JHC July 18

July 2018 • Vol.9 No.4

Cybersecurity

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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 | 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

%

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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.

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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

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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