Beware of At-Home Insurance Company Visits to Patients

 Recently, one of my patients made an appointment to ask a simple question: Should I get this test recommended to diagnose blood clots? I was confused. I asked him who recommended testing. He reported that he was seen in an urgent care clinic the week before and had blood testing done, including a test for D-dimer, which was elevated. He was advised to see his physician to order a ventilation-perfusion scan.

Douglas S. Paauw, MD

I asked him if he had been having any leg pain or swelling, shortness of breath, or any symptoms that might suggest a deep vein thrombosis or pulmonary embolus. He reassured me that he felt absolutely fine. He does have a recent diagnosis of acute renal failure, which was a good explanation for his elevated D-dimer, as almost all patients with kidney disease have elevated D-dimer values. So this test is not particularly helpful in patients with kidney disease. Why he got that test in the first place, or even ended up at an urgent care center, was a mystery. 

He told me that he had been contacted by his insurance company for a home visit to discuss and evaluate his health. Over the years I have been baffled by why insurance companies would do this, as the reports sent to me have seemed to be next to worthless. They usually recommend giving pneumococcal vaccine, which had already been given, and to do colorectal cancer screening, which was up to date. I never understood why patients receiving regular primary care would need a home visit to assess their primary care when the company had all the claims information and had a complete database on each patient. 

My patient told me that the nurse practitioner who came out to see him had done a test of his legs and told him he had severe peripheral vascular disease (PVD) and he should seek care for this immediately, thus the visit to the urgent care clinic. Why he received a D-dimer test in response to the information from the patient that he was diagnosed with severe PVD made no sense. He had no risk factors for PVD, no symptoms whatsoever, and a brief physical exam confirmed that he did not have significant PVD, as he had outstanding peripheral pulses. This patient had no risk factors for peripheral vascular disease, and screening for PVD is not recommended by the USPSTF.

So why did this happen? Insurance companies can be paid more for Medicare Advantage patients if they can find more diseases to code to increase complexity. Diagnosing peripheral arterial disease is a goldmine for insurance companies. Per a Wall Street Journal report, the companies use a device called QuantaFlo, which is not indicated as a stand-alone test for diagnosis of a condition that the USPSTF does not recommend screening for. Nurses diagnosed the condition after 568,000 home visits to UnitedHealth patients in the period analyzed by The Wall Street Journal, adding up to nearly $1.4 billion in additional payments. The same report showed that UnitedHealth made $2735 in extra revenue for each nurse home visit. 

Why is this important? Adding diagnoses that are not clinically relevant, and frequently incorrect, is costly to the Medicare program. In addition, we as healthcare providers have to sort out and counsel patients on information obtained that is low yield and frequently scares our patients inappropriately. I have frequently had patients ask questions about poor advice they have received at these home visits. The healthcare professionals that make the visits have incomplete information, spend less than an hour with the patients, and then may advise them that they should be on medications or have tests that we have already done or tried, or may be contraindicated. Our time with our patients is precious and should not be wasted on this.

Pearl of the Month: Be wary of at-home testing by health insurance companies.

Douglas S. Paauw MD is professor of medicine in the Division of General Internal Medicine at the University of Washington, Seattle

https://www.medscape.com/viewarticle/beware-home-insurance-company-visits-patients-2025a10002aj