July 2018 • Vol.9 No.4
Cybersecurity
and the Contracting Pro
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CONTENTS »» JULY 2018
4 Hep C screening still low 8 Length of Stay
States finding out that the shorter the nursing-home stay following hospitalization, the better for the patient
18 Nursing facility statistics 20 Cybersecurity and the Contracting Pro 28 People Before Problems How to encourage through difficult situations
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The Journal of Healthcare Contracting (ISSN 1548-4165) is published bi-monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media All rights reserved. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.
The Journal of Healthcare Contracting | July 2018
3
INFECTION PREVENTION
Hep C screening still low
4
Despite the steady increase of liver cancer in-
“In the United States, approximately one in 30
cidence in the United States in recent decades, data
baby boomers are chronically infected with HCV,�
from 2015 indicates that less than 13 percent of indi-
Susan Vadaparampil, PhD, MPH, was quoted as say-
viduals born between 1945 and 1965 are estimated
ing. She is senior author, senior member and profes-
to have undergone screening for hepatitis C virus
sor, Health Outcomes and Behavior Program, Mof-
(HCV), according to results published in Cancer Epi-
fitt Cancer Center, Tampa, Florida. Almost half of all
demiology, Biomarkers & Prevention, a journal of the
cases of liver cancer in the United States are caused
American Association for Cancer Research.
by HCV, she added July 2018 | The Journal of Healthcare Contracting
50
%
Nearly 50% of adults in the United States suffer from hypertension1
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INFECTION PREVENTION
“Hepatitis C is an interesting virus because people who develop a chronic infection remain asymptomatic for decades and don’t know they’re infected,” said lead author Monica Kasting, PhD, postdoctoral fellow, Division of Population Science, Moffitt Cancer Center. “Most of the baby boomers who screen positive for HCV
“ Hepatitis C is an interesting virus because people who develop a chronic infection remain asymptomatic for decades and don’t know they’re infected.”
infection were infected over
– Monica Kasting
30 years ago, before the virus was identified.” Because over 75 percent of HCV-positive individuals were born between 1945 and 1965, both the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force now recom-
among baby boomers and those born
mend that baby boomers get screened for the virus. However,
between 1966-1985, HCV screening
data from the 2013 National Health Interview Survey (NHIS)
rates were lower among Hispanics and
indicated that only 12 percent of baby boomers had been
non-Hispanic Blacks. “This is concern-
screened for HCV, Kasting explained.
ing, because these groups have higher
The researchers wanted to study if HCV screening rates had
rates of HCV infection and higher
increased following the FDA approval of several well-tolerated
rates of advanced liver disease,” noted
and effective treatments for HCV infection.
Kasting. “This may reflect a potential
Using NHIS data from 2013-2015, Kasting and colleagues an-
health disparity in access to screening,
alyzed HCV screening prevalence among four different age co-
and therefore treatment, for a highly
horts (born before 1945, born 1945-1965, born 1966-1985, and
curable infection.”
born after 1985). Participants were asked if they had ever had a
Among baby boomers, HCV screening
blood test for hepatitis C. As the researchers were interested in
rates ranged from 11.9 percent in 2013
assessing HCV screening in the general population, they exclud-
to 12.8 percent in 2015. Regardless of
ed certain populations who were more likely to be screened for
the federal screening recommendations,
the virus, resulting in a total sample size of 85,210 participants.
less than 20 percent of baby boomers
Kasting and colleagues found that females were screened less often than males in every age cohort. Additionally, 6
reported that the reason for their screening was due to their age. July 2018 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
Length of Stay States finding out that the shorter the nursing-home stay following hospitalization, the better for the patient
Long-term nursing home residence can be a poor outcome for residents and their families. Few people want to live in a nursing home, and most family caregivers want to do whatever they can to ensure that their family member does not remain in the nursing home any longer
Policymakers are not only interested in reducing length of stay in hospitals but also nursing homes. An October 2017 report from the AARP
People residing in nursing homes also
Public Policy Institute explains why and how several states are working
may face much higher out-of-pocket costs
to reduce the percentage of older adults who receive long-term nurs-
than they would for community-based
ing home care after a hospitalization.
long-term services and supports (LTSS).
