The University of South Carolina is launching a remote patient monitoring program aimed at reducing the state’s high maternal mortality rate of 32.7 deaths per 100,000 births
The University of South Carolina is launching a remote patient monitoring program aimed to improve care management for new mothers and their children.
The university is partnering with digital health company Rimidi to launch the program through an affiliated multispecialty clinic. Funded by The Duke Endowment, the platform will help care providers monitor blood pressure for patients in underserved communities following a high-risk pregnancy.
“Our partnership with Rimidi aims to address a critical maternal health challenge in South Carolina – reducing complications from postpartum hypertension,” Nansi Boghossian, an Associate Professor at the University of South Carolina who is spearheading the RPM program, said in a press release. “Through this collaboration, we are committed to improving patient care and enhancing the health of mothers in underserved communities.”
The program aims to tackle South Carolina’s high maternal mortality rate, which a recent report put at 32.7 maternal deaths per 100,000 births, by addressing key health concerns like preeclampsia, gestational hypertension, and chronic hypertension. That’s a high rate in a country whose 2022 maternal mortality rate of 22.3 deaths per 100,000 live births is one of the worst of all developed nations.
Through the health system’s Epic EHR, care teams will focus on metrics like blood pressure ascertainment during the first six weeks postpartum, in-person postpartum visit attendance, hospital readmissions through 12 months postpartum, program acceptability, retention, satisfaction, and cost-effectiveness.
RPM platforms give care providers an opportunity to monitor patients after they leave the hospital, clinic, or doctor’s office. By using connected devices to gather data from patients at home, they can spot trends, adjust care management plans, and even intervene if a patient is showing signs of developing a serious health concern.
A new program from the Digital Therapeutics Alliance and DirectTrust is betting yes.
Healthcare’s acceptance of digital therapeutics (DTx) continues to be a long and winding road. Two organizations hope to change that. DirectTrust and the Digital Therapeutics Alliance (DTA) are creating an accreditation program for DTx applications and platforms. The program will independently evaluate DTx products for their efficacy, and for data privacy, security, transparency and interoperability.
These characteristics are key for DTx regulatory approval (when required) and for another kind of approval: that of payers. DTx requires confidence: that it can improve outcomes as well or better than traditional therapies and thus be worth including in treatment recommendations, benefit designs, formularies and reimbursement.
DTx accreditation program details
In the new accreditation program, DirectTrust will administer and the DTA will develop the DTx evaluation criteria.
DirectTrust — a non-profit alliance that develops, promotes, and helps enforce healthcare data rules and best practices — already offers DTx evaluation services but is expanding them for the new accreditation program.
“This collaboration will add to DirectTrust’s growing suite of programs designed to assess the diverse digital health app and platform market,” said Scott Stuewe, DirectTrust President and CEO. Accreditation assessment will include data privacy, security, transparency — as well as interoperability to create “effective, scalable [DTx] connections to national health networks using the FHIR standard.”
The DTA is a non-profit trade association that promotes DTx understanding, adoption, and integration in healthcare.
“As the digital therapeutics industry grows, an increasing number of U.S. clinicians, provider systems, health plans, employers, and patients are evaluating how to best incorporate DTx products into their care plans to provide the highest quality of care,” said Andy Molnar, CEO of the DTA, in the program press release.
Making these decisions requires regulatory and reimbursement support.
DTx evolution: Approval and payment
Just as regulatory and reimbursement changes supported telehealth expansion during the pandemic, DTx products and developers need these tools to grow and scale.
Regulatory: Not all DTx products require regulatory approval. For those that do, the U.S. Food and Drug Administration (FDA) offers multiple pathways to demonstrate safety and efficacy, with the 21st Century Cures Act helping to further speed review. HIPAA and theThe HITECH Act govern most but not all DTx data privacy, security, and transparency requirements.
Reimbursement: “Yes, but limited” is how the DTA describes the status of most DTx reimbursement — when it occurs at all. Among public payers, Medicaid and Medicare Advantage offer more flexibility than traditional Medicare while employer-sponsored coverage requires negotiation.
According to BGO software, the FDA approved 50% more digital therapeutics in 2023 than in 2022.
There have also been setbacks and advances. Pear Therapeutics, one of the most promising DTx companies to emerge, declared bankruptcy in 2023 — just two years after going public with a $1.6 billion valuation and after securing multiple Medicaid contracts. Conversely, the Centers for Medicare & Medicaid Services (CMS) approved a new reimbursement code for AppliedVR’s DTx product that combines virtual reality hardware and software and likely helped expand the company’s partnership with the Veterans Administration.
