Several large health systems are among more than 100 organizations urging CMS to preserve a Medicare waiver that allows providers to bill Medicare for telehealth delivered from their homes.
A key Medicare waiver that allows healthcare organizations to develop provider-friendly telehealth programs is set to expire at the end of the year, and advocates are lobbying federal officials to make it permanent.
More than 110 organizations, supported by the American Telemedicine Association and including several large health systems, have signed a letter asking the Centers for Medicare & Medicaid Services (CMS) to extend a pandemic-era waiver that enables providers to bill Medicare for telehealth services delivered from their homes.
The waiver allows health systems to design programs that allow their doctors to work from home, enabling more on-demand and 24/7 coverage and cutting administrative and operational costs associated with an in-house telehealth program that requires staff to be on-site or in operations centers. It also allows health systems to develop work-at-home policies to reduce workplace stress and burnout among staff and attract new physicians.
Prior to the pandemic, CMS wasn’t clear on how a “distant site” was defined for providing telehealth services, only offering that providers should, for the purposes of billing Medicare, list the site where they typically practice healthcare. As a result, many health systems were wary of launching telehealth programs where Medicare reimbursement wasn’t assured, or they created programs where providers had to be located on-site.
“Allowing appropriately licensed and credentialed providers to practice telehealth from their home improves patient access to healthcare services, reduces healthcare costs, while maintaining and meeting patient demand for care,” the letter states. “This was necessary during the height of the COVID-19 pandemic and remains just as important today amidst provider workforce shortages and burnout, given that 78 percent of health care practitioners agree that retaining the opinion to provide virtual care from a location convenient to the practitioner would ‘significantly reduce the challenges of stress, burnout, or fatigue’ facing their profession and eight in 10 indicate that this flexibility would make them more likely to continue providing medical care.”
The letter also argues that providers should not have to explicitly state their home address as their practice location, given the heightened animosity toward medical professionals during the pandemic and increasing acts of violence against providers since then.
The letter urges Brooks-LaSure to take two steps:
Permanently continues the waiver that allows provider to bill Medicare for telehealth services delivered from “a location at which the clinician is capable of offering in-person care to patients, even when the practitioner is practicing from a different location such as the home.”
Work with stakeholders to develop an alternative method for determining reimbursable sites for delivering telehealth services that does not require doctors to report their home address. One option could be to allow the reporting of a business address for purposes of enrollment and a zip code or similar geographic indicator for purposes of billing.
“This is an extremely important issue for the healthcare providers in general and the telehealth community in particular,” the letter concludes. “As providers are beginning to update their practice and systems in a post pandemic era, we should arm them with the tools to continue to offer telehealth services as they see clinically appropriate.”
Those signing the letter include Advocate Health, Allina Health, Ascension, Avera Health, Baylor Scott & White Health, Duke Health, Intermountain Health, MaineHealth, the Mayo Clinic, MedStar Health, the Minnesota Hospital Association, Northwell Health, Stanford Health Care, the University of Kansas Health System, UPMC, and the Yale School of Medicine and Yale New Haven Health System.
Who is really in charge of tech in the C-suite? HealthLeaders takes a deep dive into the changing role of leadership and decision-making in the quest for digital transformation.
The integration of technology in healthcare—and its emphasis on forming the health system of the future—is forcing the C-suite to figure out which leaders should own decisions around digital transformation. And that’s not a bad thing.
Some health systems have created new positions to take the pressure off chief information officers, such as chief innovation officer, chief transformation officer, and chief technology officer, to handle tasks from data interoperability to digital health. But no matter what the title is, the person holding that position is becoming more important to hospital operations and management.
HealthLeaders Senior Editor and Associate Content Manager Eric Wicklund explores this shift in his white paper, “Decision-Maker or Chief Extra Officer? Next?” Read how health systems are handling technology management and defining the channels between departments to facilitate collaboration, so that other leaders like the CEO, CNO, CMO, and—especially in this economy—the CFO have insight into the technology process and can play a part in decision-making. With this structure in place, health systems are better equipped to move forward and embrace new ideas and tools.
