People will not stay in a culture where they feel unsafe, says this CNO.
On this week’s episode of HL Shorts, we hear from Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, about what nurses value in workplace culture, and how culture can be treated as a benefit. Tune in to hear her insights.
Two healthcare executives share their ideas on using remote patient monitoring to address critical gaps in care management and access
Editor’s note: Janet Simon is executive director of the New Mexico Podiatric Medical Association and a podiatric physician who has served Native Americans in New Mexico for nearly 30 years. Gary Rothenberg is a board-certified podiatrist, certified Diabetes care and education specialist, and certified wound specialist who currently holds an associate professor of internal medicine appointment in the endocrinology division at the University of Michigan School of Medicine. Rothenberg is also Director of Medical Affairs for Podimetrics.
Remote patient monitoring (RPM) devices are swiftly becoming a mainstay of the chronic disease management toolkit. From continuous glucose monitors (CGMs) for people with diabetes to Bluetooth-enabled scales and blood pressure monitors for those with cardiovascular conditions, smart devices are steadily working their way into the homes and onto the bodies of people who need regular monitoring to ensure their health and well-being.
Healthcare providers and health plans have shown themselves to be all-in on this trend, with one industry survey finding a 305% increase in RPM usage in 2023 compared to 2021. Another recent poll found that 46% of healthcare executives are planning to increase their spending on RPM in the next year to further accelerate the trend, citing measurably improved outcomes and clear financial ROI from remote device utilization.
However, these high-impact devices may not be getting into the hands of everyone who needs them. Equal access to cutting-edge care is a persistent issue among people facing systemic socioeconomic barriers, creating generational cycles of devastating complications, early mortality, and dim hopes for a different future.
For example, in a study of Native Americans living with type 2 diabetes, less than half (42%) reported using any form of RPM that connected them to their care team. Of the Native Americans surveyed who were able to get ahold of these tools, one-third said they did not have access to education or clinical support services to help them make the most of their device — lessening the potential for positive patient outcomes and reducing the financial ROI of the investment for health plans.
The limited access contrasts with strong demand for inclusion in the digital health ecosystem. More than 80% of Native Americans believe RPM devices should be a standard part of diabetes care, and close to half cited remote monitoring as the most-desired strategy for improving their personal health — even beating access to more affordable medications.
This data needs to be top-of-mind for health plan executives investing more dollars into RPM over the next few years, especially if value-based care models are part of the equation.
Breaking the cycle of poor outcomes requires the entire health system to collaborate on equitable distribution of RPM capabilities, with a particular focus on shifting the narrative of chronic disease for groups with longstanding socioeconomic and clinical challenges.
Reframing the ‘generational curse’ of chronic disease with data-driven, proactive care
For people in underserved communities, the “socioeconomic barriers to care” are the deeply traumatic, lived experiences of their parents, grandparents, aunts, uncles, and children. After seeing generation after generation succumb to chronic disease complications, it’s no wonder that younger people may experience feelings of helplessness, futility, or anger when reflecting on their own futures.
RPM tools can be part of the solution by reducing the perceived paternalism of the healthcare system, connecting individuals more deeply with their healthcare teams and putting health data directly into the hands of patients. When individuals are empowered to monitor their own health, they can more easily advocate for themselves and their loved ones while actively participating in collaborative care decisions with providers who have received timely alerts before complications emerge.
To take advantage of this potential, health plans and clinicians on the front lines need to have open, empathetic, non-judgmental conversations with patients about their experiences with the health system and commit to making changes based on the feedback.
Health plans and clinicians also need to share culturally sensitive advice on lifestyle choices, ideally working with respected members of the community to identify and deploy effective strategies. Device-specific, patient-centered education on leveraging data, such as how to interpret blood glucose fluctuations after a certain type of meal, will also be crucial to reaffirm that it is possible to live an active, productive, joyful life with chronic disease.
