CNOs must strategize to combat high projected turnover rates.
The staffing shortage affects not only the bedside nurse, but also the nurse leader. A new report from AMN Healthcare found that 31% of nurse leaders said they plan to be in a different role a year from now.
According to Allison Guste, Chief Nursing Officer at University Medical Center and Corporate Vice President of Nursing and Clinical Services for LCMC Health, workforce shortages and burnout are two of the biggest issues following the COVID-19 pandemic that CNOs have to face, along with rapid technological changes.
Here's what CNOs need to know about nurse leadership retention.
“HHS is in regular contact with [UnitedHealth Group] leadership, state partners, and with numerous external stakeholders to better understand the nature of the impacts and to ensure the effectiveness of UHG’s response,” the statement reads. “HHS has made clear its expectation that UHG does everything in its power to ensure continuity of operations for all healthcare providers impacted and HHS appreciates UHG’s continuous efforts to do so.”
“HHS is also leading interagency coordination of the federal government’s related activities, including working closely with the Federal Bureau of Investigations (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), the White House, and other agencies to provide credible, actionable threat intelligence to industry wherever possible,” the agency continued.
For providers affected by the attack, which has all but shut down UHG’s nationwide network for more than two weeks, HHS outlined five steps being coordinated by the Centers for Medicare & Medicaid Services (CMS):
Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State.
If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.
The agency also announced that it is working with MACs to address requests from providers seeking accelerated payments, similar to those issued during the pandemic.
Finally, HHS said the incident should spur the healthcare industry to take a serious look at its cybersecurity practices. The agency pointed out that it released a concept paper late last year outlining cybersecurity strategies, and that followed a National Cybersecurity Strategy unveiled a few months prior by the Biden Administration.
“HHS will continue to communicate with the healthcare sector and encourage continued dialogue among affected parties,” the agency concluded. “We will continue to communicate with UHG, closely monitor their ongoing response to this cyberattack, and promote transparent, robust response while working with the industry to close any gaps that remain.”
Both the AHA and AMA have called on federal officials to take action on the two-week old cyberattack, including asking United HealthGroup to be more transparent on its actions to resolve the issue
The American Hospital Association has added its voice to growing calls for federal intervention in the Change Healthcare cyberattack.
In a March 4 letter to Congressional leaders, AHA President and CEO Richard Pollack said the “unprecedented attack,” now more than two weeks old, has severely affected the nation’s healthcare industry. He said the organization has been in touch with UnitedHealth Group officials regarding the outage, asking for more transparency about what happened, a timeline on when the issue would be resolved, and temporary access to advance payments to help providers during the down-time.
“Unfortunately, UnitedHealth Group’s efforts to date have not been able to meaningfully mitigate the impact to our field,” Pollack said in the letter. “Workarounds to address prior authorization, as well as claims processing and payment are not universally available and, when they are, can be expensive, time consuming and inefficient to implement. For example, manually typing claims into unique payer portals or sending by fax machine requires additional hours and labor costs, and switching revenue cycle vendors requires hospitals and health systems to pay new vendor fees and can take months to implement properly.”
In addition, UnitedHealth Group’s “Temporary Funding Assistance Program” that it stood up as part of its response on March 1 will not come close to meeting the needs of our members as they struggle to meet the financial demands of payroll, supplies and bond covenant requirements, among others,” he added. “We will continue to work with UnitedHealth Group as this situation evolves to communicate the state of the field and ensure support for our members and the patients they serve.”
Pollack said the AHA had sent a letter to Health and Human Services Secretary Javier Becerra on February 26 asking HHS to step in and take action. Specifically, they asked Becerra to:
Direct Medicare Administrative Contractors to prioritize and expedite review and approval of hospital requests for Medicare advanced payments.
Issue guidance to payers on how they should be handling payments during this time.
Pressure UnitedHealth Group officials to make sure they’re taking all the necessary steps to remedy the situation, including “implementing a meaningful financial assistance program and engaging in frequent and forthright communication with providers.”
“This incident demands a whole of government response,” Pollack added. “We therefore urge Congress to consider any statutory limitations that may exist for any federal agencies that can assist hospitals at this critical moment. If such limitations exist, the Executive Branch may be unable to provide solutions to ensure our nation’s provider network remains solvent and serves patients.”
Both the AHA and American Medical Association have asked the federal government to take action on what may be the largest and most damaging cyberattack in healthcare to date.
The cyberattack on the IT business of UnitedHealth, which came to light roughly two weeks ago, has crippled operations at thousands of pharmacies across the country, and in doing so affected many more providers. Experts estimate the industry is losing more than $100 million a day due to the outage, which is rumored to have been a ransomware attack.
