Experts say hospitals must plan for providing care after an attack

Cybersecurity and patient safety

Experts offer advice for hospitals on protecting systems and patients

Tips and tough love

Criminals know smaller systems are vulnerable to cyberattacks

Targeting small hospitals

In the wake of the closures of rural hospitals, the Biden administration has proposed a new designation for rural providers that’s designed to help them survive.

The Centers for Medicare and Medicaid Services is planning to create a new provider designation dubbed “Rural Emergency Hospitals.” CMS said it will enable small, rural hospitals to provide access to emergency services, medication and outpatient services. 

Under the designation, rural emergency hospitals would be eligible to receive payments on or after Jan. 1, 2023.

Since 2010, 138 rural hospitals have closed, including what CMS termed a record 19 hospital closures in 2020.

CMS Administrator Chiquita Brooks-LaSure said the move is a key step in protecting healthcare services in rural communities and reducing disparities in outcomes. The agency said it would ensure access to emergency, outpatient, behavioral health and substance use disorder services.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” Brooks-LaSure said in a statement. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs.”

Why some doctors would consider moving to rural areas

CMS is also proposing changes for Critical Access Hospitals, which are smaller providers that are a significant distance from other nearby hospitals. Part of the change includes adding the definition of “primary roads” to location and distance requirements of critical access hospitals, CMS says.

The agency also said it plans to add a provision spelling out the privacy rights of patients as a participation requirement in order to be designated as a critical access hospital.

The Biden administration has been focused on improving healthcare in rural areas, where 20% of Americans live. In a news release touting the new designation for rural emergency hospitals, CMS said those in rural areas have fewer healthcare providers and a shorter life expectancy than Americans in other communities.

have been more likely to hurt residents of minority groups

, according to a study by the North Carolina Rural Health Research Program.

Rural hospital closures have been more likely to take place in counties with above-average populations of Black, Hispanic and American Indian residents, compared to typical rural counties, the study found.

Some analysts also project many more rural hospitals could close in the near future.

More than 500 rural hospitals are at an immediate risk of closure due to economic difficulties, according to a report from the 

Center for Healthcare Quality and Payment Reform

. And 300 more rural hospitals are facing a high risk of closure because they have low financial reserves or because they rely heavily on government funding or other sources of revenue beyond patient volume.

Nearly 900 rural hospitals – 40% of America’s rural hospitals – are facing a serious risk of closure, the group estimates.

CMS plans to develop final policies for rural emergency hospitals later this year. The agency is seeking comments from stakeholders. Comments must be submitted by Aug. 29.

 on its proposals for rural hospitals. For more information, visit the 

Articles

The Biden administration is touting it as a lifeline to help save smaller providers. More than 130 rural hospitals have shut their doors since 2010. 

CMS plans new designation of ‘Rural Emergency Hospitals’

The U.S. Supreme Court issued a ruling that critics say improperly limits the Environmental Protection Agency’s ability to fight climate change and could harm public health. 

Some analysts also say the ruling could potentially set a precedent to restrict the authority of the federal government, including healthcare agencies.

 in West Virginia v. EPA, the court said Thursday the agency lacks the authority to utilize the Clean Air Act to enforce limits on greenhouse gas emissions from power plants, a major contributor to climate change.

Hospitals wrestle with Supreme Court ruling on abortion

Writing for the majority, Chief Justice John Roberts wrote, “​​Capping carbon dioxide emissions at a level that will force a nationwide transition away from the use of coal to generate electricity may be a sensible ‘solution to the crisis of the day.’”

“But it is not plausible that Congress gave EPA the authority to adopt on its own such a regulatory scheme,” he wrote, adding, “A decision of such magnitude and consequence rests with Congress itself, or an agency acting pursuant to a clear delegation from that representative body.”

Justice Elena Kagan wrote in her dissenting opinion that the court incorrectly supplanted the EPA's authority.

“The Court appoints itself—instead of Congress or the expert agency—the decision-maker on climate policy," Kagan wrote. "I cannot think of many things more frightening.”

After Supreme Court upends Roe v. Wade, medical schools weigh impact on training doctors

HHS secretary announces steps after abortion ruling, warns providers to protect patient privacy

Jack Resneck, president of the American Medical Association, condemned the court ruling.

