A judge affirmed a fine HHS issued last year over the Texas cancer center's use of unencrypted devices.
The University of Texas MD Anderson Cancer Center must pay more than $4.3 million in fines for its failure to guard the protected health information of tens of thousands of patients.
The institution had argued unsuccessfully that the fine is excessive, but a Health and Human Services administrative law judge (ALJ) affirmed the sum, which must be paid to the HHS Office for Civil Rights.
"We are pleased that the judge upheld our imposition of penalties because it underscores the risks entities take if they fail to implement effective safeguards, such as data encryption, when required to protect sensitive patient information," OCR Director Roger Severino said in a statement Monday.
This marks the fourth-largest amount awarded to the office by an HHS ALJ and only the second time the office has won summary judgment in a HIPAA proceeding, according to the HHS statement.
MD Anderson, which is based in Houston, was notified in March last year of the proposed fine, which stemmed from three breaches the institution reported to OCR in 2012 and 2013:
Unencrypted laptop stolen: Dr. Randall Millikan, a clinician and faculty member for MD Anderson, reported on May 1, 2012, that an unencrypted laptop he used to work from home had been stolen. The device contained the electronic protected health information of more than 29,000 people. The judge described Millikan as director of research informatics at MD Anderson's genitourinary center.
Unencrypted thumb drive lost: An unnamed summer intern in the Department of Stem Cell Transplantation and Cellular Therapy reportedly misplaced an unencrypted USB thumb drive on July 13, 2012. The device contained Microsoft Excel files with protected health information of more than 2,200 people.
Another unencrypted thumb drive lost: Dr. Marisa Gomes, a visiting researcher from Brazil working in MD Anderson's infectious disease department, notified her department on December 2, 2013, that she had lost track of an unencrypted USB thumb drive over Thanksgiving break. The device, which contained information on nearly 3,600 people, was reportedly last seen in her desk at work.
In a statement released Monday afternoon to HealthLeaders, MD Anderson said there is no evidence that any patient information was viewed by an unauthorized party in any of the three cases reviewed.
"We are disappointed by the ALJ’s ruling, and we are concerned that key exhibits and arguments were not considered. MD Anderson plans to appeal the ruling, which will result in a full review of all of the arguments and evidence," the institution said.
"Regardless of the ALJ’s decision, we hope this process brings transparency, accountability and consistency to the Office for Civil Rights' enforcement process," the MD Anderson statement added, reiterating the cancer center's commitment to patient privacy.
The regulations governing electronic protected health information do not specifically require encryption, but they do require that systems containing such information be inaccessible to those who are not authorized to access the information, according to Judge Steven T. Kessel's decision affirming the fine.
"Nothing in those regulations directs the use of specific devices or specific mechanisms by a covered entity. However, the bottom line is that whatever mechanisms an entity adopts must be effective," Kessel wrote.
What got MD Anderson in such deep trouble was its failure to implement the mechanism it had adopted. The cancer center decided in 2008 to encrypt its devices, including laptops and USB drives. But even in 2013, the institution had still yet to complete the project, Kessel wrote.
Kessel described the fine as "quite modest given the gravity of [MD Anderson]'s noncompliance."
These disruptors may make better allies than you realize.
This article appears in the May/June 2018 issue of HealthLeaders magazine.
When the formal announcement came in January that Amazon had begun assembling a team to fix healthcare's most vexing problems, the healthcare industry seemed to hold its breath.
The details of Amazon's plan were nowhere in sight—and they remain scant to this day—but its history of industry-morphing success and its deep-pocketed partners were enough to knock health stock prices down a notch and incite a barrage of speculation on how the company might lay waste to the status quo.
Then came Walmart. Not to be outflanked by its biggest online competitor, the retailer best known for its chain of superstores reportedly struck up preliminary talks to acquire insurer Humana. The news could foretell the combination of a pharmacy benefit manager (PBM), pharmacies, and insurance under a single corporate umbrella—an arrangement similar to major deals pending between traditional healthcare players as well.
The emergence of these two titans is no doubt unsettling to some healthcare incumbents. Walmart and Amazon have each revolutionized other industries: What's to keep either or both of them from turning healthcare on its head, dethroning the sector's traditional powerbrokers in the process?
But healthcare executives and industry analysts alike say greeting these disruptors with blanket resistance would be counterproductive, largely because hospitals and health systems seem to need what these retailers have to offer.
"This was bound to happen. When we can't disrupt ourselves, others are going to come in," says Christopher Cornue, MSHSA, FACHE, chief strategy and chief innovation officer for Navicent Health, which is based in Macon, Georgia, and licensed for 970 beds across all facilities.