The report, titled “State strategies to reduce the risk of long-term
Long-term nursing home stays may pose
nursing home care after hospitalization,� describes strategies used
a cost problem for states as well, because
in four highly ranked or significantly improved states – Connecticut,
long-stay residents are likely to spend
Maine, Minnesota, and Oregon. The paper also includes a toolkit of re-
down their resources and become eligible
sources that can help others learn more and potentially replicate these
for assistance from Medicaid.
practices. Following is an edited summary of that report, presented with permission from the AARP Public Policy Institute. 8
than necessary.
Nursing home residents who are not discharged to the community within a July 2018 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
few months are particularly at risk of a long-term stay. The like-
Better planning shows results
lihood of a nursing home resident returning to a community
Changes in the post-acute-care land-
setting declines sharply after 90 days. Because most nursing
scape – largely driven by changes in
homes provide both SNF care and long-term custodial care,
Medicare – also may be influencing the
transitions to long-term residence can be relatively easy.
trends in long-term nursing home use,
The good news is, older adults today are less likely to un-
according to the AARP Public Policy In-
dergo long-term institutionalization after a hospital stay than
stitute. In some states and communities,
they were a decade ago. They are more likely to receive sup-
hospitals are giving greater consideration
portive services at home or in community settings due to
to discharge destinations and outcomes.
changing expectations about the role of nursing homes, the
Accountable care, value-based purchas-
growing contributions of family caregivers, and the expansion
ing, and bundled payment programs are
of residential alternatives, such as assisted living.
bringing increased attention to the role of post-acute care in helping people transition back into a community setting.
Nursing homes diversify Connecticut’s “Strategic Plan to Rebalance Long-Term Services and Supports” describes an agenda to support older adults, people with disabilities, and family caregivers in choosing how and where to receive services and supports. Nursing home diversification is an important part of the plan. To help nursing home operators diversify, the state created a grant program to help facilities fund new investments: to redesign their business models to accommodate the shift to community living, reduce the number of beds in the state, and reduce the percentage of discharges from hospitals to nursing facilities. The Connecticut Department of Social Services, in conjunction with the Connecticut Departments of Housing and Public Health, solicited proposals from nursing facilities and awarded $12 million in grants over a two-year period (2014–15). The nursing facilities receiving grant funds have invested in building an infrastructure for community services, including navigators, transition coordinators, affordable adult family living, and adult day services.
Because nursing facility quality varies widely, hospitals are creating preferred provider networks to improve transitions and avoid preventable readmissions. State policies can make a difference. The ability of low-income older adults to make a successful transition to community living depends on the availability of personal care assistance services and other home-based supports. States, however, vary widely in how they use Medicaid state plan benefits and waiver programs – as well as state-funded programs – to meet the needs of older adults who are at risk of long-term nursing home stays. Some states and communities have robust home- and community-based services (HCBS) systems that enable people with LTSS needs to live independently and avoid nursing home placement. In one recent study of nursing home use in Medicaid, nursing home stays were shorter in states with higher HCBS spending and use.
10
July 2018 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
The AARP study describes how state policies in four states
Nursing home social workers remain
– Oregon, Maine, Minnesota and Connecticut – may reduce
responsible for discharge planning, but
long-term nursing home care after a hospitalization and en-
community living specialists collaborate
sure timely and effective transitions back to community living.
with them to help residents and their fam-
The first three states – Oregon, Maine, and Minnesota – are
ily caregivers identify goals and needs,
among the highest performing on this indicator. They also have relatively low Medicare SNF admissions and low over-
The community living specialist as-
all nursing home use among older adults. Connecticut had
sesses needs and helps residents and
a higher percentage of long
families understand the community re-
stays post-hospitalization in 2012 than the other three states (16.3 percent) and a higher rate of SNF admissions in Medicare (103 admissions per 1,000 enrollees), but its percentage of long stays declined significantly, from 18.2 percent in 2009 to 16.3 percent in 2012.
