/ en Mon, 05 May 2025 17:19:22 -0500 Mon, 05 May 25 10:43:47 -0500 /advancing-health-podcast/2025-05-05-ai-stroke-treatment-expert-insights-henry-ford-health <p>May is American Stroke Month. In this conversation, Aaron Lewandowski, M.D., emergency medicine physician and the emergency medicine stroke representative at Henry Ford West Bloomfield Hospital, and Alex Chebl, M.D., interventional neurologist and director of the Henry Ford Stroke Center and the Division of Vascular Neurology at Henry Ford Health, discuss how artificial intelligence (AI) is revolutionizing stroke care. From accelerating diagnoses and streamlining team communication, to significantly improving patient outcomes, this rapid advancement in AI technology isn鈥檛 just supporting doctors 鈥� it鈥檚 saving lives.</p><hr><div></div><hr><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br>   </h2> </summary> <p> 00:00:00:27 - 00:00:24:15<br> Tom Haederle<br> Welcome to Advancing Health. For stroke victims, speed and survival are closely linked. Quicker diagnosis and treatment can make a huge difference. Coming up in today's podcast, a look at how those two letters we hear more and more about in today's health care - A and I - artificial intelligence, are being applied to protocols for stroke treatment. </p> <p> 00:00:24:18 - 00:00:43:24<br> Tom Haederle<br> Hi everyone. I'm Tom Haederle, senior communication specialist with the 黑料正能量 Association and pleased today to get to do one of my favorite parts of this job. And that's highlighting the amazing work that goes on every day among our member hospitals and health systems. And here's a great example: the integration of artificial intelligence into treatment protocols for stroke victims </p> <p> 00:00:43:24 - 00:01:08:11<br> Tom Haederle<br> at Detroit-based Henry Ford Health. Joining me from Henry Ford to talk about this are Dr. Aaron Lewandowski, an emergency medicine doctor and the emergency medicine stroke representative at Henry Ford West Bloomfield Hospital, and Doctor Alex Chebl, a vascular and interventional neurologist and director of the Henry Ford Stroke Center and the Division of Vascular Neurology. Doctors, thank you both for joining us on this Advancing Health podcast today. </p> <p> 00:01:08:11 - 00:01:09:08<br> Tom Haederle<br> Appreciate you being here. </p> <p> 00:01:09:09 - 00:01:10:07<br> Aaron Lewandowski, M.D.<br> Thanks for having us. </p> <p> 00:01:10:09 - 00:01:11:10<br> Alex Chebl, M.D.<br> Thank you for having me. </p> <p> 00:01:11:12 - 00:01:20:03<br> Tom Haederle<br> Dr. Lewandowski, let's start with you and a basic question: why is speed of diagnosis and treatment so critical when treating victims of a stroke? </p> <p> 00:01:20:05 - 00:01:40:23<br> Aaron Lewandowski, M.D.<br> There's a common saying in neurology and stroke care that time is brain. It is estimated that millions of neurons are irreplaceably lost each minute during an ischemic stroke. So the sooner that we are able to diagnose and treat a stroke, the more brain we're able to save and the patients are able to have a easier outcome and a better recovery. </p> <p> 00:01:40:25 - 00:01:45:28<br> Tom Haederle<br> And what exactly does AI lend to the process? How has it improved how we're doing this now? </p> <p> 00:01:46:00 - 00:02:12:10<br> Aaron Lewandowski, M.D.<br> AI has been used in multiple ways across medicine. In stroke care particularly, we're able to use it in helping with diagnosis of stroke in a timely manner. Our program specifically is called Rapid AI. It is a software program that allows for quicker diagnosis of strokes and also facilitates communication between physicians. Dr. Chebl was actually the physician that brought the idea to our stroke committee, and we've been using it for approximately two years. </p> <p> 00:02:12:12 - 00:02:23:19<br> Tom Haederle<br> Does it actually paint - and this is a question for both of you - does it paint a picture of what's going on inside the stroke victim inside the brain actually allow you to see something you couldn't see before. Dr. Chebl? </p> <p> 00:02:23:21 - 00:02:44:01<br> Alex Chebl, M.D.<br> It's not so much as paints a picture as gives you an exact picture of what's going on. So the challenge we have in stroke neurology, unlike, say, when a patient comes in with a heart attack, you know, a patient grabs a chest, they're having chest pain. You can do an EKG and a cardiologist emergency physician can know immediately where the problem is. </p> <p> 00:02:44:03 - 00:03:08:12<br> Alex Chebl, M.D.<br> The trouble in neurology, is that there are many different types of stroke. Some types of stroke are caused by bleeding into the brain. But the more common type of stroke and why we use AI most commonly is called a ischemic stroke where there's a blockage, and the treatment for those two types of stroke are exactly opposite. One causes the other, and so you have to know what type of stroke you're dealing with. </p> <p> 00:03:08:18 - 00:03:17:15<br> Alex Chebl, M.D.<br> And this is why it's more complicated. And knowing what's going on inside the brain with the arteries is critical. And this is where the AI helps us. </p> <p> 00:03:17:17 - 00:03:52:12<br> Aaron Lewandowski, M.D.<br> Particularly with ischemic strokes, the issue is trying to figure out what part of the brain has been affected by the stroke and also where the blood clot is. And, is it amenable to intervention? There's medicines such as TMK which we're able to use to try and break down the clot during an ischemic stroke. But particularly where I used it for our purposes is in the use of the thrombectomy procedure, which is where you're able to intervascularly go up into the brain and actually remove the clot that's causing the stroke if it's located in an appropriate and amenable position. </p> <p> 00:03:52:15 - 00:04:15:02<br> Aaron Lewandowski, M.D.<br> So the program serves multiple purposes. The AI portion of the program evaluates the CT angiogram and the CT perfusion studies of the patient looking for any asymmetry in blood vessel distribution or perfusion. This is able to allow us to quickly evaluate for signs of what we call a large vessel occlusion. Those are the types of strokes that are most amenable to the thrombectomy procedure. </p> <p> 00:04:15:04 - 00:04:24:03<br> Tom Haederle<br> How much time has the use of Rapid AI shaved off of the diagnosis and allowed you to figure out accurately what's happening? </p> <p> 00:04:24:06 - 00:04:51:18<br> Alex Chebl, M.D.<br> Approximately 30 minutes. When we look at patients who are candidates for mechanical thrombectomy, that's the procedure where we pull the clots from the brain. We've reduced our door-to-puncture time. That is, from the minute the patient arrives in the emergency department until we actually puncture the artery to get to the brain, we've been able to save about 30 minutes, bringing us down to within the 90 minute ideal window for that treatment. </p> <p> 00:04:51:25 - 00:05:13:01<br> Alex Chebl, M.D.<br> But, just as importantly, it's also helped us with our door-to-needle time. So that balloon scan mentioned that you can also give the clot busting medication. That has to be given within 4.5 hours. And so we've now are consistently able to treat patients instead of roughly within an hour presentation. We're now being able to treat almost all patients with 45 minutes. </p> <p> 00:05:13:01 - 00:05:19:16<br> Alex Chebl, M.D.<br> And we're approaching 30 minutes from door-to-needle. And every minute is essential in that effort. </p> <p> 00:05:19:18 - 00:05:22:27<br> Tom Haederle<br> That's really impressive. What's been the impact on patient outcomes? </p> <p> 00:05:23:04 - 00:05:44:13<br> Alex Chebl, M.D.<br> Tremendous patient outcomes. If you look nationally, but also at our sites, you look at the number of patients, proportion of patients who recover to normal or nearly normal has increased. If you look at the number of patients who are discharged to home rather than to rehab, a good measure of whether patients have disability, that has also increased. </p> <p> 00:05:44:15 - 00:05:58:13<br> Alex Chebl, M.D.<br> And nationally, the data clearly support, this overwhelmingly so, so that the American Heart Association, for example, keeps shortening the time metric, because the sooner we do it, we're getting better outcomes. </p> <p> 00:05:58:15 - 00:06:17:21<br> Tom Haederle<br> Really good news for patients. I'm wondering, given the size of Henry Ford, a big, big system you have. And I imagine that rolling out any new technology or software or changing how things are done, particularly across a scale like that, has got its challenges. Did you run into any kind of bureaucratic obstacles or resistance? We don't know what this thing is . . . </p> <p> 00:06:17:21 - 00:06:21:23<br> Tom Haederle<br> Prove it to us. Was it hard to sell, or not really? </p> <p> 00:06:21:26 - 00:06:45:08<br> Aaron Lewandowski, M.D.<br> What? Dr. Chebl first brought the idea to us at the West Bloomfield emergency Department, it was certainly interest in, you know, ways that we can improve our stroke care. I would say overall, we didn't really experience any significant barriers to implementing Rapid AI here at Henry Ford. I would say the hurdles that we faced were the standard hurdles you faced with integrating any new piece of software or technology into your preexisting hospital system. </p> <p> 00:06:45:10 - 00:07:23:24<br> Alex Chebl, M.D.<br> Yeah, I would second that. You know, there was some trepidation amongst some team members. You know, our implementation of Rapid AI, there's many different ways that you could implement such a program. One could be it just notifies the radiologist, "hey, there's a potential stroke. Take a look." We have gone to the exact or most extreme or the deepest implementation, meaning all members of the team are notified when we have a stroke, and this has minimized the number of phone calls we have to make to get the patient ready, to get the OR team ready, etc. and when you have that many people learning something new there can be some trepidation. </p> <p> 00:07:23:24 - 00:07:44:12<br> Alex Chebl, M.D.<br> And the biggest fear really was, why do I have to have another app? And this is just going to increase my workload, right? I'm going to be bothered all the time with these unnecessary things. And in fact, it's the exact opposite. Most people got used to it. They could not believe that they were living without it. It's made their lives better. </p> <p> 00:07:44:12 - 00:07:49:11<br> Alex Chebl, M.D.<br> Not just the patients lives better. It made all of our lives better because it's simplified the communication. </p> <p> 00:07:49:14 - 00:08:21:26<br> Aaron Lewandowski, M.D.<br> And I would certainly second that. From an emergency medicine perspective, a lot of our job on a day to day basis is discussing phone calls with consultants and trying to communicate with other team members. So being able to have that initial phone call with the stroke neurologist to discuss the initial plan of care, but then everything else being in the, HIPAA secure chat with rapid AI has certainly allowed for our communication to be much more effective and much more quicker so that everyone can see in real time what's going on, what's the plan? </p> <p> 00:08:21:26 - 00:08:23:14<br> Aaron Lewandowski, M.D.<br> What are we doing for the patient? </p> <p> 00:08:23:16 - 00:08:44:22<br> Tom Haederle<br> Yeah. You hear that so often about applications of AI and in almost any capacity, ambient listening or anything else. People are delighted. It's a time saver and a work saver. And you've seen that with the with the implementation of, Rapid AI at Henry Ford. Any thoughts you would share about another system or hospital that is considering going around and maybe integrating it for the first time? </p> <p> 00:08:44:25 - 00:08:50:24<br> Tom Haederle<br> What would you say in terms of it's utility, in terms of its ease of use, that kind of thing? </p> <p> 00:08:50:26 - 00:09:17:29<br> Alex Chebl, M.D.<br> Well, I mean, I think there's two aspects. One is you've got to lay the groundwork for this. You need a stroke champion, champions. Certainly someone from emergency department is critical. You need someone on the neurology side. And they need to then sell this to everyone. Once you've laid the groundwork and you've got buy-in from everyone </p> <p> 00:09:18:01 - 00:09:41:20<br> Alex Chebl, M.D.<br> the actual implementation isn't that difficult. Securing IT, and the firewalls, etc.. The company helped set up. They also have individuals who can come and help train users. How to use it, how to adjust the settings, etc.. So we found that it was pretty straightforward to initiate the Rapid AI in our system. </p> <p> 00:09:41:26 - 00:10:00:29<br> Alex Chebl, M.D.<br> And one way to do it, I guess, would be my suggestion would be don't start too big. You know, maybe start if you have a large system like we have, you know, start locally, 1 or 2 smaller hospitals. Don't include every single team member. Get the bugs worked out of the system and then expand. </p> <p> 00:10:01:01 - 00:10:21:13<br> Aaron Lewandowski, M.D.<br> And definitely when you're trying to, you know, sell the idea to administration or other departments, certainly focusing on the benefits to patient care, like quicker diagnosis and also the benefits to the team members, such as more effective communication. I think is a really good way to show the positive benefits that can come from this. </p> <p> 00:10:21:16 - 00:10:47:18<br> Alex Chebl, M.D.<br> You know, obviously we do everything focused on the patient. We want the best patient outcomes, but we can't deliver good health care without paying for everything that's required to do so. So the money does play a role. And I think this is where it's important for an administrator to understand is that the better the patient does, the shorter length of stay, the less money is spent on that patient. </p> <p> 00:10:47:22 - 00:11:02:22<br> Alex Chebl, M.D.