Overall, digital health investment has cooled since the pandemic due to continued economic uncertainties, but as any private equity firm will tell you: there is a lot of dry powder in search of valuable investment. Could accreditation make DTx a stronger bet?
Why it matters: Trust and economics
The DTA’s CEO Molnar continues: “With an overwhelming number of products touting a wide range of clinical rigor, it is critical that we set a high bar to build trust.”
Efficacy is one hurdle. Providers and payers must have confidence that DTx options are as good as or better than or a worthwhile companion to traditional treatments.
Another hurdle is sustainability: Does DTx not only demonstrate but sustain outcomes in a way that makes it a sound investment? That answer will vary — by condition and treatment, by product and business, and by payer.
All of the above impact payer DTx decisions: Whether to cover it, how to cover it (medical or pharmacy benefit, formulary placement), and how to pay for it.
Will DTx accreditation matter?
Bigger changes must occur for DTx to become more integrated into healthcare’s delivery system and reimbursement framework. Is accreditation one of them?
As a baby step, maybe. Accreditation does lend credibility, particularly to new directions and initiatives. For example, there's the NCQA’s newer Health Equity Accreditation (HEA) and HEA Plus programs for health plans and health systems — designations that reflect an organization’s ability to create a health equity culture, to collect vital race, ethnicity, and language (REaL) data to support patients’ needs, and to identify equity needs overall.
Accreditation signals that key frameworks are in place that support strong healthcare practices and continuous improvement. The DTA and DirectTrust hope that accreditation will achieve the same for digital therapeutics.
A new study aims to replace BMI with BRI, giving care providers a better way to measure a patient’s fat content
Could a new measurement of obesity replace BMI and give healthcare providers a more accurate representation of their patients’ weight issues?
A new study published this month in JAMA, co-authored by researchers from China and Brown University in Providence, Rhode Island, makes the argument for what is called the body roundness index, or BRI. Whereas BMI, or body mass index, measures a person’s height and weight, BRI adds in waist circumference to gain a better understanding of where fat is distributed on the body.
The difference could affect how providers develop innovative programs to address obesity and other weight-related health concerns. With a better idea of how a body is proportioned and where fat is located, providers can develop better treatments and gain a better idea of those programs’ effectiveness.
It’s a key element to care management at a time when obesity and weight-related issues are a popular topic of conversation. From the effect that weight has on chronic diseases like diabetes, asthma, and heart disease to the popularity of Ozempic and Wegovy, both consumers and their care providers are keenly interested in how to address excess body fat.
BMI has been considered the standard for body fat measurement since the 1980s, but critics have long questioned whether it’s an accurate assessment, since it doesn’t take into account organs, bone, muscle and water. The JAMA study takes this one step further, arguing that providers need a better measurement “to decipher population-based characteristics and potential association with mortality risk.”
“Besides weight and height, BRI additionally considers waist circumference, and hence it can more comprehensively reflect visceral fat distribution,” the study’s authors note. “BRI was found to be superior over other anthropometric indicators in estimating the risk for various clinical end points, including cardiometabolic disease, kidney disease, and cancer. Furthermore, longitudinal studies have shown that high BRI was associated with the significantly increased risk of all-cause mortality and cardiovascular disease-specific mortality.”
The study, using data from almost 33,000 U.S. adults taken from the National Health and Nutrition Examination Survey (NHANES) and NHANES Linked Mortality File, compared a person’s all-cause mortality risk based on BMI and BRI, and found BRI to be more accurate. This was especially true for muscular people and the elderly, who tend to have inaccurate BMI measurements because of their body shape.
Those findings, the authors said, “provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”
Nurse managers are a critical piece of the workforce puzzle, and they are spread too thin.
On this episode of HL Shorts, we hear from Rudy Jackson, senior vice president and CNE at UW Health, about what needs to change in health systems to give more support to nurse managers. Tune in to hear his insights.
A report issued earlier this year by the Bipartisan Policy Center offers a blueprint for expanding remote patient monitoring opportunities and coverage
Remote patient monitoring (RPM) has the potential to improve clinical outcomes by giving providers the ability to improve care management outside the hospital or doctor’s office, but its growth is being stymied by low reimbursement.
