The Villages Health Care Program
 

We just got a call from The Villages Health Care telling us that The Villages Health Care System is no longer taking new patients with Medicare as primary insurance and Tricare For Life as secondary insurance. That's just gone into effect today. We just got off the phone with the call center supervisor. Anyone else in our situation? They have too many patients and not enough doctors. Good luck to us veterans and our spouses.

I'm not a veteran nor are we on medicare but also were told today to try back in January. I have BCBS

Well as a member of Villages Health I am glad that they appear to be sticking to their original mission statement of each doctor having only 1200 patients. I do feel for those who are being phased out, I would be so upset to have to start the search again for new health care options. I feel your frustration, but feel happy for myself.

I would assume that those of us already in the system are grandfathered in. At least I do hope so.

You are very fortunate to have been accepted. I would love for us to be patients there. Unfortunately they have always only accepted certain kinds of insurance.


I have a feeling that this isn't a change, just their way of doing business and only certain kinds of insurance participate and are accepted.

I was at a UHC seminar and asked if it was part of TV HealthCare Network. I was informed that UHC is not part of TV HealthCare network, as I could go to any doctor I want.

Was I misinformed?

We have UHC supplement insurance and go to Villages Health.

Medicare and Tricare for Life are still listed on their web site as acceptable insurances they accept.

There is still plenty of room for new patients if you sign up with United Health Care Medicare Advantage. It's the only Medicare Advantage plan accepted by The Villages Health network. (It's Medicare Advantage, not plain Medicare, a big difference)

Accepted Insurance by The Villages Health

Two inserts in the Daily Sun already this week in addition to the weekly Sunday paper pages devoted to the product. Look at the brochure and see how many neighborhood meeting are being held from October 13 through December 3. It lists 52 different locations with multiple meetings at each location. In addition, you can walk into one of three UHC Medicare Stores located in the Villages. Based upon the numbers of meetings and unlimited access to sales personnel there is plenty of room for more patients in UHC Medicare Advantage.

As stated in the brochures, "United Healthcare pays royalty fees to Holding Company of the Villages, inc.". So there is always room for more patients as long as Morse makes a profit, otherwise SOL.

Is this TV Health trying to recruit more patients (which I doubt), or UHC trying to sell more medicare advantage policies prior to the open enrollment deadline (more likely). In the latter case, there is no guarantee of room for more patients at TV Health

So why would UHC pay royalties to Holding Company of The Villages Inc if you enroll in their advantage plan if there isn't a tie in? UHC Medicare plan has no such arrangement.

Here's another interesting link to Villages Health. Doubt he took a pay cut.

After USF failure in the Villages, top official finds job there | Tampa Bay Times

Then he did this.

Ex-USF Physicians Group boss sues USF for $600,000 pay | TBO.com and The Tampa Tribune

I'm sure there is some sort of arrangement, after all, TV Health ONLY accepts UHC medicare advantage as their only advantage plan. However, UHC sells these policies to everyone who has other doctors as well, so they may be holding these meetings to enroll non TV Health patients as well, and the "royalties" are only for TV Health exclusivity.

There are several doctors outside of The Villages Health System that take the United Health Care Advantage Plans PPO & HMOs in the UHC network.

If you have the Medicare Complete Choice PPO you could go outside the network with higher copays. Make sure your doctor will file the claims for you.

The AARP Medicare Supplements insured by United HealthCare
are taken by any doctor who accepts Medicare Assignment.

I don't understand what point you are trying to make.

And I think it is safe to say that UHC products have priority consideration when it comes to acceptance by Villages Health.

We are so disappointed in the healthcare program and restrictions. The advertising which sold us on TV while house hunting was and continues to be misleading. I particularly love the following advertisement that "health care is just a short golf cart ride away...." There is no disclaimer of: "only if you belong to UHC! Shame on the Morse family!

Copied from the Village Website:

An important part of a great retirement lifestyle is convenient access to wellness facilities and quality health care.

The Villages Health and USF HEALTH, a major academic health resource, are partnering to make The Villages America's Healthiest Hometown.

Staying healthy is easy in The Villages. Neighborhood fitness centers and health care facilities are located throughout The Villages -- just a golf car ride away. The Villages Healthcare Centers, The Villages Regional Hospital, Moffitt Cancer Center, VA outpatient clinic, senior living facilities, and a long term acute care hospital are all located here.

