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Are Robots the Solution to Senior Care Staffing Shortages?<p><img src="/Articles/PublishingImages/740%20x%20740/robotics_healthcare.png" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​The challenges we face as senior care executives are as multifaceted as they are pressing. Among the most formidable is the persistent staffing shortage that plagues our industry.</p><p>While the worst staffing shortages occurred during the pandemic, its reverberations continue to ripple through our operations. COVID-19 laid bare the vulnerabilities inherent in our current model of senior care staffing, exposing the precarious balance upon which our ability to deliver essential services rests. The sudden onset of the pandemic exacerbated an already tenuous situation, with many health care workers forced to grapple with increased workloads, heightened health risks, and unprecedented levels of stress and burnout. Even today, <a href="https&#58;//www.ahcancal.org/News-and-Communications/Press-Releases/Pages/State-Of-The-Sector-Nursing-Home-Staffing-Shortages-Persist-Despite-Unprecedented-Efforts-To-Attract-More-Staff-.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">94 percent of senior care facilities</a> find recruitment difficult, with 67 percent reporting it's due to a lack of interested or qualified candidates.</p><p>As we strive to provide the highest quality of care for our aging population, we find ourselves grappling with the reality of dwindling manpower. Therefore, we need to explore innovative solutions to alleviate the strain on our workforce and ensure the sustainability of our operations—especially in the face of future crises.</p><p>It is within this context that the prospect of integrating robotics into our senior care services takes on newfound significance. But can robots truly bridge the gap created by staffing shortages, or are they merely a stopgap measure in an ongoing struggle? What ethical considerations must we weigh as we entrust aspects of elder care to artificial intelligence and machine learning algorithms? How do we balance the imperative for efficiency and cost-effectiveness with the deep human need for compassion and companionship in our seniors’ twilight years?</p><h3>Are Robots the Long-Term Solution to the Staffing Crisis?</h3><p>It's essential to approach this question with a holistic perspective that considers both short-term imperatives and long-term strategic goals. While robots undoubtedly offer tantalizing possibilities for augmenting our workforce and alleviating immediate staffing pressures, the question of their long-term viability as a solution demands careful consideration.</p><p>In the short term, robots present a compelling case as a pragmatic response to the acute staffing shortages that have plagued our industry. With an aging population placing increasing demands on our senior care services and a dwindling pool of health care workers available to meet those demands, the integration of robots offers a means of bolstering our workforce and ensuring continuity of care. From automated medication dispensers to assistive devices that aid with mobility and daily tasks, the potential applications are vast and varied.</p><p>However, what about the long term? By leveraging robotics to automate repetitive tasks and augment the capabilities of human caregivers, we have an opportunity to mitigate staffing shortages and enhance the overall quality of care provided to our senior residents. Yet, this vision of a harmonious integration of man and machine must be tempered by a nuanced understanding of the ethical and practical implications involved.</p><p>Central to this discussion is the question of how robotics impact the human element of senior care. While robots may excel in efficiency and precision, they inherently lack the capacity for empathy, compassion, and emotional connection that lies at the heart of quality caregiving. Thus, the challenge lies in striking a delicate balance between harnessing the benefits of technology to enhance efficiency and effectiveness while preserving the essential human touch that distinguishes exceptional senior care.</p><p>In doing so, we must remain vigilant in our commitment to upholding the dignity and well-being of our senior residents, ensuring that any technological advancements complement and augment the capabilities of our human caregivers rather than supplant them.</p><h3>How Can Health Care Leaders Successfully Utilize Robots?</h3><p>Successful implementation relies on health care leaders who understand the nuanced interplay between technology, workforce dynamics, and resident care needs. First and foremost, leaders must foster a culture of openness to innovation and change among staff members. Engage frontline workers in the implementation process from the outset and address any concerns or apprehensions they may have. This will help garner buy-in and support for the integration of robots into daily workflows. Moreover, providing comprehensive training and educational resources is important to ensure that staff members feel equipped and empowered to utilize robotic technologies effectively.</p><p>Health care leaders must take a strategic approach to selecting and customizing robotic solutions that align with the specific needs and challenges of their senior care facilities. From automating routine tasks such as medication management and vital sign monitoring to enhancing social engagement through companion robots, there exists a diverse array of robotic technologies with the potential to address staffing shortages and improve resident outcomes. By conducting thorough assessments of facility needs, soliciting input from staff and residents, and piloting different robotic solutions, leaders can identify the most promising opportunities for implementation and tailor strategies accordingly.</p><p>In addition to enhancing efficiency and productivity, health care leaders must recognize the broader implications of robotic implementation for addressing the staffing crisis in senior care. By offloading mundane and repetitive tasks to robots, caregivers can focus their time and attention on providing high-quality, personalized care to residents, thereby mitigating the strain of understaffing and reducing the risk of burnout. Robots also have the potential to attract and retain talent in the senior care workforce by offering opportunities for professional development and specialization in the use of cutting-edge technologies.</p><p><span><img src="/Issues/2020/August/PublishingImages/JoelLandau.jpg" class="ms-rtePosition-2" alt="Joel Landau" style="margin&#58;5px;width&#58;175px;height&#58;212px;" /></span>Ultimately, the successful implementation of robots in senior care settings requires a proactive and adaptive approach informed by collaboration, education, and strategic planning.</p><p>As we navigate the complexities of senior care in the 21st century, embracing the potential of technological advancements such as robots offers a path forward toward achieving our shared goal of ensuring dignified, compassionate, and sustainable care for older adults.<br></p><p><em>Joel Landau is the founder and chairman of The Allure Group, a network of six New York City-based nursing homes.</em></p>2024-07-02T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/robotics_healthcare.png" style="BORDER&#58;0px solid;" />Caregiving;TechnologyJoel LandauWe need to explore innovative solutions to alleviate the strain on our workforce and ensure the sustainability of our operations—especially in the face of future crises.