Minnesota’s Return to Community Initiative Minnesota’s Return to Community Initiative (RTCI) focuses on nursing home residents who are on Medicare and pay-
Nursing home social workers remain responsible for discharge planning, but community living specialists collaborate with them to help residents and their family caregivers identify goals and needs, and plan for care in the community.
ing privately for long-term
12
and plan for care in the community.
sources that are available to them. Specialists, residents, and family caregivers develop a community living support plan that all agree can enable successful transition to the community that aligns with the resident’s goals and preferences. A community living specialist follows up with clients who have left the nursing home for their own home, an assisted living facility, or another community setting. The program includes check-ins at specified intervals (a phone call or in-person visit within 72 hours, an in-person visit within 10 days, a 30-day and 60-day check-in, a 90-day check-in, and subsequent check-ins every 90 days for up to five years). This schedule can be modified to fit individual and family needs and preferences.
nursing home care (when they no longer qualify for Medicare’s
During these follow-up calls or visits,
skilled nursing facility benefit) and who may be at risk of spend-
the specialist assesses how well the plan
ing down to Medicaid.
is working and makes needed changes
The RTCI program identifies nursing home residents who
to enable people to live successfully in
fit a community discharge profile, but who remain in the
the community, and avoid rehospitaliza-
nursing home after 60 days. Community living specialists –
tion or readmission to the nursing home.
who are nurses or social workers employed by local AAAs
Since RTCI’s launch in April 2010, RT-
– inform residents whose names appear on a list (produced
CI-assisted discharges have steadily in-
weekly) about assistance that can help them plan for a suc-
creased – roughly 390 transitions per year
cessful transition home.
and a total of 4,551 transitions as of May July 2018 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
2017. Most of the roughly 400 nursing
Care transitions improved
homes in Minnesota have some RTCI-as-
Minnesota is a national leader in setting policy standards for nursing home quality of life and quality of care. The nursing facility Performance-based Incentive Payment Program (PIPP) is one of many strategies designed to improve quality for people who need long-term services and supports. The program has funded projects designed to improve care transitions, including efforts to reduce hospitalizations and increase successful transitions to the community. Since 2007, 261 facilities (of the roughly 400 in Minnesota) have participated in the program. SNFs have focused on a wide variety of topics, including clinical quality
had five or fewer. Most of the people who
sisted discharges, although most facilities returned to the community with support from the program fit the community discharge profile, that is, they preferred to reside in the community, had entered the nursing home as a post-acute admission, were relatively independent, and were not cognitively impaired or had only mild cognitive impairment. A year after discharge, half of the RTCI-assisted individuals lived in the community, 36 percent had been readmitted to a nursing home, and 14 percent had died. Only a small percentage (11 percent) had converted to Medicaid.
Maine’s Homeward Bound program Maine’s Homeward Bound program helps nursing home residents transition to community living through an approach that relies heavily on the state’s private, nonprofit Long-Term Care Ombudsman. The Ombudsman serves residents of nursing facilities and assisted housing programs, (87 projects), psychosocial aspects of care (46 projects), organizational change (39 projects), technology (22 projects), and care transitions (20 projects). The PIPP projects focused on care transitions reflect the growing consensus that transitional care interventions can improve transfers from nursing homes to home for older adults. Improving care transitions, however, may require significant improvements in nursing home resources, including the availability of nursing and medical staff, diagnostic and pharmacological services, and adequate social services for resident and family engagement and follow-up.
