Does anyone know anything about plans for RIF in HouseCalls department? It’s nerve wracking to see all these layoffs.
15 replies (most recent on top)
@jh this is what happened in Texas, patients got letters before the layoff notices. I’m sure you will be notified soon…
@k5 I think the person's point is that house calls don't have the revenue boost potential of in-office visits powered by Optum Real with Ambient Upcoding. Pushing more MA patients to office gets them to spill the beans so we can bill the government more.
So risk adjusted diagnoses are what makes the entire medical world go around. Dr's office, hospitals---they ALL comb the coding to make sure everything is risk adjusted to the hilt.
@k4 RNs absolutely cannot diagnose. So you’re wrong there.
@jk All of the members in both counties are cancelled. And there are no other MA options here. Many members cannot afford the supplements or they have to travel to see a PCP. The NH market is struggling
@k4 Not quite the case. UHC receives capitated payments from CMS. A fixed monthly amount per enrolled member, adjusted by risk. CMS pays Medicare Advantage plans based on the predicted cost of care for each member. Every member has a risk score, calculated using ICD-10 diagnosis codes tied to Hierarchical Condition Categories (HCCs). The provider performing the HouseCall is not billing CMS directly. CMS recognizes diagnoses only from “eligible provider types” (MD, DO, NP, PA, or clinical nurse specialist) who can independently establish and code diagnoses; hence, RNs are not able to perform HRAs.
I can see scaling down, but unlikely to be eliminated as it is integral to Medicare Advantage business.
@jh well, when CMS finally does not allow diagnosis/ coding from these visits do you really think United will continue them? HRAs can be done over the phone by a RN
@jh
Whatever the case is, only time will tell. Don’t jump the ship yet to miss on severance or other benefits. Keep your resume and other certs UTD. NP here as well from PA. Can’t put my finger on it, but don’t have a good feeling about the prospects.
@hv I think you’re confusing population risk adjustment with an in office/encounter coding. I do agree however that with AI integration, home visits can be scaled down to a minimum it not eliminated altogether.
@jh yeah that's a super tough call. Wait and get the severence (maybe?) or start looking. How many of your members are reporting their plans are being cancelled?
Nurse practitioner working for HouseCalls covering two rural NH counties. Both counties have had MA discontinued with members getting letters of coverage ending.
Manager states they know nothing regarding layoff. If there are no members in my assigned counties do I have a job? I know they want us to do as many visits as we can until the end of the year. Anyone hear anything? I don’t want to jump ship in the event I get some severance or an offer to relocate. Thoughts!
Interesting. So far risk adjusted coding is not going away for 2026.
Uber and Lyft have been available on the Optum app since about 2023.
You're cooked. House calls juice diagnoses to bill government for more intensity/conditions to add margin. ONLY reason it exists. We do nothing to "help people be more healthy" if that were the case we'd become a public benefit corporation or petition the government to nationalize and give the company away. We don't do anything that doesn't maximize profit first and foremost - that is the goal of the housecall program to pick up encounters that we would have missed AND to increase billing.
Optum Real and AI listening means we need granny in an office. We no longer need granny housecalls if we can drag her in for upcoding via AI scribe.
We're adding Uber/Lyft integration in the Optum App so patients can get a ride to the provider. Rather than pay nurses to do housecalls, we pay for the rideshare (cheaper than a nurse) bill for more (visit in office vs housecall) and use Optum Real AI (cutting out nurse nagging).
Housecalls are not part of the future.
Makes sense. Thank you!
Have heard nothing YET but here are my thoughts:
- keep your soft metrics up to date on your practitioner portal; emails read, collab doc notes reviewed, hours up to date. Providers laid off in the past were ranked before the layoff and soft metrics counted apparently.
- areas where contracts are lost OR where they are cutting back in the market for next year historically have had layoffs. I read the article about losing hundreds of thousands in the MN/ Minnetonka area with interest. Seems so weird to drop so many Advantage customers in your home turf. But I would be concerned if I worked in that area.