By Brandy Sparkman-Beierle, chief clinical officer, Homecare Homebase.
Healthcare is a fast-paced and demanding industry that has undergone profound challenges over the past few years, and its frontline employees are taking the brunt of the impact. Burnout among nurses is not new, but the pandemic significantly exacerbated it. While the world begins to see the light at the end of the COVID-19 tunnel, America’s nurses are still trying to catch their breath.
The intersection of rising patient volumes and staffing challenges has led to a significant drop in nursing satisfaction rates. This overextension puts healthcare professionals at risk of burnout, impacting their physical and mental well-being. A 2023 AMN Healthcare survey discovered that the satisfaction level among registered nurses has plummeted to 71%, reflecting the strain on care teams. The consequences of nurse burnout are far-reaching, affecting the individuals directly involved and the quality of care delivered to patients. To combat this growing epidemic, many hospital systems are left with the decision to deploy comprehensive technology solutions to fill the gaps and take some of the burden off the patient care teams’ shoulders.
The Need for Innovation
Addressing nurse burnout requires a proactive approach, and innovative solutions can be pivotal in transforming the landscape of patient care, whether in-patient or home-based. Organizations must prioritize the well-being of their nursing staff and seek tools that provide actionable insights into care team satisfaction. It is crucial to investigate solutions that assess the current state of nursing satisfaction and offer strategies to enhance their professional experience. Some tools that provide these essential benefits include:
Mobile Communication for Patient Care: As clinical outcomes become increasingly tied to revenue, home health, and hospice care require intricate documentation during every visit. Overlooking even a minor detail can significantly impact the level of care provided to your patients and expose an organization’s systems to noncompliance risks. Utilizing a mobile collaboration tool, nurses receive user-friendly prompts, reminders, and notifications and can efficiently record documentation during each visit, avoiding needing to catch up later. These systems also empower users to personalize assessment forms and pathways, reducing duplicate entries and ensuring agency and state compliance.
Education and Training: Boosting retention efforts by developing programs that train, provide ongoing education, and touch base with nurses throughout their first year and beyond is crucial to enhancing the nurse experience and reducing burnout. Leveraging an end-to-end collaboration solution ensures agencies and healthcare systems have the tools and knowledge to run successful training programs. Some ways to bring these programs to life include:
Adopting a blended learning model, integrating in-person and online methods to cater to diverse learning styles for new hires.
Setting clear time-to-productivity goals with a structured roadmap for nurses, ensuring a smooth transition and realistic expectations.
Implementing a robust documentation system to address challenges, support accurate record-keeping, and address education gaps.
Streamlining compliance tracking through a reliable system, ensuring timely completion of required education and facilitating verifiable proof when necessary.
The Role of Clinician Scorecards
One of the most essential things a platform can do for its users is make it a priority to listen to caregivers and act on those insights consistently. This is where tools like clinician scorecards become paramount. These tools work as a comprehensive means to evaluate and improve the well-being of nurses and field clinicians by going beyond traditional metrics and delving into the intricacies of nursing satisfaction levels.
By Eric McGuire, senior vice president, Medical Coding and CDI Service Lines and Corporate Strategy, AGS Health.
Traditional fee-for-service reimbursements are falling by the wayside as healthcare continues its transition toward value-based reimbursement models. This is evidenced by data from the Health Care Payment & Learning Action Network (LAN), which shows more than half of healthcare payments in 2022 were made under value-based care models. Additionally, nearly 75% of health plan leaders surveyed by LAN believe value-based care model activity will continue to rise.
Integral to this transition – which requires providers to better manage patient costs based on a clear, concise, and comprehensive picture of patients’ health and medical conditions – are Hierarchical Condition Category (HCC) codes. Used by the Centers for Medicare and Medicaid Services (CMS) and commercial payers to forecast medical costs for patients with more complex healthcare needs, the HCC risk adjustment model measures relative risk due to health status to determine reimbursement levels. The more complex the patient’s medical needs, the higher the provider’s payment.
