By Bill Prentice
No matter the setting, health care providers across the country are confronting several common concerns that threaten our ability to provide high-quality care to our patients, and in some cases, to continue to provide care at all.
Economists and health care professionals agree that most of these problems are not likely to go away soon. Our best chance to turn these situations around is for everyone in health care to come together to design and support multifaceted, long-term solutions and participate in public-private partnerships to make them work.
Let’s consider what we’re up against.
Workforce Shortages
Few industries escaped the workforce shortages that occurred after the pandemic was declared, but health care was one of those hit hardest by the Great Resignation at a time when the need for top-quality staff was at its height. We all watched salaries for staff and traveling nurses soar to new levels as competition for skilled health care professionals intensified.
In December 2021, an ASCA survey of the ASC community showed that 77% of respondents were experiencing nursing or staffing shortages. A follow-up survey conducted this June suggests the situation has improved modestly as 51% of participants reported average staff turnover rates in the last year of 5% or less. Meanwhile, most of the survey participants reported increasing average hourly rates for clinical personnel between 2021 and 2022.
Projections of future physician and nursing shortages that have circulated for years compound the problem.
Drug Shortages, Escalating Costs and Supply Chain Challenges
Drug shortages, sourcing challenges for supplies and rising costs are not new in health care, but like we experienced with workforce shortages, the pandemic intensified these concerns. Again, no one is predicting a resolution to these problems anytime soon.
More than 99% of those who participated in an American Society of Health-System Pharmacists (ASHP) member survey back in March reported being affected by shortages of critical drugs. While most who responded to that survey work in hospital settings, members of the ASC community also frequently report difficulty getting the drugs they need for their patients.
Meanwhile, during August, the Bureau of Labor Statistics reported an 8.5 percent increase from July 2021 to July 2022 in the price of common consumer goods. As I write this, Medicare is projecting a 3.1% increase in the hospital market basket for 2023 (and using that figure as the basis for proposing an overall payment update of just 2.7 percent for ASCs and hospital outpatient departments in 2023), but several professional associations are saying that figure comes nowhere near the amount needed to cover the increased costs hospitals and other health care providers will need to absorb next year.
Cybersecurity
As individual health care entities continually update their systems to stay at least one step ahead of the newest security threats, the risks involved continue to escalate.
For example, in the first half of 2022, the Office for Civil Rights reported that health care organizations across the country posted 337 breaches of protected health information (PHI) affecting 500 or more individuals. Consistent with the past, unauthorized access or hacking caused the overwhelming majority of those breaches — 95 percent in the first half of 2022.
Meanwhile, a ransomware report in a mid-year update of the “SonicWall Cyber Threat Report” issued by California-based network security company SonicWall indicates that while ransomware attacks around the world in the first half of 2022 decreased from 2021 levels, they remained far above pre-pandemic levels. In addition, the health care industry saw a triple-digit increase of 328 percent. Kroll, a corporate consulting firm that manages cyber risks for its clients, recently reported a 90% increase in the number of health care organizations targeted by ransomware in Q2 2022 compared to Q1 levels.
An August 2022 article in The Hill raises concerns that countries like China, Russia, Iran and North Korea have been linked to significant cyberattacks over time or the ransom payments made in response.
Solutions
The list that follows is far from complete but provides a sample of solutions that have been proposed and the work needed to convert those plans into action.
Since concerns about shortages of physicians, nurses and skilled staff are nothing new, organizations like the American Nurses Association and the Association of American Medical Colleges already have proposed solutions for encouraging students to enroll in these career training programs. Their ideas deserve even greater attention and support today as need continues to intensify. We have also seen a proposal to encourage foreign citizens training for medical careers in the U.S. to remain in this country upon graduation. That plan would require congressional action to be put in place.
One of the proposals for building and sustaining a reliable supply chain is strong public-private partnerships that incorporate visibility, coordination, agility and trust. Others coming out of ASHP and the American Medical Association, the American Society of Anesthesiologists, the Association for Clinical Oncology and USP include:
- incentivizing the development of advanced manufacturing technology for critical drugs and active pharmaceutical ingredients;
- improving the function and composition of the Strategic National Stockpile (SNS);
- engaging pharmacists, physicians, other clinicians and supply chain experts to develop processes for maintaining and refreshing products in the SNS;
- incentivizing quality and resilience; and
- replicating requests for critical drug manufacturing transparency and oversight for medical devices and ancillary supplies, such as personal protective equipment.
In a letter sent to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra in August, Sen. Angus King (I-Maine) and Rep. Mike Gallagher (R-Wis.) urged the Biden Administration to scale up its investment in protecting the health care and public health sector from the growing number of cyber threats. A bipartisan bill introduced in Congress in March could help. The Healthcare Cybersecurity Act, co-sponsored by Sens. Jacky Rosen (D-Nev.) and Bill Cassidy (R-La.), would require that the Cybersecurity and Infrastructure Security Agency (CISA) collaborate with HHS to improve cybersecurity standards in the health care and public health sector. It would also require both agencies to share information with the private sector to increase cyber resilience.
If we act together now, we can eliminate these concerns and improve the care we offer our patients.
– Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association (ASCA).