What We Learned from the Change Healthcare Cyberattack<p></p><p><img src="/Articles/PublishingImages/740%20x%20740/computer.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" /><a href="/Articles/Pages/The-Change-Healthcare-Cyberattack-and-the-Response.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteForeColor-2"><strong>READ PART 1</strong></span>​</a></p><p>In early May 2024, the nonprofit health care operator Ascension<a href="https&#58;//www.cnn.com/2024/05/08/tech/cyberattack-disrupts-healthcare-network/index.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.cnn.com/2024/05/08/tech/cyberattack-disrupts-healthcare-network/index.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">announced</a> that it was the victim of a cybersecurity incident. Later revealed to be a ransomware attack, the incident<a href="https&#58;//www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/110082" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/110082" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">disrupted</a> clinical operations across Ascension's network, which includes 140 hospitals and 40 senior living providers. Facilities lost access to patient records, diverted ambulances, and delayed tests. ​While hospitals thankfully were able to continue providing care, the impact was significant&#58; on June 4, 2024, Ascension<a href="https&#58;//www.fiercehealthcare.com/providers/systems-clinical-operations-interrupted-ascension-amid-apparent-cybersecurity-event" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.fiercehealthcare.com/providers/systems-clinical-operations-interrupted-ascension-amid-apparent-cybersecurity-event" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">predicted</a> that its systems would not be fully restored for another 10 days.</p><p>Following closely on the heels of the Change Healthcare ransomware incident in February 2024, the Ascension outage underscores the health care system's increasing vulnerability to cybersecurity attacks—a vulnerability that risks the data privacy of hundreds of millions of patients and their very ability to obtain care. As policymakers and advocacy organizations discuss what the industry should learn from these incidents, and how providers can stay resilient in the face of rising threats, a few key themes have emerged.</p><h3>When Health Care Systems B​​ecome Too Big To Fail</h3><p>In the wake of the Change Healthcare attack, numerous commentators pointed to it as an example of the risks of consolidation in health care. They echoed concerns raised during UnitedHealth Group's acquisition of Change in 2022, when the Department of Justice<a href="https&#58;//www.healthcaredive.com/news/doj-UNH-drops-appeal-unitedhealth-change-deal/645674/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.healthcaredive.com/news/doj-UNH-drops-appeal-unitedhealth-change-deal/645674/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">tried and failed</a> to block the deal on antitrust grounds. Now, lawmakers argued that UnitedHealth's sheer size—it<a href="https&#58;//www.statnews.com/2023/11/29/unitedhealth-doctors-workforce/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.statnews.com/2023/11/29/unitedhealth-doctors-workforce/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">reportedly</a> employs or is affiliated with 10 percent of U.S. physicians, with Change processing 15 billion claims annually—effectively creates a single point of failure in the health care system.</p><p>“The attack shows how UnitedHealth's anticompetitive practices present a national security risk because its operations now extend through every point of our health care system,&quot;<a href="https&#58;//eshoo.house.gov/media/press-releases/rep-eshoo-opening-remarks-health-subcommittee-health-sector-cybersecurity" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//eshoo.house.gov/media/press-releases/rep-eshoo-opening-remarks-health-subcommittee-health-sector-cybersecurity" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">said</a> Representative Anna Eshoo (D-CA) during an April hearing held by the House Committee on Energy and Commerce Health Subcommittee. “The cyberattack laid bare the vulnerability of our nation's health care infrastructure.&quot;</p><p>In<a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/Adam%20Bruggeman_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/Adam%20Bruggeman_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">testimony</a> before the Committee, physician Adam Bruggeman argued that consolidation and vertical integration don't just pose cybersecurity risks; they can also drive up the costs of care for patients while reducing their options in the market.</p><p>“The consolidation of practices and their integration with hospital systems has the potential to drive up prices for common orthopedic procedures, while simultaneously stifling competition and limiting opportunities for independent practices within the same market,&quot; Bruggeman pointed out. “The costs for knee replacement and lumbar spine fusion procedures were found to be approximately 30 percent higher in concentrated markets compared to those in competitive markets. Expanding the scope further, a comprehensive analysis conducted by the <em>New York Times</em> in 2018 revealed that average hospital prices soar dramatically in the aftermath of mergers.