"That doesn't mean that we need to panic or that healthcare systems need to be in a state where they're worried about their long-term viability," Cornue adds. "I think that in healthcare, we need to be focusing on what we know and what we can do really, really well and then partnering with some of these other organizations who have proven themselves very successful."
Even though Walmart, Amazon, and other companies eyeing healthcare from the outside are potential partners to traditional providers, they still pose a threat.
Brian Flanigan, MBA, who leads Deloitte's Value Based Care Integrated Offering, says healthcare leaders should be moving methodically but with urgency.
"I believe that inaction in this era of business model and technology disruption would be a grave mistake," Flanigan says.
Discern friend from foe
Business leaders often use the phrase "disruptive innovation" to describe the major shifts that have restructured their industries. But it can be a nebulous expression, especially when applied in anticipation of near-future trends.
That's why Navicent Health has opted to assess both "disruption" and "innovation" as distinct but interrelated concepts, Cornue says. Disruption is defined as any force—from outside or inside the organization—that can fundamentally change a business or clinical model.
"With that definition, what we're able to do is make sure that we are aligning our organization with what possibly may end up being a disruption, and we can end up disrupting ourselves as opposed to being disrupted," Cornue says.
To that end, Navicent Health launched its Center for Disruption & Innovation two-and-a-half years ago, with three primary objectives: to optimize and equalize healthcare delivery, to apply research that leads to disruptive innovation, and to develop and commercialize new products. The center is part of Navicent Health's effort to systematically identify and respond to incoming threats like those posed by Walmart
and Amazon.
"There's a focus on horizon- scanning, making sure that we know what's coming at us," Cornue says. "And when we know something is coming at us, we discern whether or not we partner with it or we come up with something that competes with it."
Provide care in nontraditional spaces
Health systems have been relatively successful in operating hospitals, though they have struggled in other settings, says John Matthews, KPMG Strategy leader for healthcare & life sciences. That's one of the areas in which partnering with a newcomer may help.
"I think that there's a real opportunity for a place like Walmart to start building healthcare delivery in lower-acuity settings that move beyond the kind of clinics inside the stores where you're basically doing flu shots … and relatively simple, straightforward stuff," Matthews says. "I think you could start moving to more of an urgent care model, where you start dealing with patients that have somewhat more complex but still basically primary care needs."
Walmart's accessibility and its rapport with a wide range of consumers, especially among aging populations, could make it a logical partner for some providers. It could even be helpful in developing chronic care models, Matthews says.
"Smart health systems could figure out ways to partner with a place like Walmart and Humana to build that," he adds. "I think other ones might feel a little bit threatened and see some patient volume siphoned off as a consequence."
Phyllis Simpson Sherard, PhD, chief strategy officer and vice president of population health and governmental affairs for Cheyenne Regional Medical Center, which is licensed for 222 beds, in Wyoming, says her organization would be open to discussing the possibility of partnering with Walmart, noting that the retailer enjoys major advantages in scale and purchasing power.
Though located in the state's capital and its biggest city, Cheyenne Regional serves a five-county area with significant rural and aging populations, Sherard says.
Patient care services seem poised to continue their industrywide shift from centralized medical centers to less expensive, more convenient outpatient care settings, putting particular pressure on hospitals in lower populated areas.
Even so, Cheyenne Regional, which has been serving the community in one form or another for more than 150 years, sees strategic partnerships as an indispensable survival tactic for the road ahead.
"We're proven innovators, and we have survived in large part because our mission has always been about taking care of this community," says Sherard.
"This really is the time to face that fear and adapt," she adds. "That adaptation starts with really knowing your system and knowing your sweet spot."
Sherard expresses a sense of confidence in Cheyenne Regional's future, though she acknowledges the organization may look and operate differently five years from now than it does today.
For consumers in the most rural areas, that future could include much more reliance on telemedicine for lower-acuity care in nontraditional virtual spaces, industry analysts say.
Make digital enhancements
While there has been a lot of talk about the extent to which telemedicine will change healthcare, it's important for providers to remember that a potential partnership with technology-focused firms could offer a competitive edge by bringing more subtle change behind the scenes.
"We've been, in healthcare, bedeviled for years about how to really do advanced data and analytics. In part, that's because of the fragmentation of the data sets we have,"
says Matthews, from KPMG. "It's really hard for EMRs to talk to PBM data in the pharmacy, and that's really hard to talk to claims data, and that's really hard to sync up with
consumer data."
If any company has proven its mettle in harnessing the power of data, it's Amazon and perhaps a few of its peers, including Apple and Google. These tech giants specialize in reducing friction, says Rich Roth, chief strategic innovation officer at Dignity Health, which is based in San Francisco and operates 39 hospitals and more than 400 care centers across three states.
