Workplace violence prevention takes efforts from the health system and the community, according to this nurse leader.
HealthLeaders spoke to Mary Beth Kingston, executive vice president and chief nursing officer at Advocate Health, about how to CNOs can prevent workplace violence. Tune in to hear her insights.
Health systems are investing heavily in the patient experience. At Springfield Clinic, that strategy is critical to continued sustainability in a complex market.
Despite recent missteps by disruptors in the primary care space, the greatest threat to health systems and hospitals is retail healthcare. That’s why it’s important not to overlook the patient experience.
And patients don’t want to deal with paperwork, especially when they’re not feeling well.
Healthcare organizations are using digital health tools and telehealth portals to reduce the administrative burden on patients seeking care and shorten the time between entry and treatment. They’re also embracing remote patient monitoring and other platforms that bring care directly to the patient.
For an industry that traditionally waits for patients to come to them, it’s a new strategy.
“[Healthcare] is a very antiquated process,” says Zach Kerker, chief brand and advocacy officer at Springfield Clinic. “From how you schedule appointments, to how you complete processes in order to get in to see your physician, to coming into the office and having your last name shouted at you and being marched through a room of people, it’s a cold cattle-call-like experience.”
The Illinois clinic, comprising more than 650 physicians and roughly 80 specialties, is addressing engagement with a patient experience department, led by Kerker, who joined the health system in 2018 after a career in sports reporting and digital sports development.
Kerker is acutely aware of the inroads made by Amazon and others in fashioning a retail healthcare experience that focuses on convenience and accessibility. Today’s consumers, he says, favor that experience over the visit to a doctor’s office, clinic, or hospital. When they’re sick, he says, all they want is care.
That’s why health systems and hospitals are prioritizing their innovation efforts on making healthcare more personal. They’re investing in strategies and technology that reduce the paperwork and improve scheduling processes, including more intuitive patient portals and tools that allow patients to schedule their own appointments online.
It’s not an easy investment to make, given the trying times for many hospitals and health systems trying to stay in the black.
“It’s difficult to do because the economics of healthcare are very difficult right now,” Kerker notes. “But what I would say is it is an investment and it does bear fruit, and if you want longevity in a world where everybody can give it to you quick and easy, who’s going to give you their heart? Who’s going to show up and be emotionally invested with you? Is going to matter in this space.”
The results of that strategy are seen in improved patient satisfaction scores, as measured by surveys and valued by the Joint Commission, among others. Kerker says those efforts are helping Springfield Clinic keep their patients and attract consumers in a complex healthcare environment.
Kerker says that engagement strategy actually begins before the patient sets foot in the hospital. Supported by digital health tools, the health system reaches out to a patient before an appointment to gather information, including insurance details and all data pertaining to the visit.
“So when you walk in the door, we’re welcoming you,” Kerker says. “You’re walking in and we’re not demanding information from you, which is not a particularly warm experience. We’re asking you quite literally what can we do to help you and care for you today?”
To make that possible, Springfield Clinic partnered with Health Note to handle patient self-scheduling, intake and clinical documentation and integrate data collection with the health system’s athenahealth EHR. The two had first worked together in 2021, creating a digital front door for a small, rural urgent care facility; that project saw a bump in patient satisfaction scores and a sharp increase in at-home completion of forms and led to a much larger installation in 2022.
Kerker sees technology partnerships as a key to success. Health systems and hospitals don’t have the expertise or the resources to develop and manage their digital footprint, so they need partners to handle the details. This also gives leadership more time for focus on change management.
“The most ironic part about this is that people understandably expect that technology reduces the human interaction,” he points out. “But what we’ve tried to do is use technology to complement a better human experience.”
A challenge for many health systems is finding a digital health platform that can accommodate the nuances of different specialties and departments, rather than relying on a one-size-fits-all approach. Kerker advises sitting down with the vendor to map out how a patient would access each department or specialist, and what protocols would be needed to support that journey.
That’s where the retail industry has a head start. Companies like Amazon, Apple and Microsoft have the consumer experience figured out, whereas healthcare has to catch up.
“We are behind most industries in adopting this technology,” Kerker notes. And while some of the bigger disruptors are having problems figuring out healthcare, he says, healthcare leaders shouldn’t be lulled into complacency.
They “are very smart and they will figure these things out,” he says.
Healthcare organizations have an advantage over disruptors in their history of caregiving, but that can only go so far. Kerker says hospitals and health systems need to build on those relationships by making the healthcare experience more modern and convenient. That’s why staff and clinicians at Springfield Clinic are encouraged to greet patients at the door, call them by their first names, thank them for coming in today, and ask what can be done to make their visit better.
Kerker says the patient experience will improve as the technology gets better, especially as new tools like AI speed up the process.
“We’re at the doorstep of kind of growing out of that stage of clunkiness in the technology side and into a more fluid experience,” he says.
