6 Scariest Issues in Healthcare Right Now

With Halloween coming up, we at Becker's Hospital Review thought it seemed as good a time as any to recap some of the most frightening and concerning issues in healthcare. Here are six of the scariest issues in healthcare right now. These events and trends have made their fair share of headlines in recent weeks and continue to alarm hospital and health system executives.

1. Hurricane Sandy. The fall "superstorm" made landfall in the mid-Atlantic region Monday evening and left at least 38 dead — from Maine to the Carolinas — by Tuesday, according to a Washington Post report. Hospitals in the area deployed emergency plans and kept extra providers on site for an expected influx of patients, but some hospitals were unable to withstand Sandy's powerful surge.

In New York City, NYU Langone Medical Center was forced to evacuate all of its 215 patients after its backup power system failed Monday night. Patients were transported to nearby facilities, including Mount Sinai Medical Center and Memorial Sloan-Kettering Cancer Center. Staten Island (N.Y.) University Hospital evacuated its data center due to flooding, leaving it with no access to computers or electronic patient data. Fortunately, the hospital was able to "preserve patient safety by relying on paper records," according to a system spokesman in a MSNBC report. Other hospitals were ordered to evacuate Monday morning before the storm even touched down, due to their low-lying locations, such as Manhattan Veterans Affairs Hospital and New York Downtown Hospital.

2. Contaminated injections. As of the time of publication, at least 344 people were diagnosed with and 25 people had died from fungal meningitis in an outbreak linked to contaminated vials of methylprednisolone acetate, a steroid injected to treat patients' back and joint pain.

Vials of the steroid manufactured by the New England Compounding Center in Framingham, Mass., contained a fungus found in soil and plants. Those vials were distributed to more than 75 health clinics in 23 states, and up to 14,000 patients are estimated to have received injections of the contaminated steroid. State and federal inspections of NECC identified unsanitary conditions, such as surfaces coated with mold and bacteria.

The Food and Drug Administration linked NECC staffers to the outbreak, claiming there was no evidence that staff investigated or corrected the sterility problems. The center has since suspended operations. Massachusetts also shut down another compounding facility — Infusion Resource in Waltham — after conducting an unscheduled inspection, prompted by the meningitis outbreak.

The inspection's findings have sparked outcry from lawmakers, many of whom are urging the FDA to keep a closer eye on compounding pharmacies, or facilities in which pharmaceutical drugs are produced to fit unique needs of patients. Rep. Edward Markey (D-Mass.) presented concern that NECC operated as a drug manufacturer but "masqueraded" as a compounding pharmacy to avoid federal regulations. He vowed to draft a bill to enable greater oversight of compounding pharmacies.

Other lawmakers have taken action as well: Rep. Rosa DeLauro (D-Conn.) introduced a similar measure, and Sen. Richard Blumenthal (D-Conn.) called on the Justice Department to launch a criminal investigation of NECC, according to a report from The Hill.

3. Poor health of hospital employees. A recent study found hospital employees are less healthy than the U.S. workforce at large. People who work in hospitals have higher rates of emergency department utilization and hospital admission for chronic conditions, such as asthma, obesity, diabetes, coronary artery disease, congestive heart failure, hypertension and depression. Simultaneously, hospital employees are less likely to take preventive health measures: They have lower compliance rates for lipid testing and breast, cervical and colorectal cancer screening compared with the general workforce. Such findings don't bode well for health system, many of which self insure their employees.

4. Data breaches. Electronic data breaches are a perpetual fear for health systems and hospitals, but the onset of HIPAA compliance audits has reinforced this. HHS is currently in midst of its pilot phase for these audits, which span from November 2011 through December 2012, and hospitals are taking steps to assess their compliance with the breach notification rule and other HIPAA measures that will be scrutinized under the audits.

Even if a hospital passes audits with full compliance, the risk for a data breach is omnipresent. In May, an employee from Boston Children's Hospital lost a laptop at a conference, which contained protected health information for about 2,160 patients. In September, Temple Community Hospital in Los Angeles had to warn roughly 600 patients that PHI was breached when a computer was stolen from a locked office. Later that month, Massachusetts Eye and Ear Infirmary agreed to a $1.5 million settlement with HHS to resolve alleged HIPAA violations after an unencrypted laptop with PHI was stolen.

5. Physician shortage. Unlike the hurricane, there is no end in sight for the country's pressing physician shortage. There is currently a shortfall of 15,230 primary care physicians, and that number may swell to 130,000 by 2025, according to data from the Association of American Medical Colleges. The shortage may nosedive further in 2014, which is when insurance expansion for about 30 million Americans will go into effect.

Traditionally, the shortage has been most evident in rural areas, but its ripple effects are now hitting denser urban areas. For instance, Las Vegas residents may have to wait six months to see a primary care physician for a routine check-up and up to a year to see a specialist. Since physicians tend to practice in close proximity to where they trained, states like Nevada and Idaho are hit hard by the shortage, as these states don't have large medical schools or training hospitals.

Other contributing factors to the shortage include population growth exceeding medical school enrollment, younger physicians working fewer hours, more physicians nearing retirement and many medical students finding compensation for primary care unattractive.

Primary care's non-monetary motivations or deterrents are challenging to control, but many healthcare policy experts and economists have urged reforms in how primary care physicians are compensated. Most recently, Uwe E. Reinhardt, PhD, a professor of political economy at Princeton (N.J.) University, explored the idea of paying primary care physicians like hedge fund managers. The physicians would receive performance bonuses that are taxed at a low capital-gains rate, which is about 15 percent, compared with the income tax rate, which sits at about 35 percent plus payroll taxes.

6. Medicare cuts. The healthcare industry is bracing itself for a serious fiscal cliff. Unless Congress issues a permanent or temporary solution to the sustainable growth rate, physicians face a 27 percent cut to their Medicare reimbursement, effective Jan. 1.

A recent MGMA-ACMPE survey found roughly 45 percent of physician group practices said they would curb new Medicare patient appointments unless Congress enacted the doc-fix by Jan. 1. Physicians' uncertainty around the Medicare cuts also caused 54 percent of practices to say they are abstaining from participating in new care delivery models, such as accountable care organizations and bundled payments.

Sequestration cuts through the Budget Control Act of 2011 also loom at the start of the new year unless Congress, again, passes measures to prevent the cuts. Hospitals, physicians and other Medicare providers stand to lose $11.1 billion in 2013 alone if sequestration goes through unimpeded.

Although Fitch Ratings analysts previously said they believed sequestration cuts would be "averted or modified," they also said non-profit hospitals should brace themselves for the most risk: Medicare and Medicaid are the major payors for these hospitals, usually representing about 60 percent of non-profit hospitals' revenue bases. Academic medical centers and teaching hospitals are also likely to feel a sting, as Medicare payments provide support for graduate medical education. A reduction in federal GME funding could limit the ability of teaching hospitals to train residents, and there have also been discussions among lawmakers about cutting GME funding to avoid sequestration, fueling more fear for these hospitals.

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