Amid the hype and promise, a growing tension is becoming clear: the reality of what AI can deliver versus what it can't.
Welcome to our September 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year.
So, what did our team look into this month? Well, healthcare is in the middle of an evolution. Faced with a continuing decline in doctors and nurses and an increase in clinical care needs, health systems and hospitals are looking to AI to fill in the gaps.
Amid the hype and promise, a growing tension is becoming clear: the reality of what AI can deliver versus what it can’t. While advocates tout AI’s potential to revolutionize healthcare delivery, the technology still faces significant hurdles in most areas.
That may not be what a healthcare industry fraught with waste, burnout and misaligned incentives wants to hear, but that’s what we’ve got.
As healthcare faces mounting financial pressures in 2024, revenue cycle executives are under increasing pressure to reduce denials; but how?
One significant challenge is the growing burden of denials, which, if left unchecked, can critically impact a hospital's bottom line.
Recent studies indicate that denials, especially those related to prior authorizations, have escalated, leading to costly consequences for health systems.
According to a 2024 benchmarking analysis, denials now account for 13% of all claims, a jump from 11% reported in 2022. For an average-sized health system, this figure translates to 130,000 unpaid claims annually.
As denials continue to rise, many systems face significant operational and financial challenges that are compounded by increased payer scrutiny.
Why are they happening? According to the report, the top reasons for an uptick in denials remain consistent with past trends.
These include:
Insufficient data analytics to flag issues in submissions (65%)
Lack of automation in the claims and denials management process (64%)
Inadequate staff training on claims submission and denial prevention (49%)
Operational inefficiencies and insufficient resources are primary barriers that hospitals need to overcome to better manage their revenue cycle.
So How Can You Reduce Denials?
To combat the growing challenge of denials, revenue cycle leaders must take a data-driven, proactive approach to claims management.
Here are three strategies to help reduce denials and improve financial outcomes:
Invest in Advanced Data Analytics
With denial rates climbing, having the right data at hand is essential. Health systems should leverage analytics tools to identify patterns in denied claims, root causes, and the most common submission errors. These insights allow teams to address and rectify problem areas before claims are submitted, reducing the likelihood of denials.
Implement Automation in Claims Processing
Beat payers at their own game. Automation can streamline claims processing, improving accuracy and speeding up submission times. Automated systems can also flag potential denials before they happen, such as missing documentation or incorrect coding, enabling teams to fix issues early. Hospitals that have implemented automation report fewer manual errors and a decrease in denial rates.
Enhance Staff Training and Expertise
A well-trained revenue cycle team is a crucial component in reducing denials. Providing ongoing education on best practices in claims submission and payer requirements can help staff avoid common pitfalls. Additionally, building in-house expertise on navigating payer appeals can lead to faster and more successful resolutions of denied claims.
Rev cycle leaders must adopt a multi-faceted approach to address the increasing challenge of denials. Through enhanced data analytics, automation, and staff training, hospitals can not only reduce their denial rates but also improve their overall financial performance.
This article is part of HealthLeaders’ How Do I? series.
Workforce, patient engagement, patient trust: Can all of these pain points be solved with social media?
Not completely, but having hospital or health system executives leverage social media will help.
In today's digital age, a strong social media presence is crucial for healthcare executives (as well as their hospitals).
For hospital and health system c-suite executives, leveraging social media effectively can enhance your organization’s reputation, attract top talent, and even drive patient engagement.
Here are six ways c-suite execs can build a compelling online presence.
1. Optimize Your Profiles
Your LinkedIn profile, for example, is your digital business card. Start by ensuring that your profile is complete and up-to-date. Use a professional headshot that conveys approachability and confidence. Your headline should go beyond your job title—consider including a value statement that highlights your expertise and what you bring to the industry.
The “about” section on any social platform is your opportunity to tell your story. Write a compelling narrative that emphasizes your leadership journey, your passion for healthcare, and your vision for the future of your organization.
This section should also reflect your (or your health systems’) personal brand—what you stand for, what motivates you, and how you make a difference.
Regularly share content that reflects your interests and expertise in healthcare. This could include industry news, insights from recent conferences, or commentary on emerging trends like telehealth or healthcare innovation. When sharing, add your perspective—explain why the content is relevant and what others can learn from it.
