RISE summarizes recent regulatory-related and news headlines.
Change Healthcare cyberattack fallout: Physician practices struggle to stay afloat
An informal survey released this week by the American Medical Association (AMA) shows the ongoing impact of the Change Healthcare cyberattack.
The ransomware attack, first reported February 21, crippled Change Healthcare’s systems and disrupted operations at health care organizations across the United States for weeks and its effects are still being felt.
THE AMA surveyed more than 1,400 physician practices from March 26 to April 3, after UnitedHealth Group, which owns Change Healthcare, said claims processing would begin by the weekend of March 23. Most responses came from practices with fewer than 10 physicians.
According to the survey, restricted functionality since the cyberattack has led to suspensions in claim payment (36 percent), inability to submit claims (32 percent), and inability to verify eligibility for benefits (22 percent).
As a result:
- Eighty percent reported lost revenue from unpaid claims
- Eighty-five percent have had to commit additional staff time and resources to complete revenue cycle tasks
- Fifty-one percent have lost revenue from the inability to charge patient co-pays or remaining obligations
- Fifty-five percent have had to use personal funds to cover practice expenses
- Forty-four percent were unable to purchase supplies
- Thirty-one percent were unable to make payroll
“The disruption caused by this cyber-attack is causing tremendous financial strain,” said AMA President Jesse M. Ehrenfeld, M.D., MPH, in a statement. “These survey data show, in stark terms, that practices will close because of this incident, and patients will lose access to their physicians. The one-two punch of compounding Medicare cuts and inability to process claims as a result of this attack is devastating to physician practices that are already struggling to keep their doors open.”
CDC updates strategy to detect, monitor public health threats
The Centers for Disease Control and Prevention (CDC) this week launched its updated public health data strategy for the upcoming year, which aims to seamlessly share data to rapidly detect and respond to new public health threats.
“We need a modernized public health data infrastructure that is seamlessly connected to the health care data and information technology ecosystem to effectively protect the health of communities across the country,” said CDC Director Mandy Cohen, M.D., M.P.H., in the announcement. “Data are the oxygen that powers our ability to detect and respond to health threats. Early detection and monitoring of health threats rely on timely data in order for us to investigate and respond effectively.”
The report highlights the CDC’s achievements in 2023 and how it intends to continue improving its capabilities for early detection and real-time monitoring. Among its plans:
- Increasing adoption of electronic case reporting among critical access hospitals to ensure rapid detection of novel and emergent threats and diseases
- Connecting public health to health IT to enable faster sharing of data
- Expanding core data sources that are critical for detecting threats early and monitoring in real-time, such as wastewater, hospitalization, and hospital bed capacity
- Increasing reporting on additional social determinants of health-related data to more effectively identify and address health disparities
AHA urges feds to probe MultiPlan and commercial insurers for cutting reimbursements for care
The American Hospital Association this week asked the U.S. Department of Labor to immediately open an investigation into alleged practices by companies like MultiPlan, a data analytics firm, and its corporate commercial insurer partners to cut reimbursement rates for care provided to employees of companies with self-funded employer insurance plans and increase costs for patients who receive that care.
The request follows a recent investigation by the New York Times into the practices of MultiPlan to determine how much to pay providers for out-of-network claims. MultiPlan and the insurers have incentives to keep the payments low because their fees increase when the reimbursement decreases. The publication found that the health plans pay much less than the actual bill but then charge the self-funded employers the balance as a processing fee. In many instances, the fees paid to commercial insurers and MultiPlan are often higher than the reimbursement for the health care itself. Indeed, UnitedHealth Group reportedly receives $1 billion in annual fees from employers for its work with MultiPlan.
“As a result of these secretive arrangements, America’s employees are forced to pay increasing out-of-pocket amounts—even though they already pay hundreds of dollars each month for employer-funded health insurance. Even more alarming, these harmful business practices are causing patients across the United States to cease or delay necessary treatment for fear of mounting cost,” AHA President and Chief Executive Richard J. Pollack wrote.
The arrangement also harms health care providers, who must accept below-cost reimbursements, Pollack said. “These practices demand government oversight — not just investigative reporting and public outrage.”
Trade organizations release value-based care best practices
AHIP, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) recently released a playbook on voluntary best practices to advance the adoption of value-based care arrangements and improve the quality, equity, and affordability of care.
The playbook aims to provide health plans, hospitals, physicians and other clinicians, and value-based care entities with an action-oriented blueprint informed by real-world experiences to voluntarily consider during the design, implementation, and evaluation of their own value-based care participation. It includes sections on benchmarking, risk adjustment, quality performance impact on payment, levels of financial risk, payment timing and accuracy, and incentives for value-based care practice participant performance.
“In the last decade, value-based care has grown from almost nothing to undeniably significant aspect of our health system. Today, for example, accountable care organizations are 20 percent of Medicare alone,” said Clif Gaus, Sc.D., president and CEO of NAACOS, in the announcement. “This iteration of the playbook synthesizes what we’ve learned over the last decade plus, so that payers, physicians, hospitals, and ACOs can implement payment and delivery models that improve outcomes and lowers costs.”
To produce the playbook, the trade organizations established an advisory workgroup of members from each association and conducted interviews with subject matter experts. Participants were selected through an intentional process to ensure a diverse cross section of individuals with varying experiences implementing value-based care models, including national and regional health plans; large, small, rural, integrated, and independent physician practices; and value-based care entities, such as ACOs. Voluntary best practices were developed with this diversity in perspectives in mind, with a focus on specific needs for rural communities and advancing health equity for underserved populations.