Texas Hospital Association

Health Care Advocate: Feb. 22, 2024

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Advocacy News 
If you have questions or comments about the articles below, please contact [email protected].

Optum Suffers Cyberattack; Hospitals Encouraged to Disconnect for Security

The American Hospital Association has warned members about a cyberattack against Change Healthcare, which is part of Optum, a major health care technology provider. According to a story from TechCrunch, the attack started early Wednesday on the East Coast. While AHA has warned the FBI, the Cybersecurity and Infrastructure Security Agency and the U.S. Department of Health and Human Services, it is recommending hospitals consider disconnecting from Optum as a precaution until further notice.

TechCrunch notes Change Healthcare is one of the country’s largest health care technology companies and handles billions of transactions a year. The disruption of Optum’s operations is a major roadblock for hospitals and insurance revenue cycles. As the situation evolves, health care providers should expect further disruptions, especially in pharmacies. Optum is posting updates here. (Fernando Martinez)

THA Warns of Significant Impacts to Hospitals in Trauma Rule Comments

Weighing in on the state’s proposed trauma designation requirements for Texas hospitals, THA commended the Texas Department of State Health Services (DSHS) for its quest to improve the state trauma system. But THA’s comment letter to DSHS, submitted this week, said some of the department’s recent rule proposal “would require hospitals to expend significant costs to comply,” and recommended prioritizing alignment with national standards while “holding off on more ambitious requirements,” or stair-stepping them for an easier transition.

“In some instances facilities, especially Level IV and rural facilities, may choose not to or be unable to re-designate, which could strain the state’s entire trauma network,” THA warned in its comment letter. “Neighboring trauma centers may not be able to accommodate the increased capacity and Texans would have to travel further from their homes and communities for care.”

Collecting feedback from its members to inform the letter, some of THA’s comments addressed:

  • The rule’s reference to an “EMS wristband tracking number,” which THA understands “is to be implemented over time to allow tracking of a patient though a unique identifier throughout the entire healthcare continuum. The concern amongst hospitals is the need to integrate this new identifier into the patient’s medical record in a manner that accomplishes this purpose.” THA noted that several hospitals use a third-party system for similar ID programs, and said if the state is looking to create a new program, “a more feasible alternative may be for the State to engage and utilize a program already in use within Texas hospitals.”
  • A proposed requirement for hospitals to participate in their local regional advisory council (RAC), which THA said “may have disparate effect across the state” because RACs don’t operate on uniform timetables or tackle similar content in their meetings. THA said promoting uniformity among RACs “would be helpful, especially with an option for physicians to attend meetings virtually.”
  • Would-be qualifications and responsibilities for a trauma medical director that require the person to be a surgeon, at a time when many Level IV facilities use an emergency physician in that capacity. THA noted attracting a surgeon to serve as a trauma medical director may be “extremely difficult and cost-prohibitive” for many smaller and/or rural hospitals, and recommended allowing facilities to continue having the option of deploying an emergency physician in that role.

THA wrote that it hopes its comments would “minimize the opportunity for noncompliance” among hospitals. (Cesar Lopez, J.D./Erika Ramirez/Carrie Kroll)

Rove, Begala Close Out THA Conference With Election Analysis

Sizing up the 2024 election and the forces driving it, longtime political operatives and commentators Paul Begala and Karl Rove closed THA’s Annual Conference on Friday morning with a discussion that drew laughter and applause from the crowd at the Hyatt Regency Dallas.

Begala, a former Clinton administration advisor and current CNN commentator, and Rove, the former deputy chief of staff and senior advisor in the George W. Bush administration, saved some of their strongest critiques for the impact of social media on modern political discourse. Prompting those comments was a question from the moderator, Texas Tribune Editor in Chief Sewell Chan, about the tribalism in today’s politics and widespread exhaustion and disgust with the news.

“Social media, that’s now our principal way of getting news,” Begala said. “And it has driven us into these information silos which no one can penetrate.” That prompted Chan to ask, “More so than cable TV in the ’90s, or talk radio?”

“Far more, far more. And every new communications means creates its own politics,” Begala added, citing Johan Gutenberg’s invention of movable type and the subsequent printing of the Gutenberg Bible, which is credited with driving the Protestant Reformation.

