Banner Hacked-3.7 Million at Risk

A large-scale computer cyberattack at Banner Health compromised the records of up to 3.7 million patients, health-insurance-plan members, food and drink customers, and doctors according to the an Arizona Republic article by Ken Alltucker (1). Banner Health discovered unusual activity on its computer servers in late June and uncovered evidence of two attacks, with hackers accessing both patient records and payment-card records of food and beverage customers. The Phoenix-based health-care provider said it will mail letters to those affected notifying them about details of the cyberattack and steps they can take to protect themselves. Banner employees, many of whom are patients and covered by Banner Health insurance plans, also are believed to be victims of the attack.

The Banner Health attack is the largest among 32 known data breaches involving Arizona-based health and medical providers since 2010 according to an U.S. Department of Health and Human Service list. The breach exceeds all other breaches in Arizona combined by over 1,000,000 affected individuals. Banner also has the dubious distinction of the previous high in Arizona when records of 55,207 were compromised in 2014 (2).

Banner Health officials said they thus far have not received reports of hackers misusing the information, but the health-care provider will offer a free one-year membership in credit-monitoring services to patients, health-plan members and others affected by the cyberattack. The hackers apparently accessed Banner computer systems that process payment-card data at food and beverage outlets at some Banner Health locations. Potential victims can view a list of affected Banner locations in Arizona, Alaska, Colorado and Wyoming at http://bannersupports.com/customers/affected-locations/. On July 13, Banner Health discovered that hackers also may have accessed patient and health-insurance records, which may have included information about doctors and health-care providers. Those records may have included names, birth dates, addresses, doctors' names, dates of service, claims information, health-insurance information and Social Security numbers.

Bob Gregg, chief executive of Portland, Ore.-based ID Experts. said health-care providers are increasingly facing attacks from criminal organizations that resell the information for profit. According to Gregg. a record containing a name, address and Social Security number sells for $1 to $3 on the black market but detailed medical records with unique patient identifying numbers can fetch up to $100 per record.

Banner Health has established a website that details information about the data breach at http://bannersupports.com. Patients or other customers who have questions or concerns about the cyberattack can call 1-855-223-4412.

References

1. Ken Alltucker. Banner Health cyberattack breaches up to 3.7 million records. Arizona Republic. August 3, 2016. Available at: http://www.azcentral.com/story/money/business/health/2016/08/03/banner-health-cyberattack-breaches-up-3-7-million-records/88035474/ (accessed 8/6/16).
2. Robbins RA. Banner prints social security numbers. Southwest J Pulm Crit Care. 2014;8(2):140-1. [CrossRef]

Cite as: Robbins RA. Banner hacked-3.7 million at risk. Southwest J Pulm Crit Care. 2016;13(2):80-1. doi: http://dx.doi.org/10.13175/swjpcc075-16 PDF 

Top Medical News Stories 2015

Here is our list of the top seven medical news stories for 2015 with special emphasis on the Southwest.

7. Wearable health devices

A wave of wearable computing devices such as Fitbit and UP wristbands have people keeping track of how much they sit, stand, walk, climb stairs and calories they consume (1). These fitness-tracking devices herald a series of devices that will detect and monitor serious diseases. However, these so-called medical-grade wearables require approval from the U.S. Food and Drug Administration, a regulatory hurdle avoided by the fitness-tracking devices which will likely slow their introduction.

6. Caitlyn Jenner

Caitlyn Jenner became the most famous transgender woman in the world following an interview published in Vanity Fair (2). The Vanity Fair website saw 11.6 million visits curious about the former Olympic athlete. Though Jenner publicly shared her gender identity, many transgender Americans do not-12% of gender non-conforming adults said they had never told anyone about their gender identity. Jenner's "coming out" has and will likely continue to draw increasing attention to gender dysphoria. In Arizona, the Tucson VA recently established a transgender clinic (3).

