The Harsh Reality Facing Healthcare Workers and Vaccination Mandates

The Harsh Reality Facing Healthcare Workers and Vaccination Mandates

It feels like bad déjà vu, but the reality is that once again the majority of New York healthcare systems are battling the perfect storm of challenges amid a resurgence of COVID-19 cases statewide. The rising risk of the delta variant, combined with staffing shortages, and mounting mandate pressure to get vaccinations in the arms of more staff members are creating a mess for officials. Over 450,000 New York hospital workers became eligible for vaccination under Phase 1A of New York’s COVID-19 vaccination program. Hospital worker vaccination progress is self-reported by individual hospital facilities weekly via the New York State Department of Health’s HERDS survey. Currently, 79% of Mid-Hudson area hospital workers have received a complete vaccine series, with the highest percentage reported in Westchester County (85%) and the lowest (55%) reported in Putnam County. With so much information constantly fluctuating, what do you need to know about state and federal vaccination mandates, and what are the financial implications for your healthcare system?

New York State’s public health and health planning council approved emergency regulations on August 26 requiring that hospital workers be vaccinated for COVID-19, while removing religious exemptions. Vanessa Murphy, a DOH attorney said they are not constitutionally obligated to provide a religious exemption, which is also the case for the Measles and Mumps vaccine. This will be in effect for 90 days before it’s either renewed or expires.

So, what is a valid medical reason to make an accommodation for a medical worker?

For a valid medical exemption, a licensed physician or certified nurse practitioner must certify that immunization with a COVID-19 vaccination is detrimental to the health of a member of a covered entity’s personnel, based upon a preexisting health condition, and ceases to be effective if it is later found that vaccination would not be detrimental to that personnel member’s health. The nature and duration of the medical exemption must be documented in the personnel file of the member of the organization in accordance with the same timeline for the vaccination requirements, along with documentation of whatever reasonable accommodations are granted in conjunction with the exemption.

What entities does this apply to in New York State?

The requirement approved by the public health and health planning council applies to hospitals, nursing homes, diagnostic and treatment centers, adult care facilities, certified home health agencies, hospices, long-term home health care programs, AIDS home care programs, licensed home care service agencies and limited licensed home care service agencies. So, who falls under New York State’s definition of health care “personnel” in the new regulation requirements? It’s pretty all-encompassing, covering employees, students, volunteers, and any other affiliates of the organization who “engage in such activities such that if they were infected with COVID-19, they could potentially expose other covered personnel, patients or residents to the disease.” According to the state health department, these institutions are tasked with developing a plan for implementation of the mandate and any actions it will take regarding non-compliant employees. This could include firing non-compliant workers.

What’s the COVID-19 vaccination deadline for staff?

Healthcare workers at hospitals and nursing homes must receive their first vaccine dose by Sept. 27. Workers at additional entities covered by the mandate, including diagnostic and treatment centers, home health agencies, long-term home health care programs, school-based clinics, and hospice care programs, must have at least one dose by Oct. 7. Documentation of proof of vaccination must be maintained in the personnel files of each employee/affiliate of the organization.

What about federal updates?

In a bold move, President Joe Biden announced in August that he is directing all nursing homes to require their staff to be vaccinated against COVID-19 in order to continue receiving Medicare and Medicaid funding. Over 130,000 nursing home residents and 2,000 employees died due to COVID-19, according to the most recent CDC data. However, vaccination rates among nursing home workers remain low. As of mid-August, about 60% of staff per facility were vaccinated, compared to 82.8% of residents per facility.

What are the financial and emotional consequences your system could face?

Here at home, HealthAlliance of the Hudson Valley, a three-hospital system in the Westchester Medical Center Health Network, laid off an undisclosed number of workers on June 14, according to the Daily Freeman. This is just one local example of shrinking medical staff at a time when facilities are overloaded with cases and patients. Tension is running high for medical professionals on both sides of the issue. The New York State Nurses Association (NYSNA) representing more than 42,000 members in New York State, last issued a statement in mid-August. “Overall, we are seeing a crisis in hospital emergency departments that indicates a general lack of preparedness. The DOH should listen to the frontline this time not just hospital CEOs. Our healthcare workers are exhausted and traumatized. Their voices should be heard – not denied or characterized as vectors of infection- which is exactly what we are trying to avoid. When healthcare workers document what they are experiencing they must be believed. Hospitals must also ensure that new mandates do not contribute to already problematic staffing shortages. We do not want a situation where patient care is compromised because the pool of nurses and other healthcare workers continues to shrink.” Only time will tell whether or not our care system can sustain itself if healthcare organizations continue to face the arduous task of firing staff for vaccination refusal.