Building a physical environment designed for digital equity
Successful chronic disease management requires access to both physical care locations and reliable broadband internet to bridge the gaps between office visits. Many underserved rural communities, including Native American tribal lands, lack both. The Indian Health Service (IHS) lacks the funding to fully meet the scope of need — and even when care options exist, they are often many hours away from residents of remote areas.
Broadband internet is similarly hard to access, further limiting the potential reach of IHS resources. Experts estimate that only two-thirds of tribal lands in the continental US have broadband access, and the majority of that service does not meet the FCC’s “minimally acceptable” standards.
This leads to healthcare “deserts” that cannot fully support basic care, let alone the RPM devices that patients are clamoring for.
While the federal government is continuing to make investments in broadband access for rural regions, healthcare systems seeking equitable RPM deployments should also consider creative solutions for equipping hard-to-reach patients with high-value devices, such as leveraging cellular connectivity, satellite internet, or store-and-forward technologies as alternatives.
Charting a new path for RPM with innovative reimbursement options
The revenue cycle might be the most influential cycle in all of healthcare — and one that needs to catch up with the technology available in the RPM era.
The use of store-and-forward devices is a prime example. While they could aid rural patients, use is currently limited by a lack of clarity around reimbursement guidelines from the Centers for Medicare & Medicaid Services, including how to code for billing and how to manage data transmission.
In other cases, health plans want proof that RPM is effective in specific populations before they will incorporate reimbursement opportunities. But without the financial resources to put devices into the hands of these high-needs patients, providers are unable to generate the evidence required.
This Catch-22 simply perpetuates the inequities both parties are trying to avoid while leaving patients in the lurch.
Providers, health plans, and policymakers will need to work together to break free of the status quo and make RPM financially viable for more people living with chronic conditions. With leaders in agreement that RPM is a sound investment that will return clear ROI, there is a strong argument for reexamining the payment mechanisms for this home-based technology.
Only by addressing these fundamental issues of trust, technology, and reimbursement will our healthcare system be able to deploy RPM devices in an equitable, effective, and empowering manner. It is crucial to act quickly to break free of past patterns for Native Americans — and for others who have a right to equal access to the best possible chronic disease care.
Nurses are considering more than just compensation, says this CNO.
Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process.
CNOs should take a look at their health system’s offerings to make sure they are attractive to new nurses and that they are staying competitive in the industry.
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, spoke about innovative perks to attract and keep nurses, and how workplace culture and safety play a role as benefits alongside compensation.
Diversifying offerings
First and foremost, health systems need to stay market competitive with both compensation and benefits packages. According to Steaban, that is the minimum a health system can do, along with making sure that employees are fully aware of all of the offered benefits.
“Today’s workforce is so much different than it has been historically,” Steaban said. “So diversifying what’s available for your employees is really important.”
It is crucial that CNOs understand the different needs and desires of their staff. Steaban explained that many nurses who are entering the workforce for the first time do not need healthcare coverage because they are still covered by their parents.
“So how do you create programs that are a little bit diverse for them so that they can still achieve some benefit?” Steaban said.
Flexibility is also a huge need in today’s workforce, and Steaban suggested creating some positions in a health system with associated compensation that offer various degrees of flexibility. This could include an internal travel resource pool where nurses can have more options, or even for working in different hospitals within the health system. The key is to diversify the work and match compensation to it.
There are some newer benefits that health systems should consider offering, including wellness benefits, loan forgiveness, tuition assistance, and compensation for certification or advancement programs.
“All of those things help people change their compensation level and benefits in multiple ways [during] employment,” Steaban said, “versus just straight compensation.”
Culture as a benefit
Workplace culture plays a large role in nurse retention and overall satisfaction. A strong workplace culture will make nurses feel less alone and more like a part of a team, enabling them to ask questions without being judged.
“Every day I run into nurses, and I ask [them] what keeps them here,” Steaban said, “and nine times out of ten they say [their] team.”