&quot;</p><p>In late February 2024, the Department of Justice initiated an antitrust investigation into UnitedHealth Group,<a href="https&#58;//www.reuters.com/business/healthcare-pharmaceuticals/us-launches-antitrust-investigation-into-unitedhealth-wsj-reports-2024-02-27/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.reuters.com/business/healthcare-pharmaceuticals/us-launches-antitrust-investigation-into-unitedhealth-wsj-reports-2024-02-27/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">reportedly</a> focusing on how its acquisitions affect both competitors and consumers.</p><h3>​​An Underinvestment in Small Providers</h3><p>Concerns about consolidation extend beyond providers and insurers. As Representative Frank Pallone (D-NJ) suggested in the April 2024 hearing, consolidation in health care technology may also pose “unreasonable risk&quot; to broader health care systems. The question is especially pertinent for long-term care (LTC) and post-acute care (PAC) providers, who may lack the investment necessary to use the sophisticated EHR platforms employed by hospitals and other larger institutions.&#160; As a result, they have to operate independently from integrated health systems, even when they share patients.</p><p>Sadly, it's far from a new problem. The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009, invested billions in the adoption of robust, interoperable EHR systems across the health care sector—with the exception of LTC and PAC providers. The result is an immense hole in the national health care IT strategy, leaving skilled nursing facilities (SNFs) on a completely different footing when it comes to cybersecurity threats. This means that even if massive companies like UnitedHealth Group perfectly shore up their defenses, potentially devastating vulnerabilities will remain; after all, a system is only as strong as its weakest link.</p><p>In the case of the Change attack, of course, that weak link wasn't a small provider but one of the world's largest payment processing companies. Even without multimillion-dollar reserves to lean on, SNFs worked quickly to restore their systems and avoid impacts to the delivery of care, regardless of reimbursement. The inequity this incident revealed is simple but severe&#58; under current investment and reimbursement paradigms, SNFs are left wanting for revenue to invest in the technological innovations that would strengthen their ability to prepare for cybersecurity incidents rather than simply to respond to them.</p><p>“It would be really nice to get some investment on par with the level of regulation,&quot; said Grant Beebe, AHCA's Director of Medicaid Policy. “So many of our providers want to be able to do the right thing. They want to be able to be forward-thinking, they want to be proactive. But it's hard when you're running on a shoestring budget and may not have a chief information officer.&quot;</p><p>As Bruggeman argued before Congress, underinvestment in cybersecurity may also hobble the broader shift to value-based care, potentially leading to even more consolidation. “I am concerned the cost of cybersecurity protection required to accommodate this growth in patient data sharing may serve as yet another barrier for smaller and rural physician groups looking to participate in the movement towards alternative payment models,&quot; he said. “If these practices are left behind as the rest of medicine moves towards value-based care, they will face even greater pressure to consolidate with larger health systems.&quot;</p><p>For providers with limited resources to devote to burgeoning IT risks, one line of defense may lie in the use of a Managed Security Service Provider (MSSP)&#58; essentially, a third-party cybersecurity manager. “The focus should be increasing speed and efficiency in dealing with threats,&quot;<a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/Robert%20Sheldon_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/Robert%20Sheldon_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">argued</a> Robert Sheldon, Senior Director for Public Policy &amp; Strategy at CrowdStrike, during the House subcommittee hearing in April 2024. “At best, this type of partnership enables MSSPs to focus on security and health care providers focus on health care.&quot;</p><h3>The Need for Comprehensive N​ational Cybersecurity Strategy</h3><p>Still, the difficult truth is that no single organization can fully protect itself against systemic vulnerabilities. That's why many advocates are pushing for a national cybersecurity strategy that encompasses the entire sector, including LTC and PAC, rather than focusing on hospitals.</p><p>Daniel Ciolek, AHCA/NCAL's Associate Vice President for Therapy Advocacy, argued that the problem is not suited to a one-size-fits-all solution. Rather, what's needed is a federal strategy with local interventions—perhaps through the CMS's Quality Improvement Organization (QIO) program, which recently removed funding for IT support. A hybrid approach, he suggested, might regulate data exchange companies at the national level while using QIOs to provide IT support to smaller providers and ensure systemwide interoperability at the regional level.</p><p>“You can start capturing a lot of the other local types of providers that have been ignored under HITECH and do not have the capacity or expertise,&quot; Ciolek said.