-making process, including the nursing staff, interdisciplinary team members, healthcare executives, patients, families, and community partners.
"Through soliciting feedback, gathering input, and fostering collaboration, [CNOs] can ensure buy-in and support for the chosen staffing model," Tilton said.
Throughout this entire process, communication is key. Tilton emphasized the need for CNOs to promote transparency, communication, and shared decision-making to make successful changes to the organization.
"By considering these factors holistically and collaboratively," Tilton said, "CNOs can determine the staffing model that best meets the needs of their patients, optimizes nursing practice, and supports organizational goals and priorities."
New York is issuing $500 million in grants as part of a three-year, $7.5 billion effort to create a network of programs addressing issues like housing, transportation, and food insecurity.
Healthcare CIOs working on a strategy to improve health outcomes in underserved populations would do well to check out New York, which is investing $500 million in a new program addressing social determinants of health (SDOH).
The Social Care Network (SCN) program, unveiled this week by Governor Kathy Hochul, leverages state and federal funding to help Medicaid members access transportation, housing, nutritious meals and other social services. By addressing SDOH barriers, the state aims to reduce healthcare costs and improve outcomes.
“We traditionally invest healthcare dollars in direct patient care, yet it is often the factors ‘outside the exam room’ that most need to be addressed,” New York State Health Commissioner James McDonald, MD, said in a press release. “This historic investment allows these partners to connect patients to factors that often most influence our health, such as finding stable housing, reliable transportation, health insurance and other factors that improve people’s personal health.”
Addressing SDOH and health inequity is a key concern for healthcare leaders, and innovative partnerships like the SCN show potential in pushing the right resources to the right populations. A good proportion of halthcare waste is directly tied to barriers to care, which keep patients from accessing the services they need until their health declines. This leads to expensive health interventions, including ED visits and hospitalizations, and continuing care for medical issues that could have been managed or even prevented.
The $500 million will be disbursed in awards to nine social care organizations across the state. The program, administered through a Medicaid Section 1115 Demonstration Waiver, is part of a three-year, $7.5 million effort, which includes almost $6 billion in federal waiver funding.
As proof of the program’s potential clinical benefits, officials pointed to New York’s Medicaid Redesign Team Supportive Housing Initiative, which provides permanent housing and support services for homeless residents with medical conditions. That program, officials said, led to:
A 40% reduction in hospital inpatient stays
A 26% reduction in ED visits
A 15% reduction in overall Medicaid health expenditures
A 44% reduction in admissions for substance abuse rehabilitation
And a 27% reduction in inpatient psychiatric admissions.
In addition, officials said, the program helped the Medicaid program save $46,500 per person per year by prioritizing treatment for patients with some of the most complex care needs.
“Every year, hundreds of thousands of New Yorkers avoid healthcare due to concerns about money, housing, food, transportation, and other unmet needs,” Zachariah Hennessey, executive vice president and chief strategy officer of Public Health Solutions, one of the nine organizations receiving a grant, said in the press release. “They turn to healthcare only when in crisis and their lives are cut short. Through New York State’s Health Equity Reform initiative, we have a once in a generation opportunity to change this trajectory and ensure Medicaid beneficiaries receive the resources they need on time to achieve optimal health for themselves and their families.”
While unemployment is up, healthcare still added 55,000 jobs in July.
As the nation reacts to the news of a possible recession coming off on an underwhelming jobs report, CFOs must stay on top of domestic and worldwide economics to know how it might impact their business.
The Big Picture: What To Know
Typically, if roughly 200,000 jobs are added each month it shows that the labor market is in good standing and most likely won’t see a recession. However, Friday’s BLS report showed an eerie slowdown in job growth. Only 114,00 jobs were added in July, marking a big drop from 206,000 in June, and far below many economists’ expectations.
Major concerns about the job market surfaced as the unemployment rate rose by 0.2 percentage points to 4.3%. With the Sahm rule being triggered, financial executives everywhere are on-edge.
The labor market is vulnerable right now, and with an upcoming election and the Federal Reserve’s goal of 2% inflation, economists are speculating that a rate cut may be in order. If not, a recession could be underway.
Approximately 7.2 million people are currently unemployed, up from 5.9 million last year. The labor report also indicates that wages are stagnating, and workers are often using part-employment to supplement.
Healthcare jobs are generally considered “recession-proof" because of consistent need, and the industry added 55,000 jobs with big increases seen in home health (+22,000), and hospitals (+20,000), nursing and residential care (+9,000). But healthcare and government were virtually the only two sectors that added a notable number of jobs.
The CFO Checklist
While many CFOs had high hopes for profitability in 2024, the road ahead may be bumpier than expected. CFOs can strategize to adapt to a shifting economy, but only when they balance financial safety nets with precise growth plans that will benefit and add to their organization.
If the Federal Reserve decides not to cut rates in pursuit of 2% inflation, many Americans will see financing challenges for things like cars and homes. This coupled with stagnant wages will put extra strain on employees that CFOs need to be aware of.
CFOs will need to carefully strategize growth opportunities, because without this they risk losing relevancy as a business. They should also focus on creating solid safety nets for their organizations by creating a stout reserve fund.
Lastly, CFOs should also look at auditing their revenue cycle to increase profitability, as well as diversifying revenue streams as much as possible.
Decreasing repetitive needlesticks will save time and improve patient experience, says this CNO.
HealthLeaders spoke to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, about the dangers of repetitive needlesticks and how new technology might eliminate them.
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."
