Villages Health Care Centers
 

Very interesting article in today's Daily Sun. The next visionary step in creating a comprehensive health care system in The Villages. Kudos to Gary Morse and USF for pioneering this concept and taking the risk to see if it will work.

Essentially, the business owner (Morse?) will hire physicians on salary thus removing the urgency to see as many patients as possible and presumably giving the patient a more thorough, personal experience.

The business side would handle all the insurance, billing, regulatory stuff. The physician would be freed up to treat patients and practice medicine. Wonder where they will recruit the doctors?

First center to open up in Colony Plaza area... smart - go to where the newest residents are coming in and looking for medical providers.

Here's a link to the article:

The Villages strives to change medical care, bring back days of

This goes on the "pro" side of my pro/con list.

I'd love to have a "Marcus Welby" type doctor but I'm not sure how this would work. Ultimately a profit must be made for the business owner and I don't see that happening unless the patient is paying a fee in addition to their insurance/medicare. I believe this is referred to as concierge medicine where you pay a flat yearly rate to have easy access to your doctor at all times.

What am I missing?

Grand Junction CO has had a successful health care model for years that sounds very much like what USF/The Villages is proposing. There was a recent PBS program on how it works but I can't remember the name of the program. Anyway, you can Google "Grand Junction Health Care" to find several articles about how they deliver some of the best health care in the nation at a much lower cost than most others. Primary care physicians are the key to establishing it. I think it's a wonderful idea.

Ivy... I'm sure the business side has crunched the numbers to insure it will be profitable. I did not get the impression that it would be concierge, retainer type funding. It seemed as though it would work within existing insurance reimbursement framework. I assume much can be saved through economies of scale... Centralized administrative support, insurance processing, supply ordering, records maintenance, etc.

Time will tell....

Hmm, where did I hear these laudable ideas before?
Oh, yes, Romneycare/Obamacare. Excellent to see the world catching up with Boston and Washington!

But fortunately, it won't be mandatory.

Here's how it works..
 

You hire doctors who are willing to work within a lower paying model in exchange for other considerations (life style, stress reduction) as there is no way they will be paid as well as a successful fee for service practice. Then you be sure they have competant staff and a work environment that gives them the tools to succeed .. whether that is rapid access to consultants or a working microscope. You do not give them stock or a percentage of the profit as that incentivizes (at least subconsciously) keeping cost down for the wrong reason. You do not have an in office Xray or MRI or exercise lab or bone density machine. Thus you have lowered the cost of running and equiping the office to the point where you can pay the doctor to be a doctor and not a lab and test ordering machine. This system will work for patients who do not expect that medicine is a one stop shop where the doctor exists to order every test that Dr. Oz recommends. The people who might be very upset about this are all the doctors who have signed expensive leases for office space in TV and now find out that their landlord is going to open a competing office. Hmm

So true about patients expecting the dr. to order every test that Dr. Oz recommends. (If they had to pay for it themselves or had even a $5 co-pay they'd think twice about such expectations.)

And as for competing with dr. practices who signed expensive leases in TV....once again, competition and the free marketplace are a good thing for incentivizing lower fees and more accommodating service....and office hours that aren't just 9-5, M-F!!!

This model also should reduce the number of non-urgent E.R. visits, if the patient can actually get in to see their primary doctor at their office.

Maybe???
 

Very exciting. But I'll remain a cynic until I see results. The problem is: Doctors see 100 patients rather than 50, patients wait through 5 or 6 exam rooms to see the doctor for just a few minutes. The solution: put Doctors on salary and they sit and visit for an extended visit. The only mention of savings is reducing the number of test and procedures (???). Still, it's a good dream. Who wouldn't love to see The Villages implement a superior system that could become a model for the nation.

Please - read this article again, carefully, and realize that they are following the Cleveland Clinic plan - that the Obama administration noted when they wrote the first healthcare bill. Remember that Obama said that his plan was not the be-all and end-all, that it was a place to start.

Being from Ohio, and having received some medical care through the Cleveland Clinic, and currently having a good friend (from Indiana) who opted for his open heart surgery there, keep an open mind.

Interesting to me that Gary Morse is recommending the Obama model for the Villages health care model. Just saying . . .

We go to the Cleveland clinic when we are up north. All the doctors are on salary, They all are on the same computer system --- so my records from my internist, dermatologist, even ophthalmologist are available to all CC doctors. Medicare is accepted, there is central billing for departments, surgeons and oncologists and primary care docs all talk to each other. It's quite a system, for patients and doctors,and the healthcare is excellent.

