1 00:00:00,640 --> 00:00:04,419 Hi, everyone. You're listening to Becker's clinical leadership 2 00:00:04,639 --> 00:00:05,139 podcast. 3 00:00:05,759 --> 00:00:09,199 I'm Erica Carbajal with Becker's hospital review. And 4 00:00:09,199 --> 00:00:11,439 thank you so much for tuning into this 5 00:00:11,439 --> 00:00:11,939 episode 6 00:00:12,775 --> 00:00:15,754 Today, I'm joined by Gina Lade, Chief Quality 7 00:00:15,894 --> 00:00:18,474 Officer at UVA Community Health. 8 00:00:18,855 --> 00:00:21,675 We'll be discussing the growing role that standardization 9 00:00:22,134 --> 00:00:25,254 plays in care delivery today, quality and safety 10 00:00:25,254 --> 00:00:27,494 issues that she has her eye on right 11 00:00:27,494 --> 00:00:29,119 now, and what CMS's 12 00:00:29,500 --> 00:00:32,939 recent rule expanding site neutral payments means for 13 00:00:32,939 --> 00:00:35,119 outpatient quality and safety monitoring. 14 00:00:35,659 --> 00:00:37,979 Gina, welcome, welcome. We're so happy to have 15 00:00:37,979 --> 00:00:38,719 you on. 16 00:00:39,420 --> 00:00:41,520 Great. Thank you for having me, Erica. 17 00:00:42,414 --> 00:00:44,174 Yeah. Well, do you wanna start by just 18 00:00:44,174 --> 00:00:46,495 sharing a little bit about the scope of 19 00:00:46,495 --> 00:00:48,734 your work and your role as chief quality 20 00:00:48,734 --> 00:00:49,234 officer? 21 00:00:50,094 --> 00:00:52,575 Sure. Yeah. So I'm chief quality officer over 22 00:00:52,575 --> 00:00:55,695 the UVA Community Health Hospitals, which, includes three 23 00:00:55,695 --> 00:00:56,195 hospitals, 24 00:00:57,000 --> 00:00:59,020 two in Northern Virginia, which includes 25 00:00:59,719 --> 00:01:01,500 Prince William Medical Center in Manassas, 26 00:01:01,960 --> 00:01:03,719 as well as Haymarket Medical Center, which is 27 00:01:03,719 --> 00:01:04,780 located in Haymarket. 28 00:01:05,159 --> 00:01:07,319 And then lastly, one down in Culpeper, which 29 00:01:07,319 --> 00:01:09,560 is, of course, Culpeper Medical Center. As well 30 00:01:09,560 --> 00:01:11,534 as that we have over 50, 31 00:01:11,974 --> 00:01:13,275 medical groups nowadays. 32 00:01:14,295 --> 00:01:16,454 So that is an aspect of business that 33 00:01:16,454 --> 00:01:18,454 the community health side is growing all the 34 00:01:18,454 --> 00:01:18,954 time. 35 00:01:20,454 --> 00:01:22,635 Gina, do you wanna start by sharing 36 00:01:23,200 --> 00:01:26,400 what your top priority is heading into 2026? 37 00:01:26,400 --> 00:01:28,480 Hard to believe we're wrapping up the year 38 00:01:28,480 --> 00:01:30,420 already, but what do you anticipate 39 00:01:30,879 --> 00:01:34,159 will demand the majority of your focus as 40 00:01:34,159 --> 00:01:36,900 chief quality officer in the next year here? 41 00:01:37,564 --> 00:01:39,084 Sure. I mean, that's a really good question. 42 00:01:39,084 --> 00:01:41,005 And, obviously, you know, with the year winding 43 00:01:41,005 --> 00:01:43,265 down, something I've been thinking about a lot. 44 00:01:44,204 --> 00:01:46,765 I have a couple priorities in 2026. 45 00:01:47,085 --> 00:01:47,665 Of course, 46 00:01:48,125 --> 00:01:49,725 I mean, I'd be remiss if I didn't 47 00:01:49,725 --> 00:01:51,185 mention CMS team. 48 00:01:51,780 --> 00:01:53,700 With the rollout of CMS team. We've been 49 00:01:53,700 --> 00:01:55,799 looking at not only how we can manage 50 00:01:56,380 --> 00:01:56,880 our 51 00:01:57,460 --> 00:02:00,500 manage these post acute transitions will be important 52 00:02:00,500 --> 00:02:02,040 to success with that program 53 00:02:02,340 --> 00:02:04,819 but also more holistically on how we can 54 00:02:04,819 --> 00:02:07,594 reduce risk to our overall perioperative patients. 