Artificial intelligence tools, telehealth, and redesigning care models are among the effective approaches to boosting access, this CMO says.

The new CMO of Sentara Health has been involved in efforts such as redesigning care models to improve access to care.

Michael Hooper, MD, MSc, became senior vice president and CMO of Sentara Health in March. He retained his prior role as chief academic officer. His previous experience includes serving as CMO of Sentara Norfolk General Hospital.

Hooper is helping Sentara to redesign care models and use artificial intelligence tools, telehealth, advanced practice providers, nurses, social workers, and care managers to increase access to care.

"We have a process in place for care model redesign to look at our workflows and the way we interact with patients," Hooper says. "We want to match the needs of our patients with the most appropriate communication methodology and personnel to give them advice, make diagnoses, and come up with treatment plans."

Regarding advanced practice providers, nurses, social workers, and care managers, Sentara is actively looking at how the health system can maximize the use of those staff members in the ambulatory setting and hospital setting in more robust healthcare professional teams.

"This will allow us to take care of more patients and improve access to care while still maintaining or improving the quality of care that we provide," Hooper says.

Like many other healthcare organizations, Sentara has seen an explosion of telehealth capabilities since the coronavirus pandemic.

"We continue to use telehealth in hospital-based care, emergency medicine, and ambulatory care to increase access to care and make interactions with patients more convenient and efficient," Hooper says.

Embedding artificial intelligence tools in clinical workflows is helping Sentara to see more patients without straining the health system's workforce.

"Notable examples of AI tools we are using include a telenursing capability that we have inserted into many of our hospitals," Hooper says. "This use of AI is a way for us to take some of the routine nursing care that does not require hands-on effort and use a virtual nurse to do tasks such as medication reconciliation and patient education at discharge."

Stroke services, where timely care is essential for positive clinical outcomes, is another example of where AI is improving access to care at Sentara.

"When potential stroke patients come into our emergency rooms, they get rapid access to CT scans and stroke neurologists combined with an AI tool that reads their scan faster than a radiologist could," Hooper says.

Michael Hooper, MD, MSc, is senior vice president as well as chief medical and academic officer at Sentara Health. Photo courtesy of Sentara Health.

Effort to double number of residents

Hooper is involved in an initiative to double the number of residents at the health system.

"We are trying to work with our academic partners to increase the number of resident slots, so we can help address the physician shortage that everyone is experiencing across the country," Hooper says.

Sentara operates 12 hospitals, with 11 hospitals located in Virginia and one hospital in North Carolina. In Virginia, Sentara has residency partnerships with several academic institutions, including Virginia Health Sciences and Old Dominion University.

"We have partnered with medical schools for residency slot increases and are working on several specialty programs and primary care programs, which includes a neurology program that we started this year at Sentara Norfolk General Hospital," Hooper says. "We also have approval to start a cardiology fellowship program at that hospital."

Sentara is recruiting for an internal medicine program director to work toward creating an internal medicine program in the Williamsburg, Virginia, area. The health system is expanding the rural track primary care program at Sentara Albemarle Medical Center in North Carolina. At Sentara Northern Virginia Medical Center, the health system has approval to start an internal medicine residency program and hopes to start other residency programs.

Hooper and other executives at Sentara are working closely with their academic counterparts to boost the number of residents at the health system.

"We meet with officials at Virginia Health Sciences and Old Dominion University to make sure that we are aligned with our needs in terms of training facilities and training opportunities for their students," Hooper says.

Boosting preventive care

Hooper says Sentara is using population health tools to close preventive care gaps for patients, including embedded screening processes in the health system's electronic medical record that look for the care needs of patients automatically.

"Whether it is in the inpatient setting or ambulatory clinic setting, patients are automatically assessed for gaps in their population health needs such as colon cancer screening and A1C checks," Hooper says. "There are processes in place to alert physicians and other care team members about these gaps."

Once a care gap has been identified, Sentara has processes in place to intervene.

"We have resources in place such as care managers and automatic scheduling tools in the electronic medical record to make sure that once patients have an identified gap, we can set them up in the outpatient setting with the right services to close that gap," Hooper says. "We have tools and personnel in place to make sure gaps get closed at the population-health level."

Since Sentara has put care gap closure processes in place, the health system has seen significant improvement from a population health standpoint in areas such as hypertension screening, hypertension control, A1C checks, and colon cancer screening, according to Hooper.

The proposed rule for the 2026 Physician Fee Schedule seeks suggestions to replace the AMA committee that assesses the resources necessary for physicians to provide high-quality services.

The leader of an American Medical Association (AMA) committee that collects information used to help the Centers for Medicare & Medicaid Services (CMS) set physician payments says the possibility of replacing the committee is misguided.

In the proposed rule for the 2026 Physician Fee Schedule released in July, CMS asks for suggestions to replace the AMA Specialty Society Relative Value Scale Update Committee (RUC).