A report released earlier this year by the Bipartisan Policy Center gives the government and the healthcare industry a blueprint to address that roadblock.
While RPM has seen tremendous growth coming out of the pandemic, its future is in question. The Centers for Medicare & Medicaid Services (CMS) offers only a handful of CPT codes for remote physiological monitoring and remote therapeutic monitoring, enabling care providers to recoup, according to one study, as much as $170 per patient per month from Medicare. To make matters worse, the American Medical Association’s CPT Editorial Panel, which governs CPT codes, has hit a roadblock on new codes that would expand reimbursement opportunities.
The reimbursement issue could prompt healthcare organizations to avoid launching or expanding RPM programs, figuring the effort to support the program is too much for the amount of money that would come back in.
To improve the playing field, the Bipartisan Policy Center report lists five recommendations for service coverage:
CMS should work with medical specialty societies to evaluate the evidence and determine appropriate coverage mechanisms to guide the optimal use of RPM, including for which patients and over what duration. This work could include collaborating with Medicare Administrative Contractors (MACs) or issuing National Coverage Determinations (NCDs).
As more evidence emerges about the appropriate use of RPM devices, the Health and Human Services Secretary should recommend a diverse set of billing codes so providers have more options for the time they spend on the data and the number of minimum days of data required.
CMS should clarify current policies regarding appropriate coding and billing of RPM and RTM. It should also require providers not enrolled in risk-based models to attest to medical necessity for patients’ continued use of remote monitoring—at a frequency deemed appropriate by the HHS secretary and based on condition-specific clinical guidelines.
CMS should work with the AMA and relevant medical specialty societies to develop additional RTM billing codes to allow for use cases beyond musculoskeletal, respiratory, and cognitive behavioral therapy—as the evidence supports.
Congress should request the Medicare Payment Advisory Commission (MedPAC) to report on the impact of remote monitoring on clinical outcomes and cost by disease state, and on any new billing thresholds or code durations, at least every three years.
The goal of these recommendations is to move the needle forward on RPM and give more healthcare organizations—especially smaller hospitals and health systems with limited resources and those working with underserved populations—a chance to expand their reach.
Virtual nursing will address workforce shortage issues, say these nurse leaders.
Virtual nursing will open up a whole new realm of possibilities.
From admissions and discharges to patient monitoring, mentoring, and even at-home care, virtual care technology will push healthcare into the future.
The HealthLeaders Virtual Nursing Mastermind program participants met last week in Atlanta to discuss their virtual nursing programs and outcomes. There are several key points that CNOs can take back to their health systems and integrate into their own virtual nursing programs.
Building the workforce
First and foremost, virtual nursing is going to expand the capabilities of the nursing workforce. Many of the participants agreed that virtual nursing is one of the only answers to the nursing shortage.
According to the participants, tenured nurses are able to extend their careers virtually when working at the bedside is no longer a viable option. New graduate nurses from the next generation who expect to work digitally will be able to do so, and licensed nurses from all over can work remotely and provide care to other parts of the country.
Health systems should do what they are capable of when it comes to operationalizing virtual nursing programs. Some participants use a central telemedicine hub in their health systems for the virtual nurses, while others use telemedicine stations on or near the floor. Some are also exploring work-from-home strategies.
Many of the virtual nurses in the participants' health systems are centralized and working off of a task queue, and can move freely throughout the system to complete their work. Several of the participants agreed that shift flexibility is also necessary, to give nurses who have external needs the opportunity to work when it is best for them.
Choosing the technology
Technology is obviously one of the largest pieces of the virtual care puzzle. It is critical that CNOs and other leaders invest in the right technology that will help them meet their goals, while also remaining cost effective. Leaders should not be surprised, however, to get it wrong on the first try.
According to the participants, leaders have several options for virtual care technology. Many started simply with iPads and carts, which they said aren’t long-termbut do enable them to get their programs off the ground.
When upgrading technology or starting at the beginning, several participating health systems outsourced to a third-party vendor, while others developed the technology in-house. One dilemma is whether to lease or buy the technology, since new devices are frequently updated to include the newest bells and whistles.
Most importantly, CNOs and other leaders should invest in technology that will actually be used by the care team. According to the participants, the nurses' experience with the platforms should provide them with a better, more efficient experience, because if they don't like the technology, it will not be used.
Gaining buy-in
One of the biggest challenges that CNOs and other nurse leaders will face when implementing virtual nursing programs is gaining buy-in from the rest of the C-suite.
