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May 15th, 2017 | No comments

Information for your Consideration… 

A Wake Up Call? – Some of us have been predicting the events of May 12th for a long time.  While the damage assessment is pending as of this writing, it appears that the hacker attack was not as damaging as it could have been.  In fact, it appeared at first to be a health care cyberattack but has ultimately turned out to be a non-discriminate attached that extended from hospitals, to schools, to automotive, to banks, and beyond. The attack basically exploited a malicious software stolen from the National Security Agency which had evidently found a hole into the Microsoft operating system.  The hackers were able to execute a cyberattack that self-replicated and hit over 104 countries throughout the world – and, growing.  It had a major impact on the British National Health Service where computer systems were closed down and patients diverted to unaffected facilities.  It was disproportionate in that some parts of the NHS were affected more adversely than others.  In large measure the facilities that were adversely affected had not kept their Microsoft software operating system up-to-date.  The attack spread across the internet and was transmitted by email.  And, while it was the most widespread ransomware attack it was done in a way that encouraged those who were affected to pay the costs and move on with a bounty of only $300.00 paid in Bitcoin to an anonymous account.  In addition, it was a world-wide phenomenon.  With all of the debate in recent weeks about Russian attacks on the 2016 Presidential elections, there were murmurs of “there-go-the-Russians” as a first response.  But, in fact, according to Kaspersky Lab – a Russian cybersecurity firm – and other cyber-firms, Russia was the worst-hit country followed by Ukraine, India, Taiwan, the UK (notice that I’ve already implemented Brexit, J) and Europe. The reports of attacks extended across the world to Australia, China, Latin America and Africa.  No region of the world was left untouched by this attack.

While the attack seemed to be the largest ransomware assault to date affecting the health care community, it is by no means the only one nor, the last one.  It evidently began with the arrival of a simple phishing email to unsuspecting computers in health care organizations like the one used by the Russian hackers in the Democratic National Committee attack last year.  The ransomware, referred to as “WannaCry”, then spread from computer system to computer system and locked up patient records to the consternation of health care providers.  As I told a friend – it’s one thing to have your financial accounts frozen at the bank, or to have the communications network go down.  It’s a whole other thing to have the computer systems freeze in the middle of surgery – as they did in the UK – or, to have your car potentially hijacked when you’re driving down the road (proven but not part of this ransomware attack), or…or…or.  We are in the digital age and we should expect that these types of attacks are going to become more common place. To prevent them, we need to start applying appropriate cybersecurity measures.  One of the first is “keep your software up-to-date”.

So, what are the lessons learned.  #1: Cybersecurity in health care is a much bigger deal than most folks in the health care community realize.  It deserves our attention.  #2: While this had a crippling effect on some hospitals – it could have been much worse.  #3:  This is a wake-up call.  Pay attention!

Virtual Reality Depicting Real Health – If you embrace technology, you’ll be interested in this piece for the Voice of America about the use of virtual reality as a tool for training health care providers and treating patients.  The Virtual Reality Show was recently held in London and featured a host of virtual reality games and applications. Among the most interesting were those related to health and medicine.  From training health care personnel on cardiac resuscitation to surgical cardiac valve replacements to programs designed to help PTSD – the VR Show included lots of cutting edge technology.  It’s coming.  The anatomy lab of yore is becoming history – along with lots of other “real” training to be replaced by “real” training of a different sort.  It’s actually quite impressive…

