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Since the cyberattack on Change Healthcare, medical practices have continued to face cash-flow issues that threaten patient access to care and practice viability

May 17, 2024 (ACP) -- As medical practices continue to face severe strain due to the Change Healthcare cyberattack, the ¹Ü¼ÒÆÅÐÄË®ÂÛ̳ is urgently advocating for national health officials, state governors and Change Healthcare/UnitedHealth Group to take more action to help physicians who have been impacted financially.

"Physicians have continued to have cash-flow issues that severely threaten patient access to care and practice viability, and they'll feel the effects for many months to come," said Dejaih Johnson, ACP manager of regulatory affairs. "ACP is greatly concerned that without further action from the Department of Health & Human Services (HHS) and state partners, physician practices will be forced to drastically scale back patient panels, restrict the type of care provided, explore alternative financing options or close altogether."

In February 2024, UnitedHealth Group discovered that its Change Healthcare arm had been hacked. The cyberattack on Change Healthcare, which "offers payment and revenue cycle management tools and other solutions such as electronic prescription software," severely disrupted the U.S. health care system, CNBC reported.

Patients had trouble accessing medications, and physicians had to dig into their pockets as payments failed to come in. "According to an American Medical Association survey, more than a third of physician practices have seen the suspension of claim payments, four out of five said they lost revenue from unpaid claims, and more than half used personal funds to cover expenses," Johnson said. "These data show that practices are at significant risk of closure, and financially distressed practices are at risk of exploitative practices because of this incident. It's also important that compounding Medicare cuts and physician burnout issues have made this incident more problematic."

The Change Healthcare systems are gradually returning to operational status, Johnson said, but system outages have persisted for two months, and some systems still are not fully restored. ACP is disappointed that Change Healthcare and UnitedHealth Group have failed to take all necessary action to support and resource physicians, especially those in smaller practices that serve rural and underserved communities. "Most practices are unaware of the steps that HHS and others have taken to establish workarounds, which has led to miscommunication, frustration and financial strain," Johnson said.

ACP is urging HHS to take further action to require Change Healthcare and UnitedHealth Group to offer sufficient and practical solutions. "There have also been reports that other clearinghouses have significantly increased their transfer costs, and physicians have encountered difficulties integrating these clearinghouses into their existing electronic health record systems," Johnson said. "At the same time, physicians and health plans are understandably hesitant to reconnect to Change Healthcare's systems due to a lack of trust."

In letters to HHS and the National Governors Association, ACP urged additional action to alleviate the burden on physicians and provide financial relief. ACP has recommended that HHS and federal and state partners must:

• Take additional action through direct mailings, phone calls, and fax messages to communicate with smaller and more rural practices to ensure that some of the most vulnerable populations are aware of resources and funding options;
• Ensure that impacted physicians in the Merit-based Incentive Payment System are not unfairly penalized throughout the entire performance year;
• Allow and encourage paper claims for an extended grace period following the complete restoration of the electronic systems to support practices dealing with administrative backlogs;
• Provide flexibility and allocate funds to minimize the stress placed on physicians, including through supplemental advanced payments through traditional Medicare and private payers;
• Investigate predatory practices, such as taking advantage of practices that are struggling financially by buying them out and expediting mergers with UnitedHealth Group; and
• Address the ongoing and rising cybersecurity and privacy risks within the health care infrastructure.

Through the ACP Legislative Action Center, ACP is also to write to officials urging HHS to take these additional steps to help physicians by addressing cash-flow disruptions, improving communications, and maintaining alternative claims submission processes.

Meanwhile, ACP is pleased that committees of the House and Senate are working with the White House and Change Healthcare to help physicians -- particularly smaller and more rural practices -- maneuver through this complicated process of being reimbursed in a timely manner for patient care. The aggregate of these efforts will allow physicians to keep their doors open and focus on caring for patients, Johnson said, and ACP is eager to help policymakers navigate the way forward.

"It's important to understand the breadth of this cyberattack," she said. "Change Healthcare's products and platforms touch nearly one in three patients and touch nearly every hospital in the U.S. The reach of Change Healthcare and UnitedHealth Group has become incredibly expansive in the health care sector. Given the considerable amount of consolidation occurring in the sector, it is incredibly important that regulators and policymakers assess how to prevent this in the future and address the rising risks of consolidation in light of these events -- and many more that happen on a smaller scale."

Back to the May 17, 2024 issue of ACP Advocate