55 00:02:08,294 --> 00:02:10,215 This is obviously not a new approach. We're 56 00:02:10,215 --> 00:02:12,794 always looking at ways we can reduce harm. 57 00:02:13,335 --> 00:02:15,014 But it just happened to be a happy 58 00:02:15,014 --> 00:02:17,014 accident for me that I have two members 59 00:02:17,014 --> 00:02:19,415 of our perioperative team and our CMS team 60 00:02:19,415 --> 00:02:20,235 steering committee, 61 00:02:20,680 --> 00:02:22,360 which have inspired me to look at how 62 00:02:22,360 --> 00:02:24,760 we approach harm reduction at all phases in 63 00:02:24,760 --> 00:02:26,060 the patient care continuum. 64 00:02:26,680 --> 00:02:27,900 You know, for example, 65 00:02:28,680 --> 00:02:29,819 how can we restart 66 00:02:30,280 --> 00:02:32,919 the process of reducing risk for all falls 67 00:02:32,919 --> 00:02:33,705 in pre op? 68 00:02:34,344 --> 00:02:36,665 Research has shown that patient education is one 69 00:02:36,665 --> 00:02:39,224 of the most impactful interventions to reduce patient 70 00:02:39,224 --> 00:02:39,724 falls. 71 00:02:40,104 --> 00:02:41,465 So we're looking at, you know, can we 72 00:02:41,465 --> 00:02:43,465 start the education in pre op? Can we 73 00:02:43,465 --> 00:02:45,724 coordinate with the post op in inpatient 74 00:02:46,185 --> 00:02:48,264 units to ensure that the message is the 75 00:02:48,264 --> 00:02:49,819 same throughout the patient journey. 76 00:02:50,360 --> 00:02:51,639 One of the other ways we're doing this 77 00:02:51,639 --> 00:02:53,719 is we're looking at the discharge teaching that 78 00:02:53,719 --> 00:02:55,500 we provide through the same lens. 79 00:02:56,039 --> 00:02:56,699 We're starting 80 00:02:57,000 --> 00:03:00,039 discharge teaching with the pre periopt team and 81 00:03:00,039 --> 00:03:02,060 we're making sure that aligns with the 82 00:03:02,485 --> 00:03:04,485 inpatient teams to make sure that we have 83 00:03:04,485 --> 00:03:07,205 a standardized approach to patient education all the 84 00:03:07,205 --> 00:03:07,864 way through. 85 00:03:08,884 --> 00:03:10,324 The other thing I'm really looking at is 86 00:03:10,324 --> 00:03:11,224 data transparency. 87 00:03:12,405 --> 00:03:13,764 One of the things that my team has 88 00:03:13,764 --> 00:03:15,944 been looking at is we've been developing scorecards 89 00:03:16,084 --> 00:03:18,860 that show our performance in key public reported 90 00:03:18,860 --> 00:03:19,360 metrics. 91 00:03:20,219 --> 00:03:22,300 The intent is that these scorecards are gonna 92 00:03:22,300 --> 00:03:24,460 be shared widely with both staff and visitors 93 00:03:24,460 --> 00:03:25,280 in our hallways. 94 00:03:26,139 --> 00:03:28,300 But we've also decided that in addition to 95 00:03:28,300 --> 00:03:28,800 sharing, 96 00:03:30,219 --> 00:03:30,879 the actual 97 00:03:31,665 --> 00:03:34,385 key metric point. But we're gonna actually be 98 00:03:34,385 --> 00:03:37,585 sharing the corresponding outcome and process measures so 99 00:03:37,585 --> 00:03:39,685 that staff can see how they are impacting 100 00:03:39,745 --> 00:03:40,405 that measure 101 00:03:40,705 --> 00:03:42,705 as well as the impact of these measures 102 00:03:42,705 --> 00:03:43,844 on patient outcomes. 103 00:03:44,544 --> 00:03:45,925 So to give an example, 104 00:03:47,379 --> 00:03:49,620 along our SEP-one bundle compliance, which I think 105 00:03:49,620 --> 00:03:51,159 is a very normal thing to 106 00:03:51,699 --> 00:03:54,340 post, we're also sharing now our sepsis mortality 107 00:03:54,340 --> 00:03:56,519 and sepsis readmission rates right alongside 108 00:03:57,139 --> 00:03:59,294 that SEP-one bundle compliance score. 109 00:04:00,094 --> 00:04:02,974 Also alongside our CAUTI and CLABSI rates, we're 110 00:04:02,974 --> 00:04:06,175 also sharing our standardized utilization rates in our 111 00:04:06,175 --> 00:04:07,875 bundle maintenance compliance rates. 112 00:04:08,175 --> 00:04:09,614 So we've only been sharing these a couple 113 00:04:09,614 --> 00:04:11,715 months but I'm really pleased with the conversation 114 00:04:11,854 --> 00:04:13,379 that it spurred. You know, we've gotten the 115 00:04:13,379 --> 00:04:15,479 CNO has been really heavily involved in 116 00:04:16,100 --> 00:04:19,319 pushing back and giving us feedback on 117 00:04:19,860 --> 00:04:22,680 how how these metrics are reported and presented. 