I would just be happy with doctors...
 

I can understand, who went to American medical schools and did not just get board certification here, who spend more than 5 minutes talking to me and not waste most of my time by looking at the computer for 4 of them and 1 looking AT me, who don't try to sell me their products or get me to use drugs off-label so that insurance won't pay for them, who don't ask me toretry therapies that have already been shown ineffective on me just because its the only one they know!

For the past two years prior to coming to TV (and TVRH hospital) I have worked in a LARGE physicians practice group. Just our end of the business had over 80 providers and hundreds of nurses and techs. We had over 70,000 patients and we ran it similar to what I read in the paper. We were very profitable. If you include our parent company, Atrius Health, we had over 1 million patients in Massachusetts.

The one difference I see is that we were able to provide almost anything that needed to be done outside of full surgery (xray, CT, MRI, labs, day surgery etc.)

I wonder if the new TV model will end up encompassing all aspects of healthcare like this. If so, count me in (maybe even for employment)

You can read about these companies here: About South Shore Medical Center (Dr. Chiang, my favorite, on the cover) and Atrius Health - About Us - Who We Are

When you have a large group you can afford to be very profitable by providing services (products) that do not require physician time. That is, most notably, imaging services. X-rays, CATs, MRIs and DEXAs are still very profitable if you have the volumn to support the equipment costs.

Right! I would attend the NYMGMA meetings up in Saratoga and have a great time trying to top the next guy. We always said that managing physicians was like herding cats.

This is the second time you have mentioned the "generous" pay but I'm waiting to hear you tell us who pays it. Where will these large salaries come from? Medicare? Federal grant money? Mr. Morse? Health Center Patrons?

That's true. In the past I have read about people paying anywhere from 5 to 10 thousand dollars per year to belong to a group of doctors. The advantage being that they could be seen by a highly qualified doctor on a moments notice (i.e., no waiting as was mentioned by Mr. Morse).

I thought this health alliance was supposed to be about making The Villages America's healthiest home town. Now it includes families with children? I don't recall anything being said in the articles about private insurance being used to pay for this more expensive health care. Aren't most retired people covered by Medicare?

I don't believe it matters how many doctors there will be. Each person will be assigned to the doctor of his or her choice. The article said that your doctor will know you well. Even with 8 doctors, there is a population of 85,000 or more villagers not counting those people who might come here from StoneCrest and other nearby retirement communities.

Fine for anyone who can afford it. I believe it's only intended to serve a small percentage of wealthier people.

Duplicate post deleted.

Productivity for whom, the doctor or the patient? The doctor can see a lot of patients, require a lot of tests, and still give a wrong diagnosis. In other words, the patients can be poorly served while the doctor still makes his or her profit.

Health Centres in TV
 

I have been reading these threads with great interest.
I truly believe this is very exciting news for TV.
I am a Canadian but my husband is American.
For the last 8 years, he has had a chance to
experience 'Canadian' universal healthcare.
When he first came to Canada, he was quite
skeptical about our system. The doctors
being paid by the government....the care
must be terrible.
Three years ago, he got very sick and had
a chance to discover what our healthcare
was like firsthand. When our doctors discovered
that part of his lung had been removed in the U.S.,
they were horrified. According to our doctors,
it was a completely unnecessary operation.
Pharmacies share drug information online so that
drug interactions are avoided for all patients.

In his words, "Hospitilization, MRI's, Emergency
Care, Cat Scans, etc., etc. were all covered by
the Canadian government." "Our only out-of-
pocket costs for very high quality care were for
parking meters." "Like the TV proposal, the doctors
are being fairly compensated...they are not in it for
the money." "In fact, one of my operations was
cancelled at the last minute because a team of
doctors felt it was too dangerous. In the U.S.
this operation probably would have been done
anyway just for the money. I am still alive today
so I guess the Canadian doctors were right."
These are my American husband's words not mine.

I do believe this proposal for TV will set an amazing
example for the rest of the country. Please keep
an open mind.

WCS

Well, Bogie Shooter, we agree on that. I also have not read that someone will be holding a gun to my head. But isn't that a little off topic? This thread is not about me worrying about my health care. I have no health care worries. This is supposed to be a civil discussion about a topic of general interest to most Villagers. Nothing more, nothing less.

We may not know very much about these new "health centers" but one thing we do know is that they will not represent universal healthcare. However, Universal healthcare would be a good topic for another thread, in my opinion.

What this is, is a rant. Many purely speculative statements with no factual information. Patience would be good here. And forebearance.

Here my concern is that if physician productivity declines, he can serve less and less patients. Try to get an appointment now.

You typically manage around the convenience of the scarce resource. Here it is, unfortunatly, the physician.