</p><p>To be sure, regulators are already crafting a national strategy. Earlier this year, HHS issued a set of voluntary<a href="https&#58;//hphcyber.hhs.gov/performance-goals.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//hphcyber.hhs.gov/performance-goals.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">cybersecurity performance goals</a> for health care organizations. In April 2024, the Department of Homeland Security released its own<a href="https&#58;//www.federalregister.gov/documents/2024/04/04/2024-06526/cyber-incident-reporting-for-critical-infrastructure-act-circia-reporting-requirements" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.federalregister.gov/documents/2024/04/04/2024-06526/cyber-incident-reporting-for-critical-infrastructure-act-circia-reporting-requirements" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">proposed cybersecurity rule</a> for industry feedback. As these policies take shape, LTC advocates hope that their authors bear in mind the importance—and unique needs—of nursing homes and other SNFs, which may not be hospitals but are no less a vital part of the health care ecosystem.</p><p><img src="/Articles/PublishingImages/2023/SethSimons.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />“The majority of hospital patients are not our population,&quot; Ciolek concluded. “The priorities of the national health care system are still leaning towards the younger, healthier population, the one that has short-term acute medical needs. They don't want to think about people that are old, poor, or disabled.&quot;</p><p>For organizations still dealing with the impacts of the Change Healthcare attack, HHS maintains a<a href="https&#58;//www.hhs.gov/hipaa/for-professionals/special-topics/change-healthcare-cybersecurity-incident-frequently-asked-questions/index.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.hhs.gov/hipaa/for-professionals/special-topics/change-healthcare-cybersecurity-incident-frequently-asked-questions/index.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">webpage</a> with an FAQ and other resources, as well as a<a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-Payer-Contacts-and-Resources.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-Payer-Contacts-and-Resources.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">helpdesk</a> for providers.​<br></p><p><em>Steve Manning is a journalist based in New York City.</em>​</p>2024-06-27T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/computer.jpg" style="BORDER&#58;0px solid;" />Technology;Cyber SecuritySteve ManningSNFs are left wanting for revenue to invest in the technological innovations that would strengthen their ability to prepare for cybersecurity incidents rather than simply to respond to them.
The Change Healthcare Cyberattack and the Response<p><img src="/Articles/PublishingImages/740%20x%20740/computer_security.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />In retrospect, the Change Healthcare cyberattack that wrought havoc on the health care sector earlier this year was a disaster waiting to happen. The UnitedHealthcare Group-owned electronic health payment clearinghouse, the nation's biggest,<a href="https&#58;//www.hhs.gov/about/news/2024/03/10/letter-to-health-care-leaders-on-cyberattack-on-change-healthcare.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.hhs.gov/about/news/2024/03/10/letter-to-health-care-leaders-on-cyberattack-on-change-healthcare.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">processes</a> 15 billion transactions each year, touching one in three patient records. When<a href="https&#58;//www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">hackers</a> used stolen credentials to breach its systems in February 2024,<a href="https&#58;//energycommerce.house.gov/posts/what-we-learned-change-healthcare-cyber-attack" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//energycommerce.house.gov/posts/what-we-learned-change-healthcare-cyber-attack" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">exploiting</a> a lack of multi-factor authentication, their intrusion exposed a single point of failure in the American health care system. It was only inevitable that when Change took its platforms offline, millions of patients across the country would suffer the consequences.</p><p>Indeed, the attack's impacts were swift, severe, and far-reaching. More than 96 percent of health care providers in the U.S. were affected, according to one<a href="https&#58;//healthexec.com/topics/health-it/cybersecurity/qa-healthcare-cybersecurity-advocate-fears-damage-change-healthcare-breach-has-only-begun" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//healthexec.com/topics/health-it/cybersecurity/qa-healthcare-cybersecurity-advocate-fears-damage-change-healthcare-breach-has-only-begun" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">cybersecurity expert</a>. A March survey by the American Hospital Association (AHA) found that 80 percent of hospitals reported disruptions to their cash flow, with 60 percent reporting disruptions of at least $1 million per day. Claims processing was<a href="https&#58;//assets.ctfassets.net/opszt4tga0mx/6cbuJhBQA02SR0JeT3ZbfP/9a79cf5cc4ba572dd0e1b623ab7c9891/Change_Healthcare_Impacts_3.1.24.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//assets.ctfassets.net/opszt4tga0mx/6cbuJhBQA02SR0JeT3ZbfP/9a79cf5cc4ba572dd0e1b623ab7c9891/Change_Healthcare_Impacts_3.1.24.