Steaban emphasized that people will not stay in a work environment where they do not feel safe or where they cannot practice safely. Because of that, the relationships nurses have with physicians and other technicians are also extremely important.
Nurses also need to have a voice and feel heard and responded to. CNOs should provide opportunities to influence their health system, and they should help nurses be successful, advance their careers, and have the experiences that want to have at work.
“There should be forums and places where nurses can really impact the direction of the organization and the standards of care,” Steaban said, “[so they can] really put their fingerprints on their own work life.”
According to Steaban, CNOs should remember that health systems are businesses with the goal of helping patients, and that change must happen, or the business will fail. Nurses should be included in that change, and change management is a vital part of that.
“At the front line of the care continuum are those nurses,” Steaban said, “if they understand why, and they can put their fingerprints on the process a bit, they’ll appreciate that.”
Presenting culture
CNOs need to show the culture of their health system to potential candidates so they can see the benefits of working there. According to Steaban, this starts with demonstrating on first contact with a new nurse that the health system is not only interested in the work being done, but about the candidate as a person. Candidates should also be connected with the team they would be working with, so they can get an idea of what the culture is in that unit.
“Words are cheap,” Steaban said. “The actual experience of the culture is what will either glue them to you or not.”
Nurse leaders should manage the culture across their organizations and make sure that everyone is walking the walk, not just talking the talk, Steaban explained.
“Make sure that your culture is not just on a sheet of paper, or words of a mission or vision,” Steaban said, “but it’s actually the truth of what people experience when they start working.”
Flexibility
As more nurses are looking for flexibility as a benefit, health systems should evaluate where they can put programs into place to accommodate their nurses’ needs. At Vanderbilt University Hospital, Steaban says they are working on a way for nurses to contribute and describe what flexibility they need, since it is different for everyone.
For nurses going back to school, weekend programs can be beneficial, so that nurses can attend classes Monday through Friday and then work on the weekends. Likewise, for nurses with young children, mid shift assignments are helpful if they need to drop off and pick up their kids from school at the correct time while still being able to work.
Steaban says they also have a robust PRN program, where nurses are able to choose the days they want to work and they can fill in where the organization has needs and have ultimate flexibility over their schedules.
“Self-scheduling is still something we do debate all the time, [and] whether it sometimes can create a lot of stress for nurses,” Steaban said. “You actually get to pick your shifts and you can [give] yourself some time off by putting your shifts [in] early in the schedule or late in the schedule.”
There are also travel program options or short-term programs where a nurse can decide if they want to work frequently for a short period of time and then take extended periods off, so they can craft their life like they want.
“That’s really hard to do on a unit,” Steaban said, “but you can do it as an organization, [and] say we’re going to use those nurses to fill in where we have some gaps, but they’ll work a 13-week contract or 6-week contract.”
However, CNOs should still be weighing the nurses’ flexibility with the quality of patient care, according to Steaban. Nurses need to be spending enough time with their patients to develop relationships with them and fulfill care obligations.
“What’s hard for me is our ultimate responsibility is to our patients,” Steaban said. “If your nurse is changing every two or four hours, I worry about our clinical obligation to patients.”
Career advancement
Nurses are also looking for career advancement opportunities as a benefit. At Vanderbilt, Steaban said they have a career advancement program for staff nurses, with peer mentors who can help walk them through the program.
Steaban also recommends offering certification courses as a way to help nurses specialize in their practice. Continuing education credits are also important for nurses to make sure they meet the criteria for certifications and so that they can uphold standards of care.
“Offering certification courses, offering to pay for [them], [and] paying for the completion of that certification testing [are] all really important,” Steaban said, “and then aligning compensation with those accomplishments.”
Geisinger's CNE discusses their health system's goals for virtual nursing.
CNOs everywhere are talking about virtual nursing, and many predict that virtual nursing will help fill the gaps from the nursing shortage.