"When these organizations lean in, we want to be part of it," Roth adds.
Apple announced an initiative in January that relies on the iPhone as a tool to give patients control of their medical files, synthesizing disparate documentation from multiple providers into a centralized location: the consumer's own palm. Dignity Health was among 39 health systems that began using Apple Health Records in March.
While Apple is banking on the iPhone, another company might push healthcare innovation around its own signature product, such as a search bar or smart speaker. Whatever the next big thing in the development pipeline is, you should seek to be part of it sooner rather than later, Roth says.
"I think when these systems are designing and prototyping these types of things, you want to be involved," he says. "Ultimately, if you're not involved, you don't have a chance to partner and influence."
Differentiate your brand
Nashville-based Vanderbilt University Medical Center, which also was among the systems to pilot Apple Health Records, has used Amazon for web services and partnered with Verily, a research organization owned by Google parent company Alphabet Inc., says William W. Stead, MD, chief strategy officer for VUMC, which is licensed for more than 1,000 beds across its adult, psychiatric, and children's hospitals.
The key to determining whether to enter into each of these partnerships is understanding your own organization, Stead says.
"We really try not to build anything unless we're, for some reason, uniquely suited to do it. We're wired to get everything else we can through partnerships," he says. "Real partnerships take a great deal of work because both parties, in essence, have to take the time to get inside each other's head and figure out what they can do together [that] they cannot do equally well on their own."
Differentiating the Vanderbilt brand and building on its well-respected academic ties have enabled VUMC to both conduct large-scale pragmatic trials and build its business-to-business operations, says Stead.
Hospital systems that have established themselves as recognized destinations are well-positioned for the changes to come, says Vaughn Kauffman, U.S. Health Services and New Entrants Advisory Leader at PwC. "There's a differentiation there that's well-understood. I think their opportunity is to continue to say, 'How do I expand access and reach?' '' he says.
This brand differentiation is vital for providers seeking to partner with household names like Walmart and Amazon without losing relevancy to consumers.
Coupling a strong provider brand with that of a major retailer could be a hallmark of the most successful nontraditional partnerships moving forward, says Matthew A. Gibson, PhD, MSHA, MBA, FACHE, senior vice president and chief strategy officer for Chattanooga-based Erlanger Health System, which has 813 acute care beds.
"I think the best partnerships are going to center on co-branded products, or co-branding, facing to the market, so both organizations get that recognition," Gibson says.
"Some may say, 'Nope, I insist on my brand only,' " he adds. "That feels like that's a losing proposition with these national companies."
Gibson advises his fellow healthcare leaders to pursue partnerships at "a measured pace," though, carefully weighing what Walmart, Amazon, and others have to offer.
"As aggressively and constantly as you can, do your due diligence," he says. "Study from a variety of sources what these different new entrants are doing. Study their
history in other industries and in other aspects of healthcare."
"Don't feel obligated because of the rapid pace of entry of these companies," Gibson adds. "Don't necessarily feel obligated to do something reactionary and, for instance, abdicate your own position as a health system in your state or region or abdicate the leverage that you do have regarding your brand."
Embrace healthcare's consumerization
In pondering potential partnerships, it's important to recognize that retail giants are also themselves major employers. And employers are already in the healthcare business to some extent on behalf of their workers, says Jacques Mulder, MBA, U.S. Health Sector Leader at EY.
Since employers have a vested interest in both keeping their workers healthy and minimizing wasteful spending through employer-sponsored health plans, they make natural partners for some value-based care initiatives—such as Walmart's recent partnership with Emory Healthcare to establish an accountable care plan for Walmart's Atlanta-area workers.
In a statement announcing the partnership, Emory Healthcare Network CEO Patrick Hammond praised Walmart as "a progressive company dedicated to transforming health care and its delivery process" and noted that large self-insured employers are increasingly looking for ways to cut costs while boosting care quality for employees.
This shift toward value-based care is much deeper than any rubric of quality metrics a payer may use to modulate reimbursement rates. It's tangled up with a movement toward consumer-centric healthcare, which calls for treating patients like customers, earning their repeat business the way retailers do.
"These new entries into the market, quite frankly, are forcing us to either change and to become much more consumer-savvy or—at least in my professional opinion—many of us will not survive," says Donald H. Lloyd II, president and CEO of CHRISTUS St. Patrick Health System, based in Lake Charles, Louisiana, and licensed for 277 beds.
About three years ago, Lloyd says, he began noticing a shift in local consumer expectations. While patients continued to value quality care, they also seemed to be growing more insistent that the care be administered with efficiency,
accessibility, and convenience.
