/ en Fri, 25 Apr 2025 17:21:44 -0500 Mon, 09 Dec 24 12:30:00 -0600 /standardsguidelines/2020-10-15-patient-billing-guidelines <div class="container"><div class="row"><div class="col-md-8"><h2>Patient Billing Guidelines</h2><h3>Approved by AHA Board of Trustees</h3><h3>April 20, 2020</h3><p><em>The mission of each and every hospital is to serve the health care needs of its community 24 hours a day, 7 days a week. Their task is to care and to cure. America’s hospitals and health systems are united in providing care based on the following principles:</em></p><ul><li><em>Treating all people equitably, with dignity, respect and compassion</em></li><li><em>Serving the emergency health care needs of all, regardless of a patient’s ability to pay</em></li><li><em>Assisting patients who cannot pay for part or all of the care they receive</em></li></ul><p><em>The following guidelines outline how all hospitals and health systems can best serve their patients and communities. They underscore hospitals’ commitment to ensuring that conversations about financial obligations do not impede care, while recognizing that determinations around financial assistance require mutual sharing of information by providers and patients. Additionally, they balance needed financial assistance for some patients with the hospital’s broader fiscal responsibilities in order to keep their doors open for all who may need care in a community.</em></p><p><em>These voluntary guidelines represent the AHA’s expectations of what the hospital and health system field can and should do to address issues of coverage, billing and debt collection, and accountability. The guidelines are largely adapted from what is already required in federal law for tax-exempt hospitals (*) and are intended to align with a core principle of universal coverage. Specifically, all individuals should have access to and ensure they are enrolled in a form of comprehensive health coverage as the primary mechanism for paying for care. Moreover, the guidelines are crafted to reflect the hospital field’s immense diversity. Hospitals will need to adapt these guidelines to the needs and expectations of their particular communities. Hospitals in some states may need to modify use of these guidelines to comply with state laws and regulations.</em></p><h2>Guidelines</h2><h3>Helping Patients Pay for Hospital Care</h3><h4>Helping Patients Qualify for Coverage</h4><ul><li>Hospitals should help uninsured patients identify potential sources of public and private coverage.</li><li>Hospitals should assist uninsured patients with submitting an application for coverage, or direct patients to other services and supports that can help them get enrolled.</li></ul><h4>Helping Patients Qualify for Financial Assistance</h4><ul><li>Hospitals should have a written financial assistance policy.<a href="#fn1">*</a></li><li>Hospitals’ financial assistance policy should describe when care may be free or discounted, and delineate eligibility criteria, the basis for determining a patient’s out-of-pocket responsibility and the method for applying for financial assistance.<a href="#fn1">*</a></li><li>Hospitals should communicate this information to patients in a way that is easy to understand, culturally appropriate and in the most prevalent languages used in their communities.<a href="#fn1">*</a></li><li>Hospitals should publicize their financial assistance policies broadly within the community served (e.g., post on the premises and on the website and/or distribute directly to patients) and share them with other organizations that assist people in need.<a href="#fn1">*</a></li></ul><h4>Providing Financial Assistance to Patients</h4><ul><li>Hospitals should create and adhere to a reasonable and compassionate policy that governs the free care for patients with the most limited means as defined by income below 200% of the federal poverty limit (FPL) combined with a level of assets appropriate for the community.</li><li>Hospitals should create and adhere to a reasonable and compassionate policy that governs the payment obligations for other patients of limited means up to a certain percentage of income and assets, or percentage of the FPL, as appropriate for the community, regardless of insurance status.</li><li>Hospitals should provide a reasonable discount when billing patients of limited means.<a href="#fn1">*</a></li><li>Hospitals should apply financial assistance policies consistently and fairly, without regard to race, ethnicity, gender, religion, etc.</li></ul><h3>Ensuring Fair Billing and Debt Collection Practices</h3><h4>Communicating Effectively with Patients</h4><ul><li>Hospitals should use a billing process that is clear, concise, accurate and patient friendly.</li><li>Hospitals should respond promptly to patients’ questions about their bills and requests for financial assistance.</li><li>Hospitals should provide financial counseling to patients to assist them in paying their bill, and make the availability of this counseling widely known.</li><li>Hospitals should have a written debt collection policy.<a href="#fn1">*</a></li><li>Hospitals should ensure that every effort is made to work together with patients to determine whether the individual is eligible for financial assistance before undertaking significant collections actions, and those efforts can include working with other organizations or entities that can help make the determination.<a href="#fn1">*</a></li><li>Hospitals’ written collections policies should include the actions that may be taken in the event of nonpayment and require an advance notice of at least 30 days to patients identifying the specific action(s) it intends to take, when the action will be initiated, and the availability of financial assistance.<a href="#fn1">*</a></li><li>Hospitals should ensure that staff members who work closely with patients are educated about hospital billing, financial assistance, and collection policies and practices.</li></ul><h4>Oversight of Third-party Debt Collection</h4><ul><li>Hospitals should require any contracted third-party debt collection company to be compliant with the Fair Debt Collection Practices Act.</li><li>Hospitals should require any contracted third-party debt collection company to meet key components of its collection policies as well as any legal requirements that would apply if the action were taken directly by the hospital.<a href="#fn1">*</a></li><li>Hospitals should require regular reports on debt collection efforts, including attestation of compliance with hospital policies and obligations.</li></ul><h4>Protecting Patients from Certain Debt Collection Practices</h4><ul><li>Hospitals’ billing and collection policy should forgo garnishment of wages, liens on a primary residence, applying interest to the debt, adverse credit reporting, or filing of a lawsuit unless the hospital has established that the individual is able but unwilling to pay.