The topic is crucial to all healthcare organizations. As technology becomes more integral to healthcare delivery, leadership must understand its value and ensure that decisions and strategies are coordinated by the right people. And those roles must be filled by key executives who understand both the technical and the clinical aspects of healthcare.
The health system serving the nation’s active-duty military members and their families has selected Amwell and Leidos to create a ‘Digital First’ platform that emphasizes hybrid care.
Federal officials have selected Amwell and Leidos to create a $180 million hybrid care platform that will replace the Military Health System (MHS)Video Connect program.
The US Defense Health Agency (DHA) selected the two companies to power what it calls a “Digital First” strategy for the nation’s 9.6 million active-duty service members, family members, and retirees. The platform, to be rolled out over the next two years, will include virtual care and digital health tools and integrate with the MHS GENESIS electronic health record platform.
The announcements represent a commitment to hybrid care, particularly telehealth and digital health, in the nation’s largest health system, and the understanding that active-duty military members, veterans, and their families need to have multiple options to access care.
Through the task order, Amwell’s Converge platform, which offers virtual and digital healthcare services, will be offered to military members and their families through the Leidos Partnership for Defense Health, a health information system supported by Leidos, Oracle Cerner, Accenture and Henry Schein One and some 35 smaller organizations.
“Digital First addresses DHA’s goal of better outcomes, new processes, innovation, and increased standardization based on evidence,” Jason McCarthy, senior vice president of military and veterans health solutions for Leidos, said in a press release. “As part of our overall MHS GENESIS effort to enhance patient experience, we, along with Amwell, are looking forward to providing near real-time, self-service support and hybrid care options for our customer and those whom they serve.”
Highmark Health recently announced the integration of behavioral healthcare into its health plan portal. It’s evidence that health systems are taking a close look at what primary care really means.
Healthcare organizations are starting to understand that mental healthcare shouldn’t be treated as a specialty, but as an integral part of primary care.
Pennsylvania-based Highmark Health is making that connection by integrating behavioral healthcare services into its insurance plans through the My Highmark digital health portal. The platform is supported by Spring Health, a New York-based mental healthcare provider serving more than 4,500 employers and health plans.
The collaboration addresses a key pain point in healthcare, and an understanding that many primary care concerns are either linked with behavioral health concerns or can be better treated through a care plan that includes behavioral healthcare. Many primary care providers don’t have the background in behavioral healthcare to treat patients themselves, so access to specialists—especially through a digital health platform—is crucial to improving care management.
“We want healthcare to be personalized,” says Anil Singh, MD, MPH, FCC, senior vice president and executive medical director of population and curated health for Highmark Health, which announced the collaboration at last week’s HLTH conference in Las Vegas. “And we want to be proactive” in addressing health concerns before they become serious.
With a nationwide shortage of psychiatrists and other mental healthcare providers, particularly in rural regions, health systems are looking to digital health partnerships to bolster their platforms and give patients and health plan members access to hospital-approved (and branded) services. Highmark Health, a combination payer-provider, is offering the service, called Highmark’s Mental Well-Being powered by Spring Health, through its health plans.
Singh says the program mirrors a nationwide trend to shift away from episodic care and toward a value-based approach of whole-person care, or what Highmark calls its Living Health strategy. The idea is to bunch together a collection of services aimed at not only addressing immediate concerns, but chronic and preventive care as well.
"Expanding access and making it easier for members to engage with a personalized treatment plan helps us intervene earlier, driving a cultural shift in the behavioral health space and cost savings, which Highmark Health reinvests in the consumer experience as part of our Living Health model," he said in a press release accompanying the HLTH press conference.
The key to the collaboration is that behavioral health becomes a part of the primary care platform, rather than an added service.
“What we don’t want is to have a bunch of apps sitting on a person’s smartphone,” he said.
As more and more health systems look to integrate mental health and primary care, leadership will be taking a hard look at ROI. Singh said Highmark is concerned first and foremost about expanding access to care, with a platform that offers many more access points for members, including children, teens, and those in rural areas. Beyond that, they’ll take a good look at quality and outcomes, ranging from follow-up care to hospitalizations.
“It’s really about moving upstream,” he said, to help improve healthcare before it becomes emergency care.
The retailer is using drones to delivery prescription medications to customer doorsteps in Texas within an hour, bypassing traffic and terrain.
