[Jayhawk]

[ColdNoMore]

Originally Posted by Villageswimmer

Doubtful. IMHO the post was not only full of unsubstantiated conjecture, it was crude and disrespectful. Excellent? Factual? Really?

I couldn't agree more.

[rexxfan]

Originally Posted by Barefoot

As a Canadian with many older friends, I've never once heard of anyone waiting six months for an essential operation.
Or being refused treatment based on age. Never.

Who decides its "essential"? Just wondering.
--
Bob C

[CFrance]

Originally Posted by Jayhawk

That's where you are wrong. Your "wonderful doctor" may change what he accepts for insurance any time. Then what will you say?

He would have to stop accepting Medicare period. We have medigap insurance that is good anywhere that accepts Medicare. He is private, not in a group, and not beholden to any higher authority. I chose OB's that way long ago and have always chosen doctors that way as well.

Sure he could decide not to accept Medicare, but that is less likely than what is happening with "Dr. Welby-promoted" VHS.

Don't know what your agenda is, Jayhawk. People are being cast off after promises of great care. I call that false advertising.

[Mikeod]

After reading all these posts and threads, I would like to offer this. Initially, VHS was created to provide a system of health care that differed from the usual in that providers would be allocated more time to spend with their patients. In order to accomplish this, each doctor’s panel would have to be limited so that access was optimal while still spending more time at each visit. Proud of this “innovative” health care system, The Villages promoted it in their literature and in sales visits.
However, this plan flies in the face of current medical economics, where, because reimbursements to providers is the primary place bureaucrats choose to limit the growth of health care costs, practitioners need to schedule as tightly as possible. Thus, VHS at the beginning was heading down a path unlikely to succeed. It would seem they hoped more patients would opt for the MA plan that provided a more consistent flow of income, but that didn’t happen. The primary reason for that is, as seen in these posts, people already had plans either wholly or partly paid by a former/current employer or had plans that provided them the freedom of choice they desired. As a result, revenue expectations were not being met. The disparity between the reimbursement plans and the lump sum from the MA plans is significant. Thus the push for the UHC plan.
Did they anticipate this happening? I don’t think so. I think the same thing happened with Moffitt and USF. Both anticipated greater revenue from MA plans than actually occurred. Both pulled the plug when losses mounted. VHS faces the same dilemma. If they closed down instead of limiting insurance plans, would we be any better off? As far as the director of VHS being the same person that was in charge of the USF plan, I remember reading that he moved to VHS because he believed in what they were trying to do. I have had friends in primary care in various practice models. The burnout rate is high and the satisfaction is low. The VHS model looks better for both patient and provider.

[HimandMe]

Originally Posted by Barefoot

As a Canadian with many older friends, I've never once heard of anyone waiting six months for an essential operation.
Or being refused treatment based on age. Never.

My kids live in Canada, and this is true. Furthermore, speak to almost any Canadian, they value their healthcare system highly. It's not without fault but better than most but it began 50-60 years ago when perhaps things were simpler and so many others (pharmaceutical, insurance companies etc. etc.) were not making huge amounts off those sick and dying. Another difference is that Canada unlike here has encouraged more general practitioners than specialists. I heard 80-20% with GPs front liners the largest group...and they do more in office). We have a major shortage of GPs to our detriment.

You cannot compare the Canadian system negatively or positively to ours as it's different and has an almost 60 year head start.

[goodtimesintv]

Originally Posted by CFrance

He would have to stop accepting Medicare period. We have medigap insurance that is good anywhere that accepts Medicare. He is private, not in a group, and not beholden to any higher authority. I chose OB's that way long ago and have always chosen doctors that way as well.

Sure he could decide not to accept Medicare, but that is less likely than what is happening with "Dr. Welby-promoted" VHS.

Don't know what your agenda is, Jayhawk. People are being cast off after promises of great care. I call that false advertising.

Oh, but your doctor--the kind of doctor I value, too--IS "beholden to a higher authority", which is Center for Medicare and Medicaid Services.

I would count on nothing when it comes to government and private insurers, because both are in bed together via politicians and lobbyists!

See the full story on this, the most-read article this week on this blog, "Social media's leading physician voice":

How MACRA will decimate the private practice physician

"....Recently, I attended an “informational listening session” for rural physicians, sponsored by the Center for Medicare and Medicaid Services (CMS) to learn more about the new MACRA proposal known as MIPS/APM (Merit-Based Incentive Payment System/Alternative Payment Model.) This plan will penalize 7 out of 10 small 1 to 2 physician practices in this country. Why? Because we will be overwhelmed complying with statistical reporting demands that do nothing to enhance the quality of care, instead of spending precious time seeing patients.

