Crystal Hiwalker wonders if her heart and lungs would have kept working if the ambulance crew had been able to give her a transfusion as the blood drained from her body during a stormy, 100-mile ride

Because of the 2019 snowstorm, it took 2.5 hours to drive from her small town of Lame Deer, Montana, to the advanced trauma center in Billings.

Doctors at the Billings Clinic hospital revived Hiwalker and stopped the bleeding from her ruptured ectopic pregnancy. They were shocked that she not only survived after her heart stopped beating and she lost nearly all her blood, but that she recovered without brain damage.

The Montana State Trauma Care Committee, which works to reduce trauma incidents and to improve care, later realized the ambulance that carried Hiwalker had passed near two hospitals that stocked blood. What if Hiwalker had access to that blood on her way to Billings, committee members asked.

That realization, and question, inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows ambulance crews to pick up blood from hospitals and transfuse it to patients on the way to the advanced care they need.

“We kind of came up with the idea of having a blood handoff — like driving through a fast-food restaurant drive-thru — and picking up blood on the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic trauma center, where Hiwalker was treated. Riha said timely blood transfusions can prevent death or permanent brain injury.

Read more.

The 988 Suicide & Crisis Lifeline has created new social media shareables designed for use as social media posts, stories, and threads. Please be sure to utilize these free tools in your health centers to continue to spread the word about the 988 Suicide and Crisis Lifeline. The free partner toolkit can be found here.

The HHS Office of the National Coordinator (ONC) has updated FAQs on the Change Healthcare/UnitedHealth Group cyberattack, effective May 31, 2024. The FAQs address a variety of issues, including OCR’s investigation, breach report filing, ransomware guidance, HIPAA breach notifications by covered entities, and delegation of breach notifications. ONC indicates that under the HITECH Act, covered entities are ultimately responsible for ensuring that breach notifications occur. Of note, OCR says it understands that in this case, business associate notification to affected covered entities has not yet occurred and that UHG’s website states that they “are not announcing an official breach notification at this time. To help ease reporting obligations on other stakeholders whose data may have been compromised as part of this cyberattack, UHG has offered to make notifications and undertake related administrative requirements on behalf of any provider or customer.”¹ OCR says it will not consider the 60-calendar day period from discovery of a breach by a covered entity to start until affected covered entities have received the information needed from Change Healthcare or UHG. ONC recommends that covered entities coordinate with Change Healthcare and UHG who will be providing the breach notifications. Review the HHS FAQs on the cyberattack. OCR plans to update the page as needed.

Unfortunately, there’s more bad news to share on the contract pharmacy (CP) front. Last week, the drug maker Sanofi – a major manufacturer of insulin – significantly tightened its restrictions on Community Health Center use of CPs, including placing unprecedented restrictions on CHC-owned off-site pharmacies. Sanofi was one of the first three drugmakers to impose CP restrictions, starting in October 2020. Since then, Sanofi has allowed CHCs to use unlimited CPs if they submitted data to ESP. To date, CHCs have also been able to designate a single CP for each care delivery site without an in-house pharmacy. The new rules, effective July 1, 2024:

·    Sanofi is ending the option for FQHCs to receive 340B pricing at an unlimited number of CPs in exchange for submitting data to ESP. (This leaves Gilead and Novo Nordisk as the only manufacturers who still allow health centers to avoid CP restrictions by reporting data to ESP.)

·    FQHCs who own one (or more) of their own pharmacies are ineligible to receive 340B-priced Sanofi drugs at any contract pharmacy.

·    FQHCs who do not own a pharmacy that is co-located within a care delivery site registered on OPAIS can designate a single contract pharmacy to receive 340B-priced drugs. These health centers will not be required to submit data to ESP for this CP and must designate their single CP on ESP as soon as possible – even if they have already designated a CP. It appears that all current CP designations will soon be erased.

·    Sanofi distinguishes between two types of CHC-owned pharmacies: those that are co-located at an FQHC care delivery site registered on OPAIS (“CHC-owned on-site”), and those that are stand-alone (“CHC-owned off-site”). Sanofi effectively treats CHC-owned off-site pharmacies as CPs, making them ineligible to receive 340B-priced drugs unless the CHC has no on-site pharmacies and designates its CHC-owned off-site pharmacy as its single CP location. The new policy is very concerning as it marks the first time that any manufacturer (or other stakeholder) has sought to limit access to 340B drugs at CHC-owned pharmacies.

