Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

A family physician offers three case studies in virtual primary care

The New House Call?

In Our Podcast, Sundar Kamak Shares How Technology Can Help

Curing Supply Chain Woes

Health systems using telemedicine often measure patient satisfaction with the service but are less likely to measure the accuracy of a diagnosis, according to an issue brief from the Society to Improve Diagnosis in Medicine (SIDM).

SIDM conducted a series of interviews with hospitals, health systems, and clinical practices as part of its TeleDx project. The interviews and a literature review identified a gap in the health system’s understanding of telemedicine. Approximately one in 10 diagnoses are incorrect, which affects more than 12 million Americans each year.

As the use of telemedicine drastically increased during the pandemic, it is crucial to understand how telediagnosis impacts diagnostic quality and safety, according to SIDM.

“We found that telediagnosis has potential, although there is still much to learn about how virtual diagnosis can be done most effectively,” Suz Schrandt, JD, senior patient engagement advisor at SIDM and principal investigator on the project, 

. “We found that many patients like the convenience of telemedicine, but we also need more research into who is being left behind in the process, such as small practices or people without access to high-speed internet.”

Before the pandemic, telemedicine was a niche resource, but it has become a mainstay for healthcare delivery. Most research on telemedicine focuses on maintenance of health, according to the report, but telediagnosis at the current scale it’s being used to less researched.

The findings focused on five key aspects of novel implementations: reach, effectiveness, adoption, implementation, and maintenance.

 Both the literature and the interviews clearly showed telemedicine for diagnosis had rapid uptake over the course of a few months. Patients felt like to transition to telemedicine was seamless, but health systems, hospitals, and providers reported it being more stressful.

“Interestingly, in our patient listening sessions, no clear patient ‘prototype’ materialized as the most or least likely to use and benefit from telemedicine; stereotypical assumptions about age and concordant technical savvy did not fully pan out, with some clinicians sharing that many older patients were particularly engaged users,” according to the report.

 The evidence on telediagnosis is mixed and limited, based on the literature review. In the interviews, both patients and providers noted the convenience of telediagnosis, and they also reported a better connection since providers were looking at the computer, and thus at the patient.

“One challenge that emerged within each stakeholder group was the difficulty in measuring or evaluating the true impact of telemedicine on quality and safety, and this remains the key research question that needs to be addressed.”

 There were many accommodations, from state regulations to CMS changes, that led to the uptake and adoption of telemedicine. Even after the pandemic, stakeholders believe there will remain a hybrid model of care, according to the interviews. While hospitals, health systems, and providers largely agreed on adopting telemedicine, resources and capacity differed across the stakeholders.

“Larger systems and clinics with already-dedicated IT teams were able to move more quickly and expansively; smaller clinics and solo practitioners often fended for themselves,” according to the report.

 Policy issues have been the key barriers to implementing telemedicine, and the literature review also found clinicians struggled with pivoting because of the inability to perform a physical exam. In the interviews, some providers explained that they had developed workarounds to not being able to perform the physical, in-person exam.

An important question being considered is when a patient must be seen in person and when they can be seen virtually. Providers had clear examples on either end of the spectrum, but a lot of gray area in the middle, while patients felt familiar symptoms and simple issues could be kept virtual with something new or different prompting an in-person visit.

 There seems to be a desire to continue using telemedicine in some capacity, but questions around the long-term use and sustainability remain, according to the literature. Even clinicians hesitant about the use of telediagnosis said there is a place for virtual care.

“Much, if not all of the future direction of telemedicine rests on the regulatory, legal, and reimbursement landscape,” the report said.

At the beginning of the pandemic, the quick shift to virtual care was necessary. But as the pandemic wears on and people begin to look toward a future after the pandemic, there are questions about the viability of telediagnosis and how to continue utilizing it, according to the report.

“Overall, research priorities regarding the effectiveness of telediagnosis must focus on what symptoms require in-person assessments; what the right mix of in-person and virtual care looks like; who is being left behind in the expansion of virtual care; and what determines success or failure in telediagnosis,” said Mark Graber, MD, FACP, founder and president emeritus of SIDM, and co-author of the issue brief.

Articles

Telemedicine for diagnosis scaled up dramatically as a result of the pandemic, but there isn’t much known about the impact on diagnostic quality and safety.

Does Telemedicine for Diagnosis Have a Place in Healthcare?

As the COVID-19 global pandemic continues, access to personal protective equipment (PPE) remains important for both the general public and healthcare workers. However, the vaccines are an important layer of protection against the vaccine. The Biden administration’s 

 that healthcare workers at facilities receiving Medicare and Medicaid get vaccinated has been praised by many in the healthcare industry, but there are worries such a mandate could exacerbate the current workforce shortage.

Chief Healthcare Executive (CHE) recently spoke with Roman Vinfield, chief revenue officer of WeShield about the importance of PPE, vaccine mandates and healthcare workforce shortages all amid the surge of COVID-19 cases due to the Delta variant.