118 00:04:23,060 --> 00:04:24,279 And I think it's really 119 00:04:25,294 --> 00:04:27,535 it's really helped increase the visibility of our 120 00:04:27,535 --> 00:04:28,495 performance in these, 121 00:04:28,975 --> 00:04:30,274 in these, metrics. 122 00:04:32,495 --> 00:04:34,995 Yeah. So interesting, Gina. I'm glad you mentioned 123 00:04:35,214 --> 00:04:37,774 CMS teams model. Been such a big area 124 00:04:37,774 --> 00:04:40,110 of of coverage and things that quality leaders 125 00:04:40,110 --> 00:04:42,449 are really focused on right now. 126 00:04:43,709 --> 00:04:44,209 And 127 00:04:44,670 --> 00:04:46,290 and you mentioned just 128 00:04:47,550 --> 00:04:49,410 education with patient discharges 129 00:04:49,790 --> 00:04:52,290 and and fall prevention, kind of getting that 130 00:04:52,474 --> 00:04:54,714 that started earlier in the process and, 131 00:04:55,194 --> 00:04:55,935 kind of 132 00:04:56,474 --> 00:04:57,454 having this model 133 00:04:57,914 --> 00:05:00,654 raise the the importance of that even further. 134 00:05:01,194 --> 00:05:03,435 Are you working as well, like, more closely 135 00:05:03,435 --> 00:05:05,055 with post acute 136 00:05:05,639 --> 00:05:08,379 providers or long term care facilities 137 00:05:08,839 --> 00:05:10,779 to support those transitions as well? 138 00:05:12,040 --> 00:05:13,259 We are. That's, 139 00:05:13,639 --> 00:05:16,120 that's been an opportunity in all of the 140 00:05:16,120 --> 00:05:17,580 areas that we have hospitals, 141 00:05:18,464 --> 00:05:21,264 just because of the areas where our hospitals 142 00:05:21,264 --> 00:05:22,625 are located. You know, we have, for example, 143 00:05:22,625 --> 00:05:25,444 Culpeper. Culpeper is quite a rural hospital. So 144 00:05:25,745 --> 00:05:28,784 we have limited access to post acute providers 145 00:05:28,784 --> 00:05:29,444 out there. 146 00:05:29,904 --> 00:05:31,284 But this has really been 147 00:05:31,584 --> 00:05:32,084 motivational 148 00:05:32,625 --> 00:05:33,125 to 149 00:05:33,639 --> 00:05:35,319 help think outside the box a little bit 150 00:05:35,319 --> 00:05:37,080 on how we look at our post acute 151 00:05:37,080 --> 00:05:37,580 providers. 152 00:05:38,360 --> 00:05:40,839 So we have begun the process of, you 153 00:05:40,839 --> 00:05:41,339 know, 154 00:05:42,360 --> 00:05:44,779 making those care transitions a little more smooth, 155 00:05:45,160 --> 00:05:47,879 trying to get in place good relationships with 156 00:05:47,879 --> 00:05:49,100 our post acute providers. 157 00:05:50,354 --> 00:05:51,654 And it's it's probably 158 00:05:52,035 --> 00:05:54,754 something that we're going to be working on 159 00:05:54,754 --> 00:05:56,754 more as we go through year one of 160 00:05:56,754 --> 00:05:57,254 team. 161 00:05:58,834 --> 00:06:00,534 But it's it's definitely 162 00:06:01,730 --> 00:06:04,449 shown us a huge opportunity in our care 163 00:06:04,449 --> 00:06:04,949 transitions. 164 00:06:05,889 --> 00:06:06,709 Yeah. Certainly. 165 00:06:08,290 --> 00:06:10,149 Gina, I want to turn to 166 00:06:10,449 --> 00:06:13,189 standardized care as well. I think clinical leaders 167 00:06:13,250 --> 00:06:15,509 increasingly over the past year have 168 00:06:15,894 --> 00:06:18,694 pointed to standardized care pathways as a lever 169 00:06:18,694 --> 00:06:21,914 for both improving patient outcomes, but also enhancing 170 00:06:22,615 --> 00:06:23,754 operational efficiency. 