Why the PR ploy?
 

Having spent the first half of my career managing a large medical group that was primary care focused and largely salaried, I support the concept. I have seen the quality it can produce. What I question is the big PR push. A front page announcement yesterday of the concept; a front page announcement today that a local FP group has agreed to join (as if they made that decision last night) and the same repeated quotes from Gary Morse.

Am I living in "the Truman Show"?

The model could work very well if properly executed. I agree it does not sound like a concierge model. While I am guessing (since I do not know the specifics of the business model), it may ba a provider based model in which the physician offices are 'linked' to a provider such as the Villages Hospital, and this changes the reimbursement model. Many health centers so this for a lot of reasons, and frankly, it works very well. I am happy to see the developer taking a personal interest in trying to make health care a key positive of life here in the Villages. kudos to him!

This is strictly my opinion and I am not in the medical business.
 

Because I trust Blueash and his medical background I am optimistic that this new health care idea might be a good thing.

I cannot help but note that on this forum, we are pretty good at making things political or either diefying the Morses or bashing them.The Cleveland Clinic has had salaried physicians for well over forty years. It HAS nothing to do with politics. Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise. That doesn't make it BAD.

I know one thing for sure. The one thing that I think needs improvement around here is health care and dental care. With a few exceptions we have found that they aren't as good as what we left in Cincinnati. The Villages is of course a MUCH smaller area and we are predominantly on Medicare. Not an opportunity for other than very altruistic practioners and not a magnet for those with stellar credentials..who may want to make more money or gain more prestige.

For example. I can't even imagine going to a dermatologist back home and having someone try to sell you lotions for an extravagant price. Or go to a dentist and hear that you need over 14 thousand dollars worth of work when you haven't missed a six month visit in 40 years!

Just like anything, some things medical here are better or worse than others. I would just like to find a good place to go to a doctor or dentist I can trust and be able to relax.

I thought the article was promising because it offers a paradigm shift, like the Cleveland clinic model, to the traditional managed health care delivery ( or, for some, the lack of it ).

I appreciate hearing from one who has been there on the inside.
I wonder why Mr. Morse felt he needed to put down other providers? Like you, skyking, i wonder about the big PR push. Are we going to be asked for donations to buy equipment for them? (Rhetorical question).

The concept is sound and, properly managed, can be a real plus for The Villages. Cleveland Clinic and Mayo Clinic are two good examples of doing it right. I believe there are many other smaller ones that are successful.

I am a patient of Belleview Family Doctors and very pleased with them. They are my primary care physicians. I see other specialist outside their practice.

Again, my comments from another post that Morse has a vision on how healthcare should be done in TV and knows what we want. Wonder if there will be home visits in dire case? I'll drink more Kool Aid to this concept. Just as his vision of having Charter Schools to keep good employees, this is another great concept and keep all of us here more active and live longer.

I was (and still am) in "the medical business"
 

"Of course they have this health care facility concept on the front page. It is something they are trying to "sell" or establish. It is their paper. No surprise."

It is a great concept, but as previously posted it was not invented here (as you would think from reading the articles). Physician salaries are set annually by a compensation committee at organizations like Mayo and Cleveland Clinic based on criteria such as specialty, tenure, quality measures, productivity and non clinical efforts (committees, research, etc.). It takes a long time to build a Mayo, but you have to start somewhere.

I guess I just react when something is oversold. Good PR is supposed to subtle.

So your complaint is that it is on the front page and not written by a PR professional?

I just reread the background of Gary Morse and Harold Schwartz from the book Leisureville. They came a long, long, way from their very humble beginnings.

Whether this will be a successful venture, this health care concept brought here, time will tell.

Something needs to be done.

And if someone needs a consult with a PR professional, read the ad on the back of the POA bulletin this month. Not very professional sounding for an MD.

Just my opinion. I too come from a very humble beginning.

I think this is over reacting.....just sayin.

Dreaming is good. Didn't JFK make a speech about going to the moon and where are we? Even final reality doesn't match the so called PR, I am o.k. with that. It's a good dream. Are you believing every promise presidential candidates are making now? Probably not, but hope some will become a reality if it helps all of us.

Good for you. I believe this health care plan is more about making money than anything else. Not that there's anything wrong with making money of course. But it's not going to be the plan that makes The Villages America's healthiest hometown, in my opinion.