“Change Healthcare is the predominant source of more than 100 critical functions that keep the healthcare system operating,” Pollack noted in his letter. “Among them, Change Healthcare manages the clinical criteria used to authorize a substantial portion of patient care and coverage, processes billions of claims, supports clinical information exchange, and processes drug prescriptions. Significant portions of Change Healthcare’s functionality have been crippled. As a result, patients have struggled to get timely access to care and billions of dollars have stopped flowing to providers, thereby threatening the financial viability of hospitals, health systems, physician offices and other providers.”
The American Medical Association is urging the Health and Human Services Department to address the outage, including making money and resources available to affected providers
“As the situation continues to deteriorate and physicians await further guidance from Change Healthcare, we ask the Department to use all its available authorities to ensure that physician practices can continue to function, and patients can continue to receive the care that they need,” AMA CEO and EVP James Madara, MD, wrote.
The cyberattack on the IT business of UnitedHealth, which came to light roughly two weeks ago, has crippled operations at thousands of pharmacies across the country, and in doing so affected many more providers. Experts estimate the industry is losing more than $100 million a day due to the outage, which is rumored to have been a ransomware attack.
According to CNN, the affected network was still offline, though a Change Healthcare spokesman said many affected providers are using “alternative clearing houses” to submit claims.
“Since identifying the cyber incident, we have worked closely with customers and clients to ensure people have access to the medications and the care they need,” Company Spokesman Tyler Mason said in an email to the network. “As we remediate, the most impacted partners are those who have disconnected from our systems and/or have not chosen to execute workarounds.”
Nevertheless, many healthcare organizations are still struggling. According to the AMA, physician practices are dealing with five major concerns:
Interruption of administrative and billing processes. Because of the attack, providers are unable to send claims, verify eligibility to confirm insurance coverage and benefit specifications, obtain prior authorization approvals, or receive electronic remittance advice. “A considerable proportion of revenue cycle processes have ground to a halt across practices,” Madara wrote. “Are there flexibilities that HHS can encourage health plans to provide to physician practices on meeting timely claim submission requirements?”
Administrative burdens shifted to practices. Because of the outage, providers are taking on more data-entry tasks to submit claims through other portals and dealing with insurance carriers who might not accept paper claims. These workarounds are adding new burdens and costs onto already-pressured providers.
“Significant” concerns over data privacy and security. The size and severity of the attack is leaving many in the healthcare industry worried about whether their cybersecurity measures would hold up to a similar attack.
Uncertainly over when and how to re-establish connectivity to Change Healthcare. Many are also wondering how to determine whether Change Healthcare will be able to go back to business as usual. They’ll need assurances that this type of attack can’t happen again.
Concerns over sustainability. Many providers affected by the outage haven’t been able to submit claims since February 21. Not everyone has found an effective workaround, and some may be in danger of shutting down operations.
In his letter, Madara urged HHS to use emergency funds and any other financial resources to help affected providers stay afloat.
“Given the severe impact of this cybersecurity incident thus far and the significant and continuing erosion of Medicare payment to physicians, the AMA is concerned about the undue financial hardships facing physician practices if this incident is not resolved quickly,” he said. “It is especially challenging financially at the beginning of the year since many practices do not carry over reserves. We are particularly concerned about small, safety net, rural, and other less-resourced practices that often serve underserved patient communities.”
Turnover rates amongst nurse leaders are projected to be high, and CNOs need to strategize.
The staffing shortage affects not only the bedside nurse, but also the nurse leader.
A new report from AMN Healthcare found that 31% of nurse leaders said they plan to be in a different role a year from now.
AMN Healthcare's 2024 Survey of Nurse Leaders also says that 17% of nurse leaders will look for a new place to work, 9% will leave nursing, 3% will stay in a non-administrative position in nursing, and 1% will retire.
The survey consisted of several different kinds of nurse leaders, at various levels of health systems. CNOs made up 36% of participants, 37% were nurse managers, 20% were directors of nursing, and 4% were CNEs. The remaining 3% were made up of associate CNEs, interim CNEs, senior VPs, and VPs of patient care services.
While this does mean that most nurse leaders will remain where they are, a 31% turnover rate is alarming. As seen with regular nurse turnover, this phenomenon at the CNO level has the potential to greatly impact the nursing workforce and overall efficiency.
The why
Nurse leaders are facing the same workforce challenges that they are responsible for handling.
The nurse leaders who participated in the survey reported that the top three challenges they are facing in the workforce: 43% said recruitment and retention, 32% said staff burnout, and 32% said labor shortages.
