Should you sign up for Connected Care at your doctor's office?

Investment Analysis Clubs Macro Economic Trends and Risks
1

I got a text from my doctor’s office last week asking that I sign up for their new Connected Care App.

So I signed up for it, and the people with “Connected Care” start peppering me with texts asking if I need anything? I tell them “No, everything seems to be in remission and the set of labs I had done earlier in the week are all within normal limits.” So they say "Great, can we send you a copy of your “Care Plan”?

I download the “Care Plan” and it has 4 or 5 diseases on it that I don’t have.

Then I google the Connected Care people – Phamily

With Phamily, 1 care manager can serve 500 patients (vs. 50-100 under traditional model) and can generate $16,700 in reimbursement per month.

Effectively manage thousands of patients with chronic conditions at the same time — with your staff — and get paid.

So Phamily is a Private Equity-funded scheme to turn patient contact into a billing opportunity without involving the doctor or the doctor’s office staff. {{ LOL }}

Tread carefully.

intercst

16 Likes
2

Chronic Care Management …I posed/mentioned the question on a couple boards a while back…

It’s a set of procedures codes that were designed to compensate promary care offices for the added, previously uncompensated, work that patients with multiple co morbidities generate. A good idea in theory, but…

I inadvertently found that we’d been added to this program about 3 or 4 years ago…in spite of neither of us having been diagnosed with enough co morbidities to qualify and certainly not the ones listed on our medical records. I called the practice and created such a fuss that the high BP and strokes that I’d allegedly had were removed.

I wrote about it quite extensively as, should an inaccurate detail be included, it tends to cling like a limpet and can come back to haunt, should medical underwriting require a check of those records.

When I did officially qualify after my belated discovery of ASCVD/significant coronary artery involvement (thanks to my own efforts, mainly) and that I finally belonged to the multiple co morbidity club, I did agree since Medicare reimbursement is unsustainably low for even a cursory annual wellness visit. My only reservation was that I was concerned that the check-ins were going to be primarily geared towards the multiple hoards whose conditions are due to various iterations of metabolic syndrome secondary to obesity. Apparently, there’s no capacity to customise the program so I find myself deleting the weekly nudge to check my weight and BP (do that anyway), glucose, and a whole set more values that are all normal and always have been. Kind of a constant reminder of the fact that my belatedly discovered was belatedly discovered because my Red Flags were being hidden by my healthy lifestyle smokescreen…and ignored even by those who should know better.

1 Like
3

I’m not on Medicare Advantage (MA). This Phamily deal seems to be an attempt to bring the $50 Billion worth of upcoding fraud we have in MA to the traditional Medicare space.

Also this wasn’t my Primary Care doctor, it was the Nephrologist who admitted that “we don’t usually see patients with your labs in this clinic” (i.e., I’m not sick enough to be seeing a kidney specialist – my eGFR is 92 – what you’d expect in a healthy 25-yr-old.)

free link:
https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d?st=wqivra&reflink=desktopwebshare_permalink

intercst

5 Likes
4

Well if it is upcoding without a genuine diagnosis to back it up, then it certainly is fraud. On the practical side, it’s irrelevant whether or not you personally have MA. Any practice with a significant number of MA beneficiaries…or even an employer provided plan that has a capitation element to it…and who are requiring more than the annual physical are likely to be experiencing a drain on their reimbursement level from that demographic.

Not too much of a problem if this demographic makes up a small percentage of a practice’s patient base and/or the rebursement level from traditional plans or Medicare is adequate to make up for that drain…like things were a couple of decades or more ago. Neither condition exists in many places these days, I’ll wager.

BTW, have you checked to see why these conditions found their way onto your medical record? The source is likely to be your primary care if that’s where the referral came from. That was my concern when I first found out about the chronic care management codes…whether or not that document resembled me with decent accuracy.

5

I had a back muscle ache. I went to a physical therapist. My record now says I have back problems. Hogwash.

Those simple “condition” lists do not matter.

If you get texts just ignore them. They are excessive programming by computer people.

6

On the contrary, inaccuracies on your medical record absolutely can matter. Depending on how incorrect and potentially serious those issues are, future impact isn’t an impossibility…either from the perspective of future (mis) diagnoses and also can affect premiums should an insurance application require anyvsort of check on your current health status. True or not, if it’s there on your medical record…it’s there on your medical record.

3 Likes
7

If I developed in this case a worse back problem I’d be in better stead with a bit more of a history of back problems. Insurance might see it as something more major sooner in their payout.

