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Margaret Parsons, one of three dermatologists at a 20-person practice in Sacramento, California, is in a bind. Since a Feb. 21 cyberattack on a previously obscure medical payment processing company, Change Healthcare, Parsons said, she and her colleagues haven’t been able to electronically bill for their services.

She heard Noridian Healthcare Solutions, California’s Medicare payment processor, was not accepting paper claims as of earlier this week, she said. And paper claims can take 3-6 months to result in payment anyway, she estimated.

“We will be in trouble in very short order, and are very stressed,” she said in an interview with KFF Health News.

A California Medical Association spokesperson said March 7 that the Centers for Medicare & Medicaid Services had agreed in a meeting to encourage payment processors like Noridian to accept paper claims. A Noridian spokesperson referred questions to CMS.

The American Hospital Association calls the suspected ransomware attack on Change Healthcare, a unit of insurance giant UnitedHealth Group’s Optum division, “the most significant and consequential incident of its kind against the U.S. health care system in history.” While doctors’ practices, hospital systems, and pharmacies struggle to find workarounds, the attack is exposing the health system’s broad vulnerability to hackers, as well as shortcomings in the Biden administration’s response.

To date, government has relied on more voluntary standards to protect the health care system’s networks, Beau Woods, a co-founder of the cyber advocacy group I Am The Cavalry, said. But “the purely optional, do-this-out-of-the-goodness-of-your-heart model clearly is not working,” he said. The federal government needs to devote greater funding, and more focus, to the problem, he said.

The crisis will take time to resolve. Comparing the Change Healthcare attack to others against parts of the health care system, “we have seen it generally takes a minimum of 30 days to restore core systems,” said John Riggi, the hospital association’s national adviser on cybersecurity.

In a March 7 statement, UnitedHealth Group said two services — related to electronic payments and medical claims — would be restored later in the month. “While we work to restore these systems, we strongly recommend our provider and payer clients use the applicable workarounds we have established,” the company said.

“We’re determined to make this right as fast as possible,” said company CEO Andrew Witty.

Providers and patients are meanwhile paying the price. Reports of people paying out-of-pocket to fill vital prescriptions have been common. Independent physician practices are particularly vulnerable.

“How can you pay staff, supplies, malpractice insurance — all this — without revenue?” said Stephen Sisselman, an independent primary care physician on Long Island in New York. “It’s impossible.”

Jackson Health System, in Miami-Dade County, Florida, may miss out on as much as $30 million in payments if the outage lasts a month, said Myriam Torres, its chief revenue officer. Some insurers have offered to mail paper checks.

Relief programs announced by both UnitedHealth and the federal government have been criticized by health providers, especially hospitals. Sisselman said Optum offered his practice, which he said has revenue of hundreds of thousands of dollars a month, a loan of $540 a week. Other providers and hospitals interviewed by KFF Health News said their offers from the insurer were similarly paltry.

In its March 7 statement, the company said it would offer new financing options to providers.

Providers Pressure Government to Act

On March 5, almost two weeks after Change Healthcare first reported what it initially called a cybersecurity “issue,” the Health and Human Services Department announced several assistance programs for health providers.

One recommendation is for insurers to advance payments for Medicare claims — similar to a program that aided health systems early in the pandemic. But physicians and others are worried that would help only hospitals, not independent practices or providers.

Anders Gilberg, a lobbyist with the Medical Group Management Association, which represents physician practices, posted on X, formerly known as Twitter, that the government “must require its contractors to extend the availability of accelerated payments to physician practices in a similar manner to which they are being offered to hospitals.”

HHS spokesperson Jeff Nesbit said the administration “recognizes the impact” of the attack and is “actively looking at their authority to help support these critical providers at this time and working with states to do the same.” He said Medicare is pressing UnitedHealth Group to “offer better options for interim payments to providers.”

Another idea from the federal government is to encourage providers to switch vendors away from Change Healthcare. Sisselman said he hoped to start submitting claims through a new vendor within 24 to 48 hours. But it’s not a practicable solution for everyone.