Editor’s note: this interview has been edited for clarity

Roman, tell me a little bit about yourself and the company that you work for?

I'm the chief Revenue Officer for WeShield. WeShield is a company that we started, my partners and I started, during COVID. Both of our businesses closed. We're out in the New York, New Jersey area. And so, we started donating and helping in the tri-state area. We went ahead and started to help first with masks…and then it just kind of spiraled and grew and turned into a medical supply company.

We were ranked 53rd fastest growing company in the United States last year by Inc 5000. And so we were acquired by Optec International…earlier this summer. And yeah, our goal is to help stop the spread of COVID-19….So, we have Wellstar, which is a major hospital chain, Quest Diagnostics, Gap, Gucci, Caesars, and the Defense Logistics Agency. Those are some of our customers.

Now we have vaccines, but even with the vaccines, what is the role that PPE will continue to play in healthcare settings as the COVID-19 pandemic continues?

I think that's a question that a lot of people are asking. You know, unfortunately, and probably, as a surprise to a lot of people — probably not as a surprise to the immunologist community and a lot of doctors — this virus continues to evolve. And whereas the vaccine is 90 some odd percent effective against the original COVID-19 variant, the Delta variant, according to different studies — from Israel, they saw only 40% protection, and in the United States, somewhere in the 60% to 75% range, which creates penetration and breakthrough cases.

So, the vaccines we have are no silver bullet. Although, it's a miracle that we were able to develop them so quickly and so safely and with the efficacy that they have, the vaccines, unfortunately, don't kill the virus. What we're seeing is they prevent you from getting really sick and going to the hospital and dying. And so, in that environment, the virus continues to evolve. Unfortunately, you have to still have the PPE — the masks, the gloves, you know, whatever the case, depending on what you're looking to do, to prevent as much as possible of the virus getting to the person and from diminishing the viral load that you get if you're not protected.

As the science of how COVID-19 spreads improves, as we get to understand a little more, what do we learn about how much he what types of PPE needs to be worn?

So, I think masks are obviously, something that's mandatory. Also, depending on where you are, with masks, if you're in more of a medical scenario, you definitely want an N95 or a KN95. If you are in an everyday environment, I think that the three plies are probably your best bet. The cloth masks: people wear them, and they're better than nothing, but they really let a lot of droplets through, and it's definitely not ideal if you're looking for real protection. So, N95 is definitely the way to go, if you're in a kind of target-rich environment. And then other than that, I would say, three ply.

 How do hospitals work with like a company like yours to make sure that they keep the right level of supply on hand and avoid shortages?

We help numerous organizations and what happened was, we were born out of the supply chain really breaking down to the demand spiking. And so, we were able to be a lot more agile and purchase and acquire goods, both from United States manufacturers—people that had goods on the ground—and then also manufacturers out of China and Thailand.

There’s obviously medical supply companies like Cardinal, McKesson, etc, and so, we positioned ourselves where we are a secondary supplier, and we make sure that they have, you know, somebody to turn to, almost like an insurance policy, right? And what we saw the first time around is that the days of, “Well, I go on McKesson’s website and order stuff,” now it’s a “Fool me once, shame on you; fool me twice, shame on me” type of situation. So, that's where, we come in to make sure that you have a reliable source that was there reliably and was able to execute during the toughest times.

The Delta variant kind of showed it again, and now people really understand that having a secondary supplier is a must. In the beginning you had people saying, “Well it kind of happened once, but now they're back.” And now they see that that's just not a strategy. We had hospitals out of Florida, cancer hospitals, that were literally weeks away from closing, because they didn't have chemo-rated gloves. It's not a way to run a business when it comes to people's lives and healthcare. So, we are a secondary supplier, and we make sure that we have the goods necessary to backstop any potential losses.

Last year, PPE was the biggest way to protect against COVID-19 and it remains an important tool, but we do have those vaccines available now. For healthcare workers who have hesitated to get the vaccine, how do we persuade them to finally get it?

I think education and numbers. I think FDA approving the vaccine was a big step forward, because unfortunately, and this goes for both sides, the vaccines became politicized. Before the election, you had the Democrats saying, “Well, Trump, he's pushing things through, he's rushing things,” and now, you're having, the Republicans saying, “Well, it's our freedom” and things like that. And it's really about healthcare, right? It shouldn't be politicized. And I think that the FDA approving the vaccines goes a long way. I think putting in a convenience also is going to drive one type of behavior. If there is mandatory testing in place, and it's inconvenient, then, obviously, it works as a cudgel to get people to get vaccinated. And I think with education and time, I think we're going to get to where we need to go.

In July, major associations like American Nursing Association, the American Hospital Association, they really supported these vaccine mandates for healthcare workers. Why do you think they had to take such a strong stance and other vaccines, like for influenza, have already been mandated for this population of workers? Is it just the politicization or is there something else going on?