“Regulating and reducing greenhouse gas emissions is critical for combating the climate crisis and its major health implications, impacting the respiratory, cardiovascular, and immune systems of the US population, with minoritized populations disproportionately impacted,” Resneck said in a statement. “The AMA has declared climate change a public health crisis that threatens the health and well-being of all people and supports policies that reduce US greenhouse gas emissions aimed at carbon neutrality by 2050."

“As physicians and leaders in medicine, we recognize the urgency of supporting environmental sustainability efforts to help halt global climate change and the devastating health harms that it is sure to bring," he said.

The court’s ruling, significant as it is on climate change, could have wider repercussions throughout the federal government.

In the majority opinion, Roberts calls it a case involving the concept of “major questions,” an idea that Congress must give a federal agency specific authority to make sweeping policy decisions with significant economic consequences.

In an analysis of the ruling, Amy Howe of 

 wrote the case potentially affects all government agencies.

“Roberts’ full-throated embrace of the major-questions doctrine – a judicially created approach to statutory interpretation in challenges to agency authority – likely will have ripple effects far beyond the EPA,” Howe wrote. “His reasoning applies to any major policymaking effort by federal agencies.”

Robert Reich, former U.S. secretary of labor under former President Clinton, wrote on 

 that the court ruling “has major implications for both the environment and the proper functionality of our government. Our climate and the regulatory powers designed to protect individuals, our families, and our communities are in peril.”

 and called it “a major victory for limited government.”

Some analysts said the court’s ruling makes it more difficult for the EPA to regulate emissions but it doesn’t completely negate the agency’s authority.

Richard Revesz, a professor at the New York University School of Law, called the ruling “a significant setback for environmental protection and public health safeguards.” But he said the EPA still can regulate greenhouse gases.

“The EPA still has avenues to address power sector greenhouse gas emissions, which it must do to meet its statutory obligations to regulate air pollutants that adversely affect public health and welfare,” Revesz said in a 

Still, some are worried about the broader impact of federal agencies aiming to enact their own regulations.

U.S. Jerry Nadler, a New York Democrat, said in a statement the ruling “invites spurious and politically motivated legal challenges to well established statutes and regulatory standards, and will have ripple effects far beyond this case.”

“Strong regulations are key to protecting public health and safety, promoting a stronger economy, and safeguarding the environment, especially for the predominantly Black, Brown, and Indigenous communities that are on the frontlines of the climate crisis and are already disproportionately affected by a warming planet,” Nadler said in a statement. “There can be no doubt that our nation’s food supply, financial markets, and healthcare systems will all become less safe because of this holding.”

U.S. Rep. Ritchie Torres, a New York Democrat, also said he feared the ruling will do more than restrict the EPA’s ability to limit emissions.

“There may be no decision in recent memory that will do more to cripple the federal government’s ability to protect the health and safety of every American than the Supreme Court’s decision in West Virginia vs EPA, which represents judicial malpractice,” Torres said in a statement.

Kagan in her dissent argued the court is improperly taking the place of the EPA in its authority to set and enforce policy.

“Evaluating systems of emission reduction is what EPA does,” Kagan wrote in her dissent. “And nothing in the rest of the Clean Air Act, or any other statute, suggests that Congress did not mean for the delegation it wrote to go as far as the text says.”

“In rewriting that text, the Court substitutes its own ideas about delegations for Congress’s,” Kagan wrote. “And that means the Court substitutes its own ideas about policymaking for Congress’s. The Court will not allow the Clean Air Act to work as Congress instructed. The Court, rather than Congress, will decide how much regulation is too much.”

The ruling follows a number of recent Supreme Court decisions affecting healthcare in the United States.

Most notably, the court ruled last week that Americans don’t have a constitutional right to abortion. About half the states are expected to enact laws barring abortion, and some states have already taken that step. 

Healthcare groups widely condemned the ruling

, saying it could cost lives, imperil the relationship of doctors and patients, and worsen health inequities for those who can’t afford to travel to states that still allow abortion.

The court also upheld a nearly two-decade Medicare policy involving 

Earlier this month, the high court unanimously struck down Medicare cuts to hospitals participating in 

, which offers discounts on certain drugs to hospitals with a high percentage of low-income and disadvantaged patients.

