Changes in reimbursement will have a pivotal impact on value-based care and overall health in the country, the chief clinical officer of SSM Health says.
The chief clinical officer of SSM Health has five predictions for clinical care in 2025.
Stephanie Duggan, MD, became chief clinical officer of SSM in November 2023. Prior to joining SSM, she was president and CEO of Ascension Michigan for five years. Her leadership experience includes serving as CMO of Ascension Sacred Heart Hospital in Pensacola, Florida.
Prior to joining SSM, she was president and CEO of Ascension Michigan for five years. Her leadership experience includes serving as CMO of Ascension Sacred Heart Hospital in Pensacola, Florida.
Here are Duggan’s five predictions for clinical care in 2025.
1. The future of value-based care will remain uncertain
Whether value-based care makes significant advancements this year is largely in the hands of the Centers for Medicare & Medicaid Services (CMS), according to Duggan.
"So much of our business is based on CMS requirements and CMS payments. Many of our insurers will follow what CMS does," Duggan says. "With our commitment to value-based care at SSM, I am hopeful that we will get more federal support for leaning into value-based care."
2. Room for improvement in complex care
This year could be an inflection point in the care of complex patients, Duggan explains.
"If we are going to be willing to talk about complexities and multiple co-morbid conditions as being a group of diseases that we want to get to root causes and bend the health curve, 2025 is going to be an exciting time," Duggan says. "The challenge is that nothing happens quickly."
Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
3. Cautious optimism about clinical care
The United States has a strong healthcare system in terms of treating people when they are ill, but the country needs to turn a corner this year when it comes to social determinants of health and preventative care, according to Duggan.
"We have the best rescue healthcare system in the world," Duggan says. "Our challenge is to figure out how we continue to care for everyone in this country so that the social determinants of health and Zip codes do not determine the type of healthcare that one is provided. Whether it is rural, whether it is inner city, we need to find a way to help people achieve their best health."
Changes in reimbursement this year could improve the overall health of the U.S. population, Duggan explains.
"We will see some changes in reimbursement," Duggan says, "and there will be a lot of interest in bending the healthcare curve to keep people healthy and well rather than just rescuing them when they are acutely ill."
4. No short-term fix for physician shortage
While the pipeline for new physicians is likely to improve this year, physician shortages will remain a challenge, according to Duggan.
"I predict that the applications to medical school will continue to rise," Duggan says. "There is a lot of interest in young people trying to get into medical school, but we will still see a shortage of physicians."
5. Addressing work-life balance for physicians
In 2025, technology needs to play a significant role in improving the work-life balance of physicians, Duggan explains.
"The work-life balance for physicians, especially since the coronavirus pandemic, has changed the expectations for how much time clinicians will work," Duggan says. "We will have to see some innovation, whether it is AI being more supportive of physicians or in telehealth."
A recent study found that measures of physical function, such as grip strength and gait speed, are strongly associated with hospital readmission risk.
CMOs looking to reduce costly hospital readmissions should pay closer attention to their patients’ physical activity in the hospital.
According to recent research, physical function impairments can help predict the risk of readmission. Addressing them could help healthcare leaders reduce readmissions within 30 days—and the reimbursement penalties of up to 3% that can come from the Centers for Medicare & Medicaid Services for those returning patients.
"If you talk to CFOs, they will tell you that the margins are thin in treating Medicare patients, and it is hard to give back 3% of your reimbursement," says John Romano, acting CMO of Fremont, California-based Washington Health.
ZoomCare is confident that it can make serving Medicare beneficiaries financially sustainable.
While some clinics and physician practices are withdrawing from serving Medicare beneficiaries, Tigard, Oregon-based ZoomCare is doubling down on Medicare services.
The Centers for Medicare & Medicaid Services have been scaling back on reimbursement for Medicare services, most recently implementing a 2.8% reduction in physician reimbursement as part of the 2025 Physician Fee Schedule. Physician reimbursement from Medicare decreased 29% from 2001 to 2024, according to the American Medical Association.
The reimbursement reductions have driven some clinics and physician practices to stop serving Medicare beneficiaries, but ZoomCare is bucking the trend.
The 47-clinic organization launched serving Medicare beneficiaries in December in part because patients demanded it, according to Mark Zeitzer, MD, CMO of ZoomCare.
