Managing patients with Parkinson's disease should be viewed as part of a hospital CMO's responsibility for patient safety and quality, says this healthcare leader.
Parkinson's patients face three primary preventable complication risks in the hospital setting.
These risks are medication mismanagement such as nonadherence to time-sensitive medication administration; failure to ambulate Parkinson's patients; and failure to screen for dysphasia, which is associated with aspiration and aspiration pneumonia.
CMOs and their care teams need to take steps to avoid preventable complication risks among Parkinson's disease patients in the inpatient setting as part of their quality and patient care strategy, the lead author of a recently published journal article says.
The data on medication management missteps for Parkinson's disease patients in the inpatient setting is "stunning," according to the lead author of the recent journal article, Peter Pronovost, MD, PhD, chief quality and transformation officer at University Hospitals Cleveland Medical Center.
"Of the 300,000 patients with Parkinson's disease admitted to hospitals each year, about 75% of them will have some medication mismanagement," Pronovost says. "One-in-10 receive contraindicated medications that can make their symptoms worse."
In addition to the recent article, which was published by The Joint Commission Journal on Quality and Patient Safety, hospital CMOs and their care teams can learn about managing hospitalized Parkinson's patients at the Parkinson's Foundation's website.
Caring for Parkinson's patients in the hospital setting
The first thing hospital care teams need to do to limit preventable complication risks for Parkinson's patients is to identify them when they are admitted to the hospital, Pronovost explains.
"One of the main risks for patients living with Parkinson's disease when they are hospitalized is most of them are not hospitalized for Parkinson's disease," Pronovost says. "Hospitals need to be able to identify people with Parkinson's disease when they are admitted to the hospital. Most of our electronic medical records can do that."
Hospital care teams should also use alerts in the electronic health record to make sure Parkinson's patients do not get contraindicated medications, according to Pronovost.
"The electronic health record makes medication management much more feasible than having to do it manually," Pronovost says. "It just requires collaboration between the information technology team and quality team to make sure they put alerts in place."
The second thing hospital care teams can do is make sure that Parkinson's patients can get their medications on time, which can be a window as small as 15 minutes at a particular time of day, according to Pronovost.
"The average hospital patient does not get medication on a tight schedule," Pronovost says, "so there has to be a workflow for nursing, pharmacy, and physicians."
The third thing hospital care teams can do is screen Parkinson's disease patients for dysphasia, so they can identify who is at risk for aspiration, then put preventive strategies and protocols in place to make sure patients do not aspirate, Pronovost explains.
Finally, Parkinson's patients in the hospital setting must be ambulated several times a day.
"We put a mobility program in place across all 23 of our hospitals because there are benefits from mobility for all patients," Pronovost says. "Patients must be ambulated multiple times per day."
Ambulating patients requires a culture of collaboration, where roles are clarified, Pronovost explains.
"In our hospital, we decided that patients who were more ambulatory would work with nurses and patients who were less ambulatory would work with physical therapy," Pronovost says. "Then we monitor and measure who is getting ambulated."
How hospital CMOs can help manage Parkinson's patients
There are several ways hospital CMOs can ensure Parkinson's patients receive safe and effective care in the inpatient setting.
"We know that Parkinson's disease patients are at risk," Pronovost says, "so CMOs need to make sure they have a way to identify patients and make sure they get the care protocols and programs that mitigate their risk."
From a CMO leadership perspective, the best thing to do is start an interdisciplinary quality improvement team that includes staff such as neurologists, hospitalists, pharmacists, nurses, occupational therapists, and physical therapists, according to Pronovost.
"This team can look at the risks Parkinson's patients have, the protocols that should be in place, who is going to perform the protocols, and what are the workflows," Pronovost says.
CMOs should establish a culture for clinical care that is collaborative and breaks down siloes, Pronovost explains.
"If there is no clarity about who is responsible for getting the medications exactly on time or ambulating," Pronovost says, "patients are not going to get those therapies appropriately."
Pronovost recommends that CMOs also make sure there are electronic health record standards and safeguards to ensure that patients with Parkinson's disease get their medications on time.
"The same thing applies to mobility and dysphasia screens," Pronovost says. "Our electronic health records can ensure safety and ensure patients who are at risk for harm are identified."
Managing patients with Parkinson's disease should be viewed as part of a hospital CMO's responsibility for patient safety and quality, Pronovost explains.
