While many of us are likely suffering mental whiplash or migraines as political battles devolve into mind-numbing inanity, improving health care is taking a beating from greed and deceit in the health insurance industry. For the second time in as many years, my Medicare Advantage insurer has contracted with a third party to offer a “free” home health assessment. I’m waiting for the high-pressure phone call to follow written notification.
The last time this happened, my insurer contracted a firm specializing in “risk adjustment” as a way to close a supposed care gap and improve my health. After receiving a letter implying the service was optional, I politely declined when called. I explained that I have had good care from my doctor of more than 40 years and did not wish to share any of my health history with additional parties. (I did not confess apprehension about inviting a stranger into my home or being asked to disrobe or open my cabinets, closets or refrigerator for examination. Ethics did not seem to be important to the caller.)
“No, thanks” had little impact.
The firm called again the next morning asking my husband if they could confirm an appointment to see me at 5 p.m. the next day despite my objections. He also politely informed them that my decision was to decline. When my husband contacted his former employer’s human resources department to report our experience with one of these firms, he was told they were aware of the initiative, but thought it was for shut-ins. Really?
Increasingly suspicious, I decided to investigate. Like many other companies offering Medicare Advantage plans, my insurer is worried about reduced revenues from Medicare, a concern noted in a newsletter for the insurer’s own retirees. This is a legitimate concern, of course. How can they make up for lost revenue? One option is to require group plan enrollees or individuals to pay higher premiums, co-payments or deductibles. Another is to draw more compensation from the Centers for Medicare and Medicaid Services by submitting documentation for more treatments or services.
The health care consulting industry has come to the rescue by providing risk adjustment services. These firms are part of a growing, largely unregulated corporate sector that has identified a lucrative niche market. Anyone who thinks health insurance and health care consulting companies are all about improving health should take a closer look. The motive is profit.
Risk adjustment is a euphemism for the process of ensuring there are sufficient diagnoses requiring more care and compensation, whether needed or not. If possible, insurers attempt to convince doctors to increase the coding levels following a visit or treatment. How better to do this than to send out a phalanx of itinerant medical professionals on home visits to collect “data” to influence a primary care provider’s analysis and recommendations?
While this approach is apparently legal, few are questioning the ethics. Aside from the affront to primary care providers and overpayment by Medicare to insurers, what about doctor-patient confidentiality?
And what about the privacy and security concerns patients should have? While many of us are guilty of not reading the fine print in privacy policies, in nearly every case we are told how, when and why our personal information will be collected and used. We assume we are told the truth. During last year’s experience, I was told when information would be collected and how it would be reported to my primary care provider. Missing elements included:
— Identification of who would come to my home, including credentials and how to verify legitimacy.
— How to protect my personal privacy and home safety.
— How information would be gathered, secured, transferred and corrected.
— Sources of information to begin the process, including communications with my insurer and primary care provider.
The motivation behind these latest maneuvers is disturbing. There must be a better way to close the gap, whether in revenue or care, without sacrificing privacy and individual rights — or the confidence we have placed in our primary care providers. I’m ready for another call.
Judy Hanscom of Holden is a retired university instructor of personal finance and family resource management. Her views are her own.