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☆ 4 Things You Need to Know About Health Care Cyberattacks
▼ + stars: | 2024-03-29 | by ( Reed Abelson | Margot Sanger-Katz | ) www.nytimes.com time to read: +1 min

The recent cyberattack on the billing and payment colossus Change Healthcare revealed just how serious the vulnerabilities are throughout the U.S. health care system, and alerted industry leaders and policymakers to the urgent need for better digital security. Hospitals, health insurers, physician clinics and others in the industry have increasingly been the targets of significant hacks, culminating in the assault on Change, a unit of the giant UnitedHealth Group, on Feb. 21. The ransomware attack on the nation’s largest clearinghouse, which handles a third of all patient records, had widespread effects. Fixes and workarounds have alleviated some distress, but providers are still unable to collect billions of dollars in payments. Even now, very little information about the exact nature and scope of the attack has been disclosed.

Persons: UnitedHealth Organizations: Healthcare, UnitedHealth Locations: U.S

☆ With Cyberattack Fix Weeks Away, Health Providers Slam United
▼ + stars: | 2024-03-08 | by ( Reed Abelson | Julie Creswell | ) www.nytimes.com time to read: +1 min

More than two weeks after a cyberattack, financially strapped doctors, hospitals and medical providers on Friday sharply criticized UnitedHealth Group’s latest estimate that it would take weeks longer to fully restore a digital network that funnels hundreds of millions of dollars in insurance payments every day. UnitedHealth said that it would be at least two weeks more to test and establish a steady flow of payments for bills that have mounted since hackers effectively shut down Change Healthcare, the nation’s largest billing and payment clearinghouse, on Feb. 21. But desperate providers that have been borrowing money to cover expenses and employee payrolls expressed skepticism at that estimate, worrying that it could be months before the logjam of claims and payments cleared up. “We have nearly a three-week gap in cash flow,” said Brad Larsen, a psychologist and founder of Portland Mental Health & Wellness in Oregon, adding that the group had received only about 10 percent of its expected insurance payments. He said the practice had to borrow $300,000 to meet its first of two payrolls for the month.

Persons: UnitedHealth, payrolls, ”, Brad Larsen, “ It’s Organizations: Portland Mental Health, Wellness Locations: Portland, Oregon

☆ Cyberattack Paralyzes the Largest U.S. Health Care Payment System
▼ + stars: | 2024-03-05 | by ( Reed Abelson | Julie Creswell | ) www.nytimes.com time to read: +2 min

An urgent care chain in Ohio may be forced to stop paying rent and other bills to cover salaries. In Florida, a cancer center is racing to find money for chemotherapy drugs to avoid delaying critical treatments for its patients. These are just a few examples of the severe cash squeeze facing medical care providers — from large hospital networks to the smallest of clinics — in the aftermath of a cyberattack two weeks ago that paralyzed the largest U.S. billing and payment system in the country. They also urged health insurers to waive or relax the much-criticized rules imposing prior authorization that have become impediments to receiving care. And they recommended that insurers offering private Medicare plans also supply advanced funding.

Organizations: Change Healthcare, UnitedHealth, Human Services Department Locations: Ohio, Florida, Pennsylvania

☆ A Cyberattack on a UnitedHealth Unit Disrupts Prescription Drug Orders
▼ + stars: | 2024-02-26 | by ( Reed Abelson | ) www.nytimes.com time to read: +1 min

A cyberattack on a unit affiliated with UnitedHealthcare, the nation’s largest insurer, has disrupted drug prescription orders at thousands of pharmacies for nearly a week. The assault on the unit, Change Healthcare, a division of United’s Optum, was discovered last Wednesday. The attack appeared to be by a foreign country, according to two senior federal law enforcement officials, who expressed alarm at the extent of the disruption on Monday. UnitedHealth Group, the conglomerate, said in a federal filing that it had been forced to disconnect some of Change Healthcare’s vast digital network from its clients, and as of Monday, had not been able to restore all of those services. The company was acquired by UnitedHealth Group for $13 billion in 2022.

Organizations: UnitedHealthcare, UnitedHealth, UnitedHealth Group Locations: United’s

☆ Six Reasons Why It’s So Hard to Get Your Weight-Loss Drugs
▼ + stars: | 2024-02-02 | by ( Reed Abelson | Rebecca Robbins | ) www.nytimes.com time to read: 1 min

Talk to people who have tried to get one of the wildly popular weight-loss drugs, like Wegovy, and they’ll probably have a story about the hoops they had to jump through to get their medication — if they could get it at all. Emily Weaver, a nurse practitioner in Cary, N.C., said she told her patients that finding Wegovy was “like winning the lottery.”Here are six reasons why. Fueled in part by TikTok videos and celebrity testimonials, people are increasingly seeking prescriptions for appetite-suppressing medications. The drugs in this class have long been used to treat diabetes but more recently have been recognized for their extraordinary ability to help patients lose weight. The medications are injected weekly and have sticker prices as high as $16,000 a year.