My wife and I have been here five years. Both in our late seventies with a need for multiple health professionals including dermatology ,urology, dentistry, cardiology , and others . Have never had a moments problem accessing health care sine we moved here.

We have UHC (not their Medicare Advantage) plan as our supplemental and are part of Villages Health Care. Had a long wait for our initial appointments, but no problems since then.

Back to the OPs post...I believe the main issue is that Villages Health does not have enough doctors. Are their hiring standards too high or are they just having trouble recruiting into this new concept, or just not paying enough in salary? Each center supposedly could support 8 doctors. Last I looked, Creekside/Sumter only had 5. If they had more docs, they could take on more patients. Dr Eagles....do you have an opinion on this?

Well, now that you mention it........

The first problem is national---The number of primary care doctors is shrinking rapidly. Currently there are a total of about 900,000 clinicians in the US, 624,000 are involved in direct patient care, and 209,000 are in primary care. Some estimates expect the total number to decrease by 250,000 in the next 5-7 years due to a variety of factors----early retirement, alternative careers , and medical careers that do not involve patient care.
Young physicians are trending towards specialty and sub-specialty care---as the technology develops and the body of knowledge expands exponentially, there is much more to know and new niches to fill. Primary care, in particular suffers because it is considered less "glamorous", overburdened by documentation and regulation, and to a certain degree is less lucrative.
As a result, recruiting is much more difficult all over. I don't know how the recruiting goes in TV Health---I believe they were originally aiming for 8 centers with 8 docs each, but they have taken a pause. I honestly don't know the reason but recruitment may be a part of it. Personally, I don't think hiring standards can ever be too high, but realism has to set in at some point. Yes, their goal is a fairly new concept, they want to build the best ACO possible, and this involves a lot of paperwork and regulation. This is why they try to limit patient profiles to 1250 patients/physician, have 1/2 hr follow up appts and 1 hr initial appts, which is about 1/2 of the national average.
I don't think salary is a huge factor. Those who are chasing dollars have already decided to go into specialty care, or avoid a medical career entirely and go to Wall Street--it's a lot easier to get a MBA than a MD. It appears the salaries offered at TV Health are about average for primary care, so they are competitive in their financial package.
I hope this answers some of your questions, IMHO.

GE - I would add that the Feds also have a significant hand in this situation. Despite the fact that our country's population is growing, and the number of elderly is increasing, the Feds capped the number of residency positions in the late '90s. This is simply a matter of money. The Feds partially reimburse teaching hospitals for the cost of training physician so they capped the number of available slots to reduce future expenses. In essence there is an artificial choke point on the training of physicians regardless of current or future need IMO.

The FEDS are a whole other chapter in this, but yes, they did cap residency support, but this was for specialty residencies while continuing to support primary care residencies. Of course, the flaw here was that 3 years of internal medicine is required prior to a specialty. They did change many specialty fellowships from 2 to 3 years, so the number of specialists finishing went down. I don't think there is much of a choke point---most residency programs cannot fill their slots with American graduates, hence the escalating need for patients to be "multi-lingual"
At the same time, IF Obamacare succeeds in bringing in 40 million new patients, the demand will be far greater

Before moving to The Villages, my PCP was the also the Chairman of the Department of Family Medicine at The University of South Florida. He always had students with him during office visits and we often discussed the difficulties of recruiting students to Family Medicine. He mentioned many of the same issues as GE has pointed out (compensation, practice costs, prestige, etc).

I put much of the blame for our current confusion and chaos in healthcare squarely on the back of the Insurance Industry.

I am a RN and have watched, like many others out there, as Insurance companies made the decisions regarding which provider a patient could see, and making frequent changes in the list of allowable providers. ( As well as restricting medications and increasing co pays out of sight for non formulary drugs for example)

We were very concerned about the standard of health care we would receive once on Medicare. Fortunately we have been very impressed and pleased with the standard of care we receive at TV on UHC Villages Advantage plan.

We have also been able to see the specialists we have selected thus far as they have all accepted our Medicare Advantage Plan.

My father was a MD and I remember the day he walked in after work and said that the Insurance Companies had a choke hold on Doctors, Hospitals and patients. He passed away before it got really ugly.