But if a doctor asks about my back the unofficial discussion just putzes around on the topic. It does not matter IN THIS CASE.

This goes on all the time. If a doctor touches you, then you have a regional condition.

Yes things are on the record that are nonsense.

I am not as pedantic as you are.

If something matters it matters. That is different.

8

Absolutely! There’s one Party in Congress that wants to bring back “pre-existing conditions” and let the for-profit health insurers run wild & free.

Back when I was on Kaiser, they somehow diagnosed me with cancer based on a benign parotid tumor I had removed 30 years ago. I immediately called them and said, "get that cancer stuff out of my medical record immediately. The pathologist’s report is in the medical record I gave you and says the tumor was benign.

I had a $5,000 deductible Obamacare plan at the time and they wanted to send me to a head & neck specialist and no doubt run a CT-scan which would probably have been $2,000 out-of pocket to me. I told them, “No way I’m doing that”.

It’s all about creating a billing opportunity in support of excessive Executive Compensation.

intercst

7 Likes
9

I sent an e-mail to the nephrologist asking why I had all those extra diseases on the Phamily “Care Plan”. She said she has no record of me being diagnosed with those extra diseases.

I then sent her a reply saying that these Phamily people seem to have access to my medical record. Perhaps your office is being scammed by them?

Then I got I call this morning from a medical assistant in the office. Apparently my doctor had forwarded the e-mail asking if Phamily was a scam. They had just recently added my doctor’s book of patients to the Phamily app, and I guess I was the first person who asked her a question about it and the doctor didn’t know that her patients had been added.

Anyway, the medical assistant said that there must have been some kind of error in transferring the data from one electronic medical record to another and those extra diagnostic codes got added. They’ll correct it.

intercst

3 Likes
10

Is there a Better Business Bureau reporting opportunity here or is this company immune to investigation somehow because it so large and (inter?)national?

Pete

1 Like
11

It’s very unlikely that your physician was unaware that the qualifying patients were being added to the phamily app…because the company’s product is purchased by the practice to help them utilise the appropriate CPT codes. There are a slew of these different companies marketing to practices if you look. They make their $$$bucks when practices purchase their product.

Like I explained to the poster in the thread I posted, these non contact procedure codes were introduced to compensate offices (especially primary care) for the financial burden imposed by the administration involved behind the scenes when a whole slew of patients have multiple co morbidities. Especially when the need for a specialist referral or repeat prescriptions is so commonplace that extra personnel need to be hired.

12

No. My doctor’s office is working with them. It’s just legal business as usual in America as far as health care is concerned.

intercst

1 Like
13

I could understand there being a procedure code to compensate the medical practice for making a specialist referral or refilling a prescription. I don’t see how adding diseases I haven’t been diagnosed with that no doctor has treated should be part of this. But as I wrote earlier in this thread, Medicare Advantage insurers have been doing it for years to the tune of $50 billion with no apparent consequences.

intercst

3 Likes
14

Well the requirements for an office to be able to bill and receive reimbursement for any of the chronic care management CPT codes are very explicit. Having more than one chronic, lasting disease is mandatory. So, you know why. Your choice is yours to decide how. I chose to accept an honest mistake in mine

1 Like
15

That has nothing to do with the doctors. Neither does the political stuff.

The doctors have to keep records. You might need treatment later from other caregivers.

If the aca was wiped out another law for preexisting would be passed.

16

Mine is not a mistake. Back ache became categorized as back problem. No harm.

17

I bet I know what’s happening. I have lupus nephritis (my immune system is trying to destroy my kidneys – and has been doing so since 1999) When they do the periodic labs on me, the tests show a ton of antibodies that are trying to attack my kidneys. I’ve being taking the drug CellCept which is the anti-rejection drug they give to kidney transplant patients so that they don’t reject the transplanted organ for almost 25 years. My (original, native-born) kidneys appear to have suffered no damage despite the onslaught from my immune system – my kidney function is actually what you’d expect in a 25-yr-old and I’m 68. I’m one of the lucky lupus nephritis patients for whom the CellCept has resulted in a long-term complete remission without any of the side effects and complications that cause many to discontinue the drug.

But I don’t have any of the “comorbidities” that are common in lupus patients – no diabetes, arthritis, heart problems, brain fog, etc. Just the lupus nephritis.

No comorbidities, no extra payments. I wonder if the Phamily program is pre-populating the chart with all these common comorbidities and then forcing the operator to delete the ones that don’t apply? You don’t want to miss anything that might generate revenue.

