Villages Health Care Centers

[villages07]

Very interesting article in today's Daily Sun. The next visionary step in creating a comprehensive health care system in The Villages. Kudos to Gary Morse and USF for pioneering this concept and taking the risk to see if it will work.

Essentially, the business owner (Morse?) will hire physicians on salary thus removing the urgency to see as many patients as possible and presumably giving the patient a more thorough, personal experience.

The business side would handle all the insurance, billing, regulatory stuff. The physician would be freed up to treat patients and practice medicine. Wonder where they will recruit the doctors?

First center to open up in Colony Plaza area... smart - go to where the newest residents are coming in and looking for medical providers.

Here's a link to the article:

The Villages strives to change medical care, bring back days of (http://www.thevillagesdailysun.com/news/villages/article_d617fb9c-6a6d-11e1-99c7-001871e3ce6c.html)

[Posh 08]

Very interesting article in today's Daily Sun. The next visionary step in creating a comprehensive health care system in The Villages. Kudos to Gary Morse and USF for pioneering this concept and taking the risk to see if it will work.

Essentially, the business owner (Morse?) will hire physicians on salary thus removing the urgency to see as many patients as possible and presumably giving the patient a more thorough, personal experience.

The business side would handle all the insurance, billing, regulatory stuff. The physician would be freed up to treat patients and practice medicine. Wonder where they will recruit the doctors?

First center to open up in Colony Plaza area... smart - go to where the newest residents are coming in and looking for medical providers.

Here's a link to the article:

The Villages strives to change medical care, bring back days of (http://www.thevillagesdailysun.com/news/villages/article_d617fb9c-6a6d-11e1-99c7-001871e3ce6c.html)

This goes on the "pro" side of my pro/con list.

[English Ivy]

Very interesting article in today's Daily Sun. The next visionary step in creating a comprehensive health care system in The Villages. Kudos to Gary Morse and USF for pioneering this concept and taking the risk to see if it will work.

Essentially, the business owner (Morse?) will hire physicians on salary thus removing the urgency to see as many patients as possible and presumably giving the patient a more thorough, personal experience.

The business side would handle all the insurance, billing, regulatory stuff. The physician would be freed up to treat patients and practice medicine. Wonder where they will recruit the doctors?

First center to open up in Colony Plaza area... smart - go to where the newest residents are coming in and looking for medical providers.

Here's a link to the article:

The Villages strives to change medical care, bring back days of (http://www.thevillagesdailysun.com/news/villages/article_d617fb9c-6a6d-11e1-99c7-001871e3ce6c.html)

I'd love to have a "Marcus Welby" type doctor but I'm not sure how this would work. Ultimately a profit must be made for the business owner and I don't see that happening unless the patient is paying a fee in addition to their insurance/medicare. I believe this is referred to as concierge medicine where you pay a flat yearly rate to have easy access to your doctor at all times.

What am I missing?

[Carla B]

Grand Junction CO has had a successful health care model for years that sounds very much like what USF/The Villages is proposing. There was a recent PBS program on how it works but I can't remember the name of the program. Anyway, you can Google "Grand Junction Health Care" to find several articles about how they deliver some of the best health care in the nation at a much lower cost than most others. Primary care physicians are the key to establishing it. I think it's a wonderful idea.

[villages07]

Ivy... I'm sure the business side has crunched the numbers to insure it will be profitable. I did not get the impression that it would be concierge, retainer type funding. It seemed as though it would work within existing insurance reimbursement framework. I assume much can be saved through economies of scale... Centralized administrative support, insurance processing, supply ordering, records maintenance, etc.

Time will tell....

[saratogaman]

Hmm, where did I hear these laudable ideas before?
Oh, yes, Romneycare/Obamacare. Excellent to see the world catching up with Boston and Washington!

[AJ32162]

Hmm, where did I hear these laudable ideas before?
Oh, yes, Romneycare/Obamacare. Excellent to see the world catching up with Boston and Washington!

But fortunately, it won't be mandatory.

[blueash]

You hire doctors who are willing to work within a lower paying model in exchange for other considerations (life style, stress reduction) as there is no way they will be paid as well as a successful fee for service practice. Then you be sure they have competant staff and a work environment that gives them the tools to succeed .. whether that is rapid access to consultants or a working microscope. You do not give them stock or a percentage of the profit as that incentivizes (at least subconsciously) keeping cost down for the wrong reason. You do not have an in office Xray or MRI or exercise lab or bone density machine. Thus you have lowered the cost of running and equiping the office to the point where you can pay the doctor to be a doctor and not a lab and test ordering machine. This system will work for patients who do not expect that medicine is a one stop shop where the doctor exists to order every test that Dr. Oz recommends. The people who might be very upset about this are all the doctors who have signed expensive leases for office space in TV and now find out that their landlord is going to open a competing office. Hmm

[ilovetv]

You hire doctors who are willing to work within a lower paying model in exchange for other considerations (life style, stress reduction) as there is no way they will be paid as well as a successful fee for service practice. Then you be sure they have competant staff and a work environment that gives them the tools to succeed .. whether that is rapid access to consultants or a working microscope. You do not give them stock or a percentage of the profit as that incentivizes (at least subconsciously) keeping cost down for the wrong reason. You do not have an in office Xray or MRI or exercise lab or bone density machine. Thus you have lowered the cost of running and equiping the office to the point where you can pay the doctor to be a doctor and not a lab and test ordering machine. This system will work for patients who do not expect that medicine is a one stop shop where the doctor exists to order every test that Dr. Oz recommends. The people who might be very upset about this are all the doctors who have signed expensive leases for office space in TV and now find out that their landlord is going to open a competing office. Hmm

So true about patients expecting the dr. to order every test that Dr. Oz recommends. (If they had to pay for it themselves or had even a $5 co-pay they'd think twice about such expectations.)

And as for competing with dr. practices who signed expensive leases in TV....once again, competition and the free marketplace are a good thing for incentivizing lower fees and more accommodating service....and office hours that aren't just 9-5, M-F!!!

This model also should reduce the number of non-urgent E.R. visits, if the patient can actually get in to see their primary doctor at their office.

[Hal :-)]

Very exciting. But I'll remain a cynic until I see results. The problem is: Doctors see 100 patients rather than 50, patients wait through 5 or 6 exam rooms to see the doctor for just a few minutes. The solution: put Doctors on salary and they sit and visit for an extended visit. The only mention of savings is reducing the number of test and procedures (???). Still, it's a good dream. Who wouldn't love to see The Villages implement a superior system that could become a model for the nation.

[Ohiogirl]

Please - read this article again, carefully, and realize that they are following the Cleveland Clinic plan - that the Obama administration noted when they wrote the first healthcare bill. Remember that Obama said that his plan was not the be-all and end-all, that it was a place to start.

Being from Ohio, and having received some medical care through the Cleveland Clinic, and currently having a good friend (from Indiana) who opted for his open heart surgery there, keep an open mind.

Interesting to me that Gary Morse is recommending the Obama model for the Villages health care model. Just saying . . .

[KateTut]

We go to the Cleveland clinic when we are up north. All the doctors are on salary, They all are on the same computer system --- so my records from my internist, dermatologist, even ophthalmologist are available to all CC doctors. Medicare is accepted, there is central billing for departments, surgeons and oncologists and primary care docs all talk to each other. It's quite a system, for patients and doctors,and the healthcare is excellent.

[skyking]

Having spent the first half of my career managing a large medical group that was primary care focused and largely salaried, I support the concept. I have seen the quality it can produce. What I question is the big PR push. A front page announcement yesterday of the concept; a front page announcement today that a local FP group has agreed to join (as if they made that decision last night) and the same repeated quotes from Gary Morse.

Am I living in "the Truman Show"?

[dblwyr]

The model could work very well if properly executed. I agree it does not sound like a concierge model. While I am guessing (since I do not know the specifics of the business model), it may ba a provider based model in which the physician offices are 'linked' to a provider such as the Villages Hospital, and this changes the reimbursement model. Many health centers so this for a lot of reasons, and frankly, it works very well. I am happy to see the developer taking a personal interest in trying to make health care a key positive of life here in the Villages. kudos to him!

[graciegirl]

Because I trust Blueash and his medical background I am optimistic that this new health care idea might be a good thing.

I cannot help but note that on this forum, we are pretty good at making things political or either diefying the Morses or bashing them.The Cleveland Clinic has had salaried physicians for well over forty years. It HAS nothing to do with politics. Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise. That doesn't make it BAD.