</li><li>Hospitals’ billing and collection policy should establish the minimum amounts owed that could lead to debt collection or filing of a lawsuit.</li><li>Hospitals should make multiple attempts to reach and negotiate with patients before proceeding to court action.</li></ul><h3>Ensuring Accountability</h3><h4>Approval of Financial Assistance and Debt Collection Policies</h4><ul><li>The hospital governing body should approve and annually review financial assistance and collection policies, as well as routinely review the status of hospital debt collection efforts.<a href="#fn1">*</a></li><li>The hospital leadership should continually review hospital policies and practices related to these guidelines to ensure they are best serving their patients and communities.</li></ul><hr><p id="fn1">*These guidelines are currently required in federal law for tax-exempt hospitals.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2020/10/Patient-Billing-Guidelines.pdf" target="_blank" title="Click here to download the Patient Billing Guidelines PDF."><img src="/sites/default/files/inline-images/Page-1-Patient-Billing-Guidelines.png" data-entity-uuid="72a53918-793c-43ea-8d9c-d1b20ce93d15" data-entity-type="file" alt="Patient Billing Guidelines page 1" width="1870" height="2420"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2020/10/Patient-Billing-Guidelines.pdf" target="_blank" title="Click here to download the Patient Billing Guidelines PDF.">Download the Patient Billing Guidelines PDF</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/patient-billing-guidelines-affirmation" target="_blank" title="Click here to see how your hospital or health system can affirm the patient billing guidelines.">Affirm the AHA Patient Billing Guidelines</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/infographics/2022-08-18-hospitals-and-health-systems-affirming-aha-patient-billing-guidelines" target="_blank" title="AHA Members can click here to see how the hospitals and health systems who have already affirm the AHA Patient Billing Guidelines.">See Hospitals and Health Systems That Have Affirmed the Patient Billing Guidelines</a></div></div></div></div> Thu, 15 Oct 2020 08:05:12 -0500 Standards/Guidelines /center/cybersecurity-and-risk-advisory-services/preferred-cybersecurity/become-provider Mon, 09 Dec 2024 12:30:00 -0600 Standards/Guidelines /standardsguidelines/2023-11-29-guidelines-secure-ai-system-development <div class="container"> <div class="row"> <div class="col-md-8"> <h2>About This Document</h2> <p>This document is published by the UK National Cyber Security Centre (NCSC), the US Cybersecurity and Infrastructure Security Agency (CISA), and the following international partners:</p> </div> <div class="col-md-4"> <div><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf" target="_blank" title="Click here to download the Guidelines for Secure AI System Development PDF">Download the Guidelines PDF</a></div> </div> </div> <div class="row"> <div class="col-md-8"> <ul> <li>National Security Agency (NSA)</li> <li>Federal Bureau of Investigations (FBI)</li> <li>Australian Signals Directorate’s Australian Cyber Security Centre (ACSC)</li> <li>anadian Centre for Cyber Security (CCCS)</li> <li>New Zealand National Cyber Security Centre (NCSC-NZ)</li> <li>Chile’s Government CSIRT</li> <li>ational Cyber and Information Security Agency of the Czech Republic (NUKIB)</li> <li>Information System Authority of Estonia (RIA)</li> <li>National Cyber Security Centre of Estonia (NCSC-EE)</li> <li>French Cybersecurity Agency (ANSSI)</li> <li>Germany’s Federal Office for Information Security (BSI)</li> <li>Israeli National Cyber Directorate (INCD)</li> <li>Italian National Cybersecurity Agency (ACN)</li> <li>Japan’s National center of Incident readiness and Strategy for Cybersecurity (NISC)</li> <li>Japan’s Secretariat of Science, Technology and Innovation Policy, Cabinet Office</li> <li>Nigeria’s National Information Technology Development Agency (NITDA)</li> <li>Norwegian National Cyber Security Centre (NCSC-NO)</li> <li>oland Ministry of Digital Affairs</li> <li>Poland’s NASK National Research Institute (NASK)</li> <li>Republic of Korea National Intelligence Service (NIS)</li> <li>Cyber Security Agency of Singapore (CSA)</li> </ul> <h2>Acknowledgements</h2> <p>The following organisations contributed to the development of these guidelines:</p> <ul> <li>Alan Turing Institute</li> <li>Anthropic</li> <li>Databricks</li> <li>Georgetown University’s Center for Security and Emerging Technology</li> <li>Google</li> <li>Google DeepMind</li> <li>IBM</li> <li>Imbue</li> <li>Inflection</li> <li>Microsoft</li> <li>OpenAI</li> <li>Palantir</li> <li>RAND</li> <li>Scale AI</li> <li>Software Engineering Institute at Carnegie Mellon University</li> <li>tanford Center for AI Safety</li> <li>Stanford Program on Geopolitics, Technology and Governance</li> </ul> <h2>Disclaimer</h2> <p>The information in this document is provided “as is” by the NCSC and the authoring organisations who shall not be liable for any loss, injury or damage of any kind caused by its use save as may be required by law. The information in this document does not constitute or imply endorsement or recommendation of any third party organisation, product, or service by the NCSC and authoring agencies. Links and references to websites and third party materials are provided for information only and do not represent endorsement or recommendation of such resources over others.</p> <p>This document is made available on a TLP:CLEAR basis (<a href="https://www.first.org/tlp/" target="_blank">https://www.first.org/tlp/</a>).</p> <h2>Contents</h2> <p><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=5">Executive summary</a></p> <p><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=6">Introduction</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=6">Why is AI security different?</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=7">Who should read this document?</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=7">Who is responsible for developing secure AI?</a></p> <p><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=8">Guidelines for secure AI system development</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=9">1. Secure design</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=12">2. Secure development</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=14">3. Secure deployment</a></p> <p class="content-indent"><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=66">4. Secure operation and maintenance</a></p> <p><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf#page=17">Further reading</a></p> .content-indent { margin-left: 20px;\} <h2>Executive Summary</h2> <p><strong>This document recommends guidelines for providers of any systems that use artificial intelligence (AI), whether those systems have been created from scratch or built on top of tools and services provided by others. Implementing these guidelines will help providers build AI systems that function as intended, are available when needed, and work without revealing sensitive data to unauthorised parties.