5 ms·

UnitedHealth paid nursing homes to reduce hospital transfers

44 points by Jimmc414 1y ago

Jimmc414 1y ago
When health insurers create financial incentives to reduce hospitalizations, at what point does cost management cross the line into potentially criminal patient endangerment, especially when the patients themselves have no knowledge that their emergency care decisions may be influenced by secret bonus structures designed to minimize expensive treatments?
- nothercastle 1y ago
  At what point are we willing to prosecute. That’s all that matters
  - hedora 1y ago
    It looks like these programs were initiated under the CEO that was shot, and have continued under the new leadership. So, I doubt prosecution would matter much: Even if the courts somehow decided to levy murder charges + seek the death penalty, that wouldn't be enough a deterrent for UnitedHealth's leadership. At this point, it looks like criminal murder charges (seeking the death penalty) + federalizing the company would be minimal next steps towards fixing the problem. Of course, that won't happen under the current administration.
    - nothercastle 1y ago
      How about a golden parachute instead
- UncleMeat 1y ago
  The article claims that nursing homes were pressured to add DNRs to people's records against their will. That's not just near a the line. That's not just over the line. That's "absolute fucking evil" territory.
  - fzeroracer 1y ago
    I'm old enough to remember when Sarah Palin was yelling about insurance death panels and how bad universal healthcare was. Somehow it always ends up as projection, and none of those same people will care about literal death panels.
    - 13_9_7_7_5_18 1y ago
      [dead]
  - hackernewsdhsu 1y ago
    [flagged]
    - deleted 1y ago
      [deleted]
  - tekla 1y ago
    Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that others deserve to have their demands met about procedures in the face of rational argument. My parents have a DNR because they are both doctors and have spent too much time forcibly keeping people alive-ish because they were ordered to keep people on the edge of death alive, consuming incredible amounts of money, manpower, probable pain, and medication to keep someone barely alive for a week or two. So many people are kept alive in arguably incredibly painful and shitty situations because of the inability to deal with the fact that sometimes people die
    - UncleMeat 1y ago
      DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.
- FireBeyond 1y ago
  It gets worse, and on both sides of the coin. I was a paramedic (and before, an EMT) who has responded literally thousands of times to SNFs (skilled nursing facilities). Dozens, if not hundreds of these calls were for the most trivial of concerns. A nurse told us at one facility that their policy was "anything larger than a bandaid, call 911", so we'd do "first aid" while two nurses stood by and watched us. I'm sure they (the facility) had motivations on liability, etc., but nonetheless, it was utterly galling that you'd leave such a facility and see big proud billboards or ads offering "24/7 nursing care!" - and knowing that they were certainly charging the patient or their family for a rate commensurate with that, potentially five digits a month, while offloading all their work to 911 and relying on skeleton crews of an LPN per floor supervising way too many CNAs. They'd also routinely "forget" to fill out paperwork on ambulance necessity (Medicare, and many insurers, have paperwork to justify why the patient was not suitable for private vehicle or wheelchair van transport and instead needed a "fully equipped BLS/ALS ambulance"). It wasn't onerous, a single pager with a bunch of checkboxes, "Does the patient pose a fall risk?" "Need for oxygen?" "Unable to support themselves in a sitting position", etc. But we'd have to fight tooth and nail to get anything more than "patient name, DOB, and an illegible provider signature". Insurance would routinely reject payment, etc. UHG involved in more of these shenanigans? Not surprised. They were slapped several years ago for denying HEMS (Heli EMS, aka "Life Flight") from severe MVA / trauma scenes due to lack of pre-authorization... ("This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your authorization. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, I know, it's a bit loud with the jaws of life in the background... Uhh, sure, I guess I can hold for a nurse consultation...")
AStonesThrow 1y ago
Look, this is prima facie a scandal, but I can assure you that the insurance carrier is dealing with a real issue. Basically the road to hospitalization is paved with Vaseline and gingerbread cookies. In my experience, every effort is made at every level to unfailingly recommend a hospital visit at every opportune moment, regardless of the underlying medical necessities. Surprisingly some of the most neutral situations I've encountered are 9-1-1 calls to my home. Being conscious and responsive, the EMTs will determine I'm stable, and then the $64,000 question: "Do You Want To Go To The Hospital?" and all you need to say is "no". Once I visited a mini-clinic in a pharmacy. Not Urgent Care, no emergent condition, just a clinic visit with a nurse to check my BP. After reading my BP the nurse informed me she was duty-bound to contact 9-1-1. No fewer than seven extremely buff and very male EMTs poured into the tiny exam room and very insistently tried to induce me to go to the hospital with them. I became obstinate and told them that they were the only cause of my stress at that point. They finally dialed the attending physician and made me listen to him read off all my risk factors before they relented. I've been at Urgent Care telemedicine visits and if I admit to the wrong symptom they will immediately shut down the call and refer me directly to E.R. I was once signing admission papers to a BH hospital. I was conscious and responsive and arguably quite sane. The papers had a series of agreements which included one blanket consent to transfer me to any other facility they pleased. The ensuing argument and the occurrences within the BH facility led me to believe that this is a cash-cow kickback arrangement for them to funnel mentally ill patients into the "real" physical hospital with flimsy pretenses. Every medical-based exam I received seemed oriented to finding a reason to send me out there, but they would've discovered that I never granted them the consent to do so. Often, I would say that LTC and palliative care facilities may not have staff equipped to determine necessity for going to the hospital. If they have an issue with a resident and they don't know what it is, or they're feeling over their head, they're going to just punt to 9-1-1 and let the hospital figure it out on their end, and you can be sure the hospital can find stuff in a patient population like that. Every time I read about someone lamenting how medical "care" was denied by insurance, I simply consider how many medically unnecessary propositions have been placed before me, and I needed to be the voice of reason, to shut those down, before I was exploited and viewed as a cash cow to slip claims past the insurance company.
- 1y ago
philip221 1y ago
[dead]

