The New Jersey health system is partnering with care.ai to scale a pilot program in one med-surg unit to all of its hospitals
Virtua Health is partnering with an AI company to scale a new Virtual Nursing program across the enterprise.
The New Jersey-based health system is collaborating with care.ai to integrate its virtual care technology throughout Virtua Our Lady of Lourdes Hospital in Camden following a pilot program launched late last year in one med-surg unit. Virtua executives say the platform will eventually be scaled out to all hospitals in the health system.
"By embracing the transformative potential of artificial intelligence and ambient intelligence, Virtua is pioneering a new era in patient care," Tarun Kapoor, MD, MBA, Virtua Health’s senior vice president and chief digital transformation officer, said in a press release.
The partnership is part of a nationwide trend of health systems and hospitals adopting virtual nursing platforms for one or more of three primary reasons:
Many are using virtual care technology to address staffing shortages and reduce stress and burnout by assigning virtual nurses administrative tasks and allowing on-site nurses to focus on care management.
They can also target improved administrative and clinical outcomes through round-the-clock patient monitoring and data entry and analysis.
Some are also using the platform to mentor newer nurses and give older nurses a new opportunity to stay in the workforce.
Virtua executives say the platform aims to streamline patient care “from routine admit and discharge activities to documentation, fall prevention, and clinician safety.” It enables floor nurses to focus on patient interaction while the virtual nurse handles other tasks, while ambient AI sensors in the rooms keep an eye on patients at all times.
“Our focus is not just on integrating cutting-edge technologies, but on enhancing the human aspects of healthcare,” Michael Capriotti, Virtua Health’s senior vice president of integration and strategic operations, said in the press release. “By swiftly adopting optical cameras and ambient sensors, we’re poised to markedly enhance the patient and care team experience, ensuring a safer, more efficient, and empathically connected healthcare experience.”
A recent OIG audit of evaluation and management (E/M) services provided by telemedicine during the pandemic found that providers generally followed the rules for Medicare reimbursement. But they did make some documenting errors
Healthcare providers who use telemedicine often rely on reimbursements to support the platform. And according to a recent audit, they did a pretty good job documenting those virtual encounters during the pandemic.
The report, prepared by the Health and Human Services Department’s Office of the Inspector General (OIG), analyzed $10.3 billion in E/M services billed to Medicare between March and November of 2020, of which $1.4 billion, or about 14%, were conducted by telemedicine. The OIG found that providers “generally complied with Medicare requirements” to a point that the agency made no recommendations for changing or improving the coding and reimbursement process.
That being said, the OIG audit identified five common errors in documenting for an E/M visit conducted via telemedicine. They are:
Documenting how a service was provided. Some providers didn’t document whether the service was done in person or through either an audio-only or audio-visual telemedicine visit.
Documenting the location of the telemedicine visit. Some providers did not document where the provider or patient were located during the encounter.
Identifying the telemedicine product used. Some providers documented the use of audio-visual telemedicine for an E/M visit but didn’t identify the platform used (such as Zoom, Microsoft Teams, or a telemedicine vendor). The federal government relaxed both CMS and HIPAA guidelines during the pandemic to enable providers to use more telemedicine platforms, including public-facing products. Now that the pandemic and the public health emergency have passed, the government is again cracking down on telemedicine products that don’t meet rigid privacy and security guidelines and pushing providers to use platforms that are secure.
Clarifying the telemedicine modality. Some providers documented that they used audio-only telemedicine for the E/M encounter but used an audio-visual telemedicine CPT code, which is different from the audio-only CPT code. The government expanded the use of audio-only telemedicine during the pandemic to expand access to healthcare services but has been pulling back since then to focus on more secure audio-visual telemedicine platforms.
Documenting problems with the technology. Some providers reported that there were problems with the technology during a telemedicine visit, such as an unreliable internet connection or issues using video. They therefore conducted the visit via audio-only telemedicine but documented the visit as an audio-visual visit.
According to the OIG report, the problems weren’t big enough to indicate the need to take action, but they point to areas of concern that could affect future telemedicine policy. For example, CMS may wish to issue guidance in the future on how providers should deal with technology issues and how they should document the encounter.
