Cancer practices reeling from Change Healthcare cyberattack

The Change Healthcare cyberattack has created problems for hospitals, medical groups and providers of all kinds, and oncology practices are among the most impacted by the disruption.

Cancer patients can’t really deal with interruptions in care. The Community Oncology Alliance, which represents oncology practices, said the cyberattack has caused a variety of problems, including delays in payments and prior authorizations for treatments.

Ted Okon, executive director of the COA, tells Chief Healthcare Executive®, “It's a potentially devastating situation.”

“You’ve got to keep treating cancer,” Okon says. “You’ve got to keep treating patients, you can't furlough staff or stop treating cancer patients. Your first priority is making sure there's uninterrupted interrupted treatment. But when you are having to pay the staff, having to keep the lights on, having to pay for the drugs, the bottom line is that when the payments stopped flowing, you can run into a cash deficit situation very quickly.”

Providers could be on the verge of seeing some relief. The U.S. Department of Health & Human Services announced Tuesday it would expedite requests from providers to change clearinghouses they use for processing claims.

The health department said it is urging UnitedHealth Group, Change Healthcare’s parent company, to do everything possible to ensure healthcare providers are able to continue offering services. Hospitals and other providers say more decisive steps are needed.

The American Hospital Association has called the cyberattack the “most significant” in healthcare in U.S. history. United HealthGroup, Change Healthcare’s parent company, said the cyberattack was discovered Feb. 21, so providers across America have dealt with disruptions for nearly two weeks.

Risks for patients

Oncology practices are caring for their cancer patients, even if they can’t go through the normal process of pre-approval, commonly called prior authorization, from insurers to move ahead with treatments, Okon says.

Cancer practices are largely hoping that when Change’s services are restored, insurers will approve the treatments.

“In some cases, you just have to accept the risk, and hope on the back end, it's going to be fine,” Okon says. “But prior authorization is a growing problem in medicine in general, and it's certainly in cancer care.”

Like hospitals and medical groups, oncology practices use Change Healthcare’s technology for insurance approvals and also to process claims and get payments.

Okon calls the cyberattack “the most significant” he’s ever witnessed. Cyberattacks have disrupted and taken down individual oncology practices, Okon says. But the problem is Change provides so many services across the entire healthcare industry.

“The problem is they targeted an entity that is so consolidated and is such an important, huge player in the healthcare system, that it's literally shut the system down,” Okon says.

Okon says one takeaway should be a greater understanding of the downside of the growing consolidation of healthcare, considering how many providers rely on Change Healthcare.

“When you have consolidation, the problem is that the attack is on a consolidated entity, and brings everybody else down,” Okon says. He adds, “They targeted an entity that is so part of the fabric of healthcare processing and operations, that they brought everybody down.”

Beyond the business impacts, Okon says the disruptions have affected patient care. While he says he doesn’t want to overplay the impact, he says it shouldn’t be minimized.

“I certainly don't want to get anybody scared. But you know this is the kind of thing that the longer it goes on, and if everybody doesn't do something about it, you know, can lives be in danger? Absolutely,” he says.

“If patients can't get their treatment, not just cancer patients, any patients can't get their treatment, can't take vital drugs that they get at the pharmacy level for other disease states, absolutely, positively, I'm sure it's already put some people at risk,” Okon says.

Read more: Florida Hospital Association CEO describes ‘massive’ impact of Change Healthcare cyberattack

Taking on the risk

Kathy Oubre, chief executive officer at Pontchartrain Cancer Center in Louisiana, says her organization is continuing to care for patients and purchase chemotherapy drugs. She says the center received less than half in payments than the previous week.

Oubre tells Chief Healthcare Executive® the center has enough funds for the next few weeks, but she says, “at some point this will become a crisis.”

“We can probably churn along for at least another month,” Oubre says. “And at the end of that I don't know what that'll look like. But you have to remember I can't start laying off people. I have to have my employees to care for my patients. … It's not that simple as starting to lay off employees because I need my nurses and my nurse practitioners and my physicians.”

The Pontchartrain Cancer Center has continued ordering cancer drugs for patients even without having authorizations, with the hope that those medications will be approved when systems are restored.

“In order to care for patients who have active illnesses such as cancer, in some cases, we are flying blind in dispensing medications, … with the reasonable expectation that the payer will adjudicate that claim once everything's back online and make us whole,” Oubre says.

While Oubre says most of the oncology practices she’s contacted are following a similar approach, some aren’t able to do so.

“You're gonna find providers that are going at risk,” Oubre says. “You're going to find some, though, that maybe they don't have that line of credit or the financial cushion, or even for a variety of reasons, and maybe they're not going at risk.”

“I am hearing some that are saying we can't take that financial exposure,” she says.

And she adds that means patients aren’t getting their medication.