Rove agreed, citing the “pernicious effect of social media, because it is designed to, as we said, weaponize our brain. It’s addictive. It’s figuring out what we like to see and hear, and gives us more of that.”

But while that’s a huge problem, Rove said, it’s not the only reason for today’s environment. He said the nation is “going through one of those moments that we periodically go through where American politics is tribal. And in my opinion, it began with the financial crisis of 2008, 2009. Because that led to a burst of populism on the left and right. … ‘I’m working hard, I’m on the left or I’m on the right, corporations are getting made whole and I’m not. … The big man is getting the money, Wall Street, but the little man isn’t.’”

At the start of the discussion, the two pundits touched on the widespread dissatisfaction with a probable November election rematch between President Joe Biden and his predecessor, Donald Trump. Begala said the matchup seemed as if both parties were giving the nation what it doesn’t want.

“This is your choice, America: A guy with 91 felony charges and a guy with 81 birthday candles,” Begala said. “Happy election year.”

But both downplayed the idea that either likely nominee would be replaced on their respective party tickets. Alluding to each candidate’s advanced age, Rove wryly said, “It’s most likely going to be Trump and Biden. But mortality may intervene,” and Begala drew laughter from the hospital audience by adding, “It may be the first presidential debate that has Code Blue crash carts.”

Rove predicted that a moment is coming when the American people would “demand action from their government on important issues, and people are going to respond to it in positions of leadership.”

“And we’ve got to stop this thing of saying, ‘You know what? You’ve got to agree to meet the demands and desires of the hard right or the hard left in your primaries.’ Instead, reward people for doing things that are constructive for our country.” That remark drew applause.

Rove also made a point of mentioning that the Texas Republican Convention has 14,000 authorized delegates, then asked the room how many people had been to either a Democrat or Republican state convention. When only a small number raised their hands, Rove said, “More normal people need to go.” (Jennifer Banda, J.D.)

AHA Schedules Webinar on Payer Denial Strategies

The American Hospital Association is hosting a webinar on Wednesday, Feb. 28 at 11 a.m. CT titled “Strategies to Counter Payer Denial Tactics.” The webinar will be led by two speakers from health care analytics firm Corrohealth: Jerilyn P. Morrissey, MD, chief medical officer, and Samuel Dominik, managing director, strategic advisory services. The discussion will include approaches to countering Medicare Advantage payer denial strategies and implementing a robust appeals process. Registration and additional information on the upcoming webinar are available here. (Matt Turner, Ph.D.)

Designate THA to Complete COVID-19 Reporting of Zero Funds

The Texas Health and Human Services Commission (HHSC) has finalized a rule allowing hospitals to designate authorized representatives to submit their semi-annual reports of federal COVID-19 funding received as required by a rider in the current state budget. THA is willing to serve as an authorized representative only for member hospitals who have $0 to report.

If you meet the zero-funds requirement, visit www.tha.org/covidreporting to submit a form that will designate THA as your hospital or system’s authorized representative. Please ensure only one person completes the form for your hospital(s).

The first reporting deadline is March 1. Due to the short time between finalizing the rule on Feb. 16 and the deadline, HHSC has informed THA they will observe a grace period until Friday, March 15. Hospitals that wish to designate THA must submit the form to THA as soon as possible, but no later than Monday, March 10. (Anna Stelter)

Next Week: CDC Call on Xylazine Found in Fentanyl Overdoses

The Centers for Disease Control and Prevention (CDC) is holding a Clinician Outreach and Communication Activity (COCA) call to spread awareness about the non-opioid drug Xylazine, which is not approved for humans and has been associated with fentanyl overdose cases in the US. The call will take place on Feb. 29 at 1 p.m. CT over Zoom. Speakers will discuss public health and clinical activities to mitigate harms from Xylazine mixed with fentanyl, as well as overviews on overdose and treatment options. Those who are unable to attend the call live can view it on the COCA call website afterward. CDC is offering free continuing education during this call. (Carrie Kroll/Sara González/Erika Ramirez)

Federal Agencies Issue Alerts on Multiple Cyberthreats

The FBI released an alert on Friday warning hospitals about a Warzone Remote Access Trojan (RAT) tool used by thousands of cybercriminals.