Janet Tomcavage, executive vice president and chief nurse executive at Geisinger, outlined what Geisinger wants to accomplish with their virtual nursing model. Tomcavage is a part of the HealthLeaders Virtual Nursing Mastermind panel, a months-long, exclusive series where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing these new technologies.
Here are Geisinger's four goals for their virtual nursing program.
The HealthLeaders Mastermind series is an exclusive, months-long series of calls and an in-person event featuring hand-selected 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.
With HLTH, ViVE, and HIMSS, the industry seems to have settled on a schedule for fostering new ideas and technologies
As the busy exhibit hall at this year’s HIMSS24 conference in Orlando can attest, healthcare’s biggest technology event is back. But that success is tied to a change in how the industry’s decision-makers view HIMSS and its main competitors, ViVE and HLTH.
Simply put, HIMSS is becoming the place to talk collaboration and make technology deals that power a lot of the industry’s innovation efforts. But unless they’re appearing in a session or accepting an award, the C-Suite is staying away and delegating that authority to others—namely, executives who are actually using the technology.
“We need to understand what clinicians really want,” said David Sides, president and CEO of NextGen Healthcare. “And the value is in the details.”
And the ROI has to be immediate.
“Everyone is focused on doing more with less,” added Brendan Watkins, chief analytics officer at Stanford Children’s Health. “So when you look at something, you look at how it delivers the right insights to improve decision-making.”
At HLTH and especially ViVE, the C-Suite was notably present. And CIOs, CEOs, CTOs, CNOs and CFOs weren’t coming for the free food, drinks, and entertainment (though that may have helped). They were making the trip to get together with their peers and discuss strategy, and to see some of the newer ideas and technologies that aim to push healthcare out of its doldrums and advance value-based care.
HIMSS CEO Hal Wolf said as much during his press get-together as HIMSS24 opened this year. He’s not looking to attract the top-level executives, but targeting those within the health systems and hospitals who benefit the most from the technology. They’re the ones who can really define the ROI for a new platform or tool and tell their bosses whether it’s working or just costing valuable time and money.
That deals were being made at HIMSS this year is proof that the industry is focused on using technology to address its biggest pain points. AI and security were the top topics, and while health systems and hospital leaders were looking for solutions and partners to address those needs, vendors were talking to each other as well about collaborations that would create enterprise-wide, multi-point products instead of niche solutions.
“There’s quality, and then there’s paper cuts,” said David Linz, MD, chief medical informatics officer at Florida’s NCH Healthcare. “You want something that makes a difference.”
And many of these conversations were fueled by discussions that had started at HLTH and carried over to ViVE (or were even begun at CES). At those events, executives bounced ideas off each other and talked about how the industry as a whole could embrace the technology it needs. The panels and discussions were more high-level, reflecting an industry intent on collaboration.
With that in mind, the healthcare industry seems to be settling into a rhythm that will define the innovation landscape. The ideas and debates will percolate up through HLTH and ViVE, then find footing at HIMSS through deals and collaborations.
Adam Pearson’s life experiences and a recent diagnosis of a rare disease give him a unique perspective to guide the pharma company’s strategy
Adam Pearson, chief strategy officer at Astellas Pharma, has been working in pharma for 20 years, almost all at the Tokyo-based company.
Coming from a consulting background, he says he was eager to work inside the industry for which he had been consulting because he was intrigued by the challenges of a commercial business that is highly scientific and highly regulated.
"It struck me as a fascinating combination of different factors and piqued my interest in learning how to make that business successful," Pearson says.
Pearson began on the operational side of pharma, but recently moved to the global chief strategy position. About four years ago, Pearson had taken the role of head of corporate strategy and in April 2023 took the reins as chief strategy officer.
"I had built my career on the operational side, owning the P&L for different geographies," he says. "But I couldn't turn down this opportunity. I am glad to return [to strategy] to be able to steer the bigger questions and the bigger picture of the whole organization."
