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Saeed Valian is the chief information security officer of symplr

Cybersecurity is make or break for patient safety and operational integrity.

A unified front: Cybersecurity's role in healthcare operations and patient safety | Viewpoint

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Mehmet Oz, MD, has been one of America’s most famous doctors for years, and now he’s poised to take oversight of the Medicare and Medicaid programs.

President-elect Donald Trump announced Tuesday that he has nominated Oz to lead the Centers for Medicare & Medicaid Services. It’s the latest in a series of unconventional cabinet picks for Trump, including his nomination of Robert F. Kennedy Jr. to lead the U.S. Department of Health & Human Services.

 his pick, Trump touted the prospect of Oz and Kennedy working together to lead the nation’s health policy. The health department includes the CMS.

“Dr. Oz will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake,” Trump said.

Concerns mount over prospect of Robert F. Kennedy Jr. leading HHS

A cardiothoracic surgeon who once led the heart institute at New York Presbyterian Medical Center, Oz gained fame through frequent appearances on Oprah Winfrey’s talk show. He later had his own show which ran for 13 years. He stepped away from the show to run for the U.S. Senate in 2022, and he lost to current U.S. Sen. John Fetterman, D-Pa.

“Our broken Healthcare system harms everyday Americans, and crushes our country’s budget,” Trump said in his announcement. “Dr. Oz will be a leader in disease prevention, so we get the best results in the world for every dollar we spend on healthcare in our Great Country. He will also cut waste in fraud within our country’s most expensive Government Agency.”

Like some of Trump’s other choices for top Cabinet posts, including Kennedy, Oz brings no experience running a large, government organization.

 on X, Oz said he welcomed the opportunity.

“I am honored to be nominated by @realDonaldTrump to lead CMS. I look forward to serving my country to Make America Healthy Again under the leadership of HHS Secretary @RobertKennedyJr.,” Oz wrote.

 on X that he is “very excited” by the choice of Oz and thanked Trump for an “outstanding nomination.”

“Welcome Dr​. Oz to ​The Avengers,” Kennedy wrote.

The CMS’s programs touch the lives of 160 million people, or roughly 1 in 2 Americans, through Medicare, Medicaid, the Children’s Health Insurance Program and the Marketplaces.

The head of the CMS requires Senate confirmation, and with a relatively narrow margin in the Senate, Oz would need to hold onto the support of all Republican senators if most Democrats vote against the pick. Republicans are slated to hold a 53-47 majority in the Senate.

U.S. Sen. Elizabeth Warren, D-Mass., offered a 

“Running Medicare and Medicaid for over 100 million Americans isn't like hosting a daytime talk show,” Warren wrote. “Dr. Oz is another rich guy who doesn't care if your health care costs go up or an insurance company denies you coverage. These decisions have life and death consequences.”

Rep. Frank Pallone, a New Jersey Democrat, assailed the nomination of Oz.

“Given the crucial importance of this agency, I am alarmed that President-elect Trump has chosen a TV celebrity without the experience or background to lead it,” Pallone said in a statement Tuesday. “Unfortunately, this nomination further demonstrates that Trump is not concerned about Americans’ health care.”

“By nominating both RFK, Jr. and Dr. Oz, Trump is doubling down on leaders that peddle in dangerous misinformation that endangers public health,” Pallone said.

U.S. Sen. Bill Cassidy, R-La., is a physician and he offered a statement of support for Oz. Cassidy will serve as chairman of the Senate Health, Education, Labor and Pensions Committee next year.

“It has been over a decade since a physician has been at the helm of CMS, and I look forward to discussing his priorities,” Cassidy 

 on X. “This is a great opportunity to help patients and implement conservative health reforms.”

An interesting vote to watch in the Senate could involve David McCormick, the Republican Senate nominee from Pennsylvania. The Associated Press and other outlets have called McCormick the victor in his race against longtime U.S. Sen. Bob Casey Jr., D-Pa., but Casey has not conceded and 

. McCormick narrowly lost to Oz in the 2022 Senate Republican primary.

Oz may be able to count a vote from Sen. Fetterman, 

Fetterman told CNN that he could support Oz if he makes a commitment to preserve Medicare and Medicaid, and he reiterated that in a 

“If Dr. Oz is about protecting and preserving Medicare and Medicaid, I’m voting for the dude,” Fetterman wrote.

Oz brings credentials as a physician to the post, unlike Kennedy, who doesn’t have a medical or scientific background. 

Healthcare leaders have denounced Trump’s choice of Kennedy

 to lead the health department, citing his vaccine skepticism and lack of experience in health or science.

