Healthcare organizations have to look beyond the money and focus on culture and innovation to bolster the workforce, said panelists at this week’s HealthIMPACT Forum
To take on workforce shortages across the enterprise, healthcare organizations have to be innovative. And that means looking past the money.
“We can’t get into a bidding war,” said Kirk Larson, Aspirus Health’s Chief Technology Officer, noting the Wisconsin-based health system can’t match IT salaries offered by the likes of Microsoft, Amazon, and Apple.
And it’s not just IT talent that health systems are struggling to find. Mike Mosquito, CHCIO, MBA, PMP, CDH-E, who heads emerging technology & innovation special projects for the Northeast Georgia Health System, said he has to be creative to draw doctors and nurses from the more affluent Atlanta area to the south.
The two healthcare executives were part of a panel titled “Solving Your Clinical Talent Shortage” at this week’s HealthIMPACT Forum in New York City. Their discussion hit on a topic familiar to every health system and hospital: Trying to keep the employees you have and create an environment to attract new employees.
The challenge lies in making healthcare an attractive career decision beyond the thorny issue of pay. And that means adding perks that appeal to employees seeking a better work-life balance and a good work environment, such as work-from-home opportunities, child and senior care benefits, and of course better workflows.
Healthcare innovation plays a significant role in that strategy. Health systems and hospitals are using virtual care and digital health tools to improve those workflows, aiming to reduce stress and burnout in the workforce and enable doctors and nurses to work at the top of their license—in other words, in front of patients rather than in front of a computer. Some health systems are using virtual care as a hiring perk, with the idea that clinicians can on occasion work from home and senior staff can virtually mentor young recruits and work from a desktop in a telemedicine command center.
Just as important, the panelists said, are collaborations between healthcare organizations and academic institutions. At the college level, health systems need to actively support healthcare curricula and create opportunities for students to experience what they’re studying to become, from job-shadowing to internships.
That effort should extend into high school as well.
“Help [students] understand where the jobs are,” said Larson, referencing programs that highlight the culture and responsibility of the healthcare industry and the opportunities to apply for positions that are open. He and the other panelists also suggested an easier process for students to apply for jobs—like a blue button for healthcare.
“Don’t always have a money grab,” added Mosquito, noting that some of the coolest, most innovative technology—like robots—is also being used in healthcare.
The panel, which included Sandra Bossi, Senior Director of Clinical Operations Administration at LiveOnNY and moderator Shahid Shah, chairman of the HealthIMPACT Forum, stressed that healthcare organizations need to “speak the language” of today’s emerging workforce.
“You’ve got to attract the kids [and help them to see] this is the path for you,” Mosquito said. “Not everyone’s going to be a TikTok millionaire.”
The University of South Carolina is launching a remote patient monitoring program aimed at reducing the state’s high maternal mortality rate of 32.7 deaths per 100,000 births
The University of South Carolina is launching a remote patient monitoring program aimed to improve care management for new mothers and their children.
The university is partnering with digital health company Rimidi to launch the program through an affiliated multispecialty clinic. Funded by The Duke Endowment, the platform will help care providers monitor blood pressure for patients in underserved communities following a high-risk pregnancy.
“Our partnership with Rimidi aims to address a critical maternal health challenge in South Carolina – reducing complications from postpartum hypertension,” Nansi Boghossian, an Associate Professor at the University of South Carolina who is spearheading the RPM program, said in a press release. “Through this collaboration, we are committed to improving patient care and enhancing the health of mothers in underserved communities.”
The program aims to tackle South Carolina’s high maternal mortality rate, which a recent report put at 32.7 maternal deaths per 100,000 births, by addressing key health concerns like preeclampsia, gestational hypertension, and chronic hypertension. That’s a high rate in a country whose 2022 maternal mortality rate of 22.3 deaths per 100,000 live births is one of the worst of all developed nations.
Through the health system’s Epic EHR, care teams will focus on metrics like blood pressure ascertainment during the first six weeks postpartum, in-person postpartum visit attendance, hospital readmissions through 12 months postpartum, program acceptability, retention, satisfaction, and cost-effectiveness.