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">disrupted</a> across the sector, with pharmacies unable to fill patients' prescriptions or redeem their coupons, and many patients were forced to pay out-of-pocket prices. One children's hospital reported that its patients were unable to receive chemotherapy; at a cancer center in Louisiana, according to<a href="https&#58;//archive.is/wdGMD" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//archive.is/wdGMD" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><em>Bloomberg</em></a><em>,</em> the chief executive officer said that it would take “months&quot; to recover from the damage.</p><h3>A Devastating​​ Toll</h3><p>Unfortunately, skilled nursing facilities were hardly immune to the damage. The attack affected delays in claims processing through Medicaid, Medicare, and commercial payers, forcing nursing homes to spend substantial time and labor submitting claims manually, in some cases even hiring extra employees to handle the task.</p><p>In Pennsylvania, the Jefferson Hills Healthcare and Rehabilitation Center<a href="https&#58;//www.beckershospitalreview.com/post-acute/change-cyberattack-causes-nursing-home-to-temporarily-close.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.beckershospitalreview.com/post-acute/change-cyberattack-causes-nursing-home-to-temporarily-close.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">closed briefly</a> when it was unable to process payroll. As one New York-based provider<a href="https&#58;//www.mcknights.com/news/massive-cyber-attack-creates-crushing-billing-burdens-for-skilled-nursing-sparks-efforts-for-payment-relief/#xd_co_f=Y2ZhYTM2YjMtOTRmMi00YjVjLThhMWMtYjAxM2U1OWZlYTI1~" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.mcknights.com/news/massive-cyber-attack-creates-crushing-billing-burdens-for-skilled-nursing-sparks-efforts-for-payment-relief/#xd_co_f=Y2ZhYTM2YjMtOTRmMi00YjVjLThhMWMtYjAxM2U1OWZlYTI1~" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">told</a> <em>McKnights Long-Term Care News,</em> meanwhile, the need to manually submit Medicaid claims for 400 patients resulted in the facility missing its weekly submission deadline, and therefore its payments. While many facilities transitioned to alternative billing platforms, this was often a timely and costly process. For patients unable to fill their prescriptions, considerable harm was already done.</p><p>“The staggering loss of revenue has meant that some hospitals and health systems had to seek alternate ways to ensure they could pay salaries for clinicians and other members of the care team, acquire necessary medicines and supplies, and pay for mission critical contract work in areas such as physical security, dietary, and environmental services,&quot;<a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/John%20Riggi_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//democrats-energycommerce.house.gov/sites/evo-subsites/democrats-energycommerce.house.gov/files/evo-media-document/John%20Riggi_Witness%20Testimony_04.16.2024.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">said</a> John Riggi, the AHA's National Advisor for Cybersecurity and Risk, at a Congressional hearing in April 2024. “In addition, replacing previously electronic processes with manual processes has often proved ineffective and is adding considerable administrative costs for providers, as well as diverting team members from other tasks.&quot;</p><p>The attack had devastating effects even on massive national operators. When Peterson, whose 90 nursing homes across the U.S. serve nearly 7,000 residents, filed for bankruptcy in March 2024, it said the Change Healthcare attack compounded existing financial difficulties—including a previous ransomware attack in October 2023. As Reuters<a href="https&#58;//www.reuters.com/legal/litigation/nursing-home-co-petersen-files-bankruptcy-after-cyberattacks-2024-03-21/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.reuters.com/legal/litigation/nursing-home-co-petersen-files-bankruptcy-after-cyberattacks-2024-03-21/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">reported</a>, the revenue disruption was one reason Petersen defaulted on government-backed loans, which led to 19 of its properties entering receivership.</p><p>Still, it was small providers who disproportionately bore the brunt of the ransomware attack's damage, according to a March 2024 analysis by Moody's. Whereas providers were more likely to use multiple clearinghouses—and have the means to switch when Change went offline—this was less likely to be the case for their counterparts. “Providers with small scale, a weak financial profile, who only use Change and have little headroom in meeting debt covenants stand to suffer the most from the disruption,&quot; a Moody's analyst wrote, as<a href="https&#58;//www.healthcaredive.com/news/change-healthcare-cyberattack-provider-financial-impact-moodys/709875/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.healthcaredive.com/news/change-healthcare-cyberattack-provider-financial-impact-moodys/709875/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><em>Healthcare Dive</em></a><em> </em>reported. “Larger providers with more resources are in a better position to weather cash flow difficulties.