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

Becton, Dickinson and Company (BD) this week announced a plan to transform the experience of the blood draw with a “One-Stick Hospital Stay,” centered on a new device designed to eliminate multiple needlesticks for blood sample collection.

The pitch for hospital and health system executives: the company’s FDA-cleared PIVO device, while initially more expensive than a traditional blood draw, will reduce levels of patient pain and discomfort, and in turn increase patient satisfaction while delivering quality outcomes. 

BD has worked towards making the process of blood collection safer and more comfortable over 70 years through their development of the BD Vacutainer family of products. Their suite of tools helps clinicians choose the right device for the right patient to achieve “first-stick success.” The implementation of the new device comes as part of the company’s recent acquisition of San Francisco-based Velano Vascular.

“As a global leader in vascular access solutions and blood collection, BD has been on the forefront of innovations that improve the patient experience and reduce additional needlesticks,” Rick Byrd, president of Medication Delivery Solutions for BD, said in a statement. “Now, with the addition of Velano and its groundbreaking technologies, we can envision a world where a ‘One-Stick Hospital Stay’ could be a reality for many by making the numerous inpatient blood draws better for everyone.”

The single-use, needle-free PIVO device draws blood from existing peripheral intravenous catheter (PIVC) lines, reducing the number of needlesticks needed for high-quality blood sample collection. The technology promises low-acuity patients will have one “stick for their entire hospital stay.”

Blood draws by venipuncture and the insertion of PIVCs are two of the most common procedures performed in hospitals and are typically met with some degree of pain and anxiety from patients, as 1 in 5 people in the United States are needle phobic. Successive needlesticks may exacerbate levels of pain and anxiety.

“By potentially removing multiple, individual needlesticks from blood draws, we can change the decades-old practice and help transform it into a better experience for patients and providers,” Anna Kiger, DNP, DSc, RN, FAONL, chief nursing officer for Sutter Health, said in a statement. “What can be an unpleasant or anxiety inducing procedure, with multiple pokes and prods throughout the day and night, is now a more compassionate one for those in our care.”

The new device may lead to a decrease in costs, although the precise amount may vary from hospital to hospital. Compared to other blood collection methods, study data have shown the device may reduce hemolysis rates and subsequently lead to cost savings by eliminating the cost of collection supplies needed for a redraw. Further, first-attempt successes of blood draw may decrease the clinical and financial impact associated with delayed care.

 that “hemolysis accounts for 40% to 70% of poor quality, rejected samples results in delayed care, additional patient discomfort and additional redraw costs of $208 for inpatients and $337 for rejected (emergency department) samples),” citing studies that say emergency departments reject between 8% and 15% of samples.

BD did not provide a precise savings estimate when requested by Chief Healthcare Executive™. In a 

 in MedCityNews, officials with Velano Vascular said pricing would depend on the “use case” at each hospital.

According to a BD spokesperson, leading US hospital systems such as Intermountain Healthcare, Sutter Health, Centura Health, Northwestern Medicine, Henry Ford Health System, Virginia Mason Medical Center, Griffin Hospital, and more are currently using PIVO in their practices.

Articles

Device would eliminate pain, anxiety associated with the blood collection process through the implementation of needle-free blood draw device.







BD Works Toward Creating ‘One-Stick Hospital Stay’ With Needle-Free Blood Draw Device

Sheila Whatley, a chronic care management and compliance subject matter expert, is vice president of Clinical Operations at Anelto.

The COVID-19 pandemic fueled a boom in the telehealth industry as patients sought to avoid trips to the emergency room, healthcare clinic or doctor’s office. Technology solutions like remote patient monitoring (RPM) have come to the forefront, providing the freedom for patients to receive care remotely—and consistently. Because RPM solutions monitor patients and track vital statistics such as blood pressure, heart rate, temperature, and others both in real-time and over time, they have helped turn episodic care into preventive care for patients with chronic conditions.

To date, the focus of RPM has been on the technology itself and its increasing ease of use. The conversation now needs to shift to creating a patient-centric healthcare experience enabled by RPM technology, and the benefits for healthcare companies that deploy RPM solutions.

Replacing humans with technology in healthcare may seem counterintuitive to creating that patient-centric experience, yet in many cases, the patient has access to better care because of technology like RPM. RPM solutions can provide additional support between office visits with direct access to a care team member for quick intervention as needed. For patients, this means care may be received without leaving their homes.

With RPM today, healthcare providers and clinicians have access to real-time recordings of vital signs. In contrast, they previously relied on patients going to the doctor’s office, hospital or, while at home, using either store-bought devices or complicated equipment often used by hospitals. Now, RPM solutions are simplified, with devices offering support right out of the box. Direct communications with healthcare providers via voice or video can happen with a simple touch of a button. RPM also gives a better patient snapshot over time and allows the provider to see trends with the patient’s health.

