[dbussone]

[QUOTE=sunnyatlast;969601]

Originally Posted by KeepingItReal

"Outside the walls" of TV and its unique age group that is a higher risk group for more claims because of age, most primary care clinics and hospitals do not serve a population that is 90%+ on Medicare, which pays less than costs.

Outside the walls of TV, private insureds' insurance reimbursements help to cover the costs that Medicare and supplements do not. That is why the mega-hospital systems like Mayo Clinic and Cleveland Clinic are buying up practices and community hospitals: to get the private insured base.

"Like most hospitals, the Cleveland Clinic counts on privately insured patients, who generally are profitable, to balance those on Medicare, which pays about 6 percent below cost, and Medicaid, whose payments average about 14 percent below. Unlike most hospitals, though, its reputation assures it a steady stream of wealthy patients, including foreigners, whose bills do not have to pass the needle's eye of an insurance-company claims examiner…."

http://www.newsweek.com/what-health-...d-clinic-76971

Any hospital that says Medicare is paying below its costs is a bloated organization, or not telling the truth. I've run both for-profit and not-for-profit systems. We always made money on Medicare patients. Why would companies like HCA, Tenet, Florida Hospital, and Orlando Health, etc operate in FL and do so well if they could not make money taking care of Medicare patients. Now Medicaid is a different story.

[KeepingItReal]

Originally Posted by dbussone

Any hospital that says Medicare is paying below its costs is a bloated organization, or not telling the truth. I've run both for-profit and not-for-profit systems. We always made money on Medicare patients. Why would companies like HCA, Tenet, Florida Hospital, and Orlando Health, etc operate in FL and do so well if they could not make money taking care of Medicare patients. Now Medicaid is a different story.

Agree for sure, Also doubt if there is much indigent care done in the Villages unlike a lot of hospitals and most every patient has at least Medicare or better to pay the bills.



It says: "United Healthcare pays royalty fees to Holding Co. of The Villages, Inc." it does not say the Villages subsidizes anything..

[KeepingItReal]

Originally Posted by sunnyatlast

My guess is that those "royalty fees" go toward paying the TV Health physicians' the decent, stable salaries where the almost-all Medicare payments cause revenue shortfalls.

And as for thinking that there are other retirement places with similar Medicare-percentage populations in the clinic and hospital mix……not so. Other retirement communities use community hospitals with all other ages groups mixed in, yielding a lower risk pool of claimants, and more reimbursement from private insurance that pays more. I know I have read that The Villages Regional Hospital is the largest Medicare biller in the country (and I'll try to find that reference again.)

Guessing is not really a good business plan, also the Villages doesn't do much if any indigent care to drain resources. Unless there is a study to back it up we don't really know what other communities do but any hospital can inflate costs and say they are losing on Medicare. Wouldn't make business sense for them to say, don't worry we are making plenty of money as it now.. Instead it is always we need more, more, more.

[janmcn]

Originally Posted by KeepingItReal

Guessing is not really a good business plan, also the Villages doesn't do much if any indigent care to drain resources. Unless there is a study to back it up we don't really know what other communities do but any hospital can inflate costs and say they are losing on Medicare. Wouldn't make business sense for them to say, don't worry we are making plenty of money as it now.. Instead it is always we need more, more, more.

If it weren't for these "royalty fees" required to do business in The Villages, other insurance providers might locate here. So it is really the consumer who is being hurt by this practice.

[KeepingItReal]

Originally Posted by sunnyatlast

Without the developer subsidizing The Villages Health's stable and fixed salaries to the doctors, it would not stay afloat financially.

Medicare and supplement or the UHC-AARP "zero premium" plan revenues would never cover the overhead costs of keeping these practices in good shape.

Your 10 minute office visit needs 8 people and 45 minutes of work

You do realize Medicare pays the Insurers big bucks each month to cover each of their Medicare Advantage customers right?

