Fallout from last month’s Change Healthcare cyberattack and its impact on healthcare delivery nationwide continued this week, with providers waiting with bated breath to find out when the Centers for Medicare and Medicaid Services would expedite the switch to a different processor to restart claims processing after nearly two weeks of disruption.
Policy relief from CMS came Tuesday, but healthcare industry groups are calling on the government to step in and provide financial relief during the crisis.
Ted Okon, executive director of the Community Oncology Alliance, told Healthcare IT News how the nationwide disruption has affected oncology providers.
Patients face treatment delays
Optum’s payment processing going offline after the Change Healthcare cyberattack on Feb. 21 has fallen on the shoulders of healthcare providers. They are trying to “shield patients” from delayed treatment and burden, Okon said.
Manual and paper-based billing processes can slow down cancer treatment for patients, he explained. For an oral drug, which represents 30% of oncology drugs, providers must determine what the patient’s out-of-pocket copays and deductibles are.
Many cancer treatments also require prior authorization. “And in addition to that, there is financial assistance, because some of these third-party providers of financial assistance, in essence, go through Change,” said Okon.
With so many transactions going through Change – 15 billion per year, according to the company’s website – “some of that comes to a screeching halt,” he said.
Anecdotally, some patients have been delayed in getting their cancer treatment drugs as a result of the cyberattack, he said.
“I hope that right now, and believe, that practices are doing everything to keep patients being treated and getting them their drugs,” he said. “That may not be true in all cases because this is a very complex situation.”
However, “even the largest practices are very concerned” about cash flow, said Okon.
“Especially in an oncology practice,” he explained. “It’s a very expensive proposition because it’s not just keeping the lights on and paying staff, but you’re paying for very expensive drugs that you keep on hand, whether they are infusible or oral drugs.”
The longer this crisis goes on, the more it’s going to hurt providers, especially “rural providers that are on shaky ground to begin with,” he said.
Keeping cash flowing during a crisis
Half of all payments for affected oncology practices are potentially on hold due to a backlog of applications to CMS to switch processors.
Applications to Medicare to switch typically take at least 21 days, Okon explained.
“And you can imagine if there’s a whole bolus of these applications, it could take longer,” he said, noting that affected oncology providers are working to switch commercial payments to Change’s competition without having the added bureaucratic hurdles.
While Optum posted an update on its online incident page on March 1 that it completed and launched a new instance of Change Healthcare’s Rx ePrescribing service and tested transactions, “we just haven’t heard whether any of that’s working,” Okon said.
As far as Optum’s Temporary Funding Assistance Program for providers, Okon called what he has heard from several practices “absurd” because the amount of what United Health, Optum’s parent company, is offering in terms of a practice’s cash flow is “just minuscule.”
“What United is doing in terms of offering advanced funds is just an insult,” he said, noting they are also charging providers a fee for the assistance.
On the other hand, where Medicare claims payments have stopped flowing, “CMS can do something meaningful,” he said, calling it “low-hanging fruit.”
Government, as it did during COVID-19, “should be advancing practices payments that they could work off of to keep the cash flow going,” he said.
This is a different crisis than COVID, but it is nonetheless a crisis. –Ted Okon, executive director of the Community Oncology Alliance
“It felt very much like it did on March 11, 2020,” according to Farzad Mostashari, co-founder and chief executive officer of Aledade, the nation’s largest network of independent primary care practices, and former National Coordinator for Health IT.
He told the Washington Post Tuesday that physician practices are facing “catastrophic” funding shortfalls after the Change Healthcare hack, estimating that 25% are exhausting their cash reserves.
Aledade announced it is injecting liquidity into the system until alternative payment workflows are established by accelerating payment of up to $100 million in shared savings to partner practices that are experiencing financial hardships.
The American Medical Association and other organizations are appealing to U.S. Health and Human Services and the White House to release emergency funds to protect providers from the financial fallout of the attack. AMA told HHS that the attack has forced medical practices to go without revenue for 12 days.
“As the situation continues to deteriorate and physicians await further guidance from Change Healthcare, we ask the department to use all its available authorities to ensure that physician practices can continue to function, and patients can continue to receive the care that they need,” said AMA in its letter Friday.
As we interviewed Okon Tuesday, HHS released a statement on the Change Healthcare cyberattack that included instructions for Medicare providers needing to change clearinghouses that they use for claims processing.
They “should contact their Medicare Administrative Contractor to request a new electronic data interchange enrollment for the switch” and will get instructions on how to expedite new EDI enrollment, the statement said.
AMA credited HHS and CMS for responding to the unprecedented disruption to providers and patient access following the Change Healthcare cyberattack in an email statement.
However, the organizations urged CMS to also provide financial assistance “such as advanced payments for physicians.”
“Many physician practices operate on thin margins, and we are especially concerned about the impact on small and/or rural practices, as well as those that care for the underserved,” AMA said in the statement.
Why United may have paid the ransom
While United has not commented on the topic, news reports this week show BlackCat hackers boasting that $22 million worth of Bitcoin was deposited into ALPHV’s account.
Many healthcare technology leaders have reached out to Healthcare IT News to explain why the company may have done so – from protecting the data to stemming the financial bleed from payments grinding to a halt. But Okon said he believes the company would only pay ransom – something the FBI and DHS have long urged against – if it’s been technically hobbled.
“That shows you how desperate they are, that they couldn’t do any kind of workaround or a fix, even calling in all the different IT gurus that they called in. So if [the rumor] is true, that shows you this really tied them up.”
The graver concern for the entire care delivery system, Okon said, is the threat of more widespread instability for hospitals and health systems hit by cyberattacks.
“The problem here is we are seeing now and starting to realize how much consolidation hurts us in healthcare in this country,” he said. “Hospitals consolidating into mega health systems and gouging astronomical sums of patients. Insurers consolidated among themselves. Consolidated in terms of pharmacy benefit managers.
“The top three control 80% of the prescription drug market,” he added, “and entities like an insurer, namely United, own the biggest clearinghouse out there for claims.”
It’s a plush target for a cyber pirate to successfully attack. When an organization has such extensive and “meaningful repercussions throughout the system,” that could push a company to “ultimately give in to a ransom,” Okon added.
The bottom line: “This entire situation is a case study of how not to handle a crisis like this,” he said pointing to a lack of information as well as misinformation that there would be “no effect on patients, care or providers,” which was “just flat out not true,” Okon said.
This story was updated to include Mostashari’s comments.
Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.
Source : Healthcare IT News