The company announced that its reorganization plan received court approval. What's next for the company?
Cano Health has successfully climbed out of bankruptcy months after entering restructuring, the primary care chain announced.
By converting more than $1 billion of funded debt into common stock and warrants, and receiving a commitment of more than $200 million from existing investors for its business plan going forward, Cano said it emerged from Chapter 11 as a reorganizing private company.
In February, the provider filed for bankruptcy and was delisted from the New York Stock Exchange following a significant stretch of financial trouble that saw it accrue liabilities in the range of $1 billion to $10 billion.
With a “significantly improved capital structure and optimized operations,” Cano will now turn its attention to its Florida market.
"We are taking a disciplined and strategic approach to our growth over the next few years, with the primary goal of improving services for patients within our existing Florida footprint, which now consists of 80 locations,” Cano Health CEO Mark Kent said in the news release.
“We are already seeing encouraging results across our improved platform, and I am immensely proud of our associates for their continued dedication to our patients throughout this process. Despite the challenges we have faced as an organization, we have emerged as a stronger and more focused company with a bright future."
Necessary shake-up
Cano said it is on track to hit its goal of $290 million in annualized cost reductions by the end of this year, with $270 million in cost reductions and productivity improvements already achieved.
The company was forced to make changes after reporting net losses of $270.7 million and $491.7 million in the second and third quarters of last year, respectively.
Liquidity was partly achieved through strategic divestitures of underperforming expansion markets, including the sale of its Texas and Nevada primary care centers for nearly $67 million to Humana’s CenterWell Senior Primary Care business.
Cano also exited operations in California, New Mexico, Illinois, and Puerto Rico, while reducing its workforce in the third quarter of last year by 21%.
Additionally, Cano announced leadership changes to its board of directors to better align with its planned path. Alan Wheatley, a former Humana executive who ran Medicare and Medicaid programs, will join the board as Executive Chariman, serving alongside two other members, Kent and Eric Hsiao of Nut Tree Capital Management.
Registered nurses play a key role in the healthcare workforce and contribute to the health and well-being of millions of Americans, working in hospitals, nursing homes, physician's offices, and home health services. The profession has been experiencing shortages, which were exacerbated by the COVID-19 pandemic and are predicted to continue over the next decade as the 65 and older population in the U.S. grows, increasing healthcare needs. Demand for nurses will also likely increase to meet new requirements for nurse staffing levels in nursing facilities.
Immigrant workers could help address these needs. As of 2022, there were about 500,000 immigrant nurses in the U.S., accounting for about one in six of the close to 3.2 million RNs.1 However, immigration remains a hot-button political issue with ongoing anti-immigrant rhetoric and recent actions and proposals to limit immigration and immigrants' role in the workforce. These actions include the federal government extending its pause on the processing of new visa applications for international nurses in June 2024. The pause has been in place since April 2023 and, at this time, the government is only processing applications submitted on or before December 2021. Legislation has been proposed to increase employment-based visas for nurses, although it has remained stalled since 2023. Visa opportunities for nurses could also potentially be expanded through administrative action, for example via H-1B visas, though they would have limitations.
These visa restrictions could exacerbate existing shortages in the nursing workforce and negatively impact the U.S. labor market and economy more broadly, particularly given the growing role of foreign-educated nurses in U.S. hospitals. KFF analysis of data from the American Hospital Association (AHA) Annual Survey shows that the overall share of hospitals reporting hiring foreign-educated RNs has nearly doubled between 2010 and 2022, and a growing share of hospitals report hiring an increasing number of foreign-educated RNs to fill vacancies over time.
Overall, 32% of hospitals accounting for nearly half (45%) of all hospital beds say they hired foreign-educated RNs in 2022, twice the share in 2010, when 16% of hospitals accounting for about a quarter (23%) of all hospital beds said they hired foreign-educated RNs. In addition, between 2010 and 2022, the share of hospitals saying they hired more foreign-educated nurses to help fill RN vacancies compared to the previous year rose from 2% of hospitals representing 3% of hospital beds to 14% of hospitals representing 22% of hospital beds.
On this episode of the HealthLeaders podcast, Finance Editor Marie DeFreitas is joined by Chief Executive Officer of Confluent Health Dr. Kristi Henderson to discuss the benefits of mergers, as well as how to develop healthy partnerships, select the right partners, and ensure employee and clinician satisfaction throughout the process.
After roughly a decade of sometimes political wrangling, a new law mandates that payers reimburse providers for covered services offered via telehealth.
Long-standing barriers to telehealth adoption in Pennsylvania are coming to an end with the passage of a new law that includes coverage parity.