44 points by Jimmc414 1y ago

When health insurers create financial incentives to reduce hospitalizations, at what point does cost management cross the line into potentially criminal patient endangerment, especially when the patients themselves have no knowledge that their emergency care decisions may be influenced by secret bonus structures designed to minimize expensive treatments?

nothercastle 1y ago
At what point are we willing to prosecute. That’s all that matters
- hedora 1y ago
  It looks like these programs were initiated under the CEO that was shot, and have continued under the new leadership. So, I doubt prosecution would matter much: Even if the courts somehow decided to levy murder charges + seek the death penalty, that wouldn't be enough a deterrent for UnitedHealth's leadership. At this point, it looks like criminal murder charges (seeking the death penalty) + federalizing the company would be minimal next steps towards fixing the problem. Of course, that won't happen under the current administration.
  - nothercastle 1y ago
    How about a golden parachute instead
UncleMeat 1y ago
The article claims that nursing homes were pressured to add DNRs to people's records against their will. That's not just near a the line. That's not just over the line. That's "absolute fucking evil" territory.
- fzeroracer 1y ago
  I'm old enough to remember when Sarah Palin was yelling about insurance death panels and how bad universal healthcare was. Somehow it always ends up as projection, and none of those same people will care about literal death panels.
  - 13_9_7_7_5_18 1y ago
    [dead]
- hackernewsdhsu 1y ago
  [flagged]
  - deleted 1y ago
    [deleted]
- tekla 1y ago
  Oh please, DNR is a complicated territory. Sometimes people are unable to vouch for themselves, or demand very invasive procedures. It's easy to claim that others deserve to have their demands met about procedures in the face of rational argument. My parents have a DNR because they are both doctors and have spent too much time forcibly keeping people alive-ish because they were ordered to keep people on the edge of death alive, consuming incredible amounts of money, manpower, probable pain, and medication to keep someone barely alive for a week or two. So many people are kept alive in arguably incredibly painful and shitty situations because of the inability to deal with the fact that sometimes people die
  - UncleMeat 1y ago
    DNRs can be absolutely great things when people make the choice willingly. My grandmother chose to die rather than have invasive procedures performed that gave her a small chance of living in large part based on her experience seeing her sister live miserably after her stroke. But marking somebody as having a DNR when they do not want one is evil.
FireBeyond 1y ago
It gets worse, and on both sides of the coin. I was a paramedic (and before, an EMT) who has responded literally thousands of times to SNFs (skilled nursing facilities). Dozens, if not hundreds of these calls were for the most trivial of concerns. A nurse told us at one facility that their policy was "anything larger than a bandaid, call 911", so we'd do "first aid" while two nurses stood by and watched us. I'm sure they (the facility) had motivations on liability, etc., but nonetheless, it was utterly galling that you'd leave such a facility and see big proud billboards or ads offering "24/7 nursing care!" - and knowing that they were certainly charging the patient or their family for a rate commensurate with that, potentially five digits a month, while offloading all their work to 911 and relying on skeleton crews of an LPN per floor supervising way too many CNAs. They'd also routinely "forget" to fill out paperwork on ambulance necessity (Medicare, and many insurers, have paperwork to justify why the patient was not suitable for private vehicle or wheelchair van transport and instead needed a "fully equipped BLS/ALS ambulance"). It wasn't onerous, a single pager with a bunch of checkboxes, "Does the patient pose a fall risk?" "Need for oxygen?" "Unable to support themselves in a sitting position", etc. But we'd have to fight tooth and nail to get anything more than "patient name, DOB, and an illegible provider signature". Insurance would routinely reject payment, etc. UHG involved in more of these shenanigans? Not surprised. They were slapped several years ago for denying HEMS (Heli EMS, aka "Life Flight") from severe MVA / trauma scenes due to lack of pre-authorization... ("This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your authorization. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, I know, it's a bit loud with the jaws of life in the background... Uhh, sure, I guess I can hold for a nurse consultation...")

