Healthcare is stuck in a rut, with many of the same daily events and problems stemming from long-standing systemic issues that are sorely in need of urgency, attention and insistence for improvement.
Covering healthcare news on a daily basis can result in an interesting vantage point. Being a few feet removed helps one better see the shape of how local stories can build into national or industrywide trends. Being close enough helps one detect patterns, better noticing the moment when things tip the scales from rarity to recurring, or from inevitable to preventable.
Go a mile wide and an inch deep for long enough and it quickly becomes clear how inaction, apathy and tyranny of the urgent leads history to repeat itself. The U.S. is also coming off of one of the most unproductive Congresses in modern history that seems to fancy theatrics with hope of social media virality versus meaningful, substantive healthcare lawmaking. To avoid excessive reliance on the government to solve every problem, there are growing opportunities for private-public coalitions in healthcare around issues that stand to affect a lot of people.
Here are four cyclical things we at Becker's continue to run into in our newsroom and the healthcare news cycle that, if addressed further upstream by lawmakers, government officials, business and community leaders, stand to become less recurring — or at least less futile.
1. Hospital closures. It seems lawmakers only start to take notice of hospital financial solvency when closure announcements are made. Lost in this 11th-hour dynamic is concern for patient safety and care quality. The closure of a hospital is one thing. But just as important — and often neglected — is scrutiny of the quality of care patients receive in the period leading up to the announcement of closure.
Dallas-based Steward Healthcare is one of the most recent examples of this. The for-profit chain was on a buying spree in recent years. Four days into 2024, hospital landlord Medical Properties Trust reported Steward was $50 million behind on its rent. It wasn't until The Boston Globe published local reporting on the state of affairs at Steward's Massachusetts hospitals that lawmakers and officials started to pay attention.
The Massachusetts governor is now calling this health systems' financial situation an urgent priority, U.S. lawmakers from Massachusetts are giving Steward two weeks to submit information in response to their inquiry, and states around the U.S. are seeing Steward curb services or acting in response to the risk of abrupt closures. Steward operates hospitals in 11 states.
2. Hospital staff safety. The Safety from Violence for Healthcare Employees Act was introduced in the House last April and in the Senate last September. The bipartisan legislation would make it a federal crime to knowingly assault hospital workers and enact federal protections for healthcare workers like those in effect for aircraft and airport workers.
Since the legislation's introduction, individual acts of violence in hospitals continue to unfold and make headlines as more longitudinal data is released showing just how much more hostile healthcare settings have become. More than double the number of health workers reported harassment at work in 2022 than in 2018, including threats, bullying, verbal abuse, or other actions from patients and co-workers that create a hostile work environment, according to CDC data. More than 5,200 nursing personnel were assaulted in the second quarter of 2022, according to data from Press Ganey, amounting to about 57 assaults per day.
The SAVE Act is one tool that would enhance protections for healthcare workers, which are long overdue. Assault and harassment of healthcare workers began to mount early on in the COVID-19 pandemic. The legislation will not eliminate violence against healthcare workers — particularly that tied to behavioral or mental health crises — but some level of deterrence is sorely needed for the healthcare workers we have today and those we hope to gain for the future.
3. Healthcare workforce shortages. Much attention is paid to technology solutions and AI support systems to augment the healthcare staff and workers who are in short supply. But look more closely, and the foundation of data about the U.S. workforce looks like Swiss cheese.
There are more than 8,300 designated primary care shortage areas in the U.S., and nearly 200 of them have been federally designated as such for at least 40 years. This finding stems from an analysis that KFF Health News published last month. One area on the far south side of Chicago has been designated as a shortage area since 1978. Another area in the Baton Rouge metro area in Louisiana, has been named a shortage area since 1979, most recently with 22 full-time primary care physicians for nearly 140,000 people.
The federal health professional shortage area program was established in 1965 — its purpose is not to simply label pockets of the nation as shortage areas for decades at a time. Something is not working correctly with these designations; dig deeper, and you'll find other data points are missing and contributing to inaction. These data points are so straightforward, one might assume they are a given in our national conversation and problem-solving. There are no national estimates of annual physician turnover, for one. This basic, essential figure is not rigorously or systematically captured. Incomplete or missing data on where healthcare professional deficits are most critical make it unlikely for federal policy or interventions to realize their full potential.
4. Hospital cybersecurity. Becker's covered one of the earliest hospital ransomware attacks on a small hospital in Kentucky in 2016. Methodist Hospital in Henderson, Ky., operated in an internal state of emergency for five days and did not pay the ransom. Since, we've seen cybergangs and criminals grow more savvy, emboldened and nefarious in their targeting of hospitals. Health system ransomware attacks nearly doubled in 2023, with 141 U.S. hospitals affected last year and data stolen in 32 of 46 of the events.
These attacks can wreak havoc and cause harm to entire healthcare infrastructures across state lines. Last November, the hack of 30-hospital Ardent Health Services, based in Nashville, Tenn., caused ambulances to be diverted across six states. The actors behind these attacks have also grown more cruel, hitting children's hospitals (most recently Lurie Children's, a level 1 pediatric trauma center in Chicago), demanding $900,000 from a safety-net hospital in 48 hours, publishing data about hospital staff, or activating other hospital equipment mid-attack.
Unless government leaders do something more meaningful and significant to address the growing number of hospital cyberattacks — certainly than they have done to date — it's inevitable that these events and the rate of them will worsen. Most recently, a couple of lawmakers introduced legislation to beef up cybersecurity efforts within HHS. The bill basically requires the federal agency to perform routine cybersecurity checks and report findings to Congress, and doesn't contain any teeth for hospitals. HHS has released a "concept paper" on the topic.
The need for stronger regulations, more resources, and better oversight to protect the stability and resilience of hospital infrastructure is immense, nonpartisan and met with complacency.