The Delaware health system now has school-based health centers in 25 schools, with a goal to give students better access to a variety of primary care services.
The Delaware-based health system now operates school-based health centers in six elementary schools and 19 high and middle schools. The latest wellness centers were launched through a partnership with the Delaware School-Based Health Alliance, the schools and school districts and local government, with funding from the American Rescue Plan Act.
“Through the opening of these three new school-based health centers, these children now have convenient access to medical services, behavioral health services and wraparound social care,” Erin Booker, LPC, the health system’s chief bio-psycho-social officer, said in a press release. These centers can improve their health and education and set them on a lifelong path of wellness.”
The centers will provide, at no cost, comprehensive medical and mental healthcare, ranging from treatment to education. This includes screenings, women’s health, treatment of minor injuries, immunizations, nutrition and weight management, crisis intervention and suicide prevention, tobacco cessation, and substance abuse treatment and referrals. They won’t offer hospitalizations, x-rays or complex lab tests, or ongoing treatment for more complex medical and psychiatric problems.
“School-based health centers are the connection of whole-child health and education,” Priscilla Mpasi, MD, FAAP, assistant medical director for the Clinically Integrated Network and Delaware Medicaid Partners, part of the ChristianaCare network, said in the press release. “As we all know, early intervention is the key to wellness. Children can learn better when they are happy and healthy and know they have a safe place to go when they need care.”
The health centers aim to improve care management for children who might face barriers to accessing care. The Children’s Health Fund estimates that 20.3 million children in the U.S., or about 28% of the total population of children, face barriers to accessing essential healthcare. And according to the Centers for Disease Control and Prevention (CDC), some 40% of school-aged children and teens are living with at least one chronic health condition, such as asthma, diabetes, obesity, or behavioral health problems.
Sharp HealthCare has launched the Spatial Computing Center of Excellence, a new research hub aimed at turning VR technology like the Apple Vision Pro into a clinical tool
While many health systems see the new Apple Vision Pro as a consumer device, executives at Sharp HealthCare are taking a close look at what it can do for clinicians.
The San Diego-based health system recently opened the Spatial Computing Center of Excellence, an innovation center aimed at studying the healthcare applications of AR and VR technology. The center, launched in a collaboration with Epic and Elsevier, is the latest initiative to come out of the year-old Sharp Prebys Innovation and Education Center.
“This is a completely different form factor that opens up a lot of opportunities in healthcare,” says Brian Lichtenstein, Sharp’s associate chief medical informatics officer. “In the spatial realm, we have a chance to move beyond the limitations of the EHR.”
While AR and VR technology has long been focused on gaming, other industries are starting to see the value. Healthcare is no different, as health systems like Cedars-Sinai and Boston Children’s have, for the last few years, developed AR and VR programs to address health concerns like pain management, childbirth, mental health issues, and pediatric care. Cedars-Sinai, which hosts a virtual medicine conference called vMed, recently debuted an AI-enhanced app for mental health treatment designed exclusively for the Apple Vision Pro headset.
At Sharp HealthCare, though, the interest for now is solely on the clinician ranks, which are dealing with stress and burnout associated with overflowing workflows and seeing their numbers decrease. This is where Lichtenstein and his colleagues hope the technology can ease workflow pressures and make life easier for doctors and nurses.
“We’re looking at a new way of enabling humans to interact with computers,” says Dan Exley, Sharp’s vice president of clinical systems.
The new research center is closely aligned with Apple and has purchased 30 Vision Pro headsets to get the ball rolling. The latest iteration of the VR technology was initially teased in a video last June and made available to the public at the beginning of February—at a price of $3,500.
Michael Reagin, MBA, CHCIO, Sharp’s SVP and chief information and innovation officer, says Apple has been a longtime partner of the health system, and that partnership gives Sharp clinicians and engineers an opportunity to work not only with top-line technology but a consumer-facing device that has made a considerable impact in the public space. That understanding of consumer needs will be important as the health system looks at how this technology can be used in healthcare.
