MRCS Weekly Recap 1 (1.30.22 - 2.5.22)

Staying up to date on the latest healthcare news can be daunting. We at Medical Revenue Cycle Specialists hope to alleviate this pain for you in our weekly blog. We will touch on a few of the most pressing issues and trends in the healthcare space to keep you updated!

1. COVID

To put the Omicron variant in perspective, in the ten weeks since Omicron was discovered, there have been 90 million cases - more than in all of 2020! Despite President Biden's pledge to reevaluate COVID-19 protocols in prisons, many cases are from prisons. It has been over two years since this promise, and COVID-19 is still raging through the nation's prisons. Almost 3,000 incarcerated people have died and are three times more likely to die from the virus than the general population.

Last week, the FDA announced that it plans to authorize vaccines for children 6 months to 4 years old. Many experts are questioning whether this is an innovative and safe idea. On a similar note, Moderna won full approval for its COVID-19 vaccine, Spikevax. New data shows that booster vaccines effectively protect against the 'spin-off' of Omicron. A UK agency estimated that for those who are up-to-date with their vaccinations and have received the booster shot, vaccine effectiveness against the symptomatic disease was 63% against BA.1 (Omicron) versus 70% for BA.2 (Omicron "sister" variant).

While COVID-19 has been detrimental to many health practices, this is not the case for the Cleveland Clinic. The medical giant reported its most robust financial performance in 2021, with operating income at $746 million (three times more than in 2020). A large portion of this was due to the "massive number of COVID-19 patients," many of whom are unvaccinated, contributing to being sicker and requiring more complex care.

2. Practice Management Updates

In 2021 we could turn on any news channel, and more often than not, there was a headline featuring "COVID-19," "vaccines," "staffing shortage," or "mental health." Med City News released 2022's top four healthcare terms that you will hear more about this year. This includes "chronic care management," "payviders," "delegated entities," and "clinician satisfaction." Because of new technology, chronic care management improves collaboration for these complex populations. "Payviders" are the latest models integrating payers and providers to control healthcare risk and quality. Delegated entities are the organizations that many state Medicaid programs turn to take on the risk for high-need populations. Finally, clinician satisfaction draws on the increasing physician burnout and staffing shortages.

Last week, Healthcare Dive released its expected trends for 2022. This includes 1) staffing challenges with a tightening labor market. 2) The pandemic disrupted volume trends leaving patient traffic below pre-pandemic levels, posing a considerable risk to payers. 3) Mental telehealth services are becoming more popular as they provide accessible and inexpensive therapy treatments. 4) The increasing use of travel agencies. There has been increasing turnover, widespread burnout, and staff members calling in sick, forcing staffing agencies to drive up wages with nurses are being lured away. This has led some legislators to attempt to cap the rate hospitals pay agencies for temporary nursing staff. From January 2020 to this past January, travel nurses' rates have jumped 67%. The AHA and Nursing home lobbies claim staffing agencies exploit the shortages by charging unfairly high prices in a coordinated way. On the other hand, the staffing agencies argue that while pay has risen exponentially, so have the job demands.

The modern hospital will not be the same in 10 years. Patients will rely solely on EHRs, and payers will need to shift to value-based care. Doctors will need to learn/relearn how to handle patients at the hospital provide care at home and through telehealth. Digitization can help with this and address staffing issues and provider burnout. Attaining front-line staff support with a digital assistant can help healthcare managers rethink their systems and align digital solutions with their staff's needs. In addition, caring for seniors has never been harder for physicians. They are being asked to coordinate with post-acute, community-based organizations and payers frequently. Med City News Believes that these 3 strategies will help with caring for seniors. 1) connect with post-acute and home-based providers, 2) install at-home analytics tools, and 3) get care transitions right.

Low health literacy costs health employers up to $236 billion annually. Personal health literacy is how individuals can find, understand, and use the information to inform health-related decisions for themselves and others. It is estimated that more than one in three Americans have low health literacy, disproportionately affecting older adults, minority groups, and lower socioeconomic status individuals.

3. Health IT Updates

The healthcare industry has faced a considerable range of threats throughout 2021. And with healthcare data breaches occurring nearly twice a day, the importance of cybersecurity continues to grow. Here are 4 cyberattack trends the HHS' Cybersecurity Coordination Center (HC3) are warning healthcare organizations about in 2022.

Ransomware: There have been significantly increased efforts to bring down ransomware operations in the US and Europe. The threat posed by these operations has even spurred the greatest of enemies to work together. This year the United States and Russia took down 14 members of the REvil ransomware organization in a joint operation. However, despite the increased pressure on these organizations, there are still at least 68 active operations, with the top ten netting over $5.2 billion in payments.