</strong></p> <p>This document is aimed primarily at providers of AI systems who are using models hosted by an organisation, or are using external application programming interfaces (APIs). We urge all stakeholders (including data scientists, developers, managers, decision-makers and risk owners) to read these guidelines to help them make informed decisions about the <strong>design</strong>, <strong>development</strong>, <strong>deployment and <strong>operation</strong> of their AI systems.</strong></p> <h3><strong>About the Guidelines</strong></h3> <p><strong>AI systems have the potential to bring many benefits to society. However, for the opportunities of AI to be fully realised, it must be developed, deployed and operated in a secure and responsible way.</strong></p> <p><strong>AI systems are subject to novel security vulnerabilities that need to be considered alongside standard cyber security threats. When the pace of development is high – as is the case with AI – security can often be a secondary consideration. Security must be a core requirement, not just in the development phase, but throughout the life cycle of the system.</strong></p> <p><strong>For this reason, the guidelines are broken down into four key areas within the AI system development life cycle: secure design, <strong>secure development</strong>, <strong>secure deployment</strong>, and <strong>secure operation and maintenance</strong>. For each section we suggest considerations and mitigations that will help reduce the overall risk to an organisational AI system development process.</strong></p> <ol> <li><strong><strong>Secure design</strong><br> This section contains guidelines that apply to the design stage of the AI system development life cycle. It covers understanding risks and threat modelling, as well as specific topics and trade-offs to consider on system and model design.</strong></li> <li><strong><strong>Secure development This section contains guidelines that apply to the development stage of the AI system development life cycle, including supply chain security, documentation, and asset and technical debt management. </strong></strong></li> <li><strong><strong><strong>Secure deployment</strong><br> This section contains guidelines that apply to the deployment stage of the AI system development life cycle, including protecting infrastructure and models from compromise, threat or loss, developing incident management processes, and responsible release.</strong></strong></li> <li><strong><strong><strong>Secure operation and maintenance</strong><br> This section contains guidelines that apply to the secure operation and maintenance stage of the AI system development life cycle. It provides guidelines on actions particularly relevant once a system has been deployed, including logging and monitoring, update management and information sharing.</strong></strong></li> </ol> <p><strong><strong>The guidelines follow a ‘secure by default’ approach, and are aligned closely to practices defined in the NCSC’s <a href="https://www.ncsc.gov.uk/collection/developers-collection/principles" target="_blank">Secure development and deployment guidance</a>, NIST’s <a href="https://csrc.nist.gov/Projects/ssdf" target="_blank">Secure Software Development Framework</a>, and <a href="https://www.cisa.gov/sites/default/files/2023-10/SecureByDesign_1025_508c.pdf" target="_blank">‘secure by design principles’</a> published by CISA, the NCSC and international cyber agencies. They prioritise:</strong></strong></p> <ul> <li><strong><strong>taking ownership of security outcomes for customers</strong></strong></li> <li><strong><strong>embracing radical transparency and accountability</strong></strong></li> <li><strong><strong>building organisational structure and leadership so secure by design is a top business priority</strong></strong></li> </ul> </div> <div class="col-md-4"> <p><strong><strong><a href="/system/files/media/file/2023/11/Guidelines-for-Secure-AI-System-Development.pdf" target="_blank" title="Click here to download the Guidelines for Secure AI System Development PDF"><img alt="Guidelines for Secure AI System Development page 1." data-entity-type="file" data-entity-uuid="dbf88f12-ee53-4a4a-84e7-597b31244f77" src="/sites/default/files/inline-images/Page-1-Guidelines-for-Secure-AI-System-Development.png" width="636" height="900"></a></strong></strong></p> </div> </div> </div> Wed, 29 Nov 2023 12:22:10 -0600 Standards/Guidelines /standardsguidelines/2021-10-08-partnerships-mergers-and-acquisitions-can-provide-benefits-certain <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Introduction</h2> <h3><span>Hospitals and health systems face many pressures to increase the scale of their operations</span></h3> <div class="row"> <div class="col-md-7"> <p><strong>Demographic and economic forces</strong> are increasing the percentage of patients who are beneficiaries of Medicare or Medicaid. Because these programs pay below hospitals’ cost of care, hospitals must seek efficiencies of scale to drive down costs and minimize their losses. Larger organizations also can spread fixed costs across a greater number of facilities, lowering per unit costs of care.</p> <p><strong>Hospitals and health systems are assuming risk</strong> under valuebased payment programs designed to drive down the total cost of care. Assumption of risk requires a patient population large enough to diversify risk and absorb the impact of high-risk, high-acuity patients.</p> </div> <div class="col-md-5"> <p>To help mitigate these challenges, hospitals are considering a range of partnership, merger, and acquisition possibilities to gain new capabilities, realize new efficiencies, and spread costs over a larger organization. As illustrated in the <a href="/system/files/media/file/2021/10/KH-AHA-Benefits-of-Hospital-Mergers-Acquisitions-2021-10-08.pdf#page=7">spectrum of opportunities on p. 7</a>, hospitals considering these possibilities may pursue less integrated affiliations and partnerships or more highly integrated mergers and acquisitions.</p> </div> </div> <p><strong>The ongoing movement of care from inpatient to outpatient settings</strong> has opened healthcare to a new class of competitors who do not bear the high costs of providing acute-care services. These new competitors include major national retail chains and tech giants, whose scale and financial resources dwarf those of even the largest health systems. Health systems must increase scale to access capital on competitive terms. Moreover, scale helps health systems attract the intellectual talent necessary to innovate in competitive outpatient services, while maintaining access to—and enhancing the quality of—the acute-care services that they exclusively provide to their communities.