171 00:06:24,694 --> 00:06:26,375 But this you know, there's so much work 172 00:06:26,375 --> 00:06:27,354 that goes behind 173 00:06:27,654 --> 00:06:28,794 being able to 174 00:06:29,254 --> 00:06:31,949 do this effectively. So could you share an 175 00:06:31,949 --> 00:06:35,729 example perhaps where implementing a standardized care pathway 176 00:06:36,349 --> 00:06:38,689 helps drive improvements in patient care? 177 00:06:39,789 --> 00:06:41,310 Yeah. So one of the ones we've been 178 00:06:41,310 --> 00:06:43,389 working on and we're in early days, but, 179 00:06:43,629 --> 00:06:45,550 one care pathway that we've put a lot 180 00:06:45,550 --> 00:06:47,464 of emphasis on is actually implementing 181 00:06:48,084 --> 00:06:50,645 an enhanced recovery after surgery or surgery also 182 00:06:50,645 --> 00:06:51,625 known as ERAS. 183 00:06:52,245 --> 00:06:54,245 We're probably playing a little bit of catch 184 00:06:54,245 --> 00:06:56,645 up on this one, but we've made a 185 00:06:56,645 --> 00:06:58,245 lot of strides in the past six months 186 00:06:58,245 --> 00:07:00,584 to get our ERAS programs up and running. 187 00:07:00,829 --> 00:07:02,430 And we've kind of gone all in on 188 00:07:02,430 --> 00:07:03,170 this. We're 189 00:07:03,790 --> 00:07:05,790 implementing it for joints, rip and lining for 190 00:07:05,790 --> 00:07:07,550 bowels, and we're gonna be implementing it for 191 00:07:07,550 --> 00:07:09,250 hip fractures as well very soon. 192 00:07:09,949 --> 00:07:11,230 So I'd say we've done a lot of 193 00:07:11,230 --> 00:07:12,990 work in the past six months to go 194 00:07:12,990 --> 00:07:14,529 from, you know, zero to 60 195 00:07:15,314 --> 00:07:18,435 before developing our ERAS pathways. We had some 196 00:07:18,435 --> 00:07:20,914 elements of the protocols that were implemented. For 197 00:07:20,914 --> 00:07:22,694 example, we had some pretty robust 198 00:07:23,714 --> 00:07:26,055 multimodal pain management, early mobilization 199 00:07:26,514 --> 00:07:29,074 processes. We're working with PT and those were 200 00:07:29,074 --> 00:07:30,900 getting to be in place. But some of 201 00:07:30,900 --> 00:07:33,240 our other elements like, you know, fluid management 202 00:07:33,379 --> 00:07:35,800 or antibiotic usage or maintenance of normothermia 203 00:07:36,259 --> 00:07:36,759 nutrition, 204 00:07:37,300 --> 00:07:39,960 those were all really dependent on individual providers 205 00:07:40,100 --> 00:07:42,580 preference or we didn't have a standardized process 206 00:07:42,580 --> 00:07:44,040 in place, for example, in normothermia. 207 00:07:46,754 --> 00:07:48,675 So this is something that we feel is 208 00:07:48,675 --> 00:07:50,995 gonna be impactful. You know, we're you kind 209 00:07:50,995 --> 00:07:52,774 of tied a little bit in with team. 210 00:07:53,074 --> 00:07:54,914 We think it's gonna be impactful to that. 211 00:07:54,914 --> 00:07:56,354 We think it's, you know, just gonna be 212 00:07:56,354 --> 00:07:59,154 just impactful overall to improving, you know, length 213 00:07:59,154 --> 00:08:01,899 of stay, fewer post .com locations, you know, 214 00:08:01,899 --> 00:08:04,079 especially like ilias and things like that. 215 00:08:04,620 --> 00:08:07,519 Reduced opioid use always huge priority for all 216 00:08:07,979 --> 00:08:09,040 healthcare organizations. 217 00:08:09,740 --> 00:08:11,979 But also will help with a smoother more 218 00:08:11,979 --> 00:08:14,185 predictable recovery for patients. And a big element 219 00:08:14,185 --> 00:08:15,404 of this is patient education. 220 00:08:15,944 --> 00:08:17,644 Making sure that our patients are 221 00:08:18,024 --> 00:08:20,264 aware of what they can expect at every 222 00:08:20,264 --> 00:08:21,805 point in their care, 223 00:08:22,264 --> 00:08:24,104 you know, and starting that early with things 224 00:08:24,104 --> 00:08:26,024 like joint camp and things like that. So 225 00:08:26,024 --> 00:08:26,685 I think, 226 00:08:27,720 --> 00:08:30,039 it's it's probably the most important one we've 227 00:08:30,039 --> 00:08:31,639 been working at and we're hoping that this 228 00:08:31,639 --> 00:08:32,299 will be 229 00:08:32,839 --> 00:08:34,139 a bit of a, 230 00:08:35,000 --> 00:08:36,839 you know, a break in the dam for 231 00:08:36,839 --> 00:08:37,899 all of the other, 232 00:08:38,279 --> 00:08:40,379 important care pathways we'll need to 233 00:08:40,815 --> 00:08:42,415 implement to truly get to where we want 234 00:08:42,415 --> 00:08:44,415 where we're reducing variation in our care and 235 00:08:44,415 --> 00:08:46,595 we're having a consistent product all the time. 236 00:08:48,495 --> 00:08:50,415 Yeah. Sure. And I I imagine that the 237 00:08:50,415 --> 00:08:52,415 ERAS pathways will go a long way too 238 00:08:52,415 --> 00:08:54,509 in in patient experience just to your point 239 00:08:54,509 --> 00:08:57,309 about giving patients a really firm understanding of 240 00:08:57,309 --> 00:08:59,230 of what to expect in terms of the 241 00:08:59,230 --> 00:09:00,290 recovery process. 