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Small-format neighborhood hospitals offer a cost-efficient, joint venture partnership model with health systems.


A capacity solution for overflowing hospitals | Viewpoint

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

Health systems and hospitals rely on temporary staffing to provide continuity of care.

In this video, three healthcare leaders engage in a fascinating conversation about locum tenens, managing resources, ensuring financial returns, and the clinicians looking at temporary staffing roles.

Thomas Lanvers, senior vice president of Locumsmart, moderated the discussion with Ryan Schwanke, chief medical officer of Billings Clinic, and Roy Milwee, chief ambulatory officer of Appalachian Regional Healthcare.

Check out the full conversation for important insights. This is one of a series of videos on expanding healthcare access. 

Thomas Lanvers of Locumsmart moderates a discussion on locum tenens

A Locumsmart panel discussion on temporary staffing

Thomas Lanvers of Locumsmart leads a video discussion on trends in temporary staffing, financial returns, and the clinicians interested in short-term roles.



Locum Tenens and ensuring continuity of care

Hospital and healthcare leaders are urging Congress to end the government shutdown.

The shutdown began early Wednesday, as the spending legislation financing government programs expired Sept. 30. Lawmakers haven’t been able to come together on a compromise, and one of the key issues involves 

extending tax credits for the Affordable Care Act

telehealth and hospital-at-home programs have been disrupted

. With the spending bill stalled, Congress has also still yet to act on other funding streams that have been important priorities to hospitals.

Sister Mary Haddad, president and CEO of the Catholic Health Association of the United States, issued a statement Wednesday imploring hospitals to end the shutdown.

“We urge Congress to come together to fund the government for Fiscal Year 2026 and extend vital health and safety net programs that millions rely on,” Haddad said in the statement. “A government shutdown jeopardizes the health and stability of millions of families—especially those living paycheck to paycheck and communities that depend on essential services.”

With the shutdown, waivers authorizing telehealth and hospital-at-home programs have lapsed for the first time since the early days of the COVID-19 pandemic in 2020.

The Centers for Medicare & Medicaid Services have directed health systems to transfer patients getting acute care at home to their hospitals or to discharge those patients. Many seniors are affected, as they’re no longer getting Medicare coverage for telehealth programs.

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, said Congress needs to restore the waivers and ensure providers can get reimbursed.

“Most providers and hospital systems are taking calculated risks to continue care during this time, but long-term continuity depends on action by our telehealth champions in Washington to restore these flexibilities and ensure retroactive reimbursement,” Zebley said in a statement Wednesday.

“Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago,” he added. “Our healthcare services are regressing, falling woefully short for millions of patients in need.”

Nationwide, 147 health systems, and a total of 419 hospitals, are approved to provide acute care at home. 

 are operating in 39 states, according to 

Health systems and providers with telehealth services have been frustrated for months about the recurring stress over lawmakers extending telehealth programs. Since a two-year extension expired at the end of December, the telehealth waivers have been tied to short-term spending measures to fund the government. Providers have been seeking permanent reforms, or at least multi-year extensions to have some more predictability.

The lack of longer-term certainty has caused some hospitals to hold off on developing or expanding hospital-at-home programs, hospital leaders say.

Lawmakers remain supportive of telehealth programs, and President Trump first authorized telehealth waivers in the beginning of the COVID-19 pandemic. Zebley is calling on Trump and Congress to end the shutdown and allow programs to resume.

“We are grateful to Congress and the Administration for their continued bipartisan leadership and historic support for telehealth,” Zebley said in a statement. “Their efforts have been instrumental in expanding access to care, and we look forward to working collaboratively to immediately reinstate these vital services to ensure millions of patients can continue to receive care where and when they need it.”

Hospitals have been pressing Congress to preserve a Medicaid program that offers additional funding for hospitals with a high percentage of Medicaid patients. 

The Medicaid Disproportionate Share Hospital program

 delivers vital funding to safety net hospitals, and a scheduled $8 billion cut to the program went into effect on Oct. 1. Congress has agreed to block those reductions before, and hospitals have been urging lawmakers to block those cuts.

Health systems have also pressed Congress to retain two Medicare programs supporting rural hospitals: the Medicare-dependent Hospitals and Low-volume Adjustment programs. Those programs expired on Sept. 30. Congress has also kept those programs afloat in the past, and hospitals are hoping a new spending deal makes provisions for those programs.