Torres said suggestions from UnitedHealth and regulators that providers change clearinghouses, file paper claims, or expedite payments are not helping.

“It’s highly unrealistic,” she said of the advice. “If you’ve got their claims processing tool, there’s nothing you can do.”

Mary Mayhew, president of the Florida Hospital Association, said her members have built up sophisticated systems reliant on Change Healthcare. Switching processes could take 90 days — during which they’ll be without cash flow, she said. “It’s not like flipping a switch.”

Nesbit acknowledged switching clearinghouses is difficult, “but the first priority should be resuming full claims flow,” he said. Medicare has directed its contractors and advised insurers to ease such changes, he added.

Health care leaders including state Medicaid directors have called on the Biden administration to treat the Change Healthcare attack similarly to the pandemic — a threat to the health system so severe that it demands extraordinary flexibility on the part of government insurance programs and regulators.

Beyond the money matters — critical as they are — providers and others say they lack basic information about the attack. UnitedHealth Group and the American Hospital Association have held calls and published releases about the incident; nevertheless, many still feel they’re in the dark.

Riggi of the AHA wants more information from UnitedHealth Group. He said it’s reasonable for the conglomerate to keep some information closely held, for example if it’s not verified or to assist law enforcement. But hospitals would like to know how the breach was perpetrated so they can reinforce their own defenses.

“The sector is clamoring for more information, ultimately to protect their own organizations,” he said.

Rumors have proliferated.

“It gets a little rough: Any given day you’re going to have to pick and choose who to believe,” Saad Chaudhry, an executive at Maryland hospital system Luminis Health, told KFF Health News. “Do you believe these thieves? Do you believe the organization itself, that has everything riding on their public image, who have incentives to minimize this kind of thing?”

What Happens Next?

Wired Magazine reported that someone paid the ransomware gang believed to be behind the attack $22 million in bitcoin. If that was indeed a ransom intended to resolve some aspect of the breach, it’s a bonanza for hackers.

Cybersecurity experts say some hospitals that have suffered attacks have faced ransom demands for as little as $10,000 and as much as $10 million. A large payment to the Change Healthcare hackers could incentivize more attacks.

“When there’s gold in the hills, there’s a gold rush,” said Josh Corman, another co-founder of I Am The Cavalry and a former federal cybersecurity official.

Longer-term, the attack intensifies questions about how the private companies that comprise the U.S. health system and the government that regulates them are defending against cyberthreats. Attacks have been common: Thieves and hackers, often believed to be sponsored or harbored by countries like Russia and North Korea, have knocked down systems in the United Kingdom’s National Health Service, pharma giants like Merck, and numerous hospitals.

The FBI reported 249 ransomware attacks against health care and public health organizations in 2023, but Corman believes the number is higher.

But federal efforts to protect the health system are a patchwork, according to cybersecurity experts. While it’s not yet clear how Change Healthcare was hacked, experts have warned a breach can occur through a phishing link in an email or more exotic pathways. That means regulators need to consider hardening all kinds of products.

One example of the slow-at-best efforts to mend these defenses concerns medical devices. Devices with outdated software could provide a pathway for hackers to get into a hospital network or simply degrade its functioning.

The FDA recently gained more authority to assess medical devices’ digital defenses and issue safety communications about them. But that doesn’t mean vulnerable machines will be removed from hospitals. Products often linger because they’re expensive to take out of service or replace.

Senator Mark Warner (D-Va.) has previously proposed a “Cash for Clunkers”-type program to pay hospitals to update the cybersecurity of their old medical devices, but it was “never seriously pursued,” Warner spokesperson Rachel Cohen said. Riggi said such a program might make sense, depending on how it’s implemented.

Weaknesses in the system are widespread and often don’t occur to policymakers immediately. Even something as prosaic as a heating and air conditioning system can, if connected to a hospital’s internet network, be hacked and allow the institution to be breached.