Sources: Daily Freeman, CDC,

Can We Fix Our Drug Supply Chain Problem?

Can We Fix Our Drug Supply Chain Problem?

The COVID-19 pandemic highlighted the critical importance of a resilient U.S. healthcare manufacturing sector.

While healthcare leaders have made remarkable scientific strides to combat the pandemic by developing and distributing lifesaving vaccinations, critical issues remain. In fact, some issues existed long before the pandemic, but we have recently been confronted with the gravity of the challenges we face. the United States remains critically dependent on imports for a range of key pharmaceutical products and APIs—the primary ingredients of generic drugs—which represent 90 percent of all prescription medications filled. About 87 percent of API facilities for generic drugs are located overseas which has left U.S. supply chains of essential medicines vulnerable. The lesson? Instead of waiting for the next crisis to strike, leaders should act now to identify strategies and solutions for their organizations.

China and India are estimated to control substantial parts of the supply chain where there have been issues with shortages because of disruptions that have impacted supply as well as quality, and safety.

The drive toward lower costs as well as unfair trade practices has led to a hollowing out of domestic production. The Food and Drug Administration (FDA) has been tracking and reporting to Congress on the drug shortage crisis since 2014, in response to drug shortages that had impacted hospitals for years. In 2019, the FDA created an inter-agency task force to study the problem, determine the root causes and recommend solutions. The report recommends enduring solutions:

  • Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages
  • Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities
  • Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs

Earlier this month, the Biden-Harris Administration announced the first step in a whole-of-government effort to strengthen domestic competitiveness and supply chain resilience.

To address vulnerabilities in the supply chain, the Biden-Harris Administration will immediately support the domestic production of critical medicines. The Department of Health and Human Services (HHS), under the Defense Production Act (DPA) and building on current public-private partnerships, will establish a public-private consortium for advanced manufacturing and onshoring of domestic essential medicines production. The consortium’s first task will be to select 50-100 critical drugs, drawn from the FDA’s essential medicines list, to be the focus of an enhanced onshoring effort. HHS will make an initial commitment of approximately $60 million from the Defense Production Act appropriation in the American Rescue Plan to develop novel platform technologies to increase domestic manufacturing capacity for API. The goal? Greater API production domestically will help reduce reliance on global supply chains for medications that are in shortage, particularly during times of increased public health need.

Many within the healthcare field believe this is the moment to reimagine and rebuild a new American healthcare system, not go back to the way things used to be.

The current system is not sustainable, and to ensure more resilient supply chains we need to develop an approach that includes improving transparency, building emergency capacity, and investing in domestic production. At RBT, we pride ourselves on assisting healthcare professionals to build more sustainable organizations with our comprehensive services. But most importantly, we aim to pass along useful, relevant information to help our communities succeed, grow, and prosper. As we continue to dedicate time and resources to help our healthcare clients achieve success, we look forward to connecting with you and your team.

Sources: The White House, HFMA, FDA

Blockchain: The Next Healthcare Breakthrough?

Blockchain: The Next Healthcare Breakthrough

The COVID-19 pandemic highlighted many cracks in our healthcare system. If we take the “glass-half-full” approach, we can appreciate how the pandemic exposed our industry-wide weaknesses, so we can get to work making efficient and effective improvements for future public health crises. One healthcare game-changer that’s emerging as the dust begins to settle, is Blockchain technology. While Blockchain is still in its early stages of development and implementation, (think “the internet” in the late 1990s) you can expect to hear more about strides in Blockchain technology. It’s already transforming the financial world, and health authorities like the Centers for Disease Control (CDC) have been advocating the benefits of this modernization tool for years. The application of Blockchain in healthcare represents the potential to reduce costs, streamline business processes, and improve access to information across diverse stakeholders working toward a common goal: patient-centered care.

Wait, what is Blockchain again?