Democrats have been holding firm on rejecting any spending package that doesn’t extend tax credits that help Americans pay for the Affordable Care Act. Health systems say millions of Americans may lose coverage without those tax credits. The tax credits are slated to expire at the end of the year.

Lawmakers and healthcare advocates say the tax credits are vital, especially with health insurance plans projecting substantial increases next year.

Republicans and President Trump have told Democrats to sign off on a spending bill, and said they could address the tax credits in separate legislation. 

Democrats have said the tax credits need to be part of a deal to end the shutdown

. Healthcare groups have said the tax credits need to be preserved as soon as possible, since many Americans enroll in health insurance plans in the fall.

Haddad says lawmakers need to get together.

“We encourage lawmakers to swiftly work together to end the shutdown and preserve critical health programs,” Haddad said. “This includes extending essential telehealth flexibilities, preventing harmful Medicaid cuts to safety net hospitals, addressing the disproportionate burden of payments carried by hospitals serving underserved communities, and extending enhanced premium tax credits that are vital for millions of working Americans.”

, president of the Emergency Nurses Association, said the fallout from the shutdown could reach hospital emergency departments.

“Without funding, ENA-supported initiatives and programs which focus on, among other things, emergency care for children, nursing workforce development, critical nursing research, the opioid crisis and the health and well-being of health care workers are in danger of being disrupted,” Oglesby said in a statement.

Brian Frazee, president & CEO of the Delaware Healthcare Association, said in a statement that he’s anxious to see an extension of the Affordable Care Act tax credits. But Frazee also hoped to see an end to the stalemate in Washington.

“Nobody benefits from a government shutdown, and this shutdown will have real implications on critical healthcare programs,” Frazee said. “The current political gridlock creates uncertainty making these times only more challenging.”

The shutdown began Wednesday, affecting telehealth and hospital-at-home programs. Providers have implored lawmakers to extend tax credits for the Affordable Care Act and address other key programs for hospitals.


Topic

Hospitals urge Congress to end government shutdown

Some of Northwell Health’s employees weren’t born when 

 became president and CEO of the New York health system.

After leading Northwell for more than 23 years, Dowling is stepping down. Starting Oct. 1, he will transition to the role of CEO emeritus and will continue to advise the organization. He also plans to do some writing and teaching.

When asked about having a few employees who may have been born after he became CEO, Dowling laughs that there are “a lot of them.” He continues to meet all of Northwell’s employees when they are hired, and met more than 190 on a recent weekday earlier this month.

“Everybody knows who I am, but a lot of them are younger,” he tells Chief Healthcare Executive.

Dowling has been working to ease the transition to 

Northwell’s new CEO, Dr. John D’Angelo

, an executive vice president who has served with the system for 25 years.

Northwell Health's new CEO outlines top priorities

Based in Long Island, Northwell has seen remarkable growth under Dowling’s leadership. Earlier this year, 

Northwell completed the acquisition of Nuvance Health

, a system with seven hospitals in New York and Connecticut, expanding Northwell’s footprint beyond New York state for the first time. Northwell now operates 28 hospitals and boasts more than $22 billion in revenue.

Dowling, who will be 76 in November, says he’s comfortable in his decision to step down as CEO. He says he essentially came to the decision two years ago, when he told Northwell’s board at the time that he would serve two more years. He joined the system three decades ago, serving as chief operating officer before becoming president and CEO in 2002. He says the system is in good hands.

Still, Dowling says, “It's not an easy decision. This has been my life.”

(See part of our conversation in this interview. The story continue below.)

Michael Dowling, Northwell Health's CEO, talks about leading the system for 23 years

Northwell Health CEO reflects on career as he nears retirement

With 23 years as CEO, Dowling’s tenure is far longer than the typical chief executive in the healthcare industry. The average healthcare CEO serves for 7.6 years, according to a 2024 

 by Crist Kolder Associates, an executive search firm.

Part of Dowling’s decision-making process in his retirement plan was to ensure Northwell was well positioned for future success.

“I have been around long enough to see CEOs that just stay too long, and they don't realize that they may not be completely on the ball, and they haven't made plans for succession,” Dowling says. “And then the organization, when there is no plan of succession, the organization gets very, very concerned about it.”

D’Angelo was selected by the board who interviewed candidates from outside the organization, as well as a few internal candidates. They’ve had plenty of discussions, and Dowling says he’s available to be a sounding board.

But Northwell is having an orderly transition to its new leader, Dowling says.

