All about the new interoperability rules with Michael Michela

Latest From Data Book

Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

Healthcare groups react to the updated CDC guidance

The New Mask Rules

Stephanie Wilding, MPA, is CEO of CommunityHealth, Chicago, Illinois.

COVID-19 sent telemedicine on the fast track for widespread adoption, helping doctors manage and care for their patients—especially those at high risk—during the nationwide shelter-in-place ordinance. But for patients in low-income families, there wasn’t such a simple solution.

While the Affordable Care Act makes health insurance accessible for a significant number of Americans, there are still millions of vulnerable people who rely on receiving care from free clinics like CommunityHealth. So, when COVID-19 hit the United States in March 2020 and strict shelter-in-place orders went into effect across the Chicagoland area, many low-income patients were left unable to seek basic treatment for their preexisting, ongoing, or newly-developed medical needs.

At CommunityHealth, the nation’s largest volunteer-based free clinic, we strive to deliver high-quality care to those who need it most, providing 15,000 medical and dental visits to thousands of Chicagoans who are underserved and uninsured each year. Up to 65% of our patients live at or below the federal poverty line, which is $24,300 for a family of four. Many also suffer from chronic conditions such as diabetes and hypertension, which require ongoing medical treatment.

While most healthcare providers turned to telehealth solutions to continue providing care to their high-risk patients during the pandemic, we knew that many of our low-income families wouldn’t be able to download additional software in advance of a virtual visit—a common prerequisite for many telemedicine tools—or even have reliable access to high-speed internet.

What we needed was a solution that worked with any smartphone as seamlessly as possible, and an easy-to-use telehealth solution that could be rapidly deployed across our network of providers. We also needed a simple platform for physicians and, most importantly, a user-friendly and accessible solution for our patients.

After evaluating several different telehealth solutions, we discovered many of our physicians were already Doximity members and had successfully adopted Doximity Dialer for virtual patient visits. Moreover, Dialer was made available to other healthcare professionals in the clinic’s network, enabling nurses and non-clinical administrative staff to coordinate with patients in a HIPAA-protected fashion.

“Being able to just open an app on my cell phone and securely call a patient when I am working remotely has been a game-changer,” said Babs Waldman, MD, a volunteer medical director at CommunityHealth. “I can call them using the clinic phone number instead of sharing my own private cell phone number. And they don’t have to take public transportation or find child care for their kids who are e-learning so that they can come to the health center for a check-in.”

Doximity Dialer proved to be an easy-to-deploy solution, especially for a volunteer workforce of

providers with a wide range of experience and comfort levels with technology. Since many of our patients had limited access to conduct video visits via smartphone, Doximity audio calls helped mitigate issues with access to care, while maintaining both patient and provider privacy.

Once we got the solution fully implemented, we were able to clear a backlog of 300 patient visits, which had been postponed due to the pandemic. We’ve conducted nearly 4,300 telemedicine appointments, our no-show rates are down 24%, and virtual visits now account for 40% of all our medical appointments in 2020.

Our staff is relieved to be able to continue to serve our community and help low-income patients continue to receive the care they need, wherever they are.

Stephanie D. Wilding, MPA, is the CEO of CommunityHealth. She previously served as chief officer of Strategy, Planning and Development at Chicago Family Health Center (CFHC), where she increased and diversified revenue, led data-driven performance improvement projects to expand access to care and improve quality outcomes, and advanced organizational goals through strategic and annual planning. Prior to joining CFHC in 2015, she was executive director of the East Village Youth Program, a primarily volunteer-based youth services nonprofit.

Articles

Telehealth has been a lifeline for long-term patients throughout the pandemic — but what about those without reliable access to high-speed internet?

Opportunities for Telemedicine to Meet Socioeconomic Demands

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

Humana has learned plenty in more than five years of running its Bold Goal program, the population health effort that now operates in 16 communities and gave the Medicare and Medicaid giant a leg up on managing the social needs that soared when COVID-19 hit.

Chief among the lessons: We can’t do it alone.

,” which are measured based on a definition developed by the CDC. This year, Humana also features information on a Basic Needs Program launched during the pandemic and screenings that doubled the original goal of 3 million to 6 million in 2020.

Bold Goal is Humana's ongoing effort to address holistic health needs in key markets, in part by working with community partners—from health systems to faith leaders—to address social determinants of health. The initiative, designed to tackle barriers such as lack of food or housing and social isolation that contribute to chronic disease, proved beneficial when the pandemic fueled a need to deliver more services in all these areas.

In 2020, Humana found that Bold Goal helped Medicare Advantage members increase the number of physically healthy days; however, perhaps to no surprise, there was a decline in healthy days on the mental health side.

Andrew Renda, MD, vice president for Bold Goal and Population Health Strategy at Humana, said in an interview with 

™ that while it’s hard to say Humana would have fared without Bold Goal in place, it is true that the program “helped position us well” when the pandemic struck.