Persons: they’ll, Emily Weaver, Wegovy Locations: Cary, N.C

It’s a good day when Frank Lee, a retired chef, can slip out to the hardware store, fairly confident that his wife, Robin, is in the hands of reliable help. He struggled to care for her largely on his own. “As Mom’s condition got more difficult to navigate, he was just handling it,” said Jesse Lee, the youngest of the couple’s three adult children. “It was getting harder and harder.”“Something had to change, or they would both perish.”Frank Lee’s search for trustworthy home health aides — an experience that millions of American families face — has often been exhausting and infuriating, but he has persisted. He didn’t entirely trust the care his wife would get in an assisted-living facility.

Persons: Frank Lee, Lee, ”, Jesse Lee, ” Frank Lee’s, — Locations: Palms, Charleston, S.C

☆ What to Know About Home Care Services
▼ + stars: | 2023-12-02 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

And most middle-class people will have to pay for home care themselves if they will need it for the long haul. After a fall or surgery, some older people will need short-term care at home from a nurse or therapist to help them recover. Medicare, the federal insurance program for those 65 and over, typically pays for this kind of home health care. They need a home health aide or personal care assistant, who may not have much, if any, medical training. A wide range of services are available, whether it’s light housekeeping or hiring a private-duty nurse.

Persons: Monica Moreno Organizations: Medicare, Alzheimer’s Association

It was costing us $8,000 out of pocket to have people come into my mom’s house to help her, and that was only eight hours a day. She was in rehab for the maximum number of days that Medicare will cover and couldn’t return home. Because she owned a house, had two rentals, savings and two cars, she had to pay long-term care costs out of her pocket. The state says we still owe close to $20,000 for the year Medicaid paid for her nursing home. It was awful — personally all the time and energy and money to do this for her — and it was great.

Persons: I’m, —, that’s, Bryan Ness Organizations: Medicaid

Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number. They ran up $15,000 in medical and credit card debt while she took on the role of caretaker. “I had to do it.”Millions of families are facing such daunting life choices — and potential financial ruin — as the escalating costs of in-home care, assisted-living facilities and nursing homes devour the savings and incomes of older Americans and their relatives.

Persons: Margaret Newcomb, Feylyn Lewis, Sheila Littleton, ”, “ Locations: French, Seattle, England, Nashville, Houston

The suit targeted a large doctors’ group that operates anesthesia practices in several states, claiming the group and the private equity firm advising and financing it were consolidating doctors’ groups in Texas so they could raise prices and increase their profits. The agency brought the civil lawsuit in federal court against U.S. Anesthesia Partners and Welsh, Carson, Anderson & Stowe, a private-equity firm in New York. “These tactics enabled USAP and Welsh Carson to raise prices for anesthesia services — raking in tens of millions of extra dollars for these executives at the expense of Texas patients and businesses,” said Lina M. Kahn, the chair of the F.T.C., in a statement. “The F.T.C. will continue to scrutinize and challenge serial acquisitions, roll-ups and other stealth consolidation schemes that unlawfully undermine fair competition and harm the American public.”

Persons: Anderson, Anderson & Stowe, Welsh Carson, ”, Lina M, Kahn Organizations: Federal Trade Commission, U.S, Anesthesia Partners, Anderson & Locations: Texas, Carson, New York

☆ Insurers Deny Medical Care for the Poor at High Rates, Report Says
▼ + stars: | 2023-07-19 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published Wednesday. Medicaid, the federal-state health insurance program for the poor that covers nearly 87 million people, contracts with companies to reimburse hospitals and doctors for treatment and to manage an individual’s medical care. About three-quarters of people enrolled in Medicaid receive health services through private companies, which are typically paid a fixed amount per patient rather than for each procedure or visit. The report by the inspector general’s office of the U.S. Department of Health and Human Services details how often private insurance plans refused to approve treatment and how states handled the denials. Doctors and hospitals have increasingly complained about what they consider to be endless paperwork and unjustified refusals of care by the insurers when they fail to authorize costly procedures or medicines.

Organizations: Medicaid, U.S, U.S . Department of Health, Services

Historically, doctors’ practices have been relatively small, and owned by doctors themselves. Hospitals and insurance companies have also bought out many independent physicians’ practices. Optum, an arm of the publicly traded UnitedHealth Group, which also owns one of the nation’s largest insurers, employs roughly 70,000 physicians. Private equity is often viewed by physicians as an attractive alternative to having their practice bought by a hospital. “It can be a really good thing, but the private equity firms have to keep their promises and be held accountable,” she said.

