Becker’s Healthcare Podcast – Episode Summary

Guest: Gena Lawday, RN, BSN, Chief Quality Officer, UVA Community Health
Host: Erica Carbajal, Becker's Healthcare
Date: December 22, 2025
Main theme: The expanding role of standardization in care delivery, current quality and safety priority areas, AI-driven decision support risks, and considerations for outpatient quality monitoring in light of new CMS site neutral payment rules.

Episode Overview

This episode features Gena Lawday, Chief Quality Officer at UVA Community Health, discussing key challenges and strategies in quality and safety for 2026. The conversation delves into the impact of CMS policy changes, the necessity of standardized care pathways, the risks and opportunities of AI in clinical decision-making, and the critical need for robust quality oversight as procedures move to outpatient settings. Gena emphasizes transparent data sharing, patient education, and working closely with both perioperative and post-acute care teams.

Key Topics & Insights

1. Gena Lawday’s Role and UVA Community Health System (00:42 – 01:20)

• Gena oversees quality across three hospitals (Prince William, Haymarket, Culpepper) and over 50 medical groups.
  • "We have over 50 medical groups nowadays, so that is an aspect of business that the community health side is growing all the time." (00:58, Gena Lawday)

2. 2026 Quality Priorities: CMS TEAM, Harm Reduction & Data Transparency (01:20 – 04:32)

Transitional Care and Harm Reduction

• Focus on success with CMS TEAM model, particularly managing post-acute transitions and overall perioperative patient risk reduction.
  • "We're always looking at ways we can reduce harm...I've been inspired to look at how we approach harm reduction at all phases in the patient care continuum." (01:50)
• Early patient education as a key fall prevention and safe discharge tool, starting even before surgery.
• Standardizing patient education across all care phases ensures consistency and effectiveness.

Data Transparency Initiatives

• Developing and publicly posting scorecards on performance metrics (e.g., SEP1 bundle compliance, sepsis outcomes).
• Including process and outcome measures alongside traditional compliance scores for staff visibility and engagement.
  • "We're also sharing now our sepsis mortality and sepsis readmission rates right alongside that SEP1 bundle compliance score." (03:36)
• Positive staff engagement and leadership involvement resulting from increased transparency.

3. Partnerships with Post-Acute Providers & Rural Challenges (05:11 – 06:05)

• Enhanced collaboration with post-acute care providers, especially critical in rural settings like Culpepper, due to limited post-acute access.
  • "That's been an opportunity in all of the areas that we have hospitals...We've begun the process of making those care transitions a little more smooth." (05:15)
• Ongoing work to ease care transitions and ensure continuity outside the hospital, particularly under the new CMS TEAM program.

4. Standardized Care Pathways: The ERAS Example (06:05 – 09:24)

Implementation of Enhanced Recovery After Surgery (ERAS)

• Broad rollout for joints, bowels, and soon hip fractures; rapid progress over the past six months.
• Addressing previous variability in protocols such as fluid management and normothermia by standardizing processes across the system.
  • "We had some pretty robust multimodal pain management...but some of our other elements like fluid management or antibiotic usage...were really dependent on individual provider's preference." (07:25)
• Anticipated benefits: reduced complications, shorter stays, decreased opioid use, enhanced predictability, and improved patient experience.
  • "We think it's just going to be impactful overall to improving length of stay, fewer post op complications...reduced opioid use...a smoother, more predictable recovery for patients." (08:05)
• Patient education is a central component, ensuring patients understand recovery expectations from the outset.

5. Under-Discussed Quality/Safety Issue: AI Algorithmic Drift (09:36 – 12:15)

• Gena highlights the subtle risk of algorithmic drift in AI-driven clinical decision support, especially as populations shift or documentation practices evolve.
  • "The one safety issue that I think organizations...deserves a lot more attention is the potential of algorithmic drift in clinical decision support tools." (09:44)
• Continuous AI validation and oversight are lacking in many organizations as AI becomes more embedded in care.
  • "Unlike medications or equipment, most organizations may not have a defined owner for ongoing AI monitoring...As AI becomes more embedded...it'll become more important to ensure adequate and the right oversight." (10:45–11:11)
• Absence of proactive monitoring can lead to gradual, unnoticed degradation in decision support reliability, with potential for patient harm.
• Strong call for defined governance, early detection of drift, and ongoing validation to keep AI tools "safe and trustworthy." (11:20)

6. Outpatient Quality Oversight Amidst CMS Site Neutral Payment Rule (12:15 – 16:47)

• CMS's expansion of site-neutral payments and phase-out of the inpatient-only list is pushing more complex procedures to outpatient environments.
• Emphasis on robust standards for patient selection, screening, and pre-procedural optimization (including frailty and cardiac clearance assessments).
  • "Setting clear standards for which procedures can safely be done outside the hospital...clear screening to ensure the patient is truly appropriate for outpatient care." (13:06)
• Importance of standardizing discharge protocols, ensuring staff competency, and equipping outpatient sites to handle potential emergencies.
• Integration of outpatient sites under central quality/reporting structures to maintain oversight and accountability.
• Leveraging technology for remote monitoring and automating follow-up to quickly identify and address complications.
  • "Organizations are going to want to look into the possibility of remote monitoring those remote follow up checks on patients..." (14:54)
• Relentless focus on patient education so individuals understand self-care, monitoring, and when to seek help post-procedure.
  • "You can never say enough about excellent education for patients...the patient education aspect cannot be emphasized enough." (15:45)

Notable Quotes & Memorable Moments

• On standardizing performance transparency:
  • "I'm really pleased with the conversation that it spurred...I think it's really helped increase the visibility of our performance in these metrics." (04:13, Gena Lawday)
• On the risks of unmonitored clinical AI:
  • "The degradation can be subtle. Clinicians won't necessarily see a clear failure, just a gradual decline in reliability that can lead to missed deterioration or unnecessary workups..." (10:08)
• On the shift to outpatient care:
  • "Data sharing and reporting is also going to be super important in this new reality...making sure that you're doing those course corrections as things bubble up..." (14:27)
• On patient education in all settings:
  • "Patients need to understand, you know, what their course looks like, when they need to be concerned, if it deviates." (15:19)

Timestamps for Key Segments

• 00:42 – 01:20: Gena Lawday’s scope as Chief Quality Officer
• 01:20 – 04:32: 2026 priorities: CMS TEAM, harm reduction, and transparency
• 05:11 – 06:05: Building relationships with post-acute providers
• 06:05 – 09:24: Standardizing care with ERAS pathways
• 09:36 – 12:15: AI algorithmic drift as an emerging safety risk
• 12:15 – 16:47: Site-neutral payment, outpatient shift, and quality oversight

Conclusion

Gena Lawday underscores the necessity of proactive, standardized approaches across the care continuum—spanning from pre-op education, harm prevention, and transparent quality metrics, to AI governance and rigorous outpatient oversight in the face of policy shifts. Patient education and data-driven transparency emerge as recurrent, foundational threads throughout the conversation.