"CMOs can assemble diverse teams to work together to do new work that has never been done before," Pronovost says. "It requires the CMO to call the teams together with a clear commitment to zero harm and optimizing care for patients with Parkinson's disease."
With physician shortages and the high cost of employing physicians, APPs have become a mainstay of care teams.
The following is an extended excerpt from a HealthLeaders story published in August. Click here to read the full story.
With health systems and hospitals across the country experiencing physician shortages, many are turning to advanced practice providers (APPs) to fill in the gaps.
But does that mean CMOs should scale back their physicians and usher in more APPs instead? There are pros and cons to considering APP-led care teams.
Thomas Balcezak, MD, MPH, chief clinical officer at Yale New Haven Health, sees the workforce benefits in pairing APPs with physicians in a care team.
"There is a long lag time to bring new physicians online because of the years of training that it takes," he says. "You can train an APP in as little as 18 months after an undergraduate degree. If we want to bring more clinical resources to healthcare settings rapidly, using APPs is an efficient way to do that."
"Relying on APPs is a strategy we can use to expand access," he adds.
The differential between physician compensation and APP compensation also makes employing APPs cost effective, Balcezak says.
While some leaders think APPs could be the answer, others are not so sure.
Although APPs have become key members of care teams, they still need to be led by physicians, says Bruce Scott, MD, an otolaryngologist from Kentucky and president of the American Medical Association.
"The American Medical Association strongly supports physician-led, team-based care, where all members of the team use their unique knowledge and skillset to enhance patient outcomes," he says. "Nurse practitioners, physician assistants, and other advanced practice healthcare professionals can all be valuable members of a physician-led care team and help to provide high-quality care, but they are not a replacement for physicians."
"Models of care that remove physicians from the care team result in higher costs and lower quality of care," he adds. "Numerous studies show that patients have better outcomes when cared for by physician-led teams."
Can APPs lead care teams?
While some studies have said no to APP-led care teams, others have shown the effectiveness of nurse practitioner-led care teams. A study published by The Journal for Nurse Practitioners found that a nurse practitioner-led interdisciplinary team reduced the median hospital readmission rate by 64%.
"It is going to be hard for physicians to accept in many circumstances, and initially it is going to take extraordinary individual APPs to serve in leadership roles," Balcezak says. "However, APPs leading care teams will become more common over time."
Circumstances that are well-suited for APPs to serve in leadership roles include when the leadership expectations are around organization, delivery, and scheduling, he says.
"When those are the leadership requirements, the APPs can be outstanding leaders," he says. "APPs who have a clinical background and a mindset that is focused on management can lead care teams."
Where APPs can and cannot take the lead
Yale New Haven Health is moving toward more consistency in its primary care teams, with two APPs supporting each primary care physician along with the nurses, Balcezak says.
"We think this APP model is a much more efficient use of physicians' time and will open up more patient access," he says. "The division of labor in this model is still being worked out, but an experienced APP can do most of what a physician does in the primary care setting. There are some complex patients and diagnostic dilemmas that are better handled in the physician's hands, but most routine screening, health promotion, symptom management, and the urgent care that established patients require such as colds and strep throat can be handled by the APPs."
At Davis Health System, the most common primary care team model consists of one physician with a cadre of nurse practitioners, medical assistants, and nurses working to the top of their licenses, says former CMO Catherine Chua, DO, MS.
"The team approach has been advocated by the American Hospital Association and the American Academy of Family Physicians in order to stretch the ability of a physician to serve patients," she says. "Studies have shown that having the physician as the lead care provider at a primary care practice is the best approach in terms of cost savings, patient experience, and quality. One of the studies that I have seen said that about 72% of patients prefer to see a physician at some point in their care."
Chua says a physician-led primary care team should be designed with specific parameters around decision-making.
"One physician does the primary intake of the patient, then follow-up appointments are handled by APPs," she says. "There are other things like follow-up calls, renewals of prescriptions, and prior authorizations that can be done by the nursing staff. In addition, the nursing staff can prep the patient's visit, so that the nurses get to know the patient and can help the physician field questions from the patient."
The main challenge of this model is when patients present with complex conditions or difficult diagnoses during follow-up appointments. CMOs should ensure that physicians get involved in care when these circumstances arise, Chua says.
To address obesity, CMOs must promote intensive therapies in clinical settings to make a difference on the individual patient level and think globally.
Obesity is a worsening crisis in the United States, according to a recent journal article and the president-elect of the American Academy of Family Physicians (AAFP).