But erecting more defenses requires more people and resources — which often aren’t available. In 2017, Woods and Corman assisted on an HHS report surveying the digital readiness of the health care sector. As part of their research, they found a slice of wealthier hospitals had the information technology staff and resources to defend their systems — but the vast majority had no dedicated security staff. Corman calls them “target-rich but cyber-poor.”

“The desire is there. They understand the importance,” Riggi said. “The issue is the resources.”

HHS has proposed requiring minimum cyberdefenses for hospitals to participate in Medicare, a vital source of revenue for the entire industry. But Riggi says the AHA won’t support it.

“We oppose unfunded mandates and oppose the use of such a harsh penalty,” he said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Equitable access to care as well as improvements in cancer diagnosis and primary prevention strategies could prevent more than 2 million cancer deaths in women each year, according to a report published in The Lancet.1

Researchers studied premature cancer death in 2020 among women from 185 countries who had 36 cancer types.1,2 Of the 2.3 million women who died prematurely, an estimated 1.5 million could have avoided premature death via primary prevention or early detection strategies, and the remaining 800,000 deaths could have been prevented if women had equitable access to cancer care, according to researchers.

“[B]eing a woman impacts timely cancer care, more than being a man,” said Lancet report author Karla Unger-Saldaña, MD, of the National Cancer Institute of Mexico in Mexico City.

“[T]here are many mechanisms behind this — starting with different access to education, health literacy, cancer awareness, and gender roles that interfere with women’s ability to seek care,” she added.

Women Experience Delays in Cancer Diagnosis

“[W]omen tend to be disadvantaged from first access to care for cancer, even starting from diagnosis,” said Lancet report author Verna Vanderpuye, MD, of Korle Bu Teaching Hospital in Accra, Ghana.

Studies have suggested that several cancers tend to be diagnosed later in women than in men. Women tend to have longer times from first presentation to diagnosis for gastrointestinal, genitourinary, lung, hematologic, and other cancers.3-7

For example, in a UK study of 18,618 patients, women had delayed diagnoses of lymphoma, bladder cancer, colorectal cancer, gastric cancer, head and neck cancer, and lung cancer.7

Studies have also shown that women are more likely than men to first present with cancer symptoms at emergency rooms, with the greatest disparities seen for lung and gastrointestinal cancers.8,9

These delays in diagnosis can mean that women are diagnosed with cancer at later stages than men. Research has shown that women are diagnosed with colon, rectal, and bladder cancer at later stages than men.10-14

Delays in diagnosis may be partly explained by a lack of screening. For example, researchers found that health care providers are less likely to have discussions about lung cancer screening with women than with men.15 In addition, although screening has been shown to reduce the incidence of cervical cancer, many countries have not implemented widespread screening.16,17    

How Sexism Impacts Access to Cancer Care

Sexism has been shown to impact women’s access to any type of health care, and this includes cancer care.1

“Disrespectful or even discriminatory health care resulting from health care providers’ gender biases and stereotypes” affects women’s ability to receive the care they need, Dr Unger-Saldaña noted.

Studies have shown that women’s health concerns are less likely to be taken seriously and managed appropriately than men’s.18,19 Women’s symptoms are more likely to be perceived as psychosocial, women are more likely to receive non-specific diagnoses, and they are more likely to be given prescriptions for psychoactive drugs.

A cancer-specific example of overlooking women’s health concerns is how physicians have delayed the diagnosis of breast cancer by inappropriately reassuring patients that a palpable mass is benign without performing a biopsy.20

Research has also suggested that women with cancer are more likely than their male counterparts to experience adverse events related to cancer treatment, to report inadequate pain management, and to have their sexual health concerns overlooked.21-23

“[I]n the area of breast and gynecologic cancers, only very recently have people focused on sexual health and sexual side effects of cancer treatment,” said Gita Suneja, MD, of the University of Utah in Salt Lake City, who was not involved in the Lancet report. “These are life-altering treatments that affect sexual health profoundly, yet we have long neglected women’s health and well-being.”

