Research finds that a telehealth platform is more effective in helping suicidal patients than similar treatment delivered in person.
Critics of telehealth have long said a virtual visit can’t replicate in-person treatment, especially for serious concerns like treatment of patients considering suicide. But a new study from The Ohio State University’s Wexner Medical Center and College of Medicine finds that virtual care is an effective platform.
In a randomized clinical trial of 96 patients between 2021 and 2023 with recent suicidal ideation or suicidal behavior, counselors using brief cognitive behavioral therapy (BCBT) via telehealth were able to cut suicide attempts by 41% compared to present-centered therapy (PCT).
The research lends strength to the argument that effective treatment isn’t based on the mode of delivery, and that virtual care is a suitable platform for those unable or unwilling to access in-person care.
“For those suffering with suicidal thoughts and behaviors, we have good, tested treatments that will lead to significant symptom reduction and improved quality of life,” Craig Bryan, PsyD, professor in Ohio State’s Department of Psychiatry and Behavioral Health and director of its Suicide Prevention Program and a co-investigator in the study, said in a press release. “Even with lessening restrictions, many therapists are keeping a portion of their telehealth practice post pandemic. This study has the potential to increase access to needed evidence-based treatments for those in rural and hard-to-reach areas.”
Justin Baker, PhD, a clinical psychologist at Ohio State-Wexner, clinical director of the health system’s Suicide and Trauma Reduction Initiative (STRIVE) and the study’s principal investigator, said high-risk patients are historically excluded from virtual care due to risk and liability concerns. But the pandemic forced health systems and hospitals to shift to an almost all-virtual strategy, leaving many patients with no in-person access.
“We wanted a way to ensure that those who needed care the most were able to receive care during the pandemic,” he said in the press release.
According to the study, published in JAMA, 768 people were asked to participate, 112 were assessed for eligibility and 98 were eventually selected, with 52 undergoing virtual care and the other 46 seeing a clinician in person.
“A strength of this study is the use of an active, evidence-based treatment as the comparator instead of treatment as usual,” the study reported. “The use of an active comparator in this study provides a higher level of internal validity than previous studies, thereby enabling us to conclude with greater confidence that reductions in suicide attempts are likely attributable to the skills-training focus of BCBT, which prioritizes targeting core underlying vulnerabilities in how patients regulate emotions and cognitively reappraise stressful situations.”
From stroke recovery to behavioral health treatments, music is finding its niche in health systems and hospitals
Looking for a non-addictive, painless and less expensive alternative to drugs or invasive medical procedures? Music just might be the answer.
Healthcare organizations are finding value in music to address a variety of health concerns, from Alzheimer's to behavioral health concerns to stroke recovery. It's a treatment as old as time, yet often overlooked by clinicians.
"The idea of music being healing is not one that is new," says Danielle Porter, MM, MT-BC, music therapy coordinator at Brooks Rehabilitation in Jacksonville, Florida, and a neurologic music therapist fellow. "You've got theologians such as Aristotle and Plato and the Greeks. They all believed that music had the ability to heal."
Over the past 10-15 years, Porter says, healthcare has taken an interest in music, as part of a much larger strategy to embrace the arts as an alternative treatment. Music has the potential to replace costly and dangerous medications and to improve clinical outcomes. It has even been used to help nurses deal with stress.
"Everybody can relate to music," Porter points out. "A lot of people take comfort in music or are motivated by music. Music is salient. For us, it holds a lot of memories … and it makes us feel good."
According to the American Music Therapy Association, music therapists are working in more than 36,000 healthcare facilities across the country as of 2021. In 2023, Cleveland-based University Hospitals published a study detailing how music therapy is an integral part of care management.
"Music therapy services are embedded across the UH healthcare system and integrated into frontline interdisciplinary teams caring for critically ill patients," Seneca Block, PhD(c), MT-BC, The Lauren Rich Fine Endowed Director of Expressive Therapies at UH Connor Whole Health and co-author of the study, said in a press release. "We are committed to providing non-pharmacologic support to patients from diverse backgrounds for both physical and psychological vulnerabilities."
Staying Alive: Tuning in to the clinical value of music
Patients react to music much differently than, say, their doctor or nurse. It heightens engagement, even creates energy. Think of a runner using music to go that extra mile, a weightlifter powering through a tough routine, or a baseball player striding up to the plate to face a tough pitcher.
Now apply that to healthcare. Think of a person recovering from a stroke who's working to regain mobility, someone living with Alzheimer's engaging in memory exercises, a patient who's recently had major surgery, a transplant, or an amputation and needs to get back on the treadmill, the bike, the pool.
"It helps normalize what would otherwise be a difficult experience for somebody who's in a hospital setting," Porter says.
MedRhythms is among the leaders applying music to clinical treatment. The Portland, Maine-based company uses music and digital health to create a clinical playlist for walking and mobility. The process, called neurotherapeutics, was initially trialed at Spaulding Rehabilitation in Boston, as a means of helping stroke victims recover their mobility.
"We're now doing multiple clinical trials," says Brian Harris, the company's co-founder and CEO. "There's so much more research now than there was 10 years ago … and providers are much more aware that this is a potential option now."