In an interview, Renda said that partnerships for a national insurer like Humana are essential—it covers 20 million lives in commercial, Medicare and Medicaid plans—and as Bold Goal has shown, it relies on working with market-level partners, especially when managing a response to something like COVID-19.

“Partnerships are absolutely key,” he said. “Number one, we don't have all of the expertise to address all these needs, and to we don't have the resources. So, partnerships are key in a national level.

“Partnerships are really crucial on the local level as we think about building trust with people in communities in deploying interventions and getting that buy-in to participate,” Renda added. “So, partnerships are important in a number of different levels. …

Renda offered an example of building a framework to address food insecurity, which was a major focus for Humana in 2020 due to the pandemic. “If you’re going to address food insecurity, it's important that we work with key leaders in that space. So, we might work with Meals on Wheels, we might work with Feeding America, and we do work with both of them.”

On of Humana’s hallmarks: it likes to have multiple partners so that it gets different looks at how to solve a problem. If it’s testing framework, Renda said, “we want to approach that in different ways.”

Is there an ideal Humana health system partner? If so, what are the characteristics for an ideal partner for a population health initiative?

“There certainly are some characteristics,” Renda said, adding that his list might not be “as precise as you want to hear. “I look at it as creativity, willingness to partner with us openness to exploring the impact of social determinants on health and health outcomes. Because I think just that willingness to come to the table and co-create something together is really, really important. And we've done that with health systems and with providers.”

Renda offered an example of a first-of-its-kind, value-based payment innovation with a handful of providers “that were willing to jump in with us.”

“We want to incentivize primary care providers to screen for social determinants, to document a code, and to make a referral to a community based organization,” he said. “Not everybody was willing to take that leap, and certainly [not] in the middle of a pandemic.”

But some were. The inaugural participant was 

, based in the New Orleans, Louisiana metropolitan area, with operations as far north as Shreveport, La., and as far east as Pascagoula, Miss. New Orleans and Baton Rouge are both Bold Goal communities.

Does Bold Goal provide a template for health systems to be proactive in their own communities?

Renda would say yes. The toolkits, progress reports, and resources on food insecurity, which includes best practices on validated screening practices, all offer “off the shelf” help for health systems just getting started in population health.

Population health was an “aspirational goal, a little bit nebulous, frankly,” when Humana started down this path. But Renda said that didn’t matter when Humana’s CEO, Bruce Broussard charged the team with finding ways to address it—and figuring out how to measure that progress.

“We've just made such tremendous progress. I'm proud of the team and proud of our organization, how much we've learned about health-related quality of life, about social determinants, about data and interventions, partnerships.

The next step is to take what’s Humana learned and make it scalable and sustainable, Renda said. “Now we've got to move forward, I think that the new goal if there was one is to really achieve operational maturity around social determinants—it’s the proof points that these things work that justify bigger investments, so that we can scale things,” he said.

That's really the objective now—to scale that work to get those proof points, to infuse it into a variety of aspects of our business.”

Humana's 2021 Bold Goal Report, released last week, highlights the importance of health system partnerships.

Humana’s Bold Goal Effort Shows Value of Health System Partnerships 

®) seeks nominees for the Seema S. Sonnad Emerging Leader in Managed Care Research Award, which each year recognizes an individual whose early achievements in managed care demonstrate the potential to make an exceptional, long-term contribution as a leader in the field.

The award is named for Dr. Sonnad, who was the associate editor of 

® when she died unexpectedly on March 27, 2015, from a cardiac arrhythmia suffered as she competed in an ultramarathon. At the time of her death, Dr. Sonnad was a member of the faculty at Thomas Jefferson University, where she helped launch and then co-directed the Value Institute at ChristianaCare in Delaware, one of the nation’s largest, integrated healthcare systems. This position allowed Sonnad to apply research findings in real-world settings.

Dr. Sonnad took a keen interest in training investigators and nurturing careers of young women. She had long conceived of such an award to highlight early career achievement in managed care research.

To be considered for the award, nominees must be less than five years from the receipt of their highest degree or less than 7 years from their first full-time position. Other criteria are:

®will be positively noted (but not required).

Letter of recommendation outlining contributions and merit (not to exceed 2 pages) is required.

. Nominations close Tuesday, June 15, 2021.

® is the leading peer-reviewed journal covering health systems outcomes research and part of the MJH Life Sciences™ publishing family, which includes 

The award is named for Seema S. Sonnad, PhD, who helped launch and then co-directed the Value Institute at ChristianaCare in Delaware, one of the nation’s largest, integrated healthcare systems.

Nominees Sought for Emerging Leader in Managed Care

Karen S. Roush, MD, MBA, is vice chair of pathology at Methodist Health System in Dallas, Texas.

One year and over 590,000 deaths later, COVID-19 continues to exact a heavy toll on hospital systems across the country. Through it all, the Methodist Health System (MHS), including the hospital where I work in the Dallas-Fort Worth metroplex area, has found innovative ways to keep our patients and employees safe—all while ensuring that critical care services continued undisrupted.