“This one is unbelievably smooth, no dissension, no disruption, and no second guessing,” he says. “The organization keeps moving forward, and that's the goal. It's all about the health of the organization. It's not about ‘he,’ and it's not about me. It's about the organization.”

Why Northwell Health, Cold Spring Harbor Laboratory expanded their partnership

Even as Northwell has grown substantially over the course of Dowling’s career, he says he has wanted to maintain the feeling of being small and preserving the system’s unique character.

He says the key to doing that is “emphasizing relationships, being seen in person, walking the floors, meeting with employees, having demos, having breakfast, having lunches.”

“There is a big tendency these days to focus on the hard issues, the budgets, the infrastructure, the technology, the AI,” he says. “All of that is important. But what's more important is the building of relationships, building trust, getting people to know one another, sharing information, being transparent, shortening the distance between the CEO suite and the front line.”

As Northwell has grown, Dowling says he has worked to avoid a widening chasm between top leadership and the workforce.

“We have done everything possible over the years to make the gaps smaller. So I walk the floors all the time, and I take employees out to dinner every month. I meet employees for breakfast in the mornings,” he says.

As Northwell has worked to bring Nuvance into the organization, Dowling has taken that same personal approach.“I can walk into a Nuvance hospital now, even though they're not fully integrated with us yet. And I guarantee you, everybody will know who I am. And the same with our senior leadership. It’s not just me, by the way, it's our senior leadership, and they know who we are,” he says.

Dowling says that he is “big into relationships and the soft issues.”

“Texting doesn't do it. Emails don't do it. AI won't do it. They all have their benefits, but the power of relationships is what makes it work,” Dowling says.

And that’s why Dowling says he doesn’t text or email, as he favors face-to-face conversations.

“Most of what I do, if it's anything serious at all, is in person,” he says. “It requires you work longer hours. It means you're out at night. It means you have early morning meetings. But if you want to do it right, in my view, this is what you have to do. And if you have a job like this, you have an obligation to put into the time to do it right. Otherwise, don't do it at all.”

Over the course of his career, Dowling has seen significant changes in the delivery of care, including more services on an outpatient basis and the expansion of care at home.

He also says the education of medical schools has evolved, and he touts the work of the Zucker School of Medicine, a partnership of Northwell and Hofstra University.

But he points to Northwell’s work during the COVID-19 pandemic, when New York served as ground zero for the virus in 2020. Northwell treated more than 300,000 Covid patients.

Dowling marvels at the “passion” of Northwell’s staff.

“I saw what employees did,” Dowling says. “I saw the danger they put their own lives in, the danger they put their families in as they did everything possible to protect others from a terrible virus. Those things give you hope and confidence. There's a lot of criticism today by people about Covid, but most of those people that criticize you today were never in the arena.”

Even in the harrowing early days of the pandemic, Dowling maintained confidence that Northwell’s staff would endure, and that the nation would overcome an unprecedented threat. He told 60 Minutes in the spring of 2020 that “the virus is not going to win.”

“There's going to be no retreat, and there's going to be no putting up the white flag,” Dowling recalls of that time. “We win and we move forward despite how difficult it was.”

In a crisis, Dowling says it’s important to prevent a negative attitude from making matters worse.

“It's your attitude towards problems that sometimes is the biggest problem,” he says. “Now the problem is not the problem, it's people's attitude to the problem that becomes the problem. They look at a challenge rather than looking at opportunity. They look at what can go wrong rather rather than what can go right.”

Dowling has been a passionate advocate on addressing gun violence. Northwell hosts 

 to confront it as a public health problem.

the leading cause of death among children

, Dowling says healthcare leaders can’t afford to stay silent on the issue.

“Every healthcare organization across the United States is building up cancer treatment services for kids, but cancer is the third leading cause of death for kids,” Dowling says. “If you're interested in kids' health, then focus also on the leading cause of death for kids.”

The Trump administration has been staunch opponents of efforts to tighten regulations of gun ownership, and Dowling concedes there are some new headwinds to tackling gun violence. But he points to the growth of the National Health Care CEO Council on Gun Violence Prevention and Safety, which he helped establish.

“There's all of the tailwinds of people's compassion and dedication and resilience and willingness to speak up,” Dowling says, adding, “We need more people to be part of the tailwind movement.”

He also says he’s concerned about the federal government creating 

, which he fears will lead to more illnesses.