Also, with RPM, patients have peace of mind knowing that they have access to the care team 24/7 instead of calling their doctor’s office and hoping for a quick callback from the physician on call, who may or may not be familiar with their case. Patients using RPM can build a relationship with their clinical care team, which helps build trust. Since the care teams are familiar with a patient’s diagnosis and the provider’s care plan, they can react quickly when patients have an issue.

Having direct access for quick intervention can decrease emergency room/hospital admissions, increase patient compliance and satisfaction, and close gaps in healthcare. Overall, RPM solutions provide a better quality of life for patients that results in higher patient and provider satisfaction.

By consistently collaborating and engaging with patients in the decision-making process, health providers can make better decisions regarding a patient’s health.Additionally, providers now have access to longer data sets for an overall better picture than just a single report of a vital sign episode, such as high blood pressure.

But the benefits go deeper than building a relationship with the patient and delivering patient-centric care. Practices can experience a decrease in staff workload and patient incoming calls with RPM while increasing visits remotely.

In a comprehensive RPM program, providers can look at healthcare expenses and understand which patients are high utilizers. These might be patients missing appointments, visiting the emergency room frequently, and experiencing high rates of condition exacerbations with repeated hospitalizations. Providers who develop solid RPM protocols with experienced clinical staff will have a successful RPM care management program in an environment that focuses on service fees. A shift in utilizing RPM as value-based care will enable providers to provide a higher level of care and additional revenue to support the practice.

The Centers for Medicare & Medicaid Services (CMS) has loosened the requirements for providing RPM, which has helped providers launch their programs to support their patients with all care management-type services. By doing this, providers can reach more patients, which increases the dollar value of the program.

Healthcareexecutives should take a leading role to assist network providers with understanding the value of RPM as part of a patient care management solution. Executives and physician practices should review the types of Medicare patient care management programs available and perform due diligence on what types of programs and services are offered by care management companies as part of a complete solution. Full turnkey, patient outcome-driven care management programs will not only bring additional revenue but can also:

With RPM solutions, providers are improving patients’ health awareness, which helps patients take more ownership over their health. By providing a solid RPM clinical program that includes care management services such as direct access to the patient’s care team, assistance with medication management, community resource support and disease education, patients experience better health outcomes and decreased hospital admissions and ER visits, which contributes to a better quality of life.

Having a solid care management support team to provide the RPM program is important. Providing patients with direct access to their care team members who can assist them with navigating the healthcare system gives patients peace of mind and a more patient-centric experience, decreasing condition exacerbations and lowering overall healthcare costs. Comprehensive RPM programs are a win for both patients and providers.

Sheila Whatley, is vice president of Clinical Operations at 

. She is a chronic care management (CCM) and compliance subject matter expert with over 20 years of healthcare operations experience, including clinical informatics and healthcare software development. She has more than a decade of consulting experience in emerging industries and more than 24 years’ experience as a nursing provider.

To date, the focus of RPM has been on the technology itself and its increasing ease of use. The conversation now needs to shift to creating a patient-centric healthcare experience enabled by RPM technology.

How Healthcare Companies Can Benefit From Creating a Patient-First Experience With Remote Patient Monitoring

On this week's episode of Data Book, Chief Healthcare Executive™ spoke with Kate Cordell and Ken Knecht, cofounders of Opeeka. We discussed how their Person-Centered Intelligence Solution can help children and their families better manage and coordinate mental health services across multiple agencies. We also talked about how this tool can improve the workload of physicians, emergency department staff, and health care costs.

Podcasts

Kate Cordell and Ken Knecht, cofounders of Opeeka, discuss their company’s Person-Centered Intelligence Solution and how it can help children and their families manage and coordinate their mental health concerns as well as the benefits the tool can have on health systems.

Podcast: How Person-Centered Technology Can Help Children and Health Systems Manage Mental Health Care

Kindred Healthcare, LLC plans to add acute inpatient rehabilitation units (ARUs) to Kindred Hospital Denver, Kindred Hospital Melbourne (Florida), and Kindred Hospital Philadelphia – Havertown, three of the company’s long-term acute care hospitals (LTACHs).

The ARUs will be able to accommodate up to 33 total patients and are expected to begin delivering care in September 2021.

The planned addition supplements five ARUs previously added within Kindred Hospital North Florida, located in Green Cove Springs; Kindred Hospital Bay Area – St. Petersburg; Kindred Hospital South Florida – Ft. Lauderdale; Kindred Hospital Houston Medical Center; and Kindred Hospital Sugar Land (Texas) in August 2020.

“Kindred’s Hospital Division and Kindred Rehabilitation are working collaboratively to meet a growing need for inpatient rehabilitation services in our communities,” Russ Bailey, President of Kindred Rehabilitation, said in a statement. “These ARUs enable us to provide greater access and enhanced capabilities, expertise, and clinical integration to patients requiring these rehabilitation services.”

The facilities will provide inpatient rehabilitation to patients recovering from conditions including stroke, brain injury, spinal cord injury, orthopedic injury, neurological conditions, amputation, and trauma. Through the provision of intensive, interdisciplinary, clinical and rehabilitation services, the new ARUs will aid in patients’ recovery and improve their levels of function and independence so that they can be discharged and return to their homes.