The survey emphasizes the impact of burnout, stating that 72% of the nurse leaders who responded reported sometimes, often, or always experiencing burnout in the jobs, while only 28% said they rarely or never experience burnout.
According to Allison Guste, Chief Nursing Officer at University Medical Center and Corporate Vice President of Nursing and Clinical Services for LCMC Health, workforce shortages and burnout are two of the biggest issues following the COVID-19 pandemic that CNOs have to face, along with rapid technological changes.
"We know that healthcare is always changing," Guste said, "and if you're not changing, you're probably going to fall behind."
The fix
So, what should CNOs do?
There are many strategies for addressing workforce shortages, including staying competitive with compensation, building academic partnerships, and offering professional development, according to Guste.
"Recruitment and retention is the name of the game these days," Guste said.
As for burnout, CNOs need to take care of themselves as well as their nurses, and make sure they are still engaging with their nursing as a practice.
"What fills my cup every day is not when I'm in a lot of meetings," Guste said, "it's really going out there and just rounding on the floors and seeing the nurses do what they do best."
Guste believes it is a big mistake for nurse leaders not to go be with patients, as well as with nurses. She said hearing patient stories helps her remember her goals as a nurse and a leader.
"Being out on the units, not just with the patients, not just with the nurses, but with all the staff has really enabled me to realign my vision every day [and] give me purpose," Guste said, "and align me back to why I became a nurse in the first place."
Her advice to CNOs is to be authentic and listen to staff, and to lead with empathy.
"Don't every forget why we became nurses," Guste said, "so inspire collaboration and push towards transformation and everyday excellence."
Gail Vozzella, Senior Vice President and System Chief Nurse Executive at Houston Methodist, chats with nursing editor G Hatfield about cost containment and how CNOs can implement technology and...
UCM's new chief nursing officer holds a dual role as corporate VP and CNO.
Allison Guste has been in healthcare for 18 years. She began her career as an emergency nurse, and then later found her passion for quality and healthcare management in an outpatient clinic setting. She studied at the Louisiana State University (LSU) School of Nursing and holds a master’s degree in healthcare administration from LSU Shreveport.
Currently, Allison serves as Chief Nursing Officer at University Medical Center, as well as the Corporate Vice President of Nursing and Clinical Services for LCMC Health. providing leadership across eight LCMC hospitals.
For our latest installment of the Exec, we sat down with Allison to discuss how she began her journey into nursing, her thoughts on recruiting and retention, and how CNOs can fill their own cups at work.
Executives from three companies took to the stage this week in Los Angeles and said they're working hard to make their platforms more intuitive and convenient for both providers and consumers
AI and VR may be the cool new tech that everyone's talking about, but don't forget the EHR.
Executives from three of the nation's top EHR companies shared a stage at ViVE this week to tell an overflow audience that the medical record platform is chugging right along. And they emphasized that innovation is very much a part of their future.
"Our job is not done yet," Helen Waters, executive vice president and chief operating officer at MEDITECH, pointed out.
EHRs have had a rocky history in healthcare, with one popular opinion that they were forced on doctors and nurses before the industry was really ready to embrace them. But the benefits have grown right alongside the challenges, and like any other technology it's taken time to smooth out the rough edges. The latest surveys indicate only 4% to 6% of the nation's hospitals haven't adopted EHRs.
And as healthcare shifts to value-based care models and embraces new tools to improve clinical outcomes and provider workloads, a lot of that progress will pass through the foundation laid out by the EHR. Waters noted that some of the biggest disruptors in the space are working with both EHR companies and health systems to develop AI programs.
Mike Sicilia, Oracle's executive vice president, said his company and others in the space have to keep up with the concept of value-based care, embracing avenues that enable the consumer to take more control of his or her data and give providers the tools they need to address health and wellness and social determinants of health.
"Systems of record are very good at telling you what happened," he noted, "but not as good at telling you what may happen."
Part of that is developing tools to sift through the incredible amounts of data coming in, finding value to providers and giving them what they need. Doctors and nurses don't necessarily want to see more data, but they do want to see the right information.
Trevor Berceau, Epic's director of research and development, said EHR integration is a key element to the success of any new technology in healthcare, and companies should be working to make sure the platform is as easy and intuitive for physicians as the healthcare experience should be for consumers. With provider stress and burnout one of the biggest pain points in healthcare, much of the innovation now taking place is focused on improving workflows and helping doctors and nurses to use the EHR more efficiently.
But Berceau said EHR companies sometimes shoulder too much of the blame. For example, he said, federal guidelines around documentation are complex and cumbersome, and medical notes in the U.S. tend to be four times longer than notes taken by providers in other countries. There needs to be a balance between how much is required of providers using the EHR and how that affects their workflows.