“We have to be at the forefront of developing these resources,” he says.
Tommy Korn, MD, an ophthalmologist and digital health innovator with the Sharp Rees-Stealy Medical Group, says the timing is right because the health system is undertaking a major transition from four separate EHR platforms down to one Epic platform. This gives them the opportunity to develop projects that integrate better with the new platform.
He, Lichtenstein, and Exley all envision using the Apple Vision Pro to give doctors and nurses a new way of working with data, visualizing healthcare delivery, and interacting with their patients. Where clinicians now often labor to work with an EHR through a computer or laptop, a spatial computing app could create a 3D EHR, giving clinicians and patients a different look at healthcare conditions and how treatments affect the human body.
Exley, calling VR an “infinite canvas connected to infinite computing power,” says Epic has already developed an app for the Apple Vision Pro, and he envisions early uses for the technology in places like radiology and surgery. In addition, he says, the Spatial Computing Center of Excellence can draw on recent advances in AI technology and cloud computing to improve use cases.
“We want to see content that is driven by context,” Lichtenstein adds.
A collaboration between Rochester University Medical Center and Five Star Bank is putting telehealth kiosks in bank branches, offering new insights into how to improve access to care in rural regions
In a partnership with Five Star Bank, Verizon, and digital health companies Higi Health and Dexcare, URMC is co-locating telehealth stations in Five Star branches across the western part of the state. The model aims to improve access to care for rural residents, especially those on Medicaid and Medicare, who face geographical and technological barriers.
Michael Hasselberg, PhD, URMC’s chief digital health officer, says the health system came out of the pandemic seeing measurable benefits in a telehealth platform for rural residents, but most were using a phone to access care. In order to include Medicare and Medicaid reimbursements, URMC needed to establish an audio-visual telemedicine link.
“We thought, rural communities, what do you have?” he said. “You’ve got a traffic light, you’ve got a Dollar Store, and you’ve got a bank. What about banks?”
In singling out banks, Hasselberg identified a challenge facing health systems and hospitals looking to expand their telehealth networks. Many programs have focused on putting kiosks or telehealth stations in community centers, libraries, barber shops and hair salons, malls, and other retail locations. In most cases that means working with a different party at each location.
A patient uses a URMC telehealth kiosk at a Five Star Bank in New York. Photo courtesy URMC.
Banks, however “are in these branch distribution models, so they’re scalable,” Hasselberg noted. “I can’t scale a library, or a barber shop, or a community center because I, as a health system, have to negotiate with every single [site]. But if you negotiate with a bank, you have, potentially, access to all their branches across the region.”
In addition, and just as important, the costs of launching the program are reduced.
“The organizations partnering to make this pilot a success have all offered generous, in-kind support,” Hasselberg said. “Verizon Business is contributing the necessary telecommunications infrastructure. DexCare and Higi are providing leading-edge telehealth software and Smart Health Stations, respectively, to connect rural residents with UR Medicine physicians. And Five Star Bank is volunteering private space in its bank branches to create a healthcare access point for its neighbors in a familiar, trusted, community location. UR Medicine is not funding the Five Star Bank space.”
Addressing Key Gaps in Care Delivery
The program, which is currently in three branches, gives consumers and patients an opportunity to track key biometric markers, such as blood pressure, obesity, and blood sugar, through connected devices and an app managed by Higi. Through DexCare, visitors can connect for a virtual visit with a physician in the health system for treatment or to schedule an in-person visit.
“We already had an on-demand telemedicine service line that is staffed by our primary care doctors,” Hasselberg noted, “So we just kind of built off of that.”
The program addresses a number of care gaps that health systems face in serving rural regions. According to Hasselberg, roughly three-quarters of the health system’s rural patients live at least 10 miles from the nearest brick-and-mortar care site, but more than half live within three miles of a Five Star bank.
And studies have shown that consumers are often reluctant to visit a doctor’s office or clinic for a minor or nagging health concern unless or until they really need urgent medical care, often postponing care and running the risk of developing a more urgent health issue later. Co-locating a telehealth station in a bank, often located near other community services, gives the consumer an opportunity to combine a few errands in one trip, or to consider a virtual visit while out running other errands.