“The ARUs complement the care provided in our LTACHs and enable Kindred to offer a continuum of care for patients who require high-intensity rehabilitation services to continue their recovery so they can be discharged and return to their homes,” Mike Warrington, President of Kindred’s Hospital Division, said in a statement.

Under the direction of a physiatrist, a doctor specialized in rehabilitation and physical medicine, and 24/7 nursing care, patients in the ARU will undergo a minimum of three hours of therapy each day for at least five days a week. Both patients in Kindred LTACHs and patients from other healthcare providers in their communities will be eligible to receive care from Kindred ARUs.

The new ARUs add to a growing list of those managed and staffed by Kindred Rehabilitation, as approximately 100 hospitals in 30 states partner with Kindred Rehabilitation to run ARUs within their facilities. Kindred Rehabilitation delivers care to more than 118,00 patients each year and is the largest contract manager of hospital-based acute rehabilitation programs in the nation.

The nation’s leading specialty hospital company plans to expand its rehabilitation services.

Kindred Healthcare to Add Acute Inpatient Rehabilitation Units to Its Long-Term Acute Care Hospitals

Colin Carr is the founder and CEO of CARR, the nation’s leading provider of commercial real estate services for healthcare professionals.

The largest expense of your healthcare practice is primarily non-negotiable: payroll. However, the second highest expense in your practice is completely negotiable. Think about that. Payroll, equipment, technology, interest rates, marketing—there are a dozen categories of overhead to evaluate when running your healthcare business, but the second highest expense after payroll is likely one of the only truly negotiable line items: the cost of real estate.

What’s flexible about healthcare real estate? Whether you’re leasing new office space or renewing your current lease, you have a say in the economic terms, such as the length of the lease, as well as desired concessions, including tenant improvement allowances, free rent periods, your actual lease rate, annual rate increases, any build-out periods, and many other provisions.

Each one affects your bottom line. But the majority of corporate tenants and healthcare practices simply don’t have the time and expertise in commercial real estate to make the most of these negotiations—most view real estate as a necessary evil rather than an incredible opportunity to increase profitability, reduce expenses, and improve the quality of their patients’ experiences. So, here’s what you need to know to plan ahead and achieve significant savings in your next commercial real estate transaction.

1. Real Estate Favors the Healthcare Industry

The real estate market tends to favor medical providers. Why is that? Because of their long-term stability and success rate. Even in a post-COVID-19 market, healthcare providers are considered lower-risk tenants and are able to achieve better leases because landlords want their tenancy. Additionally, medical providers prefer longer lease terms—as do landlords. Providers can also get a better deal today than prior to the pandemic, which is something to keep in mind as you consider future purchase or lease decisions.

Whether you’re renewing a lease or looking for new space, a good rule of thumb is to begin the process 12–24 months before your lease’s expiration. Why so far in advance? First, most leases likely contain options that must be exercised within a specific time period, typically six to 12 months prior to its expiration. Second, even if you’re planning on renewing your lease, you’ll need multiple relocation options to create a strong posture. Ensuring your landlord knows you have the option to purchase or relocate is critical to negotiation success, as landlords don’t offer meaningful concessions unless they believe you have other realistic options—all of which take significant time to procure.

In any negotiation, leverage means you’re holding a perceived advantage—one that just might help you get to an agreement you desire. But to create leverage and posture, bringing multiple real estate options to the table is necessary. Limiting yourself to one property puts your negotiation at the mercy of the owner, and since most landlords and sellers negotiate professionally, it’s not typically hard for them to spot a tenant without other viable options, or who doesn’t know what they are doing.

An experienced healthcare real estate agent (hired as 

 exclusive agent at the expense of the landlord or seller) can provide you with the best pre-qualified, comparable properties’ lease rates, build-out allowances and other concessions, as well as the concessions and lease terms new tenants in your own building are being offered, which can then be used as valuable leverage on your behalf in negotiations. The only way to know if a landlord’s lease renewal offer is truly competitive is to actually compare it to the market.

Comparing renewal and relocation options takes time, and when there’s not ample time to relocate (or prove your relocation options), the landlord has the stronger hand. Which leads us to the next important consideration: Just like most business, commercial landlords, even if they’re a customer or patient at your dental practice or medical center, are in the full-time business of maximizing profits.

One of the most common mistakes healthcare practices make is negotiating without the help of a commercial real estate professional, specifically one who specializes in representing healthcare tenants and buyers.

Sure, your building’s ownership and management might be pleasant to work with—let’s hope they are! But when negotiations begin and their professional representatives are present, their interest will always be profitability. Landlords know that without market knowledge, tenants have no baseline against which to compare a lease offer.

This means that a successful negotiation for a lease will be far more than bartering or bluffing or asking for better terms. You can level the playing field by engaging your own professional representation, gaining competitive market knowledge and finding other favorable options for your space.