The Warzone RAT, also known as Ave Maria, is capable of penetrating remote webcams, password recovery mechanisms and more as a “precursor” to extract information from systems and extort users. The Warzone service is also associated with multiple malware products that are able to hide the threat, according to the FBI release. Warzone RAT is often distributed through emails and Microsoft files. The FBI includes a list of recommendations in the alert to mitigate the threat, such as backing up and encrypting data and creating a well-monitored infrastructure. Any suspicious or criminal activity should be reported to the local FBI field office and victims of Warzone RAT may make a report here.

Also, the FBI, U.S. Cybersecurity and Infrastructure Security Agency (CISA) and the National Security Agency (NSA) published an alert for a cybergroup known as Volt Typhoon. The group is known for using living-off-the-land techniques to exploit critical U.S. infrastructure. The FBI, CISA and NSA have published a new joint guidance to mitigate this specific method of attack. Volt Typhoon utilizes valid accounts and strong operational security to maintain persistent presence in the networks they infiltrate. Victims of these attackers are encouraged to contact CISA at [email protected] or report to their local FBI field office. NSA cybersecurity inquiries can be directed to [email protected]. (Fernando Martinez)

Last Chance: Join THA for First Hospital Communicators Summit

Registration closes this Friday, Feb. 23, for THA’s first-ever Texas Hospital Communicators Summit, scheduled from Feb. 29-March 1 at THA headquarters in Austin and open to communications professionals at Texas hospitals.

The free summit will feature an opportunity to learn about new tools and industry messaging, meet communications professionals from other Texas hospitals and develop new strategies for this year and beyond. The two-day event is open to THA member hospital communications staff only. Among the agenda items are sessions focused on:

  • Advocacy and Critical Industry Issues;
  • Hospital Challenges Discussion;
  • Public Affairs Deep Dive for 2024; and
  • Comms in Action: Leveraging THA for Your Hospital.

More information and the registration link are available here. (Carrie Williams/Joey Berlin/Amy Rios)

This Week on The Scope

Focused on THA member hospitals/health systems and the issues they face, The Scope is THA’s No. 1 source for news, information and thought leadership related to Texas hospitals and priority issues impacting health care. Featured this week:

More content is available on The Scope. (Julia Mann/Amy Rios)

Texas Register Highlights

The Texas Health and Human Services Commission (HHSC) proposed an amendment concerning recoupment of overpayments identified by retrospective payment review. The purpose of the proposal is to describe the Office of the Inspector General’s (OIG) retrospective payment review procedures related to records requests, review processes, notices and due process. Texas Government Code §531.102 authorizes OIG to conduct reviews related to the provision and delivery of all health and human services in Texas to identify fraud, waste or abuse. (Feb. 16)

The Texas Health and Human Services Commission (HHSC) proposed an amendment to establish a process for local mental health authorities or local behavioral health authorities to submit a waiver request to HHSC to hire a licensed master social worker or licensed professional counselor (LPC) associate if they are unable to hire a non-physician mental health professional (NPMHP) in their designated regional education service center. The proposal establishes the behavioral health partnership program as the program name and “behavioral health partnership program liaison” as the position title that includes an NPMHP or a person hired under the waiver process. (Feb. 16) (Cesar Lopez, J.D.)

Federal Register Highlights

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to set forth a number of provisions to strengthen the oversight of accrediting organizations (AOs) by addressing conflicts of interest, establishing consistent standards, processes and definitions and updating the validation and performance standards systems. Additionally, this proposed rule would revise the psychiatric hospital survey process, add a limitation on terminated deemed providers and suppliers when reentering the program and provides technical corrections for End-Stage Renal Disease facilities and Kidney Transplant Programs. This proposed rule also solicits comments from stakeholders and AOs to refine and revise the AO oversight standards and processes. In addition, this proposed rule includes a request for information on the time frames and expectations for the submission of AO applications. (Feb. 15)

The Centers for Medicare & Medicaid Services (CMS) issued a correction to a final rule that appeared in the Nov. 13, 2023, issue of the Federal Register, titled “Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements.” (Jan. 31) (Cesar Lopez, J.D.)

The Health Care Advocate is a publication of the Texas Hospital Association, 1108 Lavaca, Austin Tx 78701. Telephone 512/465-1570 for information. For additional information regarding specific articles, please contact the THA staff member(s) listed at the bottom of each full article. According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by Jennifer Banda, J.D., Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas 78701-2180.