</p> <p><strong>The COVID-19 pandemic</strong> has had a <a href="/system/files/media/file/2021/03/Kaufman-Hall-2021-Margins-Report-final.pdf" target="_blank" title="COVID-19 in 2021: Pressure Continues on Hospital Margins">devastating financial impact on hospitals and health systems</a>. Prior to the pandemic, about 25% of hospitals had negative operating margins. At the beginning of 2021, almost one year after the pandemic took hold in the U.S., half of hospitals had negative margins, the result of significant volume declines and increased pandemic-related costs.</p> <p><strong>Legislative and regulatory change</strong> could create new financial pressures on hospitals. These changes include site-neutral payment policy proposals, efforts to limit discounts under the 340B Drug Pricing Program, and scheduled Medicaid Disproportionate Share Hospital (DSH) and Medicare sequester payment cuts.</p> <h3><span>The impact of these forces has transformed healthcare</span></h3> <ul> <li>As of July 26, 2021, the Cecil G. Sheps Center for Health Services Research at the University of North Carolina reports that <a href="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/" target="_blank" title="UNC The Cecil G. Sheps Center for Health Services Research: 181 Rural Hospital Closures since January 2005">138 rural hospitals have closed</a> since 2010. A new record was set in 2020, with 19 rural hospital closures, driven by low patient volumes, heavy reliance on Medicare and Medicaid payments, and new financial pressures resulting from the pandemic.</li> <li>An analysis of AHA and Kaufman Hall data suggests that almost 40% of hospitals may be financially challenged or distressed prior to an M&A transaction.</li> </ul> <h3><span>For some hospitals, partnerships, mergers, and acquisition are a necessary response to these forces and have provided many benefits to patients and communities</span></h3> <ul> <li>They have saved certain hospitals from closure—even some of the most financially distressed organizations—preserving and often enhancing patient access to care</li> <li>They have given health systems the scale needed to: <ul> <li>Provide resources to support consumer-centric strategies that enhance the patient experience of care</li> <li>Engage in partnerships with health plans and large employers to improve the accessibility and affordability of care</li> <li>Obtain capital at an affordable cost to make investments in care delivery advances, technology, and population health infrastructure</li> </ul> </li> <li>They have assisted in efforts to reduce costs while enhancing the quality of patient care</li> </ul> <h3><span>Integration models reflect hospitals’ and health systems’ strategic goals</span></h3> <p><strong>Horizontal integration</strong> models between hospitals and health systems can range from looser affiliations to full acquisitions. Strategic goals of horizontal integration include:</p> <ul> <li>Increasing geographic coverage within a market to offer sufficient breadth of access to potential insurer or employer partners seeking new health plan options for their members or employees</li> <li>Bringing specialty services or management capabilities to hospitals in new markets, which expands access to healthcare services and enhances operational efficiencies</li> <li>Combining systems with complementary capabilities that can enhance care delivery, manage alternative payment model risk, or improve operations across the combined entities</li> </ul> <p><strong>Vertical integration</strong> models between hospitals and health systems and other providers (e.g., physician groups, post-acute care facilities, behavioral health services) can also range from affiliations to acquisitions. Strategic goals of vertical integration include:</p> <ul> <li>Expanding patient access to services across the care continuum</li> <li>Building care networks to coordinate patient care under risk-bearing value-based payment models</li> </ul> <h3><span>The degree of integration is determined by a range of factors</span></h3> <p>A hospital that lacks strong management capabilities in behavioral health, for example, may enter a joint venture partnership with a skilled behavioral health operator.</p> <p>A merger or acquisition may be more appropriate for a financially distressed hospital that requires major capital investment and management oversight from the acquiring hospital.</p> <p><img alt="Degree of Integration from low to high. Low: Affiliation; Collaborative; Population Health Mgmt/CIN. Low-Middle: Management Services Agreement; Joint Venture. Middle: Joint Operating Agreement. High-Middle: Member Substitution; New System Formation; Merger. High: Asset Sale/Acquisition." data-entity-type="file" data-entity-uuid="c28fdf9e-6739-4110-ad1b-402a3a3bd5ce" src="/sites/default/files/inline-images/Degree-of-Integration-chart.jpg" width="1205" height="523"></p> <p><small>Source: Kaufman, Hall & Associates, LLC.</small></p> <p><strong><em><a href="/system/files/media/file/2021/10/KH-AHA-Benefits-of-Hospital-Mergers-Acquisitions-2021-10-08.pdf" target="_blank" title="Download the Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities PDF.">To read the full report, click on the PDF link below.</a></em></strong></p> <hr> <div class="row"> <div class="col-md-3"> <h4><a href="https://www.kaufmanhall.com/" target="_blank" title="KaufmanHall homepage">kaufmanhall.com</a></h4> </div> <div class="col-md-1"> <p> <br> |<br>  </p> </div> <div class="col-md-8"> <p><small>© 2021 Kaufman, Hall & Associates, LLC. All Rights Reserved. This article may not be mass produced or modified without the express written consent of Kaufman, Hall & Associates, LLC.</small></p> </div> </div> </div> <div class="col-md-4"> <div class="panel module-typeC"> <div class="panel-heading"> <h3 class="panel-title">Latest AHA Hospital Financial Reports</h3> </div> <div class="panel-body"> <p><a href="/guidesreports/2021-09-21-financial-effects-covid-19-hospital-outlook-remainder-2021" target="_blank" title="Click here to view the Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021 report from KaufmanHall."><strong>Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021</strong></a></p> <p><a href="/guidesreports/2020-07-20-effect-covid-19-hospital-financial-health" target="_blank" title="Click here to view the The Effect of COVID-19 on Hospital Financial Health report from KaufmanHall."