In fact, HCCs are the preferred method of risk adjustment for the Medicare population, which includes nearly 60 million people on both Part A and Part B, CMS reports. As such, accurate HCC management is critical for appropriate reimbursement of the care provided to Medicare patients and beneficiaries.
Accuracy is Key
The highly complex HCC model includes approximately 10,000 diagnosis codes that map to HCC codes and 189 different HCC categories with 87 CMS-HCCs, each of which represents diagnoses with similar clinical complexity and expected annual costs of care. Any error can significantly impact reimbursements, which under HCC is determined by mapping a patient’s diagnoses to these codes to create a Risk Adjustment Factor (RAF) score.
The RAF score represents the estimated cost of caring for that patient based on their disease burden and demographic information. It is then multiplied by a base rate to set the provider’s per-member-per-month (PMPM) reimbursement amount. The sicker the patient, the higher the RAF score and, subsequently, the provider’s reimbursement.
Each year, CMS publishes a list of diagnosis codes and corresponding HCC category. Hierarchies (or ‘Families’ of categories) are listed among related condition categories, which set values based on the severity of illnesses. Improperly documenting HCC codes, or failing to document the highest appropriate specificity, results in lower reimbursement rates. For example, HCC 19 (diabetes with no complications) might pay an $894.40 premium bonus compared to a bonus of $1,273.60 for diabetes with ESRD, which requires two HCC codes mapping to 18 and 136.
Conversely, properly documenting HCCs at the highest appropriate specificity can boost reimbursements. For example, if CMS has set a $1,000 PMPM for a patient with an RAF of 2.234 who has diabetes with complications reimbursement would be just $673 per month if the condition is not coded. However, if the case was properly coded as E11.9 Type 2 diabetes mellitus without complications under HCC19 Diabetes without complications, the RAF increases to 2.366, resulting in reimbursement of $1,062 per month. If properly coded as E11.41 Type 2 diabetes mellitus w/diabetic mononeuropathy under HCC18 Diabetes w/ chronic complications, the RAF increases to 2.513 for a reimbursement of $1,312.5.
Everywhere you turn around, artificial intelligence is the topic of the hour. Indeed, the new program is taking over the world by a storm, and it has grown into the drug recovery field too. The many alcohol rehab center across the US have started using AI systems in literally every part of their treatment process.
The AI has made it easy for them to identify addiction, provide proper treatments for recovery, and even take preventive measures to combat relapse in patients. If you are addicted to alcohol, and you seek a meaningful way to come out of addiction, then you are in for a fun time ahead, for AI is in the picture now.
AI is Revolutionizing Every Field
You might have come across artificial intelligence through apps like ChatGPT, or Lensa, and OpenAI. These are applications that use a program code at their base. They are loaded with algorithms that use a set of variables to predict the outcome of a certain event. For example, the Lensa AI uses keywords to generate new images and art using already existing pictures and art pieces. The idea is to use the existing information to generate new information we desire.
This same idea is taken up for medical purposes too. In medicine, AI is very helpful in identifying symptoms of diseases, and suggesting various treatments and medication early on before the symptoms get serious and cause pain for the patients.
In the throes of an ever-intensifying cybersecurity crisis, the healthcare sector is under siege, grappling with the fallout from a wave of ransomware attacks. Among the prominent victims are Ardent Health Services and Norton Healthcare, two pillars of the industry facing sophisticated cyber threats. These incidents, and many others, coupled with a new study led by MIT professor Stuart Madnick, paint a bleak picture of the industry’s vulnerability to cyber adversaries.
Ardent Health Services, a health system overseeing 30 hospitals and more than 200 care sites across six states, was the victim of a significant ransomware attack in late November, necessitating the diversion of emergency room patients and rescheduling non-urgent procedures. The fallout has prompted Ardent to take its network offline, suspend user access to critical IT applications, and launch an effort with cybersecurity partners to restore normal operations rapidly.