I know one thing for sure. The one thing that I think needs improvement around here is health care and dental care. With a few exceptions we have found that they aren't as good as what we left in Cincinnati. The Villages is of course a MUCH smaller area and we are predominantly on Medicare. Not an opportunity for other than very altruistic practioners and not a magnet for those with stellar credentials..who may want to make more money or gain more prestige.

For example. I can't even imagine going to a dermatologist back home and having someone try to sell you lotions for an extravagant price. Or go to a dentist and hear that you need over 14 thousand dollars worth of work when you haven't missed a six month visit in 40 years!

Just like anything, some things medical here are better or worse than others. I would just like to find a good place to go to a doctor or dentist I can trust and be able to relax.

[natickdan]

I thought the article was promising because it offers a paradigm shift, like the Cleveland clinic model, to the traditional managed health care delivery ( or, for some, the lack of it ).

[downeaster]

Having spent the first half of my career managing a large medical group that was primary care focused and largely salaried, I support the concept. I have seen the quality it can produce. What I question is the big PR push. A front page announcement yesterday of the concept; a front page announcement today that a local FP group has agreed to join (as if they made that decision last night) and the same repeated quotes from Gary Morse.

Am I living in "the Truman Show"?

I appreciate hearing from one who has been there on the inside.
I wonder why Mr. Morse felt he needed to put down other providers? Like you, skyking, i wonder about the big PR push. Are we going to be asked for donations to buy equipment for them? (Rhetorical question).

The concept is sound and, properly managed, can be a real plus for The Villages. Cleveland Clinic and Mayo Clinic are two good examples of doing it right. I believe there are many other smaller ones that are successful.

I am a patient of Belleview Family Doctors and very pleased with them. They are my primary care physicians. I see other specialist outside their practice.

[Yorio]

Again, my comments from another post that Morse has a vision on how healthcare should be done in TV and knows what we want. Wonder if there will be home visits in dire case? I'll drink more Kool Aid to this concept. Just as his vision of having Charter Schools to keep good employees, this is another great concept and keep all of us here more active and live longer.

[skyking]

"Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise."

It is a great concept, but as previously posted it was not invented here (as you would think from reading the articles). Physician salaries are set annually by a compensation committee at organizations like Mayo and Cleveland Clinic based on criteria such as specialty, tenure, quality measures, productivity and non clinical efforts (committees, research, etc.). It takes a long time to build a Mayo, but you have to start somewhere.

I guess I just react when something is oversold. Good PR is supposed to subtle.

[graciegirl]

"Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise."

It is a great concept, but as previously posted it was not invented here (as you would think from reading the articles). Physician salaries are set annually by a compensation committee at organizations like Mayo and Cleveland Clinic based on criteria such as specialty, tenure, quality measures, productivity and non clinical efforts (committees, research, etc.). It takes a long time to build a Mayo, but you have to start somewhere.

I guess I just react when something is oversold. Good PR is supposed to subtle. With good PR the reader does not realize that the "news" and quotes were written by a PR professional. We get the message. We are not children (stating the obvious).


So your complaint is that it is on the front page and not written by a PR professional?

I just reread the background of Gary Morse and Harold Schwartz from the book Leisureville. They came a long, long, way from their very humble beginnings.

Whether this will be a successful venture, this health care concept brought here, time will tell.

Something needs to be done.

And if someone needs a consult with a PR professional, read the ad on the back of the POA bulletin this month. Not very professional sounding for an MD.

Just my opinion. I too come from a very humble beginning.

[Bogie Shooter]

"Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise."

It is a great concept, but as previously posted it was not invented here (as you would think from reading the articles). Physician salaries are set annually by a compensation committee at organizations like Mayo and Cleveland Clinic based on criteria such as specialty, tenure, quality measures, productivity and non clinical efforts (committees, research, etc.). It takes a long time to build a Mayo, but you have to start somewhere.

I guess I just react when something is oversold. Good PR is supposed to subtle. With good PR the reader does not realize that the "news" and quotes were written by a PR professional. We get the message. We are not children (stating the obvious).

I think this is over reacting.....just sayin.

[Yorio]

Dreaming is good. Didn't JFK make a speech about going to the moon and where are we? Even final reality doesn't match the so called PR, I am o.k. with that. It's a good dream. Are you believing every promise presidential candidates are making now? Probably not, but hope some will become a reality if it helps all of us.

[Villages PL]

Very exciting. But I'll remain a cynic until I see results.

Good for you. I believe this health care plan is more about making money than anything else. Not that there's anything wrong with making money of course. But it's not going to be the plan that makes The Villages America's healthiest hometown, in my opinion.

The problem is: Doctors see 100 patients rather than 50, patients wait through 5 or 6 exam rooms to see the doctor for just a few minutes.

The average time spent with a patient (per office visit) is 7.5 minutes. So lets say they double it to 15 minutes. That's 4 patients per hour or 32 patients per day. The news report said that patients will be able to make a same day appointment with no waiting. So that suggests there will even be a lot less than 32 per day. Let's say 3 per hour or 24 patients per day.


The solution: put Doctors on salary and they sit and visit for an extended visit.

Yes, that's it. And this premium care will come at a price. I figure that each member-patient will be asked to pay a yearly fee of several thousand dollars. That's why there was a survey question to find out our yearly earnings. The developer needed to know if there would be enough people who could afford this premium health care.

The only mention of savings is reducing the number of test and procedures (???).

That's a good point and it may be of some help but we already have HMO's that do that. If you belong to an HMO, your GP is supposed to advise you as to whether or not you need testing.

Still, it's a good dream. Who wouldn't love to see The Villages implement a superior system that could become a model for the nation.

We are going to become the model for the nation by luring the best doctors away from other cities and states? What kind of model is that? :loco:
No, I believe it's going to be nothing more than premium health care for the rich. Not that there's anything wrong with that but it's not the solution to the nation's healthcare problems. And it's not going to make The Villages America's healthiest hometown because it may only be affordable to a relatively small percentage of Villagers, in my opinion.

[ilovetv]

Paying contracted physicians a set monthly salary is not a new concept.

Obviously, with a "family practice" group of physicians providing the care, there will be "families" and younger adults and children drawn from this southern TV area to this practice--not just seniors from TV.....which means more people having private insurance and not just (low-reimbursing) Medicare to pay the bills at these TV health centers.

And as for waiting, the article in yesterday's (Sunday) Daily Sun (Section C, How would you want your mother treated?) states on p. C4 that the Colony center will be staffed with 8 doctors and 4 physician assistants, and "at any given time, 3 doctors and 2 P.A.'s will be on duty". That is good coverage, and probably, 1 or 2 of those drs. and p.a.'s will be there to treat walk-in, unscheduled patients.

And "ultimately, there will be 6-8 similar centers spaced throughout TV". I think the Morse's do their homework before starting a project like this and it will work out fine.

[graciegirl]

Paying contracted physicians a set monthly salary is not a new concept.

Obviously, with a "family practice" group of physicians providing the care, there will be "families" and younger adults and children drawn from this southern TV area to this practice--not just seniors from TV.....which means more people having private insurance and not just (low-reimbursing) Medicare to pay the bills at these TV health centers.

And as for waiting, the article in yesterday's (Sunday) Daily Sun (Section C, How would you want your mother treated?) states on p. C4 that the Colony center will be staffed with 8 doctors and 4 physician assistants, and "at any given time, 3 doctors and 2 P.A.'s will be on duty". That is good coverage, and probably, 1 or 2 of those drs. and p.a.'s will be there to treat walk-in, unscheduled patients.

And "ultimately, there will be 6-8 similar centers spaced throughout TV". I think the Morse's do their homework before starting a project like this and it will work out fine.

Thoughtful and informative post.:)

[villagerjack]

I am biding my time awaiting for cynics to start attacking Mr Morse for making big profits on this. Personally I think it is a great idea that will have some bugs at first but it can be worked out. I wish him all the luck in the worle. I believe he is a visionary and wants to build a Legacy.

[mac9]

Somehow I don't remember "Marcus Welby" utilizing a PA...

[Bogie Shooter]

Good



Yes, that's it. And this premium care will come at a price. I figure that each member-patient will be asked to pay a yearly fee of several thousand dollars. That's why there was a survey question to find out our yearly earnings. The developer needed to know if there would be enough people who could afford this premium health care.





.

Now that is a streatch of one's imagination!

[graciegirl]

Now that is a streatch of one's imagination!

yup

[Villages PL]

Now that is a streatch of one's imagination!