AStonesThrow 1y ago

Look, this is prima facie a scandal, but I can assure you that the insurance carrier is dealing with a real issue. Basically the road to hospitalization is paved with Vaseline and gingerbread cookies. In my experience, every effort is made at every level to unfailingly recommend a hospital visit at every opportune moment, regardless of the underlying medical necessities. Surprisingly some of the most neutral situations I've encountered are 9-1-1 calls to my home. Being conscious and responsive, the EMTs will determine I'm stable, and then the $64,000 question: "Do You Want To Go To The Hospital?" and all you need to say is "no". Once I visited a mini-clinic in a pharmacy. Not Urgent Care, no emergent condition, just a clinic visit with a nurse to check my BP. After reading my BP the nurse informed me she was duty-bound to contact 9-1-1. No fewer than seven extremely buff and very male EMTs poured into the tiny exam room and very insistently tried to induce me to go to the hospital with them. I became obstinate and told them that they were the only cause of my stress at that point. They finally dialed the attending physician and made me listen to him read off all my risk factors before they relented. I've been at Urgent Care telemedicine visits and if I admit to the wrong symptom they will immediately shut down the call and refer me directly to E.R. I was once signing admission papers to a BH hospital. I was conscious and responsive and arguably quite sane. The papers had a series of agreements which included one blanket consent to transfer me to any other facility they pleased. The ensuing argument and the occurrences within the BH facility led me to believe that this is a cash-cow kickback arrangement for them to funnel mentally ill patients into the "real" physical hospital with flimsy pretenses. Every medical-based exam I received seemed oriented to finding a reason to send me out there, but they would've discovered that I never granted them the consent to do so. Often, I would say that LTC and palliative care facilities may not have staff equipped to determine necessity for going to the hospital. If they have an issue with a resident and they don't know what it is, or they're feeling over their head, they're going to just punt to 9-1-1 and let the hospital figure it out on their end, and you can be sure the hospital can find stuff in a patient population like that. Every time I read about someone lamenting how medical "care" was denied by insurance, I simply consider how many medically unnecessary propositions have been placed before me, and I needed to be the voice of reason, to shut those down, before I was exploited and viewed as a cash cow to slip claims past the insurance company.

1y ago

philip221 1y ago

[dead]