The Physician Fee Schedule is based on a system called the Resource Based Relative Value Scale (RBRVS). The basic unit of the RBRVS is a relative value unit (RVU). The definition of an RVU goes back to the transformation of physician payment in the late 1980s and early 1990s. On the scale, a physician service with a higher number of RVUs has a higher resource need than a service with a lower number of RVUs.

The RUC collects information that informs the RBRVS for its relative value recommendations.

While the RUC does not set payment amounts for physician services, the committee plays an essential role in the process, according to Ezequiel Silva, MD, chair of the RUC.

"The RUC is informing the resources necessary for physicians to provide the best care possible for their patients," Silva says. "To be more specific, think about a service that a physician provides. By definition, providing a service involves some degree of physician work. That work includes several components, which can include the time it takes to perform a study, technical skill, and malpractice risk."

The RUC collects information from practicing physicians such as survey data to determine the resources necessary for physicians to provide a service at a high-quality level.

"The individuals who are best positioned to inform how relative determinations are made regarding the resources needed to provide a physician service or the absolute nature of those resources are practicing physicians," Silva says. "The AMA brings together the clinical expertise of practicing physicians through the RUC."

Conducting surveys of practicing physicians is a crucial part of the RUC's work.

"The RUC is composed of practicing physicians informing the recommendations it makes, but that is not enough," Silva says. "When we think about innovation and the 32 members of the RUC, there is no way they can understand all medical innovations and every service provided by all physicians. Therefore, we rely on practicing physicians to provide us with information."

For example, if there is a new service, the RUC wants to know what it takes to provide the highest quality for that service. That involves surveying practicing physicians who are providing the service.

"We ask physicians to compare a new service to existing services in the RBRVS," Silva says. "That comparison might involve comparisons regarding complexity. It might involve comparisons regarding intensity. It might involve comparisons regarding the amount of time necessary to perform a new service and the resources required."

Ezequiel Silva, MD, is chair of the American Medical Association's Specialty Society Relative Value Scale Update Committee. Photo courtesy of the American Medical Association.

Weighing the consequences of replacing the RUC

The RUC draws on clinical expertise that would be hard to substitute, according to Silva, since it is necessary to inform an adequate valuation of how physicians provide the best possible care.

"We are talking about a payment system that has been in place for 30 years," Silva says. "There needs to be expertise in the nature of that system, how that system is constructed, how value is determined within that system, and how that system can evolve in the future."

The work the RUC performs is transparent, Silva explains.

"Our meetings can be attended by any individual who makes a request to attend. As the chair of the RUC, I review those requests, and I cannot recall ever denying a request," Silva says. "The RUC's minutes are transparent—they are in the public domain, and they are published on our website."

An effort to replace the RUC could have negative consequences, according to Silva.

"The AMA believes that physicians provide the clinical expertise to inform innovation," Silva says. "If the clinical expertise that the RUC provides were replaced by a new entity that lacked its depth of clinical expertise, the potential shortcomings for CMS payment and the quality of care provided could be significant."

Healthcare organizations can teach clinicians and nurses compassionate communication skills, including deep listening, clarity, and understanding patients' perspectives.

Compassionate communication is essential to establish trust between clinicians and their patients. Trust is foundational in creating meaningful connections and working relationships with patients.

A fellowship program at UC San Diego Health is teaching clinicians and nurses about the intricacies of compassionate communication with patients.

"What we teach is all about the communication and connection between clinicians and patients," says Evonne Kaplan-Liss, MD, MPH, director of the Center for Compassionate Communication at the UC San Diego Sanford Institute for Empathy and Compassion. "An emotional connection between a clinician and a patient is established in the first two minutes of a clinical encounter."

There are several essential elements in compassionate communication, according to Kaplan-Liss.

"In compassionate communication, the receiver feels heard, taken care of, and understood," Kaplan-Liss says. "The skills required for compassionate communication are deep listening, clarity, understanding the receiver's perspective, and authenticity."

Evonne Kaplan-Liss, MD, MPH, is director of the Center for Compassionate Communication at the UC San Diego Sanford Institute for Empathy and Compassion.

How the fellowship program works

The UC San Diego Health Sanford Compassionate Communication Academy Fellowship program uses exercises grounded in the arts and humanities along with role playing to teach clinicians and nurses the skills necessary to communicate compassionately.

"We use journalism skills, improvisation skills, visual arts, and narrative medicine exercises to help clinicians connect with patients and communicate with compassion," Kaplan-Liss says. "As a patient myself with chronic conditions, I have seen firsthand how ineffective communication impacted my health. I have been on the receiving end of bad communication."

Journalism skills are helpful for clinicians to communicate compassionately and effectively with patients. The use of jargon is a huge problem for healthcare providers and patients, according to Kaplan-Liss.

"In journalism, people are trained to avoid the use of jargon and to connect with audiences at a sixth-grade level," Kaplan-Liss says. "So, we focus a lot on avoiding the use of jargon and distilling messages to patients. We want clinicians to put the most important information first when they are talking to patients, which is like a journalist focusing on the lead of a story."

