EPtalk by Dr. Jayne 9/25/25

Autumn has arrived in the US, and with it the corporate compliance season. Nearly all the companies I’ve worked for do their mandatory training programs in September, October, and November, so I’m getting hit from all directions.

For those of us who have a patchwork of clinical employment and appointments, it means doing training programs from different entities. There is no single national training or certification that everyone can follow.

I’ve done four “Medicare Fraud, Waste, and Abuse” training programs in the last week, and I am at the point where I could teach the class. Online offerings range from “read this document and take a quiz” to videos that have to be watched at normal speed and in one sitting, which adds to the frustration.

Just one of my employers offers a choice of modalities (video versus reading a transcript), which highlights the fact that we need better recognition of different learning styles when we’re considering our corporate training offerings. Today I’m planning to tackle all my HIPAA training, so wish me luck.

It’s also the time of year when organizations update their ICD-10 codes since updates, additions, and deletions become effective on October 1. Changing codes is usually invisible to users, although depending on the EHR and revenue cycle management systems, a fair amount of behind-the-scenes work can be required.

Ideally, the transition involves more than just code changes. Coding and billing experts should ensure that providers understand the nuances of the annual changes. They should share that information with end users in the weeks leading up to the transition date.

Early in my informatics career, it was my job to write the provider bulletin that would highlight some of the new codes. Although that was important work at the time, in hindsight it seems a bit dull compared to the AI projects and large strategic projects I’ve had my hands in more recently.

Details about disbursement of the recently approved $50 billion in assistance for rural health projects are becoming public. The initial phase has states applying for funds that they can then use to augment their own rural health initiatives.

It’s always interesting to see how things go once the money starts flowing. Several states where I’ve lived practiced the bad habit of accepting federal funds for something and then cutting any pre-existing state funds. That doesn’t do much to move projects forward compared to applying federal funds in addition to existing state-level funding.

Rural health varies widely across the US. Some states have many rural health facilities, while others have few due to denser populations. How the funds are allocated will be telling.

The program has five strategic goals that vary in their vagueness. They range from “make rural America healthy again” to “workforce development.” States will employ different approaches to goals like workforce development, recruiting, and retention given the challenges of working in a rural environment.

I’ve practiced primary care in a rural setting and it is daunting. Being a family physician without a lot of subspecialty support requires you manage more conditions than in a suburban environment or at an academic medical center. Some of my rural friends are on call nearly 24/7, which is not necessarily attractive to new graduates even though they might find the environment both challenging and rewarding.

Increasing pay, not only for physicians but for all members of the healthcare team, would improve recruiting. It would require more than $50 billion to do that in a meaningful way in the US.

Other somewhat nebulous focus areas involve “the growth of innovative care models” designed to improve outcomes and “promote flexible care arrangements.” I’m hoping that these phrases aren’t used to advance programs that lead to increasing numbers of less qualified providers in rural areas. A couple of states have put together programs to increase access that allow physicians who are not fully licensed to practice in rural areas.

As someone who did a specialty residency in primary care, I would argue that just because one graduates from medical school doesn’t mean they are qualified to care for patients in the rural environment. I come from a long line of rural folk and have seen the health challenges they face. We need to make sure that we are incentivizing our best and brightest to go to those areas rather than just trying to supply warm bodies with incomplete training.

There is room for innovation in telehealth, team-based care that might involve subspecialists consulting remotely and other worthwhile areas. I hope we see plenty of those in funding proposals.

States must submit applications in by early November, so the timeline will be tight since awards will be announced by the end of the year. Are you involved in proposal submissions? What kinds of projects are on your wish list? Do you think your odds of being funded are good? Feel free to leave a comment or drop me an email.

A recent study caught my attention. It highlights how low-tech interventions might be better than high-tech ones. It found that when trying to identify health-related social needs such as housing instability, transportation needs, or food insecurity, simple questionnaires were more effective than advanced machine learning techniques. Using a combination was even more effective. The study examined 1,200 patients from two health systems in Indianapolis and included techniques such as using natural language processing of clinical notes to identify health-related needs.

Many of the clinicians who practice the US were trained in an environment where social determinants of health weren’t routinely covered. They have gradually been added to curricula, as research has shown that the environments in which people live and work have a significant impact on health outcomes and quality of life.

Some of the elements of the rural health initiative should help address this for patients who live in those areas. But we also need more support for urban populations that are dealing with similar challenges and others such as increasing levels of gun violence.

Is your organization working on initiatives to improve health in a particular community or trying to do so across the board? What are your priorities for these efforts in the coming year? Leave a comment or email me.

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