<br> And therefore a health system can keep more of that money for the other services that they need. And I think that's very important. I mean, after all, this is why we were able to convince CMS to pay for these very complex treatments is because overall it ends up saving money. </p> <p> 00:11:02:24 - 00:11:09:23<br> Tom Haederle<br> It's a great point, thank you. As we wrap up, any final thoughts? Anything we haven't talked about that you'd like to say about Rapid AI? </p> <p> 00:11:09:26 - 00:11:35:20<br> Alex Chebl, M.D.<br> You know, these systems now? Although they're mostly started in stroke, there are many competitors, Rapid AI as well, but they have other modules. And so these systems can be used for other disease states, pulmonary embolism, the identification of intracranial hemorrhage, cerebral aneurysms. And so there are many opportunities for multiple different departments to collaborate. And that can also help with the financial aspects of this. </p> <p> 00:11:35:21 - 00:11:46:14<br> Alex Chebl, M.D.<br> You know, the more users you have on board, it tends to be, you know, cheaper than just having each individual division having their own systems working independently. </p> <p> 00:11:46:16 - 00:11:51:12<br> Tom Haederle<br> That's a great point, thank you. Thank you for bringing that up. Dr, Lewandowski, any final thoughts? </p> <p> 00:11:51:15 - 00:12:09:23<br> Aaron Lewandowski, M.D.<br> I've certainly enjoyed the implementation of Rapid AI. It makes my job simpler. It provides better patient care. You know, I don't think that AI will ever replace physician assessment and judgment, but it's very impressive what a powerful tool it can be when used appropriately, to improve the care that we provide to our patients. </p> <p> :12:09:26 - 00:12:21:22<br> Tom Haederle<br> Absolutely. Thank you both so much for your time today and this great discussion. And I hope it reaches a lot of ears and get some people thinking about just how powerful this tool is. So again, appreciate your time. Thank you for being on Advancing Health. </p> <p> 00:12:21:25 - 00:12:22:15<br> Aaron Lewandowski, M.D.<br> Thank you very much. </p> <p> 00:12:22:20 - 00:12:25:05<br> Alex Chebl, M.D.<br> Thank you. Have a wonderful day. </p> <p> 00:12:25:07 - 00:12:33:18<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details> </div> Mon, 05 May 2025 10:43:47 -0500 Telling the Hospital Story /role-hospitals-alice-peck-day-memorial-hospitals-sleep-center-diagnoses-and-treats-sleep-disorders-improve-health <div class="container"><div class="row"><div class="col-md-9"><div class="row"><div class="col-md-5"><p><img src="/sites/default/files/2025-05/ths-alice-peck-sleep-700x532.jpg" alt="Alice Peck Day Memorial Hospital. A woman sleeps while wearing a breathing device" width="700" height="532"></p></div><p>Sleep is necessary for good health. It鈥檚 estimated that 50 million to 70 million Americans have a sleep disorder such as insomnia, obstructive sleep apnea, narcolepsy or restless legs syndrome. Sleep disorders can affect a person鈥檚 performance at work or school and are closely associated with medical conditions like high blood pressure, depression, diabetes, heart disease and stroke. Despite their high prevalence, most sleep disorders go untreated.</p><p>Alice Peck Day Memorial Hospital鈥檚 accredited Sleep Center offers treatment for sleep disorders in adults and children who are over age 3. The hospital, part of Dartmouth Health, serves communities in the Upper Valley of Vermont and New Hampshire.</p><p>After a patient is referred by their primary care provider, the Sleep Center team conducts an evaluation and, if needed, a sleep study or tests to diagnose a possible sleep disorder and recommend effective treatments. Tests may include polysomnography, a sleep study that monitors a person鈥檚 heart rate, breathing rate and rhythm, eye movement, muscle activity, brain activity, blood oxygen level, and airflow.</p><p><a class="btn btn-primary" href="https://www.alicepeckday.org/services/sleep-health" target="_blank">LEARN MORE</a></p></div></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/center/population-health">Improving Health and Wellness</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Fri, 02 May 2025 11:29:47 -0500 Telling the Hospital Story /role-hospitals-vanderbilt-health-surgeons-first-tennessee-use-new-kidney-preservation-technology <div class="container"><div class="row"><div class="col-md-9"><div class="col-md-6"><p><img src="/sites/default/files/2025-05/ths-KidneyVault-Airplane-700x532.jpg" data-entity-uuid data-entity-type="file" alt="Vanderbilt Health. KidneyVault device shown strapped into a commercial airplane seat" width="700" height="532"></p></div><p>More than 106,000 patients are currently on the national transplant waitlist in the U.S.; 86% of those people are in need of a kidney. Protecting donor kidneys is key when it comes to ensuring the survival of as many of those people as possible. Now a new technology is giving potential kidney recipients in Tennessee new hope.</p><p>Vanderbilt Health kidney transplant surgeons are the first in the state 鈥� and among just a few in the Southeast 鈥� to use a new Food and Drug Administration-approved portable hypothermic perfusion technology that preserves donor kidneys during transport. The Paragonix KidneyVault Renal Perfusion System provides continuous fluids through the kidney. Traditional perfusion machines are often bulky, making them difficult to use over long distances or during air travel. The KidneyVault is much more transportable and, in addition to providing perfusion, can maintain the kidney at an optimal temperature for up to 24 hours, while transporting the organs on ice can lead to varying temperatures, possibly damaging the kidney. Moreover, a monitoring system means that technicians and surgeons can keep an eye on the kidney through its journey.</p><p>Read more about <a href="https://news.vumc.org/2025/04/03/tennessees-first-successful-kidney-transplant-using-new-organ-preservation-technology-performed-at-vanderbilt-university-hospital/">the transplant</a> and <a href="https://www.paragonixtechnologies.com/healthcare-professionals" target="_blank">the KidneyVault</a>.</p></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/topics/innovation">Innovation, Research and Quality Improvement</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Thu, 01 May 2025 15:24:11 -0500 Telling the Hospital Story /role-hospitals-intermountain-primary-childrens-hospital-opens-new-autism-clinic <div class="container"><div class="row"><div class="col-md-9"><div class="row"><div class="col-md-6"><p><img src="/sites/default/files/2025-05/ths-intermountain-childrens-autism-clinic-700x532.jpg" data-entity-uuid data-entity-type="file" alt="Intermountain Health. A young boy sits stacking blocks as a carer looks on" width="700" height="532"></p></div><p>Intermountain Primary Children鈥檚 Hospital has opened a new Applied Behavior Analysis Clinic in Riverton, Utah, that aims to address the growing need for autism services in the community. The clinic offers early intensive services such as behavioral assessments, individual therapy, and group therapy for children aged 2-6 years old and is part of the Primary Promise campaign to build a model health system for children, ensuring that families have access to essential autism care.</p><p>鈥淲e want children with autism and their families to know that we鈥檙e with you on this journey,鈥� said Katy Welkie, chief executive officer of Intermountain Primary Children鈥檚 Hospital and vice president of Intermountain Children鈥檚 Health. 鈥淲ith expanded autism services, we can help children thrive.鈥�</p><p>Made possible with a substantial donation from a Utah philanthropist and her family, the new clinic represents a significant step in closing the care gap for autism services in Utah and surrounding states, where there has historically been a shortage of programs and providers. Intermountain Primary Children鈥檚 Hospital is committed to supporting children with autism and their families, helping them connect to the necessary treatments and services.</p><p><a class="btn btn-primary" href="https://ebu.intermountainhealthcare.org/video/live/intermountain-pc-autism.aspx?j=2403902&sfmc_sub=265543256&l=238325_HTML&u=41337188&mid=515013760&jb=9003">LEARN MORE</a></p></div></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/community-benefit">Benefiting Communities</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Thu, 01 May 2025 14:56:36 -0500 Telling the Hospital Story /costsofcaring <div class="container"><div class="row"><div class="col-md-8"><h2>Introduction</h2><p>America鈥檚 hospitals and health systems are the cornerstone of the nation鈥檚 health care system, providing life-saving care to millions of patients each year. However, hospitals face a perfect storm of financial pressures: persistent cost growth, inadequate reimbursement, and shifting care patterns driven by both policy changes and an older, sicker population with more complex, chronic conditions. Hospitals are struggling to maintain access to essential services amid workforce shortages, supply chain disruptions, tariffs and policy decisions that often fail to reflect on-the-ground realities.</p><p>This report outlines the key trends impacting hospital financial stability in 2025.</p><h2>Hospital Expenses Have Surged and Remain Elevated</h2><h3>Labor Costs Dominate Hospital Expenses</h3><p><img src="/sites/default/files/inline-images/Figure-1-Labor-spend-still-dominated-hospital-expenses-in-2024_0.png" data-entity-uuid="2549d942-1df8-4906-b89f-4b2a3e7b16c1" data-entity-type="file" alt="Figure 1. Labor spend still dominated hospital expenses in 2024. Labor: 56%; $890 billion. Other: 22%; $352 billion. Supplies: 13%; $202 billion. Drugs: 9%; $144 billion. Note: Average expenses estimated by industry benchmark data from Strata Decision Technology, LLC. Labor is inclusive of purchased services and professional fees." width="485" height="457" class="align-right">Hospitals are among the few sectors that consistently employ a highly educated, highly paid workforce 鈥� anchoring local economies with middle- and high-skill jobs that cannot be outsourced or automated. Consequently 鈥� and despite growth in drug spending and other fast-rising non-labor costs 鈥� labor remains the single largest category of hospital spending. Total compensation and related expenses now account for 56% of total hospital costs (see Figure 1). Amid ongoing workforce shortages, hospitals offer competitive wages to retain and recruit staff. According to AHA analysis of Lightcast data, advertised salaries for registered nurses have grown 26.6% faster than the rate of inflation over the past four years. These increases are essential to maintain staffing levels but also contribute to the overall financial challenges hospitals face.</p><h3>Medicare and Medicaid Reimbursements Are Not Keeping Up With the Cost of Caring</h3><p><img src="/sites/default/files/inline-images/Figure-2-Inflation-Overshadows-IPPS-Net-Payment-Increases-FY-2022-to-2024.png" data-entity-uuid="dcf8f08c-3781-4459-9678-f45197fbc0e9" data-entity-type="file" alt="Figure 2. Inflation Overshadows IPPS Net Payment Increases, FY 2022 to 2024. Inflation: 14.1%. IPPS increases: 5.1%. Note: Net IPPS payment increase from FY2022-2024 market basket updates. Inflation measured using CPI-U from BLS using data between October of 2021 and October of 2024." width="484" height="403" class="align-right">Despite escalating expenses, Medicare reimbursement continues to lag behind inflation 鈥� covering just 83 cents for every dollar spent by hospitals in 2023, resulting in over $100 billion in underpayments, according to AHA analysis of AHA Annual Survey data. From 2022 to 2024, general inflation rose by 14.1%, while Medicare net inpatient payment rates increased by only 5.1% 鈥� amounting to an effective payment cut over the past three years (see Figure 2).</p><p>The AHA estimates that this erosion in payment value due to inflation resulted in $8.4 billion in lost hospital revenue during that period, further straining hospitals鈥� ability to care for Medicare beneficiaries, who make up a large share of most hospitals鈥� patients. In total, hospitals absorbed $130 billion in underpayments from Medicare and Medicaid in 2023 alone. These shortfalls are worsening 鈥� growing on average 14% annually between 2019 and 2023.</p><h3>Hospital Expenses are Growing Faster Than Inflation</h3><p>Specifically, in 2024 alone, total hospital expense grew 5.1%, significantly outpacing the overall inflation rate of 2.9%. Though expense growth has started to slow in 2025, it remains elevated 鈥� particularly in areas driven by labor and supply chain pressures. Persistent expense growth threatens hospitals鈥� solvency and their ability to sustain comprehensive services in the communities they serve. A telling indicator of this strain is the average age of plant 鈥� a measure of the age of hospital infrastructure 鈥� which has risen by more than 10% over the last two years, according to industry benchmark data from Strata Decision Technology, LLC. This trend suggests that hospitals are increasingly unable to reinvest in critical physical assets, such as medical equipment, operating rooms and facility upgrades. Delayed capital improvements not only jeopardize care quality but also hinder hospitals鈥� ability to keep pace with evolving health care standards and technology.</p><h3>Impact of Chronic Disease Burden Costs Driven by Increased Utilization</h3><p>Rising hospital costs are increasingly driven by higher utilization and acuity, especially among patients with chronic conditions. According to the Centers for Medicare & Medicaid Services (CMS), recent growth in spending on hospitals reflects increased service intensity and use.<a href="#fn1"><sup>1</sup></a> For example, emergency department (ED) visits related to heart failure increased 126.7% per capita between 2010 and 2019 (see Figure 3), with associated spending growing 177.2%. Similar patterns are observed for type 2 diabetes and acute renal failure 鈥� some of the costliest conditions in terms of patient health and resource use. These trends underscore the demand-side pressures fueling cost growth.