"As patients aged and entered Medicare, they were frustrated that they could not see us anymore," Zeitzer says. "It was important for us to take on that population and do it in a high-quality, effective, and efficient way."
ZoomCare also took on serving Medicare patients because it strives to work with other healthcare providers in Oregon and Washington, Zeitzer explains.
"Serving Medicare patients fits with our commitment to partnership," Zeitzer says, "we want to work with other healthcare providers."
ZoomCare provides primary care and urgent care. It also has three emergency care clinics and offers specialty care, including dermatology, women's health, mental health, and podiatry.
Investing in technology
In July, the clinic network invested in a new electronic health record, athenaOne, as part of the effort to serve Medicare beneficiaries and to work effectively with other healthcare providers.
"What's important is that our system connects efficiently and effectively with other systems," Zeitzer says. "You cannot operate in a silo."
Additionally, athenaOne is Medicare-certified, which was not the case with the homegrown EHR that ZoomCare had been using since 2006.
"Medicare certification is a difficult and onerous process, so an off-the-shelf solution like athenaOne was helpful to achieve that certification," Zeitzer says. "If we had tried to get Medicare certification with our homegrown EHR, it would have taken about three years."
Making Medicare services financially sustainable
ZoomCare is confident that it can make serving Medicare patients work financially and sustainably, according to Zeitzer.
"Thousands of people age into Medicare every day—it is an important population," Zeitzer says. "These are often complicated patients, but there are many things we can do to prevent problems down the line and maximize their healthy years."
Managing costs is an essential strategy to serve Medicare beneficiaries, Zeitzer explains.
"We believe that by making healthcare easy and accessible we can reduce costs," Zeitzer says. "By being able to see more Medicare patients and being able to maximize preventative services working with Medicare Advantage contracts, we believe we can serve these patients at a low cost in an efficient and effective way."
Access is pivotal, according to Zeitzer.
"If you can get into your provider, your overall health will be better, you will have less side effects, and you will have lower costs," Zeitzer says. "For example, if you can keep hemoglobin A1C scores low and keep Medicare patients who have diabetes healthier, having more frequent touch points with patients helps to make care cheaper."
Centralizing business functions and clinical services is another way ZoomCare is prepared to serve Medicare beneficiaries, Zeitzer explains.
For example, ZoomCare has a centralized team of nurses that process prior authorizations, and there is always a physician on call to answer questions from doctors and advanced practice providers about complicated cases, Zeitzer says.
A recent study found that measures of physical function, such as grip strength and gait speed, are strongly associated with hospital readmission risk.
CMOs looking to reduce costly hospital readmissions should pay closer attention to their patients’ physical activity in the hospital.
According to recent research, physical function impairments can help predict the risk of readmission. Addressing them could help healthcare leaders reduce readmissions within 30 days—and the reimbursement penalties of up to 3% that can come from the Centers for Medicare & Medicaid Services for those returning patients.
"If you talk to CFOs, they will tell you that the margins are thin in treating Medicare patients, and it is hard to give back 3% of your reimbursement," says John Romano, acting CMO of Fremont, California-based Washington Health.
The recent research, which was published by the Journal of Hospital Medicine, features a systematic review of 17 studies representing 80,000 patients.
The study includes several key findings:
Patients with chronic obstructive pulmonary disease are 10 times more likely to be readmitted within 30 days if their grip strength is weak, compared to patients with normal grip strength.
Impaired gait speed is one of the strongest predictors of readmission risk among patients undergoing transcatheter aortic valve replacement.
Impairments in daily living activities were associated with a higher number of 30-day hospital readmissions among Medicare beneficiaries with a cancer diagnosis.
Hospitalized patients at least 75 years old with low mobility, such as those limited to their beds, are twice as likely to be readmitted within 30 days, compared to those patients who can walk on their own.
Patients with deficits in instrumental activities of daily living (IADL), such as managing a trip to the grocery store, face higher risk of readmission, according to two studies. One study estimated a 17% higher chance of readmission for patients with any IADL limitations as compared with those with no limitations.
"Functional impairments are robust predictors of hospital readmissions in older adults," the journal article's co-authors wrote. "Routine assessment of physical function during hospitalization can improve risk stratification and may support successful care transitions, particularly in older adults."
Why physical function is linked to readmission risk
Physical function reflects the status of several body systems, the lead author of the journal article says.