Yes, it is. When you get several long newspaper articles with no mention of where the money will come from for the "generous" doctor's pay, you have no where to turn except to your imagination. There will be a lot less patients and doctors will be getting a lot more money. One can only imagine what that adds up to.

How long would it have taken the staff writer to include in one of the articles something about patient costs? Imagine, he had the time to tell us about the generous pay in two of the articles.

Why are they leaving it up to our imaginations? Perhaps because it will be a tough pill to swallow for the average villager.

[ilovetv]

"Generous" pay for a primary care physician would mean a set amount/rate that compensates for long, hard hours and dedication.......not what is left after paying all the overhead and employee costs including malpractice and all other insurances necessary.......which is often a figure in the red.

We've seen many primary-care drs. quit private practice because there's no take-home pay for themselves after paying all the costs and absorbing uncollectible debts.

[Number 6]

Having spent the last half of my career managing a medium sized (12 docs and 2 Pas) fee for service medical practice let me weigh in here. Any model can work if executed properly. When I read that a physician seeing 100 patients can make twice as much as 50 patients, I just had to laugh. This is not true. It all depends on the complexity of the office visit. 50 level 5 visits will pay more than 100 Level 2. My real concern is that taking the profit motive away from the physician will kill productivity. I know for a fact that when a private practice physician goes to work for a hospital, they see considerably less patients. In medical practices, the scarce resource you must manage is physician time. If they are not compensated in relation to their productivity, you will lose their time. I think that the for profit model works best in physician practices. Just my opinion.
There are physicians in The Villages who only work 9-5, M-F. They don’t do call, round in the hospital or nursing homes. Their overhead still is in place. They wonder why they do not make any money.
Oh, and I don't think you can legally mix conserige medicine with Medicare. You cannnot bill both.

[ilovetv]

Having spent the last half of my career managing a medium sized (12 docs and 2 Pas) fee for service medical practice let me weigh in here. Any model can work if executed properly. When I read that a physician seeing 100 patients can make twice as much as 50 patients, I just had to laugh. This is not true. It all depends on the complexity of the office visit. 50 level 5 visits will pay more than 100 Level 2. My real concern is that taking the profit motive away from the physician will kill productivity. I know for a fact that when a private practice physician goes to work for a hospital, they see considerably less patients. In medical practices, the scarce resource you must manage is physician time. If they are not compensated in relation to their productivity, you will lose their time. I think that the for profit model works best in physician practices. Just my opinion.
There are physicians in The Villages who only work 9-5, M-F. They don’t do call, round in the hospital or nursing homes. Their overhead still is in place. They wonder why they do not make any money.
Oh, and I don't think you can legally mix conserige medicine with Medicare. You cannnot bill both.

Good post! From what's been published about the first family practice group to join this effort by TV, it appears they know productivity is important....or their patients would not stay with them.

[skyking]

Yes, it is. When you get several long newspaper articles with no mention of where the money will come from for the "generous" doctor's pay, you have no where to turn except to your imagination. There will be a lot less patients and doctors will be getting a lot more money. One can only imagine what that adds up to.

How long would it have taken the staff writer to include in one of the articles something about patient costs? Imagine, he had the time to tell us about the generous pay in two of the articles.

Why are they leaving it up to our imaginations? Perhaps because it will be a tough pill to swallow for the average villager.

I assume the intentions here are honorable. To make the business model work you need to find savings elsewhere to help pay the physicians for taking the extra time to practice good medicine and make the best decisions for each patient.

There are many examples of medical groups who achieve high quality, have less need to use hospital services (inpatient and out), use less diagnostics and less semi elective "ancillary' services when they are not on the productivity treadmill. Maybe the Villages are planning to partner with a Medicare Advantage Plan (or may sponsor one themselves) so that these savings can be redirected to the physicians in order to allow them to see patients at the pace they feel best. If they do that it is possible to provide the service they are talking about without large increases in premiums.

As you said, it would be helpful if a reporter with some background in the business side of medicine could ask and report on these issues.

[Mikeod]

Now we're getting closer to the nuts and bolts of the project. Having worked for a medical group where the providers were salaried, I have some experience in this. For me, the only way this works is for the health centers to contract with a medical group to provide the services at the clinics for a set amount per annum. The medical group sets the salaries of its staff based on an estimate of clinic volume/patient load plus the overhead. A standard of productivity is set for each provider in order to reach those volumes. An increase in productivity nets the medical group additional income to what was projected and the staff shares in the increased revenue at the end of the year.

This is why I don't expect the "Marcus Welby" result. The reality of health care is that insurance reimbursements are declining on a per visit/procedure basis while costs to provide the services increase. This requires providers to increase the volume of patients seen per unit of time and/or to expand the hours available to see patients.

That adds up to wait times for patients and soonest available appointments being some weeks away. So, call me skeptical.

[skyking]

So your complaint is that it is on the front page and not written by a PR professional?

I just reread the background of Gary Morse and Harold Schwartz from the book Leisureville. They came a long, long, way from their very humble beginnings.

Whether this will be a successful venture, this health care concept brought here, time will tell.

Something needs to be done.

And if someone needs a consult with a PR professional, read the ad on the back of the POA bulletin this month. Not very professional sounding for an MD.

Just my opinion. I too come from a very humble beginning.
Gracie, Don't misunderstand me. Gary Morse and Harold Schwartz have set the standard for developing great retirement communities. And as far as I can see in an honorable manner. Hopefully they can also set the standard for excellent healthcare for "senior" citizens. (It hurts to say "senior citizen" outloud.)

The PR on this story though is grade school. I really doubt that Gary Morse has ghost written the stories so I am confused as to why you have taken my comments as a criticism of the Morses.

[skyking]

Number 6 and Mikeod, we should get together and start a "retired medical group managers" club. The best part of being a member of the MGMA was trading war stories and giving each other pep talks. I agree with what both of you have said on this subject.

[tumbleweed]

There are a lot of unknowns which can be speculated or assumed. A significant fact communicated is salaried doctors, which may be short-hand for capitated reimbursement, often used in HMO/PHO and other forms of managed care delivery systems. I believe TV could benefit from a well-managed non-fee for service plan, as the current environment does not promote or encourage coordination between providers, communications with patients and providers, growing encouragement for use of centralized electronic personal health records, etc. Lots of independent providers, primarily specialists, w/entrepreneurial marketing methods with virtually unfettered fee for service reimbursements from Medicare and supp plans.

There are plenty of managed care models throughout the US that could be emulated in TV and I trust that over time an appropriate effective model will evolve. A couple of other points: the USF consultant to TV is Dr. Elliott Sussman who was CEO for several years of Lehigh Valley Health Network which is network that utilizes many salaried doctors. My thoughts are that any TV system is quite likely to be influenced by his experience and expertise.

The other point- for several years there has been a shortage of primary care doctors. It will be interesting to see how TV model will address this issue, as well as how the current health care providers will adapt over time to a new competitive model.

And, I personally believe the Marcus Welby and Mayo Clinic comparisons are a little over the top. But, this could still be a real good thing.

[jflynn1]

It is exciting and a positive direction That the Villages Health Care System is embracing and taking the lead on this subject in the state of Florida.

Florida currently has one of the highest rates of un-insured residents in the country. According to the 2010 Census, Florida had the third highest percentage of residents without insurance. The 2010 Census information (.xls) finds that, from 2008 to 2010, Florida’s average percentage of uninsured people was 20.7 percent. The national average for uninsured citizens was 15.6 percent. The situation doesn’t seem to be improving. According to a December report from the Florida Health Insurance Advisory, the number of people in Florida with private health insurance has continued to decline.

The state of Florida has shunned many grants associated with the Affordable Care Act. The state is the lead plaintiff in a lawsuit against the health care reform law.

As the Affordable Care Act (ACA), was signed into law in 2010, a federal mandate stipulated that states must create exchanges (state-operated health insurance databases that allow citizens to shop around for insurance) before the year 2014. According to law, states will have to prove to the federal government by January 2013 that they will have a functioning state exchange by 2014. If they cannot, the law requires that the federal government come in and create an exchange in place of the state. The state of Florida, however, has done nothing to even begin planning for creation of the exchanges as stipulated by the law, which experts warn could compel the federal government to step in.

Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Thank you Gray Morse for understanding the true goal of The Affordable Care Act, and for taking the lead on this subject in the state of Floirda.


:BigApplause::BigApplause::BigApplause:

[Bogie Shooter]

Yes, it is. When you get several long newspaper articles with no mention of where the money will come from for the "generous" doctor's pay, you have no where to turn except to your imagination. There will be a lot less patients and doctors will be getting a lot more money. One can only imagine what that adds up to.