“Patriarchal ideas about women and women’s complaints often manifest in prevalent mistreatment, disrespect, negligence, and abuse of female patients by medical staff,” the authors of the Lancet report wrote. “These types of experiences can damage patients’ trust in health care providers and influence the patients’ willingness to participate in cancer screening or seek care for cancer symptoms.”

Another potential cause of suboptimal cancer care for women is the fact that they have been underrepresented in research, so cancers in women may not be as well understood as cancers in men.24,25 The causes of breast cancer, for example, are not well understood, despite the fact that breast cancer was the most commonly diagnosed cancer worldwide in 2020.1,26

“I think one of the key takeaways from our work was the degree to which sex and gender have not been adequately considered in cancer research, practice, and policy making,” said Lancet report author Ophira Ginsburg, MD, of the National Cancer Institute in Bethesda, Maryland. “We underestimated the massive role that gender-based and intersectional power dynamics play in the interactions of women with the cancer health system.”

Cost-Related Barriers and Intersectionality

Another barrier to optimal care that impacts women more often than men is the cost of care.1 Research has shown that women are more likely than men to have inadequate health insurance and to forgo medical care due to costs.19,27

In one study, women in Latin American countries reported that health care costs prevented them from undergoing breast cancer screening.28 In another study, women in Uganda reported that a lack of money for medical bills and transportation was the main reason they did not seek care for symptoms of breast cancer or cervical cancer.29

Women can also face barriers to care as a result of intersecting identities, such as race, ethnicity, sexual orientation, and gender identity.1 “Of course, gender intersects with other marginalized status to further complicate things,” Dr Unger-Saldaña noted.

For example, an analysis of 36 studies on access to cancer care among Indigenous people in Canada revealed that barriers to cervical cancer screening were “related to histories of trauma and abuse, including sexual and physical abuse, and residential school attendance,” as well as the inability to locate a female health care provider.30

Women belonging to sexual minority groups may also experience barriers that limit their ability to receive cancer care.1 In a US study, 29% of Black sexual minority women reported delays in breast cancer care of more than 3 months, compared with 11% of Black heterosexual women, 10% of White sexual minority women, and 5% of White heterosexual women.31

The Role of Primary Prevention Efforts

Primary prevention strategies — such as avoiding tobacco and alcohol — can prevent cancer deaths in women, but common sex-specific cancers in women are “generally not amenable to primary prevention,” the Lancet report authors noted.1 Overall, the proportion of cancers that are amenable to primary prevention strategies is greater for men than for women.

Women can benefit from interventions to reduce cancer risks, but these interventions must be gender-appropriate, according to the Lancet report authors. Women can benefit from tailored genetic testing, counseling about lifestyle changes, and HPV vaccination, for example.

Eliminating Disparities: Potential Solutions

The Lancet report authors said the report itself is a first step toward addressing disparities in cancer care.1

“The first thing is to bring the discussion to the fore,” Dr Vanderpuye said. “We need to revisit our social norms. We need to look at feminist economics.”

The report includes several recommendations for addressing disparities, such as routinely collecting and reporting data on sex, gender, and other sociodemographic factors in cancer populations; reducing exposures to known cancer risks for women; and devising strategies to increase equitable access to early cancer detection and diagnosis.

The report also recommends ensuring that health systems provide quality cancer care to women and integrating “a gender competency framework into the education and training of the cancer workforce.”

Dr Vanderpuye noted that such frameworks could “increase awareness of gender differences in cancer” and the need to prevent bias in cancer care.

Patient education is another area for improvement highlighted in the report. Educational interventions to increase women’s awareness of screening measures and cancer symptoms could lead to earlier diagnosis.

Dr Vanderpuye also suggested addressing “religious and cultural norms preventing women and girls from accessing timely care” and working to “increase enrollment of women and girls in clinical trials to direct quality care interventions.”32,33

Dr Ginsburg noted that the National Institutes of Health is offering a series of workshops on sex and gender cancer research that anyone can attend.