Dealing with a rare disease
In the past couple of years Pearson has faced several challenges, including being diagnosed with AL amyloidosis as he took on his new leadership role at Astellas. He says the diagnosis, which he calls one of the most impactful experiences of his life, has transformed both his personal and professional perspective.
Adam Pearson, chief strategy officer at Astellas Pharma. Photo courtesy Astellas Pharma.
Pearson says his illness was discovered early, and with continual treatments it is currently under control.
"I'm still under treatment," he says. "But that process, that experience, has helped me to reflect and understand much better what it means to be a patient."
Pearson has brought his new perspective to his leadership role at Astellas and to his team. He says he is much more aware of how pharmaceutical companies can support patients and incorporate an understanding of their perspectives.
"It's certainly changed my point of view," he says. "My unique experience as a patient has informed my leadership perspective. This has allowed me to relate to patients on a more personal level and reflect on how the actions we take in support of our drugs are perceived by patients.”
“I understand the gratitude patients feel from receiving treatment, as well as the challenges they face while trying to find the best treatment options, coping with side effects, and facing the uncertainties of the disease," he adds.
With a new R&D focus comes new challenges and a reorganization
About the same time he was managing his health issues, Astellas shifted its business model and created a new leadership team to manage the transition. He was promoted to chief strategy officer, at the same time that Naoki Okamura became the CEO and other executives took over new roles.
"There has been lots of change and it's been very interesting," Pearson says. "Working with a new leadership team has been an important time of reflection on how Astellas is doing and what comes next. We made a large acquisition last year with Iveric Bio and that's also been a major part of what I've been involved in."
Astellas' R&D strategy, called the Focus Area Approach, consists of three components: Biologies with high disease relevance, versatile modalities/technologies, and diseases with high unmet medical needs.
"We're trying to evolve our R&D operating model," Pearson says. "We are met with having to make difficult choices around how to allocate our resources and there are tough decisions to make. We are facing new unknown challenges in development that we never faced before with small molecules or antibodies."
One of those challenges has been determining how to maintain a high level of investment in R&D while working on other promising areas.
"One of the challenges that's certainly at the heart of it is: how can we make the best [of] these investments?” he says. “How do we get our R&D engine working better and better?"
The leadership team has reorganized R&D in one way by giving more empowerment to teams and allowing more agile decision-making at the team level. This creates a more fast-paced environment.
Another priority was to ensure that the new leadership team works together to create a clear focus for the organization. As a result, Astellas established three enterprise priorities for the company.
"Broadly speaking, the priorities are maximizing the potential of our products to reach as many patients as possible,” Pearson says. “It's around raising our sights and improving our capabilities in R&D, really driving products faster through the pipeline, and third, it's around responsible management of our margins and costs and transforming the business so that we become more sustainable in the long term.”
"It is very exciting,” he adds. “It gives us all the fuel to take on the challenges for products that show that they can make a difference to patients. For example, we've had some dramatic results from PadCev, a treatment for bladder cancer, which in combination with Keytruda has shown to double the lifespan compared to the standard of care for patients with bladder cancer."
Leadership skills needed for leading a global transition
Leading through a company-wide transition takes an accurate and realistic assessment of the situation and a deep understanding of one’s team members, all while creating a new model for the organization. Pearson believes this requires trust in one’s employees, a deep understanding across cultures, and clear communication.
"I think my role as chief strategy officer requires me to be able to articulate as clearly as possible where we are trying to go as a business," he says. "We need to articulate clearly what the challenges are and the choices that we need to make to get us to our goal."
Pearson says he is all too happy to empower his teams to work autonomously and is not interested in micromanaging. His first step to building a solid team is to hire the right people for the job, and then give them the freedom to do it.
