Optum Problems Contribute to Broader ER Surge at NWH 

Issue Captures Attention of Local Lawmaker

This column is the second installment of a multi-part series about concerns at Optum.

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Since publishing an in-depth column earlier this month on the vexing issues at Optum Tri-State medical group – the former CareMount/former MKMG – I’ve been blown away by the volume and emotional intensity of reader feedback, mostly echoing concerns in the original coverage about severe scheduling issues and alleged profit-driven doctor shortages.

I’ve probably received more comments reacting to the column than any piece we’ve ever published, spanning the past 15-plus years.

In the couple weeks subsequent to publication, we’ve been chipping away at follow-up reporting, and that chipping continues.

But, given the massive local interest in the topic and the nature of Optum’s response (meaning the organization’s refusal to respond), it seemed worth updating our readership in the interim on where the issue stands, even as we work on a separate, thorough, eventual in-depth news report.

In fact, I was already debating between waiting versus publishing my next column on the topic when Examiner Editor-in-Chief Martin Wilbur directed me to another layer of the local healthcare saga.

The layer came in the way of a Village Board report update last Monday from Mount Kisco Deputy Mayor Lisa Abzun.

ER Traffic Jam 

As it turns out, the Northern Westchester Hospital/Northwell emergency room, already dealing with a surge in use for other unrelated reasons, has become even more filled with non-emergency patients because people face soul-crushing delays and scheduling hiccups with Optum and then pivot with a visit to the ER instead.

While officials are publicly urging people to use urgent care facilities, and not the ER, for non-emergency health issues such as sprains, minor lacerations, infections such as pink eye, etc., not everyone has heard or is heeding the call.

“The recent acquisition of CareMount Medical by Optum has also left many patients seeking treatment at the (Northern Westchester Hospital) ER rather than waiting to see their primary care physicians, many times for non-emergent health issues,” Abzun said at the Dec. 19 Board of Trustees’ meeting. Her comments were part of a broader update on the emergency room issue following a Dec. 7 Zoom meeting she participated in between Northern Westchester Hospital/Northwell officials and an array of community leaders.

It’s infuriating to realize the fixable problems at Optum (chronicled in our prior coverage) now contribute to potentially clogging an already taxed local emergency room. 

It was Northern Westchester Hospital/Northwell reps, at the meeting with community leaders, who cited the emergency room concerns, Abzun explained.

She noted how the initiative to hold the wide-ranging meeting came from Northern Westchester Hospital/Northwell, and also said how no similar session has been suggested by Optum. Asked if a meeting with Optum might be in order, to review various community pain points, she said such a conversation with the company “would be lovely.”

In a phone interview last Friday afternoon, the deputy mayor also pointed to her connection to the larger issue as a patient herself. After CareMount became Optum, she received a letter from her two doctors explaining how they’d now only be available twice per week.

“Presumably it was five days before,” Abzun said. “I’ve seen the issue personally.”

(It’s also important to emphasize how various problems with scheduling and billing and other patient complaints significantly predate Optum; a chorus of especially embittered, widespread —  justified — grumbling about Mount Kisco Medical Group, and then CareMount, had already been growing for well over a dozen years).

Puzzle Piece 

Meanwhile, Northern Westchester Hospital declined my request to comment on the Optum piece of the puzzle but did offer a substantive statement about the troubling local ER issue, citing factors also mentioned by Abzun when she described the problems at the Village Board meeting.

“The Northern Westchester Hospital emergency department has been experiencing a recent surge in patient volume primarily driven by viral respiratory illnesses such as influenza, COVID-19, and RSV,” Dr. Jim Dwyer, chair of emergency medicine at Northern Westchester Hospital, remarked in a prepared statement supplied by a hospital public relations representative. “Outpatient care providers such as pediatricians, internal medicine physicians and Urgent Care Centers are also experiencing high patient volumes due to these viral illnesses. Although wait times for non-critical patients seeking care in the emergency department have increased at certain high volume times of the afternoon and evening, we have the capacity to handle this surge.”