</p><img src="/sites/default/files/inline-images/Figure-3-Hospital-ED-Cost-Growth-for-Privately-Insurance-Patients-Driven-by-Increased-Utilization_0.png" data-entity-uuid="c82f1a54-9687-4310-8eb7-944970fa7b48" data-entity-type="file" alt="Figure 3. Hospital ED Cost Growth for Privately Insured Patients Driven by Increased Utilization. Heart Failure: 177.2% Total spending; 126.7% Encounters per capita. Acute renal failure: 56.5% Total spending; 50.0% Encounters per capita. Diabetes mellitus: 75.3% Total spending; 42.6% Encounters per capita. Note: AHA analysis of the data from the Institute of Health Metrics and Evaluation (IHME). Unitied States Health Care spending by Health Condition and County (2010-2019)." width="1039" height="423"><h2>The Growing Impact of Medicare Advantage on Hospital Finances</h2><h3>Observation Stays Are Increasing in Duration</h3><p><img src="/sites/default/files/inline-images/Figure-4-MA-Drives-Longer-Observation-Stays.png" data-entity-uuid="25bdfc97-fde8-4e32-be35-e8947ed26284" data-entity-type="file" alt="Figure 4. MA Drives Longer Observation Stays. Percent Longer MA Observation Stay Compared to Traditional Medicare. 2019: 28.6%. 2024: 36.9%. Note: Data from industry benchmark data from Strata Decision Technology, LLC." width="485" height="580" class="align-right">Medicare Advantage (MA) plans have long relied on extended observation stays to avoid admitting patients as inpatients 鈥� a strategy that helps plans reduce costs but shifts financial burden onto hospitals. Recent data show that this practice is worsening. In 2019, MA patients had observation stays 28.6% longer than those in Traditional Medicare; by 2024, the gap widened to 36.9% (see Figure 4). These prolonged observation stays drive up hospital costs without a corresponding increase in reimbursement, further straining hospital finances. Compared to inpatient admissions, observation stays are reimbursed at lower rates 鈥� or in some cases, not at all 鈥� leaving hospitals to absorb much of the cost. In 2024, MA plans reimbursed just 49% of the actual cost for patients held in observation status, according to industry benchmark data from Strata Decision Technology, LLC.</p><h3>Longer Stays, Lower Payments</h3><p>The inpatient setting reveals a similar pattern: longer stays for MA patients but with lower reimbursement. From 2019 to 2024, the average length of stay for MA patients grew substantially compared to Traditional Medicare 鈥� more than doubling the gap over this period, according to industry benchmark data from Strata Decision Technology, LLC. Yet during the same timeframe, hospital reimbursement from MA plans fell by 8.8% on a cost basis. In other words, hospitals are being asked to do more with less.</p><h3>Discharge Delays Are Compounding the Problem</h3><p><img src="/sites/default/files/inline-images/Figure-5-MA-Delays-Discharges-to-Post-Acute-Care.png" data-entity-uuid="d76d655b-ff83-40d7-a6f0-f179c94a93a6" data-entity-type="file" alt="Figure 5. MA Delays Discharges to Post-Acute Care. Percent Longer MA Stay Compared to Traditional Medicare. 2019: 6.4%. 2020: 6.0%. 2021: 10.5%. 2022: 14.7%. 2023: 13.9%. 2024: 12.6%. Note: Data from industry benchmark data from Strata Decision Technology, LLC." width="592" height="434" class="align-right">Delays in discharging patients to post-acute care facilities are a growing contributor to longer inpatient stays. These delays are often driven by prior authorization requirements or insufficient post-acute provider networks within MA plans. Among MA patients, the average length of stay prior to discharge to post-acute care has doubled relative to Traditional Medicare between 2019 and 2024 (see Figure 5). These delays lead to higher costs, increased hospital crowding 鈥� including in the emergency department 鈥� and longer lengths of stay. In some cases, plans may use these delays to steer patients toward lower-cost care settings 鈥� or avoid post-acute care altogether 鈥� while the hospital continues to absorb the cost of care. A Senate Permanent Subcommittee report recently found that some MA plans disproportionately imposed prior authorization and claim denials on post-acute care, exacerbating delays and shifting costs to hospitals.<a href="#fn2"><sup>2</sup></a> Post-acute care providers also have faced lagging reimbursement rates from Medicare, which has exacerbated staffing challenges and made it difficult to accommodate discharge requests from acute-care hospitals.</p><h3>Lower Reimbursement and Increasing Administrative Burden</h3><p>Hospitals are increasingly reporting lower negotiated MA rates than Traditional Medicare for many common inpatient services (see Figure 6). These discrepancies continue to create significant financial challenges for hospitals, especially for those in rural areas that have seen relatively fast growth in the volume of MA beneficiaries in recent years.<a href="#fn3"><sup>3</sup></a></p><img src="/sites/default/files/inline-images/MA-Negotiated-Rates-as-a-Percentage-of-Traditional-Medicare-Rates-Selected-DRGs.png" data-entity-uuid="062e44a9-197b-4ab3-b674-4c5bff0ce4e5" data-entity-type="file" alt="MA Negotiated Rates as a Percentage of Traditional Medicare Rates, Selected DRGs. MS-DRG 190 Chronic Obstructive Pulmonary Disease: 96.5% of FFS rates. MS-DRG 280 Acute Myordial Infarction: 96.2% of FFS rates. MS-DRG 470 Major Joint Replacement or Reattachment of Lower Extremity: 97.6% of FFS rates. Note: AHA analysis of hospital price transparency data from Turquoise Health. Figures calculated by dividing hospital-level median MA rates by hospital-specific baseline FFS rates. Outliers excluded (5th and 95th percentiles)." width="1062" height="289" class="align-center"><p>At the same time, administrative complexity continues to increase. MA plans issued nearly 50 million prior authorizations in 2023 鈥� up more than 40% since 2020, according to KFF.<a href="#fn4"><sup>4</sup></a> A Premier study found that hospitals spent $26 billion in 2023 managing insurance claims 鈥� a 23% increase over the previous year.<a href="#fn5"><sup>5</sup></a></p><p>Notably, 70% of denied claims were eventually paid, but only after multiple costly reviews. These burdens not only strain hospitals financially but also delay care and divert clinical staff from patient care. A Morning Consult survey commissioned by the AHA found that 85% of clinicians report that prior authorization and other requirements delay necessary care.</p><h2>Impact of Tariffs on Hospital Costs</h2><p>Hospitals and health systems rely on the right medicines, devices and other supplies used at the right time to support the delivery of safe and effective care. The supply chain for these essential medical goods is complex, weaving together both domestic and international sourcing, and is prone to significant disruption. For example, as of March 2025, there were 270 active drug shortages in the U.S., including shortages of life-saving intravenous (IV) fluids stemming from Hurricane Helene in 2024.<a href="#fn6"><sup>6</sup></a> Recent changes in U.S. trade policy are creating additional uncertainty, with the Administration implementing new tariffs that affect medical devices and supplies, and considering new tariffs on pharmaceuticals. Tariffs on these critical goods could exacerbate shortages, disrupt patient care and raise costs for hospitals.</p><p>Despite efforts to bolster the domestic supply chain, a significant proportion of essential medical goods come from international sources. For example, nearly 70% of medical devices marketed in the U.S. are manufactured exclusively overseas.<a href="#fn7"><sup>7</sup></a> In 2024 alone, the U.S. imported over $75 billion in medical devices and supplies, according to AHA analysis of Census Bureau data. These imports include many lowmargin, high-use essentials in hospital settings 鈥� such as syringes, needles, blood pressure cuffs, and IV saline bags. Hospitals rely on imports for advanced surgical tools and other critical technologies as well.</p><p>Moreover, hospitals rely on international sources for a significant proportion of the protective equipment for their caregivers. In 2023, Chinese manufacturers supplied the majority of N95 and other respirators used in health care. Additionally, China was the source for one-third of disposable face masks, two-thirds of non-disposable face masks, and 94% of the plastic gloves used in health care settings.<a href="#fn8"><sup>8</sup></a></p><p>Many pharmaceuticals 鈥� and especially the key starter ingredients that go into them 鈥� also are sourced from overseas. The U.S. gets nearly 30% of its active pharmaceutical ingredients (APIs) from China.<a href="#fn9"><sup>9</sup></a> According to a 2023 Department of Health and Human Services estimate, over 90% of generic sterile injectable drugs 鈥� such as certain chemotherapy treatments and antibiotics 鈥� depend on key starter materials from either India or China.<a href="#fn10"><sup>10</sup></a> Even temporary disruptions in access to medication and supplies can impact care and increase the risk of patient harm.</p><p>Tariffs on medical imports could significantly raise costs for hospitals. A recent survey found that 82% of health care experts expect tariff-related expenses to raise hospital costs by at least 15% over the next six months, and 94% of health care administrators expected to delay equipment upgrades to manage financial strain.<a href="#fn11"><sup>11</sup></a> Tariffs also may force hospitals to seek new vendors 鈥� often at higher cost or with lower reliability. In fact, 90% of supply chain professionals are expecting procurement disruptions.<a href="#fn12"><sup>12</sup></a></p><h2>Conclusion: Supporting Hospitals Means Supporting Patients</h2><p>Hospitals are not only centers of care but also vital economic engines in their communities. Rising costs, inadequate reimbursement, and policy-driven inefficiencies jeopardize the ability of hospitals to deliver high-quality, timely care. To ensure that hospitals can continue to serve patients and communities, policymakers should:</p><ul class="arrow"><li class="arrow">Recognize that rising expenses reflect real pressures, such as labor shortages and increasing demand 鈥� not inefficiency.</li><li class="arrow">Acknowledge Medicare and MA payment policies must be updated to reflect the actual cost of care.</li><li class="arrow">Address structural drivers of cost, such as care delays and excessive administrative burdens, instead of simply cutting payments.</li></ul><p>As we look to the future, preserving access to hospital care should be a national priority. Supporting hospitals means supporting patients, communities and the entire health care system.</p><hr><h2>Notes</h2><ol><li id="fn1"><a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.01375" target="_blank">healthaffairs.org/doi/10.1377/hlthaff.2024.01375</a></li><li id="fn2"><a href="https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf" target="_blank">hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf</a></li><li id="fn3"">aha.org/system/files/media/file/2025/02/growing-impact-of-medicare-advantage-on-rural-hospitals.pdf</li><li id="fn4"><a href="https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/" target="_blank">kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/</a></li><li id="fn5"><a href="https://premierinc.com/newsroom/blog/claims-adjudication-costs-providers-25-7-billion" target="_blank">premierinc.com/newsroom/blog/claims-adjudication-costs-providers-25-7-billion</a></li><li id="fn6"><a href="https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics?loginreturnUrl=SSOCheckOnly" target="_blank">ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics?loginreturnUrl=SSOCheckOnly</a></li><li id="fn7"><a href="https://www.medicaldevice-network.com/analyst-comment/trump-tariffs-us-medical-device-market/" target="_blank">medicaldevice-network.com/analyst-comment/trump-tariffs-us-medical-device-market/</a></li><li id="fn8">AdvaMed presentation, 2023.</li><li id="fn9"><a href="https://www.atlanticcouncil.org/blogs/econographics/the-us-is-relying-more-on-china-for-pharmaceuticals-and-vice-versa/" target="_blank">atlanticcouncil.org/blogs/econographics/the-us-is-relying-more-on-china-for-pharmaceuticals-and-vice-versa/</a></li><li id="fn10"><a href="https://aspe.hhs.gov/sites/default/files/documents/3a9df8acf50e7fda2e443f025d51d038/HHS-White-Paper-Preventing-Shortages-Supply-Chain-Vulnerabilities.pdf" target="_blank">aspe.hhs.gov/sites/default/files/documents/3a9df8acf50e7fda2e443f025d51d038/HHS-White-Paper-Preventing-Shortages-Supply-Chain-Vulnerabilities.pdf</a></li><li id="fn11"><a href="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/" target="_blank">beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/</a></li><li id="fn12"><a href="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/" target="_blank">beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/</a></li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/04/The-Cost-of-Caring-April-2025.pdf" target="_blank" title="Click here to download the The Cost of Caring: Challenges Facing America鈥檚 Hospitals in 2025 report PDF."