Todd Shryock

All organizations, including those in health care, have been alerted by the 

Cybersecurity & Infrastructure Security Agency 

(CISA) of the US government to be extra vigilant against cyber threats due to the war in 

. Russia has launched cyberattacks against Ukraine, and the impacts may stretch beyond the region, especially as the United States implements sanctions against Russia.

CISA noted that organizations should be prepared to respond to disruptive cyber activity; they also asked that all cyber incidents be reported as soon as possible.

They further recommend all organizations—regardless of size—adopt a heightened posture when it comes to cybersecurity and protecting their most critical assets. Recognizing that many organizations find it challenging to identify resources for urgent security improvements, CISA has compiled a catalog of free services from government partners, and industry to assist.

More information can be found in their Alert “

Understanding and Mitigating Russian State-Sponsored Cyber Threats to U.S. Critical Infrastructure

,” which was revised March 1, 2022. Another resource is 

, a centralized, whole-of-government webpage providing ransomware resources and alerts.

Articles

With the war in the Ukraine, the government has warned health care organizations to be cautious of potential cyberattacks.

US Government Calls for Extra Vigilance Against Cyberattacks 

New data shows that although health care workers seem resilient after 2 years of working through a pandemic, there are numerous warning signs about the long-term future of the workforce.

Specifically, the survey found 52% of the health care workers were burned out, compared to 55% in 2021. In addition, almost a quarter of those surveyed are considering leaving the health care field in the future. Optimism declined compared to Spring 2021, as health care workers widely disapprove of how the rest of the country has handled the pandemic. In fact, more than a third (39%) agreed with the statement, “The American health care system is on the verge of collapse.”

Fortunately, the survey found some positive data. For instance, a majority of health care workers said they were satisfied with their jobs, with the number holding relatively steady compared with last year. Of those surveyed, 80% report being somewhat or very satisfied with their current job, down slightly from 89% in 2021. Three quarters agree with the statement, “I love working in health care.” A majority report feeling hopeful (59%), down from 76% last year. Those feeling optimistic fell from 67% to 56%.

The study was conducted February 9-16, 2022, with a nationally representative probability sample of 1170 health care workers aged 18 or older. Data were weighted to adjust for gender by age, race/ethnicity, education, Census region, metropolitan status, household income, and health care worker category. The majority (38%) of those surveyed worked in hospital settings.

American Healthcare Workers Persevering, but Remain Stressed

. February 22, 2022. Accessed February 24, 2022. https://www.ipsos.com/en-us/news-polls/usa-today-ipsos-healthcare-workers-covid19-poll-022222

Mixed results from recent study of health care workers. What does it all mean?

New Study Finds Some Resilience, Some Burnout in Health Care Workers

According to a recent poll of individuals aged 50-80, most older adults are staying resilient and finding joy despite the pandemic this holiday season. However, mental health clinicians should be aware that a sizeable minority are feeling high stress levels, including about their risk of getting COVID-19.

 Influence of Income and Mental and Physical Health on Stress Levels

The poll—which was based at the University of Michigan’s Institute for Healthcare Policy and Innovation and conducted before widespread availability of COVID-19 vaccine booster doses for older adults—found that 20% of older adults said they are feeling a lot of stress right now, while 38% said they have little to no stress. Those aged 50 to 65 were nearly twice as likely as those aged 65 to 80 to said they experience a lot of stress (25% compared to 13%), and women and participants in their 50s and early 60s were more likely to report feeling a lot of stress. This was particularly true for participants with the lowest incomes and those who said their overall physical or mental health was fair or poor. Further, 27% of older adults said that just thinking about leaving their houses caused them stress about the possibility of catching COVID-19, while 58% said thinking about going to a crowded indoor space made them feel stressed for the same reason.