Blockchain is a system of recording information in a way that makes it difficult or impossible to change, hack, or cheat the system. A Blockchain is essentially a digital ledger of transactions and it is ideal for delivering information because it provides immediate, shared, and completely transparent information that can only be accessed by permission network members. It is also the underlying technology behind the cryptocurrency known as Bitcoin.

What are examples of how it can impact healthcare?

  • Identity Management – Patients, Providers
  • Medical Record Management
  • Medicaid Management Information Systems
  • Benefits Administration
  • Data Security
  • Reimbursement
  • Clinical Trial Management
  • Pharmaceutical Supply Chain

What are some important factors to consider when implementing Blockchain technology?

Reducing Costs: While organizations can expect some added upfront technology costs that are common in the adoption of any new technology, Blockchain can streamline the supply chain and administrative processes in healthcare, which may decrease costs.

Increasing Patient Control: Blockchain technology may have the potential to empower patients with greater control of their data and privacy. For example, the technology could enable patients’ access to their medical records across providers.

Improve Transparency/Security: While Blockchain is transparent it is also private, concealing the identity of any individual with complex and secure codes that can protect the sensitivity of medical data. The decentralized nature of the technology also allows patients, doctors, and healthcare providers to share the same information quickly and safely.

Security Vulnerabilities: While the technology provides resilience to certain types of attacks, nothing is ever entirely secure. It is still susceptible to zero-day attacks and technical bugs. Also, because this technology is almost always accessed by people, it is susceptible to one of the greatest risks in information technology: social engineering.

So, where does New York stand with this technology?

This past March, The New York Department of Financial Services (NYDFS) organized a techsprint (a sort of extended hackathon with participation by both industry and regulators) to learn how to become better at regulating crypto companies. That the techsprint occurred at all is a signal of the evolution of the crypto industry, said Sandra Ro, the CEO of the Global Blockchain Business Council and one of the event’s judges. Ro said it was significant that NYDFS is not only looking at how it can parse information it collects but also how it can integrate technologies like Blockchain into its supervisory process. “I think it is a testament to how far the crypto community has come from an industry standpoint to work with regulators and legislators and various bodies, to solve for critical problems in order for the industry to grow and scale, and become mainstream within regulation and guidelines,” Ro said.

Final Thoughts

Ultimately, the healthcare industry is constantly evolving and improving, and putting the patient in control with Blockchain technology would also make switching between healthcare providers a far simpler process than presently while ensuring that any information provided is complete and verifiably accurate. Reflecting on the pandemic, this could be incredibly transformative for future illness prevention, vaccination campaigns, wellness programs, and health training. At RBT, we understand the diverse and complicated world of healthcare, and we understand the first step to a brighter financial future is having important conversations about industry-specific topics that matter to you. Feel free to contact our team today, we hope to help your team succeed.

Sources: CDC, Coindesk, NYDFS, BuiltIn

5 Things to Know When Hiring Gen Z Healthcare Employees

5 Things to Know When Hiring Gen Z Healthcare Employees

It’s been a year of immeasurable challenges for healthcare professionals across the state, country, and world. In addition to dealing with the incredibly taxing toll of the COVID-19 pandemic, healthcare management is learning how to juggle multi-generational workplaces – accommodating the needs of five generations simultaneously can understandably stretch leadership’s capacities to their limit. Gen Z has yet to be assigned a definitive age range but it mostly refers to people born between the mid-1990s and the mid-2000s, so the generation’s oldest members are now in the workforce. The people in Gen Z are often referred to as “digital natives” because they barely remember a world without Google, and they have vastly different needs than Baby Boomers and even Millennials. This article is intended to act as a structural guideline for your team as you navigate hiring Gen Z employees, so you can avoid common pitfalls and update policies accordingly, to attract top talent.

1. Embrace Tech

Changing social and economic factors are increasing our reliance on technology to complete work-related tasks more effectively and efficiently, so it’s no surprise that Generation Z’s relationship with technology will influence how the group relates to healthcare. Adopting the latest technological practices will inevitably make you more appealing to recruits who anticipate and expect cutting-edge, state-of-the-art technology in daily operations.

2. Communicate

When a recent NRC Health survey asked 970 Gen Z healthcare workers what keeps them engaged in their work, 50% of respondents said the fact that “communication among the people I work with is never a problem” is the primary driver of satisfaction with their job. Keeping lines of communication between management and employees clear is an effective way to boost job fulfillment and eliminate confusion up the chain of command.