There are some people that are honestly hesitant. You have a portion of people, obviously, that are anti-vaxxers, that are not going do anything, regardless of what you tell them. And those people are in the medical healthcare industry as well, right? You know, before the COVID-19 pandemic started, you've seen measles outbreaks in our society. So, I think there's some of that. I think, again, there's people that are that are truly worried because of the emergency use authorization and how quickly it came about. And so, I think that's where the hesitancy started from.

There's already a healthcare shortage among nurses and doctors. There are concerns that vaccine mandates could exacerbate that. What can hospitals and health systems do to ensure they're not losing workers amid a medical capacity surge while they're treating these COVID-19 cases?

Yeah, that's definitely a tough situation. We work in partnership with several companies where we provide testing, mobile testing, and vaccinations. And so, it's definitely something that we're seeing, and we're trying to assist with. And I think the fact that they’re going to be mandated at this point to do it, it's going to drive people to get it done. I don't think there's an easy solution out of it. I think they're trying to do what they can.

A provider of personal protective equipment (PPE) discusses the continued importance of PPE, vaccine mandates and healthcare workforce shortages amid the surge of COVID-19 cases due to the Delta variant

Even With Vaccines, PPE Remain an Important Layer of Protection Amid COVID-19 Surge

On this week's episode of Data Book, Chief Healthcare Executive spoke with Terri Casterton, Director of Healthcare Product and Strategy at Bottle Rocket, a consultancy that provides business strategy, product, design and technology services. We discussed the latest Apple Watch features, the use of patient supplied data in healthcare and the use of technological innovations in healthcare.

Podcasts

Terri Casterton, director of Healthcare Product and Strategy at Bottle Rocket, discussed the latest Apple Watch features, the use of patient supplied data in healthcare and the use of technological innovations in healthcare.

Podcast: Getting Health Systems and Hospitals to Utilize Data From Wearables

President Joe Biden announced on September 9 a federal COVID-19 vaccine mandate that impacts many private-sector employees, as well as healthcare workers.

The mandate requires employers with more than 100 workers must either require employees to be vaccinated or be tested weekly. In addition, all health facilities that receive Medicare or Medicaid reimbursement must be fully vaccinated.

“We’ve been patient,” he said during the announcement at the White House. “But our patience is wearing thin, and your refusal has cost all of us.”

 that 178.7 million Americans, or 53.8%, were fully vaccinated, of the population 12 years or older, 63% is fully vaccinated.

 the day after the new rule was announced, Jeffrey Zients, coordinator of the president’s COVID-19 task force, noted that vaccinations are the “best way to beat this pandemic” and that businesses, health systems, colleges and universities, and more have stepped up and adopted vaccination requirements.

“Vaccination requirements have been around for decades for diseases like polio, smallpox, and measles,” he said. “They’re widely supported, and importantly, they’re proven to work.”

While the mandate has drawn disapproval from some sectors and leaders, the healthcare industry has largely supported it. The American Hospital Association (AHA), American Medical Association (AMA), American Public Health Association (APHA), and the Society for Healthcare Epidemiology of America (SHEA) all quickly released statements applauding the requirement.

In July, SHEA and six other organizations had 

 promoting a requirement that employees of healthcare facilities get the COVID-19 vaccine. Hilary Babcock, MD, MPH, infectious disease specialist, Washington University and BJC Healthcare in St. Louis, Missouri, and a coauthor of the paper, 

 why the COVID-19 vaccination requirement is no different than the influenza vaccination requirement that has been in place for years.

Gerald E. Harmon, MD, president of the AMA, noted that his organization was happy with the new rule as it shows the Biden administration’s efforts to help control the pandemic. “Aggressive measures will be needed to prevent further widespread transmission of COVID-19. Increased testing—more available and affordable—is a major step forward…” he 

Similarly, APHA Executive Director Georges C. Benjamin, MD, said the administration’s action plan will boost vaccination rates, which is needed to end the pandemic.

“We have seen significant reductions in sickness and death among people who have been fully vaccinated,” 

. “This is now a pandemic of the unvaccinated, and it is spilling over into our children, who cannot yet get their shots. The solution is to get everyone who is eligible their vaccinations. The president’s plan can achieve that, and we are here to help.”

The AHA also supported the plan, but AHA President and CEO Rick Pollack did note the workforce challenge facing the healthcare industry right now.

“As a practical matter, this policy may result in exacerbating the severe workforce shortage problems that currently exist,” 

. “…we call on the Administration to work with us as partners in developing aggressive and creative strategies to address this matter to ensure that hospitals and health systems on the front lines of fighting the battle against COVID-19 have the necessary human resources to both win this battle and maintain essential health services for the patients and communities we serve.”

