[blueash]

Originally Posted by golfing eagles

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?
This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss. .


The Villages is a challenging location for recruitment of physicians. ..Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

.

Remember the game to find out which one doesn't belong?
So which is it?

Either TVH has a highly competitive pay and incentive package similar to other offers in Florida...

Or

There is no way it can compete with the package being offered elsewhere in addition to the disadvantages of this being isolated and old people.

[golfing eagles]

Originally Posted by mntlblok

*Please* start. Very curious and don't really have a clue.

Ok, I'll start, maybe ski bum can add to this. First of all, it is a very complex issue with a long history. The problem starts in 1966 with "The Great Society" and the formation of Medicare and Medicaid, as well as the birth of health care insurance as a near necessity and the massive proliferation of lawyers and litigation. As opposed to the "old days" when an office visit was cheap, there were now 3rd party payers that shoveled taxpayer money at providers. We had records on an index card from the stone age prior to EMRs and an office visit was $3.00. Going further back, my mother saved her obstetricians bill from 1947 and all pre-natal, delivery and post-partum care was a whopping $45.50.

Now, along with these government programs came government regulation that further drove up the cost of care. And of course , in order to pay, they wanted a specific diagnosis. This led to a complex system of charge coding under CPT and diagnostic coding under ICDM. To get these diagnoses, the technology exploded as well as specialists and sub-specialists, further driving up cost. So about 1972 those "wise" men in DC decided to "capitate" medical schools---pay them $$$$ to increase total medical school class size from about 9,000 to over 17,000. Remember, our population was only about 210 million back then. So with tons of taxpayer money on the table, almost all 100+ medical schools double their class size. But just like major league pitchers on a 5 day rotation and 20 expansion teams, this was the first dilution of the talent pool. The theory was that more doctors would drive competition up and cost down. However, it turns out, that more doctors just make more work for more doctors, particularly higher cost specialists. Then, technology exploded----ultrasound, CTs, MRIs, endoscopy, cardiac catheterizations, bypass surgery. And every new procedure was dumped into Medicare part B at an exorbitant starting cost, diluting the $$$ pool for routine primary care. The litigation forced doctors to order these expensive imaging procedures and refer to specialists, mostly unnecessarily just out of self preservation.

So now the next phase: When I applied to med school, there were 125,000 American graduate applications for 17,000 seats. Between lower physician compensation, increased regulation and increased litigation, our best candidates decided to get an MBA in 2 years and get better salaries rather than spend 7+ more years to start a medical career. That, plus the huge amount of student loans incurred. So once again the talent pool was diluted. Our teaching hospital can no longer fill their programs with American graduates, so they had to turn to FMGs for bodies to fill the space. Some are very good, some are dreadful. My residency program had 14 positions for 3 year Internal Medicine candidates and received 10,000 applications. Nine thousand were from FMGs and went immediately into the garbage. The remaining 1000 were easily pared down to 200 from which 14 were chosen. Now, 45 years later, I recently had reason to look at the staff of that program----much to my surprise I couldn't even pronounce the names of over 1/2 of them.

So now, fast forward to our situation in TV: Diluted talent pool due to the reasons listed above as well as a population that is now 330 million, residency programs filling with FMGs, and a less than desirable area of Florida for young physicians with a young family. Of course medical care is less than spectacular compared with Boston or NY. That doesn't mean it is horrible either. Remember, let's just assume there are 35,000 cardiologists in the US---only one of them is the best---and he can't keep all 120,000,000 appointments with cardiologists---somebody gets second best, and third, and down the line.

Hope this helps

[tophcfa]

Originally Posted by golfing eagles

The part about switching back to traditional Medicare, however, is unfortunately true.

Doc, why is that unfortunate? Insurance would be way too expensive if people didn’t have to pay for it until they need it. If everyone was allowed to get a less expensive Advantage plan when they are healthy, and then switch to a Medigap plan without underwriting when they come down with a serious and expensive illness, traditional Medicare supplemental plan prices would skyrocket.

[MSGirl]

Originally Posted by davephan

Medicare Advantage is really named incorrectly, it should be named Medicare Disadvantage. I’ve heard that 30% of all claims are routinely denied. If your doctor prescribes 12 treatments, they might only approve 8 treatments. You are also restricted to going to clinics that you probably wouldn’t have chosen on your own.

One of the worst things about Medicare Advantage is after one year of switching to Medicare Advantage, you have to medically qualify to switch back to Original Medicare. If you’re health declined, then you could be stuck with Medicare Advantage for life. The best option is to stay on Original Medicare with a good supplement.

You HEARD incorrectly. Unless you know for sure because you experienced it, then why bring it up? Medicare Advantage plans follow traditional Medicare. If a procedure is denied with a Medicare Advantage plan, then it’s because it didn’t follow Medicare guidelines. So the same procedure would be denied with traditional Medicare. You actually have one year to decide if a Medicare advantage plan is right for you. At that time you can switch back without going through hoops.