And while one of the primary barriers to clinical adoption is reimbursement, that may be changing.
"The technology has gotten us to a point where we can do much more than just teletherapy," Harris says. "It's advancing us to a place where we can really be helpful."
Colour My World: Part of a much larger playlist
Music is just one facet of a collection of innovative treatments that health systems are considering to offset the surge in stress, burnout, and the accompanying substance abuse epidemic, says Kelly Palmiero, COO of Sierra Tucson, a well-known Arizona treatment center.
"We're treating the whole person," says Palmiero, whose center offers such treatments as adventure therapy, nature hikes, art therapy, equine therapy, acupuncture, massage, shiatsu, even ukelele classes.
Palmiero works with the center's chief clinical officer to decide what therapies they can offer based on research into clinical outcomes and availability (because someone on the staff knew how to play the ukelele, the center could offer that treatment). And they're always looking for new treatment options.
"The buzzword right now is integration," Palmiero says. Sierra Tucson operates under the Acadia Healthcare umbrella, which includes more than 200 hospitals. The 150-acre, 40-year-old center, with some 20+ doctors on staff, gets referrals from across the country, and many of those patients have been through traditional treatments, including medication, and are looking for something more effective.
The treatments have to show clinical outcomes, and the center collects and shares data with other providers to figure out what works and what doesn't. And it's important, Palmiero adds, to think beyond the conservative healthcare mindset that focuses on medication and medical interventions.
"I think you always have to be thinking forward," Palmiero says. "It's part of life that you constantly have to be willing to change and evolve."
"Preliminary evidence suggests that dance may be better than other physical activities to improve psychological well-being and cognitive capacity," Alicia Fong Yan, MD, of the University of Sydney's Faculty of Medicine and Health and Sydney Musculoskeletal Health and lead author of the study, said. "Adherence to physical activity is an ongoing challenge in clinical trials and even more so in community. Dance can provide an enjoyable physical activity that is easier to maintain."
Don't Dream It's Over: The path to sustainability
According to Porter, the reimbursement puzzle for music therapy is complex. Some state Medicaid programs support some services, especially for pediatric care, and some private insurers are starting to take notice. Many programs still rely heavily on gifts and grants.
"We are pretty underpaid compared to our other therapeutic counterparts," Porter says.
However, the National Institutes of Health (NIH) is supporting studies on music and therapy, and there are two national publications, Perspectives and the Journal of Music Therapy, that have posted studies on the clinical relevance of these treatments.
"When we're starting to see support from the government, it's hard for these healthcare facilities to ignore the fact that it's working," Porter says, noting that Brooks Rehabilitation works with Baptist Health Jacksonville and gets referrals from Wolfson's Children Hospital, which has a music therapist on staff.
One health plan taking notice of music therapy is Avesis, based in Phoenix. Sean Slovenski, the company's former CEO (he's since moved on to lead PatientPoint), says the service is often included in specialty health benefits, which "has [kind of] been in the Land of Misfit Toys for a long time."
"I think [payers] are starting to realize that these services can make a difference in people's lives that isn't just a pill or a treatment," Slovenski says.
According to Slovenski, one factor that may propel music therapy is the healthcare industry's interest in social determinants of health. As more healthcare organizations embrace ideas, like food as medicine, and see how alternative treatment can impact clinical outcomes, they'll take a look at music, dance, art, even innovative ideas like prescribing a trip to the park, the museum, or a concert.
"They'll want to see how it can make a difference before they start talking about whether it can be reimbursed," Slovenski says.
Porter says health systems and hospitals are starting to come around to the idea of using music and other innovative treatments, but with less than 9,000 music therapists in the U.S., access is an issue.
"You have to pave your way," Porter says. "All of us are out here pioneering."
The health system is rolling out an enterprise communication strategy that gives every nurse and doctor access to a smartphone, and expecting to see ROI in everything from reduced steps per shift to better patient care.
It’s still not unusual to see a doctor or nurse walking around in a hospital with several different communication devices. Sentara Health is investing millions of dollars in a program to reduce that cluster to one smartphone.
The health system, with 11 hospitals in Virginia and one in northeastern North Carolina, is equipping nurses and doctors across the enterprise with a specialized smartphone from Mobile Heartbeat, giving them one device to communicate, access patient records, scan labels and devices, take images of patient wounds, check medications and submit orders.
Tim Skeen, Sentara’s Executive Vice President and Chief Information Officer, says the health system needs to erase pain points caused by slow or ineffective communications and problems with data access. Those problems not only endanger clinical outcomes, but also contribute to staff stress and burnout.
“This was really important for us, especially for our nurses,” he says. To accommodate clinicians who “don’t want another device,” Sentara made the platform available through an app that they could download on their own smartphones.
The devices aren’t typical smartphones. They don’t allow access to cell service, social media, games or app stores, but they are HIPAA-compliant and integrated with Sentara’s Epic EHR.
Tim Skeen, EVP and Chief Information Officer, Sentara Health. Photo courtesy Sentara Health.