Still, Oz received plenty of scrutiny during his years hosting his television show. Critics bashed Oz for pushing what he touted as miracle cures for weight loss on his show. In 

, researchers found “believable evidence” for only a third of the recommendations on “The Dr. Oz Show.”

Jonathan Reiner, MD, a professor of medicine at the George Washington University School of Medicine & Health Sciences, notes Trump’s choice of Oz is “another odd appointment.”

“True, Oz is a doctor, but the CMS post is something more suited for a policy wonk,” Reiner 

 on X. “Before assuming her post, the current administrator, Chiquita Brooks-LaSure was deputy director for policy at the Center for Consumer Information and Insurance Oversight within CMS, and earlier at HHS as director of coverage policy.”

Annie Andrews, MD, who ran for Congress in 2022, assailed the Oz nomination on the heels of Trump’s choice of Kennedy to lead the health department.

“If you asked any doctor, any reasonable doctor in this country, who, like, the worst two people for these jobs would be, these would be two people on the top of the list,” Andrews said in a video she posted to X.

Andrews said cuts to Medicare or Medicaid payments to doctors and hospitals would potentially disrupt healthcare.

“Our healthcare system is built around the existence of the Medicaid and Medicare programs. Doctors, offices and hospitals rely on funding from these two programs to keep their doors open,” Andrews said.

Hospitals and physicians have both bemoaned Medicare reimbursements. Hospitals have said 

Medicare and Medicaid don’t offer sufficient reimbursements

Doctors and their trade groups have assailed CMS for continually cutting reimbursements to doctors, saying the cuts threaten access to care and could spur some doctors to opt against seeing Medicare patients. Physicians and hospitals have called on CMS and Congress to come up with a better payment structure for doctors.

Medicare 2025 payment cuts to doctors are finalized, and physicians are fuming

Trump has said he has no plans to cut Medicare, and some analysts have expressed doubts that he will impose cuts to beneficiaries.

Seema Verma served as administrator of the Centers for Medicare & Medicaid Services during the Trump administration. 

 last month that she didn’t foresee Medicare cuts under Trump, saying, “He’s very protective of the program.”

When it comes to Medicaid, Verma said Trump would definitely give more deference to the states regarding Medicare, and he’d be focused on seeing money go to those in need.

The famed heart surgeon, television host and former Senate candidate would oversee the huge agency. Trump said he’d be a good partner to Robert F. Kennedy Jr., the HHS nominee.

Topic

From TV to CMS? Trump picks Dr. Oz to run Medicare and Medicaid, and some aren’t applauding.

Bea Grause is striving to help everyone understand the gravity of the problems facing the healthcare industry.

The president of the Healthcare Association of New York State, Grause has been talking to healthcare leaders about the difficulties which only stand to become more daunting in the future. But she’s also talking to leaders beyond the world of healthcare.

In an interview with Chief Healthcare Executive®, Grause outlines her efforts to educate leaders from all sectors and galvanize support for developing solutions to ensure patients have access to the care they need.

“It is about supply and demand,” she says. “We have an aging population. It's not just the aging population, but that's a big driver. As we have increasing and changing demand, we're also faced with a chronic national workforce shortage.”

Earlier this year, the hospital association released a 

, “The Case for Change,” outlining some of the headwinds facing health systems. More patients are having trouble getting access to the care they need, the shortage of workers could worsen over time, and many can’t afford the costs of healthcare.

“We have been using it all year to talk to other leaders, to try to level set and get everyone on the same page around what are some of the big drivers, what's happening in healthcare, that has everyone so concerned,” Grause says.

“This document is step one. It's about, how do we get everyone to get and everyone to really look and understand the underlying challenges that are causing our healthcare system to begin to fail,” she explains.

(See part of our conversation in this video. The story continues below.)

Bea Grause is reaching out to leaders to address the challenges in the healthcare industry.

Healthcare Association of New York leader aims to galvanize change

Hospitals in New York continue to face formidable financial challenges

. Three out of four New York hospitals (74%) say they don’t have sufficient margins enabling their organizations to invest properly in patient care, according to a survey by the state’s hospital trade groups released in late November.

Half of New York’s hospitals have negative operating margins, according to the survey.

In addition, New York’s hospitals project that the statewide median operating margin for 2024 will be 0.0%. Revenues are improving for some hospitals, but they aren’t keeping pace with higher costs.

The combination of higher expenses and modest revenue improvement “continues to create a financially fragile healthcare system in New York,” Grause says.

The healthcare challenges in New York state are very connected, Grause says. More patients are having trouble accessing primary care, so they often are showing up in hospital emergency departments.