This is from 2012, probably more now.... $838 per month X 12 = $10,056.00 per year at least.
There are also other plans and special circumstances that would have CMS paying more per month on behalf of the beneficiary.


Medicare Advantage Monthly Capitation Rates for 2012 for All Plans except PACE Plans [download id="20"] showed Medicare Advantage Plans were paid $838 per month in Sacramento and $850 in Placer counties for plans with 4.0 STAR rating. In an effort to reward customer satisfaction and efficiency, reimbursement rates are also adjusted based upon the plan’s STAR rating. There are also other plans and special circumstances that would have CMS paying more per month on behalf of the beneficiary.


ALSO sunnyatlast the way you are posting makes it appear in some of your posts you are quoting me when you are not...it's your post. Thanks

[KeepingItReal]

Originally Posted by janmcn

If it weren't for these "royalty fees" required to do business in The Villages, other insurance providers might locate here. So it is really the consumer who is being hurt by this practice.

I agree, probably be a lot more of the larger stores, restaurants, and other things if it were not for this practice.

[NYGUY]

IMO, The Villages Health getting in bed with UHC was a strategic mistake (although probably not a financial one) that hurts The Villages Health's reputation as well as the villagers who utilize it (you can disregard all the villages media stories about how great Medicare Advantage policies are, when in fact, the only Medicare Advantage policy The Villages Health accepts is UHC's.

[shcisamax]

[quote=sunnyatlast;969624]

Originally Posted by KeepingItReal

And as for thinking that there are other retirement places with similar Medicare-percentage populations in the clinic and hospital mix……not so. Other retirement communities use community hospitals with all other ages groups mixed in, yielding a lower risk pool of claimants, and more reimbursement from private insurance that pays more. I know I have read that The Villages Regional Hospital is the largest Medicare biller in the country (and I'll try to find that reference again.)

I would like to see the reference on that if you can locate it.

[CFrance]

According to an interactive map of hospitals by state in this article http://www.nytimes.com/2014/06/03/bu...ased.html?_r=0
TVRH billed medicare at a rate of 0.8 times the national average in 2012.

[sunnyatlast]

[quote=shcisamax;969692]

Originally Posted by sunnyatlast

I would like to see the reference on that if you can locate it.

Here is some discussion of The Villages hospital being the highest percent Medicare in the country, highlighted in red:

Fact Finder – Medicare Dependent Hospital

The American Hospital Association annual survey of hospitals in the United States listed the total number of all U.S. registered hospitals at 5,795.

Medicare and Medicaid represent 55% of care provided by hospitals, with Medicare paying only 91 cents for each dollar spent caring for Medicare patients. 64% of hospitals are paid less than the costs of services provided to Medicare patients. The Medicare funding shortfall for hospital care exceeds $18 billion dollars.

Medicaid payment falls short of the cost of caring for Medicaid patients, with hospitals receiving an average of 86 cents for each dollar spent caring for Medicaid patients. 76% of hospitals are paid less than the costs of services to Medicaid patients. The Medicaid funding shortfall for hospital care exceeds $11 billion dollars.

When Medicare and Medicaid fail to cover their share of hospital costs, hospitals are forced to make cutbacks that affect the whole community and/or look to the privately insured to make up the difference.

Medicare Dependent Hospital

There are 86 hospitals in the country that are classified as Medicare Dependent Hospitals (MDH), (i.e. greater than 60% Medicare utilization).

Of the 86 hospitals, 14 are located in Florida. Of the 86 hospitals, TVHS has the highest percent Medicare at about 82%, making it the highest Medicare Dependent Hospital in the country for hospitals with greater than 100 beds.

The estimated shortfall in Medicare reimbursement for TVHS (i.e. reimbursement less than costs) is estimated at $5-7 million….."