Controlling Alzheimer’s By Blocking Gene Activity – As my readers know – because of the increasing frequency of my blog notes on the problem – I’ve become focused on Alzheimer’s over the last couple of years.  The Spring 2017 issue of the Alzheimer’s Disease Research Review had a very interesting piece on new research that has recently been announced.  First, there are clear sex differences in the incidence of the disease.  Men have 1 in 11 odds of getting the disease versus women whose odds are worse at 1 in 6.  The reason for the difference has been unclear until recently.  Dr. Enrico Glaab from the University of Luxembourg analyzed brain samples from about 650 deceased men and women – some with the disease and some who did not have the disease.  The findings were very interesting.  Evidently, there is a specific gene – ubiquitin-specific peptidase 9 (USP9) – that has been tied to the presence of Alzheimer’s.  The level of USP9 is lower in men and appears to have an interaction with another gene that regulates the “tau” proteins – which are found in much higher levels in Alzheimer’s brains.  The researchers found that blocking the USP9 gene resulted in a significant reduction in the activity of the tau gene.  The end result is a potential path forward for an anti-Alzheimer’s drug treatment that targets the genes controlling USP9 production.  Now, wouldn’t that be nice 🙂  I’ll keep an eye on this potential path forward…

Preventive Medicine: What’s Good For The Goose Is Good For the Gander – It may come as a surprise to some but – then again – not.  Ahem, physicians are just like everybody else!  What is notable in much of the recent research on physician attitudes and perspectives about their role in health care is the evolving body of research, which is documenting an increase in the rate of physician burnout.  While there are many ongoing responses to burnout, the result is that too frequently physicians simply hang it up and quit practice.  The phenomenon is particularly acute among the Boomer physicians.  In a commitment to try and do something about the problem, the American Medical Association and a number of CEOs from large systems recently came together and made a joint commitment to address the physician burnout problem.  They published their commitment in the Health Affairs Blog which appears regularly on contemporary issues.  The specific commitments by the Association and the health system leaders included the following 11 actions, as follows:

  1. Regularly measure the well-being of our physician workforce at our institutions using one of several standardized, benchmarked instruments.
  2. Where possible, include measures of physician well-being in our institutional performance dashboards along with financial and other performance metrics.
  3. Evaluate and track the institutional costs of physician turnover, early retirement, and reductions in clinical effort.
  4. Emphasize the importance of leadership skill development for physicians and managers leading physicians throughout our organization.
  5. Understand and address more fully the clerical burden and inappropriate allocation of work to physicians that is contributing to professional burnout.
  6. Support collaborative, team-based models of care where physician expertise is maximally utilized for patient benefit, with tasks that do not require the unique training of a physician delegated to other skilled team members.
  7. Encourage government/regulators to address the increasing regulatory burden that is driving inefficiency, redundancy, and waste in health care and to proactively monitor and address new unnecessary and/or redundant regulations.
  8. Encourage and support the AMA and other national organizations to work with regulators and technology vendors to align technology and policy with advanced models of team-based care and to reduce the burden of the EHR on all users.
  9. Encourage and support the AMA and other national organizations in developing further initiatives to make progress in this area by compiling and sharing best practices from institutions that have successfully begun to address burnout, profiling case studies of effective well-being programs, efficient and satisfying changes in task distribution, and outlining a set of principles for achieving the well-being of health professionals.
  10. Continue to educate our fellow CEOs as well as other stakeholders in the health care ecosystem about the importance of reducing burnout and improving the well-being of physicians as well as other health care professionals.
  11. Support and use organizational research at our centers to determine the most effective policies and interventions to improve professional well-being among our physicians and other health care professionals.


You Heard It Already But… – The vote on TrumpCare finally came in – for the US House of Representatives – with a squeaker at 217 in favor and 213 against, which allowed passage of the American Health Care Act (AHCA).  What seemed impossible just a mere seven weeks ago, finally became a reality.  But, it wasn’t without some degree of trepidation and angst.  According to media report. Reince Preibus, the White House Chief of Staff, was on full alert in working with Speaker Paul Ryan (R-WI), to gain passage of the legislation.  The bill (Mea Culpa – I have not yet read the full legislation) essentially was a slightly modified version of the former bill that was previously struck down with two substantive changes:  1) the bill that passed allows the states to apply for waivers from the ACA-mandated requirements including waivers which allow insurers to impose health status underwriting on individuals (i.e. “pre-existing conditions”) who don’t maintain continuous coverage; and, 2) the bill adds $8 billion in funds to fund high-risk pools in states that seek such waivers.  These two provisions have caused significant concerns across the board because of the broad definition of a pre-existing condition generally employed by the insurance industry.  In addition, the $8 billion is viewed as a rather paltry sum of funding for the potentially large number of people that would be affected or, those who obtained insurance under the Obama program and would now be without coverage.