Unsure of your next real estate move? Happy in your current space? Lately, many landlords are willing to sell their buildings to healthcare tenants with term remaining on their lease, or even condo spaces that once were only available to lease. Purchasing the real estate you already occupy, 

or even a new space or building, could be a great opportunity to impact your future finances and significantly build your net worth. Additionally, with interest rates at all-time lows, many healthcare providers are able to purchase properties they previously didn’t think they could afford.

Whatever your next move, remember that when done properly with the right representation, a well-negotiated lease or purchase can have a dramatic impact on your practice’s profitability.

, the nation’s leading provider of commercial real estate services for healthcare professionals. Colin has been involved in commercial real estate for over 20 years and has personally completed more than 1,000 transactions. He trains and advises thousands of healthcare professionals, administrators, investors and students throughout the country on an annual basis through national meetings, conventions, study clubs, associations, universities, webinars, and more.

Purchasing the real estate you already occupy, or even a new space or building, could be a great opportunity to impact your future finances and significantly build your net worth.

5 Things to Consider Before Negotiating a Healthcare Real Estate Deal

 chief executive officer of Lutheran Health Network, based in Fort Wayne, Indiana. Teffeteller most recently served as senior vice president and regional operating officer for AMITA Health’s Chicago Metro Regional and president and CEO of AMITA Health Resurrection Medical Center Chicago. While in Chicago, Teffeteller expanded an ambulatory care network and led capital planning and facility development. At Lutheran Health, his immediate priorities will include the opening of Lutheran Downtown Hospital and joint venture with Acadia Healthcare on a behavioral health hospital. Teffeteller will report to Mark Medley, who will have oversight for Community Health Systems-affiliated hospitals including Lutheran Health Network and Northwest Health in northwest Indiana. Teffeteller’s appointment becomes effective August 16, 2021.

Following the announcement of the retirement of Joann Anderson, who had served as CEO for 14 years, the UNC Health Southeastern Board of Trustees have named 

 as her successor. Ellington will start October 11, and Anderson will continue in an advisory role through December 31.

UNC Health Southeastern has 30 primary and specialty care clinics across four counties, a freestanding ambulatory surgery center and clinic facility, and the Southeastern Health Mall, which provides outpatient services. Previously known as Southeastern Health, the health system and UNC Health announced completion of a 

 (MSA) in December 2020, which included the name change that took effect January 1, 2021.

Ellington, whose current role is president of UNC Health Care Network Hospitals, became known to the UNC Health Southeastern board during the development of the MSA.

 his retirement as CEO of Maury Regional Health, based in Columbia, Tennessee. The MRH Board of Trustees will conduct a national search for a new CEO, according to a statement from the health system. Watson became CEO in 2012 following his promotion from chief operating officer. During Watson’s tenure, the health system has received national recognition for quality and safety, including being named a 15 Top Health System six times since 2011. Watson told the Maury County Commission that the pandemic and personal events had caused his family to “change our focus on what is important,” according to 

, and that he wanted to spend more time with his grandchildren on his family’s 100-acre farm in East Tennessee.

MED MOVES: New Leaders for Lutheran Health Network, UNC Health Southeastern

Dialysis and kidney care company DaVita and its former CEO Kent Thiry face a two-count indictment for conspiring with competitors not to solicit each other’s senior employees, the U.S. Department of Justice 

DaVita and Thiry are charged with two counts of violating the Sherman Act, which outlaws "every contract, combination, or conspiracy in restraint of trade," and any "monopolization, attempted monopolization, or conspiracy or combination to monopolize,” according to the 

. If convicted, DaVita faces a maximum penalty of a $100 million fine per count, and Thiry faces a maximum penalty of 10 years in prison and a $1 million fine per count.

Count One charges both parties for conspiring with Surgical Care Affiliates LLC and its related entity “to allocate senior-level employees by agreeing not to solicit each other’s senior-level employees from as early as February 2012 until as late as July 2017,” according to a statement.

Similarly, Count Two charges DaVita and Thiry for agreeing with another healthcare company to not solicit DaVita’s employees from as early as April 2017 until as late as June 2019.

“These charges show a disturbing pattern of behavior among health care company executives to conspire to limit the opportunities of workers,” said Assistant Director in Charge Steven M. D’Antuono of the FBI’s Washington Field Office in the news release. “The FBI is dedicated to working with our partners to hold those accountable who would engage in labor market collusion to the detriment of their employees.”

The defendants are scheduled to appear in the U.S. District Court for the District of Colorado on July 20. DaVita is based in Denver.

The maximum fine may be increased to twice the gain derived from the crime or twice the loss suffered by victims if either amount is greater than the statutory maximum.

Karen Crummy, a spokeswoman for Thiry, issued a statement refuting the charges.

“These allegations are false and rely on a radical legal theory about senior executive recruitment without precedent in U.S. history. The government took steps to ignore – and even hide – key evidence. The facts bear it out decisively: No antitrust violations occurred, these companies hired DaVita executives for years, and the companies are not competitors.”

DaVita is one of two large dialysis providers that together account for more than 70% of the US market.