The American Medical Association said the court’s decision improperly curbs efforts to fight climate change and harms the public. More broadly, some suggest it could limit the scope of all federal agencies.

Supreme Court ruling on EPA authority carries ramifications for public health

Hospitals and healthcare companies have faced growing criticism over their environmental impact, and dozens of organizations are pledging to do better.

The White House said Thursday that 61 hospitals and healthcare companies, including some of the country’s largest, have vowed to reduce emissions. Specifically, they pledged to reach the Biden administration’s call for healthcare organizations to cut emissions by 50% by 2030.

The Biden administration said the commitments from the health systems represent over 650 hospitals and thousands of providers.

The announcement came on the same day the Supreme Court issued an 

 limiting the Environmental Protection Agency’s ability to regulate emissions from power plants. Some critics say that 

 and could also limit the government’s ability to regulate healthcare and other areas.

At the same time, environmental advocates have chastised the healthcare industry for its failure to do more to reduce pollutants and waste.

How the healthcare industry can do more to help the environment

The healthcare industry accounts for 8.5% of America’s greenhouse gas emissions, federal officials said.

President Biden’s administration touted some of the larger hospital systems that made the commitment. They include NYC Health + Hospitals, the nation's largest public health system, and two of America’s five largest private healthcare systems: Ascension and CommonSpirit Health.

And the White House singled out Pfizer and AstraZeneca, two of the country’s largest pharmaceutical companies, for working to get to net-zero emissions before 2050.

Why healthcare organizations should emulate Coca-Cola in sustainability reporting

The Biden administration also announced other steps Thursday to help the health industry reduce emissions and do better for the environment.

The U.S. Department of Health and Human Services is launching a webinar series on reducing environmental impact and tracking emissions in the supply chain. The Department of Veterans Affairs and other federal health agencies are forming a coalition to share best practices in reducing emissions.

Sustainable procurement: Improving environmental health through the supply chain

The Agency for Health Care Research Quality also will offer resources to measure emissions of health facilities and to move to “greener models of care delivery,” the White House said.

The Biden administration has been working to prod the healthcare industry to improve its environmental practices. 

, U.S. assistant secretary of health, said last fall that the administration wanted the healthcare industry to do better.

Lawmakers are also giving the health sector more scrutiny on their environmental impact. Earlier this year, U.S. Rep. Richard E. Neal, chairman of the House Ways and Means Committee, 

sent a letter to some larger hospital and healthcare systems

 asking them what they are doing to address climate change.

Here’s the list of the hospitals, healthcare companies, and trade groups that have committed to cut emissions in half by 2030, according to a 

Providence Health, HealthPartners, Kedren Health, CommonSpirit Health, University Medical Center of El Paso, NYC Health + Hospitals, Boston Medical Center, Baystate Health, Stanford Children’s Health, Stanford Health Care, Atrium Health, Cherokee Health Systems, University of California Health, Northwell Health, Rush University System for Health, Northern Arizona Healthcare, Hackensack Meridian Health, UW Medicine, RWJBarnabas Health, Sun River Health, NYU Langone Health, Ascension, Henry Ford Health, Mass General Brigham, Boston Children’s Hospital, Tufts Medicine, Southcoast Health, Children’s National Hospital, Mount Sinai Health System, Kaiser Permanente, Keck Medicine of USC, Beth Israel Deaconess Medical Center, Montefiore, Seattle Children’s, Valley Children’s Healthcare, University of Nebraska Medical Center and Nebraska Medicine, Advocate Aurora Health, Gillette Children’s, University of Utah Health, Steward Health Care System, DaVita

The National Academy of Medicine, Association of American Medical Colleges, the Joint Commission, Health Care Without Harm, American College of Physicians (NJ), Kimball Sustainable Healthcare, Mazzetti

Philips, AstraZeneca, Owens & Minor, NewGen Surgical, Chiesi Group, Pfizer, AmerisourceBergen, Excellus Health, Blue Shield of California, Vizient, Aspirus, Anthem, WCM Waste and Compliance Management

More than 60 hospitals and health groups said they would strive to reach the Biden administration’s target of reducing emissions by 50% by 2030.