In a unique example, Hasselberg noted that one of the telehealth kiosks is located in a community with a sizable Amish and Mennonite population (the bank even has a drive-through for customers using a horse and buggy). Providing easy, convenient healthcare access for a population that traditionally keeps to itself and eschews most technology at home could go a long way toward improving care and outcomes for that group of people.
Unique Benefits to Telehealth
Hasselberg noted that many rural residents, particularly those with limited incomes, have higher rates of no-shows, cancellations, and ED visits and tend to skip or avoid filling prescriptions. All of those issues, he said, were improved significantly through the use of telehealth during the pandemic. And many don’t have or can’t afford broadband services in their homes, which a telehealth kiosk addresses.
The platform also gives URMC a visible presence in rural regions where brick-and-mortar sites are few and far between, at a time when disruptors like Walmart, Walgreens, Google and Apple are looking to stake a claim in the busy primary care space.
“What we have found is healthcare is local, especially in these small, rural communities,” Hasselberg said, adding the disruptors are doing more to improve healthcare than create competition. “Having a trusted health system to deliver care, and that understands these communities … is really, really important.”
“Our [goal] wasn’t to make money,” he added. “We needed to create access…. We’re not going to be looking at this through the lens of, are we generating enough volume to make a profit?”
Tackling Social Determinants of Health
In addition, co-locating a telehealth station in a bank gives URMC an opportunity to address several social determinants of health.
“Financial health is so closely tied to physical health,” noted Hasselberg, who said a patient could be referred to the bank right after the telehealth visit for help understanding, planning for, and paying medical bills. “We might be able to affect healthcare access and financial instability at the same time.”
Hasselberg sees plenty of opportunities to expand the program, not only to other bank branches and potentially other banks, but to assisted living and skilled care facilities, which struggle to connect their patients to the care they need. In addition, he sees more services being available through the kiosks, including chronic care management and follow-up care. They could even be used as access points for resident sot connect with local primary care physicians.
“We all went into this going, ’This may be a nothing-burger,’” he said. “And patients [may] go, ‘I don’t know about getting healthcare in a bank.’ But what if it does work? That’s the really exciting part. Because if this does work, it could be transformative. It could be replicated across other health systems and across other banks across the country.”
The CommonWell Alliance and Kno2 are the sixth and seventh organizations to qualify to exchange healthcare information under the federal TEFCA framework
The U.S. Department of Health and Human Services’ Office of the National Coordinator of Health IT (ONC) announced last week that the CommonWell Health Alliance—a nonprofit alliance of healthcare and technology associations—and healthcare connectivity company Kno2 are the sixth and seventh QHINS, joining the eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies.
"These additional QHINs expand TEFCA's reach and provide additional connectivity choices for patients, health care providers, hospitals, public health agencies, health insurers, and other authorized healthcare professionals," ONC chief Micky Tripathi, PhD, said in a press release.
The Sequoia Project, the federally Recognized Coordinating Entity (RCE) for TEFCA management, is reviewing comments on a second version of TEFCA, which was unveiled last month. The group’s CEO and RCE lead, Mariann Yeager, said she expects the QHINs to begin implementing version 2 by the end of March.
“The most important thing for people to understand is that version 2.0 was revised to support FHIR-based exchange,” she told HealthLeaders in a recent interview. “There are new use cases to support healthcare operations and public health. The other thing is it does permit health systems that participate in TEFCA-based exchange to connect to multiple QHINS, to the extent that they support multiple data sources.”
TEFCA isn’t the only framework for health data exchange, but it does have the backing of the federal government and builds off of the expertise of the Sequoia Project. Each QHIN goes through a rigorous process to achieve the designation and must adhere to federal standards.
TEFCA actually become operational in December 2023, when the first five QHINS were announced.
UnityPoint Health is scaling its remote patient monitoring program out to new populations. Here’s its game plan for success.