"I put trust in them and provide them with a combination of support and coaching and challenges, but I also allow them to get on with their job," he says. "I love watching this growth happening in my team, when team members feel confident and empowered to own their responsibilities and make their own choices around them. My job is to be a sounding board mostly, and sometimes to challenge them a bit, and certainly to try to make sure that they understand how they operate in the full organizational context.”
“The ideal situation is when they're owning the plan,” he adds. “They all know their job well and do it better than I can and I'm there to empower and support them in that."
While it is difficult coordinating with people across so many countries and cultures, Pearson has had plenty of practice. Astellas' center of gravity is in Japan, but it has a large presence in the US, Europe, and other parts of the world. Pearson says this makes arranging meetings quite a challenge from a time zone perspective.
"It's difficult getting everybody on the same call," he says.
But more important than meeting times is the many cultural differences that must be accounted for and understood. The cultural differences across Astellas might be a bit broader than in a typical global company.
"Leaders need to invest more time to understand what is behind the way someone is acting and behaving because what is going on in their heads may not be what your instinct tells you,” he says. "It might be something quite different in fact."
Pearson has the experience to manage a global company, having lived in nine countries. He was born in Australia and spent much of his childhood in the UK.
"We moved around a lot and sometimes we lived abroad, sometimes we lived in the states," he says. "I lived in Greece when I was at university. I worked a bit in France, and I studied in the US. While at Astellas I have been based in five different countries; at one of my positions, I had responsibility over 10 countries. And I now live in Japan."
Pearson and his wife are settling into Japan and enjoying the many aspects of its culture, including learning the language.
"We are doing a lot of exploring and hiking and just trying to get to know the country and stay active," he says.
While it would be easy to visit other parts of Asia, Pearson says there is more than enough to explore just in Japan.
"It's really a fascinating country, and it's a privilege to live somewhere internationally," he says.
The cyberattack is the latest event to force leaders to alter their approach.
Hospital and health systems have been going through the wringer for a few years now. The last thing CEOs needed on their plate was a cyberattack at the scale and magnitude of the one Change Healthcare suffered.
And yet, what is being called “the most significant cyberattack on the U.S. healthcare system in American history” is now the latest event in a series of twists and turns to send a shiver down hospital leaders’ spines and have them rethinking their strategies.
“Cybersecurity issues are just added icing on the cake,” Matt Heywood, CEO of Aspirus Health, told HealthLeaders.
The financial implications have been massive.
Change Healthcare processes 15 billion transactions annually and the lost payments from the attack are draining hospitals by the day. According to a survey by the American Hospital Association that collected responses from nearly 1,000 hospitals, 94% of operators are reporting financial impact, with more than half reporting “significant or serious” impact. Of the 82% of hospitals reporting impacts on their cash flow, nearly 60% report that the impacts to revenue is $1 million per day or greater.
It's never a good time for hospitals to be losing money, but the cyberattack has exacerbated the multiple financial challenges many operators have already been fighting. It’s creating somewhat of a perfect storm, Heywood stated.
“I coined that 2024 is going to be ‘the year of chaos.’ What I mean by that is you're going to have organizations that have had two to three years of financial issues really start struggle,” he said.
“You're going to have some of these issues with the for profits and hedge funds because the easy money is going away. And as that easy money goes away, the structures of some of those deals are not viable anymore. So you're seeing a lot of clean up and a lot of turmoil in 2024 and you're going to see it carry on in probably 2025, if not a little further out.”
The future is now
If there were any CEOs on the fence about investing in technology, especially on the cybersecurity and IT side, the Change Healthcare situation should have plenty reconsidering their stance.
When something is affecting the bottom line so drastically, hospital decision-makers have no choice but to re-strategize with the aim of both preventing future attacks and steadying the ship when it inevitably does occur.
“Hopefully it gets a lot of CEOs’ attention because they need to cross their T's and dot their I’s, close loopholes in their systems, and upgrade systems,” Ben Wobker, founder and CEO of Lake Washington Physical Therapy, told HealthLeaders. “It sounds like that's going to be the case here according to the headlines, but then again, you have to have that allocation of security spend and technology spend and make that a bigger budget line item.”
