[blueash]

Advantage plans are paid a base rate by the government at a negotiated monthly rate to assume the cost of persons who would otherwise be on Medicare. But, and this is a big but... the rate is then adjusted upward if the patient population is sicker thus more likely to be costly to provide care.

UHC and I believe our local Villages Health Care are, reading between the lines, being looked at for managing the system to make it appear that they have a sicker population. The more diagnoses you can add to the paperwork the better your payment will be.

This is a very difficult judgment to make as a doctor or health care system. You get "blood work" every six months and this time your blood sugar is just above the cutoff. Always been fine before but some were at the top of normal.

Does the doctor enter elevated blood sugar into the computer as a diagnosis, or maybe pre-diabetic? Is that cheating or is it important as a reminder next time to ask about eating and maybe get an A1C?

How about the complaint that your fingers are stiff and ache in the morning but after an hour or so it self resolves? Does the doctor enter arthritis into your diagnoses as you clearly have it, or leave it out as it requires no management.

If the director of the Health Care system sends out a memo telling all the providers to be sure to enter all the issues into the diagnoses record is that good medical care or is that fraud?