Engagement is a two-way street. Interact with posts from your network by liking, commenting, or sharing. Engage in conversations with peers, colleagues, and even competitors. This not only increases your visibility but also positions you as a thought leader who is actively involved in the healthcare community.
3. Create and Share Original Content
One of the most powerful ways to build a strong presence online is by creating original content.
Articles, posts, and videos that showcase your expertise can significantly enhance your credibility. Consider writing about leadership challenges, successful strategies you've implemented, or your thoughts on healthcare policy changes.
When creating content, keep it concise and value-driven. Busy professionals appreciate insights that are quick to read yet rich in information. Don’t shy away from using visuals—infographics, short videos, and professional photos can make your posts more engaging.
4. Network Strategically
Building a robust network is essential. Connect with other healthcare leaders, policymakers, academics, and influencers. When sending connection requests, personalize your message to explain why you want to connect. This makes your outreach more genuine and increases the likelihood of building a meaningful relationship.
Join groups relevant to healthcare leadership. These groups offer a platform to share ideas, ask questions, and learn from others in the industry. Actively participating in group discussions can further establish your presence as a thought leader.
5. Showcase Organizational Achievements
Social media is not just about personal branding—it’s also a platform to highlight your organization’s accomplishments. Share news about your hospital’s achievements, new initiatives, and community impact.
Tag your colleagues and team members in posts to celebrate their contributions and demonstrate that you value your team’s efforts.
You can also use LinkedIn to announce job openings, attract talent, and showcase your organization’s culture. Highlighting awards, certifications, and milestones can build your organization’s reputation as a leader in healthcare.
Here’s an example from Lynn Ansley, the VP of revenue cycle management at Moffitt Cancer Center Moffit that we love. Lynn created a weekly “Motivational Monday” post series, not just to showcase her team, but the Moffitt organization as well.
Above all, authenticity matters. Be genuine in your interactions and ensure that your content reflects your true beliefs and values. Authenticity builds trust, which is crucial in healthcare leadership.
For hospital and health system executives, social media offers a powerful way to amplify your voice, share your vision, and connect with the broader healthcare community.
By optimizing your profile, engaging with relevant content, creating original material, networking strategically, showcasing your organization’s achievements, and maintaining consistency and authenticity, you can build a strong and impactful presence that benefits both you and your organization.
This article was written exclusively for our newsletter, The Buzz. The Buzz is a monthly newsletter that follows all of the top trends in multimedia and social media. Make sure to sign up so you don’t miss out!
Virtual nursing is not a fad. It's so transformative that we are near the first generation of nurses who may never touch a patient.
Welcome to our August 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to AI governance, we have a lot of stories up our sleeves this year.
So, what did our team look into this month? Well, nurses are feeling overworked and burned out, and there are not enough nurses to fill the gaps left by those leaving the industry. This means your hospital halls will soon be empty, but not for the reason you think. Your nursing staff will be virtual.
Many organizations are turning to virtual nursing to address staffing and wellbeing, and with the current trajectory virtual care will be an integral part of the future of healthcare.
So, while your rooms won’t be completely devoid of in-person nurses, soon an entire department of onsite clinical staff will be a thing of the past.
Our CNO editor G Hatfield spoke to some of the best in the industry in virtual nursing and dug into how nurse leaders can adapt and advance.
Did you miss our July cover story on the rise of the advanced practice provider? No worries, you can read it here.
As 2024 continues to unfold, healthcare executives are paying close attention to several key trends that are shaping the future of the industry.
It’s no secret that these are trying times for hospital and health system leaders. As we have learned from our interviews, research, and virtual and in-person events, there is no shortage of challenges from every facet of healthcare organizations from CEOs to revenue cycle executives.
From financial pressures to workforce challenges, these developments are set to impact how hospitals and health systems operate in the coming years.
Here are the top eight trends that our healthcare leaders have been monitoring most this year.
1. Mounting Financial Pressures
Healthcare systems are grappling with significant financial strain as costs continue to surge. Labor expenses increased by over $42.5 billion between 2021 and 2023, largely driven by workforce shortages.
The U.S. healthcare system is facing a critical shortage of doctors and nurses. Projections suggest a shortfall of up to 124,000 physicians and 450,000 nurses by next year. This shortage poses a significant threat to the quality and accessibility of care.
Negotiations over reimbursements are becoming tougher, with hospitals facing delayed payments and tighter reimbursement policies. Healthcare executives are trying to keep their heads above water in this complex payer landscape—and all while trying to ensure sustainable financial performance.