The average time spent with a patient (per office visit) is 7.5 minutes. So lets say they double it to 15 minutes. That's 4 patients per hour or 32 patients per day. The news report said that patients will be able to make a same day appointment with no waiting. So that suggests there will even be a lot less than 32 per day. Let's say 3 per hour or 24 patients per day.


Yes, that's it. And this premium care will come at a price. I figure that each member-patient will be asked to pay a yearly fee of several thousand dollars. That's why there was a survey question to find out our yearly earnings. The developer needed to know if there would be enough people who could afford this premium health care.

That's a good point and it may be of some help but we already have HMO's that do that. If you belong to an HMO, your GP is supposed to advise you as to whether or not you need testing.

We are going to become the model for the nation by luring the best doctors away from other cities and states? What kind of model is that? :loco:
No, I believe it's going to be nothing more than premium health care for the rich. Not that there's anything wrong with that but it's not the solution to the nation's healthcare problems. And it's not going to make The Villages America's healthiest hometown because it may only be affordable to a relatively small percentage of Villagers, in my opinion.

Paying contracted physicians a set monthly salary is not a new concept.

Obviously, with a "family practice" group of physicians providing the care, there will be "families" and younger adults and children drawn from this southern TV area to this practice--not just seniors from TV.....which means more people having private insurance and not just (low-reimbursing) Medicare to pay the bills at these TV health centers.

And as for waiting, the article in yesterday's (Sunday) Daily Sun (Section C, How would you want your mother treated?) states on p. C4 that the Colony center will be staffed with 8 doctors and 4 physician assistants, and "at any given time, 3 doctors and 2 P.A.'s will be on duty". That is good coverage, and probably, 1 or 2 of those drs. and p.a.'s will be there to treat walk-in, unscheduled patients.

And "ultimately, there will be 6-8 similar centers spaced throughout TV". I think the Morse's do their homework before starting a project like this and it will work out fine.

Thoughtful and informative post.:)

Villages Health Care
 

I am biding my time awaiting for cynics to start attacking Mr Morse for making big profits on this. Personally I think it is a great idea that will have some bugs at first but it can be worked out. I wish him all the luck in the worle. I believe he is a visionary and wants to build a Legacy.

Somehow I don't remember "Marcus Welby" utilizing a PA...

Now that is a streatch of one's imagination!

yup

Yes, it is. When you get several long newspaper articles with no mention of where the money will come from for the "generous" doctor's pay, you have no where to turn except to your imagination. There will be a lot less patients and doctors will be getting a lot more money. One can only imagine what that adds up to.

How long would it have taken the staff writer to include in one of the articles something about patient costs? Imagine, he had the time to tell us about the generous pay in two of the articles.

Why are they leaving it up to our imaginations? Perhaps because it will be a tough pill to swallow for the average villager.

"Generous" pay for a primary care physician would mean a set amount/rate that compensates for long, hard hours and dedication.......not what is left after paying all the overhead and employee costs including malpractice and all other insurances necessary.......which is often a figure in the red.

We've seen many primary-care drs. quit private practice because there's no take-home pay for themselves after paying all the costs and absorbing uncollectible debts.

Having spent the last half of my career managing a medium sized (12 docs and 2 Pas) fee for service medical practice let me weigh in here. Any model can work if executed properly. When I read that a physician seeing 100 patients can make twice as much as 50 patients, I just had to laugh. This is not true. It all depends on the complexity of the office visit. 50 level 5 visits will pay more than 100 Level 2. My real concern is that taking the profit motive away from the physician will kill productivity. I know for a fact that when a private practice physician goes to work for a hospital, they see considerably less patients. In medical practices, the scarce resource you must manage is physician time. If they are not compensated in relation to their productivity, you will lose their time. I think that the for profit model works best in physician practices. Just my opinion.
There are physicians in The Villages who only work 9-5, M-F. They don’t do call, round in the hospital or nursing homes. Their overhead still is in place. They wonder why they do not make any money.
Oh, and I don't think you can legally mix conserige medicine with Medicare. You cannnot bill both.

Good post! From what's been published about the first family practice group to join this effort by TV, it appears they know productivity is important....or their patients would not stay with them.

I assume the intentions here are honorable. To make the business model work you need to find savings elsewhere to help pay the physicians for taking the extra time to practice good medicine and make the best decisions for each patient.

There are many examples of medical groups who achieve high quality, have less need to use hospital services (inpatient and out), use less diagnostics and less semi elective "ancillary' services when they are not on the productivity treadmill. Maybe the Villages are planning to partner with a Medicare Advantage Plan (or may sponsor one themselves) so that these savings can be redirected to the physicians in order to allow them to see patients at the pace they feel best. If they do that it is possible to provide the service they are talking about without large increases in premiums.