242 00:09:01,149 --> 00:09:02,290 Exactly. Exactly. 243 00:09:02,990 --> 00:09:04,610 And we've our early early 244 00:09:05,304 --> 00:09:06,985 turnout, you know, we've shown that, 245 00:09:07,384 --> 00:09:09,485 people tend to like the the, 246 00:09:10,585 --> 00:09:13,865 increase in education and the expectations around pain 247 00:09:13,865 --> 00:09:15,384 management. I think that's gonna be a really 248 00:09:15,384 --> 00:09:17,485 big one is that people understand, you know, 249 00:09:17,625 --> 00:09:18,925 you can have some pain. 250 00:09:19,269 --> 00:09:20,870 How we're gonna here's how we're gonna deal 251 00:09:20,870 --> 00:09:22,089 with it on the other side. 252 00:09:24,230 --> 00:09:25,049 Yeah. Certainly. 253 00:09:26,230 --> 00:09:28,809 Well, Gina, what is one quality or safety 254 00:09:28,870 --> 00:09:30,970 issue that you believe deserves 255 00:09:31,475 --> 00:09:34,115 perhaps some more attention across the health care 256 00:09:34,115 --> 00:09:35,894 industry right now and why? 257 00:09:36,754 --> 00:09:39,415 So what I've been thinking a lot about, 258 00:09:40,434 --> 00:09:42,695 just with, you know, how much 259 00:09:43,899 --> 00:09:44,799 AI has 260 00:09:45,740 --> 00:09:46,240 infiltrated 261 00:09:46,700 --> 00:09:47,519 every part 262 00:09:48,139 --> 00:09:49,899 of of health care and, you know, even 263 00:09:49,899 --> 00:09:50,399 society. 264 00:09:50,940 --> 00:09:52,700 You know, I mean, you can't go about 265 00:09:52,700 --> 00:09:55,419 forty minutes without hearing something about, you know, 266 00:09:55,419 --> 00:09:57,759 AI and how it's gonna be changing 267 00:09:58,235 --> 00:10:00,555 things. But the one safety issue that I 268 00:10:00,555 --> 00:10:01,855 think, organizations 269 00:10:02,235 --> 00:10:02,735 and, 270 00:10:03,195 --> 00:10:05,355 you know, vendors, everyone needs to be prepared 271 00:10:05,355 --> 00:10:07,115 for and deserves a lot more attention is 272 00:10:07,115 --> 00:10:09,855 is the potential of algorithm drift in clinical 273 00:10:09,995 --> 00:10:11,215 decision support tools. 274 00:10:12,154 --> 00:10:13,710 You know, more health care shift 275 00:10:14,190 --> 00:10:16,350 systems are shifting to AI tools for things 276 00:10:16,350 --> 00:10:18,210 like sepsis alerts and triage 277 00:10:18,590 --> 00:10:21,950 and image prioritization and risk scoring. And these 278 00:10:21,950 --> 00:10:24,350 models have the the chance or the risk 279 00:10:24,350 --> 00:10:27,090 of losing accuracy as patient population shift 280 00:10:27,485 --> 00:10:30,605 or documentations have habits change or adapt to, 281 00:10:30,605 --> 00:10:31,504 you know, the 282 00:10:31,805 --> 00:10:33,504 infiltration of AI into, 283 00:10:34,285 --> 00:10:36,545 you know, our care how we give care. 284 00:10:37,004 --> 00:10:38,764 I think the dangerous part of that is 285 00:10:38,764 --> 00:10:39,504 the degradation 286 00:10:39,965 --> 00:10:40,785 could be subtle. 287 00:10:41,750 --> 00:10:44,250 Clinicians won't necessarily see a clear failure. 288 00:10:45,110 --> 00:10:47,590 Just a gradual decline in reliability that can 289 00:10:47,590 --> 00:10:50,389 lead to, you know, misdeterioration or unnecessary workups. 