><img src="/sites/default/files/inline-images/Page-1-The-Cost-of-Caring-April-2025.png" data-entity-uuid="658521c4-19cc-4776-a588-acc23144a3be" data-entity-type="file" alt="The Cost of Caring: Challenges Facing America's Hospitals in 2025 page 1." width="695" height="900"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2025-04-28-2024-costs-caring" target="_blank">View the 2024 Costs of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2024-09-10-skyrocketing-hospital-administrative-costs-burdensome-commercial-insurer-policies-are-impacting" target="_blank">View the Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Are Impacting Patient Care Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2024-05-01-2023-costs-caring" target="_blank">View the 2023 Costs of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2023-04-20-2022-costs-caring" target="_blank">View the 2022 Costs of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2021-10-25-2021-cost-caring" target="_blank">View the 2021 Costs of Caring Report</a></div></div></div></div> h2 { color: #9d2235; } h3 { color: #003087; } ul.arrow { list-style: none; margin-left: 20px; padding-left: 0; } li.arrow { padding-left: 1em; text-indent: 1em; } li.arrow:before { content: "馃牪"; color: #003087; padding-right: 10px; margin-left: -42px; } Wed, 30 Apr 2025 06:00:00 -0500 Telling the Hospital Story /role-hospitals-university-vermont-medical-center-innovative-procedure-game-changer-older-adults-heart-valve-disease <div class="container"><div class="row"><div class="col-md-9"><div class="col-md-6"><p><img src="/sites/default/files/2025-04/THS-UVM-hazel-winter-700x532.jpg" data-entity-uuid data-entity-type="file" alt="Hazel Winter, 82, underwent the tricuspid transcatheter edge-to-edge repair (TEER) procedure at UVM Medical Center" width="700" height="532"></p><p><em>Hazel Winter (Photo Courtesy of UVM Medical Center)</em></p></div><p>An innovative, minimally invasive procedure is reducing the risk faced by patients with heart valve disease and improving their quality of life. During the tricuspid transcatheter edge-to-edge repair (TEER) procedure, surgeons use a clip to repair a leaky heart valve. The University of Vermont Medical Center in Burlington is currently the only hospital in the state that offers TEER and among the most experienced performing the procedure among health systems in the region.</p><p>Heart valve disease 鈥� which occurs when at least one heart valve isn鈥檛 working properly 鈥� affects more than 5 million people in the U.S., according to the <a href="https://www.cdc.gov/heart-disease/php/data-research/heart-valve-disease-toolkit/index.html" target="_blank">Centers for Disease Control and Prevention</a>. Symptoms include fatigue, swelling in the legs, shortness of breath and irregular heart rhythms. Older adults in particular are at risk for this condition, which can lead to heart failure.</p><p>A blog on the UVM Health website, 鈥�<a href="https://www.uvmhealth.org/healthsource/wheelchair-walking" target="_blank">From Wheelchair to Walking</a>,鈥� features the story of Hazel Winter, 82, who had a minor stroke and was being treated at the UVM Medical Center emergency department, where clinicians discovered she had tricuspid valve regurgitation, a condition where the valve allows blood to leak backward into the heart.</p><p>Winter was one of the first patients in the region to undergo TEER. Before this procedure was developed, the only options for patients were undergoing open-heart surgery or living with a condition that significantly reduces their quality of life. Winter marveled at how much better she felt after the procedure: 鈥淚 arrived by wheelchair, and I鈥檓 planning on walking out of here 鈥�. I can鈥檛 believe the difference this had made for me already. It鈥檚 a game changer.鈥�</p><p>Rony Lahoud, M.D., interventional cardiologist at UVM Medical Center, observed, 鈥淭o watch people go home the very next day and immediately feel the difference 鈥� that鈥檚 the kind of outcome you aspire to have.鈥� He lauded the medical center鈥檚 multidisciplinary teamwork to develop this innovative treatment: 鈥淧ushing the boundaries of what is possible requires true collaboration between different specialties, including interventional cardiology, advanced cardiac imaging, cardiac anesthesia and cardiothoracic surgery, among others.鈥�</p><p><a class="btn btn-primary" href="https://www.uvmhealth.org/healthsource/wheelchair-walking" target="_blank">LEARN MORE</a></p></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/topics/innovation">Innovation, Research and Quality Improvement</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Tue, 29 Apr 2025 14:14:07 -0500 Telling the Hospital Story /guidesreports/2025-04-28-2024-costs-caring <div class="container"><div class="row"><div class="col-md-8"><h2><span>Introduction</span></h2><p><img src="/sites/default/files/inline-images/Figure-1-Labor-constitutes-largest-percentage-of-hospital-expenses.png" data-entity-uuid="d6c1793f-d4c3-44ea-8ba5-d1f15b6518e2" data-entity-type="file" alt="Figure 1. Labor constitutes largest percentage of hospital expenses. Labor: 60% ($839 Billion); Supplies: 13% ($181 Billion); Drugs: 8% ($115 Billion); Other: 19% ($269 Billion). Note: Average expenses estimated by Strata Decision Technology median 2023 values across all hospital spending. Labor is inclusive of purchased services and professional fees." width="718" height="752" id="figure1" class="align-right">Hospitals and health systems have been at the forefront of a major transformation while at a crossroads of increasing demand for higher acuity care and deepening financial instability. Persistent workforce shortages, severe fractures in the supply chain for drugs and supplies, and high levels of inflation have collectively fueled hospitals鈥� costs as they care for patients 24/7 (see <a href="#figure1">Figure 1</a>). At the same time, hospitals鈥� costs have been met with inadequate increases in reimbursement by government payers and increasing administrative burden due to inappropriate commercial health insurer practices.</p><p><strong>Taken together, these issues have created an environment of financial uncertainty where many hospitals and health systems are operating with little to no margin. While recent data suggest that some hospital and health system finances have experienced modest stabilization from historic lows in 2022, the hospital field is still far from where it needs to be to meet the demand for care, invest in new and promising technologies and interventions, and stand ready for the next health care crisis.</strong></p><p><img src="/sites/default/files/inline-images/Figure-2-Inflation-growth-was-more-than-double-the-growth-in-IPPS-reimbursement-2021-2023.png" data-entity-uuid="90ce5355-e63a-4187-bfae-5a641d891486" data-entity-type="file" alt="Figure 2. Inflation growth was more than double the growth in IPPS reimbursement, 2021鈥�2023. Inflation: 12.4%; IPPS Increases: 5.2%. Note: Inflation calculated using annual average CPI-U between 2021 and 2023 from BLS. IPPS increase from FY2020鈥�2023 market basket increases net of other adjustments." width="385" height="705" id="figure2" class="align-left">Fresh off a historically challenging year financially in 2022 in which over half of hospitals closed out the year operating at a loss, many hospitals spent much of 2023 simply struggling to break even.<a href="#fn1"><sup>1</sup></a> Economy-wide inflation grew by 12.4% between 2021 and 2023 鈥� more than two times faster than Medicare reimbursement for hospital inpatient care (see <a href="#figure2">Figure 2</a>).</p><p>Since the start of 2022, the number of days cash on hand for hospitals and health systems has declined by 28.3%, according to data from Strata Decision Technology, which provides data and cloud-based financial planning, decision support and performance analytics solutions.<a href="#fn2"><sup>2</sup></a></p><p>Diverting dollars from their reserves to maintain access to care has required tradeoffs that have limited many hospitals and health systems from investing in updated infrastructure, new medical technology and equipment, and other clinical needs 鈥� particularly among those hospitals in severe financial distress.<a href="#fn3"><sup>3</sup></a><sup>,</sup><a href="#fn4"><sup>4</sup></a> For example, the average age of capital investments for medical equipment and infrastructure, after years of remaining relatively flat, increased by 7.1% for all hospitals in 2023, according to data from Strata Decision Technology. While the constraints and burdens of increasing plant age present serious challenges to hospitals and health systems in their own right, the inability to make needed capital investments has contributed to bond rating agencies issuing rating downgrades, making it harder for some hospitals and health systems to borrow money.<a href="#fn5"><sup>5</sup></a> Ongoing reimbursement challenges, made worse by crises like the recent Change Healthcare cyberattack, and increased operating costs create an unsustainable financial environment.<a href="#fn6"><sup>6</sup></a> While these challenges alone could cripple any organization, hospitals and health systems continue to face additional threats from ongoing Medicaid redeterminations increasing uncompensated care<a href="#fn7"><sup>7</sup></a>, regulatory changes that add operational burden, cyberattacks that threaten the health care infrastructure and potential legislation that would further cut Medicare payments to hospitals.</p><p>This report provides a snapshot of the current cost realities facing hospitals and health systems and how they impact their ability to care for patients and communities.</p><h2><span>1. Costs of Providing Essential Services</span></h2><p><img src="/sites/default/files/inline-images/Figure-3-Cumulative-Medicaid-and-Medicare-underpayments.png" data-entity-uuid="1846fd31-a865-4fcb-8de7-b4ca6bf1b3f2" data-entity-type="file" alt="Figure 3. Cumulative Medicaid and Medicare underpayments. 2013 to 2017: -$375 Billion; 2018 to 2022: -$522 Billion. Note: AHA Annual Survey 2013 to 2022 all dollars inflation adjusted to 2022 values using CPI-U from the BLS." width="620" height="672" id="figure3" class="align-right">Hospitals often play the critical 鈥� and sometimes only 鈥� role in providing access to essential health care services, such as emergency care and behavioral health, which are necessary for the health and well-being of the communities they serve. Further, oftentimes these are services that are not offered by other types of health care providers. In 2022, the most recent year for which data are available, hospitals admitted nearly 137 million patients in emergency departments and delivered over 3.5 million babies.<a href="#fn8"><sup>8</sup></a> Many of these essential services are extremely resource intensive and costly to offer. Further compounding this issue are demographic trends such as an aging population and clinical factors such as higher patient acuity. This has driven a steady rise in the share of inpatient utilization among more clinically complex patients covered by Medicare and Medicaid.<a href="#fn9"><sup>9</sup></a> Not only are inpatient services costlier to provide, but public payer payments for these services fall well below costs. In fact, underpayments from Medicare and Medicaid totaled nearly $130 billion in 2022, and Medicare paid just 82 cents for every dollar hospitals spent caring for patients 鈥� resulting in a shortfall of almost $100 billion.<a href="#fn10"><sup>10</sup></a> Troublingly, cumulative underpayments in the second half of the last decade totaled more than half a trillion dollars 鈥� a nearly 40% increase compared to the first half even after adjusting for inflation (see <a href="#figure3">Figure 3</a>).</p><p>However, the reimbursement challenges do not end with Medicare and Medicaid Reimbursement for some services consistently fall below costs across all payer types. For example, payments for inpatient behavioral health services were 34.3% below costs across all payers on average in 2023, according to data from Strata Decision Technology (see <a href="#figure4">Figure 4</a>). This is especially concerning given the increased utilization of behavioral health services over the last few years.</p><img src="/sites/default/files/inline-images/Figure-4-Hospital-payments-do-not-cover-the-costs-of-providing-vital-patient-services-20240612.png" data-entity-uuid="96ed5e28-677a-4ba0-8659-407033fe0a56" data-entity-type="file" alt="Figure 4. Hospital payments do not cover the costs of providing vital inpatient services. Average margin on services: Behavioral Health -34.3%; Nephrology -34.1%; Burns and Wounds -24.1%; Pulmonology -19.4%; Infectious Disease -15.3%. Note: AHA analysis of 2023 average service line payment and cost across all payers from Strata Decision Technology. Does not include supplemental payments from Medicaid." width="1565" height="623" id="figure4"><p>In the outpatient setting, average payments for costly burn and wound services were 42.9% below costs across all payers (see <a href="#figure5">Figure 5</a>). These shortfalls have been especially acute for government payers like Medicare. For example, average Medicare margins for behavioral health services were -38.9% in 2023.</p><img src="/sites/default/files/inline-images/Figure-5-Hospital-payments-also-fail-to-cover-the-costs-of-providing-essential-outpatient-services.png" data-entity-uuid="a43ea45f-a309-46a9-9acc-fb54b385b5b2" data-entity-type="file" alt="Figure 5. Hospital payments also fail to cover the costs of providing essential outpatient services. Average margin on services: Burns and wounds -42.9%; Nephrology -32.3%; Behavioral Health -31.7%; Pulmonology -17.5%; Infectious Disease -12.1%. Note: AHA analysis of 2023 average service line payment and cost across all payers from Strata Decision Technology. Does not include supplemental payments from Medicaid." width="1558" height="616" id="figure5"><p>Taken together, these data highlight the challenges that hospitals and health systems face in providing essential services that communities need. This is particularly true for hospitals in rural areas, where the financial challenges can be even more severe.</p><h2><span>2. Hospital Administrative Expenses</span></h2><p><span><em><strong><img src="/sites/default/files/inline-images/Figure-6-Premiums-grew-twice-as-fast-as-hospital-prices-in-2023.png" data-entity-uuid="d158d191-431b-4548-aebc-57269df046dc" data-entity-type="file" alt="Figure 6. Premiums grew twice as fast as hospital prices in 2023. Health Insurance Premiums: 6.7%; Hospital Prices: 2.6%. Note: Health insurance premiums represent premiums for a family of four, from KFF Employer Health Benefits Survey, 2023. Hospital Prices: BLS, annual average Producer Price index for hospitals." width="607" height="790" id="figure6" class="align-right">Some commercial health insurer practices increase hospital costs and delay care to patients</strong></em></span></p><p>Hospitals have seen significant growth in administrative costs due to inappropriate practices by certain commercial health insurers, including Medicare Advantage (MA) and Medicaid managed care plans. In addition to increasing premiums, which grew twice as fast as hospital prices in 2023, commercial health insurers have overburdened hospitals with time-consuming and labor-intensive practices like automatic claims denials and onerous prior authorization requirements (see <a href="#figure6">Figure 6</a>).