Given the staggering scale of the pandemic, particularly during the grim winter months of early 2021, safeguarding our hospital system from COVID-19 was no easy task. Fortunately, however, by executing a testing strategy that leveraged fast, accurate, and reliable high-volume COVID-19 antigen tests, MHS was able to reduce infections, protect patients, and save lives.

Ultimately, the success we achieved by utilizing these high-volume testing solutions demonstrates how this same strategy could add enormous value to hospital systems nationwide. It is therefore worth elaborating on what we did “right,” the challenges we encountered, and how we evolved over the course of the pandemic to respond to the greatest health crisis of a generation.

During the initial phases of the pandemic, COVID-19 threw the proverbial “kitchen sink” at us. As cases began to surge across Texas, we knew that ramping up our testing efforts was absolutely critical to isolate infectious patients and protect hospital staff. To that end, we were among the first hospitals in the region to deploy polymerase chain reaction (PCR) tests, which are considered the gold standard of COVID-19 diagnostic assays.

However, as useful and reliable as PCR tests were, we quickly encountered serious operational challenges. Due to limited PCR testing supplies, our hospitals could only test individuals who were either exposed to SARS-CoV-2 or displayed symptoms. This left a huge gap in our screening approach, since asymptomatic individuals could slip through the cracks undetected. To make matters worse, due to the longer turnaround times associated with PCR testing, it was difficult to gather results that were timely and actionable.

Recognizing these challenges, we began searching for alternative testing solutions that could yield results rapidly. Here, rapid point-of-care (POC) tests, as the name suggested, seemed to fit the bill.

Unfortunately, as with PCR assays, our initial optimism surrounding POC tests quickly transformed into measured frustration. Over the subsequent months, we quickly learned that POC tests—while incredibly helpful when utilized among small numbers of patients—were difficult to administer at scale. Especially amid circumstances in which dozens of individuals needed to be tested at a time, POC results were usually delayed, resource-intensive, and not always reliable. If our emergency department experienced a surge, for example, turnaround times for the POC tests were anything but rapid, causing immense frustration among physicians and patients alike. 

To get accurate and consistent results at scale in our hospitals, we needed a solution that could run dozens of samples at the same time and return accurate results quickly, when they were most actionable.

Our High-Throughput Antigen Testing Solution

After months of tribulation, we finally found our answer in high-throughput (HTP) antigen tests, which could be run on analyzers already installed in our hospital labs. Since these analyzers were largely automated, this allowed our lab technicians to run hundreds of samples per hour, finally giving us a much-needed capacity boost. Better still, the same analyzers could also process antibody tests, which have been 

With this new high-throughput diagnostic tool as our first line of defense, we implemented a simple algorithm to reduce viral transmission and protect patients and hospital personnel.

First, all patients—whether or not they displayed symptoms—were tested with a high-throughput antigen assay. Following this initial screening, if a patient was symptomatic or exposed to someone with COVID-19, a subsequent PCR test was used 

The benefits of our revamped testing strategy soon became apparent. High-volume antigen tests proved to be highly accurate, yielding extremely low false positivity rates. What’s more, these lab-based antigen tests provided quick and consistent turnaround times for results, a critical factor and selling point for our physicians and nurses on the front lines of care.

Our lab technicians also appreciated the streamlined, automated process provided by HTP antigen assays, which allowed them to run hundreds of tests at a time on analyzers they already knew how to operate quickly and efficiently.

The successes of our new testing approach had positive ripple effects across the Dallas-Fort Worth Methodist Healthcare System. For example, since HTP antigen assays only required patients to be swabbed once (as opposed to POC tests which often required a second swab to confirm results through a reflex test), we were able to preserve critical diagnostic resources. This also increased patient comfortability, since tested individuals only needed to be swabbed a single time. Finally, our new approach allowed us to preserve precious PCR resources, including reagents.

Taken together, the use of a high-volume antigen test allowed us to achieve our goal of getting reliable results with consistent turnaround times. Moreover, the deployment of this new diagnostic tool, right before COVID-19 infections surged for a third time following the new year, couldn’t have come at a better time.

As the nation inches closer to herd immunity through a combination of vaccinations and natural infection, our story underscores the ongoing need for widespread COVID-19 testing, especially in America’s hospitals. It is my hope that healthcare systems across the nation can learn from this example and achieve the ultimate goals of safeguarding vulnerable patients, protecting healthcare workers and saving lives.

After months of tribulation, Methodist Health System found a solution to our COVID-19 testing challenge in high-throughput (HTP) antigen tests, which could be run on analyzers already installed in our hospital labs.

High Volume Testing Solutions Offer Timely, Accurate and Consistent Results Hospitals Need

Burnout among healthcare workers during the COVID-19 pandemic has been well-documented, but cardiovascular clinicians appear to be particularly hard hit, according to a survey presented during the recent American College of Cardiology Scientific Sessions.

Burnout rose from 20% prior to the pandemic to 38% at the peak. All cardiology team members experienced burnout, which researchers said is not a surprise, said they were more likely to be with patients as they were near death.

