An urgent care chain in Ohio may be forced to stop paying rent and other fees to cover salaries. In Florida, a cancer center is racing to find money for chemotherapy drugs to avoid delays in critical treatments for its patients. And in Pennsylvania, a primary care doctor is cutting costs and pooling all his money — including his personal bank savings — in hopes of staying afloat for the next two months.
These are just a few examples of the severe cash squeeze facing medical care providers — from large hospital networks to the smallest clinics — after a cyberattack two weeks ago paralyzed the country’s largest billing and payment system of the US in the country. The attack forced the shutdown of parts of the electronic system operated by Change Healthcare, a large unit of UnitedHealth Group, leaving hundreds, if not thousands, of providers without the ability to get insurance approval for services ranging from a prescription drug to a mastectomy — or to be paid for those services.
In recent days, the chaotic nature of this widespread breakdown of daily, often invisible transactions has led top lawmakers, powerful hospital industry executives and patient groups to pressure the US government to with the help. On Tuesday, the Health and Human Services Department announced it will take steps to try to ease financial pressures on some of those affected: Hospitals and doctors who receive Medicare reimbursements will primarily benefit from the new measures.
US health officials have said they will allow providers to apply to Medicare for accelerated payments, similar to advanced funding available during a pandemic, to get rid of them. They have also encouraged health insurers to abandon or relax much-criticized policies that impose prior authorizations that have been a barrier to receiving care. And they recommend that insurers that offer private Medicare plans also provide advanced financing.
HHS said it was trying to coordinate efforts to avoid disruptions, but it remained unclear whether these initial government efforts would bridge the gaps left by Change Healthcare’s offline mega-operations, which acts as a digital clearinghouse that connects doctors, hospitals and pharmacies with insurers. It handles as many as one in every three patient records in the country.
The hospital industry has been critical of the response, describing the measures as inadequate.
Beyond news of the damage caused by yet another health care cyberattack, the closing of parts of Change Healthcare has brought renewed attention to the consolidation of medical companies, physician groups and other entities under UnitedHealth Group. Change by United’s acquisition of a $13 billion deal in 2022 was initially challenged by federal prosecutors but went ahead after the government lost its case.
So far, United has not given any timetable for reconnecting this critical network. “Patient care is our top priority, and we have many ways to make sure people have access to the drugs and care they need,” United said in an update on website.
But on March 1, a bitcoin address connected to the alleged hackers, a group known as AlphV or BlackCat, received a $22 million transaction that some security firms say may have been a ransom payment made. of United in the group, according to a news article in the Wired. United declined to comment, as did the security firm that first saw the payment.
However, the lingering effects of the attack once again exposed the vast interconnected web of electronic health information and the vulnerability of patient data. The change handles about 15 billion transactions a year.
The closure of some of Pagbabago’s operations has disrupted its digital role that connects providers with insurers to submit bills and receive payments. This delayed tens of millions of dollars in insurance payments to providers. Pharmacies initially were unable to fill many patients’ medications because they could not verify their insurance, and providers have accumulated large amounts of unpaid claims in the two weeks since the cyberattack occurred.
“This absolutely highlights the vulnerability of our health care system,” said Ryan S. Higgins, an attorney for McDermott Will & Emery who advises health care organizations on cybersecurity. The same entity allegedly responsible for the cyberattack on the Colonial Pipeline, a pipeline from Texas to New York that carried 45 percent of the East Coast’s fuel supplies, in 2021 was thought to be behind the Change assault. “They have historically targeted critical infrastructure,” he said.
In the first days after the attack on Feb. 21, pharmacies are the first to have trouble filling prescriptions when they can’t verify a person’s insurance coverage. In some cases, patients cannot get medicine or vaccinations unless they pay cash. But they seem to have overcome these obstacles by going to other companies or developing solutions.
“Almost two weeks now, the operational crisis is over and almost over,” said Patrick Berryman, a senior vice president for the National Community Pharmacists Association.
But as the shutdown drags on, doctors, hospitals and other providers are grappling with paying costs as steady streams of revenue from private insurers, Medicare and Medicaid simply don’t flow.
Arlington Urgent Care, a chain of five urgent care centers around Columbus, Ohio, has about $650,000 in unpaid insurance payments. Worried about money, chain owners weigh how to pay bills — including rent and other expenses. They took out lines of credit from banks and used their personal savings to set aside enough money to pay employees for about two months, said Molly Fulton, the chief operating officer.
“It’s worse than when Covid hit because even though we didn’t get paid for a while then, at least we knew something was going to be fixed,” said Ms. Fulton. “Here, there is no end. I have no idea when the Change will return.”
The hospital industry labeled Change’s breach “the most significant cyberattack on the US healthcare system in American history,” and urged the federal government and United to provide emergency funding. The American Hospital Association, a trade group, has been critical of United’s efforts so far and the latest initiative to offer a loan program.
“It falls far short of plugging gaping funding holes,” Richard J. Pollack, the trade group’s president, said Monday in a letter to Dirk McMahon, the president of United.
“We need real solutions – not programs that sound good when they’re announced but are fundamentally inadequate when you read the fine print,” Mr. Pollack said.
The loan program was not well received in the country.
Diana Holmes, a therapist in Attleboro, Mass., received an offer from Optum to loan her $20 a week when she said she hadn’t submitted about $4,000 in claims for her work since Feb. 21. “It’s not like we have reserves,” he said.
He said there has been almost no communication from Change or the primary insurer for his patients, Blue Cross of Massachusetts. “It’s just crazy,” he said. He was forced to find a new payment clearinghouse with an upfront fee and a one-year contract. “You have to pivot quickly without information,” he said.
Blue Cross said it is working with providers to find different solutions.
Florida Cancer Specialists and Research Institute in Gainesville used new contracts with two competing clearinghouses as it spends $300 million a month on chemotherapy and other drugs for patients who cannot afford to delay treatment.
“We don’t have that kind of money sitting in a bank,” said Dr. Lucio Gordan, the president of the institute. “We’re not sure how we’re going to capture or absorb the double costs that we’re going to incur by having multiple clearinghouses.”
Dr. Christine Meyer, who owns and operates a primary care practice with 20 clinicians in Exton, Pa., west of Philadelphia, piled “hundreds and hundreds” of pages of Medicare claims into a FedEx box and sent them to the agency. said Dr. Meyer said he is weighing how to save money by cutting costs, such as possibly reducing the supply of vaccines the clinic has on hand. He said if he pooled all his money and his line of credit, his practice could survive for about two and a half months.
Through Optum’s temporary funding assistance program, Dr. Meyer said he received a loan of $4,000, compared to the roughly half a million dollars he normally submits through Pagbabago. “That was less than 1 percent of my monthly claim and, adding insult to injury, the notice came with this big red font that said, you have to pay it all once it’s resolved,” said Dr . Meyer. “It’s all just a joke.”
The hospital industry is pushing Medicare officials and lawmakers to address the situation by giving hospitals money. Senator Chuck Schumer, Democrat of New York and the house majority leader, wrote a letter on Friday, urging federal health officials to make expedited payments available. “The longer this disruption lasts, the more difficult it will be for hospitals to continue to provide comprehensive healthcare services to patients,” he said.
In a statement, Senator Schumer said he was pleased with the HHS announcement because it “will get cash flowing to providers as our health care system continues to recover from this cyberattack.” He added, “The work cannot stop until all affected providers have enough financial stability to weather this storm and continue serving their patients.”
