[dbussone]

Originally Posted by Mikeod

After reading all these posts and threads, I would like to offer this. Initially, VHS was created to provide a system of health care that differed from the usual in that providers would be allocated more time to spend with their patients. In order to accomplish this, each doctor’s panel would have to be limited so that access was optimal while still spending more time at each visit. Proud of this “innovative” health care system, The Villages promoted it in their literature and in sales visits.
However, this plan flies in the face of current medical economics, where, because reimbursements to providers is the primary place bureaucrats choose to limit the growth of health care costs, practitioners need to schedule as tightly as possible. Thus, VHS at the beginning was heading down a path unlikely to succeed. It would seem they hoped more patients would opt for the MA plan that provided a more consistent flow of income, but that didn’t happen. The primary reason for that is, as seen in these posts, people already had plans either wholly or partly paid by a former/current employer or had plans that provided them the freedom of choice they desired. As a result, revenue expectations were not being met. The disparity between the reimbursement plans and the lump sum from the MA plans is significant. Thus the push for the UHC plan.
Did they anticipate this happening? I don’t think so. I think the same thing happened with Moffitt and USF. Both anticipated greater revenue from MA plans than actually occurred. Both pulled the plug when losses mounted. VHS faces the same dilemma. If they closed down instead of limiting insurance plans, would we be any better off? As far as the director of VHS being the same person that was in charge of the USF plan, I remember reading that he moved to VHS because he believed in what they were trying to do. I have had friends in primary care in various practice models. The burnout rate is high and the satisfaction is low. The VHS model looks better for both patient and provider.

Mike - I tend to agree with the first part of you post. However, when you initiate discussion about USF & Moffitt, I think your premise is not correct. Let's start with Moffitt. It is a great cancer research institute- but it's primary relationship, I believe, was with The Villages Regional Hospital and the developer. The promise was that Moffitt would develop a second campus, somewhat equivalent to its Tampa campus. That was never going to happen. The cost involved in duplicating research and teaching facilities in TV could never happen - too cost prohibitive. In addition, it is highly unlikely that world class researchers would wish to relocate to a semi-rural area in central FL. After all, this is not Gainesville.

As far as USF goes, it's faculty practice plan (I.e., it's docs) most likely over promised and definitely under delivered. Their expectation, IMO, was that the hospital or some entity would highly subsidize them, so that their practice fees represent profit. This is a common model with faculty physicians and their outreach efforts. Again, though, it was probably difficult for the practice plan to convince research/teacher/practitioners to locate here. The itinerant schedule used instead likely did not suit the patients or referring physicians.

IMO both organizations saw $$$ that were not going to happen. And it was not from the MA plans. Both organizations seek private funds whenever possible because of the uncertainty associated with public funding. As I noted above , these organizations like to develop relationships with entities that will fund physician base salaries at a minimum, then generate fee for service or per member per month fees that represent organizational profit. They believe they are superior to community physicians offering the same or similar services - sometimes that is true, sometimes it's not.

Moffitt, as I would have expected, learned that patients would travel to Tampa for advanced care. Therefore, why duplicate their Tampa campus here. So they essentially trashed their agreement with TVRH and the developer.

USF was unable to generate significant referrals from physicians who weren't part of the Villages Health System. After all, they came here to assist a group of docs (the Villages Health System) that was competing with community docs with existing practices.

The developer and those that run TVRH are intelligent and business-like. The $$$ were not happening and USF/Moffitt finally figured that out. Value is in the eye of the beholder and I believe USF and Moffitt were on the negative side of the equation...just my opinion, and some career based knowledge.