Congress needs to take action to help hospitals, AHA says

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The American Hospital Association is urging Congress to address any statutory constraints that prevent the Centers for Medicare and Medicaid Services and Department of Health and Human Services from adequately helping hospitals and other healthcare providers impacted by the Change Healthcare cyberattack.

The AHA submitted a letter to the House Ways and Means Committee, ahead of a hearing with HHS Secretary Xavier Becerra on fiscal year 2025 funding for HHS.  
 
"The Administration has limited tools available, particularly because, unlike with COVID-19, the government is not operating under a declared Public Health Emergency and National Emergency," AHA wrote. "While CMS has offered [accelerated and advance payments], the agency only has authority to do so for limited time periods and amounts and with very high interest rates after repayments are due."

The letter, dated March 19, from AHA President and CEO Rick Pollack also urges Congress to put forward policies that would alleviate administrative requirements imposed by payers, including Medicare Advantage and other commercial payers.

"Without relief from these payers in the form of waivers of prior authorization and timely filing requirements, not to mention additional advance payment, providers, including hospitals and health systems, will likely see significant denials of care as a result of the shutdown of Change Healthcare," Pollack wrote. 

WHY THIS MATTERS

AHA data from a survey of hospitals and health systems outlines a "staggering loss of revenue means that some hospitals and health systems may be unable to pay salaries for clinicians and other members of the care team, acquire necessary medicines and supplies, and pay for mission critical contract work in areas such as physical security, dietary and environmental services," the  AHA wrote in a letter to Congress on March 13..

The survey finds 94% of hospitals are experiencing a financial impact from the Change Healthcare cyberattack with more than half reporting "significant or serious" impact. The survey included responses from about 1,000 hospitals from March 9-12. 

More than 80% of hospitals said the cyberattack has affected their cash flow, and of those nearly 60% report that the impact to revenue is $1 million per day or more. In addition, the survey found that 74% of hospitals reported impacts to direct patient care as a result of the cyberattack. 

The American Medical Association has said payers aren't doing enough to help.

In a response to the cyberattack, AHIP President and CEO Mike Tuffin said, "Health insurance plans have taken immediate and comprehensive steps to support providers and ensure continuity in patient care in response to the cyberattack. These efforts have enabled many providers to resume claim submissions, receive timely payments and maintain their operations. Since some providers are still experiencing operational challenges, health plans have also prioritized putting in place alternative payment processes to support partners and ensure timeliness in reimbursement."

Individual plans and providers are in the best position to assess how to maintain appropriate payments in a timely manner – and also to minimize the need for reconciliation processes, AHIP said. 

"Further, broad exemptions in prior authorization at a time of advanced payments could expose patients and employers to fraud, waste and unnecessary costs," Tuffin wrote.
 
THE LARGER TREND

Last week, healthcare leaders from HHS, The White House and the Department of Labor convened to discuss ways to mitigate harms to patients and providers caused by the cyberattack.

The American Medical Association praised the creation of the Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments.

The AMA has asked for flexibilities, including ones for the 2023 Merit-based Incentive Payment System (MIPS), as the data submission window closes on April 1.

"Due to the Change Healthcare cybersecurity breach, we are concerned that many practices will not have the resources to expend on MIPS data submission and therefore will be subject to a -9 percent penalty," the AMA said. "The AMA strongly believes that CMS should automatically apply the Extreme and Uncontrollable Circumstances Hardship exception to all MIPS eligible clinicians for the 2023 performance year."

Senators have asked for answers from the Biden administration on the February 21 cyberattack that disrupted hospital and physician insurance claims.

During a hearing, Senate Finance Committee Chairman Ron Wyden (D-Ore.) pressed Health and Human Services Secretary Xavier Becerra to institute cybersecurity requirements for both hospitals and insurers and to "start holding these executives [accountable] …" according to STAT.

Email the writer: SMorse@himss.org