This is already playing out. Before Biden announced the new rule, New York state had already mandated all healthcare workers get the first dose by September 27. On Friday, Lewis County Health System, a local hospital in upstate New York, announced 30 employees had resigned and it would have to temporarily pause its maternity services, as a result. The hospital will not be able to staff its maternity department and newborn nursery as of September 25 and will have to stop delivering babies, 

In general, rural hospitals could be hit the worst, Alan Morgan, CEO of the National Rural Health Association, 

. While larger hospitals may be able to handle a loss of workers who choose to resign instead of get vaccinated, it would be a huge blow to rural hospitals.

While the main healthcare organizations expressed effusive support over President Joe Biden’s new mandate for COVID-19 vaccinations among millions of healthcare workers and private-sector employees, there are concerns about the current healthcare workforce shortage.

Healthcare Largely Support Biden COVID-19 Vaccine Mandate, Express Concerns Over Workforce Shortages

McLaren Bay Region hospital, located in Bay City, Mich., has announced Darrell Lentz, MBA, as the new president and CEO. Lentz is assuming the role following the resignation of Clarence Sevillian, who was in the position since 2014. Lentz will continue in his position as president and CEO of McLaren Central Michigan.

He joined McLaren in August 2020 and has a 20-year career in hospital and health system operations management.

Effective December 2021, Michael Roussos will be the new president of the Virginia Commonwealth University (VCU) Medical Center. Roussos will succeed Ron Clark, MD, who served as interim president since 2019.

Roussos comes to VCU Medical Center from University Hospital in San Antonio, Texas. While there, he spearheaded the hospital’s COVID-19 response and championed the creation of the Center of Life, only the second hospital-based, regional center for organ donation in the United States.

Penny Wheeler, MD, announced she will retire as the CEO of Allina Health at the end of the year. President and Chief Operating Officer Lisa Shannon will replace her. Wheeler started her tenure as CEO in 2014, but she has a long career with Allina Health as a physician, president of the Abbott Northwestern medical staff, and chief medical officer.

Shannon has held a variety of leadership roles, including at OhioHealth Corporation, Spectrum Health, and Catholic Health Initiatives at KentuckyOne Health.

With the CEO of Ohio State University’s Wexner Medical Center, Harold Paz, MD, resigning, two interim co-leaders are being appointed. Mark Larmore, the chief financial officer, and Andrew Thomas, MD, chief clinical officer and senior associate vice president of health sciences, have been named the interim replacements.

President Kristina M. Johnson, PhD, said in a letter to the faculty and staff that the appointments are effective immediately and the medical center will launch a national search to find a permanent replacement.

Allina Health’s CEO will retire at the end of 2021 while McLaren Bay Region announced a new CEO and the Virginia Commonwealth University Medical Center has a new president. Meanwhile, two interim leaders will fill in at OSU Wexner Medical Center.

MED MOVES: Allina Health CEO Retiring, New President at VCU, and More Executive Moves

Craig Newman, the chief strategy officer at HealthChannels for ScribeAmerica, discusses the amount of time that physicians, nurses, and scribes spend on administrative work and how the pandemic has exacerbated the need for things to change.

How much of a physician’s day is spent doing administrative work and how does this time allocation impact the quality of care that patients receive?

As you know, there's about a million active physicians throughout the country working across the care continuum. And that may range depending on which care environment they're in—emergency medicine, the inpatient setting, urgent care, or the clinic-based environment. Or sometimes we think about home care. On average, most physicians are spending, just to give you a sense of the average clinic day—I'm just going to talk about the outpatient clinic—so if you're in clinical practice, you're spending between 9 minutes a clinic hour and 20 minutes of clinic hour, clicking, typing, or moving things around in the EMR [electronic medical records], navigating and working below license.

If you're in the inpatient setting, that may net out to about 3 hours of working below license. So, in a 12-hour shift, imagine 25% of the time we're paying our highest-cost FTEs (full time employees) to do remedial duties. And there's actually a study that came out in 2014, called time driven activity-based cost. And the idea behind this was how do we shift towards value and reduce costs models and think about, not just cost in terms of clinical cost, but also how we think about total costs from a labor spend perspective. And this gets to your point of how much time physicians spend below license.

Imagine they came up with an equation around capacity of a resource cost. And so, essentially, let's say if you make a quarter million dollars a year to $2 a minute. A nurse practitioner, if it's $100,000 a year, it's $1, a minute. A scribe or virtual scribe is the lowest cost, you'd see is like 35 cents a minute. So, on a minute-by-minute basis, you can begin to see and they've tested this up at Boston Children's Hospital, how much cost is going and time is being spent by a physician working below license, and how we can offset that information to a lower-cost resource, whether that's labor or technology, or a bit of both to drive value and improve care delivery models.

It was actually early on how we started thinking about the quadruple aim and really moving towards care-based models that drive high value, clinical care, reduce the cost of care and improve patient satisfaction all at the same time and getting doctors done by dinner. So, that was a long-winded way to say they are spending way too much time on clerical duties, and much less time than they should be on engaging with their patients, whether that's during the encounter or following up with them after the fact.

