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Doctors signing up patients dumped by The Villages Health

BY MARV BALOUSEK JULY 27, 20169 COMMENTS

A mad scramble is under way as many patients who plan to leave The Villages Health next year already are searching for new doctors.

The Villages Health, which operates six primary care clinics in The Villages, announced to patients earlier this month that it no longer would accept Original Medicare with supplemental policies, also known as Medigap, beginning Jan. 1 and that patients who want to keep those policies would need to find new doctors.

To receive care, new and existing patients are required to enroll in one of The Villages Medicare Advantage plans offered through United Healthcare. The clinics will continue to accept Tri-Care and some commercial insurance plans until patients become eligible for Medicare.

In letters to patients, The Villages Health did not say that it will help the dislodged patients find new doctors.

The Villages Regional Hospital, a separate entity that is part of Central Florida Health of Leesburg, will continue to accept all forms of insurance.

Patients can change their coverage during the annual fall enrollment period, Oct. 15 to Dec. 7.

The announcement unleashed a firestorm of critical comments and letters to **************.com and other local web sites. About 80 percent of patients responding to a **************.com online poll said they would keep Original Medicare with supplemental policies and leave The Villages Health.

Of the health system�s estimated 42,000 patients, about 15,000 reportedly would be affected. If 80 percent decide to keep their supplemental policies, approximately 12,000 patients would be seeking new doctors.

It�s unclear whether the community has enough primary care physicians to meet that demand.

Premier Medical Associates, another large area provider of primary care, received about 180 calls from prospective new patients during the first few days after the announcement, said Karol Shockley, office manager for the group�s six clinics.

With 14 primary care doctors on its staff, Premier is hiring more doctors to cope with the demand, Shockley said.

�I think as a health care organization, we are going to do everything we can to provide the best care,� she said.

Betty Cunningham, area coordinator for SHINE (Serving Health Insurance Needs of Elders), which offers health insurance counseling and assistance, said she received 18 phone calls and 15 web site referrals during the first three days after the announcement. She said the web site Health & Medical Directories is a good resource for finding area doctors.

Keith Hunter, assistant director of the Florida Department of Health in Sumter County said it�s difficult to determine whether the community has enough primary care doctors to handle the flood of new patients.

�I�m not aware of any resource (that measures) local physician capacity for new patients,� he said. �I believe that is a decision made by each provider or provider network.�

Three years ago, before The Villages Health opened its doors, Sumter County faced a dearth of primary care doctors.

The county had just 30 primary care physicians for a population of 118,891 and a ratio of 3,570 patients per doctor, according to 2013 statistics, the latest available from countyhealthrankings.org, a web site that tracks local health care statistics.

That ratio was higher than the Florida average of 1,390 patients per doctor. The Villages Health maintains a doctor-patient ratio below the state average.

In 2013, Lake County had 203 primary care physicians for a population of 325,875 and a ratio of 1,520 patients per doctor while Marion County had 192 primary care physicians for its population of 343,254 and a ratio of 1,757 patients per doctor.

Since then, The Villages Health has hired about 40 primary care doctors and Shockley said Premier has added about eight or nine doctors. Other providers also have come into the area.

Two providers have left the community. The University of South Florida left behind a $4 million investment, pulling out of its specialty clinic after six months in 2014 and turning it over to The Villages Health. The Moffitt Cancer Center of Tampa was replaced last year by Florida Cancer Specialists and Research Institute.

The Villages Health has been ranked highly for its primary care and its low doctor-patient ratio, but has a limited number of specialists and specialty clinics in its network. The developer reportedly has made a substantial contribution to keep the organization afloat.

Dr. Jeff Lowenkron, chief medical officer at The Villages Health, did not respond to several email and phone messages for this story. By email, he was asked whether The Villages Health will assist affected patients in finding new doctors, whether there are enough doctors in the community to serve those who leave, how many patients he expects will stay and whether there will be staff cuts resulting from fewer patients.

Treating patients with The Villages Medicare Advantage plans generates more revenue than treating those with Original Medicare and supplemental policies. The Village Health is paid for the number of Medicare Advantage patients it serves whether they see a doctor or not. Original Medicare pays the health system on a fee-for-service basis, often below the cost of providing those services.

Patients with Medicare supplemental policies pay monthly premiums, but their care is at low or no cost. They also are not required to stay within a provider network. Medicare pays 80 percent of approved rates and supplemental policies cover the rest.