14
including residential care facilities and assisted living facilities, as well as people receiving services at home or in the community, such as adult day service settings. The Ombudsman is responsible for conducting outreach, initial eligibility screening, and completion of the Homeward Bound application form. Specifically, an advocate from the Ombudsman Program provides information July 2018 | The Journal of Healthcare Contracting
about transition coordination, so an individual who is seeking services can choose one of the three agencies providing this service. Throughout the transition, Homeward Bound participants receive advocacy support from the Ombudsman. The Ombudsman Program also makes MDS section Q referrals [which address discharge planning and the resident’s desire to return to the community]. Within a matter of days of receiving a referral, the Ombudsman makes inperson contact and provides general information about community living services and supports. The Ombudsman then makes referrals to the Center for Independent Living (Alpha One) and/or the local Aging and Disability Resource Center. By the end of 2016, the Homeward Bound program had a total of 92 transitions, in line with the projected number of transitions from the program’s launch. The program had made a total of 406 outreach contacts, exceeding its goal of 308 contacts from the beginning of the program, in 2013.
Since 2008, more than 3,900 people have transitioned from nursing homes to community living through MFP. Beginning in 2015, nursing homes are required to notify
Connecticut’s ‘Money Follows the Person’
the Connecticut Department of Social Services when a resi-
Connecticut’s Money Follows the Person
period. MFP program staff may then assess the resident to
(MFP) demonstration program engages
determine if he or she prefers, and is able, to live in the com-
with people who need assistance with
munity; develop a care plan; and help the resident transition
housing and services to achieve suc-
to the community. Connecticut strives to reduce the percent-
cessful and sustained community living.
age of post-acute care discharges to SNFs. The state’s balanc-
Many MFP program participants have
ing plan calls for efforts to better inform and train hospital
lived in a nursing home for three years
discharge planners about home- and community-based options
on average.
for post-acute care.
The Journal of Healthcare Contracting | July 2018
dent is expected to qualify for Medicaid within a 180-day
15
POST-ACUTE CARE
The percentage of Medicaid beneficiaries who were dis-
Community First Choice waiver pro-
charged from SNF to a community setting within six months
gram, nursing home caseloads have
increased from 27 percent in 2009 to 41 percent in 2015.
declined, falling from roughly 5,000
Across all payers, the percentage of people needing support-
per year on average in 2005-07 to just
ive services discharged from the hospital to home increased
over 4,000 per year in 2013-15. The re-
from 47 percent in 2008 to 55 percent in 2016, while hospital
sulting drop in nursing home spend-
discharges to SNFs declined from 53 percent in 2008 to 45 per-
ing offsets some of the increased
cent in 2016.
spending on HCBS. But, unless some
Oregon’s quality improvement program Some highly ranked states, including Oregon, Connecticut, and Minnesota, have incentivized quality improvement
in
nursing
homes
(including discharge planning and transitional care services) and have worked with nursing homes to close, downsize, and diversify into community care. Oregon has among the lowest rates of nursing home use (3.3 percent of people ages 85+ reside in a nursing home) and low use of SNF
The resulting drop in nursing home spending offsets some of the increased spending on HCBS. But, unless some nursing homes close, the fixed costs associated with nursing facilities will reduce the savings associated with fewer nursing home residents.
nursing homes close, the fixed costs associated with nursing facilities will reduce the savings associated with fewer nursing home residents. That’s why Oregon has pushed for reductions in nursing home bed capacity and opportunities to expand residential and supported housing alternatives to nursing home care. A 2013 law (Oregon House Bill 2216) provided incentives to the nursing home industry to reduce bed capacity by 1,500 beds by June 30, 2016 – changing the nursing facility rate calculation if the 1,500-bed reduction target is not met. The Oregon Department of Human Services works with local nursing facility providers that are considering taking advantage of the capacity-reduction initiatives to assess opportunities for more
care in Medicare compared
residential and supported housing ca-
with the national average. A recent initiative focuses on down-
pacity development.
sizing and diversifying the nursing home industry. As Oregon has expanded its Medicaid HCBS programs, most recently with the implementation of its 1915(k)
As of May 2017, the number of nursing home beds had been reduced by 1,210, 80 percent of the 1,500-bed target.
