Diagnosed at Home, Then Left Untreated

Key Takeaway: A study of more than 21 million Medicare Advantage enrollees found that in-home health risk assessments are generating a growing share of cardiovascular diagnoses. Those diagnoses were followed by treatment and prescription fills far less often than diagnoses made in a clinic. If an insurer-arranged visitor has added a heart or circulation diagnosis to your record, make sure a clinician actually manages it.

A Diagnosis Without a Doctor

Picture a 74-year-old retired machinist in Ohio. His Medicare Advantage plan sends a pleasant nurse practitioner to his home for a free wellness visit. She checks his pulse and blood pressure, asks about leg cramps when he walks, reviews his pill bottles, and leaves within an hour. Somewhere in a billing system, his chart now lists peripheral vascular disease, which is narrowed arteries in the legs. Nobody calls him about it. No one starts a medication, orders a follow-up test, or tells his primary care doctor.

He is not unusual. In Medicare Advantage, nearly three of every four new diagnoses…