4. Regulatory and Policy Changes
Shifting regulations are reshaping the healthcare industry.
All of these shifts require hospital leaders to adapt quickly, ensuring compliance while exploring opportunities for improved care delivery and cost efficiency.
As hospitals face rising costs and competitive pressures, many are looking to consolidate to improve operational efficiencies and strengthen their financial position. M&A activity is expected to continue at a rapid pace, with health systems increasingly pursuing cross-geographic deals to share resources and create synergies in an evolving market.
These disruptors are capitalizing on new patient preferences for more convenient, cost-effective care. With the ability to offer targeted services and significant capital at their disposal, these non-traditional players are reducing inpatient utilization and attracting valuable patient segments.
Hospital executives must adapt to this competitive landscape by improving their own offerings and patient experience.
Attracting and retaining healthcare workers is an ongoing challenge for hospitals, particularly in light of the current shortages in both clinical and non-clinical roles.
Did you know: Through newsletters, multimedia content, and in-person and virtual events, HealthLeaders provides the latest expert insights, proven strategies, and invaluable networking opportunities tailored for hospital and health system executives. Don’t miss out.
The top clinical leaders in the nation agree that virtual nursing is the next step in care delivery. Here’s how they are advancing their programs.
At a time when the nursing workforce is buffeted by declining numbers and increasing rates of stress and burnout, virtual nursing offers a critical resource to address both staffing issues and clinical outcomes.
The strategy enables healthcare leaders to make better use of existing resources while improving administrative efficiency and boosting engagement and morale for nurses and patients.
The 2024 HealthLeaders Virtual Nursing Mastermind program brought together leading health systems in the nation like Geisinger Health System, Mount Sinai Health System, UnityPoint Health, Emory Healthcare, Jefferson Health, Intermountain Health, Ochsner Health, Houston Methodist, and many more, who are all advancing their virtual nursing programs.
Through virtual meetings and an in-person roundtable, the participating health systems combined their knowledge and experience to provide a framework for other health systems to learn from.
What did we learn, well as the healthcare landscape continues to evolve, the future of nursing is becoming increasingly virtual. Health systems are recognizing the immense potential of virtual nursing to transform in-patient care by creating a collaborative environment where a wide range of healthcare professionals can come together to support patients.
This integration of virtual care tools into patient rooms is not just a trend, but a necessary step towards improving outcomes in a cost-effective manner.
On top of this, we also found some common themes. In fact, the advancements in virtual nursing technology are paving the way for the creation of the "hospital room of the future." By combining nursing expertise with innovative technology, organizations are forging a path towards a more efficient and patient-centered approach to care.
Even more, the expansion of virtual nursing beyond the hospital setting demonstrates its versatility and effectiveness in facilitating care coordination for patients in various healthcare programs.
With the potential to bridge the gap between in-person and remote care, virtual nursing platforms are poised to revolutionize the way patients receive medical attention. In conclusion, virtual nursing is not just a fleeting trend but a vital component of the future of healthcare that executives must embrace to enhance patient care and streamline healthcare delivery.
Comprised of case studies, infographics, podcasts, and trends and metrics grown from our virtual and in person roundtables, we created a robust report where we dig into the details of what we learned about implementing, running, and advancing a successful virtual nursing program from the best in the country.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Nurse leaders know reducing span of control for nurse managers is crucial in addressing burnout and high turnover rates, but how?
Amid high burnout and turnover rates, nurse leaders should take a closer look at a key piece of the workforce puzzle: nurse managers.
Nurse managers need time and support from leadership to complete their tasks. According to a report published by the American Organization for Nursing Leadership and Laudio, this could be accomplished by lowering span of control.
But how can nurse leaders do it? Here are six key strategies:
1. Understand the Importance of Span of Control
Span of control refers to the number of employees a nurse manager supervises. High spans can overwhelm managers, leading to burnout and increased turnover. The median span is 46, but many managers handle over 78 staff members.
Reducing this load allows managers more time for leadership development, improving team morale, and enhancing patient care.
2. Assess and Adjust Workload
Start by evaluating the current workload of your nurse managers. Consider metrics like headcount per manager, the number of ongoing projects, and administrative tasks. Identify tasks that can be offloaded or automated.
