You okay with this? I’m not! Health care costs have zoomed into the stratosphere. And what the government pays for Medicare and Medicaid ultimately comes from the pockets of us taxpayers. As I have argued here before (click here to see), increasing government involvement surely has been a major factor in the incredulous increase in health care spending.  For example, in 1975, health care spending was $550 per person compared with more than $11,000 per person in 2017. Yep, you calculated correctly, health spending increased by more than 2,000% over 42 years. Can you think of anything else that has gone up that fast? As I mentioned in the reference above, a profit-generating machine has taken over healthcare. Today I’ll focus on one part of that money grubbing machine.

Nurse Visits Made Insurers $15 Billion

Above is the headline of a front page article in today’s Wall Street Journal.  The article reveals how Medicare Advantage insurers employ nurses to visit their insured patients, and perhaps to collect extra government cash. Here’s how it works. The insurers send nurses millions of times each year into the homes of Medicare Advantage recipients, not to treat them, but to look them over, run tests, and ask dozens of questions. During this roughly hour visit, nurses also can add diagnoses to the patients’ records. From these new diagnoses, insurance companies collected an extra $1,818 per visit (on average from 2019 to 2021). (The more diagnoses a patient has, the more money the Medicare Advantage insurer collects from the government.)

Ironically, the Medicare Advantage system was thought to be a lower-cost alternative to traditional Medicare. For a government perspective on its insurance plans, click here. In this system, private insurers are paid a lump sum to provide health benefits for the seniors and disabled people in this federal program. This program now covers more than half of the 67 million seniors and disabled people on Medicare. But things haven’t gotten cheaper. They have zoomed upward. You okay with this? I’m not!

As to be expected, adding nearly two grand per visit (had having lots and lots of visits) generates real money. According to a WSJ analysis, the added diagnoses during those nurses visits contributed about $15 billion to the insurance companies over the three years examined.

How are those diagnoses by nurses made? Here’s one example from the article. Nurse practitioner Shelley Manke, who used to work for the HouseCalls unit of United-Health Group, was part of that small army making home visits. She made a half-dozen or so visits a day, she said in a recent interview.

“Part of the routine”

Part of her routine, she said, was to warm the big toes of her patients and use a portable testing device to measure how well blood was flowing to their extremities. The insurers were checking for cases of peripheral artery disease, a narrowing of blood vessels. Each new case entitled them to collect an extra $2,500 or so a year at that time.

But Manke didn’t trust the device. She had tried it on herself and had gotten an array of results. When she and other nurses raised concerns with managers, she said, they were told the company believed that data supported the tests and that they needed to keep using the device.

“It made me cringe,” said Manke, who stopped working for HouseCalls in 2022. “I didn’t think the diagnosis should come from us, period, because I didn’t feel we had an adequate test.”

Other nurses interviewed by the Journal said many of the diagnoses that home-visit companies encouraged them to make wouldn’t otherwise have occurred to them, and in many cases were unwarranted.

A growth industry

As you might imagine from the above numbers, the home-visit conglomerate is expanding. United-Health’s subsidiary, HouseCalls, sent nurse practitioners to the homes of more than 2.7 million people last year. This was nearly matched by CVS’s Signify, which performed about 2.6 million home visits in 2023. But to make those visits, the insurance companies need to get Medicare Advantage recipients to agree to a visit, so call centers bombard those recipients with invitations for home visits, “In the case of Humana, auto-dialing them as many as ten times, according to former managers.”

As I was on my walk today, I spoke with an acquaintance in his front yard, telling him about the post I was planning to write. He told me he simply turns down all offers for a home visit from his Medicare Advantage insurer. Quite simply, he sees no reason for such visits.

The insurers, of course, have a reason. United-Health and CVS Health, owner of both Signify and Aetna, said the house calls help patients by, among other things, catching diseases early and making sure people are taking their medicine properly. The insurers said they relay home-visit findings to primary-care doctors.

A contrasting view

I think the program is a boondoggle. Remember that $15 billion mentioned above, the amount generated by home visit diagnoses in 2019 to 2021? Well, the costs actually were much more (see below). Why? Perhaps mainly because insurers can add diagnoses to ones that patients’ own doctors submit. Apparently this was incorporated so the insurers could catch conditions that doctors might have neglected to record. Is it possible that those insurers have discovered that adding diagnoses adds more income? (Don’t know why I thought of that.) Maybe one reason is the WSJ’s analysis. For example, it found many insurer-added diagnoses were for patients who received no treatment for that presumed disease, or one that contradicted their doctors’ views. Hmm! You okay with that? I’m not!

And the haul was much bigger. Insurers actually received nearly $50 billion in Medicare Advantage payments for those three years for the diagnoses they added to their insured members (and for conditions that no doctor or hospital treated). Many of the insurer-driven diagnoses were outright wrong or highly questionable, according to the WSJ. (The $15 billion from home visit diagnoses was included in the total $50 billion paid to insurers. It’s not clear to me who was responsible for the diagnoses that generated the extra $35 billion.) You okay with this? I’m not!

A lesson from this?

Perhaps this mess will aid you in your decisions as you go to the polls this November. If you believe that government funding and government control of much of the economy in these United States is salutary, I imagine you will find candidates who promise what you wish for. On the other hand, if you believe that we have become overly dependent on governmental handouts, not to mention restrictive laws galore, you likely will have difficulty finding candidates who fit your needs. After all, nearly all running for office these days are full of promises (and often much more).

As I’ve mentioned several times in this blog, I have been a Jack Kennedy Democrat since my university days. I think government had grown to be huge and unwieldy. Therefore, any candidate who offers reason and hope, and stands for a smaller government, will get my vote.

“Ask not what your country can do for you – ask what you can do for your country.”