And while no one is suggesting the Optum issues are a primary factor, or even secondary, the domino effect of how the scheduling issues would contribute to the wider ER surge are plainly obvious and simple to imagine.

• Patient develops non-emergency health issue.
• Patient contacts Optum.
• Patient can’t get appointment.
• Patient gets frustrated.
• Patient goes to emergency room.

While that patient “should” use urgent care instead, the bottom line is that not everyone does, and not everyone will.

And some worry urgent care facilities could also become overrun. (Optum operates the urgent care in Mt. Kisco, at 360 North Bedford Rd., along the Mt. Kisco/Bedford Hills line.)

The deputy mayor asked Northwell officials at the Zoom meeting earlier this month if they might open their own additional urgent care in Mount Kisco to address the broader issues, with the nearest Northwell urgent care location in Yorktown Heights; Abzun said she was told by Northwell there are no current plans to do so.

This is purely anecdotal but an Examiner reporter went to the Mt. Kisco Optum urgent care late last Friday and it was absolutely packed. One woman said she arrived at 2 p.m. that afternoon and was told she’d receive a call as soon as there was an opening. That call didn’t come till about three hours later, at about 5 p.m.

(My own occasional experiences at the Mt. Kisco urgent care have always been exceptionally positive, and it’s been a terrific resource for my family when needed. But I do wonder if the convenience it delivers could be neutralized if more people are pushed to use it and providers decline to add staff and/or locations.)

Lawmakers Loom

There’s also momentum brewing for local legislators to weigh in.

I was in touch with Assemblyman Chris Burdick (D-Bedford), and he hopes to have more detailed information to share come January, and can go into depth in an interview. But he said he’s currently “digging into” the issue while also mentioning how he needs to determine “the action which under present law and regulation the state can take.”

“There is a barrage of complaints about Optum,” Burdick told me in an e-mail exchange last Friday. “Physicians leaving the practice. Incredible frustration and endless delays getting appointments. It’s as though they’ve fallen off the cliff. I am extremely concerned about it, am delving into it and will be taking the appropriate action.”

A local legislator directing serious attention on the issue is no small development.

Silent Treatment

Let’s also examine Optum’s refusal to grant an interview.

As noted in the original column, Optum would only provide a canned e-mail quote.

After the piece published, and Optum was flooded with new complaints, I remained hopeful company leaders would take the opportunity to communicate with patients through a follow-up article by one of our news reporters. But after reaching out yet again, multiple times in recent weeks, all we’ve heard back this time is the sound of crickets.

“Patients will be able to choose from more clinicians and specialists across the tri-state region, as well as access a new, robust website that provides easy-to-search tools to help quickly find our clinicians and locations, schedule appointments online, conduct virtual visits, message their doctor, pay bills and access medical records,” stated a portion of the non-sequitur corporate communications gobbledygook provided on Sept. 8 to Examiner freelance reporter Sherrie Dulworth, submitted by Julie Robinson-Tingue, a public relations senior director.

The quote was attributed to Optum Tri-State Region CEO Dr. Scott Hayworth – the head of CareMount before CareMount joined Optum last year – and President Kevin Conroy.

“Our goal is to deliver the right care, at the right time and in a way that results in the best outcome for our patients,” the statement from Hayworth and Conroy concluded.

Well, that clears things up.

Getting ghosted by irritated or disinterested sources is commonplace for local news outlets, and not typically worthy of prominent public airing. But a corporate decision to be essentially silent amidst a torrent of desperate patient complaints speaks to what seems to be the remarkable arrogance of a company flirting with a potential future monopoly, at least figuratively speaking.

Don’t forget, Optum is a subsidiary of the multinational behemoth UnitedHealth Group, which is one of the most revenue-rich enterprises on the planet. The organization is both a healthcare provider and an insurance company.