"Whether it's in a clinic setting or whether it's in an inpatient setting, consumers have extremely low tolerance for delayed or slow service delivery, and they will not hesitate to stand up, walk out of a space, and walk across the street to a competitor," Lloyd says.
His team has since conducted extensive market research to better understand what patients want.
"We did not want to get left behind, so we began rethinking our strategy and using focus groups, and, quite frankly, we spent an awful lot of time talking to consumers out there about how they make choices and what their expectations were," he says.
As a result, the overwhelming majority of the system's primary care practices accept walk-ins, operate with extended hours, and pursue what Lloyd calls a "high-touch, high-feel" service delivery model.
How well healthcare organizations adapt the retail tactics of Walmart and Amazon to suit patient care needs and expectations will likely play a significant factor in determining which hospitals and health systems survive and thrive through the possible disruption to come.
The administration included a variety of medical supplies in a list of Chinese goods subject to a 25% tariff beginning next month.
A tariff on Chinese goods announced late last week by the Trump administration is expected to add financial pressure on the U.S. healthcare industry.
The list of goods subject to the 25% tariff beginning early next month includes a variety of components for sterilization and medical imaging equipment. A second, shorter list of Chinese goods will undergo further review before potentially being made subject to the tariff.
U.S. Trade Representative Robert E. Lighthizer said the move is a defensive tactic to protect Americans against intellectual property theft and other marketplace malfeasance. But some in the U.S. healthcare sector worry the move will harm their enterprises.
"We know the added cost of the tariff will be passed on to healthcare providers," said Blair Childs, senior vice president of public affairs for Premier, in a statement Friday.
The tariffs are "an assault on an industry that is already facing dire financial strains," Childs said, citing margins at their lowest point in the past decade.
"Increased supply costs will apply additional fiscal pressures on hospitals' already strained budgets during a time in which they are making critical long-term investments in care improvements," Childs added. "It's a step backward in our nation's efforts to curb healthcare costs and spending."
First list: The first list of products includes 818 line items covering about $34 billion worth of Chinese imports, according to the Office of the U.S. Trade Representative. The added 25% tariff on these products will take effect July 6.
Second list: The second list of products includes 284 products for which tariffs have been proposed covering about $16 billion worth of Chinese imports. These items will undergo a public notice and comment process, with a public hearing, before a determination is made on whether the tariffs will be implemented.
Exemptions possible: The USTR noted that it will "soon" provide a way for U.S. companies to request exemptions for particular products that would otherwise be subject to the new tariff. That avenue will be noted in the Federal Register in the coming weeks.
The two lists of items were compiled, based on "extensive interagency analysis," to target certain sectors of Chinese industry, including aerospace, information and communications technology, and more. The lists exclude common consumer goods, such as cellphones and TVs.
China said it would respond to the U.S. with tariffs of its own next month, striking American agricultural products, cars, and seafood, as CNN Money reported. China warned that additional tariffs on American medical equipment, chemical products, and energy products will follow, as The New York Times reported.
A two-week détente ended Friday, with medical staff deciding to oppose the reinstatement of three committees amid talks about system leadership.
A tense relationship still simmers between physicians and system leaders at CHI St. Alexius Health in North Dakota, where long-term talks have failed to produce an agreement on how the organization should be managed.
It's been a month since a group of doctors in Bismarck resigned in protest from their committee roles, calling for the ouster of four regional leaders. They also sought to have their regional leadership office moved about 200 miles, from Fargo to Bismarck.
The system said in a statement June 1 that the medical staff had decided to reinstate three committees while talks were underway. That two-week détente ended Friday, however, when the parties failed to reach a compromise.
"Leadership has worked hard and in good faith to find common ground and accommodation with the medical staff. We have the utmost respect for our physicians and have made efforts to compromise," CHI St. Alexius Health said in a statement Friday afternoon. "However, we understand that a difference of opinion continues to exist but we believe that it is not insurmountable and will continue to confer with physician leaders to find a path forward."
This impasse persists despite a tweak to the system's chain of command. Rather than reporting to the Fargo office, the facilities in Bismarck, Garrison, and Turtle Lake began reporting this week to CHI's Nebraska division overseen by Cliff Robertson, MD, MBA, according to the system's announcement. This arrangement was described as indefinite but interim.
Tony Jones, interim executive vice president and chief operating officer for CHI, also told physicians earlier this week that leaders had decided "after careful review" to keep the North Dakota division offices in Fargo.
The three physician leadership panels affected are the medical executive, peer review, and credentials committees.
Charles Allen, DO, FACOEP, FACEP, an emergency physician who had been serving as president of the medical executive committee, told HealthLeaders Media in an email that he considers the dispute at hand to be "an internal issue" that he never intended to be brought to the attention of news media.
