On this episode of the HealthLeaders podcast, Finance Editor Marie DeFreitas is joined by Chief Health Officer of Included Health, Dr. Ami Parekh, and Senior Vice President of Growth at Blue Shield of California, Tim Lieb.
Properly measuring ROI is critical to the success of virtual nursing, say these nurse leaders.
Executives from a dozen health systems met in Atlanta in early June for the HealthLeaders Virtual Nursing Mastermind program, in a forum to establish common goals, challenges, and successes.
The program, which included three virtual roundtables, established a number of key metrics that executives are focusing on as they evaluate their virtual nursing strategies.
Here are four key metrics CNOs need to be measuring to prove the ROI of their virtual nursing program. Click here to read the full article by HealthLeaders editor, Eric Wicklund.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The founder and CEO of a medical device company has been convicted of selling an implantable medical device to providers that didn't work at all—and then creating a replacement part that was also fake.
Healthcare executives looking to embrace the latest in implantable technology for patient care need to make sure their vendor partners are trustworthy.
The U.S. Attorney’s Office in southern New York has secured a six-year prison sentence for the founder and CEO of a medical device company that sold a fake neurostimulator to healthcare providers and instructed them to bill insurers, including Medicare, for thousands of dollars in reimbursements. The device contained a plastic part that was purposefully too long, forcing providers to spend thousands of dollars to buy a replacement plastic part from the company that still didn’t work.
Laura Perryman, 55, of Delray Beach, Florida, founder and CEO of Stimwave, was sentenced to six years in prison and three years of supervised release by U.S. District Court Judge Denise L. Cote for healthcare fraud and conspiracy to commit healthcare fraud and wire fraud following a two-week trial.
“Laura Perryman callously created a dummy medical device component and told doctors to implant it into patients,” U.S. Attorney Damian Williams said in a press release. “She did this out of greed, so doctors could bill Medicare and private insurance companies approximately $18,000 for each implantation of that dummy component and so she could entice doctors to buy her device for many thousands of dollars.”
“Perryman breached the trust of the doctors who bought her medical device, and more importantly, the patients who were implanted with that piece of plastic,” Williams continued. “This prosecution and today’s sentence are part of this Office’s ongoing work in combating fraud in the healthcare system and protecting patients from being exploited for money.”
According to the press release, Stimwave created and marketed an implantable neurostimulation device called the StimQ PNS System, which was supposed to treat chronic pain by stimulating certain peripheral nerves via an electric current. The device featured a so-called Pink Stylet, which was implanted in the patient to receive the electric impulses from another part, called the Lead.
Law enforcement officials said Stimwave sold the device to providers roughly between 2017 and 2020 for about $16,000 and told them they could bill insurers through two separate reimbursement codes for as much as $24,000.
Soon after receiving the device, providers told the company the Pink Stylet was too long to be safely implanted in patients. After a while, Stimwave—which didn’t lower the price of the device or alert providers to the problem—created a White Stylet as a replacement and sold it to providers for another $16,000.
“Perryman directed that Stimwave create the White Stylet — a dummy component made entirely of plastic, but which Perryman misrepresented to doctors as a receiver alternative to the Pink Stylet,” the press release stated. “The White Stylet could be cut to size by the doctor for use in smaller anatomical spaces and was created solely so that doctors and medical providers would continue to purchase the device for use in those scenarios and continue to bill for the implantation of a receiver component.”
According to law enforcement officials, Perryman oversaw training for doctors in how to use the device and also told others in her company to vouch for its effectiveness.
The lesson learned is that healthcare providers should do due diligence on vendors offering the latest medical devices with promises of improved clinical outcomes. And remember that plastic does not conduct electric currents.
What health systems are doing is not working, says this nurse leader.
On this episode of HL Shorts, we hear from Jennifer Croland, VP and CNO at OSF HealthCare Saint Francis Medical Center, about effective recruitment and retention strategies that CNOs can use to tackle workforce issues. Tune in to hear her insights.
Healthcare transformation is an evolving strategy. Some say a slow-but-steady approach works. Others—not so much.
Healthcare transformation is all the rage on the conference circuit these days, but are health systems and hospitals really transforming anything?
The litany of pain points within healthcare is long, from workforce shortages to soaring costs to ineffective outcomes. To address those issues, healthcare executives are looking at new technology like AI and virtual care. Some are looking for small, incremental gains, while others say the entire care delivery system has to change.
