7 steps to help doctors affected by Change Healthcare cyber outage

Kevin B. O'Reilly , Senior News Editor

A second, informal survey (PDF) of physicians shows the cyberattack-driven Change Healthcare outage is continuing to have a major, lingering impact on physicians and their practices. Of the nearly 600 physicians surveyed in late April, 90% reported that they are still losing revenue from unpaid claims. More than one-quarter of the respondents said that their practice revenue for the prior week was down by more than 70%, compared with an average week before the cyberattack. 

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Overall, respondents reported continuing issues with multiple operations, despite announcements of restored service from UnitedHealth Group, of which the claims-processing clearinghouse Change Healthcare is a subsidiary. Among the findings:

  • 85% continued to experience disruptions in claim payments.
  • 79% still could not receive electronic remittance advice.
  • 75% reported barriers with claim submission.
  • 60% faced challenges in verifying patient eligibility.

In addition, 62% of respondents said they were still using personal funds to cover practice expenses and 34% were not able to make payroll. Despite these challenges, and consistent with previous AMA survey results (PDF), only 15% of respondents reported reducing office hours in an effort to prioritize patient care.

Patients also face continued challenges, with 42% of physicians stating that patients were unable to access coverage and cost information and 30% saying patients could not pay copays at the time of service.

And switching from Change Healthcare is not easy. Some respondents said that they took advantage of that option, but many practices said that they were unable to switch or chose not to switch due to substantial barriers.

The AMA survey found that 54% of the respondents who did not switch clearinghouses cited the time commitment required as a main barrier, while 32% said a switch was not supported by their EHR or practice-management system. In addition, 25% shared that switching to an alternative clearinghouse was too expensive, and 36% cited incompatibilities with payers’ systems or restrictions due to contract exclusivity.

The information flow from UnitedHealth Group on when service is going to be restored is also leading to confusion for physicians. The survey indicated that 84% of respondents were not getting information—or were getting inaccurate information—regarding service restoration from UnitedHealth Group and its subsidiaries.

Respondents also indicated that health plans were not offering administrative flexibilities in response to the Change Healthcare cyberattack. Nearly one-third reported that they were required to complete prior authorizations on claims affected by the service outage and 27% said claims had been denied for failing to meet timely filing requirements.

How the AMA’s fighting for doctors

Change Healthcare started experiencing major problems Feb. 21. The AMA has assembled a resource page on the Change Healthcare cyber outage and steps that physicians can take.

In two separate congressional hearings held recently—one in the Senate Finance Committee and another in the House Energy and Commerce Subcommittee on Oversight and Investigations—UnitedHealth Group CEO Andrew Witty stated that “claims flow across the entire country is essentially back to normal.”

But in its statement for the record (PDF) to the Senate Finance Committee and letter (PDF) to the House Energy and Commerce Subcommittee on Oversight and Investigations, the AMA strongly and convincingly argued that physician practices—particularly small practices or those operating in rural areas—are continuing to struggle from the aftershocks of the cyberattack.

The AMA has outlined these seven key steps that Congress, the Biden administration, UnitedHealth Group and other insurers should take to support physicians, their practices and their patients:

  • Provide financial assistance to affected physician practices. 
  • Immediately suspend prior authorization, quality reporting and other administrative requirements. 
  • Prevent denials on claims and appeals affected by the outage.
  • Improve the transparency and accuracy of information going to physicians.
  • Focus on restoring function for small, independent physician practices.
  • Ensure the HIPAA-related reporting requirements and notification obligations fall upon Change Healthcare and not physicians or other health professionals. 
  • Establish flexibility and leniency in loan repayment and recoupment.

More broadly, Congress should take action to ensure the long-term financial stability of physician practices through Medicare payment reform

The AMA included its most recent survey results in its comments to members of Congress to underscore that—despite messaging from UnitedHealth Group, commercial health plans and insurer associations—this crisis is far from being resolved for many physicians.

Questioning and statements from members of Congress reflected many of these issues, indicating that the AMA and Federation of Medicine have successfully elevated physicians’ ongoing concerns and the need for financial and administrative relief.

The AMA will continue to stay engaged with UnitedHealth Group, the U.S. Department of Health and Human Services, and other health plans as this challenging situation continues.

In a Leadership Viewpoints column published in May, AMA President Jesse M. Ehrenfeld, MD, MPH, explained how the Change Healthcare hack shows the need for more competition in health care.