Skeen says Sentara’s leadership had planned on a two-year rollout but shortened that timeline after seeing how successful the devices have been. Scanning compliance has jumped from roughly 85% to almost 100%, he says, while access to so-called “flowsheet information” has gone from hours to minutes.
Clinicians—especially nurses--are also communicating much more frequently with the devices. Skeen says one hospital logged roughly 35 messages between clinicians in the two months prior to rolling out the smartphones, and saw more than 1,310 messages in the month after the devices were introduced.
“This phone improves workflow and patient safety,” Christy Grabus, Chief Nursing Officer of Sentara Northern Virginia Medical Center, said in a story posted by the health system in September. “All of this helps us prioritize and spend more time at the bedside with our patients.”
“We can be more in the moment with the patient,” added Adrienne Cruz, a registered nurse unit coordinator at Sentara Princess Anne Hospital. “I can answer more questions than I could’ve before. We have more time to give the patient that little extra tender loving care that we'd like to.”
Additionally, Skeen and Sentara executives are expecting to see a reduction in the time physicians spend waiting for an imaging or diagnostic test, and the time spent by nurses and physicians trying to find someone, either by paging them or just walking through the hospital. Medications will be administered and treatments started faster, potentially reducing a patient’s length of stay. They’ll also see a change in nurse workflows, such as less steps taken during a shift, a precursor to reduced stress and anxiety and a better nurse satisfaction rate.
“Giving a patient medication through an IV pump has gone from 80 steps to just 10 steps,” Madison Carrara, a nurse and senior IT specialty analyst at the health system, said in the Sentara release. “Nurses used to have to walk around the room four or five times to scan everything. Now with the phone, they can walk up to the bedside, scan the patient, medication, and pump all from the same spot.”
Skeen says that data will be important in proving the value of an enterprise device strategy.
“It’s not easy to get a hard ROI around this significant investment--it’s millions and millions of dollars,” he says, noting it will take a good 12-18 months of full operation to get the metrics they need to prove ROI. “There are some hard cost benefits, and there are benefits that are very hard to document and measure.”
The strategy isn’t new. Health systems and hospitals have been choosing between in-house communications and bring-your-own-device (BYOD) strategies for close to two decades. But the technology and the connectivity have greatly improved over that time, giving executives more of a reason to embrace devices that can efficiently address a larger number of pain points.
Still, Skeen said Sentara Health took almost a year to plan the rollout. They had to make sure every campus was fully accessible by Wi-Fi, so that no urgent messages would be dropped or lost, and that the health system’s IT infrastructure could support the additional devices. The devices themselves had to be rugged and durable, surviving drops and other potential catastrophes, and equipped with a remote-wipe capability should they be lost or stolen. And charging stations had to be mapped out, so that clinicians could easily and conveniently check in, get a fully charged device, and return them at the end of the shift to a charger.
Leadership also had to create separate protocols for doctors, with different levels of access for employed physicians and for those with access privileges. And all doctors who access the platform on their own devices have to agree to certain conditions regarding privacy and security.
Skeen advises healthcare executives looking into an enterprise device strategy to carefully map out all the uses and endpoints on the platform, making sure no program or use is overlooked. And spend plenty of time on HIPAA compliance, endpoint security and connectivity.
He says the devices play into Sentara Health’s virtual and connected care strategies, including telesitting, virtual ICU and virtual nursing. He expects the devices will someday be made available to clinicians in more than 400 care sites in the Sentara Health network and even incorporated into home health and acute care at home programs.
“There are a lot of things that we’re trying to virtualize now,” he says.
Often called neighborhood hospitals, these small-footprint facilities give health systems a branded presence in competitive and underserved markets.
That shiny new hospital complex or fancy tower might not be the best way to extend the health system footprint into new communities.
With capital expenses on a very short leash and consumers looking for a more connected approach to care, healthcare leaders are partnering to build micro-, mini- or neighborhood hospitals. They’re fully accredited and smaller in size, covering about 15,000 to 60,000 square feet, with 8-30 inpatient beds for short stays, and 24/7 ED capabilities.
“Micro-hospitals, if designed appropriately, accrue four strategic advantages to hospital sponsors: broaden market expansion, lessen capital risks, decrease operating costs and increase consumer appeal,” the Erdman report states. “They are designed and built to optimize patient experiences, maximize staff productivity and serve as a flexible footprint for additional services as demand warrants. While the regulatory climate for micro-hospitals is volatile, the sector is expected to grow as health systems deploy capital to micro-hospital projects. Therefore, micro-hospitals serve as a critical element of a hospital’s strategic plan for growth and scale.”
Fulfilling a health system’s expansion strategy
Allegheny Health partnered with Texas-based Emerus in 2014 to build four neighborhood hospitals in and around Pittsburgh, a competitive market it shares with, among others, UPMC. CFO Brian Devine says the micro-hospitals give them a means of extending the brand into neighborhoods where access to care might be limited.
“We wanted to create a way to control ED costs, to control our own destiny with access points,” he says.