Again, I think they're it's a multiprong issue. There are challenges, obviously with flow, but physicians get behind because they have to spend so much time with clerical responsibilities that could be offset to a resource like a scribe or a virtual support model or digital assistant. That could be much more effective and if they were able to offload that work, they could actually not just run a much more efficient practice or have an efficient flow but, alternatively, they could potentially see more patients, which would improve the amount of time it would take a patient to get in the door. That's a huge problem we have in healthcare today is the wait times it takes for new patients to get in to see physicians, especially specific specialists where there may be shortages, and that problem is only getting worse for so many organizations across the country. So, those clerical components, we really need to take a hard and fast look at. That's why our company, we serve 3500 hospitals and health systems and over 2000 medical groups, this is exactly the focus. How do we reduce clerical burden from physicians and their care team to improve flow, reduce cost models, and drive value to patients?

How has the pandemic impacted administrative workload for physicians?

I'd say it's only increased. Again, this is a this is a big topic, right? So, hard to cover in a short interview today. But I'd tell you that, physicians, first of all, they're people just like everybody else. And you got to remember they've got family members, they've got other folks. So, they need to protect their time as well and have a work/life balance. The problem is, there's more work being put on them. When we moved forward in the pandemic, obviously, we had a hybrid delivery system. And what I mean by that is we moved from just having in person care to telehealth visits as well.

Well, that's not just a change for them. That's a change for their office staff, as well as for the patients, which means there's more steps that went into the process to make sure that we connected that provider with that patient. That's added burden right off the top. So, I'd say that's problem number one, because if a patient doesn't show up, or maybe a patient's 10 minutes late for that telehealth visit. Well, that backs up everything else throughout the course of the day and there's cascading problems.

But then there's another challenge that we have, which is labor shortages. I've worked with a number of health systems who ranged from having a 10% shortage of medical assistants, to a 30 to 40% shortage of medical assistants. Medical assistants, there weren't enough to go around pre-pandemic. Now, we're competing with, let's say even if we're paying a pretty good salary, they can go down the street to Dunkin Donuts, make $5 an hour more and get a signing bonus, it's a huge challenge. Or maybe they have they're providing home care or childcare for their kids. And so, we're seeing that shift. So, if there aren't medical assistants who can actually help support the provider with flow, or even do some of those additional ancillary duties, it's a huge challenge that backs up the clinician or adds to their day, which means they're spending more time at night on the weekends trying to play catch up with some of those remedial duties like documentation. 

That's actually one of the reasons we have an arm of our company, ScribeAmerica, where we've actually leveraged the scribe as a care team assistant, whether in person or virtually, to actually help with some of those ancillary tests. So, it doesn't bog down the clinician, the care team. So, chart preps, documentation, pending orders, helping organize their time after the event like a personal assistant can really help drive and improve care delivery models and make life a little bit easier for the physician because at the end of the day, again, they're human. They're they're impacted by COVID-19 as well and so are their families and you want them done by dinner feeling refreshed because the last thing we need is to accelerate the burnout curve when we're already facing physician shortages.

Videos

Craig Newman Highlights How Administrative Work Impacts Physicians' Ability to Provide Quality Healthcare

Hospitals and health systems underwent a lot of changes at the outset of the COVID-19 pandemic to deliver care to patients at home, but the momentum is beginning to slow, according to results from the 

sixth annual Kaufman Hall State of Consumerism in Healthcare Survey

The survey fielded responses from more than 110 executives from nearly 95 organizations representing community hospitals, health systems, pediatric hospitals, academic medical centers, rehabilitation hospitals, and rural providers.

These respondents have noted that their organizations are moderating their moves to overhaul aspects of care delivery and pricing strategy to be more consumer friendly. In general, they’ve noted that telehealth use has “dramatically leveled off,” according to the report.

However, their organizations have shown they believe they need to be more proactive when it comes to improving digital capabilities. Less than half have said their organizations were planning for incremental improvements (45%) or are proactively shifting where they deliver care (43%). Only 25% said their organization was making significant investments so they can perform ahead of their competition. The same proportion said their organization was only willing to change to a moderate degree.

Healthcare has notoriously been behind other industries when it comes to digital offerings, but the respondents said that has changed compared with the time before the pandemic. Half said their prepandemic offerings were far behind non-healthcare companies and an additional 26% said slightly behind. When considering their 

 offerings, 28% said they were far behind and 45% said slightly behind.

The majority (80%) of respondents said they are at least somewhat concerned about the long-term impact the COVID-19 pandemic will have on hospital volume with 4% reporting they are “extremely concerned.”

However, things may be turning around. Respondents did indicate “they have seen further movement toward volumes approaching—though not yet reaching—pre-pandemic levels in recent months, as patients grow more comfortable with in-person care or seek treatment they delayed during the heights of the pandemic,” according to the report.

The survey also gauged how executives viewed disruptive threats to their organization. More than half (52%) said they view new primary care models as “strong” or “extreme” threats, and 37% said the same about new insurance providers.