RPM platforms give care providers an opportunity to monitor patients after they leave the hospital, clinic, or doctor’s office. By using connected devices to gather data from patients at home, they can spot trends, adjust care management plans, and even intervene if a patient is showing signs of developing a serious health concern.
A new study aims to replace BMI with BRI, giving care providers a better way to measure a patient’s fat content
Could a new measurement of obesity replace BMI and give healthcare providers a more accurate representation of their patients’ weight issues?
A new study published this month in JAMA, co-authored by researchers from China and Brown University in Providence, Rhode Island, makes the argument for what is called the body roundness index, or BRI. Whereas BMI, or body mass index, measures a person’s height and weight, BRI adds in waist circumference to gain a better understanding of where fat is distributed on the body.
The difference could affect how providers develop innovative programs to address obesity and other weight-related health concerns. With a better idea of how a body is proportioned and where fat is located, providers can develop better treatments and gain a better idea of those programs’ effectiveness.
It’s a key element to care management at a time when obesity and weight-related issues are a popular topic of conversation. From the effect that weight has on chronic diseases like diabetes, asthma, and heart disease to the popularity of Ozempic and Wegovy, both consumers and their care providers are keenly interested in how to address excess body fat.
BMI has been considered the standard for body fat measurement since the 1980s, but critics have long questioned whether it’s an accurate assessment, since it doesn’t take into account organs, bone, muscle and water. The JAMA study takes this one step further, arguing that providers need a better measurement “to decipher population-based characteristics and potential association with mortality risk.”
“Besides weight and height, BRI additionally considers waist circumference, and hence it can more comprehensively reflect visceral fat distribution,” the study’s authors note. “BRI was found to be superior over other anthropometric indicators in estimating the risk for various clinical end points, including cardiometabolic disease, kidney disease, and cancer. Furthermore, longitudinal studies have shown that high BRI was associated with the significantly increased risk of all-cause mortality and cardiovascular disease-specific mortality.”
The study, using data from almost 33,000 U.S. adults taken from the National Health and Nutrition Examination Survey (NHANES) and NHANES Linked Mortality File, compared a person’s all-cause mortality risk based on BMI and BRI, and found BRI to be more accurate. This was especially true for muscular people and the elderly, who tend to have inaccurate BMI measurements because of their body shape.
Those findings, the authors said, “provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”
A report issued earlier this year by the Bipartisan Policy Center offers a blueprint for expanding remote patient monitoring opportunities and coverage
Remote patient monitoring (RPM) has the potential to improve clinical outcomes by giving providers the ability to improve care management outside the hospital or doctor’s office, but its growth is being stymied by low reimbursement.
A report released earlier this year by the Bipartisan Policy Center gives the government and the healthcare industry a blueprint to address that roadblock.
While RPM has seen tremendous growth coming out of the pandemic, its future is in question. The Centers for Medicare & Medicaid Services (CMS) offers only a handful of CPT codes for remote physiological monitoring and remote therapeutic monitoring, enabling care providers to recoup, according to one study, as much as $170 per patient per month from Medicare. To make matters worse, the American Medical Association’s CPT Editorial Panel, which governs CPT codes, has hit a roadblock on new codes that would expand reimbursement opportunities.
The reimbursement issue could prompt healthcare organizations to avoid launching or expanding RPM programs, figuring the effort to support the program is too much for the amount of money that would come back in.
To improve the playing field, the Bipartisan Policy Center report lists five recommendations for service coverage:
CMS should work with medical specialty societies to evaluate the evidence and determine appropriate coverage mechanisms to guide the optimal use of RPM, including for which patients and over what duration. This work could include collaborating with Medicare Administrative Contractors (MACs) or issuing National Coverage Determinations (NCDs).
As more evidence emerges about the appropriate use of RPM devices, the Health and Human Services Secretary should recommend a diverse set of billing codes so providers have more options for the time they spend on the data and the number of minimum days of data required.