For instance, Rudy Jackson, senior vice president and CNE at UW Health and a HealthLeaders Exchange member, says UW Health's approach involved studying time allocation to understand where managers spend their time and how to reduce unnecessary burdens.
3. Leverage Technology and Support Roles
Use technology to ease administrative burdens, such as scheduling and paperwork. Additionally, consider how existing roles like charge nurses or assistant nurse managers can be optimized to support nurse managers. At UW Health, they are exploring the use of care team leaders to reduce the load on nurse managers.
4. Customize Solutions to Your Organization
Each health system is unique. Tailor your approach to your organization's size and resources. For some, splitting departments or reallocating administrative tasks may be feasible.
For others, it may involve enhancing existing roles rather than creating new ones. Innovative solutions, like giving managers time off or using technology, should be balanced with cost considerations.
5. Engage Nurse Managers in the Process
Create forums, like nurse manager councils, to give managers a voice in developing and testing new solutions.
Their insights can lead to practical, effective changes that genuinely reduce their span of control and improve job satisfaction.
6. Monitor and Adjust
Implement time studies and other assessments to continually monitor the impact of reduced span of control.
This data-driven approach will help in refining strategies and ensuring that the changes lead to positive outcomes like reduced turnover and improved patient care.
By focusing on these steps, nurse leaders can create a more manageable and supportive environment for nurse managers, ultimately leading to better outcomes for staff and patients alike.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders CNO Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Physicians are in short supply. They are costly. Is the APP the answer to the CMO's workforce and budget challenges?
Welcome to our July 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to AI governance, we have a lot of stories up our sleeves this year.
So, what did our team look into this month? Well, it’s time for physician leaders to say the unspoken part out loud: There will never be enough physicians. And even if you can find them and keep them, you can’t pay them all.
The AAMC estimates that in the next 12 years, the U.S. will be 86,000 physicians short, with more than half of those being primary care physicians. The future is a zero sum game, where the clinical need of an aging population runs up against falling numbers of physicians.
To fill those gaps, health systems and hospitals are elevating APPs and giving them more responsibilities. The resulting change in care team design is forcing CMOs and other executives to think about how they manage their physicians to ensure a productive workplace and positive clinical outcomes.
Since this shift, CMOs have begun to wonder if they need as many physicians as they thought, especially since the APPs are sometimes carrying out the majority of the tasks.
So this begs the question, is it time for CMOs to scale back their physicians and usher in more APPs instead? While the question is in part written in jest, it doesn’t mean there aren’t pros and cons to considering APP-lead teams. Our CMO editor Chris Cheney dug into what the experts have to say.
Did you miss our June cover story on turning to automation to streamline revenue cycle operations? No worries, you can read it here.
To ensure big data is used to influence outcomes that are meaningful to the nursing profession, nurse executives need to act as data visionaries and architects. But how?
Have you ever found yourself poring over stacks of data, feeling more like a statistician than a nurse? If you have, welcome to the world of big data.
"You have all of these different data sources coming at you on a weekly, monthly, quarterly basis. The CFO has a stack of data for you, your productivity-management engineer people have a stack of data for you, HR has a stack of data for you, and then your quality director, your clinical folks, have a stack of data for you," Jane Englebright, former chief nursing executive and senior vice president at Nashville, Tennessee-based HCA, previously told HealthLeaders.
"And your job is to sort through all that data and synthesize it in some way and come up with brilliant conclusions about how to run the organization," she said.
But how can it be done efficiently and effectively?
When a CNE is analyzing and synthesizing data, it's typically done manually and is a very time- and labor- intensive process, in part, because technology systems have traditionally been built in silos. "Often they don't even call the units the same thing. They don't name them the same thing. They don't necessarily define them the same way," Englebright said.
For example, the definition of a day may vary from system to system and the way a month is calculated in the finance systems may differ from how it is calculated in the payroll system.
Trying to "figure out how to keep up with your agency hours and what the cost of your agency is in the finance system versus the scheduling system," Englebright says, is "just a nightmare, trying to make all of these different things sync."
The lack of data standardization can also make it challenging for a CNE to assess how the organization or a particular unit is performing and to make well-informed decisions about what to change. Having good data is key to making effective changes.
"For those of us who grew-up studying the biological sciences, we understand that we have taken a very linear, Newtonian-approach to data over something that's really much more like a biological system," she explains. "When you perturb one part of our system… it has ripple effects throughout the entire organization."