This indictment is a result of the Antitrust Division’s ongoing investigation of employee allocation agreements within the health care industry.










DaVita, Former CEO Indicted, Charged With Collusion Over Top Employees

CHE welcomes Gary Fulbright, CEO of Citizens Memorial Hospital, for this week’s installment of Turning Points. Fulbright has spent 39 years at Citizens Memorial and was one of the first hospital employees. In his role as CEO, he has led expansion initiatives, implemented new healthcare technologies, and introduced new specialties to the hospital, all while keeping the comfort of the community in mind. He will retire at the end of the year.

This transcript is lightly edited for clarity.

You’re retiring from Citizens Memorial Hospital at the end of the year—do you have a “to do” list of things to finish before your last day?

What I plan to do, as I prepare for retirement, is pass along the knowledge that I have gained. I've been here 39 years and was here a few months before the hospital opened. So, I do have a lot of knowledge in the organization and want to be sure to pass that along to employees that will still be here, and make sure that they can be successful.

Also, we have a construction project, and I will be working with our other leaders on planning for that, with the financial projections and also the plans for the new construction.

 You’ve been at Citizens Memorial since the beginning. What are the most important changes you have seen in your time at the hospital? 

 A lot of changes. We had around 80 employees initially, and now we have over 2,000. The 2,000 does include our clinics, long-term care and home care services in addition to the hospital. We offer a lot more services, we have a lot more buildings.

There's just a lot of changes with technology and with people. Looking at our physicians, we have many specialties now. Originally, we had just family practice. We’ve been able to offer a lot more services here and give people in our community a lot less reason to have to leave to find care.

 If you could select one major healthcare advance that you knew would be important as soon as it happened, what was it and why?

I've seen a lot of them. I've been around for quite a while, so the CAT scan was a big deal once upon a time. MRI was a big deal once upon a time. PET CT was a big deal once upon a time. We started with mobile services for those and then obtained our own equipment. That's just an example.

Also, some equipment for surgery. We've got a robotic system for orthopedic surgery that's very well received. That's something we've just acquired in the last year or two. Also, robotic surgery for urology, and for other surgical procedures. So, lots of technology. Probably one of the bigger changes is the electronic health record. We started that in 2002, and that's a major change that impacts all the clinical areas.

 Running a hospital in a smaller community has become more challenging over the past decade. What can policymakers do to help stabilize the finances of rural healthcare delivery?

 I think the major thing is to pay us appropriately. Often, it seems like the payments are determined based on what the government can afford to pay, as opposed to what it really costs to provide services.

One thing that we're dealing with, in the last few years, as many other providers are, is increasing wage pressure. With nurses and other staff, we've increased wages, but the increase in payments from Medicare and Medicaid haven't really kept up with the wage increases. We are in an area with quite a few retirees and so Medicare is a big part of our business now along with quite a bit of Medicaid.

 What was the biggest challenge you faced early in your career, and what did you learn from it?

 When I started, hospitals were still under cost reimbursement. I had one year of cost reimbursement and then it became prospective payment. It was kind of interesting for me because I only had one year of cost reimbursement, and many of the others had decades of cost reimbursement. And so, they thought the world was going to end because of no cost reimbursement.

Actually, the prospective payment [system] made more sense to me. I was able to adjust to that perhaps easier than some who had been on cost reimbursement for so many years.

 How has the expansion of technology affected care delivery at the hospital? Is technology mostly a benefit, or does it have its downsides?

 I think it's mostly a benefit. We've seen some nice improvements in clinical areas, like I mentioned earlier with orthopedics, urology, and so forth.

Of course, there is an expense portion of that. It does take quite a few capital dollars to purchase the equipment that you need. But we've been fortunate to stay fairly current with our technology, in fact, be ahead of others in our area with technology, and our physicians really appreciate that. [That is appreciated] also by the staff and by the community.

 What are the most important lessons from the pandemic?

 I think probably the most important thing is to be agile. We are a large enough system that we have nice resources, we have a lot of well qualified staff that are very proactive, but yet we're not too big to where we can't move quickly.

For instance, when the monoclonal antibodies came out, one week after we received our first doses, we were able to begin infusions already. If you've seen southwest Missouri, we're in the news quite a bit with high COVID cases. So, our monoclonal antibody [infusions], we're doing quite a few of those. We did 40 last week, and by Wednesday of this week, we already did 40. That was just one area where we were able to adjust quickly. I feel like we did some other similar things to adjust quickly to the pandemic, and to try to take care of as many people as we realistically could.

 What advances do you see at Citizens Memorial Hospital in the next five years?

 I mentioned earlier about a construction project. We're planning to replace our inpatient beds with new beds, new rooms, and also increase our size of our emergency room, operating room, and also cardiology area. Those are nice improvements.

I think we'll continue to recruit physicians and bring in new specialists that will help give the community more reason to stay here when they need care.

 What advice do you have for someone considering a career in healthcare administration?