The Villages Homeowners Association Fact Finder - Medicare Dependent Hospital - The Villages Homeowners Association

[KeepingItReal]

[QUOTE=sunnyatlast;969698][quote=shcisamax;969692]

Here is some discussion of The Villages hospital being the highest percent Medicare in the country, highlighted in red:


Where in all this was it mentioned that the developer is subsidizing anything in anyway which is where this thread started about UHC paying fees to the developer to operate here. How much indigent care does TVRH provide, did not see that mentioned either? Maybe the UHC fees should be used to make up this difference.

To be fair should not the hospitals with excessive Medicaid patients and excessive indigent care actually be compensated first??

__________________________________________________ ______________________

The Villages Health System as a MDH is campaigning Senators Bill Nelson and Marco Rubio in Washington, D.C. asking them to support the Medicare Dependent Hospital Preservation Act of 2011 as co-sponsors. This bill will put a mechanism in place to assist Medicare dependent hospitals like TVHS. Under the Act, the 86 MDH hospitals in the country would qualify for a portion of the estimated shortfall in Medicare reimbursements. For TVHS, it’s estimated $5-7 million loss would be reimbursed about 75% if the Act would be passed.

Villages who desire to support the TVHS campaign may visit a table in the main lobby of The Villages Hospital with letters to the Senators telling the TVHS story. Sample letters are available for signature and sending. TVHS will take care of mailing them to Washington, DC. Additionally, sample letters are available on the VHA website for Villagers who wish to support the MDH Act.

[KeepingItReal]

Low volume and rural hospitals are saying they have an even bigger problem than the urban MDH hospitals?


Urban Medicare-Dependent Hospitals Preservation Act of 2013

There is legislation pending but not much action looks like to address urban medicare dependent hospitals, 2 sponsors from Florida..

All Bill Information (Except Text) for H.R.1390 - Urban Medicare-Dependent Hospitals Preservation Act of 2013

https://www.congress.gov/bill/113th-.../1390/all-info

All Actions, Including Floor Amendments (4)

Date
04/09/2013 Referred to the Subcommittee on Health.
Type of Action: Committee Consideration
Action By: House Ways and Means
03/21/2013 Referred to House Ways and Means
Type of Action: Introduction and Referral
Action By: House of Representatives
03/21/2013 Referred to the House Committee on Ways and Means.
Type of Action: Introduction and Referral
Action By: House of Representatives
03/21/2013 Introduced in House
Type of Action: Introduction and Referral
Action By: House of Representatives

[NYGUY]

Originally Posted by sunnyatlast

....Medicare and Medicaid represent 55% of care provided by hospitals, with Medicare paying only 91 cents for each dollar spent caring for Medicare patients. 64% of hospitals are paid less than the costs of services provided to Medicare patients. The Medicare funding shortfall for hospital care exceeds $18 billion dollars....

It should be noted that these numbers are only accurate if you assume the rates billed by the hospitals represent the actual cost of care. I don't think you will find anyone who believes that, including the hospitals.

[dbussone]

Originally Posted by NYGUY

It should be noted that these numbers are only accurate if you assume the rates billed by the hospitals represent the actual cost of care. I don't think you will find anyone who believes that, including the hospitals.

Hospital "charges" have not reflected the cost of doing business since TEFRA changed Medicare in the mid-80s. Accounting methodologies were changed more than a decade ago to reflect the fact that patient revenue noted on the books of hospitals was a specious number. Net patient revenue correctly reflects actual reimbursement after contractual allowances (insurance discounts, Medicare and Medicaid discounts, etc) have been deducted. Some of you might be interested in looking up a hospital cost report or tax return (form 990) just for the fun of it.

[CFrance]

Originally Posted by dbussone

Hospital "charges" have not reflected the cost of doing business since TEFRA changed Medicare in the mid-80s. Accounting methodologies were changed more than a decade ago to reflect the fact that patient revenue noted on the books of hospitals was a specious number. Net patient revenue correctly reflects actual reimbursement after contractual allowances (insurance discounts, Medicare and Medicaid discounts, etc) have been deducted. Some of you might be interested in looking up a hospital cost report or tax return (form 990) just for the fun of it.

I would if you'd help me read it!