"I will say the issue is not about power and control, but of leadership, vision and trust," Allen wrote. He did not respond to follow-up questions.
Noting its disappointment in the medical staff's decision, CHI St. Alexius Health suggested that the current disagreement may be best understood in a broader context that accounts for the pressures plaguing providers nationwide.
"The entire industry has had to reevaluate how it cares for patients, how patients want to be cared for and how it does business," the statement said. "We need a way forward for CHI St. Alexius Health, for the community, for our patients and for our employees—and for our physicians."
Some who have disagreed with each other in past ACA litigation argue the Trump administration's legal stance is 'exactly backward.'
In the week since the Trump administration said it would quit defending key provisions of the Affordable Care Act, a diverse chorus of legal analysts and healthcare industry stakeholders have spoken out in opposition.
The outcry from law professors, doctors, insurers, and hospitals alike comes as 17 Democratic state attorneys general challenge the Department of Justice's decision in a federal lawsuit brought in February by 20 Republican state attorneys general.
The lawsuit argues that Congress rendered the entire ACA unconstitutional when it zeroed out the individual mandate's financial penalty. The DOJ's response counters that only the individual mandate and two other clauses—the community-rating and guaranteed-issue provisions, which include protections for beneficiaries with preexisting conditions—were affected by the tax reform.
But some legal scholars who have disagreed with each other in past ACA litigation argued in a joint amicus brief Thursday that the DOJ's stance on severability is "exactly backward."
"If courts invalidate an entire law merely because Congress eliminates or revises one part, as happened here, that may well inhibit necessary reform of federal legislation in the future by turning it into an 'all or nothing' proposition," five law professors wrote, urging the court to consider the constitutionality of the individual mandate separately from every other ACA clause.
Several other stakeholder groups filed briefs of their own:
Health plans: "[The] plaintiffs seek to turn off the health insurance system as we know it with the flip of a switch. The ACA's scale and scope make that impossible," America's Health Insurance Plans wrote, calling on the judge to deny pending requests for a court order to halt the ACA's enforcement.
Physicians: "Invalidating the guaranteed-issue and community rating provisions—or the entire ACA—would have a devastating impact on doctors, patients, and the American health care system as a whole," the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Child and Adolescent Psychiatry wrote.
Hospitals: "Plaintiffs should not be allowed to get through this Court—repeal of the entire ACA through the backdoor of severability—what they could not get through Congress," the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association, and the Association of American Medical Colleges wrote. "And make no mistake: This case is but one of a multi-front battle that Plaintiffs are waging against the ACA. If the Plaintiffs are unhappy with the ACA, their remedy lies with the political branches, not this Court."
R. Lawrence Moss plans to bring his relational leadership style along with him when he moves this fall to Nemours from his current role as surgeon-in-chief at Nationwide.
The newly named top executive for Nemours Children's Health System, based in Jacksonville, Florida, says he plans to step into the job this fall with an open mind.
R. Lawrence Moss, MD, who has spent the past seven years as surgeon-in-chief for Nationwide Children's Hospital in Columbus, Ohio, says his top priority when he arrives for his first day at Nemours will be to listen and learn from the all-star team already in place, rather than showing up with an overly prescriptive strategy of his own.
Moss—who will take over October 1 for current President and CEO David Bailey, MD, who is retiring after more than two decades with the system and 12 years at its helm, as Nemours announced last week—tells HealthLeaders Media that his relational approach to empowering a team has worked well in the past and that he's excited to steer Nemours into the next stage of its legacy.
The following Q&A has been lightly edited for length and clarity.
HLM: Let's face it. You've got some pretty big shoes to fill. How should we expect you to compare to your predecessor? Do you expect to continue the trajectory Nemours is on?
Moss: I couldn't agree with you more about Dr. David Bailey. He has done a spectacular job, and it's not an exaggeration to say that he's been kind of one of my heroes in pediatric healthcare. Over the years, I've watched what he's done and watched his approach to complicated issues, and it's been very impressive.
My view of what Dr. Bailey and Nemours has accomplished over the past 13 years is that they've grown into a very significant member of the upper tier of pediatric healthcare institutions. The growth has been steady. It's been impressive. It's been geographically and culturally diverse. And my impression is that what the team has done has given the organization the opportunity to really make a quantum jump into the elite institutions in children's healthcare.
Not only would my goal be to continue this trajectory. It would be to even build on and accelerate the growth, and I think that we can do some very special things as a multi-state multi-site pediatric health system, which puts us in unique territory.
HLM: When you say "accelerate," are you speaking to merger and acquisition strategies, growing in footprint and number of facilities?