5. Ebola

Two years after the beginning of an Ebola outbreak in West Africa, the virus continues to strike fear in the US. The Ebola outbreak sickened more than 28,630 people and killed at least 11,300, according to the World Health Organization (4). While the epidemic subsided in 2015, the virus has never completely gone away. The only Ebola cases today are in Liberia, a nation twice declared "Ebola free" suggesting that eliminating Ebola may be difficult.

4. Terrorism in San Bernardino

Multiple terror attacks have occurred in far off places like Afghanistan and Paris, but terror was brought to the Southwest in 2015 by 2 terrorists who killed 14 at a holiday party earlier in December in San Bernardino, California (5). The attack generated concern about emergency preparedness and will likely generate training for triaging and care of multiple gunshot victims.

3. Vaccines

A measles outbreak that started at Disneyland spread to 117 people earlier this year and changed the national conversation about vaccinations (1). The outbreak also drew attention to Disneyland's Orange County where a relatively large percentage of the population is not vaccinated. The outbreak spurred California and Vermont to strengthen their school vaccine laws. Vermont repealed its "personal belief" exemption, which allowed unvaccinated children to attend school if their parents objected to vaccines for philosophical reasons. California went even further, putting an end to both personal belief and religious exemptions.

2. Opioids

Deaths from opioid drug overdoses have hit an all-time record in the U.S., rising 14 percent in just one year (6). More than 47,000 people died from these drug overdoses last year according to the CDC. Concomitant with the introduction of the pain scale as the "fifth" vital sign and continued criticism of doctors for undertreating pain, prescription opioid sales have quadrupled in the US since 1999. The CDC announced that it will issue guidelines to reduce opioid overdoses and prescribing.

1. Prescription Drug Prices

Concern over high drug costs has been building for years. Prices for cancer drugs often exceed $100,000 a year and Gilead priced its breakthrough hepatitis C drug at $84,000 for a 12-week treatment (4). Outrage over drug prices boiled over in 2015 when Turing Pharmaceuticals purchased the rights to pyrimethamine and immediately hiked the price from $13.50 a pill to $750 a pill. Pyrimethamine (Daraprim®) is a medication used for protozoal infections such as Toxoplasma gondii, an infection usually seen in AIDS patients. An October poll from the Kaiser Family Foundation found that 77% of those surveyed said that drug prices should be a top priority for Congress and the White House should and 63% favored government action to lower prescription drug prices.

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Reddy S. Year in review: top 10 health issues of 2015. Wall Street Journal. December, 29, 2015. Available at: http://www.wsj.com/articles/year-in-review-top-10-health-issues-of-2015-1451341107 (accessed 12/31/15).
2. Chalabi M. 2015: the top news stories of the year in numbers. The Guardian. December 28, 2015. Available at: http://www.theguardian.com/news/datablog/2015/dec/28/2015-news-stories-of-the-year-in-numbers-police-shootings-syria-gay-marriage-star-wars (accessed 12/31/15).
3. Transgender services. Available at: http://www.tucson.va.gov/services/Transgender_Services.asp (accessed 12/31/15).
4. Szabo L. That $750 pill and more: 2015's top health stories. USA Today. December 15, 2015. Available at: http://www.usatoday.com/story/news/2015/12/15/five-medical-stories-led-news-2015/77296624/ (accessed 12/31/15).
5. Domonoske C. San Bernardino shootings: what we know, one day after. NPR. December 3, 2015. Available at: http://www.npr.org/sections/thetwo-way/2015/12/03/458277103/san-bernardino-shootings-what-we-know-one-day-after (accessed 12/31/15).
6. Siegel R. Draft of CDC's new prescribing guidelines stirs debate. NPR. December 29, 2015. Available at: http://www.npr.org/2015/12/29/461409296/draft-of-cdcs-new-prescribing-guidelines-stirs-debate (accessed 12/31/15).