While the new sites proved especially valuable during the pandemic, taking pressure off of Allegheny Health’s main hospitals and especially their EDs, the strategy for sustainability goes far beyond pandemics. Allegheny Health’s four neighborhood hospitals give patients a quick and convenient access point for emergency care, and patients are either discharged home or transferred to other care sites in the Allegheny network for continued treatment.
“We saw a significant ramp-up in growth of the brand and ED visits to those facilities, and [we have] significantly benefited from transfers into our tertiary hospitals,” Devine says. “I know the market has changed. I know the competition has changed. But at the end of the day we are seeing benefits from them providing access to our system at four key points around the city of Pittsburgh.”
One key factor in the success of the partnership is medical office space. Allegheny Health has medical offices and imaging services alongside two of the four sites, enabling the health system to keep the patient’s care journey in-house. Devine says that capability will factor into future expansion plans.
As for partnering with Emerus in the first place, Devine says many health systems today don’t have the resources to “go big” and build new hospitals. They’re either building up their main campus and hospitals or looking at a strategy that expands care opportunities into communities.
The partnership with Emerus is “significantly helpful from a capital perspective,” he says, and it also allows them to outsource those responsibilities and focus on other areas of growth.
“It comes down to bandwidth and where we’re prioritizing, and what we’re prioritizing is different areas of growth with our institutes and different levels of efficiency in our core hospitals,” he says.
“We are used to running a traditional hospital, a much larger hospital facility,” Devine says. “But they have a national model that’s been proven, and we have to have some reliance on and trust in that.”
An integrated, and branded, part of the network
“We are completely licensed hospitals with a small footprint,” says Rachel George, MD, CMO for Emerus, a Texas-based developer of micro-hospitals that launched in 2000 and has built 42 hospitals to date for health systems like Allegheny Health, Ascension, Baptist Health, Baylor Scott & White Health, Dignity Health, Providence, INTEGRIS WellSpan Health and ChristianaCare. “And we are able to take care of anything and everything that walks through our door.”
George and David Hall, Emerus’ chief growth officer, say neighborhood hospitals—George dislikes the ‘micro-hospital’ moniker—are fully integrated with the partner health system, right down to the branding. They integrate with the health system’s EHR, adhere to their standards of care, and transfer all patients who need transferring to care sites within that health network.
George says these sites are not designated trauma centers, with no surgery services, but they do take care of, stabilize and manage trauma care patients, then make sure those patients are transferred to the right location for continued care. The average length of stay for observational patients is around 28 hours, and most patients are discharged in less than three days, at least one day less than the average.
Emerus staffs its hospitals with its own nurses and emergency care clinicians, pointing to a much lower nurse-to-patient ratio than most hospitals, and has an on-demand telehealth platform that connects its hospitals to physicians and specialists, such as cardiologists, intensivists, and infectious disease specialists.
“We’re able to discharge a very large percentage of our patients back to their homes, which is great for the community, great for the patient and great for the health system,” George notes.
“A big part of what we're doing right now is becoming a part of that brand, understanding exactly how they want to position themselves and what they represent to the communities that they serve,” adds Hall, noting that while it takes, on average, 35 minutes to get to the nearest hospital, neighborhood hospitals are designed to be 5-10 minutes away.
Looking to the future
Devine says Allegheny Health will plan carefully for any future neighborhood hospitals, taking into account not only location and access to medical offices but the population around such a site.
“We would be looking at communities that may not have the right access today [or are in] jeopardy of losing access,” he notes, adding this plays into Allegheny Health’s strategy of developing community healthcare hubs.
Devine says there needs to be the right mix of Medicaid, Medicare and commercial payer coverage to support a neighborhood hospital. Without commercial coverage, he says, the smaller hospital wouldn’t be sustainable, particularly as Medicare and Medicaid reduce reimbursements.
“You’d have to be very judicious around the patient mix that you expect to get, which would be payer mix,” he says. “And you also want to make sure that you can get those inpatient stays. Clearly an inpatient stay is very helpful to the economics, and you want to make sure that it's in an area that would garner enough visits to yield a few inpatient stays. That's the fine balance of balancing access with the economics of healthcare today.”
“Clearly, the rationale for developing micro-hospitals varies depending on the strategic aims of the sponsor,” the Erdman report notes. “Return on capital goals is different if a micro-hospital is part of a health system’s long-term master site plan for growth and a private investor’s goal is profitability. Both must remain flexible in the scale and scope of services offered as market opportunities evolve, regulations emerge, licensing and accreditation standards are codified, consumer expectations change and competition heats up. Thus, for a community hospital or health system sponsor, the investment in a micro-hospital is both an offensive and defensive strategy: to strengthen competitive positioning and protect against competitive encroachment.”
The agency is eliminating copayments for all telehealth encounters and putting more money into a controversial program that creates telehealth stations for veterans in remote and rural areas.
The largest telehealth provider in the country is proposing to eliminate copayments and expand a controversial program that provides access to care in rural and remote regions through telehealth stations.
The U.S. Department of Veterans Affairs announced on Veterans Day that it aims to amend the Commander John Scott Hannon Veterans Mental Healthcare Improvement Act of 2019 to end all copayment obligations for veterans, greatly expanding a decision earlier this year to waive copayments for a veteran’s first three outpatient mental healthcare visits per year through 2027.