Moss: To be clear, I haven't worked one day for Nemours yet, so the first thing I need to do for many months is to listen and learn from the associates about the organization, so I'm not coming in with specific operational objectives. I'm coming in with an overwhelmingly strong commitment to excellence, to academic success, and to making a real impact on the way that America looks at children's healthcare.
HLM: Moving from surgeon-in-chief to CEO will be a pretty significant change in terms of focusing not just on the clinical side but now really specializing in organizational strategy and finance. How do you plan to go about making that transition? What preparation have you gone through so far?
Moss: That's a good question. I guess I would suggest to you that it may not be quite as big of a transition as it might seem from afar.
I've been really blessed to have a multitude of opportunities and responsibilities at Nationwide Children's which have given me solid grounding in strategy and financial management and in operations. I give a huge amount of credit to my colleagues at my current institution that have taught me a great deal.
I don't think it's a huge stretch, and I think my approach to the transition of the increasing responsibility is to listen and learn. I'm very fortunate to be coming into a role where the senior executive team at Nemours is accomplished, they're talented, and they're wonderful people. I expect that they will teach me a lot, and I will learn and adapt to the role.
HLM: Which of those experiences at Nationwide do you see as most significant, most preparatory for your coming work as CEO?
Moss: I would say what's been most meaningful and impactful to me is my personal relationship with my colleagues. I would highlight that the department chairs who report to me are an outstanding group of people, and I've learned a great deal from those relationships.
The senior management team here at Nationwide is an outstanding group of accomplished professionals, and I've learned from every one of them. I'm a relationship guy. I've derived the most benefit from this experience from my relationships here.
HLM: How do you go about translating that to a new organization with a new set of people?
Moss: I think you listen and you learn, and you find out what makes those people tick, what they care about, what I can do to help them succeed.
If everybody on that senior management team at Nemours achieves their goals, we'll be in pretty good shape. My job is fundamentally to help all of those individuals achieve their goal.
HLM: What about you personally? When you talk about what makes people tick, I would imagine that someone with the work history that you've had might miss being able to perform surgeries. I'm guessing as CEO you will not be performing any surgeries.
Moss: I won't. And that was not an easy decision but the right decision for many reasons. What has always made me tick is helping kids. Whether it was the beginning of my career operating on one patient at a time, to a research program that could impact patients I'd never meet, to an educational program that would impact other docs who would continue to take care of those patients for generations, all the way up to running health systems, the core motivation is the same.
I think I would not just speak for myself but probably for the 8,000-plus associates at Nemours: That's why we get out of bed every day. I look at this job as just an even greater opportunity to help a lot of kids.
HLM: Whenever I speak with healthcare executives today, they typically tell me that this is not a fun time to be doing healthcare in terms of finances. So what's your plan to keep Nemours on solid financial footing?
Moss: I'll strongly disagree with you. I think this is the absolute best time in history to be doing this, a job like this. The core reason why I believe that is I think the country is finally ready to start looking at a system that actually pays for health instead of pays for volume of disease treatment, and that will be just a wonderful step forward for kids and for the entire country.
To be able to be at an institution that will be on the leading edge of that kind of change is just a dream come true for me. I couldn't be happier to be doing this job at this time.
HLM: It's my understanding that with nonprofit systems, especially, most of the revenue is still coming from the fee-for-service side, so there's some pain in making that transition, even if it's beneficial. Would you agree?
Moss: I'm going to shy away from the word "pain" because it's a positive transition. It's better for patients. It's better for doctors. It's better for the country's economy, and no transition is ever easier. But the end point is very exciting, and I'm very enthusiastic about it.
Any bumps in the road we have getting there are just bumps in the road on the way to something great.
HLM: Is there anything else you'd like to share with our readers?
Moss: I guess I'll come back and emphasize one more time that I think right now is an absolutely spectacular time in American healthcare, and we have the opportunity to make the kind of changes that we've never had before in history.
What attracts me most to Nemours is that the organization is poised to truly be a leader in defining what a children's health system is in American society and what we can do for kids in the coming generations. And that is very exciting to me.
A mammogram and other imaging services were performed on the wrong patients earlier this year, and one patient underwent surgery on the wrong part of the spine.
Providence-based Rhode Island Hospital reached an agreement with the state after four patients were subjected to incorrect tests and procedures in four different mix-ups within a month.
The hospital agreed to invest no less than $1 million in remediation efforts to improve its patient identification and verification systems and procedures, and the state's Department of Health agreed to forgo any regulatory action for the four incidents.
This case demonstrates how misidentifying patients can carry significant financial ramifications for hospitals and health systems, even when the errors do not appear to cause medical complications in the patients affected.
In a statement, the hospital said it began implementing its plan of correction immediately after identifying the incidents and has "dedicated thousands of staff hoursand committed other resources to this matter" in recent weeks, noting that 685 active doctors, nurses, technicians, and other staff members from the radiology department have participated in a forum to improve care.