While there is not final valuation on the latest version of the AHCA which passed the House, the Congressional Budget Office (CBO) did weigh in on the cousin of the bill which failed to pass a month ago.  In that bill, the CBO score of the prior AHCA estimated that by 2026 the number of uninsured Americans would reach about 24 million, federal funding for Medicaid would fall by 25%; and, the number of individuals with employer-sponsored insurance would be reduced by 7 million people.  Those numbers caused considerable heartburn among both liberals and conservatives for a piece of legislation that is increasingly viewed as a right.  By all accounts, most experts do not expect the new scoring to be much different once it is completed sometime over the next couple of weeks because except for the two changes described above, all else remains the same.  While the debate is only now just getting started in the US Senate, most of the policy wonk observers expect significant modifications before any vote is even considered.  Plus, the Senate is a much more temperate organization (at least historically) so that we should anticipate a full vetting of the bill before passage rather than the rush job we witnessed on the House side.

There was clearly lots of angst related to the bill.  Among those opposing the bill were the AARP, the American Medical Association, America’s Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association, Federation of American Hospitals, and National Association of Psychiatric Health Systems. But, it wasn’t just the health care providers, various conservative groups, including Heritage Action, the Cato Institute, Americans for Prosperity, FreedomWorks, and the Tea Party Patriots all opposed the bill as well. The politics of the moment seems to have pushed it through the House.  Now, it is on to the Senate.   I would anticipate that “something” will pass the Senate.  At this stage; however, it’s anybody’s guess as to exactly what.  We’ll continue to keep our fingers on the pulse even if it gets a bit thready in the coming weeks 🙂

Regardless of what happens, the writing is on the proverbial wall on a couple of points.  First, we are moving toward “value-based models of care delivery”.  While the details are still being worked out, everyone should anticipate that the glory days of fee-for-service payment structures will become a thing of the past.  While all of the insurers are tinkering with approaches, the gorilla in the room is Medicare so everyone in health care should be working on a strategy for managing risk in the Medicare population.  Second, consolidation will continue driven in large measure by the need for clinical alignment.  Once we get through this stage of debate (over the next year or so), I predict that the evolution of large regional systems will portend the move toward seminal national systems.  Then, as they say “Let the games begin”.  Finally, the consumers will be in charge!  Whether it’s airlines, taxis, hotels, books, legal services, food or anything else – the one lesson we should take home is that health care is in for some real transformation.  Mark my words, the consumer of services is in charge.  We should listen to them, weight their needs – and, respond!!  Those who wait to figure this one out will be left out in the cold.  And, for a kid from North Dakota – “cold” means that you are frozen, not chilled.  These are three very good reasons for kick starting change in your health care organization.  And, there are more opinions where that came from 🙂

Coffee, Coffee, Coffee!! –  There’s a new study on the street that is REALLY important for those of us who are Coffeaholics.  The new study reports that the cup-a-joe – or should I say “joes” – we consume may actually boost longevity.  Even the decaf drinkers had a positive result.  Specifically, the study – reported by the Harvard School of Public Health – found that those who consumed 3 – 5 cups of coffee per day had a 15% reduction in their risk of premature death compared to those who drank less.  There’s also a decreased risk of stroke and even some results showing a positive impact of Type II diabetes by lowering the incidence.  And, there’s even reports about enhanced cognitive function and mood enhancement – although the amount of coffee consumed for those effects was only about 2 cups a day 🙁  Stay tuned…

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