Editor’s note: The AARP Public Policy Institute’s “Long-Term Services and Supports Scorecard Promising Practices: State Strategies to Reduce the Risk of Long-Term Nursing Home Care after Hospitalization,” can be accessed at http://www.longtermscorecard.org/~/media/Microsite/Files/2017/ reducingtheriskoflongtermnursinghomecareafterhospitalization.PDF 16
July 2018 | The Journal of Healthcare Contracting
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POST-ACUTE CARE
Nursing facility statistics A recent report published by the Kaiser Family Foun-
in 2016. (The remainder – about 7 percent – were governmentowned.) Ownership patterns vary widely across states, with states in the South and West having higher shares of facilities that are for-profit.
dation – “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2016” – provides information on re-
• More than half of facilities over the
cent trends in nursing facilities in the United States, drawing on
2009-2016 period were owned or
data from the federal On-line Survey, Certification, and Report-
leased by multifacility organizations
ing system (OSCAR) and Certification and Survey Provider En-
(chains that have two or more facili-
hanced Reports (CASPER). Here are a few highlights.
ties), though the share of nursing
•N ationwide, the number of nursing facility beds has been fairly consistent since 2009, reaching 1.6 million certified
facilities that are chain-owned varies by state.
beds in 2016 (with an average of 109 beds per facility). However, nursing facility occupancy rates declined slightly from 2009 to 2016, from 84 percent in 2009 to 81 percent in 2016.
• A year of nursing facility care typically costs over $82,000, and national spending on nursing facilities across all pay-
• F rom 2009 to 2016, the share of nursing facilities that were
ers totaled $162.7 billion in 2016.
for-profit increased slightly, from 67 percent in 2009 to 69 percent in 2016, while the share that were non-profit declined slightly, from 26 percent in 2009 to 24 percent 18
• Medicaid is the primary payer source for most certified nursing July 2018 | The Journal of Healthcare Contracting
facility residents, with more than
on a wheelchair for mobility or are unable to walk without
six in ten (62 percent) residents
extensive or constant support from others.
– about 832,000 people – having Medicaid as their primary payer in
• Nearly half (45 percent) of residents had a dementia
2016. States in the East, particularly
diagnosis in 2016, and 32 percent had other psychiatric
the Southeast, have higher shares
conditions such as schizophrenia, mood disorders or other
of residents with Medicaid as their
diagnoses. In addition, nearly two-thirds (63 percent) of
primary payer than other states.
residents received psychoactive medications, including anti-depressants, anti-anxiety drugs, sedatives and hyp-
• On average, in 2016, residents’ level
notics, and anti-psychotics, in 2016.
of need for assistance with activities of daily living scored 5.8 on a scale
• In 2016, the most common deficiencies given by state
from 3 to 9, and levels of need have
surveyors concerned failures in infection control, accident
been fairly stable since 2009.
environment, food sanitation, quality of care, and pharmacy consultation. Of particular concern were deficiencies
• While only 4 percent of residents
that cause harm or immediate jeopardy to residents. In
were bed-bound in 2016, over six in
2016, more than one in five facilities received a deficiency
ten (65 percent) of residents depend
for actual harm or jeopardy.
Source: Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2016, Kaiser Family Foundation, https://www.kff.org/medicaid/report/nursing-facilities-staffing-residents-and-facility-deficiencies2009-through-2016/ The Journal of Healthcare Contracting | July 2018
19
Cybersecurity
and the Contracting Pro
Price, terms, service, warranties and fill rates have long been the stuff of contract negotiations. Now, contracting professionals are adding “cybersecurity� to the list.
20
July 2018 | The Journal of Healthcare Contracting
CYBERSECURITY
“Cybersecurity concerns have heightened the
comes for patients and providers,” says Petty. “Un-
importance of evaluating medical device vendors
fortunately, many of these devices lack the basic
and service providers on their current and future
security protections we have grown to expect from
cybersecurity management practices across the
other systems connected to the hospital network.
expected life of devices,” says Kent Petty, chief in-
This puts interconnected medical devices increas-
formation officer, HealthTrust. “The avoidance of
ingly at risk of cyberattacks that could affect patient
unexpected downtime, loss of functionality, or
care, safety, or data.
worse, harm to patients because of a cybersecu-
“Additionally, these devices can be used as easy
rity event, makes the evaluation and negotiation
targets to gain a foothold into the hospital’s network
of cybersecurity terms in purchasing agreements
to attack other non-medical systems,” he continues.
a top-of-mind focus.”