How long would it have taken the staff writer to include in one of the articles something about patient costs? Imagine, he had the time to tell us about the generous pay in two of the articles.

Why are they leaving it up to our imaginations? Perhaps because it will be a tough pill to swallow for the average villager.

I have not read anywhere that someone will be holding a gun to your head saying you will have to participate in this program. Its your imaginnation that is running wild. If you don't want to play , just go home.

[looneycat]

I can understand, who went to American medical schools and did not just get board certification here, who spend more than 5 minutes talking to me and not waste most of my time by looking at the computer for 4 of them and 1 looking AT me, who don't try to sell me their products or get me to use drugs off-label so that insurance won't pay for them, who don't ask me toretry therapies that have already been shown ineffective on me just because its the only one they know!

[Russ_Boston]

For the past two years prior to coming to TV (and TVRH hospital) I have worked in a LARGE physicians practice group. Just our end of the business had over 80 providers and hundreds of nurses and techs. We had over 70,000 patients and we ran it similar to what I read in the paper. We were very profitable. If you include our parent company, Atrius Health, we had over 1 million patients in Massachusetts.

The one difference I see is that we were able to provide almost anything that needed to be done outside of full surgery (xray, CT, MRI, labs, day surgery etc.)

I wonder if the new TV model will end up encompassing all aspects of healthcare like this. If so, count me in (maybe even for employment)

You can read about these companies here: About South Shore Medical Center (http://www.ssmedcenter.com/about/about.cfm) (Dr. Chiang, my favorite, on the cover) and Atrius Health - About Us - Who We Are (http://www.atriushealth.org/aboutUs/whoWeAre.asp)

[Number 6]

For the past two years prior to coming to TV (and TVRH hospital) I have worked in a LARGE physicians practice group. Just our end of the business had over 80 providers and hundreds of nurses and techs. We had over 70,000 patients and we ran it similar to what I read in the paper. We were very profitable. If you include our parent company, Atrius Health, we had over 1 million patients in Massachusetts.

The one difference I see is that we were able to provide almost anything that needed to be done outside of full surgery (xray, CT, MRI, labs, day surgery etc.)

I wonder if the new TV model will end up encompassing all aspects of healthcare like this. If so, count me in (maybe even for employment)

You can read about these companies here: About South Shore Medical Center (http://www.ssmedcenter.com/about/about.cfm) (Dr. Chiang, my favorite, on the cover) and Atrius Health - About Us - Who We Are (http://www.atriushealth.org/aboutUs/whoWeAre.asp)

When you have a large group you can afford to be very profitable by providing services (products) that do not require physician time. That is, most notably, imaging services. X-rays, CATs, MRIs and DEXAs are still very profitable if you have the volumn to support the equipment costs.

[Number 6]

Number 6 and Mikeod, we should get together and start a "retired medical group managers" club. The best part of being a member of the MGMA was trading war stories and giving each other pep talks. I agree with what both of you have said on this subject.

Right! I would attend the NYMGMA meetings up in Saratoga and have a great time trying to top the next guy. We always said that managing physicians was like herding cats.

[Villages PL]

"Generous" pay for a primary care physician would mean a set amount/rate that compensates for long, hard hours and dedication.......

This is the second time you have mentioned the "generous" pay but I'm waiting to hear you tell us who pays it. Where will these large salaries come from? Medicare? Federal grant money? Mr. Morse? Health Center Patrons?

[Villages PL]

Paying contracted physicians a set monthly salary is not a new concept.

That's true. In the past I have read about people paying anywhere from 5 to 10 thousand dollars per year to belong to a group of doctors. The advantage being that they could be seen by a highly qualified doctor on a moments notice (i.e., no waiting as was mentioned by Mr. Morse).

Obviously, with a "family practice" group of physicians providing the care, there will be "families" and younger adults and children drawn from this southern TV area to this practice--not just seniors from TV.....which means more people having private insurance and not just (low-reimbursing) Medicare to pay the bills at these TV health centers.

I thought this health alliance was supposed to be about making The Villages America's healthiest home town. Now it includes families with children? I don't recall anything being said in the articles about private insurance being used to pay for this more expensive health care. Aren't most retired people covered by Medicare?

And as for waiting, the article in yesterday's (Sunday) Daily Sun (Section C, How would you want your mother treated?) states on p. C4 that the Colony center will be staffed with 8 doctors and 4 physician assistants, and "at any given time, 3 doctors and 2 P.A.'s will be on duty". That is good coverage, and probably, 1 or 2 of those drs. and p.a.'s will be there to treat walk-in, unscheduled patients.

I don't believe it matters how many doctors there will be. Each person will be assigned to the doctor of his or her choice. The article said that your doctor will know you well. Even with 8 doctors, there is a population of 85,000 or more villagers not counting those people who might come here from StoneCrest and other nearby retirement communities.

And "ultimately, there will be 6-8 similar centers spaced throughout TV". I think the Morse's do their homework before starting a project like this and it will work out fine.

Fine for anyone who can afford it. I believe it's only intended to serve a small percentage of wealthier people.

[Villages PL]

Duplicate post deleted.

[Villages PL]

My real concern is that taking the profit motive away from the physician will kill productivity.

Productivity for whom, the doctor or the patient? The doctor can see a lot of patients, require a lot of tests, and still give a wrong diagnosis. In other words, the patients can be poorly served while the doctor still makes his or her profit.

[westcoastsunshine]

I have been reading these threads with great interest.
I truly believe this is very exciting news for TV.
I am a Canadian but my husband is American.
For the last 8 years, he has had a chance to
experience 'Canadian' universal healthcare.
When he first came to Canada, he was quite
skeptical about our system. The doctors
being paid by the government....the care
must be terrible.
Three years ago, he got very sick and had
a chance to discover what our healthcare
was like firsthand. When our doctors discovered
that part of his lung had been removed in the U.S.,
they were horrified. According to our doctors,
it was a completely unnecessary operation.
Pharmacies share drug information online so that
drug interactions are avoided for all patients.

In his words, "Hospitilization, MRI's, Emergency
Care, Cat Scans, etc., etc. were all covered by
the Canadian government." "Our only out-of-
pocket costs for very high quality care were for
parking meters." "Like the TV proposal, the doctors
are being fairly compensated...they are not in it for
the money." "In fact, one of my operations was
cancelled at the last minute because a team of
doctors felt it was too dangerous. In the U.S.
this operation probably would have been done
anyway just for the money. I am still alive today
so I guess the Canadian doctors were right."
These are my American husband's words not mine.

I do believe this proposal for TV will set an amazing
example for the rest of the country. Please keep
an open mind.

WCS

[Villages PL]

I have not read anywhere that someone will be holding a gun to your head saying you will have to participate in this program. Its your imaginnation that is running wild. If you don't want to play , just go home.

Well, Bogie Shooter, we agree on that. I also have not read that someone will be holding a gun to my head. But isn't that a little off topic? This thread is not about me worrying about my health care. I have no health care worries. This is supposed to be a civil discussion about a topic of general interest to most Villagers. Nothing more, nothing less.

[Villages PL]

I have been reading these threads with great interest.
I truly believe this is very exciting news for TV.
I am a Canadian but my husband is American.
For the last 8 years, he has had a chance to
experience 'Canadian' universal healthcare.

We may not know very much about these new "health centers" but one thing we do know is that they will not represent universal healthcare. However, Universal healthcare would be a good topic for another thread, in my opinion.

[graciegirl]

Well, Bogie Shooter, we agree on that. I also have not read that someone will be holding a gun to my head. But isn't that a little off topic? This thread is not about me worrying about my health care. I have no health care worries. This is supposed to be a civil discussion about a topic of general interest to most Villagers. Nothing more, nothing less.

What this is, is a rant. Many purely speculative statements with no factual information. Patience would be good here. And forebearance.

[Number 6]

Productivity for whom, the doctor or the patient? The doctor can see a lot of patients, require a lot of tests, and still give a wrong diagnosis. In other words, the patients can be poorly served while the doctor still makes his or her profit.

Here my concern is that if physician productivity declines, he can serve less and less patients. Try to get an appointment now.

You typically manage around the convenience of the scarce resource. Here it is, unfortunatly, the physician.

[ilovetv]

I have been reading these threads with great interest.
I truly believe this is very exciting news for TV.
I am a Canadian but my husband is American. For the last 8 years, he has had a chance to experience 'Canadian' universal healthcare......