However, 15% percent of older adults said they have become more resilient and more able to “bounce back” or overcome challenges during the pandemic, while 71% said they are just as resilient as they were before the pandemic. Over half of respondents—53%—said they are feeling some joy, and 30% said they are feeling a lot of joy, with only 17% saying they are feeling little to no joy. Overall, nearly half of the poll respondents—47%—reported feeling a mixture of joy and stress.

More findings from the poll about the influence of health and income on stress levels and sources of joy are available in 

“The clear differences in ability to find joy during these times, and in experiences of stress, based on health status, shows the importance of focusing on those in poor health,” said Lindsay Kobayashi, PhD, MSc, poll report author and assistant professor of epidemiology at the University of Michigan School of Public Health, in a statement. “But for all older adults, we know that alterations in daily life impact emotional and mental health, so finding safe ways to enjoy favorite activities is important.”

Poll Identifies Most At-Risk Patients During the Holidays

Joy and stress during the COVID-19 pandemic

. National Poll on Healthy Aging: University of Michigan. December 14, 2021. Accessed December 21, 2021.

Women and individuals in their 50s and early 60s reported feeling the most stress about COVID-19.

Older Adults May Be Most At-Risk for Stress During Holidays

Only 11% of medical practice owners said they did better in 2020 than in 2019, whereas 46% said they were doing worse, according to the 

Medical Economics® 2021 Physician Report

. The top reason listed was lost revenue and increased expenses because of COVID-19. Here are some strategies to boost your practice’s bottom line.

Successful practices track performance indicators to identify opportunities for improvement, said Andrew Hajde, assistant director of association content for the 

. These indicators include accounts receivable, insurance claims, reimbursement, denials, and patient satisfaction.

With those data, practices can not only track their own performance over time, Hajde explained, but also benchmark themselves against data from similar providers. He added, “It gives them [praactices] a bar to see if they’re doing well or if they have some opportunities for improvement in any of those areas.”

Similarly, it is also important to find out what other practices are doing to get positive patient engagement and quality ratings, Hajde told Medical Economics. “That’s where it is critical to work with your peers across the country that are achieving those best practices via conferences [and] member communities with associations and [by] researching, reading articles, [listening to] podcasts, or any way you can get in front of how people are achieving those things to bring to your practice.”

Additionally, thriving practices analyze their claims denials and take action to reduce them. It’s crucial to track which payers are denying claims and why they are doing so, Hajde said.

Likewise, Hajde suggested checking accounts receivable for possible causes. “Is it because you are not getting paid in a timely manner or that a lot of claims are being denied?” Hajde asked. To reduce denials, ensure information is entered correctly by office employees.

Claims should also be filed in a timely manner, and all denials that are deemed inappropriate should be appealed within the payers’ established deadlines. “Sometimes you only have 30 or 60 days, so make sure you are on top of that,” Hajde explained.

Every contract has unique details such as requirements for prior authorizations, medical necessity, and timely filing, in addition to the reimbursement agreement. Hajde recommended regularly reviewing contracts and payment rates. “I’ve talked to some practices that haven’t renegotiated with an insurance payer for 5 or 10 years,” he said, “and they are underperforming in terms of their payment rates.”

Also, verify payment compliance and do not assume the payer is always accurate. “Confirm the payment is actually for what your contracted rate is, because sometimes you are inadvertently underpaid,” he added.

Patients should be aware of which part of the payment is their responsibility and, if they cannot pay, how that will be handled, Hajde said. All payment policies and procedures also need to be clearly communicated to staff.

Rick Gundling, senior vice president of health care financial practices at Healthcare Financial Management Association, recommended surveying patients on how they wish to be contacted: text, phone, portal, or app. Different patient populations have different expectations, but knowing their preferred 

 type can help with billing- and care-related messages. An online payment portal is vital because patients expect the convenience, and it can speed up payment, Gundling added.

“You really need to…commit to customer service training to really create a high morale and great patient experience,” Hajde noted. “Patients really pick up on it, and anyone who’s been in a medical practice or other health care facility can tell when employees are dissatisfied. It doesn’t lead to a great experience. It won’t make patients want to tell their friends and family to go to this practice or organization.”