Hospitals and health companies vow to reach Biden’s goal to cut emissions. See who took the pledge.

Donna Shalala has spent many years playing a pivotal role in the nation's healthcare policy.

Shalala became the U.S. secretary of health and human services under former President Bill Clinton, and her eight-year tenure is the longest in history. She also led the University of Miami for over a decade and served a term in the U.S. House of Representatives.

Shalala participated in an online forum Wednesday with Kevin Sowers, the president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. In a wide-ranging discussion, Shalala talked about lessons of the COVID-19 pandemic, the future of telehealth, and the Supreme Court ruling that struck down abortion rights.

Following are some of the highlights of the conversation.

HHS leader announces steps after abortion ruling, warns providers to protect patient privacy

 has provided many teaching moments on communicating to the public about medicine and science, Shalala said.

Early in the pandemic, she said health officials could have done a better job of explaining that the knowledge of COVID is fluid. She said officials should have clearly, said, “This is what we know about COVID but it’s going to change.”

“I think we’ve learned a lot of lessons about this, about communication,” Shalala said.

She said there have always been anti-science voices, but in the past, health officials worked with elected officials in both parties to overcome those figures. She said it’s going to have to happen again. Even in a bitterly divided government, Shalala noted there continues to be strong, bipartisan support for the National Institutes of Health.

Shalala called for an integration of the medical system with the public health system. Otherwise, responsibilities shift with resources, she said.

The NIH budget doubled during the Clinton administration, with the backing of Republican and Democratic lawmakers. She said that paid dividends in during the COVID-19 pandemic.

Shalala maintains a friendship with Anthony Fauci, who she worked with in the Clinton administration during the earlier years of the AIDS crisis. In fact, she has a dog named “Fauci.”

 has surged in the pandemic, and Shalala spoke very enthusiastically about the future of telehealth, but also said it’s important to make sure some aren’t left behind.

“We’re in the golden age of telehealth,” she said. “We have to use it very carefully.”

She said she was impressed by how much specialists are embracing telehealth. She also said telehealth offers a remedy for reaching patients who skip in-person appointments.

The questions of reimbursement for providers still need clarity, she said, “but we can solve that problem.”

But she also noted that some seniors aren’t comfortable using telehealth, particularly video services. “We still have to continue to use the telephone until we change generations,” Shalala said.

Using telehealth to improve equity and access

Shalala condemned the Supreme Court’s ruling that abortion isn’t a constitutional right. Roughly half the states have passed or are expected to enact measures prohibiting abortion.

After Supreme Court ruling, medical schools weigh impact on training

Echoing the concerns of many health groups, she said the ruling will add to healthcare disparities among members of disadvantaged communities. Many can’t afford to travel to states where abortion is legal.

She said there must be a focus on providing greater access to contraceptives. “In low-income communities, many people can’t afford contraceptives,” she said.

“We just have to focus on low-income communities and protect low-income women” she said.

Telemedicine offers the option of helping some people get medication abortions, she noted.

Shalala, who is 81, recalled vivid memories of life in America before the Roe v. Wade ruling nearly 50 years ago. “It was devastating on college campuses,” she said.

“I know people that died from illegal harmful abortions because they didn’t have access to a safe place,” Shalala said.

Depending on the outcome of the congressional elections, Shalala said Congress can act to change the law. “SCOTUS is not the last word, if Congress can pass a law,” she said.

The COVID-19 pandemic also provided reminders of the vital roles nurses play.

Many healthcare systems have seen a shortage of nurses during the pandemic. Some nurses have also said the healthcare system 

is not doing enough to value and protect nurses

“I think of nursing as central to the healthcare system,” Shalala said.

“They are not handmaidens to medicine,” she said. “They are part of the team and a critical part of the team and need to be treated like peers.”

She also said advanced practice nurses can play a greater role in healthcare. “They can make a difference. We’ve got to expand their scope of practice,” Shalala said. Some states have already taken that step, she noted.

Shalala said the role of nursing has changed significantly, but added, “We have a long way to go.”

Shalala shared her leadership experiences running the health and human services department. Some of the department’s leaders had “strong egos.”

“They knew their jobs, but they needed to be managed as a team,” she said. She said she learned to help the team come together “in the policy-making process and the budget-making process.”