><strong>The Effect of COVID-19 on Hospital Financial Health</strong></a></p> <p><a href="/guidesreports/2021-03-22-covid-19-2021-pressure-continues-hospital-margins-report"><strong>COVID-19 in 2021: Pressure Continues on Hospital Margins Report</strong></a></p> <p><a href="/guidesreports/2021-02-23-covid-19-2021-potential-effect-hospital-revenues"><strong>COVID-19 in 2021: The Potential Effect on Hospital Revenues</strong></a></p> <p><a href="/guidesreports/2020-07-20-effect-covid-19-hospital-financial-health"><strong>The Effect of COVID-19 on Hospital Financial Health</strong></a></p> <p><a href="/issue-brief/2020-06-30-new-aha-report-finds-losses-deepen-hospitals-and-health-systems-due-covid-19"><strong>New AHA Report Finds Losses Deepen for Hospitals and Health Systems Due to COVID-19</strong></a></p> <p><a href="/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due"><strong>Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19</strong></a></p> <p><a href="/guidesreports/2020-07-20-effect-covid-19-hospital-financial-health"><strong>Americans View Hospitals Very Favorably, Support Additional Financial Aid in New Coalition Public Opinion Polling</strong></a></p> </div> </div> </div> </div> </div> Mon, 11 Oct 2021 06:00:00 -0500 Standards/Guidelines /standardsguidelines/2020-06-16-hc3-sector-note-tlp-white-remote-access-trojan-agent-tesla-targets <p class="MsoPlainText"><span><span>Agent Tesla is an established Remote Access Trojan (RAT) written in .Net. A successful deployment of Agent Tesla provides attackers with full computer or network access; it is capable of stealing credentials, sensitive information, keystrokes, screen and video activity, and form-grabbing.</span></span></p> Tue, 16 Jun 2020 21:17:58 -0500 Standards/Guidelines /standardsguidelines/2020-04-17-roadmap-aha-others-safely-resuming-elective-surgery-covid-19-curve <h2>Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic</h2> <h3>American College of Surgeons<br /> American Society of Anesthesiologists<br /> Association of periOperative Registered Nurses<br /> ���������� Association</h3> <h3>Introduction</h3> <p>In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS), the U.S. Surgeon General and many medical specialties such as the American College of Surgeons and the American Society of Anesthesiologists recommended interim cancelation of elective surgical procedures. Physicians and health care organizations have responded appropriately and canceled non-essential cases across the country. Many patients have had their needed, but not essential, surgeries postponed due to the pandemic. When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense, and health care organizations, physicians and nurses must be prepared to meet this demand. Facility readiness to resume elective surgery will vary by geographic location. The following is a list of principles and considerations to guide physicians, nurses and local facilities in their resumption of care in operating rooms and all procedural areas.</p> <h3 id="timing">1. Timing for Reopening of Elective Surgery</h3> <h4>Principle</h4> <p>There should be a sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days, and the facility shall have appropriate number of intensive care unit (ICU) and non-ICU beds, personal protective equipment (PPE), ventilators and trained staff to treat all non-elective patients without resorting to a crisis standard of care.</p> <h4>Considerations</h4> <p>Facilities should evaluate the following before resuming elective surgery:</p> <ol> <li>Timing of resumption: There should be a sustained reduction in rate of new COVID-19 cases in the relevant geographic area for at least 14 days before resumption of elective surgical procedures.<sup><a href="#fn1">1</a>, <a href="#fn2">2</a>, <a href="#fn3">3</a>, <a href="#fn4">4</a></sup></li> <li>Any resumption should be authorized by the appropriate municipal, county and state health authorities.</li> <li>Facilities in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care.</li> <li>Does the facility have appropriate number of ICU and non-ICU beds, PPE, ventilators, medications, anesthetics and all medical surgical supplies?</li> <li>Does the facility have available numbers of trained and educated staff appropriate to the planned surgical procedures, patient population and facility resources? Given the known evidence supporting health care worker fatigue and the impact of stress, can the facilities perform planned procedures without compromising patient safety or staff safety and wellbeing?</li> </ol> <h3 id="testing">2. COVID-19 Testing within a Facility</h3> <h4>Principle</h4> <p>Facilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testing.</p> <h4>Considerations</h4> <p>Facility COVID-19 testing policies should account for:</p> <ol> <li>Availability, accuracy and current evidence regarding tests, including turnaround time for test results.</li> <li>Frequency and timing of patient testing (all/selective). <ol> <li>Patient testing policy should include accuracy and timing considerations to provide useful preoperative information as to COVID-19 status of surgical patients, particularly in areas of residual community transmission.</li> <li>If such testing is not available, consider a policy that addresses evidence-based infection prevention techniques, access control, workflow and distancing processes to create a safe environment in which elective surgery can occur. If there is uncertainty about patients’ COVID-19 status, PPE appropriate for the clinical tasks should be provided for the surgical team.</li> </ol> </li> <li>Indications and availability for health care worker testing.</li> <li>How a facility will respond to COVID-19 positive worker, COVID-19 positive patient (identified preoperative, identified postoperative), “person under investigation” (PUI) worker, PUI patient.</li> </ol> <h3 id="ppe">3. Personal Protective Equipment</h3> <h4>Principle</h4> <p>Facilities should not resume elective surgical procedures until they have adequate PPE and medical surgical supplies appropriate to the number and type of procedures to be performed.</p> <h4>Considerations</h4> <p>Facility policies for PPE should account for the following:</p> <ol> <li>Adequacy of available PPE, including supplies required for potential second wave of COVID19 cases.</li> <li>Staff training on and proper use of PPE according to non-crisis level evidence-based standards of care.</li> <li>Policies for the conservation of PPE should be developed (e.g., intubation teams) as well as policies for any extended use or reuse of PPE per CDC and FDA guidance.</li> </ol> <h3 id="caseprioritization">4. Case Prioritization and Scheduling</h3> <h4>Principle</h4> <p>Facilities should establish a prioritization policy committee consisting of surgery, anesthesia and nursing leadership to develop a prioritization strategy appropriate to the immediate patient needs.</p> <h4>Considerations</h4> <p>Prioritization policy committee strategy decisions should address case scheduling and prioritization and should account for the following:</p> <ol> <li>List of previously cancelled and postponed cases.