According to the journal article, which was published by The Lancet, nearly three-quarters of the U.S. population aged 25 and older were overweight or obese in 2021. "Without immediate action," 80% of the adult U.S. population will be overweight or obese by 2050, the journal article's co-authors wrote.
"Existing policies have failed to address overweight and obesity," the co-authors wrote. "Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate."
There is no question that obesity has reached a crisis point in the United States, according to Sarah Nosal, MD, president-elect of the AAFP and vice president for innovation and optimization as well as chief medical information officer at The Institute for Family Health.
"We need to say that this is a crisis, so we can mobilize the resources that we need," Nosal says. "Unless we acknowledge this is a crisis across all communities, we will not mobilize resources, and we will not see a change."
Obesity is associated with several serious medical conditions, particularly diabetes, Nosal explains.
"We are worried about diabetes because it is associated with many other medical problems and diabetes is a chronic disease that can be a burden on its own," Nosal says. "Once you have diabetes, your likelihood is higher of having stroke, heart attack, vascular complications, amputations, and infections."
Other serious medical conditions associated with obesity include high cholesterol, cardiovascular disease, sleep apnea, arthritis, and joint pain, according to Nosal.
"Our bodies are built to carry a certain amount of pounds," Nosal says. "When the amount of pounds that are on our structural system such as our knees is too great, it leads to problems. Many adults are carrying around an extra hundred pounds that joints were not designed to carry."
How CMOs should address obesity
CMOs of health systems and hospitals need to think about obesity beyond the context of an individual patient in a clinic or hospital setting, according to Nosal.
"You need to think about patients as part of a larger community, and CMOs and others running a hospital system need to think about what health is and the interventions to improve health," Nosal says. "That may be promoting that fruits and vegetables are available in the community. That may be promoting funding for more walkable communities or more parks access for kids in communities."
In addition to promoting intensive therapies in clinical settings to make a difference on the individual patient level, CMOs need to think globally about addressing obesity, Nosal explains.
"CMOs need to think about making global changes in the community that can make a difference on the entire population," Nosal says.
How physicians should address obesity
Nosal, who is a practicing family physician, works with overweight and obese patients on what they want to prioritize.
"Their mother may have diabetes, and they are worried about what they should do," Nosal says. "I break down what they should do in steps and help them do longitudinal, intensive work."
Physicians need to help patients manage daily caloric intake and promote consumption of nutritious foods, according to Nosal.
"When you look at the United States and you look around the world," Nosal says, "all of the countries that have calorie-dense and nutrient-poor foods and a shift to those foods being processed rather than resourced locally have a dramatic shift to overweight and obesity."
Research has shown that short-term diets are ineffective at addressing overweight and obesity, Nosal explains.
"People need to make long-term changes for the rest of their lives," Nosal says. "I talk about juice and soda with my patients. Anything that is a liquid calorie is of poor nutritional value."
A single meal in a restaurant is often more calories than a person should eat in an entire day, according to Nosal.
"That is stunning for most of my patients," Nosal says. "The assumption is we should be eating multiple meals in a day, but eating out can put us high in caloric intake. I work with my patients to help them understand how much they should be consuming in a day."
Exercise is an important component of a broad strategy to address overweight and obesity, but it is insufficient on its own, Nosal explains.
"Research shows people can exercise a few days a week and it can make a difference," Nosal says. "But exercise by itself has a limited impact on your weight. It is really about the types of calories we are putting in our bodies and how many calories. We should be eating nutrient-rich rather than calorie-rich foods."
At HealthLeaders, the top CMO trend stories of this year focused on care team composition, deprescribing, 'medspeak,' physician onboarding, and physician leadership development.
As part of our CMO coverage, HealthLeaders has published more than two dozen trend articles this year. The following are the Top 5 CMO trend stories of 2024 (click on the headline link to read the full story):
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, it is difficult to pay all of them.
The Association of American Medical Colleges estimates that in the next 12 years, the U.S. will be short 86,000 physicians, 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 advanced practice providers 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 whether they need as many physicians as they thought, especially since the APPs are sometimes carrying out the majority of the tasks.
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.
For patients on multiple medications, deprescribing is a key strategy to promote patient safety and care quality.
The primary risk with multiple medications is medication interactions. This risk can lead to an increase or decrease in the effects of medications as well as undesired effects and side effects.
Cost and waste are other considerations, according to Karna Patel, MD, MPH, vice president at Tampa General Hospital and president of Tampa General Medical Group.