Amazon Pharmacy is launching a drone delivery service, giving customers in College Station, Texas, an opportunity to receive medications within an hour at their doorstep.
The program is the latest foray into drone delivery for the healthcare industry, which sees the form factor as a potential service for medicine and supply deliveries in congested or rural areas or when time and distance are a factor. Several health systems, including Intermountain Health, Michigan Medicine, WakeMed Health and Hospitals, and Rady Children’s Hospital, have either tested or are using drones to ferry supplies from one site to another or to selected patients.
“Making access to healthcare faster and more convenient will lead to better health outcomes for our patients,” former Intermountain President and CEO Marc Harrison said in 2022 when the Utah health system launched its program.
Amazon, which operates its own drone delivery services, is one of only a handful to receive Federal Aviation Administration (FAA) approval to operate drones with advanced capabilities. The company has been using drones in Texas for package delivery since 2022.
“Our drones fly over traffic, eliminating the excess time a customer’s package might spend in transit on the road,” Calsee Hendrickson, director of product and program management at Prime Air, said in a blog on the Amazon site. “That’s the beauty of drone delivery, and medications were the first thing our customers said they also want delivered quickly via drone. Speed and convenience top the wish list for health purchases.”
Healthcare providers see the potential for drones to deliver urgent or time-sensitive drugs and other medical supplies to patients wherever they’re located, bypassing traffic and terrain that would slow down traditional delivery services. Aside from pharmacy deliveries, drones could also be used to send supplies and equipment to remote clinics and health centers, accident scenes, even pop-up healthcare sites dealing with disasters and mass treatment and vaccination services. And they could also be used to deliver organs to transplant centers.
The service is also attracting pharma partners. Pfizer joined forces with drone company Zipline during the pandemic to ferry vaccines and other supplies to remote locations, and executives say the service will figure into their long-term supply chain strategy.
“We’re taught from the first days of medical school that there is a golden window that matters in clinical medicine,” Vin Gupta, chief medical officer of Amazon Pharmacy, said in the blog. “That’s the time between when a patient feels unwell and when they’re able to get treatment. We’re working hard at Amazon to dramatically narrow the golden window from diagnosis to treatment, and drone delivery marks a significant step forward. Whether it’s an infectious disease or respiratory illness, early intervention can be critical to improving patient outcomes.”
Jim Jirjis, HCA Healthcare's CHIO, says critics of the ONC's proposed data exchange framework are missing the point that the framework is an ongoing process, and that revisions will be made as healthcare executives offer their opinions.
Interoperability in healthcare is no longer an "if," but a "when," and health system CIOs, CTOs, and even CEOs would do well to include that in their strategic plans. That includes laying the groundwork to adopt the Trusted Exchange Framework and Common Agreement (TEFCA), proposed by the Office of the National Coordinator for Health IT (ONC).
Some critics, including former ONC chief Donald Rucker, now chief strategy officer for digital health software company 1upHealth, have criticized TEFCA, saying the proposed framework for interoperability will do more harm than good. But Jim Jirjis, chief health information officer for HCA Healthcare and a member of the Health Information Technology Advisory Committee (HITAC) for ONC, says those concerns are overblown.
"What ONC is developing is a glide path to interoperability," says Jirjis. "It's a long path, and I'm very impressed with what they're doing. We need to be careful and practical."
TEFCA was authorized by Congress through the 21st Century Cures Act, with version 1 published by the ONC in January 2022 and updated that April. Its goal, according to the ONC website, "is to establish a universal floor for interoperability across the country."
Jim Jirjis, chief health information officer, HCA Healthcare. Photo courtesy Jim Jirjis.
"The Common Agreement will establish the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules, and regardless of which network they happen to be in," ONC says. "The Trusted Exchange Framework describes a common set of non-binding, foundational principles for trust policies and practices that can help facilitate exchange among HINs."
Jirjis says critics are jumping too quickly on parts of the proposal that will likely be amended when the ONC releases the next draft—which he expects to be this year.