I personally am still praying for a single payer system for all, a Medicare for all. If all the young healthy people in our country were put into the same system the cost for all would go down. WE are the ones who create the highest costs in the healthcare system. But as long as the Insurance Companies can control our health care it will be a series of changes, cuts, buyouts and profits are the name of the game.

The fact that a few Insurance companies can band together, through buy outs and mergers, and excluding other companies patients, will make having predictable convenient and dependable healthcare very difficult. It hurts us all, the providers and the patients.

You are absolutely correct!!!..:bigbow::bigbow:
Another instance of the tail wagging the dog!!!

I too favor a single payer system, but with the caveat that the government is barred from administering its own program, otherwise, cost will go UP
Administrative costs for private insurance run 11-13%, government program insurance runs about 32%---which just goes to prove what we all already know---1 private sector worker can do as much as 3 government workers.
There will be those that go online and see numbers like medicare has a 5% administrative cost, but this is a fallacy. Medicare gets gov't office space, paid for in a different budget. They don't have billing and collection costs--that's in the IRS budget. They don't have mailing cost, office equipment cost, phone cost---I think the GSO covers that. They operate across state lines, which private insurance cannot do. When you add it all up from the different budgets, it comes to about 32%
And according to a BNA study, “Popular comparisons of Medicare and private group health plan ‘overhead’ costs wrongly compare only a part of administrative expenses related to the Medicare program to the whole of private sector administrative expenses for comparable large group health plans.” The report also says that Medicare’s costs for claims administration “are really about the same as claims administration costs in the private large group health plan market.” Moreover, some of Medicare’s general administration costs are expensed elsewhere in the federal budget, and others, like premium taxes, do not apply to the Medicare program. - See more at: Fact Check on Administrative Costs | AHIP Coverage
Finally, the other downside: Your dad may have been correct about the insurance company "choke hold", but that would be traded in for a GOVERNMENT choke hold. I leave it to the reader to decide which is worse

If you want to know how the government runs things, just remember that the FDA allows up to 10% miscellaneous "material" in your hot dog. Think of ObamaCare as the same sort of production process.

I hope they re-define that "10% miscellaneous" in light of terrorist attempts to acquire nuclear material!!!

Well said, Dotti!

The ACA and the feds have given more power and market share to the biggest insurers and United Healthcare-AARP than they have ever had!!

"These Medicare supplement insurance companies are the biggest of all the companies and most of them have been around the longest.

AARP– AARP is the largest and most recognized company for senior insurance. They are in every state and at the top of the food chain for all the Medicare supplement insurance companies. Find out more about an AARP Medicare supplement HERE.

Mutual of Omaha– Second only to AARP Mutual of Omaha is one of the most respected insurance companies in the U.S. They have made a big push to be a major competitor in the Medicare supplement market. Get more information on a Mutual of Omaha Medicare supplement HERE.

Humana – By forming a relationship with Wal-Mart for Medicare Part D, Humana has catapulted itself into a bigger part of the medigap market. Learn more about a Humana Medicare supplement HERE.

Gerber– Gerber made a huge splash when they entered the Medicare supplement market and moved quickly from the new guy to a major competitor. Get more information on a Gerber Medicare supplement HERE."

Medicare Supplement Insurance Companies - View Rates Online

First error is making decisions only based on what is on the internet. Second error is not talking to a real person to understand the "rules". Your sales person could have put you into the right place to call someone. You will get past this at some point and then you can just enjoy where you are.

Just how did you come to this conclusion? I have no love for the ACA, but in fairness, it has absolutely nothing to do with medicare or medicare supplemental policies. You then go on to list the 4 largest supplemental insurance companies, that had the overwhelming majority of market share both before and after ACA. The reason these companies have that market share is because CONSUMERS BUY them, not "the feds". They fill a niche, and therefore they sell their product. This may be the clearest example of the free market ay work in the whole mess

Even in the non-medicare market, about 12 million have signed up under ACA, but 7 million lost their coverage in the individual market, net gain = 5 million. In a country of 330 million, do you think this is a tremendous increase in market share? And you didn't think all the insurers have tremendous power over the care you receive both before after ACA?