 Healthcare is a lot of hard work, but it's very rewarding. I think someone kind of has to have that mindset going into it.

It's been very rewarding for me in my roles, and as I observed our previous CEO, to see people develop when we hire them and place them in certain positions and then see them flourish and do well. That's very satisfying to see people, or employees in the organization, improve their skills and provide great service.

 What are you looking forward to in retirement?

 Well, we got four grandkids. We have twin grandsons that are two years old. They live in our town and I look forward to spending a lot of time with them. I plan to golf a little bit more and plan to farm a little bit. That's kind of in my background. So, I think I'll stay busy and enjoy my time.

Videos

Third installment of Turning Points, a Chief Healthcare Executive™ video series in which retiring healthcare executives and CEOs reflect on changes they’ve witnessed over the course of their career and discuss the prospective healthcare landscape for future generations. 

TURNING POINTS: Citizens Memorial’s Gary Fulbright Urges Healthcare Policymakers, “Pay Us Appropriately”

The American Health Care Association and National Center (AHCA/NCAL)

 revealed that only a quarter of nursing homes and assisted living communities feel confident that they can operate for at least another year at the mercy of the economic crisis affecting the industry.

The survey consisted of 616 nursing homes and 122 assisted living communities across the US.

About 54% of nursing homes and 49% of assisted living communities reported that their organization is operating at a loss, as many providers are still struggling to recover from economic shortcomings incurred by the COVID-19 pandemic.

“Even though COVID cases in long-term care are at historic lows, providers are struggling to recover from the economic crisis the pandemic has induced. Too many facilities are operating under shoestring budgets simply because policymakers have failed to dedicate the proper resources, and this can have devastating consequences,” Mark Parkinson, president and CEO of AHCA/NCAL said in a statement.

Long-term care facilities reported having higher-than-normal expenses during the pandemic, as they had to financially accommodate for additional pay for staff, hiring additional staff, and personal protective equipment (PPE). The survey revealed that 84% of nursing homes experienced a loss of revenue brought on by fewer post-acute patients coming from the hospital. Other losses of revenue came in part due to fewer residents seeking long-term care and current residents moving out.

Both increased expenses and lost revenue contributed to cuts made by 49% of both nursing homes and assisted living communities in 2021.

Despite financial hardships experienced during the pandemic, the Provider Relief Fund has been helpful, as reported by 92 percent of nursing homes and 62 percent of assisted living facilities. To restore economic stability of the long-term care industry, AHCA/NCAL is urging lawmakers to approve $20 billion for nursing homes and assisted living communities, whether it be through an enhanced Federal Medical Assistance Percentage for long-term services or through the Provider Relief Fund.

Further, the AHCA/NCAL is urging lawmakers to address issues regarding Medicaid. The survey revealed that more than half of nursing homes and more than one-third of assisted living communities felt that Medicaid fee-for-service is ineffective in covering the cost of care to residents, and one-quarter of both these providers consider it a serious problem.

“Lawmakers and public officials across the country must prioritize the residents and caregivers in our nursing homes and assisted living communities,” said Parkinson. “This starts by sending immediate resources through what remains of the Provider Relief Fund, and it continues by finally addressing the chronic underfunding of Medicaid, which only covers 70 to 80 percent of nursing home care. We have laid out key proposals in our Care For Our Seniors Act to transform America’s nursing homes, but without the help from Congress and state legislators, these necessary reforms will not be possible.”

The AHCA/NCAL estimated that the nursing home industry is expected to lose $94 billion throughout the pandemic and suffer 1,800 facility closures, as determined by an 

 conducted earlier this year. Closures put caregivers out of jobs, force residents to move, and often requires loved ones to travel farther for visits with residents.

“We look forward to working with federal and state governments to ensure the stability of our care economy, so that every provider has the ability to deliver the highest quality of care. From being able to have an adequate supply of PPE to compensating caregivers for their heroic work, long term care facilities need financial assistance from lawmakers to keep serving our vulnerable residents,” said Parkinson.

A survey revealed that 84% of nursing homes experienced a loss of revenue brought on by fewer post-acute patients coming from the hospital.

Only One Quarter of Nursing Homes Confident They’ll Survive the Year, Survey Shows

Claudia Fine, LCSW, MPH, is chief professional officer, 

Healthcare’s new care coordinators are unpaid family caregivers—and research shows they are 

 in healthcare: highly relied on for their insight, but often not considered part of the care team.

Now, providing value-centered care for seniors depends on recognizing family caregivers’ role in maintaining seniors’ health and providing the support these caregivers need to improve health outcomes and quality of life.

Nearly 48 million people provided unpaid care for adults in 2020, up 16.6% since 2015, according 

. About one in four provides care or support for more than one person. Two out of three are female.

Today, the average family caregiver is a 49-year-old woman who works part-time, according to 

. Often, these women care not only for their aging parent, but also for their children. Given the cost of hiring a professional caregiver and the competition for healthcare resources during the pandemic, these women take on the demands of caregiving 

 to juggle these responsibilities. They also typically do not get adequate support from their parents’ healthcare providers or the healthcare system as a whole.