"Physical function tells us a lot about the musculoskeletal system and the cardiovascular system as well as a patient's cognitive status and psychosocial well-being," says Erin Thomas, PT, DPT, associate professor of practice at The Ohio State University College of Medicine‘s School of Health and Rehabilitation Sciences. "Physical function gives us a lot of insight, and when physical function is compromised, patients are at higher risk for readmission."
Romano says hospitalization can compromise a patient’s physical function.
"We know that movement and activity both promote health," he says. "Hospitalized patients are inherently at risk of physical decline due to their medical needs and their need for bed rest most of the time. Hospitals are a disruptive environment for rest and recovery. For example, you can get awakened early in the morning for blood draws."
At Washington Health, which includes a 415-bed acute-care hospital, Romano says about 60% of the hospital's patients automatically work with physical therapists. That figure is likely to increase, he says, with the findings of the journal article and other research.
"Now, there are more and more protocols for post-surgical care to optimize early mobility because we know that if patients stay in bed they are not going to get well," he says.
Measuring physical function
Thomas says there are many ways to assess physical function.
"You can look at strength," she says. "You can look at mobility issues such as walking. You can look at how a person is able to handle their activities of daily living such as managing bathing and dressing. The are many opportunities for clinicians and nurses to look at physical function and to think inter-professionally about physical function."
Given the research, Thomas and Romano say, hospital leaders should prioritize assessing physical function during a hospital stay.
"An important finding of our study was the importance of routine measurement of physical function," Thomas says. "In addition, you need to recognize that physical function is like a vital sign. We should be checking physical function early and frequently during a hospitalization. This can help identify patients who are at risk for readmission."
"We want to be able to identify the deficits, then provide the tools for measurement similar to lab tests for diabetes, where you measure the blood sugar," Romano says. "You measure to understand what the problem is initially. Once you identify the problem, you apply modalities to improve it."
Improving transitions of care
Understanding a hospitalized patient's physical function impairments can also improve transitions of care, Thomas and Romano say.
"Knowing about physical function impairments helps us to plan and think about where an individual should go after a hospitalization," Thomas says. "It helps us make sure we are making the right decisions for post-acute care. For some individuals, it may not be safe for them to go home. They might need to go to a skilled nursing facility or a rehab facility."
"When a patient is discharged, we have a case manager who looks at all of the patient's needs and recommends to the attending physician what to order for the patient's post-hospitalization," Romano says. "Now, because we have measures of physical function, we can apply that same process for the patient's activity needs."
Health systems and hospitals should have social media policies but should avoid limiting protected speech, a legal expert says.
Social media can be a powerful tool for CMOs, other healthcare leaders, and physicians. However, there are pitfalls.
A recent pitfall example is a wrongful termination lawsuit filed in North Carolina by a pharmacist who had complained on LinkedIn about inadequate staffing at her hospital and its corporate parent, HCA Healthcare. The lawsuit claims the pharmacist was fired to silence her and cover up staffing shortages at Mission Hospital in Asheville, North Carolina.
The firing of the pharmacist puts Mission Hospital and HCA Healthcare in legal jeopardy. According to Amanda Hill, JD, founder of Hill Health Law Group, health systems and hospitals should have social media policies, but there are limits to restricting speech on social media platforms.
"There is a fine line in setting rules," Hill says. "That is why you should have your social media policy reviewed by legal counsel. Sometimes, organizations go too far. They say you cannot talk about your pay and workplace conditions. But that is protected speech."
Health systems and hospitals should have social media policies but should avoid limiting protected speech, a legal expert says.
Social media can be a powerful tool for CMOs, other healthcare leaders, and physicians. However, there are pitfalls.
A recent pitfall example is a wrongful termination lawsuit filed in North Carolina by a pharmacist who had complained on LinkedIn about inadequate staffing at her hospital and its corporate parent, HCA Healthcare. The lawsuit claims the pharmacist was fired to silence her and cover up staffing shortages at Mission Hospital in Asheville, North Carolina.
The firing of the pharmacist puts Mission Hospital and HCA Healthcare in legal jeopardy. According to Amanda Hill, JD, founder of Hill Health Law Group, health systems and hospitals should have social media policies, but there are limits to restricting speech on social media platforms.
"There is a fine line in setting rules," Hill says. "That is why you should have your social media policy reviewed by legal counsel. Sometimes, organizations go too far. They say you cannot talk about your pay and workplace conditions. But that is protected speech."