"Some expect TEFCA and [HL7's FHIR (Fast Healthcare Interoperability Resources) standard] to be automagical,” says Jirjis, combining the words automatic and magical. "They're correct in that we want a world where one day everyone will be using [this technology]. But to get there takes a lot of cost. And a lot of people are going to have to retool their systems to get there. It's going to take a while."
To counter the negative comments surrounding TEFCA, Steven Lane, MD, MPH, a former clinical informatics director at Sutter Health who's now chief medical officer for Health Gorilla, and Dave Cassel, a former Epic engineer and executive director of the Carequality interoperability initiative who now serves as Health Gorilla's chief customer officer, sent HealthLeaders a document refuting four of the most common misconceptions.
Patient access is limited.
The first is that the ONC's proposal for an information blocking exception for TEFCA participants would hinder patient access to medical information.
"Quite the opposite," the two said. "TEFCA clearly and unequivocally supports enabling individuals to access their own health information. It mandates all participants to respond to Individual Access Services (IAS) queries made under TEFCA, ensuring that patients have digital access to their health information. ONC did propose an information blocking exception for TEFCA participants that was not well received and might have inadvertently disincentivized TEFCA participation. This feedback was recognized in the public comments on the proposed rule, and ONC is unlikely to include the initially proposed exception in the final rule."
HIE is outdated.
Regarding comments that IHE-based document exchange, which TEFCA would support, is underutilized and outdated, Lane and Cassel said "the vast majority of current health data exchange" is based on these guidelines, and they're working fine.
"It is the engine behind all of the success we've had in establishing national interoperability," they added. "The first version of TEFCA intentionally incorporated the current dominant transaction pattern so as to minimize industry disruption and to garner early voluntary adoption. IHE-based exchange was the right move to get providers and other participants in the healthcare ecosystem on board."
3. There's a limit on FHIR usage.
Critics have also argued that TEFCA doesn't use FHIR and limits the potential of FHIR-based exchange.
"The initial use of IHE-based document exchange for QHIN-to-QHIN [Qualified Health Information Network] exchange does not in any way restrict TEFCA participants from leveraging FHIR," Lane and Cassel said. "Participants can utilize FHIR exchange with their QHIN or between participants using the same QHIN. Moreover, the Recognized Coordinating Entity (RCE) has a transparent plan to integrate FHIR-based exchange in the second version of the QTF and CA, with meetings being scheduled now and implementation expected by early 2024."
Does not compute!
Finally, Lane and Cassel say the comment that data within C-CDA [Consolidated Clinical Document Architecture] documents, which will be exchanged over TEFCA, are "non-computable" is incorrect.
"The fact is that the vast majority of discrete, computable, interoperable health data is exchanged today using C-CDA documents, which serve as flexible containers facilitating the transmission of many discrete and computable elements," they said. "We're talking about billions of documents and hundreds of billions of data points every year, leveraged by providers, analyzed by administrators, and retrieved by patients. Providers, public health agencies, and others routinely extract computable data from C-CDA documents to populate EHRs and drive analytical insights to improve patient care."
"Many CEOS and CIOs are consumed with how they’re going to survive in this increasingly automated age," he says. "They don't realize the improved quality and reduced costs of getting [interoperability] right."
As the HLTH conference kicks into gear in Las Vegas, Kaiser Permanente has launched a collaboration with Instacart to study how access to nutritious food can improve care management and clinical outcomes for those with chronic diseases.
Healthcare organizations are taking a closer look at the “food as medicine” concept in an effort to curb skyrocketing care management costs.
One of the front-runners is Kaiser Permanente, which announced a collaboration with grocery technology company Instacart to study how access to nutritious food and resources on healthy eating can affect clinical outcomes. The study will focus on California residents enrolled in the state’s Medi-Cal Medicaid program who are living with chronic conditions like diabetes and heart failure.
The announcement also comes in advance of HLTH, the massive health conference taking place this week in Las Vegas that shines a spotlight on the expanded health and wellness ecosystem. Food as medicine (also called “food is medicine”) was a popular topic at last year’s event and is just as evident this year, with an entire row of booths devoted to the concept, and healthcare executives are looking at how this particular social determinant of health can reduce long-term care management costs by improving clinical outcomes.