Survey findings show some health systems have fallen short in meeting cardiologists’ basic needs, with 41% of participants saying they might cut back hours, change jobs or retire due to lack of health system support. They cited inadequate food, lodging, transportation, childcare and emotional support while caring for COVID-19 patients. As the pandemic hit the one-year mark in the United States, Kaiser Health News reported that more than 

 had died from complications, and more than 4,100 safety complaints had been filed with the U.S. Department of Labor.

And at the same time, 41% reported financial stress, often due to pay cuts.

Half of the cardiovascular team members surveyed provided direct care to patients with COVID-19 but one in five said they lacked adequate personal protective equipment, or PPE. The team members surveyed included cardiologists, physician assistants, nurse practitioners, nurses, pharmacists, and imaging technologists.

To no surprise, burnout was highest among those who provided direct care.

“We know from previous studies that burnout is pervasive in cardiology and medicine in general, but we felt it was important to take the temperature of our colleagues amid the COVID-19 pandemic,” said Laxmi Mehta, MD, vice chair of wellness for the Department of Internal Medicine at the Ohio State University Wexner Medical Center and the study’s lead author.

“The prevalence of burnout among cardiovascular professionals nearly doubled when comparing pre- to peak COVID-19 levels. It clearly shows that there are lots of opportunities to improve the work environment; COVID-19 has really put a magnifying glass on the fact that things were bad and now have significantly worsened.”

The findings portend upcoming shortages in cardiovascular care, with some of this driven by COVID-19. Some plan to cut back on work hours (23%), retire early (13%), or leave their current practice (13%). The sentiments were highest among those feeling burnt out.

COVID-19 is driving force in the decision for some, with 17% of clinicians planning to reduce their clinical work hours, 12% planning to leave their current practice and 11% planning to retire due to COVID-19.

Unprecedented stress, long hours, less pay, and uncertainty are proving a toxic mix, the survey found.

“Health systems need to take steps to help ensure basic safety, financial and personal needs of cardiology clinicians especially in the wake of COVID-19,” Mehta said. “There are also still many unknowns with emerging variants and as our communities open more, some people are choosing not to get vaccinated, not to mention on top of the already taxed health systems, there are additional burdens of caring for patients with cardiovascular disease who delayed care and are now sicker than they would have been if they presented earlier.”

The mini-Z survey on burnout emailed to participants in November 2020 to 10,019 cardiologists, fellows-in-training and cardiovascular team members. A total of 1,288 people responded to the survey (456 U.S. and 436 international cardiologists, 128 trainees and 268 cardiovascular team members). Because peaks in COVID-19 disease activity differed by region, participants were asked to ask about feelings of burnout before COVID-19 and during the peak of COVID-19 where they lived and worked.

Of note, burnout was less severe among international professionals compared with cardiovascular team members in the United States.

“Burnout is a metric, but well-being is the goal and what we are striving for,” Mehta said. “While we are resilient, these results show that we really need to be focusing on fixing the work environment, including ensuring that we have enough PPE, feeling valued and safe at work, improving team dynamics and efficiencies, which are all essential whether there is COVID-19 or not. Organizations need to focus on improving workforce care not just patient care.”

One limitation of the survey is that it asked respondents to use their own definition of burnout. Mehta said the research team will dig into the data to gain insights of differences by gender and career stage.

Survey findings show some health systems have fallen short in meeting cardiologists’ basic needs, with 41% saying they might cut back hours, change jobs or retire due to lack of health system support.

High Burnout Seen Among Cardiologists in COVID-19; Health Systems Fall Short 

This past week, health organizations across the United States took the CDC’s 

—stating fully vaccinated individuals can shed their face coverings in all outdoor and most indoor spaces—in stride, with some lauding the confirmation of data on vaccine effectiveness in community settings, and others strongly cautioning against relaxed transmission protocols.

The new guidance was announced on May 13, and specifically stated mask-wearing is still required for crowded indoor settings like health care facilities and on forms of public transportation. In addition, “fully vaccinated people should continue to follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations,” the guidance reads, while those who have not received a vaccine should still comply with all transmission mitigation efforts in place before the update.

 immediately put the new guidance into effect, others pumped the brakes and took time to assess the new recommendations prior to instituting any sweeping changes.

For hospitals and health systems, caution continues to take precedence.

The Society for Healthcare Epidemiology of America (SHEA) emphasized the importance of continued transmission mitigation efforts especially in health care facilities as measures begin to relax.

“SHEA is excited that epidemiological data has confirmed vaccine effectiveness in community settings in recent months. We agree with the recommendations relaxing requirements for post-exposure, and post-travel, quarantine and testing for fully vaccinated individuals,” the organization said in a 

“However, SHEA strongly cautions against relaxing transmission mitigation efforts, including masking in communities with ongoing high rates of transmission and within healthcare settings.”

According to the CDC, all health care personnel should continue following infection prevention and control recommendations, including universal masking in health facilities, to protect themselves and others from infection.