While physicians and other healthcare professionals can air grievances on social media platforms, they should be cautious, Hill explains.
"You need to tread lightly," Hill says. "A lot of physicians get too cavalier with sharing their workplace stories online. There are a lot of eyes and ears on the Internet—people can have a false sense of privacy that things are not going to be screen shot or shared."
Particular care should be taken when airing grievances about patients. Identifying patients on social media without their permission is forbidden by the Health Insurance Portability and Accountability Act.
"Sometimes, doctors think that they are not using a patient's name or date of birth, so posting is not a problem," Hill says. "But there are many ways you can identify a patient in a social media post. … You just need to be cautious when you are talking about patients because if you identify a patient, it can turn into a train wreck."
Physicians and other healthcare professionals should refrain from airing grievances on social media platforms, says Jennifer Khelil, DO, MBA, executive vice president and chief clinical officer at Virtua Health.
"It is not a good idea," Khelil says. "I would never recommend for a physician to air grievances on social media. There are ways of dealing with grievances in a respectful way. People need to remember that anything that is put out on a social media platform is there forever."
Physicians have other options to address grievances such as internal processes at health systems and hospitals, Khelil explains.
"Physicians should use the processes and resources that are available to them to address grievances," Khelil says. "Social media is not the place to do that sort of thing."
How healthcare leaders can leverage social media
However, there are several good uses of social media for CMOs and other healthcare leaders, Hill and Khelil say. For example, social media can be used to provide inspiration.
"If you get on social media as the CMO of a hospital, you can share your heart and where your mission lies," Hill says. "Instead of being seen as sitting in an ivory tower as an administrator, you can go on social media and talk about issues that matter to the community."
Social media was a helpful communication channel during the coronavirus pandemic in a time when there was a lot of misinformation, according to Khelil.
"There were shortages of COVID-19 tests and personal protective equipment," Khelil says. "People were distressed. We created videos that we put on social media to inform the population and let people know how we were handling things such as testing."
During the pandemic, social media enabled Virtua Health to "take the temperature down for our patients," Khelil explains.
"Social media was a way for patients to get information in a modality they felt comfortable with and in a time that was convenient for them. It opened lines of communication," Khelil says. "Using social media, we were able to reach thousands of people and give them information that they were seeking."
Social media is great for CMOs and other healthcare leaders whenever there is something big going on such as an infectious disease outbreak, according to Khelil.
"It is in real time. I can record something, and it can be out to the public in 15 minutes," Khelil says. "Any time there is a health emergency, social media is helpful. We have used social media to communicate with our patients when we have had insurance complexities—we were able to reassure patients that we were still here for them despite the insurance complication."
Social media uses to avoid
CMOs and other healthcare leaders should avoid some uses of social media, Khelil and Hill say.
Leaders should not post anything that would jeopardize patient confidentiality or patient safety, according to Khelil.
"The main thing is to remind leaders that when they are using social media in a professional capacity, they are speaking on behalf of the organization," Khelil says. "Leaders should also partner with the marketing team—it is important to have a collaborative relationship with people who are experts in social media."
CMOs should avoid polarizing topics on social media platforms, Hill explains.
"CMOs and other healthcare leaders should avoid commenting on politics or religion, unless they are comfortable with the backlash," Hill says. "They should stick with the mission of their organization without making it political. The more polarizing you are on social media, the more anger you are going to generate from one side or the other."
Healthcare organizations need to encourage physicians who are struggling with burnout or mental health issues to seek help.
In this episode of HL Shorts, we hear from Thomas Campbell, chief wellness officer at Allegheny Health Network, about ways to reduce the stigma that physicians face for burnout and mental health issues. To view the episode, click on the video below.
There are several opportunities to introduce AI tools into operating rooms.
Up to this point, AI tools are not being widely used during surgical procedures. The technology has made more of a splash in the pre-operative and post-operative settings.
However, Miami Cardiac and Vascular Institute, part of Baptist Health South Florida, is examining ways to introduce AI tools into the operating room. Tom Nguyen, MD, chief medical executive of Miami Cardiac and Vascular Institute, says his surgeons are using an AI tool to generate risk profiles for their patients.
Historically, according to Nguyen, they had risk calculators that could use the patient's age, comorbid conditions, and other factors to determine a risk profile after the patient had surgery.