"We know that without access to nutritious food, individuals are less likely to stay healthy, increasing the likelihood of new and widening health disparities and healthcare costs," Anand Shah, MD, the healthcare organization’s vice president of social health, said in a press release. "This innovative study is one of the many avenues that we're pursuing to improve the health of our members and communities with diet-related diseases."
Kaiser Permanente has been invested in this strategy since 2022, when it launched a $50 million “Food is Medicine” initiative in conjunction with the White House Conference on Hunger, Nutrition, and Health. The Instacart partnership is the next stage in that effort, and comes as Medicaid programs across the country are developing new programs to qualify for innovative Section 1115 research and demonstration waivers from the Centers for Medicare & Medicaid Services.
The collaboration will give selected Medi-Cal members the resources they need to purchase nutritious food that matches their care plan. Care providers will then track clinical benchmarks such as blood-sugar levels, health concerns that require visits to the doctor or hospitalizations, and other benchmarks that focus on food insecurity, diet-related disease quality of life, and patient engagement and readiness to change habits.
"We know food and nutrition insecurity is felt by people in the communities we serve, as well as for by millions of Americans nationwide," Pamela Schwartz, MPH, executive director of food security at Kaiser Permanente, said in the press release. "Identifying best practices to address these inequities is essential to building healthier communities."
There are, of course, questions that come with the program. Can the benefits be measured in such a way to produce ROI and support sustainability? Will healthcare organizations support helping patients map out their meals? And will enough patients follow the program to show success at scale?
The Kaiser Permanente study is just one facet of a much larger national effort to address the many different factors that make up SDOH.
Recently, WellSpan Health became one of three health systems to earn health equity accreditation through the National Committee for Quality Assurance (NCQA). The accreditation addresses a broad range of SDOH elements and pushes health systems to develop a comprehensive strategy.
"Throughout the country, there are disparities in life expectancy based on whether you live in an urban or rural area, whether you have access to education, whether you have access to housing, and whether you have access to healthy food,” Michael Seim, MD, senior vice president and chief quality officer of the Pennsylvania-based health system, said in a recent HealthLeaders article by Chris Cheney. “So, we are working on this issue as part of our community health needs assessment, our community health improvement plan, and our strategic plans. We are trying to look at all angles, including through a lens of equity."
"That focus is innovative in the fact that we have to tie together every aspect of not only our clinical practices within WellSpan but also within our community health work and our partnership programs," he added.
The agency is once again extending a pandemic-era waiver enabling providers to prescribe controlled substances via telemedicine without first needing an in-person checkup, and is expected to propose new long-term guidelines soon.
Federal officials are extending pandemic-era flexibilities for prescribing controlled substances via telemedicine through the end of 2024.
“We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations by the fall of 2024, giving patients and medical practitioners time to plan for, and adapt to, the new rules once issued,” DEA officials said in a post on the agency website.
The news isn’t surprising. The agency has been under fire for not developing a special registration process for telemedicine prescriptions, and rules proposed earlier this year to help providers use telemedicine for prescribing controlled substances were roundly panned by advocates who said they were more restrictive and confusing than what had been in place before the pandemic.
Nathaniel Lacktman, a partner with the Foley & Lardner law firm and chairman of its digital health team, said during a keynote at the Northeast Telehealth Resource Center’s annual conference last month in Nashua, New Hampshire that he expects the DEA to come up with an amended version of long-term telemedicine prescribing rules by the end of the year.
Lacktman was critical of the first DEA proposal when it was released.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote in the firm's Health Care Law Today blog last May. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply). Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."
The DEA has long resisted creating a registration process even though it was mandated by Congress in 2008 through the Ryan Haight Online Pharmacy Consumer Protection Act. Telehealth advocates have long argued that providers should be able to prescribe certain medications without first needing an in-person exam as a way of expanding access to and treatment for mental health and substance abuse issues. Several members of Congress and the American Hospital Association have also chimed in, urging the DEA to take action.
The nation’s largest health system is pledging to share veteran health data with a number of large health systems across the country to improve access to care regardless of whether it’s in a VA facility.
The Department of Veterans Affairs is making a bold pledge toward data interoperability for the nation’s 16.2 million veterans.
