Meaning of royalty fees pd to the villages
 

Full page add in today's paper for The Villages Health and United Healthcare.
At the very bottom of page it states, "United Healthcare pays royalty fees to Holding Co. of The Villages, Inc. (The Villages) for use of its intellectual property". What intellectual property is being exchanged with United Healthcare?

My guess is the name, "The Villages Health and United Healthcare".

All businesses within the Villages pay fees for that privilege of being within the compound, only ones that don't are the family….

There is big money in medicine these days, well beyond the licensing of a trade name. Here is some history on the Moffitt Cancer Center. Doctor taking on Villages over cancer center - Robert Boissoneault Oncology Institute Robert Boissoneault Oncology Institute

According to Blechman, the developer gets about $0.07 on every dollar spent in The Villages.

Intellectual property is basically patents, copyright, and trademarks.

Looks like the developer has even registered "America's Healthiest Hometown", hard to believe that one will hold up but it might.

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.

http://www.kevinmd.com/blog/2011/01/...utes-work.html

Who is Blechman?

He's the "genius" who wrote this pile of horse manure:

"Everything's owned by the developer," he says. "The government is owned by the developer. Everything's privatized — and they're happy with that. You know, they've traded in the ballot box for the corporate suggestion box."

Never mind these elected office seats for county and Villages Community Development Districts on our ballots last week……

http://www.sumterelections.org/Porta...nd%20seats.pdf


The Villages: Florida's Disney World For Retirees : NPR

Hi sunnyatlast: Two things. If one office visit takes 8 workers and 45 minutes then how much is being wasted while patients sit in the waiting room and then are left to wait in the examination rooms?

Secondly how is Villages of Lake/Sumter, Inc. assisting its medical staff since it is pulling it pre-agreed on profits off the top???????????

Villages Lake Sumter, Inc has a captive cash cow for better or for worse?????????

I knew that, but was hoping the one doing the quoting would respond. If someone is going to use Blechman as a source, I would like to know why.

[QUOTE=sunnyatlast;969488]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.

They seem to operate very well outside the walls ..It seems operating within the Villages is an extra expense for most businesses and not the other way around.

[quote=KeepingItReal;969595]"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

[quote=sunnyatlast;969601]The Villages ares not the only place where there are a lot of older people, maybe other retirement communities for one...

What does this statement from the original post say???

At the very bottom of page it states, "United Healthcare pays royalty fees to Holding Co. of The Villages, Inc. (The Villages) for use of its intellectual property"

[quote=KeepingItReal;969607]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.

Again, please see this info I added above:

"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

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.)

[QUOTE=sunnyatlast;969601]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..

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.

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

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.

[quote=sunnyatlast;969624]I would like to see the reference on that if you can locate it.

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.

[quote=shcisamax;969692]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

[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.

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.

I would if you'd help me read it!

AARP and The Villages Developer --- United Healthcare Disclosures
 

For many years the AARP has endorsed and marketed various United Healthcare plans with disclosures similar to the one in question here in The Villages. I am pasting such a disclosure from AARP as follows:
==============================

**AARP® Hospital Indemnity Insurance Plans insured by United Health Care:

For definitions, disclosures, eligibility requirements, exclusions, pre-existing conditions and limitations: NY residents click here, all others click here.

AARP endorses the AARP Hospital Indemnity Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers.

AARP does not employ or endorse agents, brokers or producers.
Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY 11749, for New York residents) Policy Form Number GRP 79171 GPS-1 (G-36000-2).

AARP Hospital Indemnity Insurance Plans provide supplemental health insurance benefits and are not Medicare supplement or major medical plans. All plans may not be available in your state/area.
This is a solicitation of insurance. A licensed insurance agent/producer may contact you.

Call a licensed insurance agent/producer at 800-523-5800 to receive complete information including benefits, costs, eligibility requirements, exclusions and limitations.
WB25464ST (07/13)

==============================

AARP's disclosure summary for various United Healthcare plans is accessible from the link below:

Insurance Disclosures
====================
I see our developer's negotiating with United Healthcare as a benefit to us. Our developer is replacing AARP as the recipient of royalties for intellectual property. As such, our version of the United Healthcare Advantage Village Plan gives us more time with the physicians since it caps the number of patients per physician at 1,250 (where the industry standard is 2,500 - 3,000).

Mostly we benefit with network referrals. At our age and stage in life, specialty physicians are often required. Although not heavily publicized, we may go to any specialist in the State of Florida within the United Healthcare network without a primary care physician's approval. This latter point is HUGE! It means when we need the best of care from a specialist, we don't have to wait for back office clerks to go through the maze of digital paperwork to see a uroligist, cardiologist, etc. Specialist appointment delays are minimized.

The United Healthcare HMO Advantage Plan also has a lightly publicized feature called PASSPORT. We may go elsewhere in the country to United Healthcare network providers; but there is a procedure that needs to be followed usually handled with one phone call.

I am not a Pro-Developer advocate; but I really think they got this one right in structuring a WIN-WIN-WIN for all parties -- residents, doctors, United Health Care, and the Morse Family Empire.

Thanks for adding some meat to the bones!!

I could do that!