Usman Choudhary, chief product and technology officer at VIPRE Security Group, said the pervasive greed among ransomware groups and calls for unity within the security community underscores the critical need for accessible and affordable cybersecurity solutions. Even advanced technical protections are futile if hindered by prohibitive costs or complexity, Choudhary said.
Norton Healthcare, another healthcare provider managing eight hospitals across Kentucky and Indiana, suffered a significant data breach impacting up to 2.5 million individuals throughout 2023. The breach took place between May 7 and 9, 2023, exposing personal and protected health information of patients and employees.
This incident at Norton Healthcare amplifies the broader concerns outlined in Stuart Madnick’s report, funded by Apple, showing that ransomware attacks during the first nine months of 2023 surpassed the total from all of 2022. Ransomware attacks impacted more than 360 million people through August of this year.
The expansion of artificial intelligence in healthcare has garnered significant industry hype over the past year, as health IT executives recognize its potential to transform healthcare delivery — and its efficiency. According to the recent Health IT Industry Outlook Survey, which highlights healthcare CIO strategic goals and pain points, 32% of hospital CIOs recognize AI and machine learning as the top health IT priority for the next year.
While not a new concept, the advancement of machine learning algorithms has accelerated generative AI’s potential to solve health system challenges, like provider shortages and clinical burnout. This has created a sense of urgency amongst healthcare organizations to rapidly implement and expand these technologies. However, IT departments — struggling with their own workforce challenges — bear heavy operational burden if resource and support strategies aren’t in place to shoulder these evolving tools and their growing user expectations.
Before expanding AI initiatives, hospitals and health systems must address operational barriers and process inefficiencies. Finding the proper balance between workforce optimization and automation is key in developing a successful IT support framework.
Securing qualified IT resources amid staffing shortages
Despite compounding IT team workload, talent strain remains a top obstacle for hospital and health system CIOs this year, with 44% of survey respondents highlighting “retaining and budgeting for qualified IT resources” as the greatest operational challenge.
To secure resources and strengthen support processes, IT executives must first evaluate their current support models, gauging their capacity to withstand project load, user experience needs, and budgetary pressures. Having identified support gaps, leaders can then consider workforce optimization initiatives — improving retention strategies, seeking staffing partnerships, or utilizing blended support frameworks — to ease talent strain.
Survey results also revealed that most healthcare CIOs (36%) deemed “flexible IT staffing support to ramp up or down with project demands” as the No. 1 area in which they desired stronger support. By moving beyond conventional staffing approaches, hospitals can develop adaptable IT programs, better equipped to support advancing consumer expectations, compete with new market entrants, and maintain new care models.
Construction is an expansive field, and each industry presents its own set of challenges and requirements for building. Health construction stands out as being unique among others industries due to the distinctive features it brings with it. Here, we will highlight these differences between health construction and other fields so as to give an in-depth understanding of what it takes to construct within this particular sector.
Architectural Planning in Health Construction
Health construction planning requires an in-depth knowledge of both medical functionality and patient comfort. As opposed to other sectors, healthcare facilities like hospitals, clinics or care homes must accommodate complex equipment while adhering to hygiene standards while aiding patient recovery. Furthermore, designing such environments must account for medical professionals working there as they must move quickly during emergencies requiring more rigorous planning processes involving specialists from various fields like medicine, engineering and architecture.
Architectural Planning in Hospitals
Hospital architectural planning presents unique challenges. To meet them, architects often face increased complexity when planning hospital structures. Not only must hospitals meet general construction requirements, they must also ensure seamless coordination among their departments such as emergency, radiology, pathology and surgery. Architectural designs must enable quick patient transfers, accommodate large medical equipment and create an environment conducive to recovery. Furthermore, design layout plays an integral part in infection control, crowd management and emergency response. Considerations for expansion or modification are typically included in the initial design, anticipating future demands and technological developments. Such attention to detail rarely seen elsewhere is reflective of hospital construction’s special demands.