The nation’s largest health system announced today that it will support data-sharing with 13 community health systems across the country, enabling veterans and their care teams to access data regardless of whether it’s stored in a VA health system.
“This pledge will improve veteran healthcare by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care — including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”
The health systems that will share veteran information with the VA are:
Atrium Health
Emory Healthcare
Inova
Intermountain Health
Jefferson Health
Kaiser Permanente Health Plan and Hospitals
Marshfield Clinic Health System
Mass General Brigham
Rush Health
Sanford Health
Tufts Medicine
University of California, Davis Health
University of Pittsburgh Medical Center
According to the pledge, the VA will:
Enable health system application access to authoritative VA resources to determine veteran status.
Enable automation of benefit eligibility determination and referrals.
Enable health system application access to identify local, state, and federal health resources.
Enable VA application access to health-system clinical and administrative data for quality assessment and care coordination.
Advance and implement federally recognized, national interoperability standards, privacy and security frameworks related to the executing the pledge’s commitments on information exchange and use of health information.
VA officials told the Federal News Network that EHRs have become sophisticated enough “where the next level of innovation can really happen,” including interoperability.
“The data that we’re talking about isn’t always going to be clinical data,” an official said. “We’re very interested in what’s referred to as the administrative data, which talks about the benefits a veteran could potentially qualify for.”
“We really want this to benefit the industry as a whole,” the official added. “As the technology advances, we really feel that VA has a leadership role. As the largest healthcare system in the country, the largest payer, we absolutely feel that responsibility to get out there and lead on what this could potentially look like.”
Health systems across the country are launching telemedicine programs aimed at improving the nurse's workload, but both value and sustainability are hard to pin down.
Virtual nursing is all the rage these days, with health systems across the country launching telemedicine-based programs aimed at helping their beleaguered nurses. But with no clear-cut path to ROI, executives are uncertain whether the programs can be sustainable.
Each hospital is approaching the issue from a different direction, ranging from basic telesitter programs targeting patient monitoring and fall prevention to platforms that support new nurses to more complex telenursing platforms that combine monitoring with administrative functions.
At the Medical University of South Carolina (MUSC) in Charleston, officials tested a virtual nursing service about a year ago, says Emily Warr, MSN, RN, administrator for the health system's Center for Telehealth. That program was geared toward helping new nurses learn the ropes.
Not long afterward, the program was shut down.
"We learned from that endeavor that it's not enough," Warr says. "It has to be much more complex and bring more value."
So MUSC pivoted, creating a platform designed not only to remotely monitor patients in their rooms but help with administrative tasks, from charting in the EMR to onboarding and discharges. That program will debut soon in four of the health system's rural hospitals, where the nursing ranks are especially strained.
"Bedside nurses spend way too much time in documentation," Warr says. The new program, she says, assigns those tasks to the virtual nurse, who can sit in a room in another part of the hospital and handle EMR documentation for several patients. It adds another set of expert eyes to the details that make up the patient record, while freeing up the bedside nurse to focus on hands-on duties and interactions that improve care management.
Warr says a virtual nursing program will only succeed if it addresses multiple pain points.
"This program can't just focus on workforce economics or quality [of care]," she says. "One is not enough. There has to be a quality component. We've got to impact patient care."
Warr says the biggest challenge to standing up a telenursing program is the CEO.
"They see this as an additional expense until proven otherwise," she says.
That's a common refrain in many health systems, as health system decision-makers struggle to balance new ideas and technology against a perilous bottom line.
'Things Are Changing Too Fast'
At a recent HealthLeaders Teams Exchange in Nashville, clinical and financial executives from several health systems across the country came together to discuss the challenges they face in sustaining a workforce. Virtual nursing was one of the hot topics of conversation, with nearly everyone agreeing they'll have fewer nurses in five years and nearly three quarters saying they've launched such programs to address that problem.
Telesitting, telenursing, and virtual nursing programs saw a dramatic increase during the pandemic, when hospital leadership sought to reduce contact between infected patients and their staff to curb the spread of the virus. In time, those hospitals using the platform saw benefits ranging from reduced stress on nurses to improved clinical outcomes through more consistent monitoring, resulting in more efficient room turnover, improved patient discharge rates, and better patient satisfaction scores.