[golfing eagles]

Originally Posted by blueash

Remember the game to find out which one doesn't belong?
So which is it?

Either TVH has a highly competitive pay and incentive package similar to other offers in Florida...

Or

There is no way it can compete with the package being offered elsewhere in addition to the disadvantages of this being isolated and old people.

Remember I posted competitive for THIS AREA. And that was 10 years ago. Remember I posted TIMES CHANGE. So yes, it WAS competitive at the time, and it is still not poverty level. However, other areas can afford to make better offers. So, if you were still practicing, late 30's and had 3 kids ages 3-10, which offer would you take-----TVH in a community of 90% Medicare and very little geared toward kids and families for say 300K, or Tampa/Clearwater with young people, families, proximity to the gulf, and a better private payer mix for closer to 500K?????

PS: Did you get that postcard as well? Many of these offers are truly astronomical.

[golfing eagles]

Originally Posted by tophcfa

Doc, why is that unfortunate? Insurance would be way too expensive if people didn’t have to pay for it until they need it. If everyone was allowed to get a less expensive Advantage plan when they are healthy, and then switch to a Medigap plan without underwriting when they come down with a serious and expensive illness, traditional Medicare supplemental plan prices would skyrocket.

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

[tophcfa]

Originally Posted by golfing eagles

Kind of depends on where in Illinois. Some rural areas may still have an 85 year old GP making house calls in his horse and buggy

Same in every state. We live in rural western Ma, where good health care is hard to come by if you need a highly qualified specialist or are on a short timeline. We use local health care for our minor usual and customary health needs that don’t require immediate care. If one of us comes down with a more serious health care need, we hit the Massachusetts Turnpike eastbound to Boston where we have in network access to the likes of Mass General, Brigham and Women’s, Beth Israel Deaconess, Dana Farber, etc…. There are many great things about living in a rural area, but access to health care isn’t one of them.

[blueash]

Originally Posted by golfing eagles

Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications.

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

[tophcfa]

Originally Posted by golfing eagles

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

Poor long term planning trying to save a buck in the short run.

[Topspinmo]

Originally Posted by justjim

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

I thought AHC act was supposed fix the health care system?

[Burgy]

I agree with you. I also think too many snowbirds can't let lose of their up north plans expecting coverage here. Perhaps they should change to a local advantage plan that may cover up north too.

[golfing eagles]

Originally Posted by blueash

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?

[Pres1939]

Originally Posted by golfing eagles

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

Very thorough response to the OP. I have a Medicare Advantage plan (Devoted North Florida Core HMO), and they have been wonderful to deal with.

[Ponygirl]

Originally Posted by blueash

Sometimes what you read on TOTV is opinion. Sometime people claim to be experts and are so wrong, so wrong.

And here was a statement that is in the so wrong category and easily checked.
See the graph below from https://www.aamc.org/media/9581/download?attachment

Forty years ago, 1983 there were about 36000 applicants for US allopathic medical schools. About 25000 were first time attempting to gain admission and about 11000 were trying again after previously failing to gain admission.

Five years ago, 2018, there were about 52000 applicants for US allopathic schools, 39000 were first time and 13000 repeats.

Please, readers, do not repeat the false claim that the number of people applying to medical school is down from 120000 to 25000. It is blatantly, totally , completely untrue.

Thank you blueash

I too was confused abt the stats for people applying to medical school.

If you use the 52,000 number for 17,000 slots. That’s an acceptance rate of over 32%.

In actuality the number for acceptance is closer to 4%

Some exact numbers are: My son went to George Washington university med school. 15.216 applications for 181 slots. Acceptance rate of 1.09%

[rustyp]

Originally Posted by villagetinker

OP, IMHO, the first thing you need to do is call your health care insurance and get a list of local providers that accept your ADVANTAGE plan, then you will need to start calling these doctors to see if they are accepting new patients. Also, IMHO, you might ask to see if it is possible to get back to original Medicare and supplemental without a huge cost increase, as there are a lot more doctors accepting original Medicare and supplemental than Advantage plans.
Hope this helps.

Originally Posted by golfing eagles

It is only unfortunate for those that thought they would be OK with an advantage plan, only to find out it wasn't the right fit for their medical problems.

Historically, most Medicare beneficiaries have chosen to receive their benefits through traditional Medicare, but enrollment in Medicare Advantage plans has grown rapidly over the past decade. Forty-five percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022, a share that is projected to rise to more than 50 percent by 2025.

I'll also offer up the fact that a portion of seniors on traditional Medicare have not considered a choice due to the fact they stick with the plan their company provides (usually Medicare plus a supplement) as part of their retirement package.

Makes me wonder if these Advantage Plans are so horrible why is their popularity growing ?