In September, Mikael Öhman took the helm of CORL Technologies, tech-enabled managed services for vendor risk management and compliance, and its sister organization Meditology Services, which provides information risk management, cybersecurity, privacy, and regulatory compliance services for the healthcare industry.
Öhman comes to CORL and Meditology from KMS Healthcare, where he was CEO of the global technology services company. Previously, he was a consultant at McKinsey and Company in Stockholm and Atlanta, managed international operations for Cerner, and led mergers and acquisitions for McKesson’s IT business. In addition to his executive health IT experience, which also includes serving as COO for software, services, and device companies, Öhman co-founded an urgent care business that was sold to Piedmont Urgent Care by Wellstreet.
We recently sat down with Öhman to discuss the current healthcare cybersecurity landscape, what’s on the horizon, and his plans for CORL and Meditology.
EHR: How would you describe the current state of cybersecurity in healthcare?
Öhman: Big, big, big worry. For everybody. Anytime you look at the news, you hear about another health system getting hit with a ransomware attack or a vendor being hacked. That’s why cybersecurity is absolutely a key priority. The bad guys know that healthcare data has tremendous value; you can get rich by holding somebody’s data hostage or selling it.
Healthcare is complex. It requires a highly networked system with many vendors involved at many different points. Data doesn’t just live in one place anymore. While all the data sharing and integration points to move information between on-premises systems and cloud environments are fabulous, they also raise the security threat level by magnitudes. The criminals are going to find the weakest link. When they do, the damage that can be done because of data aggregation is much, much higher. It’s why security is an obvious priority.
Managing and securing healthcare is a much bigger job now than it was 10 years ago when most of your systems were sitting in a data center behind your own four walls. You could see and touch it and feel that you had control. Now, there is a proliferation of cloud-based and SaaS vendors that, if not properly vetted and controlled, can create new exposure points that you may not know even exist. Every provider and payer – anybody using multiple vendors – must be prepared because it’s going to continue to get riskier every single day as new technologies come out.
The great challenge of the American healthcare system in the 21st century has been its accessibility. Hospitals are overrun with patients, doctors and nurses are bogged down by staffing shortages, and rural Americans still suffer in huge stretches of medical deserts where the nearest hospital could be fifty miles away or more.
The question then becomes, in a digital era when so many processes and organizations are becoming more efficient, flexible and convenient, can the same be accomplished in the healthcare complex?
Telehealth and digital medical technologies have begun to create a bridge in healthcare where there once was a widening gap. Patients who suffer from chronic illness and/or receive end-of-life care are often made to endure an interminable cycle of rehospitalization. These patients are shuffled endlessly between hospitals and homes, a journey that in some areas of the country could take hours to traverse. They are packed into waiting rooms and ushered through hospital hallways, where oftentimes the risk of contracting another serious illness is far higher, and they are put through a gamut of medical testing and vitals checking before they are finally able to receive the care that they desperately needed. These patients not only require the high-acuity care that hospitals can provide, but also the means to access this treatment in a comfortable and convenient setting.
Home health agencies have long provided quality care in the comfort of patients’ homes with the help of acute home care models and outpatient-at-home programs. However, as our healthcare system continues to have undue pressure placed upon it, these agencies are forced to provide higher levels of care and services to more and more patients.
This feat can be accomplished, but not without these services being buoyed by the latest in available medical technologies. We can now monitor vitals remotely and provide actionable insight to doctors and nurses who can offer treatment plans and prescribe medications that are then delivered directly to patients’ doors. In addition to this new level of virtual care, teams of mobile clinicians and nurses become integral in the delivery of quality care outside of hospital walls and help to further expand their reach into the surrounding community.
Construction is an expansive field, and each industry presents its own set of challenges and requirements for building. Health construction stands out as being unique among others industries due to the distinctive features it brings with it. Here, we will highlight these differences between health construction and other fields so as to give an in-depth understanding of what it takes to construct within this particular sector.