The AHA survey found that most hospitals are implementing workarounds to deal with the cyberattack, but those solutions are labor intensive and costly. Healthcare, as an industry, is known to be slow in implementing new technology, but with the rate tech is growing at, hospitals may not have much of a choice anymore for slow playing it.
Investment, of course, requires money and resources. That’s why Heywood believes it’s as important as ever to ensure you have some financial wiggle room to not only spend on technology, but to potentially throw capital at whatever is around the corner.
“You have to have a strong balance sheet,” he said. “You have to have cash on hand to be able to weather some of these storms that are coming. You're going to need to be in in this tight environment. You're going to need to be willing to spend money on cybersecurity and your IT. If you're already financially challenged, you do not want to be cutting your IT, your security, because that only further puts you in a bind.”
When it comes to dealing with the fallout of a cyberattack, however, technology is only one part of the equation.
You’re only as good as the systems you have in place and those systems aren’t immune to failure, Wobker noted. Updating and refreshing hardware and software should be the first step, but there also needs to be contingency plans in place to go offline.
Straying too far from traditional methods isn’t the answer either, according to Heywood.
“Now if you ask people to go back to paper, it's like, ‘Oh my gosh, I'm back in the stone age,’ he said. “So you have to have preparations to go back to paper in order to be able to get through a down time and you have to have backup systems so you could shut something down and turn it back on.”
There are few positives in the Change Healthcare attack, but the one silver lining may be the lessons that CEOs are forced to take away from it.
Whether it’s another cyberattack, pandemic, or anything else, those lessons should have hospitals better prepared for whatever is next.
The Match IT Act of 2024, now before Congress, would create a federal definition for 'patient match rate' that providers would address as they would a clinical quality measurement
A new bill before Congress aims to jump-start the unique patient identifier conversation by creating a healthcare industry standard definition for “patient match rate” and improving provider efforts to match patients with their health records.
The Patient Matching and Transparency in Certified Health IT (Match IT) Act of 2024, introduced in February by US Reps. Mike Kelly (R-PA) and Bill Foster (D-IL), would, if passed into law, set the bar for providers in matching patients to their records. It would establish the patient match rate as a clinical quality measurement, creating standards by which providers identify patients with their services and information.
The legislation addresses a key pain point in the interoperability arena, where supporters have long argued for the establishment of a unique patient identifier (UPI), or individual code similar to a social security number that would be used by providers to identify and match patient data. While that debate has bogged down (with some critics blaming the heated political environment), this bill would move away from that issue and give health systems something to work with.
“We have this major issue in the industry that’s costing lives, costing money, costing time [and] causing a lot of frustration,” says Aaron Miri, MBA, FCHIME, CHCIO, senior vice president and chief information and digital health officer at Baptist Health Jacksonville. “This gives us [an opportunity] to create a measurement of success, a benchmark.”
Clay Ritchey, CEO of digital identity management company Verato, said the bill comes as the industry is making a “mad dash” toward digital transformation and interoperability. Healthcare executives are struggling, he says, to manage and use vast amounts of data, including unstructured data coming in from outside the EHR, and trying to avoid data silos as they move toward value-based care.
“We often don’t know who’s who across each of these touch points,” he says. “That’s why we need meaningful standards in place.”
In a press release introducing the bill, Kelly said 35% percent of all denied claims result from inaccurate patient identification, costing the average hospital $2.5 million and the industry more than $6.7 billion annually. In addition, the cost of repeated or unnecessary care due to inaccurate medical data costs $1,950 per patient inpatient stay and more than $1,700 per ED visit.
And that’s not counting the patients who suffer harm from an unnecessary medial procedure (such as surgery on the wrong site or incorrectly prescribed medications).
