Doctors skipping paychecks amid medical claims crisis
No one, certainly not a medical doctor, would compare the meltdown of the nation’s largest health care claims and reimbursement system to the COVID-19 pandemic when it comes to the tragic effect on families.
But as a crisis in everyday management and a cash emergency, the ransomware attack and shutdown of Change Healthcare’s massive medical billing system could rival the global virus outbreak. That’s the view of many, including Dr. Sina Raissi, a nephrologist — a kidney specialist — in a small practice of four physicians in Middlebury.
“COVID was not a cash flow situation, it was a patient care situation,” Raissi told me. “If this situation continues I would categorize this as worse than what we were facing during the COVID.”
The good doctor is not saying the Change Healthcare crisis is worse for people’s lives than COVID. But his medical practice and thousands like it, not to mention hospitals, nursing homes and pharmacies across the state and nation, have in many cases not been paid for their work since Feb. 21.
That’s when the cyberattack hit Change Healthcare, a subsidiary of UnitedHealth Group, the giant insurer.
Raissi and his three partners, the four nephrologists at his practice, are now in their fourth week of forgoing paychecks for themselves. And they’re not alone as medical practices struggle to keep patient care going seamlessly.
That’s bad enough, especially for the younger physicians with big mortgages and medical school debt than on Raissi, whose kids are grown. But he and his partners have a staff of 10 employees, and those folks, of course, need to be paid, along with other bills.
They’re starting to run out of money. And if something doesn’t turn around soon, they will hit a wall because Change Healthcare operates on a delay of three or four weeks, from the time the docs submit claims for various payers — private insurance companies, Medicaid or Medicare — to the time they receive a check in the mail.
With the system disabled, they haven’t been able to submit claims except for a few, by hand. “From now on we anticipate a significant decline in our cash flow, essentially coming down to a trickle,” Raissi told me in an interview Thursday. And the situation has not been resolved since.
“That’s what we are bracing for right now, which is going to be a huge problem for practices like ours.”
Not to mention, in many medical practices and at many hospitals, health care providers are performing services that may or may not end up being covered. They can’t line up pre-authorization as usual. That means patients could end up with bills for work that isn’t covered, or more likely, for services that end up in dispute — on top of the usual battles over insurance coverage.
If it gets bad enough, the shutdown could mean furloughs for staff at Raissi’s practice.
“This is a hectic office like a lot of small practices,” he told me. “Even the thought of putting any one of them on furlough is scary to me because anything that slows down could impact patient care, satisfaction and the quality of the care that we provide.”
Multiplied across billions of claims — Change handles one-third to onehalf of all billings in the United States — this is a true crisis, but one of the quietest I’ve ever reported on. Why is is not creating loud headlines? Why are calls for accountability by UnitedHealth Group, and demands for action by the state and federal government, echoing blankly like a night train in the distance?
Oh sure, Sen. Richard Blumenthal, D-Conn., joined industry groups including the Connecticut Hospital Association and the Southern New England Healthcare Organization, which represents independent practices including Raissi’s, in demanding action. “What’s needed now is advance payments, not the... shockingly inadequate trickle that UnitedHealth Group has provided,” Blumenthal said at the state Capitol last week.
UnitedHealth Group and its Change Healthcare unit have given regular updates on a dedicated website which says key systems are in testing for a return to full service, and that they will address a backlog of $14 billion in claims,
That’s not good enough, of course. Blumenthal and the industry want the state to pressure federal health officials to require private insurers as well as
Medicare and Medicaid to send money to providers for services done, which would be sorted out later.
That isn’t happening, at least not fast enough. In a piece of good news, the state Department of Social Services is working toward advance payments for HUSKY and other Medicaid providers, a spokeswoman said Monday. That fix requires a formal request to the U.S. Centers for Medicare & Medicaid Services, which requires approval of two legislative committees.
“We are working diligently to get a meeting scheduled,” DSS spokeswoman Christine Stuart said late Monday. “We understand the magnitude of the situation for the small providers.”
So, considering the disruption, why aren’t we hearing more about this? The answer is, folks like Raissi and his partners, as well as hospitals and industry groups, are protecting the rest of us.
Before they furlough anyone, Raissi and his partners will run down their lines of credit with banks. They’re also working with the provider of their practice management system to find an alternative to Change Healthcare, though that takes time.
“We’re dealing with a lot of anxiety but we have kind of shielded the patients,” Raissi told me. “I grab onto any piece of news that says things are going to be better but, no,
I am not confident ... I’m not seeing anything, not at all.”
Lisa Trumble, CEO of Southern New England Healthcare, known as SoNO HEALTH, said the money offered by UnitedHealth Group is mostly loans, not outright advances. “These independent providers,” she said, “have fewer resources available to provide services to patients when things go wrong.”
She added, “From the state we would certainly want some accommodations.”
The broader picture is about accountability. Federal regulators never should have approved the takeover of Change Healthcare a few years ago by United, because Change is a service arm to the industry in which United competes as an insurer, creating a conflict.
“The entire structure deserves to be investigated,” Blumenthal said.
No, this meltdown will not kill millions of people like a pandemic, but as we’ve come to learn, these vast systems are all the more vulnerable these days. That has doctors such as Raissi and his partners struggling behind the scenes to keep patient care unaffected.
“We will fight tooth and nail for something like that never to happen,” he said, “but we are anxious.”