While the stresses associated with family caregiving have always been high, recent research shows that COVID-19 exacerbated these pressures. The impact on the health of caregivers and those they support runs deep:

Nearly half of those who care for a parent say they receive less social support in their role than they did before COVID-19, and about 75% say navigating the healthcare system is more difficult, 

. Most say their parent’s behavior has worsened (68.8%).

Two out of three unpaid caregivers experienced higher rates of depression, anxiety, fatigue and sleep disturbances than non-caregivers of the same age, a 

Among adults caring for both children of their own and aging parents, 85% experienced adverse mental health symptoms, and about half said they had struggled with suicidal thoughts in the past month—eight times the odds of serious suicidal ideation in non-parents/non-caregivers, according to the CDC.

These statistics underscore the need for health systems and health plans to recognize the mental and physical impact of family caregiving. They also demand that leaders find impactful and cost-effective ways to improve senior care by empowering caregivers to make informed care decisions and carry out professional care recommendations. Digital technology can enhance the capacity of the healthcare system to provide what is needed in a flexible way at lower cost. It’s a modern approach that could not only enhance health outcomes, but also improve quality of life for seniors and caregivers alike.

Here are three ways tech-enabled support could help avoid health complications for seniors, improve the patient experience and reduce costs.

No. 1: Decreasing competition for resources

, and they manage competing demands, from employment to other family responsibilities. During the pandemic in particular, when competition for healthcare resources is stiff, it can be easy for family caregivers and those they assist to lose track of who they are supposed to see and when, how to manage their medications and when to call a provider. Tech-enabled support, from on-demand video visits to live chats with nurses or licensed social workers, eases access to healthcare professionals, enabling caregivers to ask questions in the moment. This reduces costs of care by helping caregivers understand and act on what matters. It also provides the basis for more informed care decision making and higher-quality medical assistance, helping to reduce expensive emergency department visits as well as repeat hospitalizations.

No. 2: Enhancing access to mental health support

. As family caregivers experience more intense challenges in their role—and as mental health worsens for some seniors—an increasing number of older adults are 

more open to receiving behavioral health services

. Pairing family caregivers and their loved ones with virtual behavioral health, whether on demand or via a scheduled visit, is an important step toward reducing feelings of isolation and stress. This helps avoid caregiver burnout, enhancing quality of life while ensuring that care can remain in the home as long as possible. One study shows that a robust program for reducing caregiver stress 

No. 3: Providing remote training for specialized care needs

. Family caregivers face enormous pressure to fulfill tasks that ordinarily would be performed by a healthcare professional. For example, a woman whose husband requires long-term use of a peripherally inserted central catheter (PICC) line found she would be responsible for cleaning and flushing the PICC line three times a day. It’s a daunting task given her fears that she could inadvertently introduce bacteria into the line, further harming her husband’s health. By providing live virtual training and access to a healthcare specialist when questions arise, healthcare organizations can help maintain the integrity of care delivered. This helps keep care in less expensive settings. It also bolsters caregivers’ confidence, creating a more positive environment for all involved.

By investing in tech-enabled support for caregivers, healthcare organizations can help take the mental weight of care off those who coordinate services for seniors. This type of digital support is quickly becoming an essential part of the value equation, improving health outcomes for caregivers and patients alike while reducing care costs.

Tech-enabled support could help avoid health complications for seniors, improve the patient experience and reduce costs.

Why Digital Supports for Family Caregivers Are Healthcare’s New Value Differentiator

Technology is everywhere in healthcare, and the list of ways that digital solutions can improve health outcomes and cut costs is endless: technology is used to improve consumer engagement, identify patients who are at risk of events like a heart attack, and increasingly to help different parts of the healthcare system to talk to each other.

But when technology falls short of its promise, it can add costs and burdens for those who use it. The best example might be the electronic health record.

Next-generation digital providers are helping to leverage technology to find the value long promised. Today, DataBook welcomes CitiusTech, a next-generation specialist provider that works with payers, providers, medical technology and life science markets.

In an interview recorded earlier this year, Chief Healthcare Executive Associate Editorial Director Mary Caffrey spoke with 2 leaders of Citius Tech about meeting healthcare challenges with digital solutions. Her guests are Sridhar Turaga, the senior vice president for Digital Innovation & Data Science, and Shyam Manoj Karunakaran, who is senior vice president and market head for Health Plans.

In June, after this interview was recorded, Citius Tech announced an acquisition of SDLC Partners of Pittsburgh, expanding its footprint in the payer solutions space.

In an interview recorded earlier this year, Chief Healthcare Executive Associate Editorial Director Mary Caffrey spoke with 2 leaders of Citius Tech about meeting healthcare challenges with digital solutions. 