·    ·Going forward, Sanofi will consider all of a CHC’s care delivery sites together as constituting a single covered entity (CE.) This means that the strategy of registering one pharmacy (in-house or contract) for each delivery site will no longer work for Sanofi.

Questions? Contact Eric Kiehl, PACHC Director of Policy and Partnership.

The Pennsylvania Department of Human Services (DHS) is reminding consumers to protect their Supplemental Nutrition Assistance Program (SNAP) benefits from skimming at point-of-sale machines or ATMs. Card skimmer devices have been reported in Philadelphia and Southeastern Pennsylvania. DHS announced in 2023 that Pennsylvanians who have had their SNAP benefits stolen can have their cards replaced but must fill out a Benefit Theft Claim within 60 calendar days of the incident.

Reuters reported that the U.S. Supreme Court will hear a lawsuit alleging that Medicare underpays hospitals that serve low-income populations by an estimated $1.5 billion per year. The 200 hospitals across 32 states are requesting the court to overturn a U.S. Court of Appeals decision that upheld how the U.S. Department of Health and Human Services (HHS) calculates the Medicare disproportionate share hospital (DSH) funding. Hospitals argue that HHS only uses the number of Medicare patients who actually receive supplemental security income in their calculations and does not include those who are eligible but do not receive the benefit, when determining DSH funding. Read More.

The Pennsylvania Office of Mental Health & Substance Abuse Services (OMHSAS) has launched a web-based training platform – MyOMHSAS – designed as a one-stop for online training and resources for OMHSAS staff as well internal and external stakeholders. MyOMHSAS is a collaboration with the Office of Developmental Programs (MyODP), the University of Massachusetts Medical School (UMass), and OMHSAS. The initial launch of MyOMHSAS at the end of April 2024 included a limited number of inaugural course modules including Assisted Outpatient Treatment (AOT), the Children’s Hospital of Philadelphia (CHOP) transgender webinar series, Child and Adolescent Service System Program (CASSP)/System of Care (SoC), and Suicide Screening modules. Additional offerings are under development, they include a crisis worker certification curriculum, under development in partnership with Temple University Harrisburg (TUH), which will be launched later this year as a pathway for entry-level crisis workers to achieve accreditation. A dedicated MyOMHSAS resource account is available for questions, feedback, suggestions, and other communication related to the platform: RA-PWMYOMHSAS@pa.gov.

The White House announced their collaborative efforts with Microsoft and Google that will provide a range of free or discounted cybersecurity services to rural hospitals across the country to help them in their efforts to prevent cyberattacks.

Microsoft has committed to working in close collaboration with The White House, the National  Rural Health Association (NRHA), and the American Hospital Association (AHA) to coordinate the rollout, adoption and effectiveness of the program.

“Rural hospitals face a unique challenge in cybersecurity, balancing limited resources with the increasing sophistication of cyberthreats, which puts patient data and critical healthcare infrastructure at risk,” said Alan Morgan, chief executive officer of NRHA. “This important partnership with Microsoft will help ensure that rural hospitals are prepared in the future to meet this rising threat in small rural facilities.”

As part of this initiative to improve security and resilience of our rural hospital system, these private sector partners have committed to the following:

• For independent Critical Access Hospitals and Rural Emergency Hospitals, Microsoft is extending its nonprofit program to provide grants and up to a 75% discount on security products optimized for smaller organizations.
• For participating larger rural hospitals already using eligible Microsoft solutions, Microsoft is providing its most advanced security suite at no additional cost for one year. Additionally, Microsoft will extend security updates for Window 10 to participating hospitals for one year at no cost.
• Microsoft will also provide free cybersecurity assessments by qualified technology security providers and free training for frontline and IT staff at eligible rural hospitals throughout the country to deepen our resiliency to malicious cyberattacks.
• Google will provide endpoint security advice to rural hospitals and non-profit organizations at no cost, and eligible customers can get discounted pricing for communication and collaboration tools and security support and a pool of funding to support software migration.
• In addition, Google is committing to launch a pilot program with rural hospitals to develop a packaging of security capabilities that fit these hospitals’ unique needs.

Learn more.