&quot;</p><p>Daniel Ciolek, AHCA/NCAL's associate vice president for therapy advocacy, noted that this held true for many of AHCA's members. &quot;More than half our owners have 10 or fewer buildings, and some have only one building,&quot; he said. “They don't have time to get a clearinghouse agreement.&quot;</p><h3>​Flexibilities and Relief for​​ Providers<br></h3><p>As news of the attack spread in late February 2024, advocacy organizations across the health care sector moved swiftly to secure relief from the federal government. On February 29, 2024, AHCA/NCAL sent a<a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/Letters/HHSLetter-ChangeHealthcare.pdf#xd_co_f=Y2ZhYTM2YjMtOTRmMi00YjVjLThhMWMtYjAxM2U1OWZlYTI1~" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/Letters/HHSLetter-ChangeHealthcare.pdf#xd_co_f=Y2ZhYTM2YjMtOTRmMi00YjVjLThhMWMtYjAxM2U1OWZlYTI1~" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">letter</a> to Health and Human Services (HHS) Secretary Xavier Becerra to announce that the incident met the criteria for HHS to issue accelerated payments through Medicare; instruct Medicare Administrative Contractors (MACs) to notify providers of this policy; and to encourage Medicare Advantage plans to provide a similar advanced payment option.</p><p>“The nation's nursing homes are experiencing significant challenges with claims submissions, timely payment for services provided, and reconciling remittances within standard workflows while Change Healthcare's services remain offline,&quot; AHCA/NCAL CEO Mark Parkinson wrote. “Timely payments are essential for facilities to maintain daily operations and to keep their doors open for residents and patients, and we request your support for providers to access accelerated payments.&quot;</p><p>HHS acted on AHCA/NCAL's requests within a matter of days. On March 5, 2024, HHS announced a number of flexibilities, including Centers for Medicare and Medicaid Services (CMS) guidance that would encourage Medicare Advantage organizations and Medicare Part D sponsors to remove or relax prior authorization. It also informed providers that they could submit accelerated payment requests to their MACs.</p><p>A few days later, on March 9, 2024, HHS announced the availability of accelerated payments for Part A providers and advanced payments for Part B suppliers, while again encouraging Medicare Advantage organizations to offer advance payments. At the same time, CMS was working closely with state agencies and encouraged Medicaid managed plans to offer payment options to affected providers.</p><p>As AHCA/NCAL pushed the federal government for decisive action—like extended temporary pre- and post-pay audit flexibility for impacted providers—it also provided necessary information and resources to its members. “This event underscores the importance of robust business continuity plans that include preparations for cyber incidents,&quot; the organization noted in a<a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-CMS-Approves-Advanced-Payments.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-CMS-Approves-Advanced-Payments.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">March 2024 <em>​</em>blog post</a>. “Providers should review continuity plans to ensure they can effectively respond to similar disruptions, safeguarding patient care and business operations.&quot;</p><p><strong>Looking Forward</strong><br>While Change Healthcare's systems were largely restored by mid-March, the attack's ramifications stretched well beyond that. It was not until mid-May 2024, for instance, that the U.S. Department of Veterans Affairs<a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-VA-Providers-with-VCAs-Impacted-by-Cybersecurity-Breach-May-Resume-Claims-Processing.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"> </a><a href="https&#58;//www.ahcancal.org/News-and-Communications/Blog/Pages/Change-Healthcare-Update-VA-Providers-with-VCAs-Impacted-by-Cybersecurity-Breach-May-Resume-Claims-Processing.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">announced</a> that its direct Veterans Care Agreements claims processing systems were back online—welcome news to providers that had been submitting paper claims since the systems went down (and which were permitted to continue doing so if their own systems were still affected).</p><p><img src="/Articles/PublishingImages/2023/SethSimons.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />As the federal government continues to provide resources to impacted organizations, trade organizations like AHCA/NCAL are turning their eyes to the future. What are the most important learnings from the Change Healthcare attack? What can providers do to protect themselves from future cybersecurity breaches, and what steps should the federal government take to protect millions of SNF residents and their data? Stay tuned to <em>Provider</em> for <a href="/Articles/Pages/What-We-Learned-from-the-Change-Healthcare-Cyberattack.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">another article</a> discussing these questions.​<br></p><p><em>Steve Manning is a journalist based in New York City.</em><br></p>2024-06-25T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/computer_security.jpg" style="BORDER&#58;0px solid;" />TechnologySteve ManningWhen hackers used stolen credentials to breach its systems in February 2024, exploiting a lack of multi-factor authentication, their intrusion exposed a single point of failure in the American health care system.