Podcast: Using Digital Solutions to Address Technology Shortfalls with Citius Tech Senior VPs

Over the course of the COVID-19 pandemic, use of telemedicine declined after its initial early increase, but continued to most commonly be used for established patients and the delivery of psychiatric or behavioral treatments.

 analyzed data from the IQVIA National Disease and Therapeutic Index regarding outpatient care in the United States between January 1, 2018, and December 31, 2020. The researchers sought to understand the changes in ambulatory care through characterizing the most common conditions or diagnoses for office-based and telemedicine care and by classifying each visit as a short-term, long-term, or preventive issue.

“While the COVID-19 pandemic has driven increases in the use of telemedicine, much less is known about how the pandemic has changed the clinical content of ambulatory care,” the authors explained.

While the volume of office-based care was stable until the fourth quarter of 2019, it began to dip in the first quarter of 2020 before declining sharply from a mean of 84.0 million visits per month in the first quarter to 49.3 million visits in the second quarter. Visits increased slightly to 60 million in the third and fourth quarters.

Meanwhile, telemedicine visits saw the opposite trend: they stayed stable through the first quarter of 2020 and increased sharply in the second quarter, before declining a bit in the third and fourth quarters of 2020.

Preventive care had greater declines between the second and fourth quarters of 2020 than long-term or short-term care for both office-based and telemedicine visits.

In 2018/2019, short-term care accounted for 22.2% of office-based care and 24% of telemedicine visits, which increased slightly to 23.5a% and 26.8%, respectively, in 2020.

In 2018/2019, long-term care accounted for 64.5% of office-based visits and 71.6% of telemedicine visits in 2018/2019, which decreased for office-based visits to 60% and increased for telemedicine visits to 77.1% in 2020.

Preventive care increased in the proportion of office-based visits from 22.5% in 2018/2019 to 24% in 2020 but decreased in the proportion of telemedicine visits from 5.3% to 2.6%.

The researchers also identified the most common diagnoses managed during 2020. There were 9 that were the among the 15 most common for both office-based and telemedicine care: hypertension, hyperlipidemia, diabetes, depression, conduct disorder, respiratory infection, anxiety, asthma, and urinary tract infection.

Psychiatric and behavioral conditions were more common in the telemedicine diagnoses, while preventive care was more common in the office-based diagnoses. The researchers highlighted the noteworthiness that telemedicine was often used for psychiatric and behavioral conditions, adding that other studies have noted the increase in pandemic-related mental health conditions.

While specialty care, primary care, and surgical care all saw increases in telemedicine between +700% and +3,364%, office-based visits decreased enough for all of them to have an overall decrease in care.

It remains unclear if the shift to telemedicine will remain after the pandemic given that many of the historical barriers to telemedicine adoption remain and modifications at the federal and state level may not be permanent.

“Interestingly, despite the large decrease in office-based visits and increased telemedicine delivery early during the COVID-19 pandemic, we noted a rebound in in-person visits during the third and fourth quarters of 2020,” the authors concluded. “This rebound may have been associated with a relaxation of clinical policies that were previously restricting such care, pent-up demand on the part of patients, and greater comfort on the part of clinicians and patients in managing face-to-face workflows safely.”

During the pandemic, telemedicine use increased overall, but was more commonly used for established patients and the delivery of psychiatric and behavioral health care and less commonly used for preventive care.

Telemedicine Use During the Pandemic Less Frequently Used for Preventive Care

This week, CHE welcomes Will Ferniany, PhD, CEO of the University of Alabama at Birmingham Health System (UABHS), for the fourth installment of Turning Points. Ferniany has led the 11-hospital, $5 billion system for 13 years. As the CEO of UABHS, Ferniany has spearheaded healthcare equity campaigns and expanded healthcare delivery throughout Alabama, including rural areas. He will retire at the end of the year. 

This transcript is lightly edited for clarity. 

 Can you describe the evolution of the health system during your tenure?

I've been here since 2008. I would say there's two major changes that have taken place. One is growth; we have grown from being a little over a $1 billion system to close to $6 billion, and we've grown from two hospitals to 11.

But that's not the main thing that I'm proud of--what I'm mostly proud of is the alignment. This is an academic health system, and as an academic health system, we have three missions. One is clinical, one is research, and one is education. When I got here, these were not very well aligned. Those three missions are very well aligned now. [They're] pretty much of equal importance, and in  just about everything we do, we consider all three of those missions.

I'm very proud to work here at this institution, and I've always been proud of the people that work here. It's a wonderful institution in the sense that it takes every patient complaint extremely [seriously], and we have one of the highest patient satisfaction [rates] in the country. That is something I'm also proud of [that we did not have] when I got here. We have strong engagement; the health system and the university together, were voted the best employer in the country by Forbes. That's of everybody, that's of General Motors, Amazon, which is pretty amazing. We take every patient complaint very seriously and respond to it and deal with it, every one of them.

We make sure we don't do things that are what I call "gray;" we're always compliant with the law. We don't do anything that we don't want to see in the newspaper. 

In the fourth installment of the Chief Healthcare Executive™ video series Turning Points, the retiring leader of Alabama's largest academic health system discusses the need for healthcare equity and the mission to improve the health of everyone in the state.

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