<a href="#fn11"><sup>11</sup></a></p><p>A 2021 study by McKinsey estimated that hospitals spent $10 billion annually on dealing with insurer prior authorizations.<a href="#fn12"><sup>12</sup></a> Additionally, a 2023 study by Premier found that hospitals are spending just under $20 billion annually in appealing denials 鈥� more than half which was wasted on claims that should have been paid out at the time of submission.<a href="#fn13"><sup>13</sup></a> Denials issued by commercial MA plans rose sharply by 55.7% in 2023.<a href="#fn14"><sup>14</sup></a> Notably, many of these denials were ultimately overturned, consistent with a study by the Department of Health and Human Services鈥� (HHS) Office of Inspector General (OIG) that found 75% of care denials were subsequently overturned.<a href="#fn15"><sup>15</sup></a> These denials are particularly concerning because they often occur for medically necessary care, which can result in direct patient harm. In fact, a recent HHS OIG report found that nearly one in five MA denials met Medicare coverage rules, which meant that had they been paid via Medicare fee-for-service, they would have been paid without denial.<a href="#fn16"><sup>16</sup></a> Even when denials are ultimately overturned, hospitals are not paid for the costs incurred to navigate that burdensome and resource-intensive process. Making matters worse, MA plans paid hospitals less than 90% of Medicare rates despite costing taxpayers more than traditional Medicare in 2023.<a href="#fn17"><sup>17</sup></a><sup>,</sup><a href="#fn18"><sup>18</sup></a> Although partly a function of lower rates, the worsening administrative overload is simply costing hospitals more and more.</p><p>Though these issues are often felt most acutely with MA and Medicaid managed care plans, it also is true for other commercial payers, where claims denials increased by 20.2% in 2023. Moreover, the time taken by commercial payers to process and pay hospital claims from the date of submission increased by 19.7% in 2023, according to data from the Vitality Index. For hospitals and health systems, these practices result in billions of dollars in lost revenue each year, which require hospitals to divert dollars away from patient care to instead focus on seeking payment from commercial insurers.<a href="#fn19"><sup>19</sup></a> Without further intervention, these trends are expected to continue and worsen. National expenditures on the administrative costs of private health insurance spending alone are projected to account for 7% of total health care spending between 2022 and 2031 and are projected to grow faster than expenditures for hospital care.<a href="#fn20"><sup>20</sup></a></p><h3><span>Other expenses</span></h3><p>Hospitals also are spending more on things that are not direct patient care services but are still critical to delivering care and maintaining operations. For example, the costs associated with implementing, maintaining and upgrading information management systems and overall technology infrastructure, while critical to improving efficiency and quality of care, typically represent significant investments.</p><p>Additionally, given the confidential nature of patient data in these systems, hospitals have increasingly become targets for cyberattacks. As a result, the costs of defending against these attacks and protecting patient data has grown steadily.<a href="#fn21"><sup>21</sup></a> Health care data breaches are by far the costliest of any other sector.<a href="#fn22"><sup>22</sup></a> As cyberattacks and data breaches in health care have grown and regulators are requiring more robust protections, hospitals and health systems are finding themselves increasingly trying to invest in cybersecurity.<a href="#fn23"><sup>23</sup></a> Protecting against cyberattacks and other vulnerabilities is important to patient care, but is increasingly costly. In 2022, hospitals spent nearly $30 billion on property and medical liability insurance, according to data from Lightcast.</p><h2><span>3. Hospital Drug Expenses</span></h2><p>An area of persistent cost pressure for hospitals and health systems has been the rapid and sustained growth in drug expenses. Hospitals spent $115 billion on drug expenses in 2023 alone. One of the factors fueling this growth is drug company decisions to impose large price increases on existing drugs. However, 2023 also saw a continuation of a long-standing trend of drug companies introducing new drugs at record prices. In 2023, the median annual list price for a new drug was $300,000, an increase of 35% from the prior year (see <a href="#figure7">Figure 7</a>).<a href="#fn24"><sup>24</sup></a> A recent report by the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that between 2022 and 2023, prices for nearly 2,000 drugs increased faster than the rate of general inflation, with an average price hike of 15.2%.<a href="#fn25"><sup>25</sup></a></p><img src="/sites/default/files/inline-images/Figure-7-Annual-List-Prices-of-Novel-Drugs-Launched-in-2023.png" data-entity-uuid="b88a70d2-300e-48d9-90f9-e3fbe3b80e83" data-entity-type="file" alt="Figure 7. Annual List Prices of Novel Drugs Launched in 2023*. Elevidys: $3,200,000; Roctavian: $2,900,000; Veopoz: $1,799,980; Altuviiio: $970,000; Pombiliti: $650,000; Talvey: $360,000; Orserdu: $280,526; Adzynma: $245,000; Zynyz: $170,880; Filspari: $129,965; Velsipity: $74,000; Leqembi: $26,000. Median price of new drug: $300,000. Median household: $74,580. Average price of a new car: $48,759. Source: Annual list prices of novel drugs launched in 2023 are from a Reuters survey of new drug costs. Median household income is from 2022 Census Bureau data. Average price of new care is from Kelly Blue Book new-vehicle transaction price in December 2023." width="1563" height="771" id="figure7"><p><img src="/sites/default/files/inline-images/Figure-8-Increase-in-drug-shortages-and-drug-prices-2022-2023.png" data-entity-uuid="e6973989-b4db-4b1f-a2ac-dd8b512598d6" data-entity-type="file" alt="Figure 8. Increase in drug shortages and drug prices, 2022鈥�2023. 2022: Drug Shortages 8.0%; Drug Prices 11.5%. 2023: Drug Shortages: 13.0%; Drug Prices 15.2%. Note: Drug shortage data from Utah Drug Information System; Drug price data from ASPE." width="607" height="691" id="figure8" class="align-right">While high drug prices alone pose significant challenges for hospitals and health systems, it is compounded by the fact that many of these same drugs are in shortage. In fact, 2023 saw the most drug shortages in over a decade; there were an average of 301 drugs in shortage per quarter, an increase of 13.0% from the previous year (see <a href="#figure8">Figure 8</a>). These shortages added as much as 20% to hospital drug budgets, according to data from the American Society of Health System Pharmacists (ASHP). These shortages can occur for many reasons, including fractured global supply chains lack of available raw materials, and decisions by drug companies that lack incentives to produce low-margin generic medications.<a href="#fn26"><sup>26</sup></a> An ASHP survey found that more than 99% of hospital and health system pharmacists experienced drug shortages in 2023, with 85% of respondents describing the severity of drug shortages as critically or moderately impactful.<a href="#fn27"><sup>27</sup></a> While generic drugs comprised the majority of medications in shortage, estimated to make up as much as 83% of shortages, many of these drugs also were used to treat cancer and autoimmune diseases.<a href="#fn28"><sup>28</sup></a></p><p>Hospital pharmacy staff have limited options for navigating drug shortages. They can purchase the drug by going outside their traditional suppliers and group purchasing agreements, access alternate concentrations or package sizes of the drugs than what is needed or purchase a substitute drug with the same clinical indication. However, all three of these options mean hospitals pay higher prices to acquire the drugs. An ASPE report found up to a 16.6% increase in the prices of drugs in shortage; in many cases, the increase in the price of substitute drugs were at least three times higher than the price increase of the drug in shortage.<a href="#fn29"><sup>29</sup></a> The costs incurred as a result of drug shortages are compounded by staff overtime needed to find, procure and administer alternative drugs, to manage the added challenges of multiple medication dispensing automation systems and changing electronic health records (EHRs), and to undergo training to ensure medication safety using alternative therapies.<a href="#fn30"><sup>30</sup></a></p><h2><span>4. Hospital Supply Costs</span></h2><div class="row"><div class="col-md-5"><p>Having adequate and up-to-date medical supplies, devices and equipment are necessary for hospitals to deliver high quality care to patients. These can include artificial joints used to treat patients with conditions such as arthritis, robotic surgery machines used to perform laparoscopic surgical procedures, and complex imaging machinery used for clinical diagnostics. Most of these items are expensive to acquire and maintain and rely on increasingly volatile global supply chains. Comprising approximately 10.5% of the average hospital鈥檚 budget, medical supply expenses collectively accounted for $146.9 billion in 2023, an increase of $6.6 billion over 2022, according to data from Strata Decision Technology. As technology and science are constantly evolving, hospitals routinely need to purchase new supplies, devices and equipment that meet clinical care standards and ensure high quality care.</p><p>The upfront costs for critical equipment and device upgrades come at a significant cost (<a href="#table1">Table 1</a>). For example, the advanced technology of cardiac magnetic resonance imaging (cMRI) machines, which have allowed doctors to develop a deeper understanding of cardiac pathologies and has led to improved diagnostics, costs hospitals on average $3.2 million. For some hospitals that have high demand for cardiac services, they may need to purchase multiple cMRI machines. The additional costs for ongoing maintenance, upgrades and staff training also add to the total costs hospitals must incur to deliver their patients with the high quality care.</p></div><div class="col-md-7"> table, th, td { border: 1px solid; } th { background-color: #69b3e733; } } <table id="table1"><tbody><tr><td><h3>Table 1. Medical Device and Equipment Market Prices</h3></td></tr><tr><td><em>Cutting-edge innovation and technologies provide hospitals with the means to enhance patient outcome in their continuous commitment to delivering top-tier patient care. The featured equipment is intricately connected to advancements in diagnostics, heightened success rates in cardiovascular surgery, and more effective joint replacement procedures.</em></td></tr></tbody></table><table><thead><tr><th>Medical Devices and Equipment</th><th>Average List Price</th></tr></thead><tbody><tr><td colspan="2"><strong>Point of Care ultrasound devices</strong></td></tr><tr><td>Pocket-sized handheld or tablet-based</td><td>$8,143</td></tr><tr><td>Compact ultrasound systems*</td><td>$73,797</td></tr><tr><td colspan="2"><strong>Cardiovascular diagnostic and surgical equipment</strong></td></tr><tr><td>Cardiac magnetic resonance imaging (cMRI) machine</td><td>$3,230,728</td></tr><tr><td>Cardiopulmonary bypass system</td><td>$325,442</td></tr><tr><td colspan="2"><strong>Joint implant proprietary software and equipment</strong></td></tr><tr><td>Image based planning software</td><td>$222,132</td></tr><tr><td>Navigation software system (guide surgeons in real-time)</td><td>$135,365</td></tr><tr><td colspan="2"><p>*Larger than handheld devices, but still portable. May have more advanced features.</p><p><span><strong>Note:</strong></span> Market prices of medical devices and equipment are courtesy of ECRI, an independent not-for-profit corporation that provides a wide range of services dealing with health care technology.</p></td></tr></tbody></table></div></div><h2><span>5. Hospital Labor Costs</span></h2><p>Hospitals鈥� labor costs increased by more than $42.5 billion between 2021 and 2023 to a total of $839 billion, accounting for nearly 60% of the average hospital鈥檚 expenses. Hospitals continue to turn to expensive contract labor to fill gaps and maintain access to care, spending approximately $51.1 billion on contracted staff in 2023.</p><p><img src="/sites/default/files/inline-images/Figure-9-Growth-in-Total-Hospital-Employee-Compensation-Far-Outpaces-Inflation.png" data-entity-uuid="5fa4709d-12e9-47f3-af06-07ac3b0937b6" data-entity-type="file" alt="Figure 9. Growth in Total Hospital Employee Compensation Far Outpaces Inflation. 2014 to 2023: Inflation 28.7%; Hospital Employee Compensation 45.0%. Note: BLS Annual average Employee Cost Index, 2014 to 2023 for hospitals and CPI-U, 2014 to 2023." width="522" height="592" id="figure9" class="align-right">Though expenditures on contract labor have moderated since pandemic highs, the spending remains elevated and has added to the financial challenges hospitals and health systems face. This is especially true for smaller, rural hospitals where the local workforce pool is smaller and it can be more difficult to recruit staff. Hospitals鈥� labor costs also can be very sensitive to sudden fluctuations in the demand and supply of labor. Growth in wages and benefits of hospital employees has vastly surpassed economy-wide inflation over the last decade (see <a href="#figure9">Figure 9</a>).