“My skillset is my ability to understand  multiple cultures and how to weave people together,” she said.

In a time of turmoil, such as the early years of AIDS, she stressed the importance of having a team focusing on that challenge. “You have to look at the big crisis and make sure you have a team that’s managing that,” she said.

Shalala also stressed the importance of casting a wide net for ideas. She said she sent a note to staff asking for any and all ideas, and some researchers pointed to a study that found putting babies on their back could reduce Sudden Infant Death Syndrome.

The department launched a “back to sleep” campaign that included hospitals, diapers, and even the AARP to reach grandparents that were caring for babies. The campaign helped lead to a sharp reduction of deaths due to SIDS.

“The back to sleep campaign was hugely successful,” she said.

Leaders need to juggle, she said, which involves maintaining focus but also being open to new ideas.

The former health and human services secretary offered lessons for healthcare leaders in a forum with Kevin Sowers, president of the Johns Hopkins Health System. 

Donna Shalala talks about COVID-19, telehealth, abortion rights, and leadership

Federally Qualified Health Centers are serving more and more patients, and they are also struggling to recruit and retain staff, according to a new survey.

Those health centers are community-based providers serving patients in underserved communities. They are playing a greater role in healthcare

Sixty percent of health center leaders identified recruitment as a strategic imperative, according to a new report by Qure4U, a digital health platform. Nearly half (48%) of the leaders said hiring was a top challenge, while more than a third (36%) said burnout was a key factor keeping them from their goals.

The report incorporates findings from a March survey of 71 leaders of those health centers. The survey was conducted by Sage Growth Partners, a healthcare consulting firm.

Those health centers are community-based providers serving patients in underserved communities. They are playing a greater role in healthcare in recent years. In 2020, nearly 1,400 health centers served 29 million patients, nearly triple the number they served in 2000, according to 

 from the Health Resources & Services Administration. Put another way, about one in 11 Americans receives care from one of these health centers.

More than four in five (83%) of the healthcare leaders surveyed said their strategic plans were driven by expanding access to healthcare to underserved communities.

Healthcare companies do more electronically, but there’s still room to improve

They also are keen to expand their digital health options. Most of the respondents (87%) said they were looking for a digital health platform solution that addresses a variety of needs.

At the same time, a vast majority (83%) of the leaders of federally qualified health centers said they were in the middle of the technology curve, according to the report. In assessing digital maturity, about three quarters of the respondents (76%) said their health centers were in the early stages.

Many hospital leaders said they don’t have a digital strategy

Significantly, a quarter (25%) of the leaders said patients weren’t able to access digital technology, such as video appointments or forms that were online.

 released earlier this year found disparities in access to telehealth that were apparent in minority communities. Black, Asian and Latino patients were less likely to use video telehealth services than white patients, the study found.

Nearly all federally qualified health centers (97%) offer telehealth services, and most (92%) provide a patient portal.

But some digital services aren’t as widely available. While more than half (59%) of executives said they offered digital check-in for patients, less than half offered digital payment collection (46%), self-scheduling (45%), or remote patient monitoring (42%).

Monica Bolbjerg, co-founder and CEO of Qure4u, said federally qualified health centers should be looking for comprehensive digital solutions that mesh with their electronic health record systems.

“Solutions from various vendors that don’t integrate with EHRs create more burden for patients and burnout for staff. The research confirms that, for FQHCs, a holistic platform is critical,” she said in a statement.

Looking ahead, recruiting and keeping new talent emerged as the top priority for leaders of federally qualified health centers over the next 12 to 24 months. The second-highest on the list was improving the patient experience.

Healthcare leaders also listed reducing no-shows for patient appointments and expanding care to the home, including 

, among their top objectives in the near future.

A survey of executives find recruiting and retention are top challenges, along with improving the patient experience and expanding digital health options. 

Federally Qualified Health Centers battling issues with staffing, digital technology

Dozens of hospitals have earned high marks in a ranking that examines healthcare systems for their social responsibility.

The Lown Institute, a non-partisan think tank, named the 66 “most socially responsible hospitals” in the country. The organization examined hospitals for their success in health equity, value and patient outcomes. Other metrics examined include racial inclusivity and avoiding overuse or unnecessary procedures and services.