"As you add more medications, there is more cost to pay for those medicines," Patel says. "Globally, prescribing multiple medications can lead to waste of pharmaceuticals."
When assessing patients on multiple medications, clinic visits and visits in other healthcare settings are an opportunity to go over a patient's medication list, according to Patel.
"At that time, we want to make sure all the medications the patient is taking are appropriate for their conditions," Patel says. "We also check for interactions. That is a great time to try to deprescribe or consolidate medications."
"Medspeak" is characterized as medical terminology used by clinicians that leads to communication gaps with patients. Medspeak gets in the way of effective shared decision-making for clinicians and patients.
There are several steps clinicians can take to make sure they communicate medical terminology and procedures effectively, and it's the CMO's job to make sure their clinicians are aware of medspeak and how to avoid it.
"The jargon, the abbreviations, and the terms we use in medicine seem natural to clinicians, but patients often do not understand these terms," says Donald Whiting, MD, CMO of Allegheny Health Network and president of Allegheny Clinic. "Clinicians can fly through an explanation without getting the patient engaged, then leave them behind."
Onboarding is about more than helping clinicians navigate the hiring process.
According to the Physician and Clinician Onboarding Research Report by the Association for Advancing Physician and Provider Recruitment (AAPPR), successful onboarding programs integrate clinicians into an organization, acquaint clinicians with an organization's culture, and provide clinicians with resources and support to help them excel in their new role. AAPPR compiled this data from a survey conducted in collaboration with Jackson Physician Search and LocumTenens.com.
Providing effective clinician onboarding is pivotal in a health system's success, according to Pranav Mehta, MD, MBA, CMO of HCA Healthcare American and Atlantic Groups. HCA Healthcare, which features more than 180 hospitals, has more than 45,000 employed and affiliated physicians.
"It is critically important that we orient those physicians in a systematic way and approach," Mehta says. "We spend time onboarding them as they come from outside of our organization into our practices. That gives us the ability to make sure they are successful in clinical practice."
Physician leadership development is pivotal for the U.S. healthcare system because many of the top-performing hospitals are physician-led.
Research shows there is a gap between physician interest in leadership development and opportunities to gain this experience.
A report from Jackson Physician Search and the Medical Group Management Association found that 67% of physicians surveyed were interested in leadership development opportunities, but only 18% had been exposed to nonclinical leadership development through their education or experience in clinical practice.
It is essential for health systems and hospitals to offer leadership development opportunities, says Kristin Mascotti, MD, MS-HQSM, CPE, CMO of Penrose Hospital, which is part of CommonSpirit Health's Mountain Region.
At CommonSpirit, there are formal and informal leadership development opportunities for early career and mid-career physicians who have shown influence in their department or on committees, according to Mascotti.
"It is vital to provide physicians with leadership development opportunities," Mascotti says. "Some of the best-performing healthcare centers and hospitals in the nation are physician-led."
Chief clinical executives such as CMOs are focused on a range of issues, including quality, patient capacity, care variation, and high reliability.
This year, HealthLeaders interviewed more than a dozen new CMOs, chief physician executives, and chief clinical officers. Here are seven executives that are poised to make an impact in 2025:
Frost was named senior vice president, CMO, and chief quality officer of Lifepoint in July. He has served in two other leadership roles at the Brentwood, Tennessee-based health system: chief medical officer of Lifepoint Communities and national medical director of hospital-based services. Frost is a member of the HealthLeaders CMO Exchange.
Frost says the core elements of promoting quality care include a leadership component, a process improvement component, and a culture of safety.
The leadership component includes the recognition of the importance of leadership in every aspect of the organization, according to Frost. It also includes engagement of all the quality stakeholders and an accountability process.
Frost says Lifepoint has a checklist of 10 critical components for performance improvement, including huddles that clinical care teams use to focus on clinical workflows, whiteboards at every clinical care unit to identify opportunities for improvement, and tracking data that demonstrate progress or regression.
The culture of safety at Lifepoint includes the engagement of patients and their families as well as fostering an environment where all team members experience psychological safety and have a voice in the safety process, according to Frost.
Galante was named CMO of the Sacramento, California-based academic medical center in July. He had served as interim CMO for a year and was the hospital’s trauma medical director for many years.
Addressing patient capacity is one of his top challenges.
A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, which prompted the closing of many beds, according to Galante.
"We have had to close 70 beds over the past year," he says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."
UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, Galante explains.
"You must apply the operations and workflows to be able to move patients more seamlessly and get them discharged," he says.