In addition, the VA plans to establish a grant program to support new telehealth access points in non-VA facilities. The funding would bolster The Accessing Telehealth through Local Area Stations (ATLAS) program, which launched in 2019, by supporting organizations, such as non-profits and businesses, to create and maintain telehealth stations where veterans could access VA care services.
The idea behind the program is to create a network of locations that would enable veterans to access care outside of VA hospitals and care sites, giving veterans more convenient options for care. Current sites are located in Walmart stores, American legion posts and Veterans of Foreign Wars posts.
Interestingly, the ATLAS program so far hasn’t performed up to expectations. Just a month ago, the Government Accountability Office (GAO) issued a report that found that 14 of the 24 sites supported by the program weren’t used at all in FY 2022 or 2023.
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in an October interview. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
VA officials said the two new announcements aim to build on a successful platform for veterans, and an understanding that many veterans either can’t or won’t visit VA centers or other VA-affiliated care sites.
“Waiving copays for telehealth services and launching this grant program are both major steps forward in ensuring Veterans can access healthcare where and when they need it,” VA Secretary Denis McDonough said in a press release. “VA is the best and most affordable care in America for veterans. With these steps, we can make it easier for veterans to access their earned VA healthcare.”
The announcement continues a growth trend for the nation’s largest health system, which serves more than 16.2 million veterans. In fiscal year 2023, more than 2.4 million veterans, or 12% of that total, were treated through more than 11.6 million virtual care encounters, including some 9.4 million on the VA Video Connect platform.
Also last month, the VA expanded its tele-emergency care (tele-EC) platform to veterans across the country, after the success of pilot programs in selected regions. Veterans can now use a smartphone and associated app to access emergency care at any time and from any location.
Supporters say the extension merely kicks the can down the road and they may soon urge either Congress or the White House to step in and create a permanent rule.
Healthcare providers will be able to prescribe scheduled drugs via telemedicine for at least one more year, thanks to a last-minute extension of a pandemic-era waiver by the U.S. Drug Enforcement Administration (DEA).
The announcement late Friday may have been met with relief by advocates, but it’s little more than a stopgap measure. The federal agency has been tasked with creating a special registration process for prescribing via telemedicine since the passage of the Ryan Haight Online Pharmacy Consumer Protection Act in 2008, but has resisted calls from advocates and lawmakers to do so.
Nevertheless, the latest announcement garnered some praise.
“We are pleased to see the DEA act to ensure patient care is not interrupted next month,” Chris Adamec, executive director of the Alliance for Connected Care, which spearheaded a letter signed by more than 300 organizations urging Congress to take action, said in a press release issued Friday. “We look forward to working with the Trump Administration next year to finish the work they started in 2020 through a permanent rulemaking that creates access to comprehensive medical care, including a controlled substance when necessary, through telemedicine.”
“The DEA’s extension of telehealth flexibilities of controlled substances is a lifeline for many mental health and substance use disorder patients,” Debbie Witchey, president and CEO of the Association for Behavioral Health and Wellness (ABHW), said in a separate release. “Buprenorphine, in particular, is very safe and one of the gold standards of care for opioid use disorders (OUD). The option to provide buprenorphine-based treatment via telemedicine will enhance access to care and address health disparities. ABHW strongly supports removing the in-person requirement permanently for tele-prescribing buprenorphine as this requirement hinders access to care.”
Supporters, including many health systems and hospitals, say the ability to prescribe controlled medications via telemedicine is critical to improving treatment and access to care for substance abuse and behavioral health issues, as patients often can’t or are reluctant to seek in-person treatment. They also worry that ending the waiver will disrupt and potentially end treatment for patients who have relied on virtual prescriptions for the past few years.
According to the DEA, the extension “ensure(s) a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions.” It also gives the DEA and the Health and Human Services Department (HHS) more time to come up with a final rule, and for providers to be ready for that rule when it goes into effect.
That hasn’t worked out too well in the past.
In 2023, the DEA unveiled a proposal for a final rule, but advocates quickly criticized the proposal as being too complex and restrictive, leading the agency to shelve the plan and extend the waiver. Earlier this year, the DEA floated another draft of a final rule, but a leaked copy of the plan was deemed by supporters to be “a significant blow to the telemedicine industry.”
The one-year extension isn’t a surprise. Those familiar with the process have been anticipating either a one- or two-year continuance for some time. But there’s a growing concern among telehealth advocates that the DEA won’t come up with a final rule that meets their concerns, and that they will have to put extra pressure on either Congress or the White House to bypass the DEA and create a permanent rule that is amendable to everyone.
That may be why advocates like the American Telemedicine Association (ATA) were quick to praise not only the DEA but HHS, Congress and the White House for the waiver.
“As we close out this year and prepare for 2025, we will remain actively engaged with the incoming Trump administration, the DEA, the Department of Health and Human Services (HHS), interagency partners, and other key stakeholders to establish a permanent framework that ensures appropriate and necessary access to care for millions of Americans,” Kyle Zebley, the ATA’s senior vice president of public policy and executive director of ATA Action, the organization’s lobbying arm, said in a press release last week.