But Arthur Gianelli, MA, MBA, MPH, FACHE, chief transformation officer for New York’s Mount Sinai Health System, points out that technology may have caused just as much harm as good. For example, he says, EHRs transformed the healthcare industry “the wrong way.”
During a HealthIMPACT Forum this past week in New York City, Gianelli said the EHR is a great tool for collecting information, “but right now it has made the lives of our practitioners demonstrably worse.” Clinicians, he says, now spend as much time in front of computers as they do in front of their patients.
As a result, the industry sees transformation as a return to the past, when patient and clinician faced each other and talked about health.
That said, technology has the potential to improve healthcare—if executives know how to use it. And that comes with practice.
“You want people to try, to experiment, to potentially fail and to try again,” he said.
What’s the fix? Call your baby ugly.
Sachin Jain, MD, MBA, FACP, thinks healthcare hasn’t done enough yet to transform—and it’ll take a lot more pain and suffering to move the industry in the right director.
Jain, president and CEO of the SCAN Group and Health Plan and a long-standing voice in the healthcare field, is critical of efforts by health systems and hospitals to enact change because, he says, they haven’t really changed anything yet.
“Why have we made changing healthcare harder than putting a man on the moon?” he asked.
In a colorful appearance by video at the HealthIMPACT Forum, Jain said the industry has “normalized the abnormal” and put the wrong people in charge of care, creating a generation of people trained not to ask the tough questions—such as, why is healthcare having such a hard time defining value-based care?
It’s a question many healthcare innovation leaders are asking as disruptors like Walmart, Walgreens, and CVS Health all struggle with their primary care strategies. The popular response to this has been “Healthcare is hard,” but why is it hard? Have years and years of pay-for-procedure and episodic healthcare clouded the playing field so much that healthcare executives can’t understand what constitutes value?
Jain argued that healthcare leaders have to get serious about change, to the point of shutting down programs that aren’t working and enduring declining revenues and job losses. But healthcare, he said, has a very hard time shutting down anything.
“You can’t change without changing,” he said. “It starts by calling our baby ugly, and that’s really, really hard to do because it’s our baby.”
Jain likens AI to the printing press in its potential to transform an industry but says healthcare leaders have to ask the tough questions now, cutting programs and positions that aren’t working.
“When people talk about workforce strategies, a lot of times it’s because you have a [horrible] workforce,” he said, using a NSFW phrase.
To Gianelli, that means moving away from the same old conversations about financial benefits and looking more closely at what healthcare should be doing: Making people healthier. AI could do that, he says, and it could also “change the types of people that we actually need in the organization.”
He described transformation as a culture, rather than a strategy, and said healthcare organizations need to enact change not in the boardroom, but on the floor. That means pulling nurses, doctors, and patients into the conversation.
“Clinicians in a hospital attach to purpose,” he said, emphasizing the idea that everyone needs to be on the same page to enact change.
Jain said that will be tough.
“We’ve eroded people’s purpose,” Jain added. “And we’ve tried to solve the problem by giving doctors tchotchkes on recognition day.”
Americans would no longer have to worry about medical debts dragging down their credit scores under federal regulations proposed Tuesday by the Consumer Financial Protection Bureau.
If enacted, the rules would dramatically expand protections for tens of millions of Americans burdened by medical bills they can’t afford.
The regulations would also fulfill a pledge by the Biden administration to address the scourge of health care debt, a uniquely American problem that touches an estimated 100 million people, forcing many to make sacrifices such as limiting food, clothing, and other essentials.
“No one should be denied access to economic opportunity simply because they experienced a medical emergency,” Vice President Kamala Harris said Tuesday.
The administration further called on states to expand efforts to restrict debt collection by hospitals and to make hospitals provide more charity care to low-income patients, a step that could prevent more Americans from ending up with medical debt.
And Harris urged state and local governments to continue to buy up medical debt and retire it, a strategy that has become increasingly popular nationwide.
Credit reporting, a threat traditionally used by medical providers and debt collectors to induce patients to pay their bills, is the most common collection tactic used by hospitals, a KFF Health News analysis has shown.
Although a single unpaid bill on a credit report may not hugely affect some people, the impact can be devastating for those with large health care debts.
There is growing evidence, for example, that credit scores depressed by medical debt can threaten people’s access to housing and fuel homelessness. People with low credit scores can also have problems getting a loan or can be forced to borrow at higher interest rates.