“While these indirect attacks may not directly harm a patient, the disruption to op-
“ The avoidance of unexpected downtime, loss of functionality, or worse, harm to patients because of a cybersecurity event, makes the evaluation and negotiation of cybersecurity terms in purchasing agreements a top-of-mind focus.” – Kent Petty
erations could affect the speed, accuracy, and overall delivery of patient care.” Examples of common cybersecurity-related
risks
include
lack of support and/or timely release of security patches, the continued selling or use of unsupported operating systems (e.g., Microsoft Windows XP),
Ross Carevic, director, technology sourcing op-
and the overall lack of basic security controls within
erations for Vizient Inc., says, “A recent report from
the device, including open services and ports that
Symantec indicates some threat actors appear to be
can be easily exploited by cyberattacks, says Petty.
fine-tuning their attack tactics to more specifically
Historically, the U.S. Food and Drug Administra-
target medical devices. While the exact intent is still
tion has been charged with providing reasonable
unknown, it shows the changing tactics of threat
assurance that the benefits of a medical device or
actors and their willingness to probe deeper into
technology to patients outweigh the risks, he says.
medical systems to look for potential vulnerabilities.”
With today’s networked devices, that’s not so easy.
What’s the problem?
cybersecurity risks adds to the device’s risk profile
It turns out that the strength of modern medical de-
and complexity, and the responsibility falls to the
vices is also their weakness.
manufacturers and providers to work together to
“The interconnected medical device is critical in
22
“A medical device’s network connectivity and other
remediate or mitigate these risks.”
today’s diagnostic and patient treatment ecosystem,
Given the number of medical devices that are
as it brings automation, accuracy and improved out-
networked and/or contain patient data, and the July 2018 | The Journal of Healthcare Contracting
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PATIENT CARE
INTERVENTIONAL CARE
ENVIRONMENT OF CARE
CYBERSECURITY
potential impact on patient health and safety, cyber-
Contracting implications
security poses a big risk to providers, says Carevic.
Healthcare providers can reduce their risks of cyberat-
Common risks include default login credentials
tack through attentive and informed contracting, ac-
and unencrypted data storage and transfers, he
cording to those with whom the Journal of Healthcare
says. The greater risks involve the failure to under-
Contracting spoke. But they’ll need help doing so.
stand the medical device profile information, or the
“Contract negotiators, along with IT and security
failure to identify the systems with which devices
teams, need to coordinate their efforts during the
exchange information. Another risk is the failure to
contract review and negotiation process to bet-
compile detailed device profile information of the
ter identify the supportability and longevity of the
deployed devices in advance of the next major cy-
underlying operating system and third party applications that are necessary for
bersecurity exploit.
these devices to function,” says
Patches
Petty. “During the sourcing and
“To date, medical devices haven’t
procurement process, they need
been specifically attacked that
to identify those medical devic-
we are aware of, but they have
es that may run unsupported or
been impacted indirectly by ex-
with end-of-life operating sys-
ploits targeting the off-the-shelf
tems, such as Windows XP. Doing
software that the devices often
so will call for collaboration with
utilize,” says Carevic. “As an example, the WannaCry virus quickly spread across unpatched Microsoft XP operating systems. This attack highlights a big debate in the industry about the frequency of regular software patches for medical devices.” Patching a medical device always carries some degree of risk because of its unintended im-
“Unpatched devices with off-the-shelf software are more vulnerable when a large virus outbreak occurs.”
pacts to device functionality, he
24
– Ross Carevic
vendors, clinicians, IT and cybersecurity representatives.”