3. Cameron Mantor, MD, MHA, chief physician executive at OU Health and president of OU Health Partners
In September, Mantor was named chief physician executive at the Oklahoma City, Oklahoma-based academic health system and president of OU Health Partners, the health system's physician practice. He had been serving in the roles on an interim basis since January.
OU Health Partners is positioned for growth, and one of Mantor's primary responsibilities is to help manage the recruitment of new physicians. Oklahoma ranks low for the number of physicians per capita in the country for almost every primary care area as well as specialties.
One recruiting advantage for OU Health and OU Health Partners is the tripartite mission of the organization: education, research, and clinical care, according to Mantor.
"Our goal is to show physician recruits what we are looking to create, so they see what our vision is and hopefully that aligns with them," he says. "That tends to attract recruits. We have a great academic health center, with seven colleges on our campus, so we can attract physician recruits both from an education standpoint and a research standpoint."
McGinn was appointed senior executive vice president and chief physician executive officer of the Chicago-based health system in September. He joined the health system in 2021 as executive vice president for physician enterprise.
McGinn says he is passionate about reducing clinical care variation to boost patient safety and quality.
"My background is in evidence-based medicine and looking at clinical standards," he says. "We have a national program that sets clinical standards."
According to McGinn, the key to success in setting clinical standards is to have clinicians drive the process.
"It is not a top-down approach," he says. "We put the standards in front of the clinicians, we give them some options, we have multiple group meetings, then the clinicians come to a consensus about the clinical standards."
Pancioli assumed the role of senior vice president and chief clinical officer at the Cincinnati-based academic health system in August. Prior to taking on his new position, he was chief transformation officer of the health system.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
Puri was appointed CMO of the Chicago-based academic medical center in September. He joined UChicago Medicine as an internal medicine resident in 1999 and has held several physician leadership roles, most recently associate CMO.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
"It starts with asking questions about health equity," he says.
The next step is harnessing data, Puri explains.
"You need to have data that you can act on," he says. "Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes."
Schissel became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, in August. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
Like Pancioli, Schissel is focusing on high reliability, which he also pursued in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
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 Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Since November 2020, health systems and hospitals have been providing acute care in the home setting through the Acute Hospital Care at Home (AHCAH) program under a waiver from the Centers for Medicare & Medicaid Services (CMS). Ochsner's Acute Care at Home program, which was launched in March, does not receive reimbursement from CMS and serves patients who are participants in value-based contracts.
"With the Acute Hospital Care at Home program, under the regulations you are providing inpatient care at somebody's home, and there are restrictions such as number of visits as well as continuous monitoring," says Sidney "Beau" Raymond, MD, CMO of Ochsner Health Network.
"In addition, Acute Hospital Care at Home billing is done as an inpatient visit," Raymond says. "With our Acute Care at Home program, there is not 24/7 remote patient monitoring, and we are not billing to insurers as you would with an inpatient visit."
Billing is a key difference between AHCAH and the Acute Care at Home program, according to Raymond.
"This is a pilot, and we are serving our value-based lives now," Raymond says. "In this pilot with about 400 patients, we are getting about a two-and-a-half times return on investment for the access that we are opening up."
In the Acute Care at Home program, patients participate in a 15-day episode of care at home, with virtual care provided by a physician, nurse, and care manager staffed by myLaurel, according to Logan Davies, MD, medical director of hospital access and throughput at Ochsner Medical Center—New Orleans. The virtual visits by a physician are accompanied by a paramedic in-person visit.
"Over the 15-day episode of care, myLaurel is managing acute care, the clinical plan, and transitional care services," Davies says, "where we have virtual nursing and virtual care management doing everything from medication reconciliations, to fall risk assessments, to education for patients and their caregivers."
Clinicians employed by myLaurel conduct the home care, but they are Ochsner-credentialled providers, Davies explains, which allows them to have full access to the health system's electronic medical record.
To be enrolled in the Acute Care at Home program, patients must be stable and able to be treated safely in the home, according to Davies.
"A cornerstone of the program is appropriate acuity," Davies says.
Patients are transferred to the Acute Care at Home program from the emergency department, hospital observation units, and inpatient units.
Acute Care at Home patients are being treated for several medical conditions, Davies explains.
"For the conditions we are managing, the most common are infections, including urinary tract infections," Davies says. "The second most common condition is congestive heart failure. After CHF, we are treating pulmonary conditions such as chronic obstructive pulmonary disease as well as upper respiratory infections. We also treat patients for electrolyte issues and renal issues."