.....In his words, "Hospitilization, MRI's, Emergency Care, Cat Scans, etc., etc. were all covered by the Canadian government."
"Our only out-of-pocket costs for very high quality care were for
parking meters."

"Like the TV proposal, the doctors are being fairly compensated...they are not in it for the money." "In fact, one of my operations was cancelled at the last minute because a team of doctors felt it was too dangerous. In the U.S.
this operation probably would have been done anyway just for the money. I am still alive today so I guess the Canadian doctors were right."
These are my American husband's words not mine.

I do believe this proposal for TV will set an amazing example for the rest of the country. Please keep an open mind. WCS

First of all, the proposed TV primary-care dr. practice is not comparable to Canada's national health service, because in the TV proposed practice, bills will be paid by Medicare (senior citizens) and private insurance, and self-payers, not all by the federal government. And patients choose their doctors/clinics/hospitals.

And when it comes to diagnostics and treatment that people with cancer and other dreaded diseases, these two comparisons illustrate some of the other major differences between the U.S. and Canada's patient access to needed advances in care:

(Canada) "If you’ve been prescribed an MRI scan (Magnetic Resonance Imaging), you’re likely familiar with the wait-lists that have filled BC’s public health care system with patients desperate for a diagnosis

Canada has one of the lowest rates of MRI scanning machines per capita in the developed world, with six MRI scanners per million people, compared to 40.1 in Japan, 14.4 in Switzerland and 26.6 in the United States. Pittsburgh alone has more MRI machines than all of Canada......"

MRI Scans: Waiting for Public Health Care vs. Paying for a Private MRI Clinic | bcliving (http://www.bcliving.ca/health/mri-scans-waiting-for-public-health-care-vs-paying-for-a-private-mri-clinic)

Also:

Mohs Surgeons in all of Canada: 18

Mohs Surgery.Canada: Locate A Mohs Surgeon (http://www.mohssurgery.ca/locate_mohs_surgeon.html)

Mohs Surgeons in the State of Minnesota: 23

At the USA association link to locate Mohs surgeons, choose State: Minnesota
- American Society for Mohs Surgery (http://www.mohssurgery.org/i4a/member_directory/feSearchForm.cfm?directory_id=3&pageid=3286&showTitle=1)

Mohs Micrographic Surgery is most commonly used to remove non-melanoma skin cancers, like basal cell carcinoma and squamous cell carcinoma, or tumors where specific indications apply. MMS is designed to provide the highest cure rate of any form of skin cancer removal and at the same time limit the loss of unaffected (normal) tissue.

It is for this reason that Mohs surgery is very highly utilized to remove skin cancers in the area of the head and neck, where preservation of the greatest amount of normal tissue, on critical anatomic areas (eyelids, nose, ears, and lips), greatly improved the final esthetic outcome.

[westcoastsunshine]

My wait for an MRI was less than two weeks and my physicians were top notch including a family Dr. who spends and average of over 30 minutes per patient and a specialist who's text book is used by many of the leading US medical schools including Harvard.
Yes, ther are wait times for elective procedures because in (B.C.) Canada, procedures are priority based on need rather than ability to pay. Cancer, accidents, and other severe illnesses always come before any elective procedure,

[Villages PL]

Essentially, the business owner (Morse?) will hire physicians on salary thus removing the urgency to see as many patients as possible and presumably giving the patient a more thorough, personal experience.

What kind of business person would payout "generous" salaries to doctors who may only be serving 3 patients per hour instead of the national average of 8 per hour. Will they have to charge $300.00 for each office visit? Or, perhaps a large yearly fee?

[westcoastsunshine]

Yes, it is true that the Canadian healthcare system could
use some improvement in many areas.
We can only hope and pray that the Morse family can
get it right for all residents of TV. They have done
such an amazing job so far one can only think that
the same will be true of the healthcare system they
create.
I wish them the very best and truly admire the huge
responsiblity they are taking on trying to give TV the
best health system possible.

WCS

[Bogie Shooter]

Well, Bogie Shooter, we agree on that. I also have not read that someone will be holding a gun to my head. But isn't that a little off topic? This thread is not about me worrying about my health care. I have no health care worries. This is supposed to be a civil discussion about a topic of general interest to most Villagers. Nothing more, nothing less.

However, your civil discussion comments all seem to be on the negative side. Right?

[Villages PL]

However, your civil discussion comments all seem to be on the negative side. Right?

Well, not so much now that I have had a conversation with Amy Wixted.

[westcoastsunshine]

First of all, the proposed TV primary-care dr. practice is not comparable to Canada's national health service, because in the TV proposed practice, bills will be paid by Medicare (senior citizens) and private insurance, and self-payers, not all by the federal government. And patients choose their doctors/clinics/hospitals.

And when it comes to diagnostics and treatment that people with cancer and other dreaded diseases, these two comparisons illustrate some of the other major differences between the U.S. and Canada's patient access to needed advances in care:

(Canada) "If you’ve been prescribed an MRI scan (Magnetic Resonance Imaging), you’re likely familiar with the wait-lists that have filled BC’s public health care system with patients desperate for a diagnosis

Canada has one of the lowest rates of MRI scanning machines per capita in the developed world, with six MRI scanners per million people, compared to 40.1 in Japan, 14.4 in Switzerland and 26.6 in the United States. Pittsburgh alone has more MRI machines than all of Canada......"

MRI Scans: Waiting for Public Health Care vs. Paying for a Private MRI Clinic | bcliving (http://www.bcliving.ca/health/mri-scans-waiting-for-public-health-care-vs-paying-for-a-private-mri-clinic)

Also:

Mohs Surgeons in all of Canada: 18

Mohs Surgery.Canada: Locate A Mohs Surgeon (http://www.mohssurgery.ca/locate_mohs_surgeon.html)

Mohs Surgeons in the State of Minnesota: 23

At the USA association link to locate Mohs surgeons, choose State: Minnesota
- American Society for Mohs Surgery (http://www.mohssurgery.org/i4a/member_directory/feSearchForm.cfm?directory_id=3&pageid=3286&showTitle=1)


I lived in Scottsdale, Arizona for 1 year plus Hawaii for a few months
and almost every person I met along the way was curious about the
"Canadian" healthcare system. By the way, we also have a private
medical system for those people who prefer to pay for all their medical costs.
It was very interesting that most Americans seem to think that we
are not allowed to choose our physicians/hospitals/specialists. Nothing
could be further from the truth. We can choose any hospital, walk-in
clinic,doctor or specialist available in our province. We show our care
card when we walk in and that is the end of it. In fact, we don't even
know how much it costs because we never see a bill. The government
is NEVER involved in these very personal decisions or we would tell them to
stuff it where the sun don't shine.
The United States is one of the greatest countries in the world yet it
truly saddened me to hear tales of bankruptcies due to medical bills
or children not being treated because parents could not afford to
pay the doctor's fee.
Yes, we pay higher taxes which help pay for our medical costs. When
I was younger this upset me because I didn't understand why I had to
pay for everyone else....after all....I was healthy. When tragedy struck
my own family and all medical costs were covered for things like cancer,
diabetes, dementia, heart attacks, I finally got it! When I had my children,
all costs were covered including an emergency C-section.
It sounds like the Morse family is trying to create something that is some-
where in between the U.S. and Canadian system. All I can say is, "Wow!".
If it works, the residents of TV will very lucky people.

WCS

[graciegirl]

Well, not so much now that I have had a conversation with Amy Wixted.

So. Do tell!

[Villages PL]

So. Do tell!

Well, we had a good long discussion. But this was a couple of days ago and I'm not sure I can tell everything accurately. I didn't take any notes. You know there can be a difference between someone saying "yes"..."no"...or, "I think so".

But I'll give you some of the highlights we covered as best I can remember: 1) Mr. Morse will be the business owner and I believe that means he will be paying the "generous" doctor salaries.

2) The Villages healthcare centers will NOT take any walk-in traffic as ilovetv had speculated. To the contrary, they will have to find a way to limit the number of patients per doctor.

3) When I asked if it would be an HMO, she said she didn't think so but then admitted that "it could be."

4) I told her I'm happy with my HMO because I'm in good health and I get my medicare premium refunded every month. My doctor doesn't seem to have a lot of patients so if they open a new healthcare center nearby, it might put him out of business. She responded by saying there will be a meeting of all the Villages doctors to discuss this issue and that it is not their intention to put any doctors out of business. Some of the Villages doctors may end up working for the healthcare centers.

5) USF is in the process of putting information together so there will be a lecture coming up to inform everyone just how these healthcare centers will operate.