“For health care personnel, it is often not known whether patients have been vaccinated when they first arrive in need of care, and we provide care for many highly immunocompromised patients who may remain vulnerable to COVID-19 even after vaccination,” SHEA’s statement reads.

“The potential for exposure to SARS-CoV-2 [the virus which causes COVID-19] is not limited to direct patient care interactions since transmission can also occur through unprotected exposures in common areas to asymptomatic or pre-symptomatic co-workers or visitors, whose vaccination status may also not be known,” they stated.

In a similar vein, America’s largest nurses’ union, National Nurses United, condemned the CDC’s announcement and called on it to revise its guidance, stating it would jeopardize the health of frontline workers and the general public, and disproportionately impact people of color, 

 reports. Less than 40% of the country’s population is currently fully vaccinated.

"It's important for patients to know that this new guidance doesn't apply to health care settings,” 

 John C. O’Horo, MD, MPH, a critical care and infectious disease specialist at the 

. "We ask our patients and visitors to continue to wear masks and socially distance to protect our patients. Also, state and local government may continue to require masking, particularly in places with increasing cases and relatively low COVID-19 vaccination rates.”

The Clinic is asking patients and visitors to continue to wear masks and socially distance even if they are fully vaccinated, in an effort to protect patients with weakened immune systems.

The American Hospital Association (AHA), a national organization representing all types of hospitals and health care networks, had 

 from the CDC following the announcement of relaxed guidelines.

Staff, patients, residents and visitors should continue to wear masks in health care facilities, the CDC told the AHA. The Center directed facilities to continue to refer to its infection prevention and 

 when it comes to source control and physical distancing.

“We appreciate the fact that fully vaccinated people are likely to have sufficient protection to be able to remove their masks now in many other settings, which will likely encourage others to consider getting their vaccination,” said Nancy Foster, AHA’s vice president of quality and patient safety policy.

“At the same time, we recognize that patients in hospitals may be immunocompromised and thus, less likely to be able to fight off the virus if they are exposed. This is why CDC’s directive stipulates that masks and other precautions should still be used in hospitals and other health care settings.”

Following an announcement from the CDC that fully vaccinated individuals no longer need to wear masks in all outdoor and most indoor spaces, health systems and hospitals responded by continuing to encourage caution. 

How Have Health Systems, Hospitals Responded to the CDC's Relaxation of Mask Guidance?

 spoke with Carol McCall, chief health analytics officer with ClosedLoop.ai. We discussed the recent AI Health Outcomes Challenge conducted by CMS and how ClosedLoop.ai was able to stand out from the crowd and win. We also talked about what physicians and healthcare administrators should look out for when deciding to implement artificial intelligence (AI) and machine learning in their health systems.

Podcasts

Carol McCall, from ClosedLoop.ai., discusses what’s holding back healthcare administrators from taking advantage of what artificial intelligence (AI) platforms have to offer and what the future holds for AI and machine learning in healthcare.

Podcast: A Healthcare Administrators’ Guide to AI and Predictive Analytics with Carol McCall

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

When it comes to managing expenses in your business, there’s no shortage of categories to evaluate—equipment, technology, insurance, benefits, wages and more. And while the highest expense for most healthcare practices is payroll, that’s typically followed by real estate. However, when you consider the financial impact of each, only one is truly negotiable.

The economic terms of a lease or purchase agreement can vary significantly, and as a healthcare provider, you have the ability to negotiate the length of lease and desired concessions, including build-out periods, tenant improvement allowances, free rent periods, annual rate increases and other important provisions. Understanding that each element can be dramatically negotiated to increase profitability is vital.

So, here’s what you need to know heading into your next transaction.

Despite the most obvious challenges to the vast majority of healthcare practices, the healthcare real estate market has remained quite strong. Low interest rates, in-demand tenants, long-term leases and stable occupancy for the healthcare industry have much to do with this.

One thing the pandemic has certainly reinforced is that medical providers represent some of the most sought-after prospects for a landlord or seller—something to keep in mind as you consider future purchase or lease decisions. Because medical providers prefer longer lease terms, often five, seven or 10-year-plus leases (which are favorable for both tenants and landlords) and because they’re considered low risk compared to traditional office or retail users, most landlords will offer more favorable lease terms and concessions today than before the COVID-19 outbreak, if properly represented.

The pandemic has also forced innovation in telehealth services, the popularity of which soared over the past year. And despite the widespread adoption of virtual appointments—a great addition to healthcare services—healthcare executives anticipate telemedicine could actually boost in-person visits by increasing patient engagement and reaching those in remote or underserved locations.

Timing is everything in real estate. If you’re considering purchasing, relocating, expanding or have a lease expiring in the next two to three years, it’s not too early.

More than 80% of healthcare practices lease their office space, and one of the most common mistakes healthcare tenants make is failing to familiarize themselves with their current lease terms and how they compare to the best options in the immediate market. It is vital to be aware of every viable option in your market, as well as tracking with all the important dates and deadlines in your current lease, as most leases contain options that must be exercised within a specific time period, typically six to 12 months prior to the expiration.

