Patients noticed that one tool often predicted a patient’s date of discharge that coincided with the date their insurer cut off coverage.
At the time, she could not walk more than a few feet, even with assistance — let alone manage the stairs to her front door, she said, and she still needed help using a colostomy bag after her operation.
But patients, providers and patient advocates in several states said they have noticed a suspicious coincidence: The tool often predicts a patient’s date of discharge that coincides with the date their insurer cuts off coverage, even if the patient needs further treatment that government-run Medicare would provide.
After UHC cut off her nursing home coverage, Sullivan’s medical team agreed with her that she wasn’t ready to go home and provided an additional 18 days of treatment. Her bill came to $10,406.36. Aaron Albright, a NaviHealth spokesperson, said in a statement that the NH Predict algorithm is not used to make coverage decisions and instead is intended “to help the member and facility develop personalized post-acute care discharge planning.” Length-of-stay predictions “are estimates only.
David Lipschutz, associate director of the Center for Medicare Advocacy, questions how CMS will enforce the rules, which don’t include specific penalties for violations.
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