Becker's Spine Review

48 Becker's 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine - call (800) 417-2035 Criminal Attacks No. 1 Cause of Healthcare Data Breaches: 5 Key Notes By Akanksha Jayanthi S pine surgeons face a constant back-and- forth with insurance companies to gain approval for surgical procedures, which has become more difficult over the past decade with the rising cost of surgical procedures and new coverage guidelines from payers. Insurance companies are more willing to approve than in the recent past, but it takes persistence. "A lot of insurance companies have begun to fight less vigorously but it still seems an endless battle because surgeons have different expectations and priorities than the insurance companies," says Thomas Roush, MD, founder of Roush Spine in Lake Worth, Fla. "The insurance companies have to think about their shareholders and other non- patient-related entities while surgeons must focus on ways in which to optimize a patient's condition while striving to exceed patient expectations." As the practice of medicine becomes more cor- porate, here are five key trends Dr. Roush sees in the future: 1. Surgeons will stop spending time fight- ing insurance companies. Most surgeons are already heading busy practices and don't have the resources to fight for coverage. "More and more surgeons are disconcerted and not putting up as much of a fight regarding procedure approv- als and as a consequence it has become easier for those of us who do call the insurance companies to get through," says Dr. Roush. "In my experi- ence, it has become easier to communicate with the insurance companies now than it was five years ago." 2. Technology is limited because insur- ance companies won't cover new innova- tions. "Many technological advances in surgery aren't considered by the insurance market because their algorithms aren't compatible with applying new technology," says Dr. Roush. "Most of the technology is denied but not understood by in- surance companies. You might have to make three or four calls and talk to someone familiar with the technology before you can get it covered." 3. Insurance companies could suc- ceed in limiting some unnecessary sur- gery. "There is a mismatch between patients, surgeons and insurance company indications," says Dr. Roush. "The interfering third party is a necessary evil to provide some regulation of the industry. But insurance companies and their rep- resentatives aren't adequately educated or expe- rienced in the field of spinal surgery, so they be- come an impediment and patients are denied the best available technology for surgery." 4. Insurance companies are limiting out- of-network options for patients and spine surgery is costly enough that many pa- tients aren't able to pay out-of-pocket. "Pa- tients will often just settle for whatever treatment is approved," says Dr. Roush. "They might opt for a more invasive and morbid fusion instead of motion preservation because insurance compa- nies don't cover it. Or patients might not be able to work through the entire approval and denial process. They'll wind up settling for a suboptimal treatment option simply because that specific op- tion is approved. The irony is that the insurance companies will often spend considerably more money covering procedures that are less optimal for patients as these procedures tend to be associ- ated with longer hospital stays and complications." 5. Surgeons will join together in larger practices for leverage with insurance companies. "When you're in private practice, there are fewer people to fight the battles for you and make the calls to the insurance company. This preserves the obstruction," said Dr. Roush. "In larger practices, the appeals process can be centralized such that designated employees may regularly communicate with the insurance com- panies and surgeons may regain their focus on optimizing patient care by strengthening the pa- tient-physician relationship." n 5 Key Observations on Spine Surgeon Interaction With Insurance Companies By Laura Dyrda Dr. Thomas Roush T he threat of data breaches in healthcare continues to rise, and with it rises the incidence of malicious attacks on hospital and health system networks. A new report from the Ponemon Institute indicates criminal attacks have become the main cause of healthcare data breaches for the first time. Here are five key things to know. 1. Over the past five years, the occurrence of criminal attacks on health- care organizations has increased 125 percent. Of the 178 healthcare or- ganizations and business associates surveyed by Ponemon Institute, 45 percent of healthcare organizations and 39 percent of business associates reported a data breach whose root cause was a criminal attack. Addition- ally, 12 percent of healthcare organizations and 10 percent of business as- sociates reported a data breach whose root cause was a malicious insider. 2. In the past year, 78 percent of healthcare organization breaches and 82 per- cent of business associate breaches were due to web-borne malware attacks. 3. However, few entities appear concerned with the growing security risk. Just 40 percent of healthcare organizations and 35 percent of business associates are worried about cyber attackers, according to the study. 4. What's more, organizations said they do not have the adequate budget or resources to protect both electronic and paper-based pa- tient information, according to the study. Approximately 56 percent of healthcare organizations and 59 percent of business associates said their incident response process lacks funding and resources. 5. While one half of healthcare organizations reported having a four- factor risk assessment following a security incident involving electron- ic information, approximately one-third — the majority —said they have an ad hoc process for the assessment. For business associates, 42 percent of respondents indicated having a four-factor risk assessment, and the majority again was an ad hoc process at 38 percent. n

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