290 00:10:50,389 --> 00:10:51,669 You know, the things that we are trying 291 00:10:51,669 --> 00:10:53,370 to avoid, we're trying to increase efficiencies, 292 00:10:54,389 --> 00:10:55,129 with AI. 293 00:10:55,964 --> 00:10:58,524 And the other thing is is is something 294 00:10:58,524 --> 00:10:59,804 that's all seeping on my mind a lot 295 00:10:59,804 --> 00:11:01,964 is that, you know, unlike medications or equipments, 296 00:11:01,964 --> 00:11:02,704 most organizations 297 00:11:03,404 --> 00:11:05,504 may not have a defined owner for ongoing 298 00:11:05,565 --> 00:11:06,304 AI monitoring, 299 00:11:07,245 --> 00:11:09,759 you know, with maybe in quality. You know, 300 00:11:09,759 --> 00:11:12,179 we we've dealt with some kind of Perry 301 00:11:12,399 --> 00:11:13,459 AI tool Perry 302 00:11:13,759 --> 00:11:14,500 AI tools. 303 00:11:16,320 --> 00:11:18,159 And so I've I've seen this firsthand and 304 00:11:18,159 --> 00:11:19,700 I think that there might be an element 305 00:11:20,399 --> 00:11:22,904 of learning the best government structure for it. 306 00:11:23,384 --> 00:11:25,225 As AI becomes more embedded in care, I 307 00:11:25,225 --> 00:11:28,205 think it'll become more important to ensure adequate, 308 00:11:29,225 --> 00:11:30,365 and the right oversight 309 00:11:30,745 --> 00:11:33,225 continuously be validating the performance of the AI 310 00:11:33,225 --> 00:11:33,725 products, 311 00:11:34,504 --> 00:11:36,185 have a plate have a process in place 312 00:11:36,185 --> 00:11:38,105 to detect drift early and make sure that 313 00:11:38,105 --> 00:11:40,040 the tools stay safe and are trustworthy. 314 00:11:42,100 --> 00:11:43,779 Yeah. That is a really great one around 315 00:11:43,779 --> 00:11:46,580 clinical decision support tools, one that hasn't I 316 00:11:46,580 --> 00:11:48,259 haven't heard a ton about. I think you 317 00:11:48,259 --> 00:11:50,360 raise a really interesting point there. 318 00:11:52,514 --> 00:11:54,274 Jeanne, I wanted yeah. Sorry. Go ahead. I'm 319 00:11:54,274 --> 00:11:55,634 sorry. No. I was just gonna say I 320 00:11:55,634 --> 00:11:57,554 was like, yeah. It's it's just, you know, 321 00:11:57,554 --> 00:11:58,455 ever since, 322 00:12:00,115 --> 00:12:01,634 you know, I've been talking to a number 323 00:12:01,634 --> 00:12:03,715 of vendors around, for example, like, you know, 324 00:12:03,715 --> 00:12:04,215 sepsis 325 00:12:04,539 --> 00:12:06,139 tools and things like that. And that's the 326 00:12:06,139 --> 00:12:08,940 question that I keep having is, you know, 327 00:12:08,940 --> 00:12:11,019 if if AR AI at some point time 328 00:12:11,019 --> 00:12:13,120 is potentially referencing AI, you know, 329 00:12:13,660 --> 00:12:14,799 is is that a risk? 330 00:12:15,820 --> 00:12:18,595 Oh, thanks for sharing that. Wanted to talk 331 00:12:18,595 --> 00:12:21,075 just a little bit about a recent policy 332 00:12:21,075 --> 00:12:24,195 as well. Obviously, CMS has passed a rule 333 00:12:24,195 --> 00:12:26,834 expanding site neutral payments and phasing out the 334 00:12:26,834 --> 00:12:27,334 inpatient 335 00:12:27,954 --> 00:12:30,754 only list, another signal that we're seeing more 336 00:12:30,754 --> 00:12:31,254 complex 337 00:12:31,589 --> 00:12:33,929 procedures moving into outpatient settings. 338 00:12:34,470 --> 00:12:37,610 And this just got me thinking, you know, 339 00:12:37,909 --> 00:12:40,649 what this means for quality and safety monitoring 340 00:12:40,949 --> 00:12:43,110 in the outpatient setting as more care is 341 00:12:43,110 --> 00:12:44,169 moving there. So 342 00:12:45,264 --> 00:12:46,485 what kinds of standards, 343 00:12:46,945 --> 00:12:49,504 structures, or innovations do you believe are needed 344 00:12:49,504 --> 00:12:53,105 to ensure there is robust oversight as more 345 00:12:53,105 --> 00:12:55,825 care moves outside the four walls of the 346 00:12:55,825 --> 00:12:58,980 hospitals? How should systems be thinking about evolving 347 00:12:58,980 --> 00:13:02,340 their approach to quality and safety monitoring in 348 00:13:02,340 --> 00:13:03,399 outpatient settings? 