“We’ve heard stories of individuals who couldn’t get jobs because their medical debt was impacting their credit score and they had low credit,” said Mona Shah, a senior director at Community Catalyst, a nonprofit that’s pushed for expanded medical debt protections for patients.
Shah said the proposed regulations would have a major impact on patients’ financial security and health. “This is a really big deal,” she said.
Administration officials said they plan to review public comments about their proposal through the rest of this year and hope to issue a final rule early next year.
CFPB researchers have found that medical debt — unlike other kinds of debt — does not accurately predict a consumer’s creditworthiness, calling into question how useful it is on a credit report.
The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop including some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.
Those moves have substantially reduced the number of people with medical debt on their credit reports, government data shows. But the agencies’ voluntary actions left out many patients with bigger medical bills on their credit reports.
A recent CFPB report found that 15 million people still have such bills on their credit reports, despite the voluntary changes. Many of these people live in low-income communities in the South, according to the report.
The proposed rules would not only bar future medical bills from appearing on credit reports; they would also remove current medical debts, according to administration officials.
Officials said the banned debt would include not only medical bills but also dental bills, a major source of Americans’ health care debt.
Even though the debts would not appear on credit scores, patients will still owe them. That means that hospitals, physicians, and other providers could still use other collection tactics to try to get patients to pay, including using the courts.
Patients who used credit cards to pay medical bills — including medical credit cards such as CareCredit — will also continue to see those debts on their credit scores as they would not be covered by the proposed regulation.
Hospital leaders and representatives of the debt collection industry have warned that restricting credit reporting may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.
But consumer and patient advocates continue to call for more action. The National Consumer Law Center, Community Catalyst, and about 50 other groups last year sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.
State leaders also have taken steps to expand consumer protections. In recent months, a growing number of states, led by Colorado and New York, have enacted legislation prohibiting medical debt from being included on residents’ credit reports or factored into their credit scores. Other states, including California, are considering similar measures.
Many groups are also urging the federal government to bar tax-exempt hospitals from selling patient debt to debt-buying companies or denying medical care to people with past-due bills, practices that remain widespread across the U.S., KFF Health News found.
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
CNOs need to be clear and transparent in communication surrounding AI, says this nurse leader.
AI has been all over the news recently, especially when it comes to nurses.
Many have questions about implementation and ethics, and it is up to CNOs and other nurse leaders to communicate with their workforce about what AI means for nurses.
Concerns
According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, there are three main concerns that nurses have with AI. The first is about the ethics of generative AI.
"We've not explored this too much in nursing workflows," Rocchio said, "so taking a look at some of those ethical considerations and getting out ahead of it may help us a little bit."
The second concern is job displacement.
"While we have no plans on it taking out jobs, I do think it is informing, a little bit, how we practice," Rocchio said, "which can make some just a little bit nervous."
The third is loss of human touch and connection with the patients.
"Nursing depends on us being up close and personal with the patient," Rocchio said. "Sometimes nurses think that some of these automated, generated things may get between that relationship with the patient."
Nurses also have concerns about how AI will integrate with their workflows. Since AI implementation is so new, many health systems do not know where they will use it yet.
"That unknown entity of how we might use it in the future might be driving some of the trepidation behind AI," Rocchio said.
Settling doubts
The purpose of generative AI implementation in nursing, according to Rocchio, generally consists of these three key points:
"I think the purpose is going to be around leveraging technology to optimize nursing practice to assist some nurses with [getting] information out of our EHR directly to the front lines, [and] to help us improve outcomes for patients," Rocchio said.
Rocchio mentioned three ways that Mercy is communicating to their workforce, to help nurses understand AI's relationship with their workflows.
The first is through education and training. Nurses are used to receiving a lot of education and training, Rocchio explained, but not usually around process issues.
"We're going to have to start thinking about [incorporating gen AI] into our training programs," Rocchio said. "There are going to be applications where we use it in healthcare and many nurses may not even be aware that we are using it in certain circumstances today."
The leaders at Mercy are also trying to emphasize that when AI is placed into workflows to help quicken information delivery and documentation processes, it frees up nurses to spend more time with patients.
"That [loss of] human touch they're so worried about can be mitigated [by] giving them back more time at the bedside," Rocchio said.
Additionally, Rocchio said they try to engage nurses directly with the AI implementation process on the front lines.
