Why don't you tell me the story of Frances Walter? What happened to her?

Frances Walter had suffered an injury. She had fallen and broken her shoulder.

That's Casey Ross, National Technology Correspondent at Stat.

She had an acute hospital stay, so she stayed in the hospital for some period of time and

had a surgery to repair her shoulder and then was discharged to a nursing home.

And once she got into the nursing home, an algorithm was run about her care to suggest

how long she ought to be in the nursing home. This algorithm, a hidden aspect of Medicare

Advantage insurance plans, looked through Frances' past health records and considered how long

other patients typically need care when recovering from this kind of injury. It determined she only

needed 16.6 days to recover. And on the 17th day, she gets a notice from her insurer,

security health plan of Wisconsin, that she no longer meets Medicare coverage criteria

to continue to stay in the nursing home. She doesn't know anything about this algorithm and

neither does her family. Frances had a number of other health complications. And despite

with the algorithm determined, 17 days just was not enough time. At that point, she can't

dress herself. She can't push her walker without assistance. And she can't carry on sort of

basic activities of daily living. And you have to remember that this is a person who's 86

years old. You don't just bounce back from an injury like that. You need to have some

amount of rehabilitation care so that you can get to the point where you can again live independently.

More and more, insurance companies are relying on algorithms like this to make life and death

decisions for patients. What's meant to be a reference point to estimate the level of care a

person might need is increasingly being taken as fact. You'd expect that an insurance company

would be carefully reviewing the details of her care and making a decision based on that,

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