</li> <li>Objective priority scoring (e.g., MeNTS instrument).<sup><a href="#fn5">5</a></sup></li> <li>Specialties’ prioritization (cancer, organ transplants, cardiac, trauma).<sup><a href="#fn6">6</a>, <a href="#fn7">7</a></sup></li> <li>Strategy for allotting daytime “OR/procedural time” (e.g., block time, prioritization of case type [i.e., potential cancer, living related organ transplants, etc.]).</li> <li>Identification of essential health care professionals and medical device representatives per procedure.</li> <li>Strategy for phased opening of operating rooms. <ol> <li>Identify capacity goal prior to resuming (e.g., 25% vs. 50%).</li> <li>Outpatient/ambulatory cases start surgery first followed by inpatient surgeries.</li> <li>All operating rooms simultaneously – will require more personnel and material.</li> </ol> </li> <li>Strategy for increasing “OR/procedural time” availability (e.g., extended hours before weekends).</li> <li>Issues associated with increased OR/procedural volume. <ol> <li>Ensure primary personnel availability commensurate with increased volume and hours (e.g., surgery, anesthesia, nursing, housekeeping, engineering, sterile processing, etc.).</li> <li>Ensure adjunct personnel availability (e.g., pathology, radiology, etc.).</li> <li>Ensure supply availability for planned procedures (e.g., anesthesia drugs, procedurerelated medications, sutures, disposable and nondisposable surgical instruments).</li> <li>Ensure adequate availability of inpatient hospital beds and intensive care beds and ventilators for the expected postoperative care.</li> <li>New staff training.</li> </ol> </li> </ol> <h3 id="postcovid19">5. Post-COVID-19 Issues for the Five Phases of Surgical Care</h3> <h4>Principle</h4> <p>Facilities should adopt policies addressing care issues specific to COVID-19 and the postponement of surgical scheduling.</p> <h4>Considerations:</h4> <p>Facility policies should consider the following when adopting policies specific to COVID-19 and the postponement of surgical scheduling:</p> <ol> <li><strong>Phase I: Preoperative</strong> <ol> <li>Guideline for preoperative assessment process. <ul> <li>Patient readiness for surgery can be coordinated by anesthesiology-led preoperative assessment services.</li> </ul> </li> <li>Guideline for timing of re-assessing patient health status. <ul> <li>Special attention and re-evaluation are needed if patient has had COVID-19-related illness.</li> <li>A recent history and physical examination within 30 days per Centers for Medicare and Medicaid Services (CMS) requirement is necessary for all patients. This will verify that there has been no significant interim change in patient’s health status.</li> <li>Consider use of telemedicine as well as nurse practitioners and physician assistants for components of the preoperative patient evaluation.</li> <li>Some face-to-face components can be scheduled on day of procedure, particularly for healthier patients.</li> <li>Surgery and anesthesia consents per facility policy and state requirements.</li> <li>Laboratory testing and radiologic imaging procedures should be determined by patient indications and procedure needs. Testing and repeat testing without indication is discouraged.</li> <li>Assess preoperative patient education classes vs. remote instructions</li> </ul> </li> <li>Advanced directive discussion with surgeon, especially patients who are older adults, frail or post-COVID-19.</li> <li>Assess for need for post-acute care (PAC) facility stay and address before procedure (e.g., rehabilitation, skilled nursing facility).</li> </ol> </li> <li><strong>Phase II: Immediate Preoperative</strong> <ol> <li>Guideline for pre-procedure interval evaluation since COVID-19-related postponement.</li> <li>Assess need for revision of nursing, anesthesia, surgery checklists regarding COVID-19.</li> </ol> </li> <li><strong>Phase III: Intraoperative</strong> <ol> <li>Assess need for revision of pre-anesthetic and pre-surgical timeout components.</li> <li>Guideline for who is present during intubation and extubation.</li> <li>Guideline for PPE use.</li> <li>Guideline for presence of nonessential personnel including students.</li> </ol> </li> <li><strong>Phase IV: Postoperative</strong> <ol> <li>Adhere to standardized care protocols for reliability in light of potential different personnel. Standardized protocols optimize length of stay efficiency and decrease complications (e.g., ERAS).</li> </ol> </li> <li><strong>Phase V: Post Discharge Care Planning</strong> <ol> <li>PAC facility availability.</li> <li>PAC facility safety (COVID-19, non-COVID-19 issues).</li> <li>Home setting: Ideally patients should be discharged home and not to a nursing home as higher rates of COVID-19 may exist in these facilities.</li> </ol> </li> </ol> <h3>6. Collection and Management of Data</h3> <h4>Principle</h4> <p>Facilities should reevaluate and reassess policies and procedures frequently, based on COVID-19 related data, resources, testing and other clinical information.</p> <h4>Considerations</h4> <p>Facilities should collect and utilize relevant facility data, enhanced by data from local authorities and government agencies as available:</p> <ol> <li>COVID-19 numbers (testing, positives, availability of inpatient and ICU beds, intubated, OR/procedural cases, new cases, deaths, health care worker positives, location, tracking, isolation and quarantine policy).</li> <li>Facility bed, PPE, ICU, ventilator availability.</li> <li>Quality of care metrics (mortality, complications, readmission, errors, near misses, other – especially in context of increased volume).</li> </ol> <h3>7. COVID-related Safety and Risk Mitigation surrounding Second Wave</h3> <h4>Principle</h4> <p>Facilities should have and implement a social distancing policy for staff, patients and patient visitors in non-restricted areas in the facility which meets then-current local and national recommendations for community isolation practices.</p> <h4>Considerations</h4> <ol> <li>Each facility’s social distancing policy should account for: <ol> <li>Then-current local and national recommendations.</li> <li>The number of persons that can accompany the procedural patient to the facility.</li> <li>Whether visitors in periprocedural areas should be further restricted.</li> </ol> </li> </ol> <h3>8. Additional COVID-19 Related Issues</h3> <ol> <li>Healthcare worker well-being: post-traumatic stress, work hours, including trainees and students if applicable.</li> <li>Patient messaging and communication.</li> <li>Case scheduling process.</li> <li>Facility and OR/procedural safety for patients.</li> <li>Preoperative testing process. <ol> <li>For COVID-19-positive patients.</li> <li>For non-COVID-19-positive patients.</li> <li>Environmental cleaning.