349 00:13:04,180 --> 00:13:05,540 Yeah. I think this is such a great 350 00:13:05,540 --> 00:13:08,420 question, and it really touches on, in my 351 00:13:08,420 --> 00:13:09,720 view, you know, 352 00:13:10,065 --> 00:13:12,644 every aspect of hospital care in a way. 353 00:13:13,904 --> 00:13:16,304 You know, is as CMS is pushing these 354 00:13:16,304 --> 00:13:17,684 procedures into outpatient 355 00:13:18,384 --> 00:13:18,884 settings, 356 00:13:19,745 --> 00:13:21,345 I think health systems need to be thinking 357 00:13:21,345 --> 00:13:24,225 more proactively about the patients. You know, success 358 00:13:24,225 --> 00:13:25,524 is going to be about 359 00:13:26,129 --> 00:13:29,170 setting clear standards for which procedures can safely 360 00:13:29,170 --> 00:13:30,470 be done outside the hospital. 361 00:13:31,009 --> 00:13:33,970 I think very importantly, clear screening to ensure 362 00:13:33,970 --> 00:13:36,769 the patient is truly appropriate for outpatient care, 363 00:13:36,769 --> 00:13:38,930 having really good processes in place to make 364 00:13:38,930 --> 00:13:39,430 sure 365 00:13:39,809 --> 00:13:40,790 that, you know, 366 00:13:41,845 --> 00:13:42,585 we understand 367 00:13:43,684 --> 00:13:46,164 the risks of, you know, all of the 368 00:13:46,164 --> 00:13:48,325 the comorbidities are coming with these patients if 369 00:13:48,325 --> 00:13:50,184 they're being taken care of in that setting. 370 00:13:50,725 --> 00:13:52,245 And that and we do have a a 371 00:13:52,245 --> 00:13:54,085 roadmap for this. You know, this is something 372 00:13:54,085 --> 00:13:56,490 that we've done in in other realms of 373 00:13:56,649 --> 00:13:57,149 hospital 374 00:13:57,690 --> 00:13:58,190 care. 375 00:13:59,529 --> 00:14:01,209 But this also means that we have to 376 00:14:01,209 --> 00:14:04,250 have a mature pre procedure optimization process such 377 00:14:04,250 --> 00:14:06,429 as, you know, we're doing those frailty assessments, 378 00:14:06,570 --> 00:14:08,190 getting cardiac clearance, 379 00:14:08,904 --> 00:14:10,445 as well as having standardized 380 00:14:10,904 --> 00:14:11,404 discharge 381 00:14:11,785 --> 00:14:13,325 and observation requirements. 382 00:14:15,065 --> 00:14:16,924 Again, it always comes back to, 383 00:14:17,465 --> 00:14:19,485 you know, reducing variation in care. 384 00:14:20,424 --> 00:14:22,519 It also means that organizations will have to 385 00:14:22,519 --> 00:14:24,360 be a bit more mindful of these outpatient 386 00:14:24,360 --> 00:14:26,039 care sites and ensure that we have the 387 00:14:26,039 --> 00:14:28,279 right staffing, the right training for the staff, 388 00:14:29,320 --> 00:14:31,179 because they potentially be doing, you know, 389 00:14:31,720 --> 00:14:33,820 procedures have traditionally been done in hospitals, 390 00:14:35,014 --> 00:14:37,495 equipment and rescue capabilities to make sure that 391 00:14:37,495 --> 00:14:38,554 the staff understand, 392 00:14:39,095 --> 00:14:40,315 you know, how to rescue. 393 00:14:40,934 --> 00:14:42,695 Hospital leaders will also want to be sure 394 00:14:42,695 --> 00:14:44,934 the facilities are well integrated into your bigger 395 00:14:44,934 --> 00:14:45,835 quality structure. 396 00:14:47,009 --> 00:14:49,090 Make sure that they have the same levels 397 00:14:49,090 --> 00:14:51,490 of reporting and accountability to senior leadership and 398 00:14:51,490 --> 00:14:54,470 the governing board. And that the oversight is 399 00:14:55,090 --> 00:14:57,269 comparable to that inside the hospitals. 400 00:14:58,529 --> 00:15:00,855 Data sharing reporting is also going to be 401 00:15:00,855 --> 00:15:03,514 you know, super important in this new reality. 402 00:15:04,375 --> 00:15:05,514 Things like tracking, 403 00:15:05,815 --> 00:15:07,595 unplanned transfers, complications, 404 00:15:08,615 --> 00:15:10,855 38 risk admission sites. So you're making sure 405 00:15:10,855 --> 00:15:12,315 that you're doing those course corrections, 406 00:15:14,054 --> 00:15:14,554 as 407 00:15:15,490 --> 00:15:17,570 things bubble up, you know, as as tries 408 00:15:17,570 --> 00:15:19,250 that we might, we're not able to always 409 00:15:19,250 --> 00:15:21,730 see all of the wrenches that was thrown 410 00:15:21,730 --> 00:15:23,029 into machines sometimes. 