UnitedHealth Group/Optum is viewed as the biggest competitive threat in general with 76% responding that they see it as a strong or extreme threat. CVS/Aetna is the next biggest threat (64%), followed by Walmart (58%) and Amazon (57%).

According to the report, many executives noted that their organizations are in the early stages of exploring partnerships or joint ventures in order to offer new services and reshape their routine care for consumers. Nearly half (46%) said they are planning to implement new models but haven’t fully implemented them yet, and 33% said they have implemented new models but haven’t fully integrated across the system. In addition, 13% aren’t planning for any new models and reported they are “using the same care models that have been used historically.”

While a majority of respondents said they offer telehealth (90%) and walk-in clinics (73%), far fewer offer other innovative primary care services, such as in-home patient monitoring (37%), home-based primary care (22%), or artificial intelligence (12%). Five percent said they offer no innovative primary care services.

“Moving forward, organizations that seek to thrive must be prepared to deliver care when, where, and how consumers want to receive it,” the report noted.

The pandemic has introduced healthcare consumers of all ages to telehealth and other home-based services, including older Americans. The report expects younger generations will demand digital experiences in their healthcare to match their experiences from other industries.

“Organizations that have moved toward more consumer-friendly models for some time may be better positioned to make a more focused, total transformation effort to a consumer-centric model,” the report concludes.

Hospitals and health systems started to improve digital capabilities as a result of the pandemic, but that momentum is starting to slow, according to new report. 

Healthcare Not Yet Meeting Consumers' Digital Expectations, Execs Say

The COVID-19 pandemic has put pressure on hospitals and health systems throughout the United States and highlighted the need for medical surge preparedness.

, researchers applied the Hospital Medical Surge Preparedness Index (HMSPI) methodology to measure surge capacity in U.S. hospitals. The goal was to quantify hospitals’ ability to respond to mass casualty events.

“As an individual’s health depends on access to and delivery of quality healthcare, mass casualty emergencies require a hospital to ‘medically surge’ to save lives,” the authors explained.

After the 9/11 attacks, there was an increase in federal investments for disaster preparedness, but health systems continue to struggle in this area, they added. Understanding which hospitals can respond to an influx of patients is crucial for response planning and saving lives.

The researchers used 2005 to 2014 data from the American Hospital Association on 6,239 hospitals (3,123 had 82 or fewer beds), as well as data from the Dartmouth Atlas Project. HMSPI is a theoretical framework that reviews 4 metrics of surge capacity: staff, supplies, space, and systems.

Over the course of the study period, there was a steady increase in HMSPI scores. From 2005 to 2014, Montana had the largest increase in scores, followed by Kansas; Nevada had the smallest increase. Just looking at 2013 to 2014, many states had little or no differences, but North Dakota had the greatest increase, and Maine and Arkansas had the greatest decreases.

“From the analysis, and as might be expected, larger hospitals (those with more than 82 beds) had significantly higher surge capacity in terms of the space metric,” the authors noted.

They also reviewed the effect the Affordable Care Act (ACA) might have had on HMSPI scores; however, they did not find any statistically significant difference in scores between the year prior to ACA implementation and after ACA implementation.

There are a number of limitations that the authors highlighted. For instance, since the HMSPI has yet to be validated in relation to hospital performance during actual disasters, it cannot estimate access to care or outcomes. In addition, data until 2014 was analyzed, which only provides one year after the ACA was implemented, and more years of data may provide different results.

They wrote that future studies are needed to refine the score, assess the validity of the index, and evaluate its performance to disasters and policy changes.

“In the future, the HMSPI could serve as an objective and standardized measurement to assess the ability of hospitals, counties, and states to manage public health emergencies, such as the current coronavirus pandemic, and improve planning for mass casualty medical surges,” the authors concluded.

A tool that can accurately measure hospitals’ medical surge preparedness can be beneficial when responding to future crises and large-scale emergencies.

Hospitals Have Improved Capacity to Respond to Mass Casualty Events Since 2004

On this week's episode of Data Book, Chief Healthcare Executive spoke with Steve Wigginton, CEO of Icario, platform that promotes health action to connect everyone to better health. We discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Steve Wigginton, CEO of Icario, discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Podcast: Joining Technology and Value-Based Care to Provide More Personal Care

During holiday weekends, like Labor Day, there tends to be an increase in ransomware attacks, the FBI and the Cybersecurity and Infrastructure Security Agency 

. The agencies noted that these attacks have increasingly been taking place during holiday weekends, such as Mother’s Day weekend, Memorial Day weekend, and the Fourth of July weekend.

From January 1 to July 31, 2021, there were 2,084 ransomware complaints, a 62% increase over the same time period a year earlier, and more than $16.8 million in losses, a 20% increase from the previous year.

In general, healthcare data breaches are on the rise, according to the 

. Compared with 2019, healthcare experienced a 51% increase in the total volume of records exposed.