Apache Log4j: In late November 2021, the Apache Log4j logging library vulnerabilities were made public. Since then, multiple attacks have exploited these vulnerabilities. With these exploits becoming a growing threat, HC3 released a brief on January 20th to help bring more attention to this issue and mitigate the risk of attack.

Emotet Botnet: Since Emotet malware first surfaced in 2014, it has been used extensively in cyberattacks on healthcare organizations. Emotet malware works by adding infected devices to a botnet, allowing other cyberthreat groups to access the device. Luckily, the botnet was taken down in January 2021. However, there are indications that the botnet is being rebuilt with even greater resilience and new capabilities. Emotet malware is typically distributed through phishing emails, so it will be crucial for healthcare organizations to implement email security measures.

Vulnerabilities: Patching and updating software are the best ways to improve your cybersecurity. Patches and updates fix vulnerabilities and close backdoors. The Cybersecurity and Infrastructure Security Agency's (CISA) Exploited Vulnerabilities Catalog is here.

There are many vulnerabilities within the healthcare tech field, but there are also many opportunities. AI technology has emerged as a promising solution to many issues such as detecting illnesses, enhancing patient engagement, automating clinical and administrative workstreams, etc. However, implementing and ensuring the safety of AI is no easy task. Healthcare boards need to create a framework for governance oversight regarding new AI technology. AI is changing with the health market, and boards need to act now to maximize what AI and machine learning offer.

4. Policy Updates

ARPA-H: The Biden Administration recently founded ARPA-H, a new research agency to advance biomedical research. The controversy is that ARPA-H will not be housed within the NIH but rather will exist as a distinct unit within the HHS.

CURES: The antibiotic market is "an ecosystem that is fragile, failing, and dying." However, two representatives (with bipartisan support) are creating '21st Century Cures 2.0' to make an initial $11 billion fund for antibiotic purchases. This lays out a plan for evaluating what types of infectious diseases need new treatments and the standards to qualify. The current requirements favor chemically distinct drugs from anything in the past or represent new treatments.

Surprise Act: Smaller and third-party physician groups are most exposed to the surprise billing laws. Yet, the top lobbying groups and hospitals are suing the federal government over the ban's adoption. This has puzzled many legal experts. Katie Keith, a lawyer and health policy expert at Georgetown University, said, "I don't understand why hospitals would be pushing so hard. It doesn't affect most of them." Even though surprise bills are 'rare' for the Children's Hospital Association, they stand with other medical trade associations (AHA and AMA) in opposition to the Act. They are suing the HHS over the same issue. All have agreed that relying on the qualifying payment amount is unfair because it sides with the insurers. This law affects smaller physician groups much more than more prominent hospital associations. Still, these associations are fighting for cause because of how this will affect the industry.


5. Pharma Predictions

Reuters recently released an industry predictions report for pharma from 2022-2027. Here are a few of the common themes.

A) Hybrid Work Environments: COVID changed our commercial organizations, but we will not be fully remote or digital. While in-person is still preferred by many, a segment of the population is more open to telehealth. There will be more face-to-face interactions but still a large portion of online engagement. This is just the tip of the iceberg for how quickly the landscape can evolve. There needs to be adaptive planning to "get back to normal" due to the resurgence of new COVID variants.

B) Patient Centricity: Pharma companies need to think beyond the traditional physician stakeholder to stay relevant. With the expansion of remote care, personalized medicine, and holistic approaches to care, patients are now considered "pharma partners." R&D will be decentralized, requiring patient experience data to enhance engagement further. Patient-informed R&D, patient-generated health data, and value-based customer relationships are "the new norm."

C) Artificial Intelligence: We will continue to see an increase in the use of AI to create more efficiency in care management, coordination, and communication. AI will expand beyond wearables to monitor disease progression. Technologies at home will measure and monitor signs of disease and alert/recommend timely and appropriate interventions. Mark Montgomery, the Head of Business Insights & Execution at Novartis, said, "with the advancements in the connected digital ecosystem, data integration and applied AI/ML, the pharmaceutical industry will continue to become more agile in its approach to patient-centric collaboration to accelerate positive outcomes."

D) Equity and inclusion: Pharma needs to view patients as individuals and treat them in their ecosystem with personalized approaches. Pharma will focus on the social, behavioral, and cognitive components of health and diseases' biological and genetic features. Pharma needs to ensure that the voices align with the most heavily impacted stakeholders.

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