"Rhode Island Hospital is committed to adhering to all the requirements established by the Department of Health to help prevent errors in the future and will continue to work closely with the Rhode Island Department of Health on this matter," the statement said. "Mandatory audits of processes will also be implemented to ensure that changes become permanent solutions."
February 21: A patient underwent a computed tomography angiography (CTA) scan of the brain and neck that had been intended for a different patient.
February 26: A patient who was not correctly identified underwent an angiogram intended for a different patient.
March 12: A patient underwent surgery on the wrong part of the spine.
March 16: A patient underwent a mammogram intended for a different patient.
Regulators conducted an unannounced survey then issued states of deficiency on March 29, according to the consent agreement.
In addition to the $1 million investment, the agreement requires the hospital to request written recommendations from The Joint Commission's Office of Quality and Patient Safety on how to prevent problems like those that led to the four incidents outlined above. The agreement, which lasts for one year, also requires the hospital to hire an independent compliance contractor.
"While Rhode Island Hospital is a national leader in patient safety and quality, we are not perfect," Rhode Island Hospital President Margaret M. Van Bree wrote in a memo to staff, as the Providence Journal reported. "When mistakes occur, we must acknowledge them and act immediately to improve care."
The agreement was announced Friday, as the Journal reported.
The federal government is siding with conservative states in a challenge of the Obama administration's signature healthcare law.
In perhaps its biggest move yet to axe the Affordable Care Act, the Trump administration has announced that it will not defend key provisions of the Obama-era healthcare law against a legal challenge.
Weighing in on a lawsuit brought by 20 conservative states, the U.S. Department of Justice urged a federal judge Thursday evening to find two of the ACA's provisions unconstitutional on the basis that they are inextricably linked to the law's individual mandate.
Although the Supreme Court declared the mandate constitutional in 2012, it did so on the basis that the mandate qualifies as a tax. Since lawmakers passed a tax reform package late last year that zeroed out the mandate's financial penalty effective January 1, 2019, it will no longer be accurate next year to describe the mandate as a tax, rendering the provision unconstitutional, the DOJ argued.
Additionally, the DOJ's filing argued that the individual mandate cannot be severed from the ACA's community-rating and guaranteed-issue provisions. Among other things, these provisions protect beneficiaries with preexisting conditions from being locked out of coverage.
"This question of statutory interpretation does not involve the ACA's constitutionality and therefore does not implicate the Department's general practice of defending the constitutionality of federal law," Attorney General Jeff Sessions wrote in a letter Thursday to House Speaker Paul Ryan. "Outside of these two provisions of the ACA, the Department will continue to argue that [the individual mandate] is severable from the remaining provisions of the ACA."
Obama's team shocked: Andy Slavitt, who ran the Centers for Medicare & Medicaid Services during the previous administration, described the DOJ's filing as the "biggest health care news of the year."
Three attorneys quit: Shortly before the DOJ's filing, three career DOJ attorneys quit the case. They were replaced by two political appointees, as the Associated Press reported.
Legal scholars dubious: Jonathan H. Adler, director of the Center for Business Law & Regulation at Case Western Reserve University School of Law in Cleveland—who has argued in past years that the ACA's implementation overstepped its legal authority—took issue with the DOJ's argument. "The problem with the Trump Administration's response to the latest ACA suit is not its refusal to defend the mandate so much as its adoption of problematic (and quite cynical) approach to severability," Adler wrote in a tweet. "No matter how one conceives of severability doctrine, the underlying premise here is absurd," he added.
Legal scholars taken aback: Nicholas Bagley, who teaches health law at the University of Michigan, wrote that he was astounded by the DOJ's abandonment of a longstanding and bipartisan commitment to defending the law when arguments can be made that aren't frivolous. "I am at a loss for words to explain how big of a deal this is," he wrote, arguing that this case is substantially different from the Obama administration's decision in 2011 to quit defending the Defense of Marriage Act.
Not so fast: "To be clear, the ACA remains intact, and will remain intact for the foreseeable future. This case is not going anywhere fast, and the likelihood that the Supreme Court endorses this travesty of an argument is slim," Bagley wrote in a tweet.
Liberal states file challenge: Sixteen state attorneys general, led by California's Xavier Becerra, announced Thursday a challenge to the plaintiffs seeking to undo the ACA. "The lawsuit initiated by Texas is dangerous and reckless and would destroy the ACA as we know it. It would leave millions of Americans without access to affordable, quality healthcare. It is irresponsible and puts politics ahead of working families," Becerra said in a statement.