Benefits of the Acute Care at Home program
The main benefit of the Acute Care at Home program is that patients get to receive care in the home, which is an appropriate care setting for these patients, according to Raymond.
"People are eligible because they are stable enough to not be hospitalized, but they do need more than just intermittent care that would require travel to and from a clinic or other care setting on multiple visits," Raymond says. "It's the right care in the right place. These patients get to be home, where they and their caregivers are more comfortable."
Secondarily, the Acute Care at Home program is beneficial because it meets an acute need for a patient at a lower cost than hospital inpatient care, Raymond explains.
"This program is currently available to patients that we share in the total cost of care in some way," Raymond says. "This allows us the freedom to try different models of care while always keeping the patients first. Another benefit is that it frees up beds inside the hospital for those that need that level of care or intervention, and it avoids delaying that care by having better access."
The Acute Care at Home program exemplifies value-based care, according to Raymond.
"The goal of value-based care is to provide high quality care at a lower cost with a great experience," Raymond says. "This checks all of those boxes. People are getting great care at an appropriate cost in their home. Value-based reimbursement allows us to do this."
The Acute Care at Home program is reducing total cost of care by avoiding hospital admissions and readmissions, Raymond explains.
"Hospitalizations are some of the costliest events in healthcare for not only the payer, but also the patient through deductibles and coinsurance," Raymond says. "Reducing hospitalizations has a direct and noticeable impact on the total cost of care."
This HealthLeaders podcast focuses on several infection prevention topics, including respiratory virus season, emerging pathogen considerations, and healthcare-acquired conditions.
Health systems and hospitals are entering the respiratory virus season with little guidance from local and federal public health agencies, according to the executive medical director of infection prevention and control at UChicago Medicine.
Infection prevention and control staff are the first line of defense for infectious diseases and infections at health systems and hospitals. They help health systems and hospitals manage interventions such as masking and promote best practices in areas such as healthcare-acquired conditions.
Coming out of the COVID pandemic, there are a lot of questions about the role of masking and other interventions for respiratory viruses such as restricting visitors in hospitals, says Emily Landon, MD, executive medical director of infection prevention and control at UChicago Medicine.
"For a long time, we had a lot of rules that we had to follow from our local public health agencies and the Centers for Disease Control and Prevention," Landon says. "Most of those rules sunset before this year's respiratory virus season."
In the absence of guidance from public health agencies, it is challenging to know when to require masks at healthcare settings, but it is clear that masking helps prevent transmission of respiratory viruses, Landon explains.
"What type of mask you wear helps determine whether or not you are going to be protected," Landon says. "If you want to be protected from a sick person near you, then you need to wear a tight-fitting, N95 mask. If you want to help prevent yourself from giving someone else COVID or influenza, you can do that safely by wearing a surgical mask."
Emily Landon, MD, is executive medical director of infection prevention and control at UChicago Medicine. Photo courtesy of UChicago Medicine.
UChicago Medicine has created a "masking ladder" to manage the wearing of masks during this respiratory virus season.
"We have a team of people including ambulatory staff, people from occupational medicine, people from pharmacy, and people from infection control, and we huddle every Thursday for about 15 minutes," Landon says. "We use a set of metrics to determine how we move up and down the masking ladder."
The bottom rung of the masking ladder is when staff wear masks when they are sick. The next rung of the masking ladder is called the yellow level, according to Landon.
"At the yellow level, we know something is coming such as seeing a new variant or seeing more cases of influenza," Landon says. "At the yellow level, staff still wear masks when they are sick, but we also tell people that respiratory virus season is heating up and they should be more careful, they should stay home if they are sick, and they should get tested if they feel sick."
The next rung on the ladder is the orange level.
"When we start seeing higher respiratory virus numbers in our community and among staff at our care settings, we switch to the orange level," Landon says, "which requires all staff members to wear masks when they are in direct patient care."
The top rung on the ladder requires universal masking, including for patients.
"If we see widespread problems such as lots of people being admitted to the hospital with respiratory viruses or lots of staff sick in multiple areas of the hospital," Landon says, "then we would consider universal masking, including for patients."
So far during the early days of this year's respiratory virus season, UChicago Medicine has been able to limit infections in healthcare settings, according to Landon.
"We track hospital-acquired COVID, influenza, and RSV at the University of Chicago, and we have been successful in preventing patients from getting sick in the hospital just by requiring masks for staff members when we see infections in healthcare workers," Landon says. "You can get by using fewer masks than you did during the COVID pandemic, but masking has the benefit of patients not getting sick from healthcare workers."