“We remain grateful to the Biden Administration, the DEA and other key agencies, and our bipartisan, bicameral Congressional telehealth champions, as well as President-elect Trump and his first Administration, for their staunch support,” he added. “However, our work is far from over. We are buoyed by this important ruling and will continue to pursue permanent access to essential virtual care services on behalf of healthcare providers and the millions of patients who have come to rely on telehealth.”
Deciphering value in new tools and strategies is a constant challenge for healthcare leaders. At the HealthLeaders RevTech Exchange, they came togetheer to discuss the best strategies and biggest hangups.
New technologies like AI may have a bright future in healthcare, but many revenue cycle executives say the ROI just isn’t there yet. And they’re having some tough conversations with vendors and their own staff about how to move forward with new ideas.
At this week’s HealthLeaders RevTech Exchange in Nashville, some 30-40 healthcare leaders discussed a variety of strategies for embracing new tech. Those strategies almost always focus on defining and seeing ROI, and that factor alone can make or break a new technology contract or scuttle a promising program before it begins.
“Some very good products don’t justify the expense” said Jonathan Davis, Executive Director of Patient Access and Revenue Cycle Analytics at Yale New Haven Health. RCM execs may not have the budget or the time and resources to spend on new ideas that take too much time to develop value or don’t have clear value to begin with.
RCM executives are in a tough spot right now, caught between the value-based care movement and business strategies that still adhere to episodic care. Their definition of value often clashes with clinical leadership, and it’s in technology that those differences hit the spotlight. ROI for a new tool that improves clinical outcomes is far different than the ROI for a tool that improves administrative efficiency.
At the same time, a new tool that greatly improves clinical outcomes won’t be useful to a hospital that can’t keep its door open because of unsustainable revenues. So the delicate balance of priorities continues.
Several exchange attendees said they follow a technology ROI threshold of 3:1, meaning a new product or program has to produce in revenue three times what it cost to launch the project. No one touches anything with a 1:1 return, and a 2:1 return won’t hold up against unexpected and additional costs.
So the technology has have an immediate and impactful ROI, particularly at a time when so many health systems and hospitals are skating on thin margins. One of the first places to cut expenses is in innovation, putting the pressure on executives to be sure they’re finding the right vendors with which to partner.
Lynn Ansley, Vice President of Revenue Cycle Management at the Moffitt Cancer Center, says healthcare executives are becoming more critical in their evaluation of vendors. They’re asking for more details about products and avoiding ambiguity at all costs, and they’re looking at shorter contracts—three years was mentioned more than once—so that they can back out if the ROI isn’t there.
In many instances, RCM executives are asking for a detailed proof of concept from vendors, requiring them to map out how their product will benefit the health system and even asking for assurances or guarantees. That’s not unlike the shared risk that we see in arrangements between payers and providers.
And if there are multiple vendors vying for the same contract? How about a “bake-off,” in which they put their products up against each other to determine who’s better at proving ROI. Some health systems are even working with two vendors that offer the same tools, so that both are accountable and giving their best effort.
This is crucial, exchange attendees said, because payers often seem to be ahead of the game in tech adoption, particularly with AI. Some even said their health systems are moving fast to adopt AI just to stay in the game with payers.
“You show up at the contract table with any payer and they know more about your business than you do,” one executive pointed out.
In terms of staffing, which is a sore spot at every health system and hospital, RCM execs are defining ROI in automation and AI tools not by how technology can replace humans, but by how it frees up staff to handle more important tasks.
“There are other things that we need smart people for,” notes Ansley.
And they’re countering staff concerns that AI will replace them by pointing out that those upskilling opportunities often come with salary increases. That, in turn, helps with staff retention and hiring.
Finally, RCM execs are looking at a future that sees them playing more of a role in the patient’s healthcare journey. That means not only collaborating with clinicians to advance the right technology purchases but highlighting the role that revenue cycle staff can play in helping patients understand and fulfill their financial obligations.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
The company behind the stylish, AI-enabled CarePod has abruptly closed, following a similar spiral as the HealthSpot more than a decade ago. The news proves that healthcare innovators shouldn’t just be trying to recreate the doctor’s office.
Another kiosk-based telehealth company has shut down, proving once again that a high-tech virtual care platform isn’t the successful business model that disruptors think it can be.
Forward, which launched in 2016 with a cash-based model and unveiled the stylish, AI-enabled CarePod just last year, announced its abrupt demise in a company post this week, putting some 200 employees out of work. The company said it was immediately discontinuing its app, cancelling all scheduled visits and shutting down all operations, while keeping a support team available for about a month.
The collapse is reminiscent of the HealthSpot, a similarly-styled kiosk that debuted at the CES show in Las Vegas in 2012. The company behind the kiosk raised almost $50 million, built close to 200 kiosks and had deals in place with Rite-Aid, the Mayo Clinic, Cleveland Clinic and Kaiser Permanente before going bankrupt in 2016.
