A Modest Proposal for Next Week's House Hearings
Why not give Stephen Hemsley a health risk assessment...?
Yesterday, Sen. Grassley’s staff released a very comprehensive report regarding UnitedHealth’s efforts actions regarding Medicare Advantage—or, as the Senator’s office put it, how UHG “puts the risk in Medicare Advantage risk adjustment.” The study, compiled after reviewing a reported 50,000 pages of documents, goes into exhaustive detail about how UnitedHealth goes out of its way to generate diagnosis codes for its patients—because those codes translate into additional payments to UHG.
Reading the report last night amazed me over the mini-empire that UnitedHealth, and to a lesser extent its competitors, have created around risk adjustment. I’ve heard about wacky ICD-10 codes (e.g., “Sucked into a jet engine, subsequent encounter”) in the past, but the Grassley report revealed a veritable army of people engaging in home visits (i.e., health risk assessments), coding software, chart reviews, and other procedural machinations to generate every last diagnosis code possible. And, by and large, this empire isn’t designed to make patients healthier—but to make UHG richer.
My second thought turned to the hearings that the House Energy and Commerce and Ways and Means Committees will be hosting with insurance company executives, including UnitedHealth CEO Stephen Hemsley, next Thursday. If UHG thinks its “digging for diagnoses” strategy is so appropriate, and only uncovers legitimately undiagnosed and life-threatening conditions, then why shouldn’t Congress subject Hemsley himself to a real-time—and public—“health risk assessment” using UHG’s own software?
One wonders if such a public assessment wouldn’t turn an otherwise-outwardly-healthy 73-year-old Hemsley into an enfeebled individual suffering from rickets, beri-beri, bonus eruptus, or any other manner of otherwise undiscovered ailments that haven’t kept Hemsley from running UHG, but would prove lucrative for his company. That might make the point about the ways in which big companies are raising health care costs more than any line of questioning ever would…