UPMC's CMIO, a HealthLeaders AI in Clinical Care Mastermind program participant, provides advice on adopting AI tools.
Health systems and hospitals need to understand the outcomes and goals they are trying to accomplish with AI, says Robert Bart, MD, chief medical information officer at UPMC.
"We are past the time that people are saying they want to use AI because it is AI," Bart says. "You need to make sure as you are examining the use of AI in your health system that it drives the type of clinical outcomes you are trying to achieve. In addition, AI models should have the scale that your organization needs."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
Bart says the process for identifying the desired goals and outcomes of an AI tool depends on the problem you are trying to solve.
"You want to identify your goals and desired outcomes early on when you are evaluating whether you want to adopt an AI tool, whether it impacts clinical care, the efficiency of care delivery, or other aspects that a health system has targeted," he says.
Health systems and hospitals also must have appropriate AI governance, so that they not only are evaluating AI when it is adopted but also reviewing how AI models are functioning.
"The thing about AI is that the algorithms are always learning," Bart says. "You need to go back and re-examine the algorithms at intervals after you have started using them. You need to make sure that an algorithm provides the type of guidance or insights that were intended at the outset."
UPMC has established an AI governance council to make sure that the health system is leveraging AI appropriately and in a safe manner, Bart says. The council has a dozen members and includes clinicians, technologists, as well as diversity and equality staff.
"We have governance to make sure we are understanding the algorithms, understanding the use cases, and understanding the test data that the algorithms were generated on," he says. "All of those things go into making sure we are leveraging AI in a safe manner to enhance care delivery."
Diversity and equality are also key issues for AI governance.
"There are some concerns that AI has algorithms that create segmentation of the patient population inappropriately," Bart says. "We want make sure that AI can be leveraged for all of the patients we serve at UPMC."
Robert Bart, MD, is chief medical information officer at UPMC. Photo courtesy of UPMC.
Clinical care AI models at UPMC
UPMC was an early adopter of predictive algorithms, launching these AI tools about six years ago.
"We have been using AI for predictive algorithms related to length of stay and risk for readmission or hospitalization," Bart says. "We have been trying to predict and understand those types of parameters for patients."
The health system is using the technology to be more proactive in care delivery.
"Where we identify patients who are outliers such as high risk for hospitalization or readmission after hospitalization, we are trying to put in interventions to mitigate their risk of hospitalization or readmission," Bart says.
The health system is also using AI in pathology to identify disease states in tissue slides.
"The AI is prioritizing slides of tissue that might have areas of concern and need to be reviewed," Bart says. "It allows the pathologist to be more efficient with their time."
In a similar use case, UPMC is using AI in radiology.
"One of the AI tools we are using in the radiology space is related to stroke detection," Bart says. "For strokes, seconds and minutes make a difference for the brain in the type of care you are delivering. So using AI in image analysis helps improve the speed with which our neurologists and neurosurgeons can make decisions for patients who have brain tissue at risk."
As is the case with most health systems and hospitals that have adopted AI tools for clinical care, UPMC is using ambient listening AI technology to record conversations between clinicians and patients, then generate clinical documentation.
"We have been using AI to aid our physicians and advanced practice providers in improving the quality and efficiency of documentation," Bart says.
Compared to the other AI tools that the health system has adopted, the ambient listening AI technology has had the most profound impact on clinicians, according to Bart.
"We were one of the early adopters of ambient voice technology in documentation," he says. "Our deployment is broad compared to what I have seen in other health systems. The feedback that we get from the clinicians who have adopted this tool is very good."
For example, a family practitioner may see 20 patients through the course of a day in a clinic, then face "pajama time." They may finish their office day at 5 or 6 p.m., go home and see their family, then finish the documentation for the patients they saw over the course of the day.
"One of the things we have seen is that pajama time has decreased significantly; and for some clinicians, pajama time has gone away completely," Bart says. "For a clinician, it makes a huge difference if they can leave the clinic at 5 or 6 and have all of their documentation done as opposed to having to spend two hours in the evening catching up on documentation."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. This clinical AI program is sponsored by Microsoft-Nuance, Rapid AI, and Ambience.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Memorial Healthcare System’s new $1.7 million Care Coordination Center aims to eliminate gaps in patient navigation and care management.
The new Care Coordination Center at Memorial Healthcare System is expected to boost care quality and patient safety, the CMO of the health system says.