</p><p>Yet, critical labor shortages persist, especially in the face of growing burnout among clinicians. Employee burnout hastened by the pandemic and further exacerbated by commercial insurer administrative burden and increase in violence against hospital employees, led to an unprecedented exodus of health care professionals in recent years.<a href="#fn31"><sup>31</sup></a> Resignations per month among health care workers grew 50% between 2020 and 2023, according to data from McKinsey.<a href="#fn32"><sup>32</sup></a> Additionally, hospitals have been forced to contend with record high turnover rates 鈥� fueling additional expenses for hospitals looking to recruit new workers.<a href="#fn33"><sup>33</sup></a></p><p>Consequently, hospitals and health systems have invested more to attract and retain talent. Data from Lightcast indicates that advertised wage rates across all hospital jobs jumped by 10.1% during 2023. With a growing gap between supply and demand for health care workers over the next decade, labor costs will likely continue to be an issue for hospitals.</p><h2><span>A Look Ahead to the Rest of 2024</span></h2><p>Though 2024 is the first full year out of the most recent public health emergency period, hospitals and health systems continue to face many challenges. Credit ratings agencies have painted a bleak picture for the hospital sector in 2024.<a href="#fn34"><sup>34</sup></a> According to the S&P, negative outlooks for not-for-profit hospitals are proportionally at their highest in over a decade, affecting 24% of the sector.<a href="#fn35"><sup>35</sup></a> Similarly, Fitch reported a credit downgrade-to-upgrade ratio of 3:1 鈥� alarmingly close to the ratio seen during the 2008 financial crisis 鈥� calling it a 鈥渕ake or break鈥� year and highlighting the sector鈥檚 struggles, particularly among smaller hospitals with annual revenues under $500 million.<a href="#fn36"><sup>36</sup></a> While it is expected that hospitals and health systems will continue to face cost increases for labor, drugs, and medical supplies, there are additional headwinds to consider which include:</p><ul><li>Coverage losses due to Medicaid redeterminations: More than 19 million Medicaid enrollees have been disenrolled through 2023.<a href="#fn37"><sup>37</sup></a> Though partially offset by record Marketplace enrollment and possible enrollment in employer-sponsored coverage, this has still resulted in a steady increase in uncompensated care costs throughout 2023 and will likely continue into 2024 鈥� particularly for states that have not expanded Medicaid.<a href="#fn38"><sup>38</sup></a></li><li>Potential legislative actions to cut hospital Medicare payments for patient care: Congress is considering several bills that would impose additional payment reductions to services provided in hospital outpatient departments. These proposals, referred to as 鈥渟iteneutral鈥� payment cuts, would exacerbate financial challenges for hospitals and threaten patients鈥� access to quality care.</li><li>Cybersecurity risks impact providers and patient care: The cyberattack on Change Healthcare in February 2024 has underscored the extensive repercussions such incidents can have on patient care and hospital operations. The disruptions stemming from that cyberattack have significantly hindered revenue cycle management, pharmacy services, select health care technologies, clinical authorizations, and more across multiple health systems, serving as an example of how an attack can reverberate across the entire health care sector when a business that provides numerous mission-critical services is compromised.<a href="#fn39"><sup>39</sup></a></li><li>Ongoing and escalating hospital violence: There has been a significant uptick in violence against health care workers in recent years.<a href="#fn40"><sup>40</sup></a> To address this issue, hospitals are making significant investments in violence prevention and preparedness efforts to support their employees.</li></ul><h2><span>Conclusion</span></h2><p>America鈥檚 hospitals and health systems are dedicated to providing high-quality 24/7 care to all patients in every community across the country. While the commitment to caring and advancing health never wavers, hospitals continue to face significant challenges making it difficult to ensure the care is always there.</p><p>The AHA continues to urge Congress and the Administration to support policies to make sure hospitals and health systems have the resources they need to continue providing 24/7 care to all patients and communities. These include:</p><ul><li>Rejecting Medicare and Medicaid cuts to hospital care, including harmful site-neutral proposals and forthcoming reductions to Medicaid Disproportionate Share hospitals.</li><li>Supporting and strengthening the health care workforce.</li><li>Protecting the 340B Drug Pricing Program from any harmful changes and reining in the increasing costs of drugs.</li><li>Taking actions to hold commercial insurers accountable for practices that delay, deny and disrupt care.</li><li>Bolstering support to enhance cybersecurity of hospitals and the entire health care system.</li></ul><hr><h2>End Notes</h2><ol><li id="fn1"><a href="www.kaufmanhall.com/news/2022-worst-financial-year-hospitals-and-health-systems-start-pandemic" target="_blank">www.kaufmanhall.com/news/2022-worst-financial-year-hospitals-and-health-systems-start-pandemic</a></li><li id="fn2"><a href="https://www.syntellis.com/sites/default/files/2023-11/aha_q2_2023_v2.pdf" target="_blank">www.syntellis.com/sites/default/files/2023-11/aha_q2_2023_v2.pdf</a></li><li id="fn3"><a href="https://fortune.com/well/2024/01/11/rural-hospitals-are-caught-in-an-aging-infrastructure-conundrum/" target="_blank">fortune.com/well/2024/01/11/rural-hospitals-are-caught-in-an-aging-infrastructure-conundrum/</a></li><li id="fn4"><a href="/guidesreports/2023-04-19-essential-role-financial-reserves-not-profit-healthcare" target="_blank">www.aha.org/guidesreports/2023-04-19-essential-role-financial-reserves-not-profit-healthcare</a></li><li id="fn5"><a href="https://www.modernhealthcare.com/finance/hospital-2023-credit-rating-downgrade-fitch-ratings-sp-global-moodys" target="_blank">www.modernhealthcare.com/finance/hospital-2023-credit-rating-downgrade-fitch-ratings-sp-global-moodys</a></li><li id="fn6"><a href="/cybersecurity/change-healthcare-cyberattack-updates" target="_blank">www.aha.org/cybersecurity/change-healthcare-cyberattack-updates</a></li><li id="fn7"><a href="/news/blog/2023-09-20-unwise-dsh-cuts-combined-rise-uncompensated-care-due-medicaid-redeterminations-coverage-losses-further" target="_blank">www.aha.org/news/blog/2023-09-20-unwise-dsh-cuts-combined-rise-uncompensated-care-due-medicaid-redeterminations-coverage-losses-further</a></li><li id="fn8">AHA analysis of 2022 Annual Survey data.</li><li id="fn9"><a href="https://www.trillianthealth.com/insights/the-compass/the-total-available-market-of-commercially-insured-patients-is-shrinking" target="_blank">www.trillianthealth.com/insights/the-compass/the-total-available-market-of-commercially-insured-patients-is-shrinking</a></li><li id="fn10"><a href="/news/headline/2024-01-10-aha-infographic-medicare-underpayments-hospitals-nearly-100-billion-2022#:~:text=AHA%20infographic%3A%20Medicare%20underpayments%20to%20hospitals%20nearly%20%24100%20billion%20in%202022,-Jan%2010%2C%202024&text=Medicare%20paid%20hospitals%20a%20record,negative%20Medicare%20margins%20that%20year." target="_blank">www.aha.org/news/headline/2024-01-10-aha-infographic-medicare-underpayments-hospitals-nearly-100-billion-2022#:~:text=AHA%20infographic% 3A%20Medicare%20underpayments%20to%20hospitals%20nearly%20%24100%20billion%20in%202022,-Jan%2010%2C%202024&text=Medicare%20 paid%20hospitals%20a%20record,negative%20Medicare%20margins%20that%20year.</a></li><li id="fn11"><a href="https://www.wsj.com/health/healthcare/health-insurance-cost-increase-5b35ead7" target="_blank">www.wsj.com/health/healthcare/health-insurance-cost-increase-5b35ead7</a></li><li id="fn12"><a href="https://www.mckinsey.com/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/administrative%20simplification%20how%20to%20save%20a%20quarter%20trillion%20dollars%20in%20us%20healthcare/administrative-simplification-how-to-save-a-quarter-trillion-dollars-in-us-healthcare.pdf?shouldIndex=false" target="_blank">www.mckinsey.com/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/administrative%20simplification%20 how%20to%20save%20a%20quarter%20trillion%20dollars%20in%20us%20healthcare/administrative-simplification-how-to-save-a-quarter-trillion-dollars- in-us-healthcare.pdf?shouldIndex=false</a></li><li id="fn13"><a href="https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims" target="_blank">premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims</a></li><li id="fn14"><a href="https://www.syntellis.com/sites/default/files/2023-11/aha_q2_2023_v2.pdf">www.syntellis.com/sites/default/files/2023-11/aha_q2_2023_v2.pdf</a></li><li id="fn15"><a href="https://oig.hhs.gov/oei/reports/OEI-09-19-00350.pdf" target="_blank">oig.hhs.gov/oei/reports/OEI-09-19-00350.pdf</a></li><li id="fn16"><a href="https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf" target="_blank">oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf</a></li><li id="fn17"><a href="https://www.ensemblehp.com/blog/the-real-cost-of-medicare-advantage-plan-success/" target="_blank">www.ensemblehp.com/blog/the-real-cost-of-medicare-advantage-plan-success/</a></li><li id="fn18"><a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf#page=401" target="_blank">www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf#page=401</a></li><li id="fn19"><a href="https://www.ama-assn.org/practice-management/prior-authorization/health-systems-plagued-payer-takeback-schemes-110000#:~:- text=authorization鈥檚 financial impact-,Prior authorization鈥檚 financial impact,an increase of 67%.鈥�" target="_blank">www.ama-assn.org/practice-management/prior-authorization/health-systems-plagued-payer-takeback-schemes-110000#:~:- text=authorization鈥檚%20 financial%20impact-,Prior%20authorization鈥檚%20financial%20impact,an%20increase%20of%2067%25.%E2%80%9D</a></li><li id="fn20">AHA analysis of NHE projections of 2022-2031 expenditures.</li><li id="fn21"><a href="https://www.healthcaredive.com/news/healthcare-ransomware-costs-comparitech-77-billion/698044/" target="_blank">www.healthcaredive.com/news/healthcare-ransomware-costs-comparitech-77-billion/698044/</a></li><li id="fn22"><a href="https://intraprisehealth.com/the-cost-of-cyberattacks-in-healthcare/" target="_blank">intraprisehealth.com/the-cost-of-cyberattacks-in-healthcare/</a></li><li id="fn23"><a href="https://www.healthcareitnews.com/news/cisos-face-budgetary-pressures-burnout-during-global-recession" target="_blank">www.healthcareitnews.com/news/cisos-face-budgetary-pressures-burnout-during-global-recession</a></li><li id="fn24"><a href="https://www.reuters.com/business/healthcare-pharmaceuticals/prices-new-us-drugs-rose-35-2023-more-than-previous-year-2024-02- 23/?utm_source=facebook&utm_medium=news_tab" target="_blank">www.reuters.com/business/healthcare-pharmaceuticals/prices-new-us-drugs-rose-35-2023-more-than-previous-year-2024-02- 23/?utm_source=facebook& utm_medium=news_tab</a></li><li id="fn25"><a href="https://aspe.hhs.gov/reports/changes-list-prices-prescription-drugs" target="_blank">aspe.hhs.gov/reports/changes-list-prices-prescription-drugs</a></li><li id="fn26"><a href="https://www.fda.gov/media/131130/download?attachment" target="_blank">www.fda.gov/media/131130/download?attachment</a></li><li id="fn27"><a href="https://news.ashp.org/-/media/assets/drug-shortages/docs/ASHP-2023-Drug-Shortages-Survey-Report.pdf" target="_blank">news.ashp.org/-/media/assets/drug-shortages/docs/ASHP-2023-Drug-Shortages-Survey-Report.pdf</a></li><li id="fn28"><a href="https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/drug-shortages-in-the-us-2023?utm_campaign=2023_ Drug_Shortages_Report_INSTITUTE_IS&utm_medium=email&utm_source=Eloqua" target="_blank">www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/drug-shortages-in-the-us-2023?utm_campaign=2023_ Drug_Shortages_Report_ INSTITUTE_IS&utm_medium=email&utm_source=Eloqua</a></li><li id="fn29"><a href="https://aspe.hhs.gov/reports/drug-shortages-impacts-consumer-costs" target="_blank">aspe.hhs.gov/reports/drug-shortages-impacts-consumer-costs</a></li><li id="fn30"><a href="https://link.springer.com/article/10.1007/s13181-023-00950-6#:~:text=Shortages%20compromise%20or%20delay%20medical,morbidity%20%5B1%2C%202%5D." target="_blank">link.springer.com/article/10.1007/s13181-023-00950-6#:~:text=Shortages%20compromise%20or%20delay%20medical,morbidity%20%5B1%2C%202%5D.</a></li><li id="fn31"><a href="/system/files/media/file/2023/06/fact-sheet-examining-the-real-factors-driving-physician-practice-acquisition.pdf" target="_blank">www.aha.org/system/files/media/file/2023/06/fact-sheet-examining-the-real-factors-driving-physician-practice-acquisition.pdf</a></li><li id="fn32"><a href="https://www.mckinsey.com/industries/healthcare/our-insights/how-health-systems-and-educators-can-work-to-close-the-talent-gap" target="_blank">www.mckinsey.com/industries/healthcare/our-insights/how-health-systems-and-educators-can-work-to-close-the-talent-gap</a></li><li id="fn33"><a href="https://www.healthcarefinancenews.com/news/rn-turnover-healthcare-rise" target="_blank">www.healthcarefinancenews.com/news/rn-turnover-healthcare-rise</a></li><li id="fn34"><a href="https://on24static.akamaized.net/event/44/67/84/2/rt/1/documents/resourceList1709062595167/ushealthcaresectorcreditbeat227241709062595167.pdf" target="_blank">on24static.akamaized.net/event/44/67/84/2/rt/1/documents/resourceList1709062595167/ushealthcaresectorcreditbeat227241709062595167.pdf</a></li><li id="fn35"><a href="https://www.spglobal.com/ratings/en/research/articles/231206-historical-peak-of-negative-outlooks-signals-challenges-remain-for-u-s-not- for-profit-acute-health-care-provi-12927513" target="_blank">www.spglobal.com/ratings/en/research/articles/231206-historical-peak-of-negative-outlooks-signals-challenges-remain-for-u-s-not- for-profit-acutehealth- care-provi-12927513</a></li><li id="fn36"><a href="https://www.fitchratings.com/research/us-public-finance/us-not-for-profit-hospitals-health-systems-outlook-2024-05-12-2023" target="_blank">www.fitchratings.com/research/us-public-finance/us-not-for-profit-hospitals-health-systems-outlook-2024-05-12-2023</a></li><li id="fn37"><a href="https://www.