I inquired as to how CMS proposes to ease our burden of data reporting.

“I am not sure, but leave a website comment and someone might consider your needs.”

Not likely. A family practice physician described how technical mistakes at the claims clearinghouse froze her Medicare payments for eight months.

“Thank God my father died and left me a small inheritance,” she said.

Otherwise, her solo practice would have gone bankrupt. Is this the future of medical care in this country? Over 50 percent of her patients are on Medicare. If we allow this MACRA atrocity to go into effect, who will be left to care for the sick, disabled, and elderly?...."

How MACRA will decimate the private practice physician

[dbussone]

Originally Posted by Mikeod

After reading all these posts and threads, I would like to offer this. Initially, VHS was created to provide a system of health care that differed from the usual in that providers would be allocated more time to spend with their patients. In order to accomplish this, each doctor’s panel would have to be limited so that access was optimal while still spending more time at each visit. Proud of this “innovative” health care system, The Villages promoted it in their literature and in sales visits.
However, this plan flies in the face of current medical economics, where, because reimbursements to providers is the primary place bureaucrats choose to limit the growth of health care costs, practitioners need to schedule as tightly as possible. Thus, VHS at the beginning was heading down a path unlikely to succeed. It would seem they hoped more patients would opt for the MA plan that provided a more consistent flow of income, but that didn’t happen. The primary reason for that is, as seen in these posts, people already had plans either wholly or partly paid by a former/current employer or had plans that provided them the freedom of choice they desired. As a result, revenue expectations were not being met. The disparity between the reimbursement plans and the lump sum from the MA plans is significant. Thus the push for the UHC plan.
Did they anticipate this happening? I don’t think so. I think the same thing happened with Moffitt and USF. Both anticipated greater revenue from MA plans than actually occurred. Both pulled the plug when losses mounted. VHS faces the same dilemma. If they closed down instead of limiting insurance plans, would we be any better off? As far as the director of VHS being the same person that was in charge of the USF plan, I remember reading that he moved to VHS because he believed in what they were trying to do. I have had friends in primary care in various practice models. The burnout rate is high and the satisfaction is low. The VHS model looks better for both patient and provider.

Mike - I tend to agree with the first part of you post. However, when you initiate discussion about USF & Moffitt, I think your premise is not correct. Let's start with Moffitt. It is a great cancer research institute- but it's primary relationship, I believe, was with The Villages Regional Hospital and the developer. The promise was that Moffitt would develop a second campus, somewhat equivalent to its Tampa campus. That was never going to happen. The cost involved in duplicating research and teaching facilities in TV could never happen - too cost prohibitive. In addition, it is highly unlikely that world class researchers would wish to relocate to a semi-rural area in central FL. After all, this is not Gainesville.

As far as USF goes, it's faculty practice plan (I.e., it's docs) most likely over promised and definitely under delivered. Their expectation, IMO, was that the hospital or some entity would highly subsidize them, so that their practice fees represent profit. This is a common model with faculty physicians and their outreach efforts. Again, though, it was probably difficult for the practice plan to convince research/teacher/practitioners to locate here. The itinerant schedule used instead likely did not suit the patients or referring physicians.

IMO both organizations saw $$$ that were not going to happen. And it was not from the MA plans. Both organizations seek private funds whenever possible because of the uncertainty associated with public funding. As I noted above , these organizations like to develop relationships with entities that will fund physician base salaries at a minimum, then generate fee for service or per member per month fees that represent organizational profit. They believe they are superior to community physicians offering the same or similar services - sometimes that is true, sometimes it's not.

Moffitt, as I would have expected, learned that patients would travel to Tampa for advanced care. Therefore, why duplicate their Tampa campus here. So they essentially trashed their agreement with TVRH and the developer.

USF was unable to generate significant referrals from physicians who weren't part of the Villages Health System. After all, they came here to assist a group of docs (the Villages Health System) that was competing with community docs with existing practices.

The developer and those that run TVRH are intelligent and business-like. The $$$ were not happening and USF/Moffitt finally figured that out. Value is in the eye of the beholder and I believe USF and Moffitt were on the negative side of the equation...just my opinion, and some career based knowledge.

[Barefoot]

Originally Posted by golfing eagles

But you are deluding yourself by referring to it as "free" Income tax? GST? PST?.

Of course Canadian health care isn't free. It's funded by residents of Canada.
However Canadians don't have monthly health care premiums and health care is available to all without charge.
I also refer to The Villages as having "free golf for life". Obviously also funded by residents.

[dbussone]

Originally Posted by Barefoot

Of course Canadian health care isn't free. It's funded by residents of Canada.