CEOs and CFOs are largely concerned about ROI and how virtual nursing programs will save money. The participants recommended starting with concrete metrics like decreased discharge times to prove ROI. However, most metrics will depend on each health system's needs, and how they define ROI.
CNOs also need to provide their support to virtual nursing programs. According to the participants, there have been some concerns about ratio changes and nurses getting taken off the floor, and about how the technology will interfere with nurse workflows, which worries the nurses. This is why proper messaging, education, and a clear roll-out plan are critical, according to the participants.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling 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.
At the HealthLeaders Virtual Nursing Mastermind event this week in Atlanta, healthcare leaders discussed the KPIs they're measuring to prove ROI.
Healthcare executives are embracing innovative ideas like virtual care to stabilize a shrinking nursing workforce and boost clinical outcomes, but they need to know what to measure to prove ROI.
Virtual nursing programs are becoming popular in health systems across the country, either as a stand-alone program or, more commonly, as one part of a more comprehensive reimagining of care. And while each health system or hospital is advancing its own strategy, there are common objectives, such as nursing turnover and well-being, administrative tasks, and patient engagement.
Executives from a dozen health systems met in Atlanta this week 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.
Staff turnover and well-being. The initial impetus for many health systems in launching virtual nursing programs is to address a shrinking workforce. Nursing executives are looking for ways to not only reduce turnover, but improve the environment so that nurses want to stay (and others want to join in). Virtual nursing programs create new opportunities for the workforce while revising workloads so that floor nurses are doing less administrative work and spending more time doing what they trained to do: spend time with patients.
While the trurnover rate is a key metric, others include nurse satisfaction (measured in surveys) and time spent on the computer, usually tracked through the EHR platform. While these metrics often are difficult to translate into dollars, Clair Lunt, RN, DHSc, Senior Director of Nursing Informatics at New York’s Mount Sinai Health System, noted they’re seeing a decline in the use of travel nurses and overtime, as well as PTO and even sick time (such as so-called mental health days), all of which significantly affect the bottom line.
The results aren’t limited to nurses, either. Providence is one of seeing a reduction in all-staff turnover, according to Sherene Schlegel, RN, BSN, COO and CNO of Virtual Care and Digital Health. These programs can thus impact all members of the care team, including CNAs and physicians.
As these programs involve, the executives in the Mastermind class noted that virtual nursing can be used as a marketing tool to attract new talent, especially as programs grow to include work-at-home policies.
Patient satisfaction. With the industry’s gradual shift to value-based care, health systems are placing more emphasis on patient experience—and a virtual nursing program can have a profound impact on how a patient feels about the care they receive. Most health systems see these effects in their HCAHPS scores, and some are even tailoring patient surveys to include specific questions on patient interactions with nurses.
It's important to remember that patient satisfaction and engagement do factor into an effective care management plan. Engaged patients are more likely to communicate freely with their nurses, listen to their care teams and adhere to those plans—something that can be measured in medication adherence.
To see those high patient satisfaction scores, health systems need to make sure patients are comfortable with virtual care, including the idea of having a camera in the room, trained on them. Mastermind participants recommended engaging with the patients as soon as they’re settled in their rooms to explain the technology and its uses, as well as designing the technology so that patients know when the camera is off.
Sara Pletcher, MD, MHCDS, SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, pointed out that patients need to understand that virtual care is a routine standard of care, and not an add-on or a luxury. She noted that Houston Methodist now includes virtual care monitoring as part of its consent form, rather than as a separate opt-out.
Patient Throughput. Many health systems are embracing virtual nursing to address patient admission and discharge times, and consequently patient length of stay, all key metrics. But those processes are often complex, involving more than just nurses.
Emily Warr, Administrator of the Center for Telehealth at the Medical University of South Carolina (MUSC), noted that patient discharge is a key pain point in healthcare, one that affects patient satisfaction as well as clinical outcomes, and health systems like Intermountain have a benchmark of three hours from the time a discharge notice is entered to when the patient leaves the hospital. A virtual nursing program is then designed to reduce that time by having a virtual nurse handle as much of the administrative details as possible, including patient education, while the floor nurse manages in-person care duties.
The upshot is that a virtual nurse can oversee those details that a floor nurse would have had to do, reducing time spent and helping the patient get home faster. The same could be said for getting a patient settled into his or her hospital room, with the virtual nurse handling data entry and the floor nurse making sure the patient is comfortable. Both of those processes, as well as any data entry during the patient’s stay, contribute to the overall PLOS.