For many health systems, remote patient monitoring (RPM) Is still a challenge. It’s not easy to find the right patient population, match those patients to the right devices, and develop a process that meets clinical goals and doesn’t put a strain on clinician workflows.
Health systems like UnityPoint Health are addressing those challenges by partnering with digital health companies who act as the middleman. The Iowa-based, three-state network has collaborated with HealthSnap over the past two years to build out RPM and chronic care management (CCM) programs that now collectively serve more than 25,000 patients through 94 primary care clinics and involving more than 400 physicians.
“Logistics are not something that healthcare organizations are typically good at,” says Dawn Welling, chief nursing officer at UnityPoint Clinic. By partnering with someone to handle the technology, she points out, the health system can focus on care management and clinical oversight.
Outsourcing the Tech
That strategy, of course, involves careful planning on the part of healthcare leadership. Executives have to balance the cost of outsourcing against the financial and clinical outcomes of the program.
“There is a financial play in this,” Welling says. While the short-term benefits, such as identifying unhealthy trends and reducing hospitalizations offer “bread-and-butter fee-for-service crisp ROI,” she says, the long-term benefits should also come into play, especially as the industry moves toward value-based care. A program that reduces hospitalizations now is great, but one that encourages healthier trends and cuts down the chance of many more healthcare events down the road is even better.
“Are we keeping people healthier?” she asks. “That takes longer to figure out. You definitely see fee-for-service [benefits] faster, but that’s not the only [measurable outcome.]”
Reimbursement is also important. The Centers for Medicare & Medicaid Services (CMS) has been slow in embracing RPM, which it calls remote physiological monitoring and remote therapeutic monitoring, but does offer some codes for Medicare coverage of data capture at home. Recently CMS expanded that coverage to include rural regions.
“That was big,” says Welling, who notes UnityPoint is moving quickly to expand its RPM program to rural communities in Iowa. “You have to have that up-front investment for those long-term gains I think we all know will come.”
Identifying the Right Tools for the Right Patients
CCM and RPM are in fact two different programs, each addressing a different patient population (though some patients are enrolled in both programs at the same time). CCM is more selective, focusing on patients with chronic health conditions and relying on a patient’s ability and willingness to manage their care at home. RPM, meanwhile, matches a patient’s health concern with a specific device aimed at tracking a key metric and relaying that data back to the care team.
According to Welling, UnityPoint developed its RPM program by creating a protocol to match patients with certain health concerns with a specific device that would be sent to them (unless they were using a device on their own). For patients living with more than one health concern, the clinician must choose what device that patient gets.
This process, she says, needs to be integrated with the patient flow process, so that patients get their devices at the appropriate time at home, along with whatever training is needed. Without that structure in place, patients could get their devices before they’re ready to use the technology, in some cases even affecting their willingness to use the devices.
“If you don’t do that well, you will frustrate your care teams,” she says.
Healthcare leaders also have to plan ahead for more complex patients. In some cases, Welling says, a physician could prescribe more than one device for a patient if the physician felt that strongly about multiple devices, even though Medicare reimbursement is limited to one device per patient.
“We didn’t automate that in any way, shape, or form,” she says. “There isn’t an algorithm for that. That is truly a physician and patient decision.”
That type of exception could become more commonplace as more patients present with multiple health concerns. Welling says this could also lead UnityPoint Health to develop more intricate and integrated RPM programs, adding resources such as behavioral health and home health care.
Episodic Vs. Continuous Care
Welling says it’s also important to understand how data from devices reflects a patient’s health. A single reading can capture a patient’s health at a specific moment, but it doesn’t accurately capture the patient’s continuous health journey. For that reason, the RPM program charts seven readings at the beginning of monitoring, allows some time for the patient to get used to the program, then captures seven more data points.
“It takes some time to get into [a] normal lifestyle,” she points out. And while that information is gathered by HealthSnap and included in quarterly reports, a physician can ask to look at a specific patient’s data at any time.
Understanding how that data is used goes a long way toward determining the ROI for an RPM program—and helping reluctant physicians buy into the program.
“This is not easy – it’s a big change,” she says. “Some [physicians] run towards it; they love it. Others see it as relinquishing control.”