“This includes basic, translational, and clinical research where even sex as a biological variable has been under-examined as a factor that can influence treatment efficacy and toxicity… and the way that power dynamics influence a woman’s rights and opportunities to understand her cancer risks and to seek and obtain respectful cancer health services from primary and secondary prevention through treatment and survivorship care,” Dr Ginsburg said. 

“There’s much more to be done, and we are hoping this [the Lancet report] will create a movement and generate not only interest but real-world actions to make a transformational change among our many partners, stakeholders, and those who might read the report in the future,” Dr Ginsburg said.

Disclosures: Drs Suneja, Ginsburg, and Unger-Saldaña reported having no conflicts of interest. Dr Vanderpuye and other Lancet report authors disclosed a range of affiliations that can be found in the report.

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This article was updated from a prior version.

The gender pay gap among US physicians exists across specialties, with women consistently earning less than their male counterparts, recent data suggest.1

The data, released by Doximity, come from a survey of more than 190,000 US physicians over 6 years, including more than 31,000 full-time physicians in 2022.

The survey showed that men out-earned women across every medical specialty in 2022, and nearly all specialties had gender pay gaps greater than 10%. The exceptions were pediatric cardiology (with a gap of 9.2%) and nuclear medicine (with a gap of 3%).

The average annual salary for an oncologist in 2022 was $403,324 for women and $465,288 for men (a 13.3% pay gap). The average annual salary for a hematologist was $320,938 for women and $358,736 for men (a 10.5% gap). And the average annual salary for a pediatric hematologist/oncologist was $220,839 for women and $255,168 for men (a 13.5% gap).

A prior study, published in JAMA Network Open in 2022, showed similar results but revealed that the gender pay gap starts immediately after qualification and persists over time.2 In this study, female physicians earned less than their male counterparts in more than 90% of academic medical specialties, both when starting their careers and 10 years later.

This study included compensation data from 24,593 female and 29,886 male academic physicians across pediatric and adult subspecialties, both medical and surgical. The data showed that the average starting salary for women in academic medicine is 10% lower than the average starting salary for men (a median of $26,800 lower). After a decade on the job, the average salary for women is 9% lower (a median of $22,890 lower).

“We already know there are [pay] discrepancies at the moment of hiring, but women then tend to work twice as hard to get recognition, so my hope was that [the gender pay gap] was no longer there after 10 years, but the data shows that, in many cases, after 10 years, the pay discrepancies are even worse,” said Narjust Florez, MD, of the Dana-Farber Cancer Institute in Boston.

Women had a lower starting salary across 42 of the 45 subspecialties evaluated (93%). The average starting salary was $34,036 lower for women in adult hematology/oncology and $14,270 lower for women in pediatric hematology/oncology.

In contrast to the Doximity data, the JAMA Network Open study showed that women earned more than men in 3 subspecialties. They were all in pediatrics — gastroenterology, nephrology, and rheumatology. The study authors noted that pediatric specialties are a traditionally lower-paying area of medicine.

Year-10 salaries were lower for women in 43 of the 45 subspecialties (96%). The average year-10 salary was $6683 lower for women in pediatric hematology/oncology and $26,363 lower for women in adult hematology/oncology. The subspecialties in which women did not earn less than men were pediatric neurology and pediatric rheumatology.

The subspecialty with the largest pay disparity after 10 years was adult neurosurgery, with men earning about $333,000 more each year than women. Other subspecialties with large gaps at 10 years were adult cardiology and adult dermatology. The gap favoring men exceeded $100,000 annually, on average, for both of these subspecialties.

“Over the last few years, we’ve increasingly seen more objective data around all types of gender disparities in medicine,” said Pamela Kunz, MD, of Smilow Cancer Hospital and Yale Cancer Center in New Haven, Connecticut.

“Objective data is helpful, but I think that many of us in this space are starting to ask, how much more data do we need? There’s clearly a problem, and I think we need to really pivot towards focusing on the solutions,” she added.