Here is a look at some recent healthcare data breaches:

 In August, the Illinois-based physician group notified 600,000 patients that their personal health information was exposed when the computer network was hacked in July, 

A breach of employee email accounts at the physician group that includes more than 100 infectious disease physicians in the Chicago area may have exposed data for 171,740 patients. The incidence was 

. Patients’ names, birth dates, Social Security numbers, medical data, and more may have been accessed.

 After a ransomware attack on its network, the Indianapolis-based hospital is 

 that some stolen data is being posted online. The attack happened on August 4, although the hospital did not reveal how many patients were affected.

 After an email account of an employee at the Utah-based physician group was breached in June, about 12,000 medical records 

. Medical record numbers, birth dates, procedures, and provider and insurance provider names were all exposed, although they were not shared online.

 in early August that a cyberattack in January had exposed names, Social Security numbers, birth dates, financial account numbers, diagnoses, and more. Since the attack, there have been no reports of fraud or use of the personal health information.

. The Las Vegas-based hospital reported to HHS that 1.3 million people were affected by a cyberattack. Personal data obtained in the attack was 

 that 1.4 million individuals were affected by a data breach that occurred in June. However, while the activity was discovered June 17, the hacker had initially accessed the network as early as December 18, 2020. Names, Social Security numbers, addresses, financial details, and more were exposed.

 The health system, based in Albuquerque, 

 patients that they may have been affected by the attack. The breach was discovered June 4, but the files were accessed May 2. The files contained patient names, addresses, medical record numbers, and more. Some Social Security numbers were exposed.

Ransomware attacks tend to increase around holiday weekends, like Labor Day weekend. Here is a look at some recent healthcare data breaches.

Recent Healthcare Data Breaches as of September 6, 2021

revealed inconsistent findings on the effectiveness associated with interventions to reduce hospital length of stay (LOS) across all high-risk populations, underscoring important evidence gaps and the need for further research.

LOS is often used as a proxy for efficient hospital management, while reductions in LOS help improve bed turnover. This allows hospitals to match demand with capacity for elective and emergent admissions, intensive care unit (ICU) care, and interhospital transfers, researchers explained.

Numerous strategies to reduce LOS have been developed; however, a paucity of evidence exists when it comes to the effectiveness of interventions in unplanned hospitalizations, as opposed to elective admissions. This is especially true for populations at-risk for poor outcomes, including those with heart failure or older or medically complex patients.

To identify interventions aimed at reducing LOS among those at high risk of prolonged LOS, researchers conducted a systematic review of MEDLINE, PubMed, Embase, CINAHL, the Cochrane Library, and gray literature sources for studies published between 2010 to 2021. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study.

A total of 19 systematic reviews were included, of which 10 included a mix of study designs, 8 included only randomized clinical trials, and 1 included only retrospective cohort studies. Eight strategies to reduce LOS in high-risk populations were assessed: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth.

“Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure,” authors wrote, while “there were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk.” These could have included patients with housing instability, social isolation, limited English proficiency, or other factors.

Reviews also did not assess LOS interventions among those with substance use disorder or common chronic diseases.

Although analyses did find that for patients with heart failure, clinical pathways and case management were linked with reduced LOS , due to the heterogeneity across studies included, authors underscored the important roles local contexts and resources may play in streamlining care.

In addition, they found that “for patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations.”

Overall, this review showed no single intervention consistently reduced LOS in all high-risk populations.

“Future research assessing interventions for LOS reduction in high-risk populations or subpopulations should also consider implementation science measures to inform local adaption,” researchers concluded.

Interventions aimed at reducing hospital length of stay (LOS) among at-risk patients lack consistent efficacy, according to a systematic review. 

Are Hospital-Led Interventions Reducing LOS for High-Risk Populations?

On this week's episode of Data Book, Clay Ritchey, CEO of Verato, a next-generation patient-matching solution for healthcare, speaks with Chief Healthcare Executive. He discusses how patient-matching technology can alleviate stress for providers and improve patient care. He also talks about the financial benefits this technology can have for hospitals and health systems, as well as potential data privacy concerns.

Clay Ritchey, CEO of Verato, highlights the administrative and financial benefits that patient-matching technology can provide hospitals and health systems, as well as how it can improve the patient experience.

Podcast: Match Made in Hospitals — Patient-Matching Technology Can Improve Healthcare

The need for efficient and timely dissemination of electronic health information (EHI) between hospitals and public health agencies has never been more important, nor received more scrutiny, than amid a global pandemic.

Prior to the pandemic, sharing hospitals struggled to share EHI with as amny as 70% reporting challenges in 2019, 

 from CMS’ Office of the National Coordinator (ONC) for Health Information Technology (IT).