CMS should clarify current policies regarding appropriate coding and billing of RPM and RTM. It should also require providers not enrolled in risk-based models to attest to medical necessity for patients’ continued use of remote monitoring—at a frequency deemed appropriate by the HHS secretary and based on condition-specific clinical guidelines.
CMS should work with the AMA and relevant medical specialty societies to develop additional RTM billing codes to allow for use cases beyond musculoskeletal, respiratory, and cognitive behavioral therapy—as the evidence supports.
Congress should request the Medicare Payment Advisory Commission (MedPAC) to report on the impact of remote monitoring on clinical outcomes and cost by disease state, and on any new billing thresholds or code durations, at least every three years.
The goal of these recommendations is to move the needle forward on RPM and give more healthcare organizations—especially smaller hospitals and health systems with limited resources and those working with underserved populations—a chance to expand their reach.
At the HealthLeaders Virtual Nursing Mastermind event this week in Atlanta, healthcare leaders discussed the KPIs they're measuring to prove ROI.
Healthcare executives are embracing innovative ideas like virtual care to stabilize a shrinking nursing workforce and boost clinical outcomes, but they need to know what to measure to prove ROI.
Virtual nursing programs are becoming popular in health systems across the country, either as a stand-alone program or, more commonly, as one part of a more comprehensive reimagining of care. And while each health system or hospital is advancing its own strategy, there are common objectives, such as nursing turnover and well-being, administrative tasks, and patient engagement.
Executives from a dozen health systems met in Atlanta this week for the HealthLeaders Virtual Nursing Mastermind program, in a forum to establish common goals, challenges, and successes. The program, which included three virtual roundtables, established a number of key metrics that executives are focusing on as they evaluate their virtual nursing strategies.
Staff turnover and well-being. The initial impetus for many health systems in launching virtual nursing programs is to address a shrinking workforce. Nursing executives are looking for ways to not only reduce turnover, but improve the environment so that nurses want to stay (and others want to join in). Virtual nursing programs create new opportunities for the workforce while revising workloads so that floor nurses are doing less administrative work and spending more time doing what they trained to do: spend time with patients.
While the trurnover rate is a key metric, others include nurse satisfaction (measured in surveys) and time spent on the computer, usually tracked through the EHR platform. While these metrics often are difficult to translate into dollars, Clair Lunt, RN, DHSc, Senior Director of Nursing Informatics at New York’s Mount Sinai Health System, noted they’re seeing a decline in the use of travel nurses and overtime, as well as PTO and even sick time (such as so-called mental health days), all of which significantly affect the bottom line.
The results aren’t limited to nurses, either. Providence is one of seeing a reduction in all-staff turnover, according to Sherene Schlegel, RN, BSN, COO and CNO of Virtual Care and Digital Health. These programs can thus impact all members of the care team, including CNAs and physicians.
As these programs involve, the executives in the Mastermind class noted that virtual nursing can be used as a marketing tool to attract new talent, especially as programs grow to include work-at-home policies.
Patient satisfaction. With the industry’s gradual shift to value-based care, health systems are placing more emphasis on patient experience—and a virtual nursing program can have a profound impact on how a patient feels about the care they receive. Most health systems see these effects in their HCAHPS scores, and some are even tailoring patient surveys to include specific questions on patient interactions with nurses.
It's important to remember that patient satisfaction and engagement do factor into an effective care management plan. Engaged patients are more likely to communicate freely with their nurses, listen to their care teams and adhere to those plans—something that can be measured in medication adherence.
To see those high patient satisfaction scores, health systems need to make sure patients are comfortable with virtual care, including the idea of having a camera in the room, trained on them. Mastermind participants recommended engaging with the patients as soon as they’re settled in their rooms to explain the technology and its uses, as well as designing the technology so that patients know when the camera is off.
Sara Pletcher, MD, MHCDS, SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, pointed out that patients need to understand that virtual care is a routine standard of care, and not an add-on or a luxury. She noted that Houston Methodist now includes virtual care monitoring as part of its consent form, rather than as a separate opt-out.
