There are more articles about UHG making huge profits in comparison to other insurers with their in home visits for medicare advantage patients. Its really shocking how much more. I was not in a position to be asked to find (they used another vague word/phrase I can’t recall) missed or old diagnoses. But I do remember market leaders pushing for this. That and , quite frankly, the harassment to get patients to sign up. NCMs and LMPs would periodically make comments about these pushy tactics. Have LM clinicians been contributing to over diagnosing patients? Have we been a part of this and DIDNT know? We’re talking over a billion in profits. WAY more than all other medicare advantage plans combined.
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Of course.
So now that they can’t rip off medicare AS much they’re dumping us? If we can’t be an accessory to sticking it to Medicare they’re kicking us off the train?
The Wallstreet Journal on 8/4/24 was the latest.
Where are these articles?
That’s the principle reason Housecallls exists they don’t even treat the members.
Other programs heavily focused on documentation to improve RAF; landmark, ISNP, IESNP, housecalls, optum at home !
I think LM was made for the purpose of keeping hospital readmittance low, but when Optum sees us they see dollar signs via data capturing for higher reimbursement, their AI can’t do that for them because it su-ks. Now that the reimbursement is decreasing, they don’t need LM anymore.
In charting, the DAT alone is problematic because it asks about diagnoses that are extreme or out of left field entirely compared to what the patient has. We don’t even need a DAT, we read records, but it’s how AI suggests to us a path to higher reimbursement. It’s dirty business.
Yes, yes and yes. Pushing for additional diagnosis!! And we didn’t know. It’s horrible.