To improve disease surveillance capabilities across hospitals and public health agencies, CMS has adopted policies that require hospitals to meet specific public health objectives in order to participate in the Promoting Interoperability program.

submission, and in some cases receipt of data, for the purposes of immunization registries

The new ONC report utilized nationally representative survey data from the 2019 American Hospital Association IT supplement to shed light on the number and types of challenges hospitals experienced regarding electronic reporting. Notably, while challenges around reporting may have been exacerbated during the pandemic, this report identified ongoing obstacles to health information exchange.

In both 2018 and 2019, half of all hospitals reported a lack of capacity to electronically exchange information with public health agencies

In 2019, seven in 10 hospitals experienced one or more challenges related to public health reporting

Small, rural, independent, and Critical Access Hospitals (CAH) were more likely to experience a public health reporting challenged compared with their counterparts

The types of public health reporting challenges experienced by hospitals varied substantially at the state level

Additionally, the report found that the top two public health reporting challenges in 2018-2019 included interface-related issues and lack of capacity to electronically exchange information among hospitals and public health agencies. Nearly one in five hospitals reported problems with exchanging information due to differing vocabulary standards, as well as difficulty extracting relevant information from electronic health records (EHR).

Small, rural, independent, and CAH institutions were more likely to report:

difficulty extracting relevant information from the EHR

confusion about where to send the information

The findings of this report indicate that there is a significant need to improve the methods hospitals employ to electronically exchange health information with public health agencies. Analyzing hospitals’ experiences with public health reporting a year prior to the start of the pandemic allowed for a broader, more in-depth view as to why the challenges already present were exacerbated when hospitals were faced with an onslaught of patients. Now that these barriers have been identified, they can be addressed and remedied, according to ONC.

The report also noted that as these findings are only reflective of the hospitals’ perspectives — future research should focus on public health agencies’ viewpoints on the obstacles associated with public health information exchange.

A majority of hospitals had challenges related to public health reporting in 2019 with half reporting a lack of capacity to electronically exchange information with public health agencies.

Hospitals Struggled to Share Electronic Health Information With Public Health Agencies in 2019

Rodney Hanners has been named the permanent CEO of Keck Medicine of University of Southern California (USC) and CEO and president of USC Health System after serving as interim CEO since June 2020. He will oversee two acute care hospitals, a community hospital, and more than 40 outpatient facilities.

Hanners joined Keck Medicine in 2015 from the Children’s Hospital Los Angeles.

Pardee UNC Health Care announced Brett English is the new chief financial officer when he joins the organization October 11, 2021. English is currently the division financial executive for Spartanburg Regional Health Services District in South Carolina, where he is responsible for all financial operations for the health system.

English has decades of experience in financial operations.

The CEO of Dignity Health’s southwest division, Linda Hunt, will retire January 2022 after 51 years in healthcare service. Hunt has been with Dignity Health since 1998 and has led the southwest division since 2009. She oversaw 11 hospitals in Arizona and Nevada.

Before joining Dignity Health, Hunt served in leadership roles at the University of Colorado Health Sciences and Regis university in Denver. A national search is being conducted to find Hunt’s successor.

Amy Perry will join Banner Health as president and chief operating officer on November 1, succeeding Becky Kuhn, who will retire on November 3. Perry is currently at Atlantic Health System in New Jersey, which includes more than 400 sites of care. She served as executive vice president of integrated care delivery and CEO of the hospital division.

Kuhn announced her retirement in April 2021. She has been with Banner Health for 20 years in various leadership roles, including the inaugural CEO of Banner Gateway Medical Center, which opened in 2007.

Marna Borgstom, the CEO of Yale New Haven Health (YNHHS) will retire March 25, 2022. Her entire 43-year career was spent with the organization from her first job as an administrative fellow at the Yale New Haven Hospital. In 1994 she was appointed executive vice president and chief operating officer for the hospital and in 2005 she became the CEO of the hospital and YNHHS.

Borgstom will be succeeded by Christopher O’Connor, the current president of YNHHS. He was named to the position in August 2020. Previously, he was president and CEO of the Hospital of Saint Raphael prior to its integration with Yale New Haven Hospital.

Memorial Sloan Kettering Cancer Center (MSK) has announced Tracy Gosselin, PhD, RN, will be senior vice president, chief nurse executive and chair of nursing after Elizabeth McCormick retires. Gosselin is the current chief nursing and patient care services officer at Duke University Hospital.

Yale New Haven Health's CEO is retiring after 43 years with the organization, Memorial Sloan Kettering has a new chief nurse executive after two decades and more executive moves and appointments.

Are Hospital-Led Interventions Reducing LOS for High-Risk Populations?

Podcast: Match Made in Hospitals — Patient-Matching Technology Can Improve Healthcare

Hospitals Struggled to Share Electronic Health Information With Public Health Agencies in 2019

MED MOVES: Yale New Haven CEO Retires After 43 Years With Organization, MSK Has a New Chief Nurse Executive, and More

Craig Newman: How Technology Can Reduce Administrative Burden for Physicians

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