And both physicians and patients have had concerns about having a technology vendor in the loop. Both are used to the concept of episodic care, where a patient visits a doctor for treatment, everything is done in that visit or in subsequent follow-ups, and that’s it. RPM, on the other hand, understands that a lot of healthcare happens outside the doctor’s office, with patients and doctors connecting via the device to keep patients on a care path.
Welling says the health system is still learning the intricacies of RPM, and that should be the strategy for the program that needs to adjust continuously to the ebb and flow of its patients. It’s important, she says, for the physicians in the program to know they can check on their patients at any time, guiding each patient rather than waiting for the next scheduled doctor’s visit. And patients in the program are encouraged by knowing that a care team is monitoring them, helping them get through the ups and downs of healthcare management.
She expects both the RPM and CCM programs to continue evolving. She also sees the platform branching out to address behavioral health concerns, which play a role in many care pathways. As well, the program could link in pharmacies.
“In time, we will think that what we’re doing before was just silly,” she says.
AI NOW panelists from Scripps Health and Providence say a health system needs to be up-front and transparent about how AI will be used, while making sure the resources are in place for educating staff and clinicians
Healthcare organizations need to establish a clear and transparent process for enterprise-wide AI governance. The first step is knowing whether you’re mature enough to use the technology.
That’s the opinion of executives from Scripps Health and Providence who participated in the recent HealthLeaders AI NOW summit. Both agreed that health system leadership needs to look at both culture and infrastructure before moving on to developing programs.
“This is truly a team sport,” said Shane Thielman, FACHE, CHCIO, corporate SVP and chief information officer at San Diego-based Scripps Health, who noted that leadership has to commit to open dialogue and transparency to not only educate staff and clinicians but keep patients and the public aware of how AI will be used.
And that conversation will be ongoing. It may even mean ending a program if the results just aren’t there yet and waiting for the technology to improve.
“This is not something that you turn on and then walk away to the next opportunity,” he said.
Sara Vaezy, EVP and chief strategy and digital officer at Seattle-based Providence, says health systems often have to start by surveying their staff and clinicians about what they want to know about AI, then creating specific resources to address those concerns. That might include creating a resource hub, work groups, and videos.
“Everyone’s getting their hands dirty,” she said, referencing the evolving nature of AI. “It’s a constant undertaking because so much is happening out in the market.”
She also noted that the hype around AI has taken on a life of its own, in some cases obscuring what health system leadership should be focusing on with the technology. Some AI models can drift away from what they were designed to accomplish, and leadership needs to “lean in with your hands on the wheel and make sure you’ve got the right processes and the right technology in place.”
Thielman said the analysis and decision-making need to be multidisciplinary, as AI extends into and affects many departments within the enterprise, from administrative to clinical to IT to security. All departments, he said, need to “understand what the lift will be to do that successfully.”
“There’s a significant element of change management that goes into introducing any AI solution,” he pointed out.
Aside from creating a culture around AI readiness, Thielman and Vaezy said health systems need to assess their infrastructure. Do they have the technology in place and the capacity at hand to support AI programs, which include data storage, quality, and analysis?
“Many organizations don’t necessarily have the capability or the capacity from a capital perspective to make investments,” Vaezy said. “Finding the right partners to build that out is a great way to extend that.”
Providence, for example, has partnered with Microsoft for more than eight years.
“If you don’t have a cloud structure, it’s going to be difficult,” she noted.
Thielman said data quality is an often-overlooked part of AI governance, especially with generative AI programs that require continuing oversight.
“If you have garbage data, it isn’t going to help you do much,” Vaezy added.
A key component of assessing AI maturity is understanding where the technology will be used. Too many organizations jump at what’s being called the “low-hanging fruit,” or programs that involve minimal effort and produce quick results, without planning ahead. Those early wins may be great for establishing a base and building morale, but a forward-thinking organization should be planning several steps ahead from the outset.
Thielman pointed out that early programs are tied to back-office and administrative gains and focus on financial improvement. But clinical outcomes need to be considered as well, as they usually take longer to prove value. Taking those into consideration at the start enables leadership to map out costs and outcomes over time.