Again, healthcare executives need to understand that these metrics involve much more than just the nursing department, and that one aspect like virtual nursing won’t necessarily move the needle to a large degree. But incremental improvements are just as important, and for health systems engaged in a redesign of the entire care process, this is one vital step in that evolution.
Administrative tasks. Aside from handling admission and discharge processes, a virtual nursing program can also take on most, if not all, tasks which involve putting a floor nurse in front of a computer (a pain point noted in nurse well-being measurements). This could range from virtual rounding to physician visits to surveys for ancillary programs like sepsis detection, wound care, or medication adherence.
Health system executives can measure success here in accuracy of data entry, or in time taken to complete a task. Some executives have noted that floor nurses are often so busy they fail to do all the data entry and paperwork they should be doing. The end result is that care management is more efficient, and in turn leads to better outcomes.
Additionally, in a separate interview, Warr noted that after a while, floor nurses and virtual nurses in their program were so adept at working together that they could handle tasks without stopping to let the other person know. They also felt comfortable jumping in when needed and helping each other with tasks.
A key to success here is the relationship between the virtual nurse and the floor nurse. Health systems must establish clear protocols for both nurses before launching a program, so that each nurse knows their responsibilities. A good collaboration will be seen in efficient documentation, timely care delivery, and nurse satisfaction.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling 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 longtime leader of Banner Health shares how the role is different now from when he first started.
Since taking the helm at Banner Health 24 years ago, up until his retirement at the end this month, veteran CEO Peter Fine has seen how leading a hospital has changed over time.
As patients' wants and needs have shifted, the CEO has had to follow suit. At a certain point, around 2017, hospitals realized they weren't just dealing with patients, but "customers" because "the public was judging us not on our clinical product, but the ease of usage," Fine told HealthLeaders.
"The focus before was all we have to do is provide a good clinical product and that satisfies everybody. Well, that's not the case," Fine said. "So that causes you to have to change certain things in your style and your approach and the things that you say and do in front of others become way different. Creating that recognition for everybody that you also have to look for opportunities to take away pain points that get in the way of the consumer interacting with us. It's a different approach because how you speak and what you say become way different."
Fine will retire on June 30 after two-plus decades as CEO of the Phoenix, Arizona-based nonprofit health system, giving way to president Amy Perry, who aims to build on his foundation with a technology-forward approach.
Pictured: Banner Health CEO Peter Fine.
As many hospital CEOs are calling it a career, it's contributing to a steady churn at the position that has been exacerbated in recent years due to mounting challenges. According to Fine, the pressure has never been higher and between private equity, relationships with payers, and the growth of Medicare Advantage plans, it's no surprise that leaders are willingly stepping aside.
"COVID took its toll on many, many leaders," Fine said. "Partly because of what we went through for a two-plus year period, but also the change in how you have to lead. I was always used to walking out of my office, walking to one of 10 other offices on the floor there at 4:00 in the afternoon and just sitting down and talking about strategy and the organization. Now everything is a scheduled Zoom call or a Teams call and there's no spontaneity. So for many, they had to learn a new way of leading an organization, figuring out how to be visible and figuring out how to stylistically be out in front of the organization as much as they can."
For Fine, how the CEO role evolved during his tenure was part of the reason why he found the job so intellectually stimulating, causing him to keep tacking on years to the "highly unusual" 47 overall he spent in healthcare.
"It changed and morphed as an organization into a different kind of business today than it was back in 2000," he said. "It was fun and interesting and when something's fun and interesting and intellectually stimulating, in my case, having tremendous governance along the way and board leadership that's very professional, that was advantageous as well. Not everybody has that.
"The idea of watching an organization grow and finding opportunities for an organization to grow made it, quite frankly, a fun job."
California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets
The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.
Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?
The jury is out, and it could be for many years.
California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.
Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.
In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”
Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.
It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.
And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.
“If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”
Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.
In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.
The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.
Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.
The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”
But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.
Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.
Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.
The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.
Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.
For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.
In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.
Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”
Reducing span of control will allow for leadership development, this nurse leader says.
HealthLeaders spoke with Rudy Jackson, senior vice president and chief nurse executive at UW Health, and HealthLeaders Exchange member, to find out how leaders can lower span of control for nurse managers to improve workforce development without adding additional cost. Tune in to hear his insights.
TheHealthLeaders 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.