Vikas Saini, president of the Lown Institute, touted the unique nature of this study of hospitals. The hospital launched the analysis in 2020.

“This kind of ranking didn’t exist so we had to do it,” Saini said in an online event Tuesday.

The institute is known for casting a critical look at how healthcare systems use their resources, including their compensation of top executives compared to other employees.

Hospitals’ tax breaks outweigh charity care by billions, Lown Institute says

How much should CEOs of nonprofit hospitals be paid?

In addition, the Lown Institute also recognized 15 hospitals for their work in their communities even as they faced a high concentration of patients with COVID-19.

At a time when health equity has gained increasing attention in the healthcare industry, Saini said the list has a value to spotlight hospitals that are serving their communities. He said he hopes the rankings could lead to change and inspire other hospitals to improve.

The Lown Institute examined 3,606 hospitals in its analysis, and only 66 hospitals - less than 2% - earned “A’s” in every category.

“Hospitals do much more than provide medical care,” Saini said. They invest in their communities and their workers, and some are engaging in broader efforts to improve the health of their communities to help keep people out of the hospital.

In light of the COVID-19 pandemic and growing attention to the disparities in healthcare outcomes among disadvantaged groups, hospitals are facing growing pressure to do more for their communities.

“This is a moment when expectations for hospitals are high,” Saini said.

A few common themes emerged in the study.

“In general, we found that nonprofit hospitals tend to do better and for-profit hospitals don’t do as well in some metrics, such as overuse,” Saini said. Nine of the top 10 hospitals in social responsibility were non-profit hospitals.

In addition, healthcare systems with a religious affiliation, tend to do a little better in terms of social responsibility, he said.

Adventist Health Howard Memorial Hospital, based in Willits, California, earned the top spot on the list of socially responsible hospitals.

Jordan Howe, the hospital’s president, said the organization knows its responsibility isn’t just to keep the doors open but to improve the health of the surrounding communities. He also said if the hospital remains relevant to its communities today, it’ll be around tomorrow.

“It’s knowing your sacred or social responsibility to the communities around you,” Howe said during the Lown Institute’s online event.

Boston Medical Center ranked fourth on the list of responsible hospitals, and this is the hospital’s third year in the top 20. Kate Walsh, president and CEO of Boston Medical Center, attributed the hospital’s success in serving its community to “a spirit of inquiry, restlessness and humility.”

Walsh described Boston Medical Center’s efforts to improve health equity, and she said a starting point involved looking at what was happening within the organization. Looking through a lens of health equity, the system found areas where the medical center was doing well and where improvement was needed.

The COVID-19 pandemic helped drive the medical center to say, “What is it we’re doing now that we need to do differently?”

Boston Medical Center examined disparities in outcomes among patients by race and ethnicity in 100 domains. When the medical center was distributing COVID-19 vaccines, it “geo-targeted” neighborhoods to be sure some groups weren’t being left behind.

Walsh added another benefit to the medical center’s increased focus on health equity. She said the effort has helped energy a healthcare workforce that has been burned out and exhausted due to the pandemic.

The Lown Institute examined Medicare claims, federal hospital cost reports, data from the Internal Revenue Service in compiling its rankings.

Adventist Health Howard Memorial Hospital (Willits, Calif.)

Tristar Horizon Medical Center (Dickson, Tenn.)

Salinas Valley Memorial Hospital (Salinas, Calif.)

Legacy Mount Hood Medical Center (Gresham, Ore.)

Banner University Medical Center South Campus (Tucson, Ariz.)

Saint Alphonsus Medical Center – Nampa (Nampa, Idaho)

Saint Alphonsus Medical Center – Ontario (Ontario, Ore.)

Denver Health & Hospital Authority (Denver, Colo.)

Top 5 hospitals with a high COVID-19 burden

Sharp Chula Vista Medical Center (Chula Vista, Calif.)

Beth Israel Deaconess Hospital - Plymouth (Plymouth, Mass.)

Multicare Auburn Medical Center (Auburn, Wash.)

Saint Michael’s Medical Center (Newark, NJ)

Only 2% of the nation’s hospitals earned recognition from the Lown Institute. Some were singled out for their success even with a high concentration of COVID-19 patients.