“What’s the return on investment?” he asked. “That can have a financial element and it can also have a value element. As we explore AI further it is not only about a direct financial benefit … particularly if there is an up-front financial investment that is necessary. There are some other really intractable challenges … that we’re all interested in addressing.”
Vaezy noted that many technology projects “are worse before they get better,” and need time to settle in and show value. That’s especially true of AI.
“In some cases … with generative AI, frankly the solutions aren’t really ready for enterprise-grade adoption,” she said. “You don’t want some mission-critical function rely on something that’s a flash-in-the-pan.”
Finally, Thielman noted that health system leadership needs to pay attention to the ongoing debate over who should govern AI. The Biden Administration has unveiled its own strategy, with an emphasis on collaboration, but many within healthcare feel the reins should be in their hands.
“It is important that the autonomy continues to reside with healthcare systems relevant to AI that is not currently regulated today,” he said. “We don’t want to have an unintended consequence [or] a negative clinical outcome. We don’t want to place more burden on our clinical workforce. … We don’t want to introduce more inefficiency in our operations through the introduction of AI. … That level of decision-making should continue to be retained within the individual healthcare system.”
A new bill before Congress would create a pilot program to examine whether the Hospital at Home care model could be extended to other patient populations
Congress is wading into the question of whether the Hospital at Home model of care should be made permanent.
U.S. Senators Marco Rubio (R-Florida) and Tom Carper (D-Delaware) have introduced a bill that would set up a pilot program to test whether the Acute Hospital Care at Home initiative could be expanded to new populations beyond those needing acute care services.
The At Home Observation and Medical Evaluation (HOME) Services Act, if passed, would give the strategy some life beyond the planned December 31, 2024 expiration date for the Medicare waiver that supports the program.
“Addressing our healthcare challenges requires innovative solutions,” Rubio said in a joint press release issued yesterday. “The At HOME Services Act builds on the success of the hospital-at-home program to lower costs and burdens and improve patient outcomes and satisfaction.”
The bill adds a new wrinkle in the ongoing debate over whether the program should continue after this year.
The model targets patients who would otherwise be admitted to the hospital, creating a home-based care management plan that includes often-multiple daily visits by care teams, virtual care services and remote patient monitoring. Some programs have added ancillary services to address social determinants of health, imaging and tests, and pharmacy and rehab needs.
While acute care at home programs have been in existence in some form for several years, the Hospital at Home concept took off during the pandemic, when health systems and hospitals were struggling to keep up with the wave of new patients and were looking for ways to treat certain patients at home. The Centers for Medicare & Medicaid Services (CMS) established a waiver that enables Medicare reimbursement for health systems following the CMS model, which sets rigid guidelines for in-person visits and digital health and telehealth use. The waiver was due to end with the Public Health Emergency (PHE), but has been extended until the end of this year.
Supporters, including an advocacy group formed out of several of the more than 300 hospitals using the CMS model, are lobbying both CMS and Congress to make the Medicare waiver permanent, arguing that many programs would struggle or even shut down without Medicare support. They also point to a recent nationwide study that shows positive clinical outcomes in the Hospital at Home model.
On a related front, New Jersey recently passed a law that enables Garden State health systems to expand the Hospital at Home program to residents on Medicaid or NJ Family Care programs, as well as those on private insurance.
“We are excited to see Hospital at Home expand in New Jersey through this legislation, and we believe our state can serve as a template for the rest of the country,” Michael Capriotti, MBA, senior vice president of integration and strategic operations for New Jersey-based Virtua Health, told local media after the law went into effect. “It is important that we continually innovate to create the best possible experiences and outcomes for our patients.”
Health systems and hospitals are using more and more new technology to address clinical care gaps. That puts a strain on execs charged with making sure they’re safe and secure
Healthcare cybersecurity standards need to be strict for a reason: Compromised technology could lead to a patient’s harm, even death. But when a health system uses technology from a vendor, sometimes those standards aren’t the same.