Don’t wait for your landlord to approach you on a lease renewal negotiation, as it will typically be too late. Start by consulting a healthcare buyer/tenant-specific agent who understands what’s needed to get the most out of your renewal process. When properly negotiated, build-out allowances, free rent and other concessions can be gained to the amount of tens to hundreds of thousands of dollars in your favor. It’s also very common to start a commercial lease-renewal term at a lower rate than what you are currently paying, as annual increases in leases often outpace inflation. The amount of overall savings depends on the availability of competitive vacancies, your understanding of the immediate market, and your exclusive agent’s ability to establish a strategic posture on your behalf.

It’s virtually impossible to win in a negotiation without leverage and posture, both of which are created by bringing multiple, top real estate options to the table. Simply telling a landlord you have another proposal won’t work, and most landlords assume unrepresented tenants aren’t serious about making them compete for your business. With the right timing, professional representation, an understanding of the best available options near you, and a detailed game plan of what you want to accomplish to capitalize on the market, you can negotiate to achieve the most favorable terms on your second highest expense.

Something that has become common is that landlords who were not sellers previously are now willing to sell their buildings to healthcare professionals with term remaining on their lease. For tenants happy in their current space, this is an incredible time to consider purchasing the real estate you already occupy. Many landlords are also willing to condo their buildings, selling healthcare providers their individual unit, which can open up even more opportunities for healthcare providers to own commercial real estate. Ownership in a space you would otherwise lease can make a massive impact on your overall profitability, and change your net worth by hundreds of thousands of dollars in just a few short years.

How can you best select a real estate broker for your next opportunity? Look for one who understands commercial real estate, only works for you as the tenant or buyer, can help you find the most viable options for leverage, has strong knowledge of medical office needs—which can be vital when negotiating build-outs and tenant improvement allowances—and can take and absorb the conflict and confrontation that is inherent in high-stake negotiations.

Significant amounts of money can be won or lost in every commercial real estate transaction, and the difference between a properly or poorly negotiated transaction is tens to hundreds of thousands of dollars.

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

COVID-19 has shifted the bargaining power for healthcare providers in the real estate market.

How to Maximize Your Profitability Through Healthcare Real Estate

After historically having kept the cloud at a distance, hospitals and healthcare organizations were forced to enter a new era last year when they arrived at the front lines to fight the COVID-19 pandemic. After transitioning to remote patient care, many have accelerated their digital transformation, migrating to the cloud and the use of different SaaS technologies. These shifts became necessary overnight; the healthcare sector, like many others, had no time to think through the consequences of how they could be left vulnerable to cyber threats.

After seeing only 11% of patients virtually in 2019, healthcare providers saw 46% of patients via telehealth in 2020, according to the 

. A survey by Intel found the number of healthcare leaders who adopted SaaS grew from 

; in that same survey, 16% of respondents said that their telehealth systems are still in developing stages, and many are worried that their businesses will suffer from new software vulnerabilities.

, nearly $4 trillion, according to CMS, is struggling to keep up with a rapidly evolving SaaS environment.

Cybercriminals can seize a wealth of information to blackmail patients, access prescriptions, create fake identities, tamper with medical equipment, records, and diagnoses, and even stop pacemakers.

Hackers could sell patient data on the black market for thousands of dollars, or they could hold data hostage with an intent to destroy it so that healthcare institutions would pay ransom to the criminal organization. If patient data is leaked, the affected patients may be denied insurance coverage depending on the nature of information getting revealed. No matter the scenario, organizations risk their reputation and their patients’ trust and will run into issues regarding cyber insurance companies and getting coverage.

 involved hackers stealing sensitive patient data. Since 2019, the number of healthcare breaches in the United States rose by 55.1%, most of which were caused by hackers or IT disturbances. Given the rise in healthcare data leaks from cloud services, healthcare leaders must ramp up their security efforts tenfold.

Why Are Attackers Targeting Healthcare More Than Other Industries?

Around 2014, hackers realized that big healthcare organizations that amass an abundance of confidential patient records, like Kaiser and Blue Shield, were not as secured as hackers’ usual targets.

Financial institutions and the National Security Agency, for instance, have traditionally been earmarked by attackers and thus use more mature security programs than other sectors. As attackers started to discover the many ways they can use sensitive information that is trickier to secure by healthcare providers, healthcare organizations started to become more aware of the issue at hand and became more diligent about security.

Last year, when a pandemic ensued, healthcare institutions that were already hustling to secure themselves better had to ramp on telehealth solutions and many new cloud services. Doctors and nurses who are not necessarily tech-savvy had to adapt quickly, doing upwards of 20 virtual health screenings per day, while IT teams were strapped just to get the new infrastructure in place. In the meantime, legacy medical equipment and old-school hardware are expensive to replace, can’t necessarily be updated as cloud-based infrastructure can, and are inherently vulnerable.

What the sector ends up with is a lot of fragilities.