3. Create Clear Pathways to Success

Gen Z is a very ambitious generation; with 32% of them believe they’ll be in a supervisory role within the first five years of their career. Healthcare organizations can fuel their motivation by providing a clear pathway to success, with attainable goals and criteria Gen Zers can follow to meet career milestones.

4. Create an Impactful Environment

On a daily basis, Gen Z healthcare workers want to feel that they’re making a difference: 71% reported that this makes them feel that they “love coming to work every day.” Regardless of the industry, passionate employees create positive environments, so this is a great trait to tap into. It’s not hard to feel like you are making a difference in a vital industry like healthcare where lives are at stake, but keep this personality trait in mind during one-on-one evaluations and opportunities to highlight individual contributions or achievements.

5. Prioritize Mental Health Care

While the pandemic has put an emotional strain on every generation, research shows Gen Zers are on the verge of the most severe mental health crisis for young people in decades. Only 45% of Generation Z reports good or excellent mental health, by far the lowest of any generation, according to the American Psychological Association. Coupled with the psychological impact clinicians are enduring while they navigate the COVID-19 pandemic, the mental health and wellbeing of Generation Z clinicians (and all employees) should be top of mind.

As we navigate blending different generations of healthcare professionals, developing a collaborative network of peers within your organization to update the onboarding process is crucial to ensuring the successful transition of clinicians into new professional roles. Together, the healthcare industry has a great opportunity to benefit from the strengths that each generation offers while welcoming new clinicians and colleagues into teams. At RBT, we understand the diverse and complicated world of healthcare, and we understand the first step to a brighter financial future is having important conversations about industry-specific topics that matter to you. Feel free to contact our team today, we hope to help your team succeed.

Sources: NRC Health, Abbott, Vizient, American Psychological Association

340-B Drug Pricing Program

What do I need to know about the 340B Program?

The 340B Program enables covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices. The program allows 340B hospitals to stretch limited federal resources to reduce the price of outpatient pharmaceuticals for patients and expand health services to the patients and communities they serve. Hospitals use 340B savings to provide free care for uninsured patients, offer free vaccines, provide services in mental health clinics, and implement medication management and community health programs. According to the Health Resources and Services Administration (HRSA), which is responsible for administering the 340B program, enrolled hospitals and other covered entities can achieve average savings of 25 to 50% in pharmaceutical purchases. Tax-exempt hospitals are required to publicly report on the ways in which they improve the health of the communities they serve yearly through the IRS Form 990 Schedule H, which is publicly available. In 2017, the most recent year for which this information is available, tax-exempt hospitals participating in the 340B drug savings program provided $64.3B in total benefits to their communities.

Is my healthcare organization eligible?

Eligible health care organizations/covered entities include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities. To participate in the 340B Program, eligible organizations/covered entities must register and be enrolled with the 340B program and comply with all program requirements. Once enrolled, covered entities are assigned a 340B identification number that vendors verify before allowing an organization to purchase 340B discounted drugs.

What if my organization’s eligibility changed over the past year?

Covered entities must recertify their eligibility every year and notify the Office of Pharmacy Affairs whenever there is a change in their eligibility. If there is a change in a covered entity’s eligibility status, the covered entity has a responsibility to immediately notify OPA and should stop purchasing drugs through the 340B Program. Learn more about the process here: Recertification.

How does COVID-19 impact my organization’s eligibility?

Many 340B stakeholders are concerned about the evolving impact of the COVID-19 pandemic. The circumstances surrounding this public health emergency may warrant additional flexibilities, especially to affected 340B covered entities. To the extent a 340B stakeholder has a specific circumstance where they believe their COVID-19 response may affect their compliance or eligibility in the 340B Program, the stakeholder should contact the 340B Prime Vendor at 1-888-340-2787 (Monday – Friday, 9 a.m. – 6 p.m. ET) or email Additionally, plan on contacting this resource if your organization is currently seeing a surge in patients and need to expand services to another site, to learn if any special exemptions be made for covered entities or any changes will be made to the registration process. The 340B Prime Vendor will coordinate with HRSA technical assistance and evaluate each issue on a case-by-case basis.

Source: HRSA, AHA