</li> </ol> </li> <li>Prior to implementing the start-up of any invasive procedure, all areas should be terminally cleaned according to evidence-based information.</li> <li>In all areas along five phases of care (e.g. clinic, preoperative and OR/procedural areas, workrooms, pathology-frozen, recovery room, patient areas, ICU, ventilators, scopes, sterile processing, etc.): <ol> <li>Regulatory issues (The Joint Commission, CMS, CDC).</li> <li>Operating/procedural rooms must meet engineering and Facility Guideline Institute standards for air exchanges.</li> <li>Re-engineering, testing, and cleaning as needed of anesthesia machines returned from COVID-19 and non-COVID ICU use.</li> </ol> </li> </ol> <hr /> <ol> <li id="fn1"><a href="https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-toreopening/" target="_blank">https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-toreopening/</a></li> <li id="fn2"><a href="https://www.wsj.com/podcasts/the-journal/dr-anthony-fauci-on-how-life-returns-to-normal/" target="_blank"">https://www.wsj.com/podcasts/the-journal/dr-anthony-fauci-on-how-life-returns-to-normal/</a></li> <li id="fn3"><a href="https://covid19.healthdata.org/united-states-of-america/illinois" target="_blank">https://covid19.healthdata.org/united-states-of-america/illinois</a></li> <li id="fn4"><a href="https://penn-chime.phl.io" target="_blank">https://penn-chime.phl.io</a></li> <li id="fn5">Prachand V, Milner R, Angelos P, et al. Medically-Necessary, Time-Sensitive Procedures: A scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. JACS in press. <a href="https://www.journalacs.org/article/S1072-7515(20)30317-3/pdf" target="_blank">https://www.journalacs.org/article/S1072-7515(20)30317-3/pdf</a></li> <li id="fn6"><a href="https://www.facs.org/COVID-19/clinical-guidance/triage" target="_blank">https://www.facs.org/COVID-19/clinical-guidance/triage</a></li> <li id="fn7"><a href="https://www.facs.org/-/media/files/covid19/guidance_for_triage_of_nonemergent_surgical_procedures.ashx" target="_balnk">https://www.facs.org/-/media/files/covid19/guidance_for_triage_of_nonemergent_surgical_procedures.ashx</a></li> </ol> Fri, 17 Apr 2020 09:01:12 -0500 Standards/Guidelines /standardsguidelines/2018-12-11-how-borrow-items-library-collection <h3>Who can borrow items from the Resource Center’s library collection?</h3> <p>AHA staff and members, including employees of member hospitals/systems or associate members, may borrow books and other print publications from the AHA Resource Center.</p> <p>The Resource Center will also loan to other libraries.</p> <p>For those who are not AHA members, you may ask your local library to borrow an item for you through interlibrary loan. You’ll pick up and return the borrowed item to your local library to return to the Resource Center.</p> <p>Note that issues of journals and selected items are not made available for loans. Generally, loans of print publications are limited to borrowers located in the U.S. only.</p> <h3>How do I make a request?</h3> <p>Simply email the Resource Center at <a href="mailto:rc@aha.org">rc@aha.org</a>.</p> <p>For libraries, the Resource Center participates in OCLC and DOCLINE electronic interlibrary systems:</p> <ul> <li>OCLC routing ID: IHD</li> <li>DOCLINE ID: ILUAHA<strong> </strong></li> </ul> <h3>Is there a cost for borrowing items, and if so, how is payment made?</h3> <p>There is no cost for AHA staff.</p> <p>There is no cost to members who visit the library and check-out publications on-site. However, to defray shipping and processing costs, <a href="/data-insights/resource-center/service-fee-schedule">fees</a> do apply for loans made to off-site users.</p> <p>Members and libraries may be invoiced for the loan charge or may pay in advance with an American Express, MasterCard or Visa credit card. Invoices or credit card receipts are usually separately mailed or emailed.</p> <p>Libraries may also use DOCLINE’s EFT system or OCLC’s IFM system for electronic payment processing.</p> <h3>What is the loan period?</h3> <p>Items are loaned for a period of four weeks, and if no other user has reserved it, may be renewed an additional four weeks at no additional cost. Further renewals are at the discretion of the Resource Center and would entail a new loan fee.</p> <h3>Can items be express shipped?</h3> <p>There is a $25 express shipping surcharge fee that applies unless the user provides his or her own FedEx or UPS shipping account number to be used.</p> <h3>How are items to be returned?</h3> <p>If shipping the item back, please use UPS, FedEx, DHL, or USPS package tracking service to ensure safe delivery. Borrowers are responsible for the <a href="/data-insights/resource-center/service-fee-schedule">replacement costs of lost items</a>. Please include the original loan wrapper that was included on the book when it was shipped. Loaned items may also be returned on-site in the Resource Center.</p> <p>Last updated Dec. 2018.</p> Tue, 11 Dec 2018 09:17:48 -0600 Standards/Guidelines /standardsguidelines/2018-04-02-hospital-leadership-guide-digital-social-media-engagement <p>Hospital and health care executives have a unique role to play in social media execution. Recognizing the importance of social media is the first step in taking your hospital into the digital world. Understanding the value and the potential of this medium can help leverage your community benefit programs and patient engagement in a way never possible before the advent of the Internet.</p> <p>This guide will help to explain the possibilities of using digital media to manage patient experience in your hospital. From connecting with community members and potential patients before they arrive at your doorstep to managing their care transitions after they leave – social media can help.</p> <p>This guide aims to provide information and best practices for using social media from the provider perspective in a proactive and thoughtful manner. It is important to understand the various implications of using social media as they relate to, among other issues, the Health Insurance Portability and Accountability Act (HIPAA) and employee and human resource considerations. As technology changes, so too will the options and availability of new resources for social engagement. This guide will provide you with the tools necessary to implement, manage and make informed decisions about the professional use of social media, no matter the current trend. While this guide is not meant to be an exhaustive resource, we hope it will serve as a blueprint for effective ways to engage online.</p> Mon, 02 Apr 2018 16:27:23 -0500 Standards/Guidelines /standardsguidelines/american-hospital-association-social-media-policy <h2>POLICY PURPOSE</h2> <p>This policy describes how the ���������� Association (AHA or Association) makes use of Social Media and how AHA employees manage AHA-branded Social Media accounts.