Manufacturers’ role Manufacturers can play a role in minimizing cyberattacks, says Carevic. “Suppliers can immediately help healthcare providers by acknowledging the issues and providing more information about their device designs and the proper controls that should be put in place
says. “However, unpatched de-
when deploying and using their
vices with off-the-shelf software
products in a safe and secure man-
are more vulnerable when a large
ner. Vizient is taking steps to request
virus outbreak occurs, so there needs to be a bal-
this type of information in new contracts and RFPs go-
ance where patches can be tested and released on
ing forward, but a lot of this information can be made
a defined schedule.”
available from suppliers today.” July 2018 | The Journal of Healthcare Contracting
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CYBERSECURITY
Manufacturers themselves are prepared to work
discussions on mitigating associated risks well before they become an issue.”
with providers. “Concerns about cybersecurity are nothing new
Says Garrison Gomez, senior director of vitals and
in the medical industry,” says Chad Darling, senior
cardiology, Welch Allyn, “IT has a more prominent
product manager, EMR business development, Mid-
seat at the table than ever before – and for good rea-
mark. “Our customers primarily use various Security
son: No one wants to make front-page news with a
Risk Assessment questionnaires to understand the
data breach. They are engaging with vendors earlier
impact of software to their organization. With cy-
and more often to make sure the technology select-
bersecurity being an increasingly prominent topic
ed aligns with their security policies. Of course, this
in the industry, we’re seeing those questionnaires
means the CIO must partner closely with the CNO,
becoming longer and more detailed. And, more or-
informatics and other medical teams to make sure
ganizations are using them than what we’ve seen in
clinical needs and workflows remain prioritized. “At a minimum, [contracting professionals should]
the past. “Using a Security Risk Assessment questionnaire
ask vendors about their methods for encryption, device
early in the contracting process has been helpful for
access control and cybersecurity patch release policies.
organizations to understand how the software func-
Understanding the opportunities and options for solu-
tions and where patient health information is stored
tions that are both secure and offer high clinical usabil-
and transferred. This can help identify potential se-
ity should be an important aspect of the technology
curity concerns early on in a partnership and lead to
evaluation process for connected medical devices.”
Cybersecurity checklist Providers and manufacturers can work together to address current and future cybersecurity-related issues for the life of the device, says Kent Petty, chief information officer, HealthTrust. Some points for contracting professionals to consider: • Require the vendor to disclose and discuss security-related features or vulnerabilities associated with the product or service the vendor seeks to sell into the healthcare system. • Clearly define a set of cybersecurity requirements within the contract that must be met before the device or technology is introduced in the facility, and independently validate that the vendor has met the requirements. • E nsure contract language requires manufacturers to maintain the cybersecurity of the device (e.g., timely patching, supported operating system version, etc.) over its expected lifespan.
26
• Clearly define roles and responsibilities for addressing cybersecurity risks identified during the system’s lifespan within the contract. • When evaluating new products and/or vendors, include cybersecurity requirements in the scorecard to ensure they are a part of the purchase decision. • E ncourage participation in vulnerabilitysharing organizations (e.g., National Health Information Sharing and Analysis Center, or NH-ISAC) to bring added visibility and crowdsourcing to cybersecurity issues in a timely manner.
July 2018 | The Journal of Healthcare Contracting
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LEADERSHIP
By Lisa Earle McLeod
People Before Problems How to encourage through difficult situations Imagine your spouse calls you to say, “I lost my job.” What are the first words out of your mouth? Do you blurt out,
imagine you lost your job. You’re scared,
“Oh god, what are we going to do for money?” Or do you pause,
humiliated, and likely angry. When you
and think about how your spouse feels in this moment?
tell your spouse, which reaction would
If you’re like most people, a spouse losing their job is panic induc-
you prefer? How are we going to pay the
ing. It’s natural to worry about how you’re going to pay your bills.
mortgage? Or, “Oh baby, I’m so sorry, tell
Your natural first thought is how will we pay our bills. But just because that’s your first thought doesn’t mean it has be your first words. 28
Put yourself in your spouse’s shoes;
me all about it.” The person who lost their job already feels terrible. They’re likely in full throttle July 2018 | The Journal of Healthcare Contracting
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LEADERSHIP
panic. Adding more shame and fear won’t make things better.
them know you’re angry is appropriate.