More New York hospitals are boarding patients for longer periods in emergency departments, reflecting 

a serious problem affecting hospitals nationwide

. In New York, as in other states, many patients are stuck in the emergency department because there aren’t inpatient beds available, either due to staffing shortages or a lack of beds at nursing homes and other post-acute care facilities, Grause says.

The lack of nursing home beds is creating added strain on New York hospitals.

“We have 7,000 fewer nursing home beds today in New York state than we did in 2018,” Grause says.

The shortage has been especially problematic in Rochester, which has seen significant boarding of patients in emergency departments, while some hospital patients could be discharged but are still waiting to be placed in nursing homes, she adds.

In addition to causing financial strain for hospitals by limiting their ability to treat more patients, and boarding others for longer periods, patients are suffering as well.

“It hurts patients in terms of them being able to get the care they need,” Grause says.

And that’s why Grause is urging policymakers and business leaders to see that there’s a need to address the workforce challenges affecting all levels of healthcare, including primary care, hospitals, and post-acute care.

“That supply and demand challenge is not going to be a blip on the screen. It is going to be over the next 25 years,” Grause says.

Fundamentally, the healthcare industry is facing rising demand for services, especially as the last of the Baby Boom generation approaches retirement age at the end of the decade. And Grause notes many doctors and nurses are in their 50s and may be approaching retirement as a growing wave of older Americans have more needs from the healthcare system.

Many hospitals continue to struggle to hire and keep enough nurses, and that’s a problem at many New York hospitals as well, Grause says. It’s one that is especially meaningful for her as a registered nurse who previously worked in the emergency department.

But as Grause says, hospitals are struggling to fill a number of positions.

“There's a lot of competition, particularly as if you are thinking about certified nurses’ assistants, LPNs or other technical positions,” she says. “There's competition for those entry level positions in other industries.”

While staffing shortages are a statewide problem, rural hospitals are having significant difficulty in filling positions, she says.

Grause says it’s time to think more creatively about recruiting people at earlier ages, including high school and even middle school, to develop an interest for careers in the healthcare industry.

That’s why Grause says she has been reaching out “beyond our traditional partners.” Grause says she has been talking to leaders in other businesses, union groups, and teachers unions “about ways that we can work together on workforce priorities.”

With the costs of healthcare out of reach for many patients, Grause also says she’s trying to help gain support for policymakers to tackle affordability. Actually, she calls it “the paralysis of unaffordability.”

In more than 30 years of health policy, leaders have been talking about reducing healthcare costs.

Grause suggests reframing the question, asking, “How do we meet increasing and changing demand in ways that produce affordability over time?”

She also sees more potential to treat patients outside the four walls of the hospital, including hospital-at-home programs. And she says she’s hopeful that artificial intelligence can help health systems operate more efficiently and improve the delivery of care to patients.

“We have to think about ways that we are going to continue to deliver high quality care in ways that meet consumer demand, but actually are more efficient and effective for the population we serve,” Grause says.

Despite the problems facing New York hospitals, Grause maintains a sense of confidence that solutions can be found.

“It's going to require strategic and bipartisan approaches,” she says.

She also says it’s going to take time, but she’s aiming to rally policymakers around the problem.

“There's no cheap, easy or quick solutions to any of this,” Grause says.

“It's going to take a lot of years to figure out how we address these drivers,” she adds. “But until we agree on the problem, we're never going to get there.”

Taking a proactive approach to reducing violence in healthcare

Bea Grause talks about the struggles of New York hospitals and the need for a comprehensive approach to alleviate staff shortages and ensure access to healthcare.

Healthcare Association of New York State leader makes the case for change

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The Health Infrastructure Security and Accountability Act (HISAA), introduced in the U.S. Senate last month, is a big step forward in addressing the monumental cybersecurity challenges the healthcare sector faces. 

While we can debate whether the specific proposals in the bill are the best ones to drive change, it is encouraging to see lawmakers taking action to address the gaps that many healthcare organizations have in their cybersecurity controls and risk management practices.

While certainly there are organizations who are following industry best cybersecurity practices, the reality is that many others are not. Cyberattacks on healthcare organizations include devastating ransomware attacks that create major disruptions in healthcare services and data breaches of highly sensitive electronic protected health information, causing significant harm to patients.

Healthcare providers – and their business associates, including digital health and health IT companies - must ensure they are safeguarding patient information if they plan to create, receive, transmit or store it. Furthermore, if they are relying on technology to deliver services, they must ensure these systems are available and maintain their integrity. 

Creating mechanisms to ensure all healthcare organizations are meeting cybersecurity standards is essential to reduce the number of breaches and ransomware attacks. This bill aims to do just that.