What Long Term Care Professionals See as the Greatest Operational Risks<p><img src="/Articles/PublishingImages/740%20x%20740/0820_News2.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />Recently, I polled a number of professionals in the long term care industry to find out what operational risks are the most pressing and concerning. The poll provided a list of commonly voiced concerns divided into six parts&#58;<br></p><ol><li>Employee and employment issues.</li><li>Regulatory and political risks.</li><li>General insurance concerns.</li><li>Specific insurance lines concerns.</li><li>Financial and litigation concerns.</li><li>Property and safety.</li></ol><p>Each part also contained subsections. For example, (3) general insurance concerns had subsections of&#58;<br></p><ul><li>Cost of insurance (how much coverage is needed, proper deductible/retention, etc.). </li><li>Difficulty getting coverage regardless of costs (capacity).</li><li>Gap in coverage (E.g., your coverage did not cover the type of cost or deductible was so high that it will create a significant problem if a loss occurs or concern that the upper limit is too low).</li><li>General concern due to lack of understanding of insurance coverage.</li><li>Other.</li></ul><p></p><p>All responses were sent to me privately, which was surprising. No one wanted to publicly share their concerns. This is concerning because if we are not comfortable discussing risk, we as stakeholders, facility managers, and as an industry are not able to address the threats that could shutter our doors. </p><p>Many of the comments that accompanied the responses acknowledged the interdependence of risk. By example, one respondent tied regulatory/political risk (changes in laws/compliance with regulations) and cyber-risk pointing out that cyber breaches in medical data crosses over both risks. It also incorporates reputational risk and directors &amp; officer insurance risks. Several respondents confided that they had not thought about all the different risks until they saw the list. </p><h3>Cyber Threats</h3><p>The top concern is the same as in most industries&#58; cyberattacks. The few comments accompanying this concern voiced a feeling of helplessness and a lack of control. Respondents felt that they could manage their safety issues, physical property exposures, and general liability concerns, but that cyberattacks were beyond their control.</p><p>One person stated that they “foolishly” hope that they are too small to be a target. But, this makes you a great target for cyberattack. Chances are that you are too small to have a mature defense in place and have an inadequate response plan. You are the perfect target for a quick payout, and that attack could close your doors overnight.</p><p>Gallup often surveys employees to gauge job satisfaction. Willis Towers Watson analyzed the intersection of job satisfaction and cyberattacks. What it found was amongst organizations who had engaged the Gallup survey and later were breached, the breach occurred in those locations or departments where job satisfaction was lowest in the organization.</p><p>Constant training such as having internal spam email tests and proper security management activities start to give organizations real control of this risk. Without employee engagement, you are a ripe target. Although the world of cybersecurity is constantly evolving, its prevalence has resulted in a lot of companies entering the marketplace with solutions. This in turn has led to more affordable options to protect yourself. As a warning, some service providers are better than others. It can be difficult to assess who is good. Do your homework.</p><h3>Litigation and Insurance</h3><p>Litigation and insurance issues remain a perennial concern. Respondents appear to have a clear understanding of workers’ compensation claims but less of an understanding of the general liability, professional liability, and directors &amp; officers liability breakouts. This in turn appears to elevate the insurance coverage concerns beyond what was expected.</p><p>Within the insurance coverage responses, the comments indicated a lack of understanding of insurance in general. The basic understanding was there but comments as to how to decide deductibles and concern that your losses won’t be covered means that insurance coverage issues are not easily bucketed. The confusion can, and often does, result in gaps in your coverage.</p><p>The take-away from this result is that your leadership team needs to have ongoing conversations with their risk managers and broker(s) to understand the distinct types of exposures that not only your facility faces, but also those experienced in the industry. You may not be aware of emerging exposures and therefore may miss the opportunity to address them until they are realized.</p><p>As an example of a potential coverage gap that could be catastrophic, if a fire in your facility destroys the kitchen, will your standard general liability policy cover it, or should you have had a business interruption policy? If you have a business interruption policy, does it kick in immediately or is there a waiting period? How do you address feeding the residents during the time until the policy kicks in?</p><h3>Reputational and Financial Risks</h3><p>Reputational and financial risks got less attention than I expected. Prior to the advent of cyberattacks, reputational risks were a perennial chart-topper. Reputational risk is always the secondary risk to anything such as cyberattacks, general security issues, food-borne illness issues, work conditions, and accusations of regulatory or financial irregularities. Conversations that I have had with brokers indicate that inquiries in obtaining reputational risk insurance is as strong as it has ever been. Perhaps it did not score higher because leaders may, at some level, realize that if they can get the issues that can attack their reputations under control—such as building a good cyberattack defense, instituting safety measures, etc.