"This legislation would promote interoperability of patient matching systems, which would protect patients and decrease burdens on healthcare providers,” added Foster.
The bill has drawn support from a number of healthcare organizations, including HIMSS, CHIME, and AHIMA, all part of the Patient ID NOW coalition. Another member of that coalition is Intermountain Health, whose chief digital and information officer, Craig Richardville, MBA, CHCIO, also backs the bill.
“[T]his legislation will address our nation’s current inability to consistently and accurately identify patients to their health records. Improved standardization of patient demographic data will lead to more accurate patient matching, which in turn will produce advances in patient safety, more complete information for clinical care, and cost savings from reducing the need for repeated medical care, among other benefits,” Richardville said in a Patient ID NOW press release on the legislation.
Aside from reducing patient harm and unnecessary medical expenses, Miri said the bill would gives hospital and health system executives an important tool in managing patient data—including that of their own doctors and nurses. And with Baptist Health Jacksonville managing some 35 million unique patients now and seeing roughly 100 people a day moving into northern Florida, the health system needs to keep track of who it’s treating and hire more clinicians to handle the growth.
It would also fit well with the industry’s emphasis on patient-centered care and patient engagement initiatives.
“We have a consumer demand that’s insatiable for their own data,” he points out.
So while the UPI argument seems stalled, advocates for the Match IT Act of 2024 are hoping that bipartisan support will propel the bill at a time when Congress is struggling to agree on anything.
The health system is working with a Norwegian digital health company to develop an app that would allow parents to test their babies at home
Intermountain Health is developing a digital health app for smartphones that will help parents identify jaundice in their babies at home.
The Salt Lake City-based health system is partnering with Norwegian digital health company Picterus AS to create the app, which would use a smartphone camera and a laminated card to measure bilirubin levels in newborns without the need for a return trip to the hospital or clinic and a blood draw.
“Bilirubin and jaundice management has long been based in the hospital and the clinic,” Tim Bahr, MD, an neonatologist who is leading the study, said in a press release. “Taking a newborn to the clinic or laboratory for frequent blood tests in the first days of life can be a huge inconvenience and burden on families. We hope to simplify this care and move more of it into the home. This is a win for families and for our healthcare system.”
The app addresses a care management pain point for hospitals. According to the March of Dimes, three of every five babies born in the US develop jaundice within days after birth. Many recover quickly with little medical intervention, but jaundice can lead to serious health concerns, including Hyperbilirubinemia, brain damage, or hearing loss, if untreated.
Intermountain, which greets and tests 33,000 newborns a year, aims to turn the smartphone into a diagnostic tool that would enable parents to quickly check their baby’s health at home after discharge from the hospital, and to contact their care providers if jaundice is evident. Parents would use their phone to snap roughly six photos of the laminated calibration card placed on the chest of their baby, and the app would translate those photos into a diagnosis.
“We do know that parents are pretty good at taking pictures of their babies,” Bahr noted in the press release.
“This technology is exciting to us because it makes it possible to measure the bilirubin in a baby without taking blood,” he added. “Right now, the only way to measure bilirubin levels in babies is to take them to a laboratory and draw blood. By having this technology available on a smartphone, we will eventually empower parents to make these measurements without having to leave their homes with an easily accessible and affordable tool.”
The health system is testing the digital health tool on about 300 term babies born at Intermountain Utah Valley Hospital in Provo, Intermountain McKay-Dee Hospital in Ogden, and Intermountain Medical Center in Murray, as well as on about 100 pre-term babies. They’ll test the app against the traditional method of drawing blood.
If proven reliable and introduced to clinical care, the app could not only save new parents the hassle of return trips and treatment, but help providers identify and treat jaundice earlier and more effectively, improving clinical outcomes and reducing costs.
As healthcare costs rise, CNOs must brainstorm ways to lower them.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task. To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Here's what you need to know about cost containment, according to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist.