The lesson to be learned in these closures is that technology alone won’t solve anything, and that consumers and business owners are looking past all the bells and whistles for convenient, no-frills healthcare connections. A kiosk that can replicate a complete visit to the doctor’s office may look and sound great, but it’s still a healthcare visit to a different location. If consumers want the experience to look that much like a doctor’s office, they’ll go to their doctor’s office.
To be fair, the kiosk concept is still enticing. Pursuant Health, which began as SoloHealth in 2007 with the EyeSite vision kiosk, now has more than 4,600 health kiosks in high-traffic retail and grocery stores across the country. And Canada-based UniDoc Health Group, which unveiled its H3 Cube Virtual Care Simulations Model (VCSM) at the American Telemedicine Association conference in 2022, rolled out the first commercial shipment this week, and is pursuing an international “AI-focused eHealth” strategy that would out its kiosks in remote and resource-thin regions around the globe.
Health systems and hospitals are also interested in the form factor. Rochester University Medical Center has partnered with Five Star Bank to locate smaller telehealth kiosks in several bank branches, eyeing a strategy that that improves access in rural upstate New York. And several healthcare organizations across the US have located smaller kiosks--some no more than a laptop and connected devices in a cubicle—in libraries, malls, community centers and other locations with the goal of giving consumers quick and easy access to virtual care providers for small health concerns.
As Forward and HealthSpot have proven, bigger isn’t better and telehealth companies, care providers and disruptors who are looking to recreate the doctor’s office in other settings are missing the point. Small, quick and easy may be the key to sustainability.
As the HealthLeaders 2024 RevTech Exchange kicked into action this week in Nashville, executives from dozens of health systems discussed how they're managing new technology like AI
Today's revenue cycle management leaders need to be agile. The healthcare industry is going through a significant period of change, buffeted by costs and quality concerns and workforce shortages and buffered by new technologies like AI. That's a challenging environment for any leader to navigate.
Roughly 40 RCM leaders from health systems across the country gathered in Nashville this week at the HealthLeaders 2024 RevTech Exchange to talk about those challenges and opportunities.
Here are a few key plot points from the first day of the Exchange:
Train, train, and train some more. And don't stop training. Due in large part to the advances in automation and the potential of AI, the revenue cycle workforce is evolving. Managers need to develop a strategy that prepares staff for that evolution. They need to address that worry that AI is taking people's jobs by pointing out that jobs aren't disappearing, but they are changing. RCM staff will become monitors, overseers and auditors, keeping a close eye on the technology that is doing all the manual tasks they used to do.
And that training won't stop. A key element of generative and predictive AI is that it keeps on learning, and RCM staff will need to keep on learning alongside those tools.
That goes for leaders as well. New technologies like AI are new to everyone, including those in the C-Suite. Healthcare leaders need to have a clear understanding not only of these new opportunities, but how they'll affect staff and workflows. Be ready to talk to people who are worried that AI will replace them, as well as staff who are perhaps a bit too eager to try something new.
Technology isn't the answer. "We look at technology like it's going to solve all our problems," says Derek Dudley, VP of Revenue Cycle Operations at Tidelands Health. "But a $200 hammer isn't going to make you a better carpenter."
As with clinicians, RCM managers need to understand that technology is a tool that will help them become better, but it won't solve all the pressing problems of healthcare on its own. Managers and staff need to understand how to use those tools to improve rev cycle performance.
For example, Beth Carlson, VP of Revenue Cycle at the West Virginia University Health System (WVU Medicine), noted her health system developed a tool to predict denials from a certain payer. The tool was wildly successful—but it was scrapped, because the denials were still happening. In other words, they'd created a great tool, but it didn't have any value.
Look for proactive solutions. Taking the WVU Medicine example one step further, what the health system needed was a tool that would identify the root causes of those denials, and develop a strategy for preventing denials in the first place.
Several health system executives at the Exchange emphasized the need to develop new tools and programs that tackle key pain points in RCM, such as denials, appeals and prior authorization hangups, before they happen. The appeal of AI lies in gathering all the data at hand and predicting when those issues occur, then using that data to plot the best way to avoid them.
Collaborate with IT and especially clinicians. Revenue cycle departments shouldn't exist in their own silos, and yet they sometimes think they do. Because of this, and because many of the sexy new AI tools address clinical care, RCM staff may be feeling a bit inferior to their medical counterparts.
That's a load of baloney. Successful health systems and hospitals thrive on collaboration, and it's important that executives look for those opportunities to collaborate on new tech and programs. Lynn Ansley, VP of Revenue Cycle Management at the Moffitt Cancer Center, said revenue cycle leaders should even go on rounds with clinicians to understand their workflows and see where RCM technology intersects.
In fact, revenue cycle managers should even find clinician champions, much like CIOs and CNOs will do to support the rollout of new clinical technology. Having clinician support and have clinicians understand how RCM technology benefits their workflows will go a long way toward establishing that elusive ROI.
Find that elusive ROI. This is the biggest challenge in healthcare technology today. New tools like AI may look great and even produce amazing results in pilots, but they need to prove long-term value, and that hasn't been easy so far. With health systems and hospitals on razor-thin margins and reluctant to spend money on new ideas (especially something as pricey as AI), there has to be a proven ROI attached.
