Medicare Advantage house calls: Necessary care or cash machine?

In-home health assessments of Medicare Advantage customers generate billions of dollars in payments to insurers, but the value of these services is in dispute. Payers say visits improve elder care, while critics say house calls are a vehicle for abusive billing, according to the Center for Public Integrity.

"Who wouldn't want a physician to sit across from them for an hour asking what is ailing them free of charge?" Sy Zahedi, CEO of the home assessment company MedXm, said to the CPI.

But federal officials say there's little evidence that home visits do much besides raise costs. The Centers for Medicare & Medicaid Services proposed regulations to control these services. But the proposal was denounced by America's Health Insurance Plans and didn't become final policy, the article noted.

"As Medicare Advantage enrollment grows, the [health insurance] industry is amassing political clout in Congress that is muting criticism [that] the health plans overcharge the government by billions of dollars every year," the CPI wrote. In-home care is part of a growing data analysis industry that's helping Medicare Advantage organizations optimize revenues as federal officials work to curb costs, the article noted.

The CPI found a correlative relationship at one plan between rising beneficiary risk scores and home visit utilization. Risk scores jumped 20 percent in four years as the plan's house calls program grew.  

Still, payers insist that raising revenues isn't the main purpose of home assessments. Visits identify undiagnosed conditions, insurers say, or expand continuum of care options for customers with complex, chronic care needs. House calls may also remedy home health dangers such as loose rugs that may cause falls or medicine cabinets stocked with expired or incompatible drugs. 

After implementing a program where pharmacists made post-hospitalization home visits to beneficiaries, one payer saw its Medicare Advantage readmission rate drop from 14 percent of patients readmitted within 30 days of discharge to 8 percent within six months, as FierceHealthPayer reported.       

But Reid Blackwelder, M.D., president of the American Academy of Family Physicians, told the CPI that house calls often aren't well coordinated with doctors and haven't helped much with care of his patients.

For more:
- read the CPI article

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