[blueash]

What kind of business person would payout "generous" salaries to doctors who may only be serving 3 patients per hour instead of the national average of 8 per hour. Will they have to charge $300.00 for each office visit? Or, perhaps a large yearly fee?

The average income for a family physician is about 150,000/yr per Medscape in 2011 (registration required). Medicare pays 70 per patient for a routine 99213 office visit. The time expectation is 15 mins for that code. So a doctor working at a comforatable pace will see 4 patients an hour. I have no idea where you get the idea that doctors see 8 per hour. I'd love a reference for that. Thus the doctor is generating 280/hr and if we pay her 100/hr she will make 192,000 yr working 40 hr/wk allowing 4 weeks vacation/CME. This allows 180/hr to cover all the fringe benefits and office costs which should be more than adequate as overhead should represent no more than 50% of practice income although in primary care it may slide a bit higher. We are allowing 180/280 or 64%. The doctor is well paid, the practice makes money and the pace of work is fair to patient and provider. Note that we have not assumed any income generated from lab work, EKGs or any other testing. We also though have not allowed for no shows or people who refuse to pay their copays or other income killers. Perhaps the office managers who are on this thread can confirm these numbers

[Bogie Shooter]

Who is Amy Wixted?

[CFrance]

You hire doctors who are willing to work within a lower paying model in exchange for other considerations (life style, stress reduction) as there is no way they will be paid as well as a successful fee for service practice. Then you be sure they have competant staff and a work environment that gives them the tools to succeed .. whether that is rapid access to consultants or a working microscope. You do not give them stock or a percentage of the profit as that incentivizes (at least subconsciously) keeping cost down for the wrong reason. You do not have an in office Xray or MRI or exercise lab or bone density machine. Thus you have lowered the cost of running and equiping the office to the point where you can pay the doctor to be a doctor and not a lab and test ordering machine. This system will work for patients who do not expect that medicine is a one stop shop where the doctor exists to order every test that Dr. Oz recommends. The people who might be very upset about this are all the doctors who have signed expensive leases for office space in TV and now find out that their landlord is going to open a competing office. Hmm

This is exactly the kind of excellent care we get with the University of Michigan Medical Center. the doctors there are so unconcerned with the dollar end of the deal. Our family doctor there says she works there because she doesn't have to have anything to do with billing/profits. Their focus is on providing you with health care, and someone else takes care of the dollars. It works. You get good care for your dollar. I am thrilled that this model might appear in TV.

[English Ivy]

Who is Amy Wixted?

I didn't know who she was and Googled her name to find the answer to that question. She's the program director for USF Health in The Villages. Her picture was actually in today's paper.

[Dick K]

Do I foresee the joining of The Villages Health System and a popular local Medicare Advantage Provider in the not too distant future. Perhaps after the Supreme Court rules on Obamacare? Just supposing !!Hmmmm!!!!

[Carla B]

According to the article in today's paper they need another 3,000 surveys to be turned in. So...Villages PL, did you decide to turn yours in?

[English Ivy]

Do I foresee the joining of The Villages Health System and a popular local Medicare Advantage Provider in the not too distant future. Perhaps after the Supreme Court rules on Obamacare? Just supposing !!Hmmmm!!!!

Probably not because United Healthcare recently purchased Preferred Care Partners.

UnitedHealthcare to Strengthen Service to Florida with Purchase of Preferred Care Partners and Medica Healthcare - MarketWatch (http://www.marketwatch.com/story/unitedhealthcare-to-strengthen-service-to-florida-with-purchase-of-preferred-care-partners-and-medica-healthcare-2012-02-28)

[Villages PL]

Who is Amy Wixted?

I believe she is the "project manager" or "program director" for the USF health alliance in the Villages.

[Villages PL]

According to the article in today's paper they need another 3,000 surveys to be turned in. So...Villages PL, did you decide to turn yours in?

Thanks for asking.

Well, I've been thinking about it. I have it completed but I have no enthusiasm for it. Granted, I have a little bit better opinion of the health care centers after talking to Amy Wixted but the community is not together on this project anyway. We were told that the purpose, of the focus groups and the survey, would be to see what we (Villagers) want. And presto! We get a plan for health care centers. It may be a good idea but I doubt that it was the result of the focus groups or the survey. So, I believe we were decieved.

In my opinion, they want us to feel as though we have some input but in the end, they are going go give us what they had planned all along. The health care centers were not just thought up lately, were they?

Poor lifestyle habits are so deeply entrenched in our culture that we have all but given up trying to do anything about it, except to attack it from the back end by giving people "better" doctoring. If The Villages was truly on board with making this America's healthiest hometown, they could at least have given us a token sign of it by making some changes in the food they promote on the front page of the lifestyle section. They couldn't even do a little thing like that. So why should I bother sending in my survey? It's not going to change anything.

[Avista]

Thanks for asking.

Well, I've been thinking about it. I have it completed but I have no enthusiasm for it. Granted, I have a little bit better opinion of the health care centers after talking to Amy Wixted but the community is not together on this project anyway. We were told that the purpose, of the focus groups and the survey, would be to see what we (Villagers) want. And presto! We get a plan for health care centers. It may be a good idea but I doubt that it was the result of the focus groups or the survey. So, I believe we were decieved.

In my opinion, they want us to feel as though we have some input but in the end, they are going go give us what they had planned all along. The health care centers were not just thought up lately, were they?

Actually it WAS brought up in the focus group I was in. The folks in my group were quite positive about it.

[Villages PL]

Actually it WAS brought up in the focus group I was in. The folks in my group were quite positive about it.

Avista, you were too fast for me. I hadn't finished my post yet. :024:

You mean someone suggested putting up health care centers where doctors would spend more time with patients? And as soon as Mr. Morse heard about it he said, "Okay, lets do it!" Just like that?

It's interesting to see that you're an RN who's certified in Gerontology. Guess what one of my suggestions was when it was asked (in my focus group) how we could improve the medical community. I said we could use a lot more geriatricians. Right now, I don't think we have any.

[Avista]

Avista, you were to fast for me. I hadn't finished my post yet. :024:

You mean someone suggested putting up health care centers where doctors would spend more time with patients? And as soon as Mr. Morse heard about it he said, "Okay, lets do it!" Just like that?

It's interesting to see that you're an RN who's certified in Gerontology. Guess what one of my suggestions was when it was asked (in my focus group) how we could improve the medical community. I said we could use a lot more gerontologists. Right now, I don't think we have any.

The topic to our group was concerning USF having centers where our health care would be coordinated. I forgot the exact question

[ilovetv]

Probably not because United Healthcare recently purchased Preferred Care Partners.

UnitedHealthcare to Strengthen Service to Florida with Purchase of Preferred Care Partners and Medica Healthcare - MarketWatch (http://www.marketwatch.com/story/unitedhealthcare-to-strengthen-service-to-florida-with-purchase-of-preferred-care-partners-and-medica-healthcare-2012-02-28)

Good grief. Looks like "competition" is a dead concept....when can you remember an acquisition of this size being halted by government regulators because of a "monopoly" resulting??

It looks like it would take somebody with the bucks the developer here has to be able to compete with this already too-big conglomerate. If Morse does that, more power to 'em.

[buzzy]

The survey was forwarded to us at our other residence, and the cutoff date passed before we could fill it out. Is there now an extension to the due date to get more participation?

[Bogie Shooter]

Avista, you were to fast for me. I hadn't finished my post yet. :024:

You mean someone suggested putting up health care centers where doctors would spend more time with patients? And as soon as Mr. Morse heard about it he said, "Okay, lets do it!" Just like that?

It's interesting to see that you're an RN who's certified in Gerontology. Guess what one of my suggestions was when it was asked (in my focus group) how we could improve the medical community. I said we could use a lot more gerontologists. Right now, I don't think we have any.

You are still being negative with your comments!

[jojo]

The survey was forwarded to us at our other residence, and the cutoff date passed before we could fill it out. Is there now an extension to the due date to get more participation?

Today's paper indicated they would still accept surveys. Said they have 32,000 returned and that the record which they would like to surpass is 35,000.

[Pturner]

The offering seems promising to me, especially since other models of health care delivery will still be available.

Whether the concept is being oversold remains to be seen. A rush to condemn the proposal, however, seems premature. Anyone who doesn't like the delivery of medical services under the Villages Health Care Centers model, or who can't afford it or who tries it and is dissatisfied, presumably can simply choose not to participate.

What's so wrong about having another option?