I don’t pretend to be an expert on antitrust issues. But, speaking of a monopoly, it sure sounds to me like United almost owns the medical industry equivalent of Boardwalk and Park Place.

Speaking of which, the U.S. Justice Department seems to generally hold that same big picture assessment, as it’s appealing a judge’s decision to permit United, one of the country’s largest health insurers, to acquire Change Healthcare, a firm that connects payers, providers and patients. (A fascinating related ProPublica article describes Change as “the pipes that carry insurance claims between health care providers and insurers.”)

New York State of Mind  

Pushback begins right here in New York, as state Attorney General Leticia James in February filed the aforementioned antitrust lawsuit with the Justice Department and the state of Minnesota to stop the proposed acquisition of Change Healthcare by United.

“We are suing United to stop its attempted acquisition of Change to ensure that New Yorkers benefit from competitive healthcare markets,” James stated in a Feb. 24 press release. “I will continue to fight to ensure New Yorkers have access to affordable, quality healthcare.”

The lawsuit claims the acquisition would give United, as described in the press release, “an unparalleled competitive advantage – allowing it to use Change’s enormous repository of claims data to raise costs for its competitors, hobble their ability to compete with United, and deny them access to innovations.”

I called and e-mailed James’ office, asking what thoughts the attorney general might have on whether the problems described by patients could be seen as evidence of real-world fallout from broader antitrust issues.

“We have no comment at the moment on this matter,” the attorney general’s deputy press secretary, Halimah Elmariah, stated in an e-mail reply.

Patient Pushback

All the elected official reaction aside, the bottom line is how the issues impact everyday people. While most local patients feel powerless to Optum’s offenses, Stephanie Porteus, who just happens to also be an attorney, is taking action. 

She believes the toxic cocktail of infrastructure problems and staffing issues at Optum combine to create a negligent organization, in the legal sense of the word.

“When I say negligent, I truly believe that the delay in both care, follow up and production of medical records necessary for specialist review and/or another practitioner, is going to cost a patient, or many patients, dearly,” she said.

Porteus, of The Porteus Law Firm in Yorktown, stressed how she’s complained to Optum “numerous times with zero results,” and couldn’t previously obtain radiology records or reports despite repeated e-mails, calls and texts about a “fairly urgent” medical concern. An in-person visit to Optum on Dec. 15 to secure her records finally did the trick.

Porteus told me several maddening stories of waits and aggravation, but the story that struck me most involved her recent departure from Optum.

The positive experience she described with her new provider helps illustrate how the problems at Optum shouldn’t be viewed as the inevitable, acceptable manifestation of a complex healthcare system.

After the laborious process of obtaining her records from Optum, she called another medical practice with “live human beings answering phones, uploading records, making appointments.”

“I was seen within 48 hours of my call and now have a specialist appointment as well as a follow-up radiological study,” she recounted. “Imagine that? A practice not focused on money, but on patients.”

Persistence Pays Off

However, escaping Optum wasn’t easy, and wouldn’t necessarily have happened if not for Porteus’s know-how and persistence.

“Had I not filled out a release, begged and pleaded and ultimately threatened the poor folks at medical records, I am sure I would still be waiting for them,” Porteus observed. “And, not everyone has the contacts I had or the insight or time or courage to not accept this type of mistreatment and/or negligence. Unfortunately, I believe that many folks will just accept it. But, at what cost?”

Porteus did contact the Board of Health about her concerns with Optum but was told only complaints about medical misconduct would be entertained. She filed a complaint anyway. But she’s not done.

“I fully intend on pushing this matter,” she said.

And here’s the thing: We already know from firsthand accounts that many of the elite doctors and staff at Optum are just as frustrated as patients like Porteus. That’s the story we’re most eager to tell next.

As I noted in my last column, if you’re a current or former employee, please be in touch. We want to share that pivotal part of this local healthcare story in rich detail.

E-mail me at astone@theexaminernews.com.