Failure to recognize how this data interacts throughout the system has been a limitation in the types of data analytics that have been put forth.
"The frustration that we often have as nurse leaders in looking at this data, is [that] some of the variables we care about the most, aren't even in the data," Englebright says. "We don't have something that measures nursing competence, for example. We don't have something that measures how committed the nurses are. We don't have something that measures if the patient really [is] going to do the stuff we just invested all this time in teaching them to do."
Because of this, CNEs end up having to advocate for the things they care about in a person-on-person debate, rather than being able to make a persuasive business case based on data, she says.
For all its current stumbling blocks, big data holds the potential to change healthcare delivery for the better. But for that to happen, nurse executives need to act as data visionaries and architects.
To support CNEs in doing this a workgroup that grew out of the University of Minnesota's annual Nursing Knowledge: Big Data Science Conference developed the CNE Big Data Checklist.
It outlines three main areas where nurse executives should become leaders in driving the use of big data:
To create a culture that thrives on data
To develop big data competencies for the organization
To create an operation infrastructure to support big data use
This article is part of HealthLeaders’ How Do I? series. Read the entire article here.
Failure to streamline AI in the clinical setting could result in missed opportunities that healthcare leaders can't come back from.
In today's fast-paced healthcare environment, it is crucial for healthcare executives to stay ahead of the curve and embrace AI technology to ensure the highest quality of care for their patients.
AI has the potential to revolutionize healthcare by streamlining processes, improving patient outcomes, and reducing costs. From diagnosing diseases to predicting patient outcomes, AI can help clinicians make more informed decisions and provide better care to patients.
Failure to streamline AI in the clinical setting could result in missed opportunities for improving patient care, increasing efficiency, and reducing errors.
As the healthcare industry becomes increasingly more complex and data-driven, AI is no longer a luxury but a necessity for hospitals and health systems to remain competitive and provide the best possible care to their patients.
What the clinical leaders are saying
Clinical leaders must act quickly and decisively to integrate AI into their institutions, leveraging its power to enhance clinical decision-making, optimize workflows, and ultimately save lives.
In fact, healthcare is continuing to see clinicians embrace and get more comfortable with AI to ease workflows, boost the flow of patient and provider data, and improve quality of care and outcomes, Peggy Duggan, MD, executive vice president, chief physician executive, and chief medical officer of Tampa General Hospital previously told HealthLeaders.
"The important steel thread here is the 'why,' which for our physicians and team members at Tampa General Hospital is the delivery of the highest quality care possible," she says.
Clinical documentation is an example of a key area for AI adoption, Duggan says. There is a lot of work physicians do that is not value added but is required to advance care, so incorporating AI into documentation continues to offer an opportunity to free up clinicians to spend more time with patients and directly provide care, she says.
Managing data is another area where AI can boost healthcare, Duggan says. "It's critical that provider-level data flows freely, as well as patient and system-wide data, so AI will be able to help us identify more opportunities to improve patient care," she says.
AI will also continue to be used more frequently to guide clinical decision-making, Duggan says.
"At Tampa General Hospital, we are already piloting data-driven technology that supports the proper choice of antibiotics and pathways that prompt when antibiotics can be decelerated," she says. "These are great tools to support our teams while ensuring that a large volume of data—especially at a large academic health system treating some of the most complex conditions—doesn't overshadow a salient data point, which could drive not only safer care but also the delivery of the right care at the right time."
AI is likely to make major advancements in healthcare next year, says Ghazala Sharieff, MD, MBA, corporate senior vice president and chief medical and operations officer for acute care at Scripps Health.
"We recently had a retreat with a two-hour session on AI. The radiologists are asking to use AI more as they are doing their diagnostic readings. Telemedicine made a big splash during the coronavirus pandemic, and AI is the next big thing for healthcare," she says.
What are the next steps?
The time to embrace AI in healthcare is now, and the consequences of inaction could be detrimental to both patients and providers.
That is why HealthLeaders is introducing a new track of this first-of-its-kind national program HealthLeaders Mastermind: Clinical AI, to bring together leading health systems to share what they have learned about utilizing AI in the clinical space.
This event is currently underway and there are still a few spots open. E-mail exchange@healthleadersmedia.com if you would like to be considered for this one-of-a-kind program before it fills up.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Clinical AI Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program.