Potential consumer impact: The Kaiser Family Foundation estimated in 2016 that 27% of American adults under age 65 have health conditions "that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states." Many in this group have insurance through work, so they wouldn't automatically lose access to coverage, the KFF noted.
Politico's Renuka Rayasam noted that the DOJ is asking the judge to dismantle two of the ACA's most popular provisions—but to wait until after the midtermsthis fall to do so.
'I never understood why it was hard,' the president said during a signing ceremony Wednesday at the White House.
Patients with life-threatening illnesses will have more leeway to undergo treatments that have not yet received final approval from the Food & Drug Administration, thanks to a signature Wednesday by President Donald Trump.
As expected, Trump signed the "Right-to-Try" bill, which Congress approved last week, despite concerns raised by critics who argued bypassing the FDA could make it easier for fraudsters peddling unproven remedies to take advantage of vulnerable patients.
"We worked hard on this. I never understood why it was hard. They've been trying to have it passed for years," Trump said during a signing ceremony at the White House.
Proponents of the measure have argued the slow-moving bureaucracy of the FDA approval processes can inappropriately impede an individual patient's ability to access potentially life-saving experimental treatment.
A great name: "In my State of the Union address four months ago, I called on Congress to pass 'Right-to-Try.' It's such a great name," Trump said. "Some bills, they don't have a good name, OK? They really don't. But this is such a great name. From the first day I heard it, it's so perfect: Right. To. Try. And a lot of that trying is going to be successful. I really believe that. I really believe it."
Bipartisan backing: Vice President Mike Pence, who introduced Trump for Wednesday's ceremony, praised members from both major political parties for backing the measure. "This is how Congress should work to advance the interests of the American people," Pence said. When the House voted 250-169 in favor of the bill last week, 22 Democrats voted with the majority. All 169 who opposed it were Democrats.
Commitment from FDA: "This new law amends the Federal Food, Drug, and Cosmetic Act to establish a new pathway aimed at increasing access to unapproved, investigational treatments for patients diagnosed with life-threatening diseases or conditions who have exhausted approved treatment options and who are unable to participate in a clinical trial," FDA Commissioner Scott Gottlieb, MD, said in a statement. "Our implementation of the Right to Try Act will build on our long-standing efforts to help patients and families who are facing life-threatening diseases or conditions, in a way that seeks to protect their autonomy, their safety, and the safety of others following in their paths.
Although some proposals had applied only to "terminally ill" patients, this version applies to those who have been "diagnosed with a life-threatening disease or condition."
Editor's note: This story was updated to include a statement from FDA Commissioner Scott Gottlieb.
Virginia seems poised to pass the measure, while Utah and Idaho gear up for votes. Don't count Nebraska out just yet.
Three of the four initiatives currently underway to expand Medicaid coverage have shown recent signs of progress, and the fourth still has time to pull through.
If the push for expansion proves successful in all four states, more than 600,000 people could be added to the jointly funded state-federal program.
Furthermore, if all four initiatives succeed, that would leave just 14 states having declined to expand Medicaid as authorized by the Affordable Care Act, according to a tally compiled by the Kaiser Family Foundation.
Here's an overview of where the four initiatives stand:
Virginia: Add to hospital taxes?
State senators are expected to consider a package of proposed budget amendments Wednesday that includes Medicaid expansion, according to the Richmond Times-Dispatch. The expansion would be funded by billions of dollars in funding from the federal government and two new taxes on hospital revenues.
Expansion in the state could add more than 300,000 residents to the Medicaid program, as the Times-Dispatch reported.
Utah: To the ballot box.
The state's top election official, Lt. Gov. Spencer Cox, announced Tuesday that a push to expand Medicaid secured enough petition signatures to qualify as a ballot initiative during the election this fall, as The Salt Lake Tribune reported.
Expanding the program in Utah could add 150,000 people to Medicaid, as the Tribune reported.
Idaho: To the ballot box?
A proposed ballot initiative in Idaho appears to have secured enough signatures to qualify, but supporters are still waiting for official word, as Public News Service reported.
Expansion would add about 62,000 Idahoans to the Medicaid program, as PNS reported.
Nebraska: Don't count us out.
Proponents of expansion in Nebraska have until July to gather enough signatures for a ballot initiative of their own, as The World-Herald reported. The measure could affect about 90,000 potential beneficiaries in the state.
Gov. Pete Ricketts, a Republican, has opposed the initiative in no uncertain terms: "Expanding Medicaid in Nebraska is a risky proposition for taxpayers not only because of the expense but also because we cannot trust the Federal Government’s long-term financial commitment to state programs."
Editor's note: A previous version of this story misstated the number of states that would be left having not expanded Medicaid if the four initiatives described above all succeed.