There will be plenty of time for shared panic in the coming days.
But if the person is a valued team mem-
In that critical moment – when the person first shares the bad
ber, who simply had something go the
news – what they need most is support.
wrong way, shaming and blaming them
The first words out of your mouth will be what they remem-
is not going to improve their perfor-
ber most. You can make the person feel loved, or can leave them
mance in the future. Nor will it improve
feeling alone.
their alliance with you.
When someone shares bad news, it’s natural to think first
Good performers hate failure, and
about how it will impact you. But again, the first thing you think
they really hate having to tell their boss
doesn’t have to be the first thing you say.
they failed. You may be thinking, “Oh crap, how am I going to tell my boss?” Again, your first
But if the person is a valued team member, who simply had something go the wrong way, shaming and blaming them is not going to improve their performance in the future. Nor will it improve their alliance with you.
thoughts do not need to be your first words. Job losses and lost deals are high stakes situations, the same dynamic plays out in lesser circumstances. Your kid dings up the car, your coworker erases the file, your neighbor’s tree swings the wrong way and falls onto your garage. We’ve all seen that person who
This principle applies at work as well. Imagine your sale rep
gets bad news, tenses up, acts like it’s a
calls and tells you she lost the big deal you were counting on to
calamity and makes everyone around
make the quarter. Do you immediately blast her with, “No way,
them feel worse. It’s never helpful.
you lost it? This is awful, we needed that deal.” Or do you empathize with their loss, “Oh geeze, I’m so sorry. I know you were counting on it. What happened?” The deal is already lost. Even if you can save it, three minutes on the phone with your rep won’t make a difference. The question in that moment is, how do you want your employee to feel? If they’re a low performer and you’re already frustrated, letting
When someone confesses a problem or mistake to you, the best thing you can do in that moment is empathize and connect. Deal with the person first, the problem second. The people you care about will thank you.
Lisa is a sales leadership consultant, and author of Selling with Noble Purpose. Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales forces. She has appeared on The Today Show, and has been featured in Forbes, Fortune and The Wall Street Journal. She provides executive coaching sessions, strategy workshops, and keynote speeches. Visit www.LisaEarleMcLeod.com 30
July 2018 | The Journal of Healthcare Contracting
Better, faster. It’s what we want for patients.
What about your clinicians?
Connecting vital signs monitors to the EMR has been shown to: Y
Reduce errors caused by manual processes1
Y
Save clinicians time by removing manual documentation steps2
Y
Increase clinical time spent on value-added care3
40
1
Reduction in minutes of vital signs data latency in the EMR after connecting vital signs4
Welch Allyn partners with leading EMRs to send data from the Connex® family of vital signs devices directly to the patient’s record. Our goal is simple: help your clinicians work better, faster so they can focus on getting patients better, faster.
Start today at www.welchallyn.com. 1 CIN: Computers, Informatics, Nursing: Eliminating Errors in Vital Signs Documentation, FIELER, VICKIE K. PhD, RN, AOCN; JAGLOWSKI, THOMAS BSN, RN; RICHARDS, KAREN DNP, RN, NE-BC, 2013. The paper vital signs recording had an error rate of 18.75%. 2 JHIM FALL 2010 Volume 24:Number 4, Vital Time Savings: Evaluating the Use of an Automated Vital Signs Documentation System on a Medical/Surgical Unit 3 Going One Step Further at Scott & White Medical Center—Temple: Eliminating manual vital signs documentation to prioritize value-added care. 2017 Welch Allyn. www.welchallyn.com 4 CareAware® VitalsLink: Eliminating Data Latency & Manual Documentation at Naples Hospital. Prepared by Cerner, 2013. © 2017 Welch Allyn
MC14605
At HealthTrust, we use science supported by data. Others may claim big data. But they can’t duplicate our experience and insight in guiding informed decision-making that supports improved care and lowered cost. Let us help you amplify your voice and turn data into action.
Empower your conversations. healthtrustpg.com/amplify