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview/" target="_blank">ww.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview/</a></li><li id="fn38"><a href="/news/blog/2023-09-20-unwise-dsh-cuts-combined-rise-uncompensated-care-due-medicaid-redeterminations-coverage-losses-further" target="_blank">www.aha.org/news/blog/2023-09-20-unwise-dsh-cuts-combined-rise-uncompensated-care-due-medicaid-redeterminations-coverage-losses-further</a></li><li id="fn39"><a href="/2024-02-24-update-unitedhealth-groups-change-healthcares-continued-cyberattack-impacting-health-care-providers" target="_blank">www.aha.org/2024-02-24-update-unitedhealth-groups-change-healthcares-continued-cyberattack-impacting-health-care-providers</a></li><li id="fn40"><a href="https://apnews.com/article/hospitals-workplace-violence-shootings-aa6918569ff8f76ff8a15b9813e31686" target="_blank">apnews.com/article/hospitals-workplace-violence-shootings-aa6918569ff8f76ff8a15b9813e31686</a></li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/05/Americas-Hospitals-and-Health-Systems-Continue-to-Face-Escalating-Operational-Costs-and-Economic-Pressures.pdf" target="_blank" title="Click here to download Costs of Caring 2024: America鈥檚 Hospitals and Health Systems Continue to Face Escalating Operational Costs and Economic Pressures as They Care for Patients and Communities report PDF."><img src="/sites/default/files/inline-images/Page-1-Americas-Hospitals-and-Health-Systems-Continue-to-Face-Escalating-Operational-Costs-and-Economic-Pressures.png" data-entity-uuid="4315111b-85e5-46dd-9949-8bb4ee5e6246" data-entity-type="file" alt="Costs of Caring 2024: America鈥檚 Hospitals and Health Systems Continue to Face Escalating Operational Costs and Economic Pressures as They Care for Patients and Communities page 1." width="695" height="900"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2024-09-10-skyrocketing-hospital-administrative-costs-burdensome-commercial-insurer-policies-are-impacting" target="_blank">View the Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Are Impacting Patient Care Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2024-05-01-2023-costs-caring" target="_blank">View the 2023 Costs of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2023-04-20-2022-costs-caring" target="_blank">View the 2022 Costs of Caring Report</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2021-10-25-2021-cost-caring" target="_blank">View the 2021 Costs of Caring Report</a></div></div></div></div> Mon, 28 Apr 2025 15:04:37 -0500 Telling the Hospital Story /role-hospitals-university-oklahoma-cancer-center-implements-new-technology-make-cancer-care-more-comfortable <div class="container"><div class="row"><div class="col-md-9"><div class="col-md-5"><p><img src="/sites/default/files/2025-04/ths-oklahoma-radiation-700x532.jpg" data-entity-uuid data-entity-type="file" alt="University of Oklahoma Medical Center. A patient receiving radiation therapy is viewed from inside the machine looking out" width="700" height="532"></p></div><p>The Stephenson Cancer Center at University of Oklahoma Medical Center is the second hospital in the nation to introduce a groundbreaking cancer treatment called surface-guided radiation therapy. The treatment uses a non-invasive technology known as the Accuray Radixact System, offering cancer patients faster, more precise and comfortable treatments. The Radixact System delivers image-guided intensity-modulated radiation therapy, helping health care teams to effectively position patients and target tumors with increased accuracy while protecting healthy tissue. This advanced technology is particularly beneficial for patients with tumors in challenging locations, such as the lungs or near critical organs, as it minimizes the impact on surrounding healthy tissue. It can also track tumors in real time and adjust treatment to account for changes in tumor size.</p><p>鈥淓very advancement in cancer treatment technology means new hope for our patients,鈥� said Jerry Jaboin, M.D., radiation oncologist at the Stephenson Cancer Center. 鈥淲ith the Radixact System, we can offer more patients access to precise, personalized treatment plans that fit their specific needs while minimizing disruption to their daily lives."</p><p><a class="btn btn-primary" href="https://www.ouhealth.com/blog/2025/january/new-cancer-treatment-technology-at-stephenson-ca/" target="_blank">LEARN MORE</a></p></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/topics/innovation">Innovation, Research and Quality Improvement</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Mon, 28 Apr 2025 12:03:06 -0500 Telling the Hospital Story /role-hospitals-penn-medicine-chester-county-stroke-surgery-and-advanced-care-team-close-home <div class="container"><div class="row"><div class="col-md-9"><div class="col-md-5"><p><img src="/sites/default/files/2025-04/ths-penn-carotid-700x532.jpg" data-entity-uuid data-entity-type="file" alt="Penn Medicine Chester County Hospital. A health worker passes an ultrasound probe over a woman's neck" width="700" height="532"></p></div><p>Donna Carr's life was saved by a timely and advanced medical intervention at Penn Medicine Chester County Hospital, thanks to the hospital's investments in advanced operating rooms and trained personnel.</p><p>In late 2024, Carr experienced symptoms of a stroke due to blood clots blocking her carotid artery. She underwent a minimally invasive procedure called transcarotid artery revascularization (TCAR), which filtered out the clots and prevented further strokes. This procedure involves reversing blood flow around the blockage, using a balloon and stents to reopen the artery while filtering out plaque and clots. The hybrid operating room at Chester County Hospital, equipped with advanced imaging tools, facilitated this precise and life-saving intervention.</p><p>The hospital鈥檚 investment in upgraded capabilities has paid off by attracting innovative care providers and improving patient outcomes. Chester鈥檚 facility combines the capabilities of a standard operating room with the imaging tools needed for endovascular procedures, allowing for detailed and accurate interventions. This setup also streamlines scheduling and reduces the number of personnel needed for procedures.</p><p>The hospital's commitment to cutting-edge care has led to successful recruitment of skilled clinicians like vascular surgeon, Daniel Lee, M.D., of whom Carr said 鈥淗e saved my life, what can I say? ... I can鈥檛 brag about him enough.鈥�</p> <a class="btn btn-primary" href="https://www.pennmedicine.org/news/news-blog/2025/march/a-stroke-a-surgery-and-an-advanced-care-team-close-to-home" target="_blank">LEARN MORE</a> </p>--></div><div class="col-md-3"><div><h4>Resources on the Role of Hospitals</h4><ul><li><a href="/topics/innovation">Innovation, Research and Quality Improvement</a></li><li><a href="/roleofhospitals">All Case Studies</a></li></ul></div></div></div></div> Mon, 28 Apr 2025 11:45:20 -0500 Telling the Hospital Story /advancing-health-podcast/2025-04-28-leadership-dialogue-series-cybersecurity-and-fight-safeguard-health-care <p>From ransomware attacks to data breaches, the stakes for hospitals and health systems to protect their patients have never been higher. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with John Riggi, national advisor for cybersecurity and risk at the 黑料正能量 Association, about how health care leaders are planning to mitigate cyberattacks, the need to build resilience to these threat-to-life crimes, and why forging partnerships with the government and the private sector is crucial for defense.</p><p>This podcast has been modified for time. To view the entire Leadership Dialogue, please visit <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fyoutu.be%2FfHgCZJFQa60&data=05%7C02%7Cdsamuels%40aha.org%7Cf8bf1343f184401f206708dd866f9398%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638814536022345698%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=BRGMWCo2BCIUx3%2B25Wb4Eax0qRNgJOK%2Bzc1tpZWzLzg%3D&reserved=0">https://youtu.be/fHgCZJFQa60</a>.</p><hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br> </h2> </summary> <p> 00:00:01:01 - 00:00:26:02<br> Tom Haederle<br> Welcome to Advancing Health. Cybersecurity is a risk. And because of that, a priority for all hospitals and health systems. In this Leadership Dialogue, Tina Freese Decker, chair of the 黑料正能量 Association, and John Riggi, AHA鈥檚 national advisor for Cybersecurity and Risk, discuss planning for cyber attacks, putting protections in place, navigating cyber threats, and rebuilding trust and confidence in the system </p> <p> 00:00:26:04 - 00:00:31:01<br> Tom Haederle<br> when cyber attacks do occur. </p> <p> 00:00:31:04 - 00:01:00:23<br> Tina Freese Decker<br> Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president CEO of Corewell Health and the board chair for the 黑料正能量 Association. From data breaches to ransomware attacks to outages, cybersecurity affects patient safety and enterprise risk and is increasingly a strategic priority for hospitals and health systems. Planning for cyber attacks and putting the proper protections in place is key to ensuring sustainability, patient privacy and clinical outcomes. </p> <p> 00:01:00:26 - 00:01:34:22<br> Tina Freese Decker<br> So I am so pleased to have the 黑料正能量 Association's John Riggi joining me for today's conversation. John is an expert in this field, and he serves as the AHA's first national advisor for cybersecurity and risk. He joined AHA in 2018 after a long, distinguished 30-year career with the FBI. He brings with him tremendous experience in the investigation and disruption of cyber threats, as well as the unique ability to provide informed risk advisory services to hospitals and health systems. </p> <p> 00:01:34:24 - 00:01:41:26<br> Tina Freese Decker<br> So before we jump into the conversation, John, can you just tell me a bit about yourself so that our audience can get to know you a little bit better? </p> <p> 00:01:41:29 - 00:02:08:13<br> John Riggi<br> Thank you, Tina, so much for inviting me here today to discuss these topics, which unfortunately, as you said, top of mind for everyone. So when I ended my 30-year career at the FBI, I still wanted to be in a position to serve. I spent a lifetime doing that, and in my last role at the FBI, my job was to establish mission critical relationships with private sector, with critical infrastructure in the health care sector in particular. </p> <p> 00:02:08:15 - 00:02:29:22<br> John Riggi<br> That's when I had the privilege and honor to be introduced to AHA and Rick Pollack in talking about cyber threats. And that's when I really learned how critical a role that the 黑料正能量 Association served for the entire health care sector. I could send over, you know, an immediate urgent alert to the and with a single press of a button </p> <p> 00:02:29:29 - 00:02:56:16<br> John Riggi<br> 5000 plus hospitals received that alert. 50,000 executives received it. So I understood at that point we needed to engage in that continuing relationship. And when I retired, fortunately for me, Rick Pollack in the team said, John, you know, we've been listening to you and we think cyber will be an emerging threat, going forward. Unfortunately, none of us realized how significant a threat it would be. </p> <p> 00:02:56:19 - 00:03:00:12<br> John Riggi<br> And so, again, my privilege and honor to be here with you today. </p> <p> 00:03:00:14 - 00:03:22:21<br> Tina Freese Decker<br> Well, we are privileged and blessed that you are part of the 黑料正能量 Association team, and you're helping us navigate so many of these issues that come forward. Let's start with kind of one of the underlying questions that I have. We've seen all these cyber and physical threats that have targeted hospitals and health systems. How have they evolved over the last, let's say, 7 to 8 years? </p> <p> 00:03:22:24 - 00:03:58:21<br> John Riggi<br> Yeah, unfortunately they've increased pretty dramatically. So not only are they increased in frequency, but also in complexity and severity of impact. So on the cyber front, we have seen a, for instance, in hacking of patient health information. In 2020, it was about 450 hacks impacting 27 million individuals, not inconsequential. Last year, last year with the Change Healthcare attack, we had 259 million Americans had their health care records stolen or compromised by foreign bad guys, by foreign bad guys. </p> <p> 00:03:58:27 - 00:04:24:17<br> John Riggi<br> If we add up the numbers, just since 2020, over 500 million Americans have had their health care records compromised or stolen. So, John, wait a minute. There's only 330 million Americans. That's the population. Meaning that every American in this country has had their health care records compromised more than once. But what really concerns us are the dramatic increase in ransomware attacks, which are often accompanied by data theft attacks. </p> <p> 00:04:24:19 - 00:04:51:12<br> John Riggi<br> So these bad guys, primarily Russian speaking, believed to be provided safe harbor by the Russian government primarily but not exclusively Russian, have increased these attacks so that the impact really is not only disablement of technology, internal networks get shut down, data gets encrypted, organizations are forced to disconnect from the internet has a very, very dramatic impact on care delivery. </p> <p> 00:04:51:15 - 00:05:18:21<br> John Riggi<br> So this resulting disruption, delay to care delivery and ultimately posing a serious risk to patient care and safety, not only for the patients in the hospital, but for the entire communities that depend on the