We’re witnessing an unprecedented transition overload where too much is happening at once, and security teams are having trouble keeping their heads above water.

How should healthcare CISOs and CIOs change their IT strategy based on newly added cloud-based software applications? To properly secure cloud-based infrastructure, aside from hiring more IT and security personnel, healthcare leaders should evaluate how they do business using cloud applications and figure out which applications contain the most sensitive information, and prioritize those.

Reduce the landscape of cloud applications they need to accomplish business functions. Are there overlapping functions that can be attributed to one or fewer cloud applications?

Focus on the SaaS applications that hold the most sensitive data and are thus the most susceptible to insider threats. Monitor who touches the controls and accesses this data.

Disable features within cloud applications that are unlikely to be used.

Focus on the weakest link--people. Implement 

It won’t serve an organization to solve everything at once. That’s why business leaders need an opportunity to invest in tools that expedite auditing of cloud applications in a much easier fashion than how it’s being done now. Less grunt-work from personnel means fewer vulnerabilities. Ideally, you won’t have to work for the analytics and instead have the analytics work for you.

Grant Wernick is a multi-time founder who is currently working on his third venture, Fletch, which is his second venture in data analytics and cybersecurity. Fletch is pioneering a new category called ready-to-use analytics. It is the product of 10+ years of work to productize natural language, machine learning and search technologies to solve some of the most challenging data problems. If interested in joining our private beta, please reach out directly or join our waitlist at fletch.ai.

 Given the rise in healthcare data leaks from cloud services, healthcare leaders must ramp up their security efforts tenfold.

Healthcare Sector to See Rise in Cyber Misbehavior Connected to Cloud Migration

The COVID-19 pandemic has shined a light on the physical and emotional risks healthcare workers face in addition to systemic inequities present prior to the health crisis.

In an effort to spark a national movement for change, a coalition of health system CEOs has devised and signed a 

 setting new safety standards for these workers. The Coalition consists of 10 health system CEOs from across the country committed to improving safety, well-being and equity for all who work in the healthcare field.

The Declaration expands the definition of safety to cover psychological and emotional well-being, states equity and anti-racism are core components of safety, and works to ensure safety by eliminating physical and verbal workplace violence, according to a recent 

To learn more about the Coalition’s formation and how it devised these principles, 

 spoke with Johnese Spisso, MPA, president of UCLA Health and CEO of UCLA Hospital System. Spisso is a co-founder of the CEO Coalition and also co-wrote the Declaration. 

 Can you discuss how the CEO Coalition came together? Has the group worked on initiatives in the past?

Well, certainly this past year has brought a lot of new issues forward in healthcare and as our role as employers for an incredibly dedicated and talented workforce in healthcare. The coalition was founded by 10 healthcare system CEOs from across the country. The founding healthcare systems are diverse in both the background, the region, and types of hospitals they lead. It represents academic medical centers, not-for-profit hospitals, and safety net facilities. The group of CEOs convened because we all shared a common commitment that we really cared deeply about the safety of our team members and wanted to help spark a movement to set new standards of safety for the nation. We recognize that the COVID-19 pandemic was amplifying and bringing visibility to safety issues for team members. It also particularly amplified the physical and emotional risks healthcare team members face, as well as systemic inequities. It gave us an opportunity to look at issues through a new lens and think about how we could bring all of this talent and energy together and create a movement that would be impactful.

The Declaration of Principles covers some areas that were workplace concerns before the pandemic—such as protecting healthcare workers from violence. Is the Coalition drawing on efforts that were in motion before COVID-19 to improve the health and safety of the workforce?

The Declaration of Principles was drafted and refined based on feedback from in-depth interviews and convening with the executives and CEOs over the course of three months in the early part of 2021. We relied on research and strived to understand what core principles underline team members' ability to feel and be safe at work, even prior to the COVID-19 pandemic—because a lot of these issues were there in the past. The CEO Coalition, we have the goal of turning that Declaration of Principles into action by collaborating with healthcare institutions to conduct research and identify a set of evidence-based practices and measures that help support the Declaration of Principles. So, there's still a lot of work to do.

The Principles discuss investments in technology to reduce mental and physical burdens for staff. This sounds like it could include everything from reducing time in front of screens to equipment to help move/transfer larger patients. What is the breadth of investment envisioned?

Are best practices emerging to deal with staff burnout? If so, what are they?

Yes, and we certainly have seen burnout and fatigue throughout this pandemic, and it's come in waves. I think starting out, not only were our staff worried about their own safety, they were also worried about the safety of their families when they were coming into work, and then taking care of patients and going back home, particularly early in the pandemic when we didn't have all the information that we needed about COVID-19. We've tried to make sure we can continue to support their health and well-being and their families' health and well-being as we navigate through the pandemic and provide that direct frontline care. We've tried to do a lot of wraparound services to support the staff going the extra mile for us. I think a lot of institutions have done this with support for meals, support for groceries, support for housing, support for childcare. We've also, here at UCLA health, we've run a variety of virtual and online wellness programs like mindfulness meditation, yoga, as well as reaching out and calling our staff and seeing how they're doing, particularly those who were working in our COVID-19 units.