As you said, it would be helpful if a reporter with some background in the business side of medicine could ask and report on these issues.

Now we're getting closer to the nuts and bolts of the project. Having worked for a medical group where the providers were salaried, I have some experience in this. For me, the only way this works is for the health centers to contract with a medical group to provide the services at the clinics for a set amount per annum. The medical group sets the salaries of its staff based on an estimate of clinic volume/patient load plus the overhead. A standard of productivity is set for each provider in order to reach those volumes. An increase in productivity nets the medical group additional income to what was projected and the staff shares in the increased revenue at the end of the year.

This is why I don't expect the "Marcus Welby" result. The reality of health care is that insurance reimbursements are declining on a per visit/procedure basis while costs to provide the services increase. This requires providers to increase the volume of patients seen per unit of time and/or to expand the hours available to see patients.

That adds up to wait times for patients and soonest available appointments being some weeks away. So, call me skeptical.

Gracie, Don't misunderstand me. Gary Morse and Harold Schwartz have set the standard for developing great retirement communities. And as far as I can see in an honorable manner. Hopefully they can also set the standard for excellent healthcare for "senior" citizens. (It hurts to say "senior citizen" outloud.)

The PR on this story though is grade school. I really doubt that Gary Morse has ghost written the stories so I am confused as to why you have taken my comments as a criticism of the Morses.

MGMA for retirees?
 

Number 6 and Mikeod, we should get together and start a "retired medical group managers" club. The best part of being a member of the MGMA was trading war stories and giving each other pep talks. I agree with what both of you have said on this subject.

There are a lot of unknowns which can be speculated or assumed. A significant fact communicated is salaried doctors, which may be short-hand for capitated reimbursement, often used in HMO/PHO and other forms of managed care delivery systems. I believe TV could benefit from a well-managed non-fee for service plan, as the current environment does not promote or encourage coordination between providers, communications with patients and providers, growing encouragement for use of centralized electronic personal health records, etc. Lots of independent providers, primarily specialists, w/entrepreneurial marketing methods with virtually unfettered fee for service reimbursements from Medicare and supp plans.

There are plenty of managed care models throughout the US that could be emulated in TV and I trust that over time an appropriate effective model will evolve. A couple of other points: the USF consultant to TV is Dr. Elliott Sussman who was CEO for several years of Lehigh Valley Health Network which is network that utilizes many salaried doctors. My thoughts are that any TV system is quite likely to be influenced by his experience and expertise.

The other point- for several years there has been a shortage of primary care doctors. It will be interesting to see how TV model will address this issue, as well as how the current health care providers will adapt over time to a new competitive model.

And, I personally believe the Marcus Welby and Mayo Clinic comparisons are a little over the top. But, this could still be a real good thing.

Healthcare in The Villages
 

It is exciting and a positive direction That the Villages Health Care System is embracing and taking the lead on this subject in the state of Florida.

Florida currently has one of the highest rates of un-insured residents in the country. According to the 2010 Census, Florida had the third highest percentage of residents without insurance. The 2010 Census information (.xls) finds that, from 2008 to 2010, Florida’s average percentage of uninsured people was 20.7 percent. The national average for uninsured citizens was 15.6 percent. The situation doesn’t seem to be improving. According to a December report from the Florida Health Insurance Advisory, the number of people in Florida with private health insurance has continued to decline.

The state of Florida has shunned many grants associated with the Affordable Care Act. The state is the lead plaintiff in a lawsuit against the health care reform law.

As the Affordable Care Act (ACA), was signed into law in 2010, a federal mandate stipulated that states must create exchanges (state-operated health insurance databases that allow citizens to shop around for insurance) before the year 2014. According to law, states will have to prove to the federal government by January 2013 that they will have a functioning state exchange by 2014. If they cannot, the law requires that the federal government come in and create an exchange in place of the state. The state of Florida, however, has done nothing to even begin planning for creation of the exchanges as stipulated by the law, which experts warn could compel the federal government to step in.

Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Thank you Gray Morse for understanding the true goal of The Affordable Care Act, and for taking the lead on this subject in the state of Floirda.


:BigApplause::BigApplause::BigApplause:

I have not read anywhere that someone will be holding a gun to your head saying you will have to participate in this program. Its your imaginnation that is running wild. If you don't want to play , just go home.