</p> <h2>DEFINITIONS</h2> <p>“Social Media” refers to a website or platform that allows the creation and exchange of user- generated content. Examples include, but are not limited to, Facebook, LinkedIn, Pinterest, Twitter, YouTube and any AHA-affiliated internal or external online community platforms.</p> <h2>SCOPE</h2> <p>In fulfilling the AHA’s mission and vision, the AHA uses Social Media to build relationships with the health care field, the media and the public. Our use of Social Media enables the AHA to communicate with and educate our various audiences about health care issues and trends as they affect hospitals and health systems, and to ensure that the perspectives and needs of the health care field are clearly articulated and understood.</p> <h2>POLICY IMPLEMENTATION</h2> <h3>A. ENSURING CIVIL DISCOURSE OVER SOCIAL MEDIA</h3> <p>The AHA uses Social Media to create a dialogue about issues that affect the health care field and welcomes, as part of that dialogue, anyone with any interest in discussing these issues in a civil and respectful manner. At the same time, the AHA does not tolerate Social Media dialogue that does not conform to the reasonable standards of civility outlined in this policy. We reserve the right to take appropriate actions – including blocking any user, ending any communication with a blocked user, or involving proper law enforcement authorities if necessary – against dialogue participants who fail to observe the following guidelines on civil discourse:</p> <p> </p> <ol> <li>All AHA employees are expected to conduct online interactions in accordance with the same values, ethics, confidentiality and other AHA policies that apply to employee off-line conduct, including this policy. As we all represent the AHA, whether in the office or out, we must always be aware of the impact our professional and personal online interactions may have on the AHA brand.</li> <li>AHA accepts responsibility for the content it posts on its Social Media sites and will not impersonate, mislead or purposely obscure the Association’s identity when using Social Media. Social Media is about enhancing the Association’s credibility and reputation. The AHA also expects participants in dialogue on our Social Media sites to refrain from impersonating, misleading or purposely obscuring their identities.</li> <li>AHA protects its own intellectual property and respects the intellectual property of others. We will not intentionally use copyrighted material without permission or use others’ business name, logo or other trademark-protected materials in a manner that may mislead or confuse others with regard to the business’s brand or business affiliation. The AHA also expects that participants in dialogue on our Social Media sites display the same respect for the intellectual property of the AHA and others. We will respond to clear and complete notices of alleged copyright or trademark infringement.</li> <li>AHA respects antitrust laws and does not use its Social Media sites to improperly coordinate discussions between market participants about prices, salaries, expansion plans, market allocation, refusals to deal or other anti-competitive practices.</li> <li>AHA recognizes the importance of maintaining the confidentiality of an individual’s personal and medical data and we will not include, reference or reveal such personal data in dialogue on our Social Media sites. We expect participants in the dialogue on our Social Media sites to similarly respect confidentiality and to refrain from including, referring to or revealing individuals’ personal or medical data.</li> <li>AHA accepts differences and differing opinions about health care issues affecting the health care field and we strive to maintain a courteous, polite and professional dialogue about these issues even when we might disagree with opinions expressed by others. AHA expects that participants in dialogue on the Association’s Social Media sites also will accept differences and differing opinions by responding in a respectful way when they disagree or have a difference of opinion.</li> <li>AHA does not use Social Media to bully, intimidate or threaten others and we expect participants in dialogues on the Association’s Social Media sites to refrain from bullying, intimidation and threatening harm or violence to anyone, including threats directed to the Association or any of its employees.</li> <li>AHA does not use Social Media to defame the reputation of others and we will not tolerate the use of the Association’s Social Media sites by any dialogue participants in order to defame the reputation of the Association, any individuals or groups of individuals or any organization or business entity.</li> <li>AHA does not publish or post profanity or obscene or pornographic communications on its Social Media sites. We do not tolerate the use of profanity or posting obscene or pornographic images by any participants in the dialogue on the Association’s Social Media sites, whether in a user profile or background or in a response, comment or message posting.</li> <li>AHA intends that Social Media serve as an effective communications tool for the Association and will refrain from spamming and other abusive uses of the Social Media technology/capability. We expect that participants in dialogue on the Association’s Social Media sites will properly use the technology/capabilities as an effective communications tool and will not engage in spam or other misuse of these technologies/capabilities.</li> </ol> <p>*AHA reserves the right to eliminate, change or modify policies at any time.</p> Mon, 02 Apr 2018 15:23:51 -0500 Standards/Guidelines /standardsguidelines/2018-03-08-guidelines-releasing-patient-information-law-enforcement <h2>Introduction</h2> <p>Hospitals and health systems are responsible for protecting the privacy and confidentiality of their patients and patient information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations established national privacy standards for health care information. HIPAA prohibits the release of information without authorization from the patient except in the specific situations identified in the regulations. This document is based on the HIPAA medical privacy regulations and provides overall guidance for the release of patient information to law enforcement and pursuant to an administrative subpoena.</p> <p>THIS INFORMATION IS PROVIDED ONLY AS A GUIDELINE. CONSULT WITH LEGAL COUNSEL BEFORE FINALIZING ANY POLICY ON THE RELEASE OF PATIENT INFORMATION. ALSO, BE AWARE THAT HEALTH CARE FACILITIES MUST COMPLY WITH STATE PRIVACY LAWS AS WELL AS HIPAA. CONTACT YOUR LEGAL COUNSEL OR YOUR STATE HOSPITAL ASSOCIATION FOR FURTHER INFORMATION ABOUT THE APPLICATION OF STATE AND FEDERAL MEDICAL PRIVACY LAWS TO THE RELEASE OF PATIENT INFORMATION.</p> Thu, 08 Mar 2018 15:38:24 -0600 Standards/Guidelines