—it will mitigate the reputational exposures. It is no different than reducing your general liability exposures by making sure your facility is safe for residents and visitors. It is no different than mitigating your property loss exposures by performing roofing inspections, repairing uneven and cracked walkways, and checking fire suppression systems, to name a few. </p><h3>Identification Is Key</h3><p><img src="/Articles/PublishingImages/2024/Jeff-Marshall.jpg" class="ms-rtePosition-1" alt="Jeff Marshall" style="margin&#58;5px;width&#58;125px;height&#58;155px;" />The takeaway from this exercise is that facilities may not be able to identify their risks and therefore are not able to develop plans for addressing those risks. Even when they are able to either clearly identify the risk or sense the outlines of a risk exposure, they are unable to articulate the concerns and get the proper guidance for addressing them. This, in turn distorts their understanding of their exposures.</p><p>The good news is that whatever your risk exposures are, you are not alone. Other facilities have experienced them too. Now what is needed is tapping into the collective industry knowledge to identify these risks and their solutions. </p><p><em>Jeff Marshall is a risk and claims management consultant focusing on nursing homes and assisted living facilities. He can be reached at <a href="mailto&#58;IManageRisk4U@gmail.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">IManageRisk4U@gmail.com</a>.</em><br></p>2024-06-20T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/0820_News2.jpg" style="BORDER&#58;0px solid;" />ManagementJeff MarshallThe good news is that whatever your risk exposures are, you are not alone. Other facilities have experienced them too. Now what is needed is tapping into the collective industry knowledge to identify these risks and their solutions.

 

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More than vitals, <span style="text-decoration&#58;underline;"><a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a></span> also manages assessments, protocols, and progress notes and monitors pain, blood glucose, weight and more.&#160;​<br></p><h2>Top 5 Features That Set <a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a> Apart&#160;</h2><p><strong>1. 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Personalized Pain Evaluation</strong></p><p> With <span style="text-decoration&#58;underline;"><a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a></span>, you can measure dis​comfort on a scale from 1 to 10, giving residents the power to express their pain clearly. You can also utilize the PAINAD scale, providing caregivers with the necessary resources to precisely assess and meet the needs of individuals who cannot voice their pain.&#160;<br></p><p><strong>​​3. Easily Monitor Weight Changes&#160;</strong></p><p>Effortlessly track resident weight changes and early health risk indicators with Bluetooth wheelchair scales. <span style="text-decoration&#58;underline;"><a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a></span> automates variance analysis from the last record, eliminating manual calculations and increasing precision.&#160;</p><p><strong>4. Proactive Health Monitoring&#160;</strong></p><p>Stay proactive in managing health crises by implementing personalized health check protocols and receiving real-time alerts to prioritize your care team's daily to-do tasks. This will ensure your residents' safety and enhance your community's readiness.&#160;</p><p><strong>5. Streamline Care Assessments&#160;</strong></p><p>Streamline early and follow-up neurological evaluations for Head Injury Routine (HIR) assessments for your residents, enhancing the efficiency of the post-fall care protocol for caregivers.&#160;</p><p>​​Maintaining a personal connection between caregivers and their charges is crucial in senior care. As AI and digital health technologies advance, there's a big chance to boost care quality and efficiency. The goal is to use these technologies to support, not replace, caregivers, ensuring care remains warm and human. Senior care leaders must find a balance where technology empowers caregivers for more personal​ized and compassionate care.&#160;</p><p>​Solutions like <span style="text-decoration&#58;underline;"><a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a></span> show how technology can enhance caregiving, strengthening the bonds between caregivers and residents. By blending high-tech with a high-touch approach, these innovations aim to improve outcomes for everyone in the care ecosystem.&#160;</p><p>​​Take a <span style="text-decoration&#58;underline;"><a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">3-minute online product tour​</a></span> to discover ​how <a href="https&#58;//www.jubohealth.com/lp/vital-link?utm_source=ahca&amp;utm_medium=marketplace_banner&amp;utm_campaign=product_tour&amp;utm_content=content" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">VitalLink</a> can transform your senior care quality today.​<br></p>2024-05-16T04:00:00Z<img alt="" src="/Marketplace/PublishingImages/AHCA_Marketplace_(340%20x%20340%20px)_JuboHealthTech.png" width="340" style="BORDER&#58;0px solid;" />Health Information TechnologyNavigating the challenges in Long-Term Care and Skilled Nursing facilities, providers are examining staffing, technology, and quality of care, seeking innovative solutions like VitalLink.