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Do you want a house call—from your insurance plan?

Medicare Advantage plans are offering home visits to healthy people who have their own doctors. Their purpose isn’t clear.

For many of the 17 million people insured by a Medicare Advantage plan, the offer of a home visit may come as a surprise. (Medicare Advantage plans, which cover about a third of Medicare recipients, are offered by private companies approved by Medicare, and Medicare reimburses those companies for part of the care they pay for.) According to the Centers for Medicare & Medicaid Services, home visits are on the increase among people with these plans, and not just among the sick or housebound. Patients who are healthy and mobile are also being offered home visits, and millions have undergone them.

What are home visits?

The home visit—which typically lasts 45 minutes to one hour and includes a physical exam, health history, and lab tests—is conducted by a nurse practitioner or physician under contract to the insurance plan. The results are forwarded to the person’s primary care provider for follow-up. The insurers stress that the home visits are not a substitute for an annual physical or recommended screening tests.

Why are these visits offered?

Dr. Michael McWilliams suggests an answer. As an associate professor of health policy at Harvard Medical School, he understands the regulations that cover how Medicare reimburses Medicare Advantage plans for the care they cover. He explains that each person covered by these plans is assigned a risk score. As a person develops more health problems, his or her risk score increases. Dr. McWilliams 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. So if the clinician sent by the insurance company makes a diagnosis that increases a person’s risk score, the company will get a larger reimbursement from Medicare every time that person gets medical care. “The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts payments from Medicare to the health plan. Generally speaking, the more diagnoses recorded, the higher the payment,” Dr. McWilliams says.

Do these visits help?

According to a report from the RAND Corporation published in the December 2015 issue of Health Affairs, the extra exam was linked to reduced hospitalizations, primarily in patients with serious chronic conditions like diabetes, heart failure, or chronic obstructive pulmonary disease. Whether they improve health outcomes in lower-risk seniors remains to be seen.

What to consider if you’re offered a home visit

If you are offered a home visit from a Medicare Advantage plan, you may want to check with your primary care physician before making an appointment for a house call. You may also want to keep the following in mind:

  • It might help you avoid a hospital stay. However, this benefit is greatest for people with serious chronic illnesses.

  • The care 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. It’s completely optional.

Posted by: Dr.Health

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