“That’s a challenge,” says Adam Zoller, chief information security officer at Providence.
“As a large hospital system, we are relying on hundreds of third parties,” he says. “And when some of those devices are 100% vendor-managed, they often won’t modify anything,” making it much harder for the health system to ensure that technology can be used safely and securely.
“Cyber incidents affecting hospitals and health systems have led to extended care disruptions caused by multi-week outages; patient diversion to other facilities; and strain on acute care provisioning and capacity, causing cancelled medical appointments, non-rendered services, and delayed medical procedures (particularly elective procedures),” the HHS report, issued in December 2023, noted. “More importantly, they put patients’ safety at risk and impact local and surrounding communities that depend on the availability of the local emergency department, radiology unit, or cancer center for life-saving care.”
Zoller has nothing but good things to say about the federal government’s efforts to improve cybersecurity, particularly in elevating the responsibilities of the National Institute of Standards and Technology (NIST). And while many vendors in the clinical space are taking steps to better secure their technology, the rapid advance of AI and digital health is prompting health systems and hospitals to partner with companies outside the healthcare industry—companies with different philosophies around security.
“There needs to be more accountability,” he says.
Health systems like Providence spend a lot of time addressing cybersecurity through these devices—even when the vendor isn’t responsive to making changes on their end. Those are time-and labor-intensive projects that a smaller hospital or health system might struggle to accomplish, and which could be avoided if the organization and vendor could just work together.
This is an issue that has plagued healthcare for years. The gradual advance to consumer-facing care and the introduction of consumer-facing technologies and strategies has created a gap between those devices and clinically validated technology. In other words, health systems and hospitals have been looking at the consumer tech space with an eye toward expanding healthcare opportunities, but they’re wary of the value of the data coming from these devices as well as the safeguards in place to protect that data.
For Zoller, those gaps exist in any technology using commercial operating systems. Clinical technology, he says, is designed for a longer life-cycle, while commercial tech operates on shorter life-cycles and relies more heavily on updates and patches (which also add to the revenue stream). But each of those updates and patches represents another security risk that healthcare organizations have to address before those changes can go live.
“If I’m still having to educate the vendors who produce these devices about security [every time there’s an update}, that’s a real problem,” says Zoller.
Now multiply that by the number of vendors are large hospital system like Providence works with, and the problems become even bigger.
“We are very dependent on those third parties,” Zoller says, “so the biggest challenge for me is in managing third party risk at scale.”
To be clear, this is an industry issue, not just a Providence issue. The American Hospital Association has been advocating for better cybersecurity safeguards for this party vendors for years, and large health systems like Providence are a part of that effort. But Zoller notes his voice is one of many, and while the big guys have the resources to manage multiple third-party partnerships, smaller health systems and hospitals are stretched thin and apt to have more issues.
Likewise, with the evolution of smart devices and the smart home and an increase in remote patient monitoring and acute care at home programs, “the complexity you’re introducing to a healthcare ecosystem increases the risks,” Zoller adds.
He says healthcare organizations “are on the receiving end” of more and more technologies that don’t meet clinical cybersecurity standards because the industry is embracing new tools and concepts that have proven themselves in other markets, like retail. What might be a great new platform that boosts clinical care in the home setting might also be a security nightmare.
Zoller wants the federal government to extend its cybersecurity guidelines to vendors in the healthcare space who manage their products on commercial operating systems, to bring them to the table to discuss with healthcare organizations how their technology can better adhere to clinical cybersecurity standards. He says the new HHS cybersecurity guidelines set a good baseline that health systems and hospitals can use when working with vendors.
“We need to look at where the equities are aligned,” he says. “It is great that we’re beginning to see more of these conversations around security … but more needs to be done.”
The introduction of disruptors into the healthcare industry could have an effect as well. Companies like Amazon, Google, Apple and Microsoft are introducing healthcare services and products that aim to give consumers a choice as to where and how they get their healthcare. Given those options, consumers could look for services and platforms that better protect their data.
“The disruptors in this space could see security as a differentiator,” he says. “That could certainly make a difference.”