"Those risk calculators did not take into account the patient's Zip code, the particular surgeon, the time of the surgery, and a host of other factors," Nguyen says. "AI can use machine learning to predict more outcomes."
Risk calculators that use regression analysis to generate risk profiles have been available for more than a decade, but the AI tool that Miami Cardiac and Vascular Institute is using is more powerful, according to Nguyen.
"Unlike regression models," Nguyen says, "AI can add more variables and personalize the predictive risk for each individual patient."
AI has taken hold in the perioperative arena, according to James Blum, MD, chief health information officer at The University of Iowa.
Ahead of surgery, some surgeons are using AI for imaging to look for defects or tumors that have metastasized, Blum says.
"After surgery, there is monitoring in the hospital with predictive algorithms for people suffering deterioration," Blum says. "There is also remote patient monitoring that is being used after sending surgical patients home with algorithms that can show when they are getting into trouble."
AI opportunities in the operating room
In the future, AI will assist surgeons during procedures, according to Blum and Nguyen.
"We have worked with a company that uses AI to make surgeries safer," Blum says. "Essentially, this AI tool monitors things that are going on during an operation and provides feedback."
AI will help anesthesiologists in the operating room as well, Blum explains.
"There are technologies being used in Europe to maintain the blood level of the anesthetic and calculations for individual patients," Blum says, "particularly if an anesthetic is being given as an IV infusion."
In the future, the da Vinci robot will likely have AI features that could make it a better assistant to the surgeon, according to Blum.
Nguyen is bullish on the future of AI tools in the operating room, particularly in robotics.
"Just as with automated driving, you could have AI do almost automated procedures," Nguyen says. "There have been studies to use AI to watch an operation then alert the surgeon not to take a certain action or alert the surgeon that they are doing something out of sequence."
One of Nguyen's responsibilities is looking for opportunities to improve operational efficiency, which could be a near-term application of AI at Baptist Health South Florida.
"We are working with some companies that have AI technology that will help us understand our current operational efficiency, understand where the gaps are, and help guide us to become more efficient," Nyugen says.
Miami Cardiac and Vascular Institute is exploring AI technology that could manage the counting of supplies in the operating room, where every single sponge and needle must be accounted for. The concern is that an object could be inadvertently left inside a patient.
"Those counts are done by people," Nguyen says. "Every time you rely on a person, you are subject to variability and subject to inaccuracy."
According to Nguyen, there is a piece of AI technology that involves using a camera that takes pictures of all the needles and counts them. In complex cases that can have as many as 300 needles, the technology can be a big help.
"If your count is wrong, you must go around the room and try to find the missing needles," Nguyen says. "You may have to take an X-ray to make sure you did not leave a needle in the patient's body."
Nguyen is excited about AI, and he believes it will transform medicine.
"We need to approach it with cautious optimism," Nguyen says. "We need to have components in place to ensure that AI does not spiral out of control."
Considerations for AI adoption in the surgical realm
When adopting AI tools in the surgical setting, healthcare organizations must make sure that patient information is secure, according to Nguyen.
"In using AI, you use many data points for each patient," Nguyen says. "Something we are very cognizant of and have committees adjudicate is how we use patient information."
Additionally, healthcare organizations should not impose AI tools on their surgeons, Blum explains.
"You need to understand your surgeons' needs, and you need to understand their pain points," Blum says. "You should avoid finding a tool, acquiring it, then telling surgeons to use it."
Healthcare organizations should find an AI solution and pair it with a surgeon champion, according to Blum.
"The best way to adopt AI technology in the surgical field is to have the right technology with the right surgeon," Blum says, "who can then champion that technology throughout the organization."
The new chief clinical officer of Virtua Health shares her best practices for creating residency programs.
Jennifer Khelil, DO, MBA, led the creation of residency programs at Virtua Health before becoming the health system's chief clinical officer.
Khelil was promoted to executive vice president and chief clinical officer of Virtua early this month. She had served as CMO of the health system since 2019 and was previously vice president of medical affairs starting in 2013.
Virtua has added several residency programs to the institution over the past five years, including residencies in family medicine, internal medicine, obstetrics and gynecology, surgery, and psychiatry. The health system has a fellowship program in cardiology and will be adding an anesthesiology residency program.
Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