Patient Throughput. Many health systems are embracing virtual nursing to address patient admission and discharge times, and consequently patient length of stay, all key metrics. But those processes are often complex, involving more than just nurses.
Emily Warr, Administrator of the Center for Telehealth at the Medical University of South Carolina (MUSC), noted that patient discharge is a key pain point in healthcare, one that affects patient satisfaction as well as clinical outcomes, and health systems like Intermountain have a benchmark of three hours from the time a discharge notice is entered to when the patient leaves the hospital. A virtual nursing program is then designed to reduce that time by having a virtual nurse handle as much of the administrative details as possible, including patient education, while the floor nurse manages in-person care duties.
The upshot is that a virtual nurse can oversee those details that a floor nurse would have had to do, reducing time spent and helping the patient get home faster. The same could be said for getting a patient settled into his or her hospital room, with the virtual nurse handling data entry and the floor nurse making sure the patient is comfortable. Both of those processes, as well as any data entry during the patient’s stay, contribute to the overall PLOS.
Again, healthcare executives need to understand that these metrics involve much more than just the nursing department, and that one aspect like virtual nursing won’t necessarily move the needle to a large degree. But incremental improvements are just as important, and for health systems engaged in a redesign of the entire care process, this is one vital step in that evolution.
Administrative tasks. Aside from handling admission and discharge processes, a virtual nursing program can also take on most, if not all, tasks which involve putting a floor nurse in front of a computer (a pain point noted in nurse well-being measurements). This could range from virtual rounding to physician visits to surveys for ancillary programs like sepsis detection, wound care, or medication adherence.
Health system executives can measure success here in accuracy of data entry, or in time taken to complete a task. Some executives have noted that floor nurses are often so busy they fail to do all the data entry and paperwork they should be doing. The end result is that care management is more efficient, and in turn leads to better outcomes.
Additionally, in a separate interview, Warr noted that after a while, floor nurses and virtual nurses in their program were so adept at working together that they could handle tasks without stopping to let the other person know. They also felt comfortable jumping in when needed and helping each other with tasks.
A key to success here is the relationship between the virtual nurse and the floor nurse. Health systems must establish clear protocols for both nurses before launching a program, so that each nurse knows their responsibilities. A good collaboration will be seen in efficient documentation, timely care delivery, and nurse satisfaction.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The new simulation lab will use new technologies and interactive labs to train healthcare workers on care management for pregnant women and their children
The Stanford Medicine Children’s Health Simulation Innovation Center will use AR, digital health-enabled mannequins, and other tools and technology to give healthcare workers a more hands-on education on a wide variety of health concerns, from difficult births to neonatal care.
“The Innovation Center is … a tool for enhancing care delivery, research, and quality improvement initiatives,” Kristine Taylor, DNP, executive director of the Innovation Center and Center for Professional Excellence and Inquiry, said in a press release. “By analyzing simulation data and outcomes, healthcare teams can identify areas for improvement and implement evidence-based practices to enhance patient care.”
The 4,900-square-foot center is one of several innovative projects being launched across the country to address the nation’s high maternal mortality rate and significant care gaps in children’s health. The maternal mortality rate in 2022 was 22.3 deaths per 100,000 live births, according to the U.S. Centers for Disease Control and Prevention; that’s down compared with 32.9 per 100,000 in 2021, during the height of the pandemic, but still high compared to other developed nations.
Healthcare leaders at Stanford Children’s say the new center and technology will help train healthcare workers of all levels, even social workers, in an interactive learning environment that includes debriefing rooms, where they can go over what they’ve learned and discuss new ways of delivering care.
“We are able to enhance our critical thinking, decision-making, and communication skills, ultimately improving patient care outcomes without putting actual patients at risk,” Emily Tomich, RN, a triage nurse and labor and delivery nurse educator, said in the press release. “This is especially important in high-stress situations where clear communication is critical, from basic procedures to complex surgical techniques.”