[Russ_Boston]

I've got an idea.

Let's wait until it's built.

Then wait until it's open.

Then check it out for ourselves.

Then decide if we want to utilize it. Just like any other business we decide to use.

We can debate about heath care all day long but it won't change a thing about what they are intending to do. As far as I can determine none of my money is being used on this unless I decide to use their services. Right?

[graciegirl]

I've got an idea.

Let's wait until it's built.

Then wait until it's open.

Then check it out for ourselves.

Then decide if we want to utilize it. Just like any other business we decide to use.

We can debate about heath care all day long but it won't change a thing about what they are intending to do. As far as I can determine none of my money is being used on this unless I decide to use their services. Right?

Russ Boston. I so agree with you as usual.

[asianthree]

My husband and I both work in two different hospital groups. Both own their docs. He needed an appointment waited three weeks. Doctor had a FOUR minute chat and told him he needed surgery. No exam. We were not happy. I caught one of the doc in the hall at my hospital had a ten minute conversation, he had me call the office and set an appointment soon as possible. Two days later my husband sat with my doc had a full exam and conversation. Appointment lasted forty-five minutes. And by the way no surgery. Yes we both work in the OR and know our way around the health care field. But when you look at the two health care that we work at: One just wants to get it done. The other wants to make sure the patient comes first. We just need to see which the Villages will have to offer and then make up our minds where to take OUR health care needs. There still will be other docs out there if this new group is not up to everyones standards

[CFrance]

My husband and I both work in two different hospital groups. Both own their docs. He needed an appointment waited three weeks. Doctor had a FOUR minute chat and told him he needed surgery. No exam. We were not happy. I caught one of the doc in the hall at my hospital had a ten minute conversation, he had me call the office and set an appointment soon as possible. Two days later my husband sat with my doc had a full exam and conversation. Appointment lasted forty-five minutes. And by the way no surgery. Yes we both work in the OR and know our way around the health care field. But when you look at the two health care that we work at: One just wants to get it done. The other wants to make sure the patient comes first. We just need to see which the Villages will have to offer and then make up our minds where to take OUR health care needs. There still will be other docs out there if this new group is not up to everyones standards

It would be helpful to know who your doctor is, or what group he is with. It takes time, energy, and frustration to search good doctors out on your own when you're new to an area. Recommendations give you a place to start--much better than opening the yellow pages or reading lists of doctors provided by your insurance co. If someone has a doctor group that treats people with care, if you could please acknowledge them, it would simplify the search for others.

[Russ_Boston]

Quick story about MD's who take their time with the patient.

As I mentioned I worked for a practice that had 80 providers. We had a few docs who took forever with their patient. We actually had to allocate an extra 15 minutes per patient for them.

But do you know what? Every single person who worked in the facility that I talked to would rather have had Dr. X who usually spent much less time with the patient. Why? Because he was a BETTER doc. Period!

Time is not the most critical aspect of quality health care IMHO. The most critical aspect of quality health care is - wait for it - Quality!!

[ilovetv]

Quick story about MD's who take their time with the patient.

As I mentioned I worked for a practice that had 80 providers. We had a few docs who took forever with their patient. We actually had to allocate an extra 15 minutes per patient for them.

But do you know what? Every single person who worked in the facility that I talked to would rather have had Dr. X who usually spent much less time with the patient. Why? Because he was a BETTER doc. Period!

Time is not the most critical aspect of quality health care IMHO. The most critical aspect of quality health care is - wait for it - Quality!!

THANK YOU!!!!! We have seen too many people wooed into a schmoozing hand-holder's flattery, charming talk, and telling the patient only what they want to hear.....leading patients to believe that bedside manner and the amount of time spent is everything.

But many times, hand-holding and spending a lot of time with a patient is the hideout of somebody who is groping for answers and won't admit he/she doesn't know.

Of course spending time is important....I can't stand abrupt, mechanical doctors....but being caring without being skilled and knowledgeable is a bad combination.

[Villages PL]

As far as I can determine none of my money is being used on this unless I decide to use their services. Right?

Do you pay federal income taxes? The Villages/USF health alliance is being funded by federal grant money. Amy Wixted said she didn't think Mr. Morse would receive any federal grant money for the new healthcare centers but she couldn't give me a definite "no" to my question. An upcoming lecture by USF, to explain how the health centers work, will be paid for out of the federal grant money. So there is a connection; we just don't know the extent of the connection.

As long as there's a connection, I think we, as taxpayers, have a right to be vigilant. And, also, as taxpayers, we have a right to critical analysis of what we see, without being nagged about being negative.

[Villages PL]

Another question I asked Ms. Wixted was: How will we know if the new medical centers are successful or not in living up to what we have been told? She couldn't say, just yet, exactly how that would work, but she did say something would be put in place. I expressed my doubts because I know that doctors don't like to report their failures. But she seemed confident that there would be a way to do it.

If it were up to me, I would give each patient a survey form for each visit to their doctor. Or at least a survey once a year.

[graciegirl]

THANK YOU!!!!! We have seen too many people wooed into a schmoozing hand-holder's flattery, charming talk, and telling the patient only what they want to hear.....leading patients to believe that bedside manner and the amount of time spent is everything.

But many times, hand-holding and spending a lot of time with a patient is the hideout of somebody who is groping for answers and won't admit he/she doesn't know.

Of course spending time is important....I can't stand abrupt, mechanical doctors....but being caring without being skilled and knowledgeable is a bad combination.

OH you are so right. Give me a doctor who knows his/her stuff any day over the Marcus Welby type who is not up on things. Helene went to a pediatric specialist at Cincinnati Childrens for many years and I saw her be so abrupt and mean to staff and underlings. She was civil to us but barely warm, but in the end she spotted a serious situation and it was remedied, saving our daughters life. I don't care she was not warm and fuzzy, she knew her stuff and that is what you go to get; Medical expertise.

[Russ_Boston]

Do you pay federal income taxes? The Villages/USF health alliance is being funded by federal grant money. Amy Wixted said she didn't think Mr. Morse would receive any federal grant money for the new healthcare centers but she couldn't give me a definite "no" to my question. An upcoming lecture by USF, to explain how the health centers work, will be paid for out of the federal grant money. So there is a connection; we just don't know the extent of the connection.

As long as there's a connection, I think we, as taxpayers, have a right to be vigilant. And, also, as taxpayers, we have a right to critical analysis of what we see, without being nagged about being negative.

Critical of course. We have the right. But since we have questions then wouldn't we need these lectures to find out? Catch 22?

[pbeinetti]

I received my enrollment application for the health care center at Colony today. Hmmm! Some concerns. First, the centers will not be billing your supplemental insurance companies -- that's up to the patient. That means waiting for the medicare 'explanation of benefits' document to arrive, which can take 2-3 months. Then the patient needs to dicipher the medicare document, and fill out a form to send to their supplemental insurance company. All told, it could take 4-6 months to get reimbursed. There are a lot of people in TV who will 1) forget to submit the form, or 2) not have a clue how to fill out the form and just ignore it. My current doctor takes care of all insurance submissions, and is a very good doctor. The enrollment application also indicates that the health care center will refer patients to specialists, if needed, so the patient doesn't have to figure out who to call. The information packet makes this sound like a big benefit. My current doctor does this, and every doctor I've gone to for the past few decades has also. I guess I'm a cynic! Morse is the owner of the care centers, and I'm sure he has a way to make lots of $$$ from them. If he was being totally honest about the reasons the care centers are being opened he would say, 1) to make more money for the Morse family and 2) to provide health care(hopefully better) using an established network of doctors.

[njbchbum]

I received my enrollment application for the health care center at Colony today. Hmmm! Some concerns. First, the centers will not be billing your supplemental insurance companies -- that's up to the patient. That means waiting for the medicare 'explanation of benefits' document to arrive, which can take 2-3 months. Then the patient needs to dicipher the medicare document, and fill out a form to send to their supplemental insurance company. All told, it could take 4-6 months to get reimbursed. There are a lot of people in TV who will 1) forget to submit the form, or 2) not have a clue how to fill out the form and just ignore it. My current doctor takes care of all insurance submissions, and is a very good doctor. The enrollment application also indicates that the health care center will refer patients to specialists, if needed, so the patient doesn't have to figure out who to call. The information packet makes this sound like a big benefit. My current doctor does this, and every doctor I've gone to for the past few decades has also. I guess I'm a cynic! Morse is the owner of the care centers, and I'm sure he has a way to make lots of $$$ from them. If he was being totally honest about the reasons the care centers are being opened he would say, 1) to make more money for the Morse family and 2) to provide health care(hopefully better) using an established network of doctors.

sounds like the highlighted sentences could make for a great start-up opportunity for an enterprising villager with a background in dealing with hospitsl/doctor billing with medicare and other insurances!