Governor Josh Shapiro last week signed into law SB 739, ending a decade-old battle to ease barriers that have kept hospitals and health systems in the Keystone State from embracing virtual care. The new law requires health insurers and managed care plans to reimburse providers for any covered services that are offered through telehealth, as well as setting accessibility standards for state Medicaid and Children’s Health Insurance Program (CHIP) coverage.
“Every Pennsylvanian deserves to have access to quality, affordable healthcare when and where they need it – and it shouldn’t be up to an insurance company to pick and choose what they cover,” Shapiro said in a press release. “More and more Pennsylvanians are relying on telemedicine to see their doctors, and this bill requires insurers to cover services delivered via telemedicine the same way they cover traditional in-person services. My administration will continue to work across party lines to expand access to healthcare for all Pennsylvanians, including those in our rural communities.”
The signing ends more than 10 years of efforts by telehealth advocates to get a parity law on the books. More than 40 states now mandate coverage parity, which requires payers to reimburse providers for telehealth services if they offer those same services in person. Some also require payers to reimburse at the same rate as in-person care, which is called payment parity.
The bill was sponsored by State Senator Elder Vogel, Jr., a Republican from rural Rochester who has long argued that the state needs to reduce telehealth barriers to improve access to care in rural and remote regions where brick-and-mortar providers are scarce and in-person visits are challenging. Some 33 Pennsylvania hospitals have shut down in the past 20 years, with 15 occurring in just the last five years, according to the state.
Vogel first sponsored the bill in 2016, but it never got out of committee. At least two versions introduced since then were shot down by Democratic lawmakers after Republican lawmakers added amendments to ban the use of telemedicine in abortion care. In 2020, then-Governor Tom Wolf, a Democrat, vetoed the bill after it was passed along party lines.
Among those supporting the new law is the Hospital and Healthsystem Association of Pennsylvania (HAP), a membership organization comprising more than 230 hospitals and health systems in the state.
“Today’s passage of Senate Bill 739 is a long-sought win for Pennsylvania patients and health care providers,” HAP president and CEO Nicole Stallings said in a press release. “Telehealth helps meet patients where they are, increasing access to routine and preventative care to improve health outcomes. It also extends the reach of providers at a time when the commonwealth’s growing need for care is outpacing the professionals available to deliver it.”
The Supreme Court's decision will impact patients receiving care through Medicare, Medicaid, and CHIP.
The United States Supreme Court recently overturned the long-standing Chevron deference doctrine, which held that courts should defer to agency interpretations of statutes that fall under the particular agency's purview, when the interpretation is reasonable, and the meaning of a statute is not made explicitly clear by Congress.
Hospitals and health systems will now potentially have to wait through legal challenges to regulations that were previously determined by the many federal agencies that influence healthcare.
The 6-3 decision was made on June 28 to reverse the original ruling made in the landmark case Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., in 1984. It is now up to the courts to determine their own interpretations of ambiguous regulatory standards.
There are many unknowns about how this decision will ultimately play out, but the impact on federal agencies such as the EPA, FDA, and OSHA and their ability to regulate environmental, health, and safety matters is undeniable.
This decision will also potentially impact the healthcare industry in two key ways.
Access to public healthcare
An amicus brief, published in September 2023, warned that "overruling Chevron would have enormous impact on the administration of federal programs, including Medicare, Medicaid, and CHIP, that are critical to public health."
According to the brief, approximately 65 million Americans receive healthcare coverage through Medicare, while Medicaid and CHIP cover 90 million low-income children and adults and seniors with disabilities.
The brief was signed by the American Academy of Pediatrics, American Cancer Society, American Cancer Society Cancer Action Network, ALS Association, American Heart Association, American Lung Association, American Public Health Association, American Thoracic Society, Bazelon Center for Mental Health Law, Campaign for Tobacco-Free Kids, Child Neurology Foundation, Epilepsy Foundation, Muscular Dystrophy Association, National Health Law Program, Physicians for Social Responsibility, The Leukemia & Lymphoma Society, and Truth Initiative.
When Chevron was still in effect, the brief stated, courts deferred to the Centers for Medicare & Medicaid Services (CMS) to make policies that the agency needed to make while "plugging the interstitial gaps that inevitable arise as it administers the health insurance statues in a myriad of every-changing real-world settings."
In a press release published the day of the ruling, the organizations said they were disappointed in the Supreme Court's decision, saying Chevron has helped those organizations ensure that healthcare laws are "interpreted and implemented appropriately."
"We anticipate that today's ruling will cause significant disruption to publicly funded health insurance programs," the contributors said, "to the stability of this country's healthcare and food and drug review systems, and to the health and well-being of the patients and consumers we serve."
The brief’s signees argued in favor of the importance of having experts interpret standards that will have that impact.
"As our amicus brief noted, large health programs such as Medicaid and Medicare, as well as issues related to the Food, Drug and Cosmetic Act, are extremely complex," they said in the press release. "So it is key that decisions about how to interpret and implement relevant laws are made by experts at government agencies."
