Medicare Advantage: The doctor would like to visit.
by Denise Early on May. 11, 2012, under HealthI have been contacted by several clients who received phone calls from their Medicare Advantage plan saying the plan would like to send a doctor to their home to give them a physical exam. My clients called me to ask if this was legitimate. Or was it a scam?
Mindy called to say her Advantage plan is “bugging” her about letting their doctor come to her house. “My plan is really pissing me off about this”, she told me. She said they call her once a month to ask the same question, and each time she gives them the same answer: “No thanks”.
Mindy said a friend of hers, who is 90 years old, agreed to a visit by her Advantage plan’s doctor. The visit went just fine. The doctor was accompanied by a nurse, and they took her blood pressure and asked lots of questions. Then they checked this lady’s home to see if there were rugs or other items that might put her at risk of tripping and falling.
Soon after the visit, this lady’s Advantage plan gave her a list of tests they think she should get. The lady took the list to her primary care doctor who poo-pooed it and said the Advantage plan should butt out of this lady’s business. I guess doctors don’t like insurance companies getting in between them and their patients, even if the insurance company is trying to be of help.
It’s about money.
The reason Medicare Advantage (MA) plans are sending doctors and nurses to people’s homes has to do with getting more money from Medicare. Medicare pays Arizona Advantage plans around $800 per month for each person enrolled with them. However, MA plans get more money for sicker members. This is called “risk adjustment”, and it is very important since MA plans are now being paid a lower base rate than they were a few years ago. MA plans can get more money up front if they are able to identify members with serious health issues like diabetes and heart conditions, and this is the reason for the house calls.
It’s about stars.
The house calls are also about the Medicare star rating system. The ratings go from one to five stars and are based on more than 30 criteria such as: surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get preventive screening tests and flu shots.
Most of the Medicare Advantage plans in Arizona get 3 to 3.5 stars, meaning they are average. The more stars a plan gets, the more bonus money it receives from Medicare. One plan in Tucson got four stars this year. In Phoenix, Cigna gets 4.5 stars. The plans have until 2014 to get to 4 stars and keep getting bonus money from Medicare.
Is it political?
Some people are calling the star rating bonus program “Obama’s Medicare slush fund“, and I wrote about it recently.
Over 45% of Medicare beneficiaries in Tucson, Phoenix, and Pinal County are enrolled in Medicare Advantage plans. But they are not accustomed to their plan reaching out to them and asking to come over for a visit. This outreach is confusing for some. It is a bit scary for others. And in Mindy’s case, she is pissed off by her plan. I’m sure there are many people who think the doctor visits are a good idea. I just haven’t heard from them.