[CFrance]

I received my enrollment application for the health care center at Colony today. Hmmm! Some concerns. First, the centers will not be billing your supplemental insurance companies -- that's up to the patient. That means waiting for the medicare 'explanation of benefits' document to arrive, which can take 2-3 months. Then the patient needs to dicipher the medicare document, and fill out a form to send to their supplemental insurance company. All told, it could take 4-6 months to get reimbursed. There are a lot of people in TV who will 1) forget to submit the form, or 2) not have a clue how to fill out the form and just ignore it. My current doctor takes care of all insurance submissions, and is a very good doctor. The enrollment application also indicates that the health care center will refer patients to specialists, if needed, so the patient doesn't have to figure out who to call. The information packet makes this sound like a big benefit. My current doctor does this, and every doctor I've gone to for the past few decades has also. I guess I'm a cynic! Morse is the owner of the care centers, and I'm sure he has a way to make lots of $$$ from them. If he was being totally honest about the reasons the care centers are being opened he would say, 1) to make more money for the Morse family and 2) to provide health care(hopefully better) using an established network of doctors.

Thank you so much for this information. It's hardly a "Marcus Welby" type care center if you have to take over your own insurance billing. I received a letter (supposedly from Gary Morse) today extolling all the virtues of these health. Are centers and saying this was his dream that he had fought for. The letter neglected to mention what you have claimed.

[getdul981]

I thought, that when I first enrolled in Medicare, I was told, by them, that they would automatically forward the remaining balance along with their EOB to my secondary insurance. It's been sevral years, so I may have dreamed that somewhere.

[CFrance]

Ah, maybe that's the answer. But why wouldn't they mention that in the application?

[mickey100]

...If he was being totally honest about the reasons the care centers are being opened he would say, 1) to make more money for the Morse family and 2) to provide health care(hopefully better) using an established network of doctors.

Many people I've spoken to say the same thing. There is a lot of skepticism out there. We'll have to wait and see how things shake out.

[graciegirl]

Many people I've spoken to say the same thing. There is a lot of skepticism out there. We'll have to wait and see how things shake out.



And as I said before, I am pretty sceptical that anybody can fix the lack of good medical care here.

And as I said before making money is not shameful. Not working when you can work and living off of others who do work is shameful.

[wannab]

I must have been among the missing when the application letters were sent out, or maybe I had not been to settlement yet. Nothing was said about it when I did go to closing tho. So, does that Mean I'm out in the cold when the health center opens at Colony, even though it will be the closest one to where I live (Village of Charlotte)?

[graciegirl]

I must have been among the missing when the application letters were sent out, or maybe I had not been to settlement yet. Nothing was said about it when I did go to closing tho. So, does that Mean I'm out in the cold when the health center opens at Colony, even though it will be the closest one to where I live (Village of Charlotte)?


We just received the letter yesterday and they have been arriving to all of us for the past few days according to people posting on this forum.

If you recently closed probably you aren't on the mailing list. I am pretty sure that no one will be left out if they want to participate.

[skyguy79]

I must have been among the missing when the application letters were sent out, or maybe I had not been to settlement yet. Nothing was said about it when I did go to closing tho. So, does that Mean I'm out in the cold when the health center opens at Colony, even though it will be the closest one to where I live (Village of Charlotte)?Apparently you are correct that Colony is the closest to you, but there are three others planned that are not all that much further. One where Morse will eventually meet with Rt. 44, another down near the County offices at Powell off of 466a and the third at Brownwood. However, I believe what you would feel is more important to you is something that was stated in the letters that are currently being sent out, and I quote:
"Remember we're 92,000 Villagers and we don't know what percentage of you will want to join, but no Villager will be turned away."
You'll probably be a little uneasy until you know what's what for sure. I know I am as the provider my wife and I have is going to be with the Colony facility, and I've been assured by the Program Director that as her patients we will be able to stay with her. But I won't rest easy until what should be, actually is! Welcome to The Villages and have a Merry Christmas!

[jflynn1]

You hire doctors who are willing to work within a lower paying model in exchange for other considerations (life style, stress reduction) as there is no way they will be paid as well as a successful fee for service practice. Then you be sure they have competant staff and a work environment that gives them the tools to succeed .. whether that is rapid access to consultants or a working microscope. You do not give them stock or a percentage of the profit as that incentivizes (at least subconsciously) keeping cost down for the wrong reason. You do not have an in office Xray or MRI or exercise lab or bone density machine. Thus you have lowered the cost of running and equiping the office to the point where you can pay the doctor to be a doctor and not a lab and test ordering machine. This system will work for patients who do not expect that medicine is a one stop shop where the doctor exists to order every test that Dr. Oz recommends. The people who might be very upset about this are all the doctors who have signed expensive leases for office space in TV and now find out that their landlord is going to open a competing office. Hmm

xcellent response. Recruit businesses, healthcare professionals, to come here, lease them office space or build them buildings, then compete against them. What a concept.
We have great Drs, in The Villages.

Morse needs to do some administartive work on the Hospital, more professionals and support staff needed there to supprt The villages and the surrounding area

[Russ_Boston]

Not sure why anyone would treat this announcement any different than any other doctor's office opening. If you want to try them out then do so and see if you like them. If you don't - then don't!

FYI - In case anyone missed it, TVRH is expanding (in it's current location) by almost 100 beds. A new 3,4,5 floor being added to the area that only has two right now. This will make two 'towers' that have 5 floors. Not sure yet as to any new specialties that will be covered etc. Stay tuned.

[Dr Winston O Boogie jr]

Very exciting. But I'll remain a cynic until I see results. The problem is: Doctors see 100 patients rather than 50, patients wait through 5 or 6 exam rooms to see the doctor for just a few minutes. The solution: put Doctors on salary and they sit and visit for an extended visit. The only mention of savings is reducing the number of test and procedures (???). Still, it's a good dream. Who wouldn't love to see The Villages implement a superior system that could become a model for the nation.

Really?? You think that the people who are paying those salaries are not going to demand that the doctors see as many patients as possible? Do you know of any salaried people that can just take their time and do their job at their own pace? If a company is going to invest in salaries for doctors, they are going to want to see a return on their investment. You think that investors are going to accept a doctor seeing 50 patients when they could see 100? You think that they'd be willing to pay two doctors if they could get the job done with one? How will this change anything?

[Russ_Boston]

Really?? You think that the people who are paying those salaries are not going to demand that the doctors see as many patients as possible? Do you know of any salaried people that can just take their time and do their job at their own pace? If a company is going to invest in salaries for doctors, they are going to want to see a return on their investment. You think that investors are going to accept a doctor seeing 50 patients when they could see 100? You think that they'd be willing to pay two doctors if they could get the job done with one? How will this change anything?
Think you may have a point.

BUT

Why not try it out and see if it does make a difference? We can speculate all we want on this forum, but go with an open mind if you need a new doc. Then decide.

[skyguy79]

Not sure why anyone would treat this announcement any different than any other doctor's office opening. If you want to try them out then do so and see if you like them. If you don't - then don't!

FYI - In case anyone missed it, TVRH is expanding (in it's current location) by almost 100 beds. A new 3,4,5 floor being added to the area that only has two right now. This will make two 'towers' that have 5 floors. Not sure yet as to any new specialties that will be covered etc. Stay tuned.Russ, I like your straight-forward approach to this instead of the speculation that's going on which can lead to rumors and misinformation. Being you're in the health care industry, I give you more creditability than I would give to... say, myself who is not.

Now that doesn't mean I don't have some ideas of my own and here's one I'd like to pass on to you for your thoughts. I suspect that this USF Villages Health Care initiative is in part going to attempt to hold down costs by moving more toward something that has been around for many years now. That being a reduced number of MD or DO physicians and an expanded use of PA's, NP's and/or ARNP's under the supervision of MD's or DO's. This can result in considerable savings as the average salary of an MD or DO is well over twice or even thrice or more of the salary of MD's or DO's.

Personally we have been using an ARNP as our provider and it has been as good as an experience as we have ever had with any MD's we've ever had, even better in some ways. The only thing I've detected so far that the ARNP can't do is write script for controlled substances on their own. They need it done by the supervising physician. But I've read that there are some ARNP's in the US that can write CS scripts and that will probably be increasing in the future.