The South Florida health system invested about $1.7 million in the 3,000 square foot facility and equipment. The annual cost of operating the center is estimated at $3.7 million.
The Care Coordination Center has five primary capabilities, according to Aharon Sareli, MD, executive vice president and CMO at Memorial Healthcare System.
At Providence, AI governance addresses several issues such as safety and security of patients and their data.
Providence is taking a comprehensive approach to AI governance, the health system's chief clinical officer says.
"Our approach to the use of AI tools is methodical and anchored in our mission, values, and organizational vision and priorities," says Hoda Asmar, MD, MBA, executive vice president and system chief clinical officer for Providence. "While we believe AI advancements have the potential to elevate quality of care and allow our caregivers to perform at the top of their license, the safety and security of our patients and their data will always be our top priority."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
According to Asmar, Providence has established AI governance to get ahead of several issues raised by AI models,
"Providence proactively assembled an AI governance structure to ensure alignment around priorities and strategy, and ensure safety, privacy, security, equity, and the ethical use of AI," Asmar says. "This governance structure will evolve as our experience and knowledge around AI deepens."
The AI governance structure has several elements, Asmar explains.
"Providence has put together an AI guardrails workgroup led by our system's chief data officer; an Information Protection committee led by our chief information security officer; and a Data Ethics Council, led by our chief ethicist," Asmar says. "The work of these three teams feed into the Generative AI Leadership Council that oversees our responsible use of AI and advances our AI strategy."
The health system has also convened expert groups to manage AI governance, Asmar explains.
"We have stood up four subject matter expert groups: clinical, patient and consumer, workforce and administration, and back office," Asmar says. "These groups identify and prioritize key use cases for their areas and leverage the guardrails, data protection, and other governance structures to guide work to develop and implement AI solutions."
Hoda Asmar, MD, MBA, is executive vice president and system chief clinical officer for Providence. Photo courtesy of Providence.
AI models at Providence
The health system is integrating AI tools into daily work to accelerate decision-making, simplify workflows, and reduce non-clinical task burdens.
This includes internally generated innovations that leverage AI to enhance patient experience and reduce clinician burnout, according to Asmar.
"Some examples include automating non-direct patient care tasks in the form of ambient documentation; clinical decision support by bringing together multiple information sources in a way that allows the clinician to easily analyze and make decisions; and employing predictive analytics that speed up access to just-in-time data and information," Asmar says.
An AI tool developed at Providence helps to manage patient messages sent to clinicians' electronic in-baskets.
ProvARIA (automated realtime in-basket assistant) organizes inbox messages to physicians and caregivers in the ambulatory setting based on acuity, urgency, and content. The AI model uses a natural language processing engine to organize the messages, and a tailored user interface integrated into the electronic health record.
"ProvARIA supports clinicians in responding to their in-basket messages by augmenting them and supporting them in understanding a patient in-basket message, triaging, and responding to the message more readily," Asmar says." ProvARIA has not only eased the way for our care teams but also improved the response time to patients by 50%."
AI's impact on Providence care teams
Some of the clinical AI tools being used at Providence are still new, and the health system is assessing how they are impacting care teams.
"Early indicators suggest these tools have a high level of engagement and satisfaction with the care teams by allowing clinicians to spend more time with their patients, reducing stress and administrative task burdens, and allowing clinicians to focus on what matters most to them and their patients," Asmar says.
Computer-assisted physician documentation and ambient technology, in which physician-patient conversations are automatically transcribed and uploaded directly to EPIC and Providence's EHR through tools such as Nuance's DAX, remove the technological barrier that typically inhibits personal connection in exam rooms and allows caregivers to deliver even better care, according to Asmar.
Providence has also introduced MedPearl, a clinician education and referral platform designed by clinicians for clinicians, which gives primary care providers advice on whether—and where—to send patients for specialty care, Asmar says. Generative AI is used to accelerate content creation and enhance the end user's search experience.
Another example of an AI tool that is having a positive impact on care teams is an AI-powered surgical scheduling tool, according to Asmar.
"Surgical teams have indicated improved role satisfaction as surgery scheduling is easier and more efficient, and this satisfaction is also shared by the surgeons and their office staff," Asmar says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. This clinical AI program is sponsored by Microsoft-Nuance, Rapid AI, and Ambience.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Hoda Asmar, MD, MBA, is executive vice president and system chief clinical officer for Providence. Photo courtesy of Providence.