Healthcare leaders and workers will likely feel the effects of this decision through the impact it will have on public health.
"As leading organizations that work on behalf of people across the country who face serious, acute and chronic illnesses, as well as many people who lack access to quality and affordable healthcare," the signees said, "we will continue to work to ensure that healthcare laws are implemented in ways that benefit the public health."
AWS is providing $10 million in grants to health systems and hospitals for pediatric research using AI and the company’s cloud storage platform.
Three pediatric health systems are receiving $1 million each to support ongoing programs using AI and cloud computing to improve children’s healthcare.
The announcement underscores the hype surrounding AI in healthcare and the efforts by tech companies to partner with health systems for long-term projects that require lots of data storage. Health systems and hospitals are hampered in developing AI programs because of the cost of storing and moving around data, and these partnerships can give them the leeway to improve research and develop new programs.
Adam Resnick, director of CHOP’s Center for Data Driven Discovery in Biomedicine, said AI can be a vital factor in developing treatments for pediatric cancers, which make up less than 1% of all cancers diagnosed annually in the U.S.
“(D)espite being a rare disease, pediatric cancers truly provide a unique proving ground for new technology because of their dependency on real-time discovery and collaborative networks,” he said in the AWS press release announcing the awards.
Research on pediatric diseases and treatments is often limited because of the size of the patient population. Most studies are small-scale and limited, and the pharma industry has little incentive to pursue treatments. In fact, innovation in pediatric care is often based on adult models that are adapted to fit children, with less-than-optimal results.
AWS is banking on its considerable could storage resources to improve what it calls the sandbox in the cloud, giving healthcare providers access to large amounts of de-identified and anonymized data to improve research.
“What’s driving discovery, in the most immediate term, is enabled by the cloud,” Elaine Mardis, PhD, co-executive director of the Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children’s Abigail Wexner Research Institute, said in the AWS release.
With so many organizations engaged in AI these days, a key question moving forward will be how health systems and hospitals share that information, and which processes are proprietary. That may be where value is determined.
“What we really want to do is make rare cancers less rare by providing this comprehensive information to those who really want to investigate for a variety of discovery-based goals,” Mardis added.
Virtual nursing ROI can be measured in a variety of ways, including sick time, says this nurse leader.
On this episode of HL Shorts, we hear from Clair Lunt, senior director of nursing informatics at Mount Sinai Health System, about using sick time as an ROI metric for virtual nursing. Tune in to hear her insights.
How can CMOs reduce hospital mortality rates at their organizations?
CMOs play a crucial role in helping hospitals reduce mortality rates by overseeing initiatives and strategies aimed at improving patient outcomes, but it’s not as simple as it sounds.
By analyzing mortality data across the healthcare system, CMOs like Andy Anderson, MD, MBA, executive vice president and chief medical and quality office, at RWJBarnabas Health can identify opportunities for improvement and implement tactics to drive change.
In fact, several initiatives at RWJBarnabas Health over the past two years have led to a significant reduction in the hospital mortality rate.
"We recognized a couple of years ago the opportunity to improve our mortality outcomes after doing an analysis of those outcomes across the health system's hospitals," he says. "We saw that we could improve."
One of the strategies RWJBarnabas launched is a mortality review process, which basically means reviewing and learning from a patient's death.
"Each of our hospitals has a team that reviews those cases and identifies whether there are any learning opportunities," Anderson says. "They go back and educate the team that took care of a deceased patient when learning opportunities arise."
The health system can then take those lessons from its 12 hospitals, put them in a single database, and identify common themes, Anderson says.
"For example, we may identify themes in cardiology or neurology cases, then we can go back to the service line and discuss how they can perform better or think differently in the future," he says. "Sometimes, there is nothing to learn from a death, but other times there is something to learn, and we must share that knowledge."
Another mortality reduction initiative has focused on ICU care, Anderson says.
"We are making sure that patients who are on ventilators are getting the right care," he says. "We are making sure that we have appropriate staffing in our ICUs. We are making sure we have enough ICU beds."
RWJBarnabas is heading in the right direction by focusing on the right things, Anderson says.
"We have reduced mortality by 20% across our health system hospitals over the past two years," he says.
The mortality reduction initiatives reflect how RWJBarnabas approaches patient safety and quality in three ways, Anderson says.
"No. 1, we are using data to drive improvement," he says. "We know more clearly how we are doing and the goals we need to achieve. We are monitoring mortality data over time. No. 2, we are working as a health system, sharing best practices, and identifying the best ways to do this work. No. 3, we are using our electronic health record as a driver of change. Examples of using the EHR to address mortality include the deterioration index and the sepsis alert. Epic is helping us standardize best practices."
This article is part of HealthLeaders’ How Do I? series. Read the entire article by Chris Cheney here.
