Health Care

 I am new to all this medicare stuff, but here is something that I don't understand. I received a call from my supplementary insurance. They wanted to send someone out to my house to assess my health situation. 

"Why?" I asked. 

"Because they want to make sure that all my health needs are being addressed," I was told.

Now...wouldn't that be between me and my doctor? HIPPA and all of that? Why would I want to discuss things like that with a stranger coming to my home? So I asked that.

I was assured that they would share all this important information with my doctor. 

I said, "I guess I still don't understand why I need a third party to assess me when I have a doctor to assess me..." 

They said, "Well, we can do this via zoom, if you'd rather." 

I said, "I'm not comfortable with any of this. I don't understand the point." I turned them down, and I don't think they knew what to make of it. 

I've been pondering this ever since the call, and what I've come up with is this: They are matching my health information up with other agencies, i.e., if a person is diabetic, they can sell that information to agencies selling diabetic supplies. Or if a person has mobility issues, they can sell that information to businesses who are marketing medical equipment. 

I will bet that businesses would pay a lot of money for targeted business opportunities. 

Dunno.

Anyone else heard of this? 

LATE EDIT: Wendy led me off on a very interesting bit of reading. I cannot access the Wall Street Journal, but one of the days that Tim goes hunting this week, I'm going to scoot over to the library and read it there. But this article explains that article:

https://www.risehealth.org/insights-articles/latest-wsj-investigation-finds-ma-insurers-collected-15b-from-nurse-home-visits/

It reads as follows:

When I was growing up, my doctor still made house calls when we were too sick to get to his office. But he stopped visiting people at home long before he retired. Both he and his patients realized they were perhaps better served by going to his clean, well-equipped office for whatever care they needed.

So I was more than a little surprised when a woman representing my health insurance plan called to schedule me for a home visit from either a nurse practitioner or physician. I have a Medicare Advantage plan, and I thought I was being offered this visit because the caller assumed I was frail and house-bound. I assured her I could easily get to my doctor's office if I needed to. I'd also just had my annual physical, my immunizations and screenings were up to date, and I felt great. Why would I need a home visit?

The only reason she could give was that the clinician would have more time to spend with me than my own doctor did. The home visit would last 45 minutes to an hour and would include a health history, a physical exam, screenings, and health advice. Since I work full-time, I could schedule the visit for a weekend. And she'd even throw in a $25 Walmart gift card if I completed the exam.

I declined, feeling a little creeped out — especially after checking with my doctor and learning that she knew nothing about this. So I did a little research.

I learned that these visits are legitimate — in fact, over a million patients have signed up for them so far. And I learned that the extra exam had reduced hospitalizations, primarily for patients with diabetes, heart failure, or chronic obstructive pulmonary disease. But what still puzzled me was why my insurer would want to incur the extra expense of duplicating the exam and tests I had just gotten from my doctor. I don't have any serious conditions and my doctor consistently receives top grades from all the ratings systems.

Dr. Michael McWilliams suggested an answer. As an associate professor of health policy at Harvard Medical School, he understands the arcane regulations that cover how Medicare reimburses my Medicare Advantage plan for the care I get. He told me that each of us covered by these plans is assigned a risk score. As we develop more health problems, our risk score increases. "The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare.  Generally speaking, the more diagnoses recorded, the higher the payment," Dr. Williams says.

He explains that the risk adjustment system was created to ensure that plans don't enroll only the healthiest patients, who are less likely to run up charges for expensive procedures and hospital stays. To provide an incentive for insurers to cover sicker patients, the plans are paid commensurately more for their care.

I've received two more calls since I first declined the home visit, each more persistent than the last. Now I understand why. If the clinician could diagnose me with a serious health condition, the company could raise my risk score and get a higher Medicare reimbursement each time I visit the doctor.

If you or someone you know is offered a home visit from a Medicare Advantage plan, keep the following in mind:

• If you have a serious health condition, the extra care might help you avoid a hospital stay.
• The care they provide isn't ongoing. This is the only time you will see the clinician who examines you. The results of the exam and tests will be forwarded to your regular clinician for follow-up.
• If you are healthy and the visit results in an increased risk score, you won't have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation's rising health care costs.
• You are not obligated to have a home visit — they're completely optional.