Closing the Gap: Potential Solutions

Two interventions that could help close the gender pay gap are equalizing starting salaries and equalizing annual salary growth rates, according to the authors of the JAMA Network Open study.

They found that equalizing starting salaries for the subspecialties in which women earned less could increase women’s earning potential by a median of $250,075. Equalizing annual salary growth rates could increase a women’s earning potential by a median of $53,661.

Dr Duma noted that some institutions already equalize starting salaries. “Even when starting salaries are equal, there are many ways in which these rules can be broken,” she said. “For example, an institution may provide a signing bonus for a man and not for a woman, or more funding for research for men than women.”

“Salary often refers to base salary, and there are a lot of variable components that are missed in this,” Dr Kunz said. “Women often get asked to do more administrative tasks that may not be compensated fully, and there are differences in startup packages that are also very subjective.”

There are also nonacademic roles wherein women are less likely to be represented than men, including a presence on pharmaceutical and biotechnology advisory boards where honoraria are typically provided. Data on representation and compensation for those roles are lacking.

“Advisory boards have historically been predominantly male,” Dr Kunz said. “Roles like these not only have an impact on compensation but also have a downstream impact on opportunities to lead trials, to have podium talks, to be on other steering committees, which influence whether women get promoted and obtain leadership roles. So there is this huge domino effect.”

Additional Disparities

Dr Duma and Dr Kunz both pointed out that gender is only one variable affecting pay in academic medicine, and intersectionality involving other characteristics needs to be considered in approaches to tackle the gender pay gap.

“It’s important to recognize that women who have other underrepresented characteristics — whether it be race, age, disability — often carry an additional burden of disparities and face additional challenges,” Dr Kunz noted.

Addressing these disparities will likely require multiple approaches in parallel, but transparency about compensation is a start, the authors of the JAMA Network Open study noted. They pointed out that physician groups, including the American Medical Association and American College of Physicians, have implemented policies to promote transparency in compensation.

“As with many of the solutions around dismantling disparities, you have to be really deliberate and intentional to start trying to tackle them,” Dr Kunz said. “I think a key starting point is transparency around data and metrics for institutions and organizations; in many cases, we just don’t have access to the data.”

Disclosures: Dr Kunz and Dr Florez reported having no relevant conflicts of interest.

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Early in the morning of Feb. 21, Change Healthcare, a company unknown to most Americans that plays a huge role in the U.S. health system, issued a brief statement saying some of its applications were “currently unavailable.”

By the afternoon, the company described the situation as a “cyber security” problem.

Since then, it has rapidly blossomed into a crisis.

The company, recently purchased by insurance giant UnitedHealth Group, reportedly suffered a cyberattack. The impact is wide and expected to grow. Change Healthcare’s business is maintaining health care’s pipelines — payments, requests for insurers to authorize care, and much more. Those pipes handle a big load: Change says on its website, “Our cloud-based network supports 14 billion clinical, financial, and operational transactions annually.”

Initial media reports have focused on the impact on pharmacies, but techies say that’s understating the issue. The American Hospital Association says many of its members aren’t getting paid and that doctors can’t check whether patients have coverage for care.

But even that’s just a slice of the emergency. CommonWell, an institution that helps health providers share medical records, also relies on Change technology. The system contained records on 208 million individuals as of July 2023. Courtney Baker, CommonWell marketing manager, said the network “has been disabled out of an abundance of caution.”

“It’s small ripple pools that will get bigger and bigger over time, if it doesn’t get solved,” Saad Chaudhry, chief digital and information officer at Luminis Health, a hospital system in Maryland, told KFF Health News.

Here’s what to know about the hack:

Who Did It?

Media reports are pointing a finger at ALPHV, a notorious ransomware group also known as Blackcat, which has become the target of numerous law enforcement agencies worldwide. While UnitedHealth Group has said this is a “suspected nation-state associated” attack, some outside analysts dispute the linkage. ALPHV has previously been blamed for hacking casino companies MGM and Caesars, among many other targets.