Balance established tech with new tech. Many healthcare organizations don't have the resources to develop new technology like AI, so they outsource, looking for a company with a good background and product or even a startup that they support. On the other hand, EHR companies are developing their own tools that integrate into the medical record. Is it better to wait for that tool or spend money on an outsourced product that may have to be bolted onto the EHR?
It's not an easy question to answer. Some Exchange participants said they don't want to wait for their EHR provider to develop a tool they need now and are willing to look for help. Others are against bolted-on functionality and are willing to wait. And then there are those who would consider buying a new tool or capability and then switching over when the EHR provider comes along with that tool.
Look at RCM from the outside. Many of the new ideas coming into healthcare have proven themselves in other industries, like retail, banking and travel. And while the healthcare sandbox is a difficult place in which to play with new concepts, savvy leaders will look for ways to adopt them and adapt to the changes. Part of that process includes understanding how these ideas worked in other industries and learning how they might fit in.
Beyond that, RCM leaders also need to look at their departments from the perspective of other parts of the healthcare ecosystem. How does IT see the RCM process? How do doctors and nurses view those operations? This is particularly important when developing a culture of collaboration.
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In this HealthLeaders podcast, Jim Blum, CMIO at University of Iowa Health Care and a Mastermind participant, talks about giving clinicians the tools to improve their workflows and patient care without hitting them over the head with governance.
Is it possible to do too much with AI governance?
James Blum, MD, thinks so. The CMIO at University of Iowa Health Care and a participant in the HealthLeaders Mastermind program on AI in clinical care, says the technology needs to be treated with the proper safeguards, but that doesn't mean separating it from all other innovative tools and processes.
"AI and healthcare probably shouldn't exist in the vacuum," he said during a recent HealthLeaders podcast. "And we shouldn't be acquiring AI for the sake of AI. We should probably be looking to solve problems that people have, and if that involves AI, great. If it doesn't, that's probably in many ways better because it takes out display of governance and potentially a lot of additional expense."
UI Health Care has launched two AI tools for clinical care: An ambient transcription platform developed by Nabla, which roughly 1,100 of the health system's 3,000 doctors are now using, and a chart mining platform from Evidently that collects all relevant data on a patient from multiple sources to give clinicians a concise view of the patient.
"I can see these very sick patients [with] long, complex medical histories and, really, I'm able to know as much about that patient as the intern that was up all night trying to comb through their entire medical history," he points out.
Blum says both tools were carefully reviewed by UI Health Care through a normal process for reviewing new vendors. With AI, that includes bringing in clinicians and IT personnel who understand the nuances of the technology.
"It is with a group of individuals that are qualified to review the AI right and really understand the performance characteristics and what can be expected of the technology in addition to our typical acquisition process," he said.
"And that's where the AI committee can get engaged and say, ‘OK. Let's look at the performance characteristics and training set and those types of things and give a thumbs up or thumbs down' as to [whether] they think the science behind the AI algorithms is good. And if it's not, then convey that to the groups that are doing the acquisition and say we really don't endorse this because we think it's not a product that's really going to deliver what they're purporting it will deliver to you."
Blum says AI is such an intuitive technology that it doesn't need the intensive resources and training for adoption that health systems typically set aside.
"With all types of departmental meetings and going to individual clinics and a lot of hand-holding … we would we would get nowhere near this level of adoption this quickly if we did it the way we typically roll out," he said.
Instead, with the ambient dictation tool, the health system held one training session and made that available on video. This takes the pressure off of the IT department and gives clinicians more of a responsibility to understand how AI will work for them.
"If it's not working for you, go back and do things [the old way}," he said. "So you don't need to have this really comprehensive, elaborate rollout and you can go ahead and basically turn the technology on and let the use of it grow organically."
"It's a much more targeted intervention and I think results in a much greater utilization," Blum added, noting the health system can identify who isn't using the new technology and help them if needed. "We're not going to go ahead and force you to use the technology you don't want to use, and we're also not going to spoon-feed you. But if you want to be better, you want to be more efficient, it takes a little bit of self-motivation. How many people went to a class on how to use their smartphone before they started using it?"
Blum says he's excited to see how generative and predictive AI evolve and are worked into the clinical space. And while UI Health Care is always looking for new partnerships, the health system will balance doesn't want to buy or build a new tool that will be rendered obsolete by a new capability from its EHR partner in a few years.
More important, he said, are the cost and data storage concerns that come with AI.
"All this stuff, all these large language models and all this processing and the tokenization just requires a ton of computational power," he said. "And this introduces an entire new realm of expense for health systems, without there being necessarily a great financial upside on these things."
Blum says health systems will have a hard time defining an ROI that will please everyone. AI might be great at reducing physician stress, but is that enough for CFOs and CEOs who want the health system to meet increasing patient demands?
"This leads to millions of dollars a year that you're spending on these types of technologies and you may not see a financial upside for that," he says. "And in this era of 1% margins, this gets to be a real challenge."
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