"When you're thinking about what may help them at the front lines, [in] that implementation phase," Rocchio said, "they should be directly responsible and [involved] in some of that."
Beyond AI
It's important for nurse leaders to communicate about all new forms of technology and integration, beyond just AI, so that nurses can understand what's coming next. According to Rocchio, one of the best things to do is talk about what regular communication patterns will look like between leaders and nurses.
"Nurses need to know what to expect and where the communication source is coming from," Rocchio said, "not just from nursing leadership, but [also from] our office of transformation."
Nurse informaticists and the rest of the digital team should be a part of the communication process as new technologies are deployed. Rocchio said that the communication patterns that come from nurse leadership and digital leadership should be consolidated into one single framework so that nurses can consume it.
Mercy has also launched a learning module around some of the new technologies.
"Nurses are starting to learn that there are going to be different ways to do things within our learning management system," Rocchio said, "so we're using what they're used to getting education and communication patterns with…to talk about AI."
Transparency
CNOs must be clear with nurses about the implementation process, goals, and outcomes, Rocchio explained.
"Being transparent about our plans for the new technologies as well as our timelines and goals and our expected outcomes," Rocchio said, "and then making sure we provide regular updates on [if we are] hitting the goals."
Leaders also need to be clear about when problems arise.
Rocchio explained how when they launched their emergency department to inpatient handoff process with AI, they did not get it right the first time. When the pilot was launched on one unit, the AI had a couple "hallucinations," where the incorrect data was pulled into the format.
"We were very transparent with the nurses," Rocchio said. "We showed them how it happened, and we went back and corrected it, so they could see ethically that we were doing the right thing."
Leadership visibility and accessibility are also key.
"When we launched our workforce platform with AI in the background, the other thing we did was make sure that leaders and individual caregivers were there to make decisions around how that AI was put into the system," Rocchio said.
"I think both of those things are really important to make sure that those key messages are consistent across all platforms," Rocchio said.
Creating the workforce of the future is one of the biggest challenges for nurse leaders, says this CNO.
Dr. Jesus Cepero, PhD, RN, NEA-BC, has spent his entire career in nursing leadership roles, and is passionate about the care of babies, children, and moms. Cepero earned a doctorate in nursing from Catholic University in Washington, D.C., and a Master of Science in Nursing from Kean University. He also holds a Master of Public Administration from Seton Hall University.
Most recently, he served as chief nursing officer for the University of Michigan’s Mott Children’s Hospital and Von Voigtlander Women’s Hospital in Ann Arbor, MI. He was responsible for leading all aspects of nursing administration across the two hospitals. He developed a nursing philanthropy committee, implemented a system-wide program for senior leadership rounding, and co-led a response to the opioid crisis.
Now, Cepero serves as the CNO at Stanford Medicine Children's Health, where he provides nursing and patient care leadership across the entire enterprise, partnering with leaders in the outpatient, treatment center, and inpatient areas.
On our latest installment of The Exec, HealthLeaders sat down with Cepero to discuss his journey into nursing, and his thoughts on trends in the nursing industry. Tune in to hear his insights.
Healthcare organizations have to look beyond the money and focus on culture and innovation to bolster the workforce, said panelists at this week’s HealthIMPACT Forum
To take on workforce shortages across the enterprise, healthcare organizations have to be innovative. And that means looking past the money.
“We can’t get into a bidding war,” said Kirk Larson, Aspirus Health’s Chief Technology Officer, noting the Wisconsin-based health system can’t match IT salaries offered by the likes of Microsoft, Amazon, and Apple.
And it’s not just IT talent that health systems are struggling to find. Mike Mosquito, CHCIO, MBA, PMP, CDH-E, who heads emerging technology & innovation special projects for the Northeast Georgia Health System, said he has to be creative to draw doctors and nurses from the more affluent Atlanta area to the south.
The two healthcare executives were part of a panel titled “Solving Your Clinical Talent Shortage” at this week’s HealthIMPACT Forum in New York City. Their discussion hit on a topic familiar to every health system and hospital: Trying to keep the employees you have and create an environment to attract new employees.
The challenge lies in making healthcare an attractive career decision beyond the thorny issue of pay. And that means adding perks that appeal to employees seeking a better work-life balance and a good work environment, such as work-from-home opportunities, child and senior care benefits, and of course better workflows.