Cite as: Robbins RA. Top medical news stories 2015. Southwest J Pulm Crit Care. 2015;11(6):285-6. doi: http://dx.doi.org/10.13175/swjpcc159-15 PDF

Banner Plans to Issue New Bonds to Cover University of Arizona Medical Center Purchase

Modern Healthcare is reporting that Banner Health is issuing new bonds this week to refinance older debt (1). Banner financed the $1 billion purchase of the University of Arizona Health Network (UAHN) including the University of Arizona Medical Center with a $700 million short-term loan from investment bank Mizuho in February. Banner is issuing $100 million in tax-exempt, fixed rate Series 2015A bonds. It is also planning to take on an additional $500 million in taxable and tax-exempt debt that will be used to replace the short-term loans associated with the purchase.

Banner is focusing on how to improve the return on its UAHN investment, which has dragged down its earnings. UAHN's financial performance has deteriorated with an operating margin declining to -4.3% in fiscal 2014, down from -1.2% the previous fiscal year. Before that, UAHN was profitable, according to Banner Chief Financial Officer Dennis Dahlen. Banner reported an operating surplus of $107.6 million on $3.4 billion in revenue for the first half of this year (2). In the prior-year period, its operating surplus was $186 million on $2.7 billion in revenue.

In an attempt to increase profitability, Banner has implemented a leadership incentive plan at UAHN and labor productivity tools. The executive compensation firm Sullivan Cotter has also been hired to design a new physician practice compensation structure. Dahlen noted that Banner believes that it will stabilize UAHN's finances by the end of next year, with profitability returning in 2017.

With the purchase of UAHN and the much smaller 44-bed Payson Regional Medical Center in July, Banner now reaches 82% of Arizona residents and is by far Arizona's largest health care system. Banner also plans to expand UAHN's health plans statewide to capture additional market share. The impact the debt from Banner's drive for market share will have on health care prices and Banner employees is unclear.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. Kutscher B. Banner prepares to issue new debt amid UAHN turnaround efforts. Modern Healthcare. October 20, 2015. Available at: http://www.modernhealthcare.com/article/20151020/NEWS/151019914?utm_source=modernhealthcare&utm_medium=email&utm_content=20151020-NEWS-151019914&utm_campaign=am (accessed 10/21/15).
2. Kutscher B. Banner aims to cut costs from UAHN as earnings lag. Modern Healthcare. August 25, 2015. Available at: http://www.modernhealthcare.com/article/20150825/NEWS/150829923 (accessed 10/21/15).

Cite as: Robbins RA. Banner plans to issue new bonds to cover university of Arizona medical center purchase. Southwest J Pulm Crit Care. 2015;11(4):191. doi: http://dx.doi.org/10.13175/swjpcc136-15 PDF

HealthCare.gov Shares Personal Data with Third Parties

According to the Associated Press, the Centers for Medicare and Medicaid's (CMS) website, HealthCare.gov, has been sending consumers’ personal data to private companies that specialize in advertising and analyzing Internet data for performance and marketing (1). What information is being disclosed was not immediately clear, but it could include age, income, ZIP code, and smoking status. It could also include a computer’s Internet address, which can identify a person’s name or address when combined with other information collected by sophisticated online marketing or advertising firms. “We deploy tools on the window shopping application that collect basic information to optimize and assess system performance,” said CMS’s Aaron Albright in a statement. “We believe that the use of these tools are common and represent best practices for a typical e-commerce site.” There is no evidence that personal information has been misused. But connections to dozens of third-party tech firms were documented by technology experts who analyzed HealthCare.gov and then confirmed by AP. A handful of the companies were also collecting highly specific information.

Created under the Affordable Care Act (ACA, Obamacare), HealthCare.gov is the online gateway to government-subsidized private insurance for people who lack coverage on the job. It serves consumers in 37 states, while the remaining states operate their own insurance markets.

Marilyn Tavenner, administrator of CMS, resigned last Friday, effective  February 1. Much maligned for the shaky roll-out of HealthCare.gov, it is unclear if Tavenner's resignation and the revelation of the breech in patient confidentiality are related.

References

1. Associated press. Government health care website quietly sharing personal data. Available at: http://www.cnbc.com/id/102355634 (accessed 1/22/15).
2. Alonso-Zaldivar R. Medicare chief steps down, ran health care rollout. Available at: http://abcnews.go.com/Health/wireStory/medicare-chief-steps-part-health-care-roll-28270777 (accessed 1/22/15).