To help clinicians gain an appreciation of patients' different perspectives, the fellowship program uses visual arts exercises.

"We have fellows view the same piece of artwork, and many of them see the artwork differently," Kaplan-Liss says. "There are elements of the artwork that people do not see or see differently. This is an important exercise because it encourages the fellows to slow down and helps them understand that something can be seen in many ways."

Role playing is a primary component of the fellowship program. Clinicians not only role play with other clinicians, but also with theater artists, and they receive feedback from the artistic lens of actors.

"The beauty of role playing is getting to practice outside of your normal environment as well as getting feedback from colleagues and artists," Kaplan-Liss says. "Clinicians can try communicating in ways that are different from the ways they are normally communicating with patients."

The feedback from role playing exercises gives clinicians insights into how they are communicating with patients.

For example, during one role playing exercise between a physician and an artist, the artist noticed during the exercise that the physician's body language and facial expressions were not matching what the physician was saying. The physician looked intense, and the news that was being conveyed came out more intense than it needed to be delivered.

"With in-the-moment feedback during a role-playing exercise, a clinician can gain insight about their facial expressions and eye contact," Kaplan-Liss says. "These are important bits of information that a clinician can learn from and practice."

Role playing also hones listening skills. Listening involves observation skills to make sure patients feel heard, Kaplan-Liss explains.

"Clinicians should not interrupt their patients," Kaplan-Liss says. "When a physician interrupts a patient, it diminishes trust and lessens the likelihood that a patient is going to answer questions that need to be addressed. Clinicians need to give patients time and space, and they need to avoid cutting off a patient."

The fellowship program teaches clinicians and nurses about the nonverbal elements of compassionate communication.

"We teach fellows about the importance of body language, eye contact, facial expressions, and where they should be physically in an exam room," Kaplan-Liss says. "We teach physicians, advanced practice providers, and nurses about where they should be in a room when there is a computer in the room that they must use. We teach fellows about where they should sit and the level where they are positioned when they communicate with patients."

Healthcare organizations should not rely on workarounds to set up and complete follow-up imaging, this CMO says.

Follow-up imaging can require complicated processes to set up studies and make sure they are completed, with multiple clinicians often involved in a patient's care. Establishing standardized processes is crucial, and artificial intelligence has the potential to improve radiology workflows.

That's why St. Tammany Health System is using high reliability organization principles and artificial intelligence to make sure follow-up imaging is conducted for patients.

"The need for follow-up imaging is a potential risk for patients because follow-up recommendations may not be completed or they may not be in keeping with the provider team's intent for what they had planned for images," says Patrick Torcson, MD, senior vice president and CMO of St. Tammany Health System. "The traditional approach that has been used is a series of workarounds; historically, there has not been a hard-wired process for how follow-up imaging occurs."

The health system is using a high-reliability approach to follow-up imaging to hard wire the process, so it does not rely on the memory of care team members or some type of workaround.

"It is part of the workflow process that goes with the scheduling, registration, completion of the study, and the interpretations of the imaging that patients expect to get," Torcson says. "It is a complex process that occurs over several sites and over time, so we are reducing risk with standardization to make sure the follow-up imaging occurs."

One of the principles of high-reliability organizations that St. Tammany Health System has embraced for follow-up imaging is the difference between individual accountability and system-level accountability.

"In the past when it comes to functions such as follow-up imaging, we have relied on individual accountability, whether it has been relying on the patient's role in receiving follow-up imaging or relying on an ordering physician such as a primary care doctor," Torcson says. "What we have learned is that follow-up imaging requires a system-level process."

Patrick Torcson, MD, is senior vice president and CMO of St. Tammany Health System. Photo courtesy of St. Tammany Health System.

AI tool adoption

Using an AI tool to improve the follow-up imaging process is part of St. Tammany Health System's efforts to establish high reliability in this area of care. AI offers a great opportunity to integrate with current radiology technology and the electronic health record to make sure that patients get the follow-up imaging that is needed in multiple sites of care, Torcson explains.

"It is a complex process to arrange follow-up imaging," Torcson says. "It is more complex than human-focused appointment scheduling and should not rely on memory."

AI can help standardize and automate the follow-up imaging process.

"We are partnering with a third party, Inflo Health, which has an advanced platform that is going to be integrated with our radiology workflows to improve completion of follow-up imaging," Torcson says.

The AI tool automatically identifies studies requiring additional imaging or consultation, then relays the information to referring clinicians, which streamlines communication between imaging centers and clinicians. It also continuously tracks open follow-ups. By offering follow-up management with the AI tool, imaging centers can position themselves as partners with referring clinicians and contribute to better patient care.

"AI provides an augmentation for the workflow that makes the follow-up imaging process hard wired, so it occurs consistently and non-ambiguously," Torcson says. "It also helps create a standardized process. With AI, we can establish a process that exceeds human cognitive capacity, especially when you factor in different sites of care and different providers."