The Department of Justice alleged in December, before the Change hack, that the group’s victims had already paid it hundreds of millions of dollars in ransoms.

Is This a New Problem?

Absolutely not. A study published in JAMA Health Forum in December 2022 showed that the annual number of ransomware attacks against hospitals and other providers doubled from 2016 to 2021.

“It’s more of the same, man,” said Aaron Miri, the chief digital and information officer at Baptist Health in Jacksonville, Florida.

Because the assaults disable the target’s computer systems, providers have to shift to paper, slowing them down and making them vulnerable to missing information.

A study published in May 2023 in JAMA Network Open examining the effects of an attack on a health system showed that waiting times, median length of stay, and incidents of patients leaving against medical advice all increased — at neighboring emergency departments. The results, the authors wrote, mean cyberattacks “should be considered a regional disaster.”

Attacks have devastated rural hospitals, Miri said. And wherever health care providers are hit, patient safety issues follow.

What Does It Mean for Patients?

Year after year, more Americans’ health data is breached. That exposes people to identity theft and medical error.

Care can also suffer. For example, a 2017 attack, dubbed “NotPetya,” forced a rural West Virginia hospital to reboot its operations and hit pharma company Merck so hard it wasn’t able to fulfill production targets for an HPV vaccine.

Because of the Change Healthcare attack, some patients may be routed to new pharmacies less affected by billing problems. Patients’ bills may also be delayed, industry executives said. At some point, many patients are likely to receive notices that their data was compromised. Depending on the exact data that has been pilfered, those patients may be at risk for identity theft, Chaudhry said. Companies often offer free credit monitoring services in those situations.

“Patients are dying because of this,” Miri said. Indeed, an October preprint from researchers at the University of Minnesota found a nearly 21% increase in mortality for patients in a ransomware-stricken hospital.

How Did It Happen?

The Health Information Sharing and Analysis Center, an industry coordinating group that disseminates intel on attacks, has told its members that flaws in an application called ConnectWise ScreenConnect are to blame. Exact details couldn’t be confirmed.

It’s a tool tech support teams use to remotely troubleshoot computer problems, and the attack is “apparently fairly trivial to execute,” H-ISAC warned members. The group said it expects additional victims and advised its members to update their technology. When the attack first hit, the AHA recommended its members disconnect from systems both at Change and its corporate parent, UnitedHealth’s Optum unit. That would affect services ranging from claims approvals to reference tools.

Millions of Americans see physicians and other practitioners employed by UnitedHealth and are covered by the company’s insurance plans.

UnitedHealth has said only Change’s systems are affected and that it’s safe for hospitals to use other digital services provided by UnitedHealth and Optum, which include claims filing and processing systems.

But not many chief information officers “are jumping to reconnect,” Chaudhry said. “It’s an uneasy feeling.”

Miri says Baptist is using the conglomerate’s technology and that he trusts UnitedHealth’s word that it’s safe.

Where’s the Federal Government?

Neither executive was sanguine about the future of cybersecurity in health care. “It’s going to get worse,” Chaudhry said.

“It’s a shame the feds aren’t helping more,” Miri said. “You’d think if our nuclear infrastructure were under attack, the feds would respond with more gusto.”

While the departments of Justice and State have targeted the ALPHV group, the government has stayed behind the scenes more in the aftermath of this attack. Chaudhry said the FBI and the Department of Health and Human Services have been attending calls organized by the AHA to brief members about the situation.

Miri said rural hospitals in particular could use more funding for security and that agencies like the US Food and Drug Administration should have mandatory standards for cybersecurity.

There’s some recognition among officials that improvements need to be made.

“This latest attack is just more evidence that the status quo isn’t working and we have to take steps to shore up cybersecurity in the health industry,” said Sen. Mark Warner (D-Va.), the chair of the Senate Select Committee on Intelligence and a longtime advocate for stronger cybersecurity, in a statement to KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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