Reference as: Robbins RA. Healthcare.gov shares personal data with third parties. Southwest J Pulm Crit Care. 2015;10(1):51. doi: http://dx.doi.org/10.13175/swjpcc009-15 PDF

2014's Top Southwest Medical Stories

The end of the year has traditionally been a time to reflect on the top stories of the year. Here's our list of the top local medical stories.

1. VA scandal

Phoenix was the epicenter of the VA scandal but Albuquerque and the Greeley, Colorado clinic also figured prominently in the falsification of patient wait lists. Investigations revealed that at least 70% of the VA hospitals falsified records leading to the resignation of VA secretary, Eric Shinseki, and his under secretary for health, Dr. Robert Petzel. Eventually the director of the Phoenix VA, Sharon Helman, was fired-not for the falsification of medical records but for taking inappropriate gifts. However, most of the directors of the VA hospitals that falsified data remain untouched, still receiving their bonuses. Similarly, the politicians, the inspector general and those in the VA central office whose job was to provide oversight remain unscathed. On the bright side, the scandal did result in a modest influx of monies which hopefully will be spent on patient care rather than administrative bonuses.

2. Ebola outbreak

This seems a bit odd for a local news story but the Ebola epidemic in Africa did impact locally. The outbreak was largely ignored by the American public until a patient and several healthcare workers became infected in the US. Politicians and healthcare administrators seized the opportunity to hype the hysteria and insist on training of healthcare workers. One Arizona Thoracic Society meeting was cancelled because a nursing service needed the room to do "Ebola training". As Peter Sagal said on "Wait, Wait, Don't Tell Me" there have been more Americans married to Larry King that infected with Ebola illustrating the hysteria and resultant overreaction. This year's true medical heroes are the thousands of physicians and nurses who worked on the frontlines of the Ebola crisis in Africa at tremendous personal risk and despite chaotic conditions, underequipped facilities, and overwhelmed local health systems. In contrast to the politicians and healthcare administrators, Anthony Fauci has consistently offered reasonable recommendations and insight based on science.

3. Banner Health, University of Arizona Health Network merger

In June, the Banner Health and University of Arizona Health Network (UAHN) began negotiations to merge with Banner absorbing UAHN's $146 million debt. Banner promised to spend at least $500 million toward capital projects in the next five years and pay $300 million to establish an academic endowment. The deal is to be completed about the end of January, 2015. Mergers between the private and public health sectors have been a mixed bag and this one warrants close watching.

4. Meaningful use

Many physicians suspected that the Centers for Medicare and Medicaid Services' (CMS) meaningful use was little more than a scheme to have physicians perform useless clerical tasks. When they were not done, payment would be denied. At the end of 2014 this appears to be true. There remains no data that the meaningful use is "using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities" as intended. About 257,000 physicians will receive a 1% reduction in reimbursement in 2015.

5. Reduction in CMS hospital payments

Despite the lack of data that CMS' value-based healthcare program is doing much to benefit patients and some data that performance of the measures has been associated with adverse outcomes, CMS continues to reduce hospital payments because of hospital-acquired conditions and high readmission rates. We initially reported on this in June, 2013. We are not advocating for hospital-acquired infections or readmissions, but are advocating for measures that improve patient outcomes. Despite a phone call assuring us that CMS would look into it, nothing has seemed to change. Furthermore, much of the data is self-reported by the hospitals. As the VA scandal illustrates, self-reported data is not always reliable especially when money is involved.

6. Congress again fails to pass SGR fix

Congress passed a budget but failed to fix the widely hated sustainable growth rate (SGR) formula for physician reimbursement under Medicare. Also missing was an extension of the current pay bump for primary care. SGR has been present since 1997 and the one of the few things the politicians seem to come together on is not paying physicians, especially primary care physicians, a decent living wage.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

Reference as: Robbins RA. 2014's top southwest medical stories. Southwest J Pulm Crit Care. 2014;9(6):350-1. doi: http://dx.doi.org/10.13175/swjpcc167-14 PDF