availability of their nearest emergency department for life saving care, radiation oncology, so forth. So we've seen that evolve again very significantly, and one of the reasons I think it's evolved so dramatically. </p> <p> 00:05:18:23 - 00:05:30:21<br> John Riggi<br> Geopolitics is part of that. But I think on a very base level, we as a sector depend more and more on network and internet connected technology and data. </p> <p> 00:05:30:24 - 00:05:56:13<br> Tina Freese Decker<br> Very true. You know, I did a podcast earlier this year about trust and rebuilding confidence and trust and having that public trust in health care systems and hospitals. And when you have a cyber attack or an act of violence that targets hospitals, health systems, it impacts patients, like you said, it impacts staff and our communities. How can we go about building that trust and regaining that confidence when we have these instances occur? </p> <p> 00:05:56:15 - 00:06:06:23<br> Tina Freese Decker<br> And do you have some examples of stories or insights organizations have used that have helped them navigate those cyber threats and build that public trust? </p> <p> 00:06:06:26 - 00:06:32:07<br> John Riggi<br> Great question, Tina. And also on the on the violence side, unfortunately, as I wanted to mention as well, that's increased pretty dramatically to set the stage there. I was shocked, as a former law enforcement officer, to find out nurses are the second most assaulted profession outside of law enforcement. And, you know, we expect it as law enforcement officers to be engaged, confrontational engagements. </p> <p> 00:06:32:07 - 00:06:37:09<br> John Riggi<br> You're making arrests, but nurses who just want to deliver care to help people? Shocking. </p> <p> 00:06:37:09 - 00:06:38:19<br> Tina Freese Decker<br> It's sad and unacceptable. </p> <p> 00:06:38:23 - 00:06:58:27<br> John Riggi<br> Agree, totally. So I think how do we how do we get that trust in the community? I think one - and I think we've done a fantastic job with your leadership and the AHA - acknowledge the risk, acknowledge the threat. Let's not hide it. Let's not pretend it's not there. But then to take real steps to prepare and help mitigate the impact of these threats. </p> <p> 00:06:59:00 - 00:07:25:01<br> John Riggi<br> So now we see, on the cyber side, hospitals are actively working to develop better downtime procedures, better backup systems to help shorten the length of the impact and help recover more quickly. And work with the federal government. Exchange threat information across the sector with our partners in other sectors. And really understand if we're attacked, this isn't a stigma. </p> <p> 00:07:25:02 - 00:07:51:18<br> John Riggi<br> This isn't something that an organization failed to do. We're all in this together. And on the physical side, we're working very closely with the FBI to help develop resources to help identify and mitigate targeted acts of violence directed toward health care organizations. But most importantly, our frontline health care heroes, our frontline health care workers. And again, working with the community, this is all partnership with the community as well. </p> <p> 00:07:51:20 - 00:08:08:05<br> Tina Freese Decker<br> So I'm sure you have a top ten list of things that we could do to prevent these attacks. But if you could share the top three things that we should do to prevent these attacks and how we can be resilient. And when I say attacks, I'm talking cyber and physical. We have limited time, we have limited resources. </p> <p> 00:08:08:05 - 00:08:10:19<br> Tina Freese Decker<br> But what is the most important things that we should be doing? </p> <p> 00:08:10:22 - 00:08:36:21<br> John Riggi<br> I think the overarching umbrella that all the others follow under is leadership. And really looking at these risks, acknowledging them and ensuring that both cyber and physical risks are treated as an enterprise risk issue. And then within that, on the cyber side, making sure on the defensive side that you're following well known, well-established, recognized cyber frameworks, making sure you start there. </p> <p> 00:08:36:24 - 00:09:03:08<br> John Riggi<br> Second, really thinking about third party risk. What we have seen is that a majority, the vast majority of cyber risk, cyber attacks we face come to us through insecure third party service providers. Insecure third party technology and insecure supply chain. Doesn't negate us from our responsibility to do what we can, but we have to understand that. And then the third thing is ultimately prepare. </p> <p> 00:09:03:10 - 00:09:24:08<br> John Riggi<br> We must prepare for the attack. There's an often, I would say, overused expression in the cyber security world. It's not a matter of if, but when. It's true. But I would also change that a little bit about it's not a matter of if you will be attacked. The question is are you prepared? So focusing on resiliency and so forth. </p> <p> 00:09:24:10 - 00:09:55:13<br> John Riggi<br> And then with on the physical side, education of staff, leadership priority, and working with the FBI and local law enforcement to potentially identify ahead of an incident acts of targeted violence directed towards the hospital. And then working together as a community help mitigate and prevent that act. The police always want to respond, can respond after the FBI. But I can tell you from personal experience, we'd rather prevent a crime, prevent an act of violence than respond after the fact. </p> <p> 00:09:55:15 - 00:10:19:15<br> Tina Freese Decker<br> Agree. And I think that developing those relationships with local FBI, with local law enforcement is critical because you to your point, it's not if, but when. But we'd like to be able to prevent all of it. Having those relationships is key. So I know that the AHA has been working very closely with the FBI and some health care systems to exchange that threat intelligence and enhance collaboration across our sector </p> <p> 00:10:19:15 - 00:10:28:21<br> Tina Freese Decker<br> and with federal agencies. Can you share more about that partnership and how it has helped us in identifying and mitigating both physical and cyber threats? </p> <p> 00:10:28:24 - 00:10:51:26<br> John Riggi<br> Great question again, Tina, and thank you for highlighting what we're doing with the FBI. So on the cyber front, we've been actively engaged in cyber threat, information threat intelligence exchange. Both on a very technical level, exchanging what - without getting too technical - threat indicators, malware signatures and so forth, but also identifying big strategic threats that we may face as a sector. </p> <p> 00:10:51:28 - 00:11:19:23<br> John Riggi<br> So, for instance, working with the FBI, we helped identify last year a threat to the blood supply before it was on the government's radar. We helped the government understand that cyber attacks on hospitals are not just data theft crimes. These are truly threat to life crimes. So the federal government actually previously raised the investigative priority level of ransomware attacks on hospitals to equal that of a terrorist attack once they understood what the impact was. </p> <p> 00:11:19:24 - 00:12:00:17<br> John Riggi<br> We are working very closely with the famed Behavioral Analysis Unit of the FBI, the profilers that many books and TV shows and movies have been written about to develop resources to help hospitals identify targeted acts of violence, threats that are pending against hospitals, and again, help intercede, intervene and help prevent those attacks. We have a whole series of resources available on the first ever joint FBI and Joint Health Care Sector webpage. We're about to issue a manual coming out here within the next month or so, based upon, joint work with the FBI in the field on best practices and lessons learned to prevent these acts of violence. </p> <p> 00:12:00:17 - 00:12:06:08<br> John Riggi<br> So we have a robust, almost daily interaction with the FBI and other federal agencies. </p> <p> 00:12:06:10 - 00:12:25:15<br> Tina Freese Decker<br> It's so helpful to know that we have those robust partnerships at the national level, and then we can create it at the local level, and to make sure that we're all in this together to, help protect our patients and the people that we care for in our community. So that's wonderful. My last question for you is just one about how we look forward. </p> <p> 00:12:25:17 - 00:12:38:26<br> Tina Freese Decker<br> Can you tell us what you think about is going to happen in the threat environment for 2025 and maybe into 2026? What are those things we should be watching, looking out for? And is there anything positive that you can see? </p> <p> 00:12:38:29 - 00:13:11:18<br> John Riggi<br> I will let you know there is some hope. Talk about the realistic environment. Then we'll talk about where I see the hope. So first of all, I do believe that the frequency of the attacks may decrease, but I think the bad guys are looking to make a greater impact. We have seen them go after systemically important organizations that serves health care. Change Healthcare, for example. Last year, attacks against the blood supply. The year before they attacked - found vulnerabilities in a commonly used technology and software known as Move It. </p> <p> 00:13:11:21 - 00:13:41:03<br> John Riggi<br> By attacking that software, it gave the bad guys, a Russian ransomware group, were able to gain access to millions and millions of patient records. I do believe geopolitics will have a very significant influence, for better or worse, on the level of cyber threat we face. Depending on how we deal in the outcomes of our negotiations, of our diplomatic efforts with Russia, China, North Korea and Iran has the potential to mitigate or increase the cyber threats that we face. </p> <p> 00:13:41:05 - 00:14:08:19<br> John Riggi<br> And ultimately, again, third party risk, major, major issue. Where do I see the signs of hope? And there are signs of hope, folks. Honestly, I have never seen the sector come together to share threat information to prepare for attacks, best practices, lessons learned not only amongst the sector. We see channels of threat information sharing and best practice across with other critical and sectors, with the federal government. </p> <p> 00:14:08:21 - 00:14:45:26<br> John Riggi<br> We've had victim organizations, CEOs come out publicly. Dr. Leffler from University of Vermont, Chris Van Gorder from Scripps. We've had Eduardo Conrado from the recent attack against Ascension not only come out publicly, but testify before the UN Security Council last November about the impact of this Russian ransomware attack against Ascension. So what I see is hope. The fact we are banding together and with the government and I hope, as we did in the great fight against terror, international terrorism, we will come together in a whole of nation approach to help mitigate that risk. </p> <p> 00:14:46:01 - 00:15:09:17<br> John Riggi<br> Now, Tina, I know I've done a lot of speaking here, and if I may, and with all due respect, I'd like to ask you a question if I could. Tina, in your role, you have very unique dual role. You're CEO of a large health system, and you're also the chair of the 黑料正能量 Association board. So how do you think about cyber and physical threats for your own organization </p> <p> 00:15:09:19 - 00:15:11:20<br> John Riggi<br> but on a national level? </p> <p> 00:15:11:22 - 00:15:33:26<br> Tina Freese Decker<br> Well, I believe that cyber and physical threats must be prioritized. It's a strategic risk. We have to understand how we focus on it, and we have to significantly prioritize it and emphasize what we're doing there. Previously, maybe 5 or 10 years ago, it was just thought of as a technical issue. It's not that. It's how we operate. Because like you said, we're so connected, </p> <p> 00:15:33:26 - 00:16:01:07<br> Tina Freese Decker<br> it's critical infrastructure and we must make sure that we are coming together. So for us as an organization, we prioritize our efforts, our investments, our work on it, but also prioritize business assurance. So how do we operate and make sure that everyone understands all the key components and the lessons that you shared on this discussion today, but also when we've had conversations before, how are we making sure that we know those and our teams know those? </p> <p> 00:16:01:09 - 00:16:25:19<br> Tina Freese Decker<br> I think the importance of safeguarding sensitive patient data and ensuring the integrity of our systems cannot be overstated. And that applies for my organization, and that applies for all of our members throughout the 黑料正能量 Association. And so I think those are some critical points. As we think about this it is making sure that we are safeguarding sensitive patient data and ensuring the integrity of our systems, as we go forward. </p> <p> 00:16:25:19 - 00:16:59:14<br> Tina Freese Decker<br> That cannot be overstated. And as we do that, I think we all uphold that level of commitment to excellence that our patients and the people in our community want. So, John, thank you so much for your time today, for sharing your expertise. While we may not be able to prevent or mitigate everything, you have given us such great advice and we should make sure we take that down, but also listen to many of your podcasts that you put out or the Action Alerts that you sent through because they are helpful and direct and provide that great advice to move forward. </p> <p> 00:16:59:16 - 00:17:17:11<br> Tina Freese Decker<br> And I know that you are available to connect with all of our members if there is a specific situation, or they just want to learn more to make sure that we're better. So thank you, John, for being here. And thank you to all of those that have tuned in to this conversation. We will be back next month for another Leadership Dialogue. </p> <p> 00:17:17:13 - 00:17:25:24<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details></div> Mon, 28 Apr 2025 11:08:26 -0500 Telling the Hospital Story