About 10 years ago when I got my Pilot’s license, I needed to get a “Special Issue” FAA Medical Certificate because of my health history. I hired this former Navy doctor and PC-3 anti-submarine warfare pilot who was an expert at working with the FAA to go through the super involved process of getting the medical certificate. When I told him I had lupus nephritis, the first thing he asked was “How many fingers have you had amputated?” I told him none, I’m actually very healthy. He said, “Everyone tells me they’re very healthy”. I said, “I understand that, but in my case it’s true” I sent him about 250 pages of medical records covering everything since age 21. And he e-mails back, “Holy Crap, I’ve never gotten this much detailed information from one person before. Let me review it for a while and get back to you.”

So over the next month, I get an occasional e-mail from the good doctor to clarify one thing or another in the medical file and finally he reports. "You are very healthy. I think the only thing we need is a medically unnecessary MRI of your head to prove that those 2 benign tumors that were removed 20+ years ago didn’t grow back. The MRI was clean and a couple of weeks later I flew to his office in Illinois for the exam and I got an email from him while I was waiting to change planes in Chicago on the way home saying that he’d talked to the FAA and I should have my Medical Certificate in 2 weeks.

The other surprising thing was he only charged me $150 for the month long review of the 250 page medical file. I was expecting to pay $4,000 to $5,000. The package he sent to the FAA included a 2 page cover letter and about 80 pages of supporting documentation out of the 250 I sent him to prove my case. It was a significant amount of work.

The Vanguard checkbook I had with me wouldn’t allow me to write a check for less than $250, so I gave him that. Then he took me out to lunch and drove me to the airport. I’ve never received service like that, before or since, from a medical professional.

intercst

6 Likes
18

It’s not the doctors. The Medicare Advantage insurers are looking for ways they can strip mine your medical chart and make the case for “mild anxiety” actually being full-blown schizophrenia. They’re getting Medicare to pay for diseases you don’t have that no doctor has ever treated you for. And it’s all legal.

intercst

3 Likes
19

Are you sure they don’t get some kind of commission on the extra medical billing revenue they generate? That’s where the big money would be if they’re successful. That’s what made the Senator from Florida rich when he was in the health care Medicare profiteering biz.

{{ Scott was pressured to resign as chief executive of Columbia/HCA in 1997. During his tenure as chief executive, the company defrauded Medicare, Medicaid, and other federal programs. The Department of Justice won 14 felony convictions against the company, which was fined $1.7 billion in what was at the time the largest healthcare fraud settlement in U.S. history.[8][9] Following his departure from Columbia/HCA, Scott became a venture capitalist and pursued other business interests.}}

I note that the criminal convictions didn’t appear to stunt his subsequent career – no doubt he’s hailed as an innovator and job creator. {{ LOL }}

intercst

3 Likes
20

It’s always good to keep close scrutiny on the insurance industry but there comes a point when too much close scrutiny in that direction can leave you blind to an actual problem in your own backyard that’s come from another source. The erroneous diagnostic codes almost certainly arose in your/a doctor’s office…quite possibly long before this practice even purchased this particular company’s CCM implementation product. The financial arrangements might well be a % of revenue generated…or a straightforward flat fee…but the diagnostic codes that made you eligible for the CCM procedure codes are those used by providers to communicate with insurance companies and other medical facilities using the same system, and will follow you around via the electronic records.

Electronic records are great but can be a bear to use depending on the system and all it takes is for someone to inadvertently make a wrong keystroke or make an entry from convenience and there you have a non existent disease on your medical record. Also, I fancy that some in office CCM utilization packages must have a software setup that “patrols” patient records and flags them by medications they’re taking and requires human oversight to double check this. Not everyone is always very interested in the doing their job to the best of their ability, I’ve found. Go into your patient portal and scroll back to see when these fake diseases appeared. You’ll have a better idea then.

This isn’t an issue that’s confined to Medicare, BTW. As comorbidities are becoming more prevalent in younger populations some employer provided group plans are now providing rebursement for extra admin duties. A reason for everyone to keep an eye on their medical record periodically…just in case. No one is going to care more about its accuracy than you.

I noticed the irony of having to insist on removing two conditions from my medical record that I didn’t have when, had the only Red Flag on my bloodwork received a bit more attention, there would’ve been two legit diagnostic codes to use…and get me started on some aggressive lipid management. Funny that🤔

2 Likes