Persons: ’, “, ”, Richard Scheffler, Lisa Walkush, Grant Thornton, Michael Kroin Organizations: Physicians, Institute, Petris, . Hospitals, UnitedHealth Group, Growth Partners Locations: U.S, Berkeley, Chicago

☆ Medicare Advantage Plans Offer Few Psychiatrists
▼ + stars: | 2023-07-05 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

People with private Medicare coverage may not be getting the mental health services they need because they cannot find a psychiatrist within their plan’s network, according to a new study. More than half of the counties the researchers studied did not have a single psychiatrist participating in a Medicare Advantage plan, the private-sector counterpart to traditional Medicare. Some 30 million people, just over half of all participants in the federal program, are enrolled in these private plans. The researchers, in an article published on Wednesday in the journal Health Affairs, found that of the plans reviewed, nearly two-thirds were narrow, with fewer than a quarter of available psychiatrists in a plan’s network. The more limited “networks present a frustrating additional barrier in mental health services even when, on paper, there are a sufficient number of providers in a geographic region,” the researchers wrote.

Organizations: Health Affairs

☆ It’s Not Just You: Many Americans Face Insurance Obstacles Over Medical Care and Bills
▼ + stars: | 2023-06-15 | by ( Reed Abelson | ) www.nytimes.com time to read: +3 min

The NewsA majority of Americans with health insurance said they had encountered obstacles to coverage, including denied medical care, higher bills and a dearth of doctors in their plans, according to a new survey from KFF, a nonprofit health research group. Those who were most likely to need medical care — people who described themselves as in fair or poor health — reported more trouble; three-fourths of those receiving mental health treatment experienced problems. The survey also underscored the persistent problem of affordability as people struggled to pay their share of health care costs. Among the nearly 60 percent who reported difficulty with their insurance coverage, 15 percent said their health had declined. Background: Insurance coverage is confusing to everyone.

Persons: ”, Drew Altman, Karen Pollitz, Amanda Parente Organizations: Kaiser Family Foundation Locations: KFF, Nashville

☆ Unions Accuse UPMC of Wielding Market Power Against Workers
▼ + stars: | 2023-05-18 | by ( Reed Abelson | ) www.nytimes.com time to read: +1 min

A coalition of labor groups on Thursday filed an antitrust complaint with the Justice Department against UPMC, the giant Pittsburgh-based hospital employer, accusing the system of using its enormous clout to depress wages and harm workers. Healthcare Pennsylvania, claims UPMC workers are subject to a “wage penalty” because of the health system’s dominance in local markets. “We have watched UPMC grow and amass power,” said Matthew Yarnell, the president of the S.E.I.U. group there, which has long sought to organize workers at the health system, which is largely not unionized. After a series of acquisitions, it is Pennsylvania’s largest private employer with more than 40 hospitals, 800 doctors’ offices and clinics, and a health plan.

☆ Corporate Giants Buy Up Primary Care Practices at Rapid Pace
▼ + stars: | 2023-05-08 | by ( Reed Abelson | ) www.nytimes.com time to read: +1 min

It’s no surprise that the shortage of primary care doctors — who are critically important to the health of Americans — is getting worse. So why are multibillion-dollar corporations, particularly giant health insurers, gobbling up primary care practices? CVS Health, with its sprawling pharmacy business and ownership of the major insurer Aetna, paid roughly $11 billion to buy Oak Street Health, a fast-growing chain of primary care centers that employs doctors in 21 states. And Amazon’s bold purchase of One Medical, another large doctors’ group, for nearly $4 billion, is another such move. The appeal is simple: Despite their lowly status, primary care doctors oversee vast numbers of patients, who bring business and profits to a hospital system, a health insurer or a pharmacy outfit eyeing expansion.

☆ Kaiser Permanente to Acquire Geisinger
▼ + stars: | 2023-04-26 | by ( Reed Abelson | ) www.nytimes.com time to read: +3 min

The company expects to add five or six health systems to Risant in that time. The formation of the company is also a response to the rapid changes taking place in the health care industry. Large for-profit companies like health insurers, pharmacy chains and other corporations are scooping up physician practices and urgent care centers and devouring more of the country’s health care dollars. As national systems and new players grow larger, “they are pulling away in some respects from our communities and from our community health systems,” he said. “Covid has really shown not having integrated, value-based relationships puts our health systems and our communities at risk,” Mr. Adams said.

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