However Canadians don't have monthly health care premiums and health care is available to all without charge.

I also refer to The Villages as having "free golf for life". Obviously also funded by residents.

And their yearly cart fees. [emoji41] Feel better Bare.


Sent from my iPad using Tapatalk

[Barefoot]

Originally Posted by dbussone

Feel better Bare.

Thanks for the good wishes, I appreciate them.
I'm really sorry I ever got involved in defending "free" health care in Canada.
This is a thread about The Villages Health Care System, and obviously feelings run deep.
It's not the time to be discussing international health care policies.

[kja966]

I am a working family practice physician looking at retiring to TV in 3 months. The original post actually contains some very believable information. This is not isolated to TV but is a nationwide phenomena. Budget cutting, pink slips, higher patient loads and a lot more documentation has been the norm since the Affordable Care Act (quite misnamed) started to bite. When I first bought in TV about 4 years ago I heard the flowering reports from friends of the "Marcus Welby" style of health care. I considered it a fairy tale as the only way to provide that level of service is either concierge medicine (say an extra 3-7K a year) or a white knight willing to heavily subsidize the plan. Otherwise its not (to use one of the current fashionable buzzwords) sustainable. Did they really think they had found the holy grail no one else has found? Two patients and hour won't pay for a medical assistant, receptionist, triage specialist and the100k a year for the electronic medical record. I don't know what UHC is paying for the standard medical visit (99214 ICDM code) but I doubt it covers 30 min. Economics says if you want to stay afloat you see at least 4 patients per hour and 6 if you can do it. Specialists can give more time but they charge a lot more. A 5 min dermatology visit can run $400 retail which is reduced by insurance company contract to $80.
One of the new wrinkles of Obamacare is physicians and hospitals have part of their income determined by "patient satisfaction". This is a total wild card as few send the surveys in unless they have an ax to grind. In short medical systems are cutting costs and consolidating because of declining revenues. TV is not immune, and its not finished yet. Shortage of providers is on the horizon which will push wait times into months. Urgent Care waits will typically be 4 hours or more and ER's will be jam packed. A good analogy is kind of like a gallon of milk is only $1 - if you can find anyone who has it.

[dbussone]

Originally Posted by Barefoot

Thanks for the good wishes, I appreciate them.

I'm really sorry I ever got involved in defending "free" health care in Canada.

This is a thread about The Villages Health Care System, and obviously feelings run deep.

It's not the time to be discussing international health care policies.

You have every right to discuss the Canadian system. It has its positives and negatives, but more pluses than minuses. Some of us who posted on this thread know a little about your system, but you know more. No harm in sticking up for something you believe in.

But could you please bring some lobster back when you return to TV? I won't tell GE!


Sent from my iPad using Tapatalk

[wendyquat]

I, for one, do not see why someone who is obviously not affected by this Medicare Advantage fiasco (for lack of a better word) is commenting at all! It's perfectly sane that those of us that are affected can express and share our disappointment! No, we did not receive "in writing" a promise that we would always be covered by VHS but it was pretty strongly IMPLIED since they had built and we're building beautiful and permanent offices and hiring many staff members! I do not blame the developer at all and I do understand that it comes down to making payroll BUT BUT BUT I do resent the manner with which it was presented with absolutely NO mention or "we're sorry for the inconvenience this has caused you"! It's not as if it weren't IMPLIED (I believe someone loves this word) that we would enjoy the Marcus Welby concept. After all, how many times did we hear it? Again, if it doesn't affect you, just BUTT OUT! Skip the thread! Move on!

[rubicon]

Originally Posted by Buffalo Jim

A conspiracy theory really ? Two people alone in a room can`t keep a secret .

Do you also believe that our astronauts did not really land on the Moon ?

Do you believe that the CIA and the " Military Industrial Complex " conspired to take out JFK ?

What would be the " upside " for an employee of the VHS to come on here and try to mislead everyone . So they can protect a job that pays them $52K per year ?
And what would be gained by the VHS by doing so ? Explain what the financial benefit to the business would be .

Buffalo Jim: In all due respect and for the simple reason of offering an alternative view ,in that same vein then I ask what or why would a resident feel the need to defend the Developer, The Villages or anything remotely related to the aforementioned? I long ago gave up the idea that people think, feel and emote the same. In this case this employee may be responding out of some sense of loyalty to her employer while perhaps other employees in her /his office may agree with posters who are angry. Also patients, customers etc do not always experience the same thing. A business may be performing at their peak one day and for a variety of reasons fail the next. Customers can only judge by their experience. I believe the same principle applies to residents here

To thine own self be true