Cybersecurity and risk management issues aren’t confined to one corner of the sector—it's a challenge for the entire system, and it’s about time we all moved in the same direction. As we saw with the Change Healthcare and OneBlood ransomware attacks, a disruption to the supply chain can have a rippling effect on the entire sector.

The Change Healthcare cyberattack affected 100 million Americans

The American Hospital Association has repeatedly argued that much of the challenge in healthcare cybersecurity lies in software vendors shortcomings. HISAA seems to recognize this point, as it would require that business associates covered under HIPAA comply with the same standards that providers must adhere to. HISAA also includes incentives in the form of funding from the government, however, this support is reserved for hospitals.

The bill takes several important steps to strengthen healthcare cybersecurity:

Establishes minimum and enhanced standards

: HISAA sets minimum cybersecurity standards for covered entities and business associates, with enhanced standards for those deemed critical to national security. The standards are also set to be updated at least every two years.

: While healthcare organizations are already required to conduct risk analyses under HIPAA, HISAA expands this to include risks related to business associates, strengthening the entire supply chain.

: Organizations will need to create and stress-test incident response, business continuity, and disaster recovery plans to ensure they can bounce back quickly when (not if) something goes wrong.

: CEOs and CISOs will be held formally accountable by attesting that their organization complies with the security standards—and they’ll have to post this attestation on their website for all to see.

: Organizations will need to bring in third-party auditors to assess compliance with the minimum standards, and certain entities will have to submit those results to HHS annually.

: The bill mandates that HHS audit at least 20 covered entities or business associates per year, keeping everyone on their toes.

Funding for rural and urban safety net hospitals

: HISAA allocates $1.3 billion in funding to help hospitals—particularly smaller, rural, and urban safety net hospitals—implement better cybersecurity practices.

The funding piece is a good start, but let’s be clear—it’s not enough. While $1.3 billion sounds like a lot, it’s still insufficient when you consider the sheer size of the sector and the financial struggles of many organizations, especially non-profits. We need more funding, particularly for those organizations that don’t have the resources to meet even the most basic cybersecurity controls.

One thing that would really move the needle is providing incentives, like we saw with the Meaningful Use/Promoting Interoperability programs, to motivate organizations to invest in cybersecurity. Fines and penalties alone aren't enough to spur the kind of proactive investment we need.

It’s also crucial that smaller healthcare organizations—especially critical access hospitals and rural health centers—get ongoing support. These organizations are vital to our health system, and they simply don’t have the resources to meet the new standards without additional help.

I’m also glad to see the bill includes third-party audits, but we need to make sure these auditors are vetted and certified, much like the Department of Defense’s Cybersecurity Maturity Model Certification (CMMC) program does. Otherwise, we risk inconsistent or subpar assessments.

And it’s good to see there might finally be some accountability at senior levels of the organization, with proposed requirements to have the CEO attest that the organization meets the minimum cybersecurity requirements. 

Just as Sarbanes-Oxley raised the stakes for financial accountability in the early 2000s, this legislation is likely the beginning of a new era of accountability in cybersecurity. When senior executives are held responsible, we can expect to see more organizations take these requirements seriously.

Notably, the bill falls short on providing safe harbor to those organizations who are meeting recognized security standards and meeting HIPAA requirements, such as on-going risk analysis and risk management. 

Healthcare organizations that do everything they can to prevent, detect and stop an attack, and who have strong resiliency plans in place, should not be penalized or face class action lawsuits if they are attacked by criminals, who are often supported or harbored by adversarial nation states. These types of laws already exist in some states, such as in Ohio, which passed the Data Protection Act in 2018.

Healthcare leaders should not wait for this bill to become law in order to act. Threats to healthcare continue to grow in both frequency and severity. 

Healthcare breaches and ransomware attacks are becoming more impactful to operations, revenue, brand reputation and most importantly patient safety. It should not take regulations to implement what is already required under HIPAA and already considered best practice for healthcare organizations. 

As with any patient safety issue, or threat to the business, leaders should ensure that their organizations are protecting themselves and that they have long term strategies in place to assess and mitigate high risks. Unfortunately, while this is obvious to some, others will continue to ignore the issue, or simply not be able to afford to address it. 

Therefore, whether it’s HISAA or some other bill, we need some catalyst to drive change and help our healthcare industry to achieve a more secure, compliant and resilient state.

Chief Healthcare Executive® presents a discussion on cybersecurity in healthcare from three of the top experts in the field. 

Cybersecurity issues aren’t confined to one corner of the sector—it's a challenge for the entire system, and it’s about time we all moved in the same direction.

Saeed Valian

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