Expert management tips can help clinicians ensure their practices thrive, even during the worst of times.   

Strategies for Successful Medical Practices

Medical liability insurance premiums are increasing after a decade of mostly steady rates, according to a new analysis from the American Medical Association (AMA). In 2020, more than 30% of premiums reported on a survey of 

 insurers increased from the previous year, the highest percent increase since 2005.

For a second consecutive year there has been an exceptional surge in the size of the increase. Between 2010 and 2018, the share of premiums that increased ranged from 12% to 17%. In 2019, that proportion almost doubled to 26.5% and rose in 2020 to 31.1%.

According to the AMA analysis, although some 2020 premiums may have been set after the onset of the COVID-19 pandemic, it was still too early for them to be affected by it.

“Increases in medical liability premiums compound the economic stress on medical practices as the 

 pandemic resulted in significant reductions to patient volume and revenue, and higher expenses for scarce medical supplies,” AMA President Susan R. Bailey, MD, said in a news release. “Practice revenue has not fully recovered as the pandemic has stretched on and a protracted upward trend in medical liability premiums will threaten the viability of many practices that already face a difficult road to recovery.”

The analysis identified the 14 states that had premium increases of 10% or more. Those states and their shares of reported premiums that increased by such magnitude in 2020 are: Kentucky (29.6%), South Carolina (27.8%), Maryland (18.8%), Nebraska (16.7%), Oregon (16.7%), Montana (16.7%), Georgia (14.8%), Missouri (14.8%), New Hampshire (13.3%), Illinois (11.9%), Michigan (11.6%), Texas (9.2%), North Carolina (6.7%), and Virginia (1.3%).

The AMA report also found striking differences in premiums by geography.

“Keeping medical liability premium growth in-check is imperative to ensure patient access to care is not jeopardized by unaffordable liability insurance costs that make it impossible for physicians to remain in practice,” said Bailey. “This concern is particularly pressing given the negative impact that the COVID-19 pandemic has had on access and practice viability, as many physicians have had to suspend patient visits or elective procedures, and some have had to close their practices.”

Together with state medical societies, the AMA is pursuing both traditional and innovative medical liability reforms to preserve premium stability. This includes limited and targeted emergency protections for physicians who continue to treat patients during the pandemic without adequate resources and support.

The newly released AMA analysis on medical liability insurance premiums is based on an annual survey of professional liability insurers conducted by the Medical Liability Monitor (MLM). The MLM reports base premiums for 3 specialties in each state where the responding insurers provide coverage. ❒

Between 2010 and 2018, the share of premiums that increased ranged from 12% to 17%. Are they continuing to rise? 

Medical Liability Costs Are on the Rise

An analysis of data from the US Department of Health and Human Services conducted by the security firm 

 that collectively affected more than 26 million people. The report resulted in 6 key findings.

Attacks are increasing each year.Since 2018, the number of hacking and IT incidents has increased. Last year, hacking was the top cause of breaches, leading to 403 and 599 breaches (67%).

Hacking is resulting in larger breaches.Hacking compromised 91.2% of all exposed health care records in 2020—24.1 million out of 26.4 million.

The cost of breaches is rising. The average cost per breached record increased from $429 in 2019 to $499 in 2020. Data breaches cost health care organizations $13.2 billion last year.

Hacking is not the only problem.The remaining breach categories—unauthorized disclosure of personal health information by internal parties or systems, loss of theft devices, and miscellaneous leaks—exposed the personal details of about 2.3 million people, exposing victims to identify theft, phishing, and other forms of cyberattacks.

Breach numbers are up everywhere. 37 of 50 states suffered more breaches in 2020 than they did in 2019. California had the most at 49, surpassing last year’s leader, Texas, which suffered 43 in 2020.

Recovery is slow.In 2020, the average health care firm took 236 days to recover from a breach. ❒

Hacking and security breaches are rising at an alarming rate.