We had a recent commentary submitted that said one challenge of ensuring adequate staff is the lack of slots in nursing education programs. Has this problem come up at UCLA Health?

How will the Coalition measure the success of implementing the Principles?

That's a really important point. I think, as we bring forward new work to make sure it is having the impact that is desired, and I think that as we look at the CEO coalition, we'll be successful if healthcare team members' safety, as defined in the Declaration of Principles, is measurably improved within one to two years. Our vision is to build momentum by gaining the support of CEOs across the country to help demonstrate the importance of the issue, and specifically around those three pillars that we've defined for our healthcare system nationally. Those are the emotional and psychological safety, the health justice, and the physical safety. We also hope then, that we can use that work and those measured improvements to influence health policy, funding, and culture to create a safer experience for all who work in healthcare, and to keep our healthcare workforce on the job longer in their careers.

Chief Healthcare Executive™ discusses the CEO Coalition's new Declaration of Principles aimed at improving healthcare worker safety with Coalition co-founder and Declaration co-author Johnese Spisso, MPA.

Johnese Spisso on the CEO Coalition's Efforts to Improve Healthcare Worker Safety 

The drive toward quality metrics demands a certain amount of standardization, but that doesn’t mean individual hospitals across a multistate system must lose all their local flavor, said Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, who recently sat down for an interview with 

Your operations spanned 20 different states in very different diverse parts of the country What

processes do you have to balance the need for quality standards across your whole system, while still being able to adapt to the local conditions in each market?

: We tell people, we want to be as standard as possible, but as different as necessary. And, I will say that quality care is a rallying and a levelling, that we always fall on. [During COVID-19] We released almost 250 treatment guidelines on care delivery. And all of those treatment guidelines, as well as operational issues went through the [Executive Vice President and Chief Operating Officer], my partner, 

, and me. We signed off on every one [and had teams working to get them to front-line staff]. When things would change, when the science would change, when the CDC would make new recommendations, we would push those out to the front line. So, the front-line staff didn't have to spend the time finding the new guideline, seeing what the new guideline was. If a new drug came out, when remdesivir came out, we push that out and created the documents to help [the staff], “Here's the how to give remdesivir here's what you need to do. Here's how you create an infusion clinic for this, for a COVID-sensitive infusion clinic.”

So, we leveraged our national quality infrastructure to help push those guidelines and help standardize care. … From the time that we started [to] the time that we got to the end of calendar year 2020, our mortality rates have evolved differently.

Videos

Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension, explained the advantages of working in a multi-state system during a pandemic and how Ascension catered its response to better serve diverse populations.

“Standard as Possible, Different as Necessary,” Is Ascension’s Approach to Quality Across Multistate System, Dr Cacchione Says

Houston Methodist staff say requirement “unlawful.” 

As more hospitals and health systems require staff to receive coronavirus vaccines, some are pushing back. On Friday, 117 staffers at Houston Methodist sued, saying they don’t want to be “guinea pigs.” The suit, filed in state court, claims the requirement violates medical ethics standards based on the Nuremberg Code, which bars experiments on human beings without their consent. The code emerged after World War II in response to atrocities Nazis committed against prisoners in concentration camps. According to 

, this strategy is being deployed around the country by groups resisting COVID-19 vaccination requirements. Elsewhere, the University of Louisville became the first in the state of Kentucky to require the 

CNN Report: Health systems sues thousands during pandemic. 

Since March 2020, Community Health Systems Inc., 

 against patients over allegedly unpaid medical bills, according to an investigation by CNN. The health system, which runs 84 hospitals mostly inn the South, has pursued litigation even as other hospital chains have eased up on litigation during the pandemic. Health system officials told CNN that legal action is the last resort when patients do not pay their bills. The network’s review found that patients were taken to court for bills as small as $201 and as high as $162,000. Most did not hire a lawyer or fight the complaints, which led to default judgments against them, and CHS would then move to garnish wages to collect payment. Patient advocates told CNN that in these cases, low-income patients can be left in financial ruin, especially given the circumstances of the pandemic. The network cited documents filed with the Securities and Exchange Commission to report that CHS enjoyed its most profitable year in at least a decade in 2020, earning $511 million in net income and paying top executives millions of dollars in bonuses.

“Standard as Possible, Different as Necessary,” Is Ascension’s Approach to Quality Across Multistate System, Dr Cacchione Says

MED MOVES: Hospital workers sue over vaccine mandate; health system sues patients

Dr Cacchione Shares Ascension’s Lessons From the Pandemic’s Challenging Early Days

Data Helps Drive the Mission of Helping the Most Vulnerable During COVID-19, Dr Cacchione Says

Higher Transfusion Rates in GI Cancer Surgery Associated with Worse Outcomes

Featured Content

Latest From Data Book

Contract Lifecycle Management

The New Mask Rules