The conversation naturally turned to interoperability, a key buzzword and the focus of a federal effort to create a nationwide framework for data exchange. All agreed that TEFCA and FHIR are good concepts, and that the interoperability train will continue to chug along, running through crowded stations where a wide variety of passengers—health systems, vendors, HIE networks, and other providers—try to get on.
"I wouldn't say it's great; I wouldn't even say it's good enough," said Sicilia, adding that "data interoperability for providers and patients is a basic right."
"We've come a long way [and] there's still a long ways to go," added Berceau. "I don't think that we'll ever be done with interoperability."
That said, there is a consensus that hard lessons have been learned from the legacy era of EHRs, and today's platforms are more malleable. Waters said the industry is moving forward with the goal of "making information easier to find … and more intelligent." And innovation is just as much a goal of the vendors in the space as it is of the providers looking to get more out of their technology.
Innovation execs from four top health systems shared a stage at ViVE to discuss how they want to change healthcare.
The key to a successful innovation strategy in healthcare is understanding and handling change management.
Executives from four of the most innovative health systems in the country shared the stage at ViVE 2024 Tuesday for a discussion on why they do what they’re doing. And while technology like AI and digital health are on everyone’s agenda, they all noted that nothing new will ever get done unless and until clinicians are ready for it.
“Innovation isn’t about creating or building,” Sara Vaezy, EVP and chief strategy and digital officer at Providence, pointed out. “It’s about a creative way to solve a problem.”
In an industry that has been traditionally reluctant to change, it’s not surprising that innovators face strong headwinds. The ability to clearly define a pain point or problem is vital, as is the ability to explain how one plans on fixing it.
“[Putting] good technology into a bad process is going to fail,” said Rebecca Kaul, PhD, MBA, SVP and chief digital and transformation officer at Northwell Health.
Vaezy and Kaul were joined on the stage by Chris Waugh, Sutter Health’s vice president and chief design and innovation officer, and Michelle Stansbury, vice president of innovation and IT applications at Houston Methodist. And while each has a unique way of approaching innovation, they all share the same understanding that the healthcare industry is in dire need of change. Healthcare organizations are facing workforce shortages across the board, alongside high rates of stress and burnout, cost and reimbursement issues, increasing competition from new entries, and a consumer population unhappy with the status quo and looking for new ways to access the care they want.
And while AI and other tools might eventually address those challenges, the biggest need right now is to, as Kaul said, “put people back in front of people.” In other words, eliminating all the barriers that have cropped up between the patient and the provider, including paperwork, technology, and processes.
Stansbury spoke of the desire to create the smart hospital of the future, and of a system that will deliver as much care outside the hospital as within. Vaezy talked of putting an emphasis on navigation, and creating more convenient pathways for consumers to get to care. And Waugh talked of redefining healthcare to focus more on health.
“We’re going to go to all the places where care doesn’t exist, where actual health is happening,” he said.
To do that, physicians, nurses and others within the industry need to be prepared to embrace change. And healthcare’s decision-makers need to know how to nudge everyone in that direction.
Building a positive patient financial experience is the cornerstone to any successful revenue cycle.
Revenue cycle leaders must pay attention to each aspect of an organization's revenue cycle to have a prospering organization. Although there is an individual argument for streamlining each segment of the cycle, when it comes to improving the patient experience, it's imperative to put the microscope on the patient’s financial experience.
Now more than ever before, patients are responsible for more of their healthcare costs, causing stress not only on the patient, but an organization’s bottom line when pre or post service collections fall flat.
Luckily, there are three areas that revenue cycle leaders can place the focus on to improve these processes that will be featured during today’s Patient Financial Experience NOW Summit.
Let’s take a look at what revenue cycle executives from Avera Health, Community Health Systems, Ochsner Health, Vanderbilt University Medical Center, and VHC Health will be chatting about.
Patient Communication
Communicating with patients through their preferred method can benefit revenue cycle operations, and options like text and email front desk staff are able to focus on nurturing relationships with patients during face to face interactions. Panelists will discuss their organization’s approach to patient communication and how they leverage their staff in their patient experience.
Patients As Consumers
How can organizations tailor their revenue cycle operations to be more consumer friendly for higher patient satisfaction? By making the billing and payment process as easy as possible. Panelists will discuss price transparency efforts, billing statement clarity, and how payment methods like cash sharing apps can enable bills to be paid faster.
Billing Made Simple
This panel takes a more in-depth look at billing, particularly at how to simplify statements so patients know exactly what they’re paying for. Panelists will discuss ways they simplify their organization’s billing statements, as well as strategies to streamline data from process to process.