Gerard Phillips, the health system’s Senior Director of Nursing, explains in this week’s HealthLeaders podcast how UCSD Health is improving patient safety--and where they expect to use the technology next
UC San Diego Health has avoided more than $10 million in healthcare costs since adding remote video monitoring to its telesitting program in 2012.
In this week’s HealthLeaders podcast, Gerard Phillips, DNP, MBA, RN, the health system’s Senior Director of Nursing, says the bidirectional cameras placed in patient rooms enable specially trained video monitoring technicians to monitor patients and communicate with them around the clock.
The 24/7 monitoring program is designed for patients deemed at risk of falling, wandering, or causing harm to themselves by pulling out attached lines and tubes. The health system now has 30 cart-based cameras stationed across five healthcare sites, monitored by three technicians, who are trained CNAs, at a central video monitoring hub.
Phillips says the program not only has allowed UCSD to “maintain a higher level of safety [for] our patients,” but enabled the health system to use those savings to invest in other areas of the organization.
He also says UCSD envisions using remote video monitoring in a number of areas, including virtual nursing, staff safety and home-based care management. And they’re embedding AI technology into the cameras to help monitors spot visual cues of signs of concern with patients.
Listen to Phillips and learn how the health system is making the most out of its virtual telesiting program here.
The nations largest retailer by number of stores is ending a partnership launched in 2022 with DocGo. Here's what it means.
Another healthcare disruptor is abandoning its mobile health plans.
Dollar General, the nation’s largest retailer by number of locations, and digital health provider DocGo have reportedly ended their partnership, ending a two-year-old program that sought to place mobile clinics in select Dolar General stores across the country.
The two joined forces in the fall of 2022 to target persistent health inequalities, particularly in rural America, where some 80% of Dollar General stores are located. The mobile clinics, offering urgent and primary care services, charged $69 for self-paying customers and accepted Medicare, Medicaid, and private insurance.
According to news reports, the two companies mutually agreed to part ways.
The announcement rings a familiar tune in the direct-to-consumer healthcare market, where disruptors have been trying to compete with healthcare providers. Walmart recently announced plans to close all 51 of its health centers and shutter its virtual care business, while Walgreens is closing more than 100 of its VillageMD clinics and CVS is seeking private equity funding to prop up its Oak Street Health primary care clinics.
The lesson to be learned is that healthcare—especially for-profit primary care--is hard, especially for those outside the industry who think they have better ideas of how it should be run.
Automakers are applying the smart home concept to the automobile, with plans to include sensors that can track a driver’s physical and mental health
The next healthcare access point for providers could be the car.
General Motors is seeking a patent for technology inside the automobile that tracks a driver’s behavior and health through sensors, according to Autoblog.com. The technology could help to identify drivers who are impaired or affected by a wide range of health concerns, ranging from drugs and alcohol to issues with mental acuity, breathing, blood pressure, or blood sugar.
The company’s plans, which have been ongoing since at least 2022, are to create a tech platform inside the car that establishes a profile of the driver’s habits, called a “vehicle occupant mental well-being assessment.” The platform would then identify any trends that fall outside the norm and use “counter-measure deployment,” which would range from asking the driver to perform a “mental health exercise,” calling family members or a trained professional, or even taking control of the car.
The idea isn’t exactly new. Automotive displays at CES in Las Vegas have for many years hinted at or even featured prototype sensors and technology aimed at tracking the driver’s health. Cars can now be fitted with technology that prevents a driver under the influence of alcohol from starting the car.
The effort has ties to the remote patient monitoring movement, in which healthcare providers are looking to track patients and provide on-demand services outside the hospital, clinic or doctor’s office. And with programs like Lake Nona’s WHIT House in Florida targeting smart home concepts, automakers are aiming to do the same thing with their newest vehicles.
Aside from tracking people with substance abuse issues, healthcare providers and public health advocates say the technology could address accidents each year linked to driver distress, such as mental health issues, blood pressure, diabetes, cardiac issues, even allergic reactions. While those accidents only represent about 2% of all crashes in the U.S. each year, according to data compiled by the U.S. Department of Transportation, 84% of those are caused by medical emergencies that could potentially be detected and prevented.