411 00:15:23,649 --> 00:15:26,389 Technology is probably gonna be super important with 412 00:15:26,850 --> 00:15:27,670 this shift. 413 00:15:28,690 --> 00:15:30,414 I mean, Organizations are going to want to 414 00:15:30,414 --> 00:15:32,434 look into the possibility of remote monitoring 415 00:15:32,894 --> 00:15:34,195 those remote follow-up 416 00:15:35,294 --> 00:15:36,355 checks on patients, 417 00:15:37,134 --> 00:15:40,014 things like potentially having more automated follow-up calls 418 00:15:40,014 --> 00:15:41,774 to check-in on patients and having a really 419 00:15:41,774 --> 00:15:44,240 good algorithm on what gets kinda kicked back 420 00:15:44,240 --> 00:15:46,720 to a nurse or a provider during those 421 00:15:46,720 --> 00:15:47,620 follow-up calls. 422 00:15:49,200 --> 00:15:51,360 And, you know, that because of the fact 423 00:15:51,360 --> 00:15:52,980 that patients will be leaving 424 00:15:54,000 --> 00:15:55,540 so quickly after the procedure, 425 00:15:56,080 --> 00:15:58,660 I think you can never say enough 426 00:15:59,054 --> 00:16:00,514 about excellent education 427 00:16:02,014 --> 00:16:03,794 patients. Patients need to understand, 428 00:16:04,174 --> 00:16:05,615 you know, we talked about this in ERAS. 429 00:16:05,615 --> 00:16:07,054 They need to understand what the course looks 430 00:16:07,054 --> 00:16:07,554 like, 431 00:16:08,174 --> 00:16:09,554 when they need to be concerned, 432 00:16:09,934 --> 00:16:10,754 if it deviates, 433 00:16:11,399 --> 00:16:13,240 if you're trying to keep, you know, patients 434 00:16:13,240 --> 00:16:14,139 out of unnecessary 435 00:16:14,440 --> 00:16:16,039 ED visits, you know, that's a metric that 436 00:16:16,039 --> 00:16:17,179 we look at a lot. 437 00:16:17,639 --> 00:16:19,159 You'll want to make sure that they understand, 438 00:16:19,159 --> 00:16:21,079 you know, what truly is a complication and 439 00:16:21,079 --> 00:16:23,019 what is something that's expected to happen. 440 00:16:23,695 --> 00:16:25,294 So I think the big takeaway for me 441 00:16:25,294 --> 00:16:27,134 is that organizations with one on one good 442 00:16:27,134 --> 00:16:28,815 on be proactive here and be thinking about 443 00:16:28,815 --> 00:16:29,554 this stuff, 444 00:16:30,815 --> 00:16:32,034 on ongoing basis, 445 00:16:32,414 --> 00:16:34,254 making sure their teams are ready for this 446 00:16:34,254 --> 00:16:36,014 change, making sure they're aware of this change, 447 00:16:36,014 --> 00:16:37,774 making sure most of all that their patients 448 00:16:37,774 --> 00:16:38,700 ready for this change. 449 00:16:39,179 --> 00:16:41,679 I think that, the patient education aspect, 450 00:16:42,139 --> 00:16:44,399 you know, again, cannot be emphasized enough. 451 00:16:47,740 --> 00:16:49,980 Yeah. Absolutely. We touched on there's so many 452 00:16:49,980 --> 00:16:53,440 considerations. Right? I mean, comprehensive screening, staff training, 453 00:16:53,580 --> 00:16:54,080 equipment, 454 00:16:54,934 --> 00:16:56,855 so much for leaders to start thinking about 455 00:16:56,855 --> 00:16:59,434 and making sure that all these mechanisms are 456 00:16:59,495 --> 00:17:01,254 are up to par for these site of 457 00:17:01,254 --> 00:17:01,995 care shifts. 458 00:17:02,534 --> 00:17:05,174 Well, Gina, thank you so much for joining 459 00:17:05,174 --> 00:17:07,255 me on the podcast today. It was truly 460 00:17:07,255 --> 00:17:09,089 a pleasure to have you on to talk 461 00:17:09,089 --> 00:17:11,569 about a number of different things, and I'm 462 00:17:11,569 --> 00:17:13,509 sure we will be in touch again. 463 00:17:14,210 --> 00:17:15,809 Yeah. Thank you so much. Thanks again for 464 00:17:15,809 --> 00:17:17,089 having me, and it was it's always a 465 00:17:17,089 --> 00:17:20,049 pleasure to talk to you. Yeah. Absolutely. Thanks, 466 00:17:20,049 --> 00:17:20,549 everyone.