00:00Thank you. Good reminder to get the car in this weekend. I appreciate that.
00:10Dr. Miller, there have been concerns. All of you answered lots of questions, a lot of questions that they got to answer.
00:22I'm going to ask just two individual ones. I'd love some context on it, but it's in relation to what we just heard.
00:28Concerns about upcoding. Let's dig into that a little bit.
00:32Concerns that upcoding in-home risk assessments is increasing the cost of Medicare Advantage.
00:39So a specific example for the taxpayer. So the cost is going up.
00:45Medicare Advantage insurers appear to be using health risk assessments and chart reviews to inflate payments for Medicare.
00:51In 2023, insurers received billions in payments for diagnosing patients during home visits with new conditions
00:57that apparently don't warrant treatment. Several health plans have been sued for under-scrutiny or either failing to remove inaccurate codes or willfully upcharging.
01:07We have to get a handle on these out-of-control costs. I think we've established that today.
01:12How can lawmakers best ensure that Medicare Advantage accountability without sacrificing services like in-home assessments?
01:18Because my example here on in-home assessments isn't saying they're not worthwhile. I'm just saying there's been some taken advantage of here.
01:26How can we balance the accountability without sacrificing these assessments?
01:30So you want all patients to be completely and accurately coded for their diagnosis.
01:38If they have diabetes, you want to know whether it's controlled or uncontrolled.
01:41If they have kidney complications, nerve complications, visual complications, you want that all coded appropriately.
01:48What you don't necessarily want to do is incentivize plans to just go harvest diagnosis codes to get paid more and not do anything about it.
01:56So the way to do that is to integrate diagnosis coding into routine clinical practice.
02:02And we could do that by having it be a component of electronic health records.
02:07So instead of me as the physician selecting that the patient I've admitted to the hospital has X or Y or Z diagnosis or some coder going after me to tell me to do that,
02:17have the software automatically code that because many and then have the physician make a decision as to whether it's appropriate or not at the point of care.
02:25And then that gets on to claims for fee for service and Medicare Advantage beneficiaries.
02:31And I don't know all the specifics of this, but as I've been involved in these issues, I've seen a lot of discussion about you can use preexisting data to get some norms and generally target what's needed and get pretty close.
02:51And then I like the part that you just mentioned that you would have the physician be able to make a final determination on what's really necessary.
02:58Yeah. And make it just again, you can use doctors, nurse practitioners to do documentation.
03:06That's probably not a great use of our brains and time like we can do that, but that's not what you want us to do.
03:12So making that just a routine automated process, just like spell check, auto correct, you know, completion of emails from your Apple iPhone, making diagnosis coding that way and having that engine pull from labs imaging notes, that would just make it easier.
03:30And then you'd know that the patient is completely and accurately coded whether it's in fee for service or Medicare Advantage or whether they're on Medicaid or whether they have commercial insurance.
03:41And then you would be facilitating better clinical communication because the chart would have the diagnoses that the patient has.
03:49Yeah. Well, thank you very much.
03:51Mr. Jane, the Medicare Advantage quality bonus programs may have started as an incentive for better care, but without being regularly updated or tuned up as we've now established, it has become less effective.
04:03The star rating system, for example, is complicated. It considers a lot of different measures. The ratings are reported on a contract level rather than a plan level, which ropes in several vastly different benefits, networks, populations, making it hard for an individual to make sense of the ratings.
04:19How could a more efficient value based system that focuses on outcomes and quality metrics provide more transparency and easily digestible information for seniors in particular?
04:29Yeah, I think there's not enough attention paid to star ratings at the point of sale.
04:34And I think there's two reasons for that. One is I think there's not a lot of belief in the star ratings by brokers.
04:40They're not necessarily convinced that a four and a half star plan is better than a four star plan.
04:46And to be fair, there's one of the challenges with the system is that very small differences can lead to big swings in performance in the star rating system.
04:55So in that way, it's not really as robust as it should be.
04:58Am I confident that a four and a half star plan is better than a three star plan? I am.
05:02But am I confident that a four and a half star plan is meaningfully better than a four star plan? I'm not.
05:06And so I think that the reality is, is that we need to actually be to revise the system so that differences in star ratings actually mean something.
05:16And I think that right now consumers don't necessarily feel that and they're not being told that by brokers who don't necessarily have that confidence either.
05:24Probably a great time to finish that. I just checked in my Uber profile as a passenger is 4.84.
05:30And I just wanted that to be on the record.
05:33Mr. Moore, you're better than me.
05:34I wanted that to be on the record and I yield back.
05:36Chairman.
05:37So now we know Mr. Moore is a big tipper.
05:40Mr. Moore, of course.
05:41senhor went on the rule for Congress that you put in the amendment right now.
05:42All thanks.
05:45Thank you very much.
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