One of my big concerns with the huge monopoly type insurance companies who buy up their competition is the fact that they have a very large lobby which is an industry in and of itself. They are proud of the fact that they line the pockets of the house and senate members who are elected to represent OUR best interests. Our representatives are no longer representing us, they are representing the special interests who pay them well to do so.

Citizens United needs to be overturned and term limits in place before we will have elected officials who are willing to represent the citizens who voted them into office. $$ is running politics now, and big business supplies the big bucks. The insurance industry is one of the largest and most successful in getting laws drafted to their advantage.

When ACA came out with Insurance Companies in charge, we were guaranteed to have higher premiums, co-pays and less option for seeing the provider/specialist of our choice.

As they have put out the programs for 2016, there have been many changes and most are again in the favor of the insurance companies.

Our healthcare system, like our political system would be better run without the SuperPacs, and lobbyists who have the insidious power to determine our political future and the future of our healthcare, to a much greater degree than the citizens who elected those officials.

That is a recipe for disaster for all except the big boys with the big bucks.

While I would agree in principle that lobbies and superpacs diminish the influence of individual citizens with their elected representatives, I think there may be room for debate on your health insurance statements.
Here is a list, from CNN, of the top 10 lobbies in Wash DC:
The full list: Here are the publicly traded companies that have done the most direct lobbying since 2009, plus a bonus:

1. General Electric (GE): $134 million
2. AT&T: (T, Tech30) $91.2 million
3. Boeing Co (BA): $90.3 million
4. Northrop Grumman (NOC): $87.9 million
5. Comcast Corp (CMCSA): $86.4 million
6. Verizon Communications: (VZ, Tech30) $86.4 million
7. FedExCorp (FDX): $85.7 million
8. Exxon Mobil (XOM): $85 million
9. Lockheed Martin (LMT): $78.8 million
10. Pfizer (PFE): $77.8 million
...
16.Google (GOOG): $62.2 million
CNNMoney (New York) October 1, 2014: 11:36 AM ET

I don't see any insurers here

"When ACA came out with Insurance Companies in charge, we were guaranteed to have higher premiums, co-pays and less option for seeing the provider/specialist of our choice."

Actually, when ACA came out, period, with 40 million who for the most part could not pay their own premiums destined to enter the system, no exclusion for pre-existing conditions, and children up to 26 on their mommy's policy (and couch) who were not paying their own premiums, WE WERE GUARANTEED TO HAVE HIGHER PREMIUMS regardless of who was running it. The concept that the 3 TRILLION in cost over 10 years would be offset by more efficient care, EMRs and decreasing so called "fraud" was a joke from the beginning. So, as Obama exits next year and Obamacare gets fully implemented, hold on to your wallets. So far his $2000 saving/family has been a $5000 increase, not including higher deductibles, and will go up even further. If you think you are safe on medicare, NOT. Obamacare takes 550 billion from that program which already has financial problems, especially part B.
Remember, ACA had very little to do with health care reform and everything to do with being the largest tax increase and power grab by the federal government in our history. If they were serious about health care reform, the targets would have been pharmaceutical costs, tort reform, slashing regulation, and durable medical equipment costs---none of which were touched

Ok Doc, now you're really making me sick. I thought you were supposed to first do no harm.

How so?? Just posted some facts about insurance lobbies, health care costs, and the ACA. Yes, I might have done it differently, but for now it is what it is, so we should all understand it

People blaming the insurance companies are going to be so disappointed when/if the US ever goes to universal single payer healthcare. If health insurance companies were getting so rich off of healthcare, why would investors own any other stocks? Why wouldn't health insurance companies dominate market capitalization? Why wouldn't the health insurance companies be the most expensive stocks? If you think it's difficult getting a doctor now. Wait until universal health care. Forget a knee replacement so you can continue playing golf or pickleball. That's what walking canes are for. Watch the new miracle drug line dry up because the government decides that the drug companies profit margin is too high and arbitrarily sets the price for these drugs. It's coming. Remember, you asked for it.

Actually, I was kidding. I agree with your post. You see, your truthful explanation of the state of our health care system was so sad that it was making me sick...get it. You're a doctor; making me sick....get it. Knock knock. Anyone there?

:bigbow:Way too early for me to get it

Primum non nocere

I guess it would have been funnier if I would have posted in Latin.