“That worries me when you undermine the infrastructure on public health. That worries me when you create distrust of vaccines,” he says.

Even as he moves into a different role, Dowling says he plans to continue to speak his mind about gun violence and the need for federal health policies based on science.

“I hope to be involved in some of these issues going forward,” Dowling says. “Silence is the worst possible thing now, and it's not about politics. It's about health, because health is affected by everything.”

After leading the New York health system for more than two decades, Dowling is moving to an advisory role. He reflects on his remarkable tenure.

Northwell Health CEO Michael Dowling prepares to step down: ‘This has been my life’

Congress is moving closer to a partial government shutdown, as lawmakers remain at odds on a deal for a short-term spending plan.

Healthcare advocates are pressing Congress on some key priorities, including telehealth programs, because waivers authorizing those programs are poised to expire at the end of the month.

And it’s a situation that’s been all too familiar for hospitals and providers utilizing telehealth programs.

Here’s a rundown of what’s happening.

last approved a short-term spending bill in March

, the legislation only funded government programs through the end of September. And the clock is ticking.

As part of that legislation, Congress also approved the extension of telehealth programs, which were poised to expire. But the extensions only run through the end of September.

Former President Biden and Congress brokered a two-year extension

 of telehealth waivers in 2022, but it expired at the end of 2024. And since then, lawmakers have granted only short-term extensions, 

Q: Are telehealth programs truly at risk?

A: While healthcare groups have expected that telehealth waivers will ultimately be granted, advocates are getting nervous, because there’s only a week left before the government runs out of money. Congress is out of session this week and isn’t set to return until Sept. 29.

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, says the situation is causing anxiety.

“We are asking – urging – Congress to not leave millions of patients and beleaguered healthcare providers dangling on the telehealth cliff while they deliberate over dynamics around a government shutdown,” Zebley said in a statement.

A: The waivers cover all telehealth programs, including 

programs providing acute care at home via telehealth

. While the government requires hospital-at-home programs to provide some in-person visits from nurses, these programs also involve virtual care.

If there’s not a resolution and waivers aren’t extended, Zebley said, health systems offering hospital-at-home programs could see “major disruption.”

“Hospitals and clinicians will struggle to sustain telehealth-based care if reimbursement disappears. It’s untenable,” Zebley said.

As of Sept. 22, there are 419 hospital-at-home programs operating in 39 states, according to 

 from the Centers for Medicare & Medicaid Services. There are 147 health systems operating those programs.

A: Republicans and Democrats in Congress have shown strong support for telehealth in the past.

Zebley told Chief Healthcare Executive® in July

, “There’s essentially universal support on Capitol Hill,” Zebley says.”

As part of the sweeping tax package approved in July 

that is expected to leave millions without Medicaid coverage

, telehealth scored a win. Lawmakers inserted a provision that reinstates first-dollar coverage for telehealth for Americans using High-Deductible Health Plan-Health Savings Accounts.

Telehealth isn’t preventing lawmakers from reaching a spending deal. The issue of 

extending Affordable Care Act tax credits

, however, is very much a key part of the Clash in Congress.

President Trump has been a supporter of telehealth, Zebley has said.

A: Hospitals are pressing Congress to extend waivers for telehealth programs.

The American Hospital Association placed telehealth programs high atop their priorities in Washington in 

 sent to congressional leaders in both parties.

“Telehealth provides a tremendous ability to leverage geographically dispersed provider capacity to support patient demand,” the association said.

Q: Is there any chance of a long-term extension for telehealth programs?

A: In all likelihood, Congress will probably sign off on another short-term extension, tied to a temporary spending bill, advocates have said.

Healthcare groups have been pushing for lawmakers to approve permanent waivers, or, at minimum, a multi-year extension of those programs.

“Congress should permanently adopt telehealth waivers and expand the telehealth workforce,” the hospital association said in its letter to Congress.

The American Hospital Association has said the inability of Congress to approve permanent or even long-term waiver have deterred some health systems from launching hospital-at-home programs.

A: The American Telemedicine Association is hoping a deal will be reached that includes extending telehealth programs. But the group is also hoping that providers and patients won’t pay the price if there is a shutdown.

“We should at least give providers some reassurance that they will receive back payment for essential healthcare services delivered during this shutdown,” Zebley said.

Congress has yet to agree on a spending plan, and one of the big healthcare priorities centers on telehealth, including hospital-at-home programs.

Vic Schmerbeck

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