Ideally, the technology might someday be used to identify hazards to drivers, like smog or high pollen counts for people with respiratory issues, or direct (or even steer) drivers to a nearby healthcare site in an emergency.
Several carmakers are giving health and wellness tools a serious look. In the past few years Mazda, Audi, and Toyota have said they are working on next-generation cars armed with a wide variety of sensors, including ECG sensors in the steering wheel and earpieces designed to measure a driver’s impairment.
And back in 2011, the Ford Motor Company announced partnerships with digital health companies WellDoc, Medtronic, and SDI Health to include health and wellness connectivity solutions on the Ford SYNC platform.
“We want to broaden the paradigm, transforming SYNC into a tool that can improve people’s lives as well as the driving experience,” Paul Mascarenas, chief technology and vice president of Ford Research and Innovation, said in a May 2011 press release.
The company also announced plans to embed sensors in the seats to monitor a person’s heart rate, though by 2015 the company had ditched those plans. And while the latest SYNC platform offers integration with apps, no mention is made of health and wellness monitoring.
In many cases, automakers have abandoned these plans on the idea that wearables would do a much better job monitoring drivers, as well as passengers. But the fact that GM is taking an active look at the technology means they haven’t given up on the idea.
As health systems shift more care services to the patient's home, they're looking at drones to solve key supply chain challenges
Health systems and hospitals are turning to drones to address supply chain care gaps—including challenges that both providers and patients face in accessing drugs and other medical supplies.
In the latest example, the Mayo Clinic has announced a partnership with Zipline to integrate drone deliveries into its Advanced Care at Home program. The deal aims to improve care management for the home-based acute care program by giving providers quick access to medical supplies. Mass General Brigham unveiled similar plans in January when it announced a partnership with Canadian drone company Draganfly.
Just last month, Houston’s Memorial Hermann Health System announced a partnership with Zipline to deliver specialty prescriptions and medical supplies to patients’ homes beginning in 2026.
“As a system, we are continuously seeking ways to improve the patient experience and bring greater health and value to the communities we serve,” Alec King, Memorial Hermann’s executive vice president and chief financial officer, said in a press release. “Zipline provides an innovative solution to helping our patients access the medications they need, quickly and conveniently, at no added cost to them.”
Drones have been on the fringe of the healthcare space for several years, usually showing up in small pilot programs aimed at improving delivery of time-sensitive supplies between two health system sites or from a health system to a patient’s home and vice versa. The use case aims to address delays or slow deliveries caused by geography, weather, traffic, or transportation issues as well as giving patients access to tests, medicine, and vaccines in their homes rather than making them travel to a hospital or clinic.
In January, Axios called 2024 a “breakout year for delivery drones,” noting that the Federal Aviation Administration eased the rules last fall to allow some companies to fly drones beyond the visual lines of sight, called BVLOS. That opened the door to companies like Zipline, Amazon, and Wing (part of the Alphabet stable) expanding their services. The FAA is expected to create standards for BVLOS operations in the near future.
The Mass General Brigham and Mayo Clinic programs represent a different use case. Both health systems plan to use drones to transport medical supplies to and from the homes of patients in acute hospital at home programs. Those programs, which have gained traction since the pandemic, require hospitals to combine digital health and telehealth services with in-person care for patients in their homes, as an alternative to in-patient care.
The complexity of the program might mean that drones would be used almost every day to send medical supplies to the patient’s home and/or transport tests and specimens from the home back to the hospital.
“At Mass General Brigham, we are looking at the future of healthcare, and part of that vision is taking care of patients in the comfort of their homes,” David Levine, MD, MPH, MA, clinical director of research and development for the Mass General Brigham Healthcare at Home program, said in a press release. “In accomplishing this at scale, we understand that we need to continue to evolve our processes to support home-based care. These types of technological solutions allow us the opportunity to create a paradigm shift in our care delivery.”
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