And they're seeing a lot of potential in the platform, especially as health systems look to address the changing nature of the hospital stay.
"With inpatient virtual care, it opens up a lot of doors," says Colleen Mallozzi, MBA, RN, senior vice president and chief nursing informatics officer at Jefferson Health, which recently launched its Virtual Nursing Program after a trial run earlier this year involving nearly 400 patients.
"The virtual nurse can do anything except physical touch," adds Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, an associate chief nursing information officer and division director of clinical informatics at the Philadelphia health system.
Jefferson Health is launching its virtual nursing program after a four-month pilot in two units and will be watching a wide range of benchmarks that include patient length of stay, patient satisfaction, patient flow (including transfers), nurse turnover and overtime, and documentation compliance. The program will be incorporated into the wall-mounted television unit in each room, a familiar form factor for many in-patient telehealth programs.
"We want our nurses to be doing what they should be doing, which is caring for patients," says Gartner.
But a nurse can't physically be in a patient's room at all times, and with fewer nurses that time spent in the room is even smaller. Jefferson Health's program puts a nurse virtually in each room at all times, accessible through the wall-mounted TV, giving patients the comfort of knowing there's someone looking in on them and answering their questions when needed.
"It's an evolving landscape," says Mallozzi, noting the program is separate from Jefferson's 10-year-old telesitting program, which focuses solely on monitoring and safety care and has shown value in reducing patient falls.
Starting Small and Scaling Up
To be fair, telesitting, whose roots trace back to the practice of using volunteers (sometimes retired nurses) to sit with patients with behavioral health concerns or at risk of falling, has proven its value, with studies finding it reduces patient falls and self-harm and can save hospitals hundreds of thousands of dollars a year in associated costs. But those programs don't address nursing workflow or stress issues. Telesitting can be incorporated into a virtual nursing program, but it can't be stood up as a telenursing service.
Farther south, Valley Health went live with its virtual nursing program in May. The six-hospital network, serving parts of Virginia, West Virginia, and Maryland, partnered with Teladoc Health to launch a pilot in one hospital, with plans to expand soon.
"We started this way, beginning with a traditional med-surg unit, so that we would have lots of options," says Theresa Trivette, DNP, RN, CENP, the health system's chief nursing officer. "Each unit is going to have its own culture and needs … so we need to begin slowly and let our nurses [help us to] build out this model together."
Trivette says the health system saw the value of an inpatient telemedicine platform during the pandemic, and officials wanted to find a way to keep that going after COVID. Not surprisingly, executives jumped on the idea of using the platform to support nurses.
"They're getting tired, and many are considering retirement," she says. "We thought about how we could keep them in care delivery longer."
Trivette says the program focuses more on care management, with administrators inviting nurses to map out the platform and prioritize what they do in the patient's room. And while some nurses initially saw this as an intrusion that affected their job responsibilities, she says, the attitudes turned positive as the program was fleshed out to address their stresses.
She says the platform has become popular with patients (especially seniors) who just want someone to chat with each day and has led to a 20% jump in patient experience scores. In addition, it has boosted staff morale and engagement, which in turn will improve care management and coordination.
"We're focusing on supporting the whole care team, not necessarily plugging a pain point," Trivette says. "How do we help our nurses in all aspects of care delivery?
At the HealthLeaders Exchange, much of the focus around virtual nursing was on hard results, such as clinical and administrative outcomes that translate into savings. At Mount Sinai South Nassau, for example, Senior Vice President and Chief Nursing Officer Stacey Conklin, MSN, RN-BC, MHCDS, NE-BC, is working side-by-side with John Pohlman, CPA, the hospital's chief financial officer and senior vice president of finance, to make sure virtual nursing outcomes align with financial considerations.
That might include reduced patient length of stay, which improves patient satisfaction scores as well as the room turnover rate. Or the extra pair of eyes on the EMR could not only cut down on documentation time but reduce errors, improving not only the coding and billing process but clinical outcomes.
"You have to have your CFO at the table," noted Helene Burns, DNP, RN, NEA-BC, senior vice president and chief nursing officer at Jefferson Health New Jersey. "We have to think about where we invest our dollars."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange/. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.
