golfing eagles: I’m trying to figure out what conclusion to draw from the numbers you present here.
Are you saying the 20M royalties make it possible lose a large number of patients in the transition to MA only but still run a system with 30 minute appointments, same day appointments, and doc’s that support no more than 1250 patients, and TVH doc’s managing Villages Hospital patients until enough TV residents see the value/quality of this system so that it is viable without the royalties?
I ask because I, as a patient, I see TVH as way, way better than any other medical service, including simple medical events, specialists and hospital stays, than any other I’ve experienced. My only worry is that the transition to MA puts TVH out of business.
BTW your explanation about picking the “best” specialist clarified something I’ve thought for decades. I’m not in the medical field but could never figure out how I could pick the “best” specialist/surgeon.. I’ve run into and had some friends run into some of the points you mentioned. I’ve also run into what seemed to me as doc’s doing a good job of marketing themselves as “best”.
But on the other hand in one case though TVH I feel I did end up with the “best” in field….
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Originally Posted by golfing eagles
Well, it's not quite as monolithic as you stated it. TVH has only been around for about 4 years, therefore the population of TV prior to 2012 had doctors not in TVH. I doubt huge numbers of these people dumped their physician of 5, 10, 15 or even 20 years just because a new option opened up---there were plenty of options before TVH. So a large part of TVH patient base is made up of those that came here in the last 4 years, and there are a large number of those people who are under age 65. TVH's decision does not affect the insurances of those under 65.
In growing, non-retirement areas, such as Research Triangle, practices are about 15-20% Medicare. Our NY practice was 41% Medicare. I would guess TVH is about 70% Medicare, maybe higher. With the exception of Tricare, almost all these people either have traditional Medicare with a supplement or already have a MA policy. So essentially they are dropping one Medicare insurance plan in favor of the other, and the people will choose what's best for them.
To use our NY practice as an example, we only dropped one insurance completely in the last 30 years, because it became absolutely ridiculous to accept it. This was an insurance that was offered by several large employers, and most patients picked it because it deducted the least amount from their paycheck (which is generally how most employees choose). We lost about 70% of those patients, but over the ensuing years about half returned due to changing their insurance for whatever reason. Any other insurance we dropped we only stopped accepting NEW patients with that insurance and "grandfathered" the rest---we thought that was the higher moral ground, but many practices will just drop all that have a given insurance.
I doubt the remaining partners would introduce a drastic change to 41% of the practice. But for argument's sake lets say that such a decision would cost the practice 2 million/year. So it wouldn't even be a consideration. Now for the wild card---say UHC came along and said they wanted to use the name of our practice on their MA plans, and for that right they would pay $20 million in royalties. Now the whole decision process changes dramatically, doesn't it? It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.
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