Healthcare innovation plays a significant role in that strategy. Health systems and hospitals are using virtual care and digital health tools to improve those workflows, aiming to reduce stress and burnout in the workforce and enable doctors and nurses to work at the top of their license—in other words, in front of patients rather than in front of a computer. Some health systems are using virtual care as a hiring perk, with the idea that clinicians can on occasion work from home and senior staff can virtually mentor young recruits and work from a desktop in a telemedicine command center.
Just as important, the panelists said, are collaborations between healthcare organizations and academic institutions. At the college level, health systems need to actively support healthcare curricula and create opportunities for students to experience what they’re studying to become, from job-shadowing to internships.
That effort should extend into high school as well.
“Help [students] understand where the jobs are,” said Larson, referencing programs that highlight the culture and responsibility of the healthcare industry and the opportunities to apply for positions that are open. He and the other panelists also suggested an easier process for students to apply for jobs—like a blue button for healthcare.
“Don’t always have a money grab,” added Mosquito, noting that some of the coolest, most innovative technology—like robots—is also being used in healthcare.
The panel, which included Sandra Bossi, Senior Director of Clinical Operations Administration at LiveOnNY and moderator Shahid Shah, chairman of the HealthIMPACT Forum, stressed that healthcare organizations need to “speak the language” of today’s emerging workforce.
“You’ve got to attract the kids [and help them to see] this is the path for you,” Mosquito said. “Not everyone’s going to be a TikTok millionaire.”
CNOs are responsible for making sure their nurses stay safe and healthy at work, both mentally and physically.
Editor's note: Mary Beth Kingston is Chief Nursing Officer for Advocate Health, the third-largest non-profit health system in the country.
Being a nurse requires so many skills.
They are patient and understanding when we’re suffering and recovering. They are experts, knowing the latest medical advances and care techniques. They are always available and ready when we need them the most.
They also need to be safe.
And yet nurses and health care workers are among the professionals most likely to face violence on the job in America.
According to the American Hospital Association, 44% of nurses have been subject to physical violence, and 68% reported verbal abuse. The Bureau of Labor Statistics shows that health care workers are five times more likely than others to be physically attacked on the job.
As the Chief Nursing Officer for one of the nation’s largest health systems, I’ve unfortunately heard these stories frequently from the nurses who have experienced these traumas. Somehow, because they’re so committed to caring for people, many victims of this violence press on.
Health care leaders like me must continue to support them, especially at a time when our industry is recovering from the stress and staff shortages exacerbated by the pandemic. Here are three key ways.
First, we need to listen to nurses.
We’re proud of the programs we have at Advocate Health to help prevent violence and help nurses with their wellbeing. The best ideas come directly from them. When I’m rounding in our hospitals and talking to the people who care for patients every day, I make sure to ask them what they need. What is going well and what isn’t? They’re doing the work every day, so they know better than anyone.
Nurses often tell me that – like so many other workers -- they find their greatest supporters in their teammates and direct leaders. So we must keep investing in training great nurses and nursing leaders.
Second, we must prioritize patient safety and worker safety at the same time. For health care providers, safety is paramount. We spend immense amounts of time, energy and resources working to ensure patients receive the safest care possible at our hospitals and clinics.
Violence prevention and addressing violence-driven injuries should be a priority for health systems as they look to advance health equity in their communities. For example, Advocate Health has several programs that are dedicated to helping patients recover after experiencing trauma and mitigating violence-related injuries. So we’re equipped to offer this support to our teammates, too.
And while the strategies are different, we need to prioritize our workers’ safety in the same way we do with patients. Nurses who feel safe at work provide great, safe care to patients.
Third, we need to ensure high-level leaders know how important this issue is to nurses and workers on the ground. June 7 was the American Hospital Association’s Hospitals Against Violence Day, a national awareness campaign that highlighted how America’s hospitals and health systems combat violence in their workplaces and communities. This work continues every day.
Among the leaders who must prioritize this issue are federal officials, who should advance the Safety from Violence for Healthcare Employees Act – known as the SAVE Act. This legislation would give health care workers the same legal protections against assault and intimidation that flight crews and airport workers have under federal law.
This law alone won’t solve the problem of violence in health care, but it will be an important tool and powerful statement to support all the work that’s being done locally to protect our nurses and health care workers.
Through the most difficult and trying times of our lives, they come through for us and ensure our safety. We must continue to come through for them.
Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content.