First of all, the proposed TV primary-care dr. practice is not comparable to Canada's national health service, because in the TV proposed practice, bills will be paid by Medicare (senior citizens) and private insurance, and self-payers, not all by the federal government. And patients choose their doctors/clinics/hospitals.

And when it comes to diagnostics and treatment that people with cancer and other dreaded diseases, these two comparisons illustrate some of the other major differences between the U.S. and Canada's patient access to needed advances in care:

(Canada) "If you’ve been prescribed an MRI scan (Magnetic Resonance Imaging), you’re likely familiar with the wait-lists that have filled BC’s public health care system with patients desperate for a diagnosis

Canada has one of the lowest rates of MRI scanning machines per capita in the developed world, with six MRI scanners per million people, compared to 40.1 in Japan, 14.4 in Switzerland and 26.6 in the United States. Pittsburgh alone has more MRI machines than all of Canada......"

MRI Scans: Waiting for Public Health Care vs. Paying for a Private MRI Clinic | bcliving

Also:

Mohs Surgeons in all of Canada: 18

Mohs Surgery.Canada: Locate A Mohs Surgeon

Mohs Surgeons in the State of Minnesota: 23

At the USA association link to locate Mohs surgeons, choose State: Minnesota
- American Society for Mohs Surgery

My wait for an MRI was less than two weeks and my physicians were top notch including a family Dr. who spends and average of over 30 minutes per patient and a specialist who's text book is used by many of the leading US medical schools including Harvard.
Yes, ther are wait times for elective procedures because in (B.C.) Canada, procedures are priority based on need rather than ability to pay. Cancer, accidents, and other severe illnesses always come before any elective procedure,

What kind of business person would payout "generous" salaries to doctors who may only be serving 3 patients per hour instead of the national average of 8 per hour. Will they have to charge $300.00 for each office visit? Or, perhaps a large yearly fee?

Healthcare Centres
 

Yes, it is true that the Canadian healthcare system could
use some improvement in many areas.
We can only hope and pray that the Morse family can
get it right for all residents of TV. They have done
such an amazing job so far one can only think that
the same will be true of the healthcare system they
create.
I wish them the very best and truly admire the huge
responsiblity they are taking on trying to give TV the
best health system possible.

WCS

However, your civil discussion comments all seem to be on the negative side. Right?

Well, not so much now that I have had a conversation with Amy Wixted.

Healthcare Centres
 

I lived in Scottsdale, Arizona for 1 year plus Hawaii for a few months
and almost every person I met along the way was curious about the
"Canadian" healthcare system. By the way, we also have a private
medical system for those people who prefer to pay for all their medical costs.
It was very interesting that most Americans seem to think that we
are not allowed to choose our physicians/hospitals/specialists. Nothing
could be further from the truth. We can choose any hospital, walk-in
clinic,doctor or specialist available in our province. We show our care
card when we walk in and that is the end of it. In fact, we don't even
know how much it costs because we never see a bill. The government
is NEVER involved in these very personal decisions or we would tell them to
stuff it where the sun don't shine.
The United States is one of the greatest countries in the world yet it
truly saddened me to hear tales of bankruptcies due to medical bills
or children not being treated because parents could not afford to
pay the doctor's fee.
Yes, we pay higher taxes which help pay for our medical costs. When
I was younger this upset me because I didn't understand why I had to
pay for everyone else....after all....I was healthy. When tragedy struck
my own family and all medical costs were covered for things like cancer,
diabetes, dementia, heart attacks, I finally got it! When I had my children,
all costs were covered including an emergency C-section.
It sounds like the Morse family is trying to create something that is some-
where in between the U.S. and Canadian system. All I can say is, "Wow!".
If it works, the residents of TV will very lucky people.

WCS

So. Do tell!

Well, we had a good long discussion. But this was a couple of days ago and I'm not sure I can tell everything accurately. I didn't take any notes. You know there can be a difference between someone saying "yes"..."no"...or, "I think so".

But I'll give you some of the highlights we covered as best I can remember: 1) Mr. Morse will be the business owner and I believe that means he will be paying the "generous" doctor salaries.

2) The Villages healthcare centers will NOT take any walk-in traffic as ilovetv had speculated. To the contrary, they will have to find a way to limit the number of patients per doctor.

3) When I asked if it would be an HMO, she said she didn't think so but then admitted that "it could be."

4) I told her I'm happy with my HMO because I'm in good health and I get my medicare premium refunded every month. My doctor doesn't seem to have a lot of patients so if they open a new healthcare center nearby, it might put him out of business. She responded by saying there will be a meeting of all the Villages doctors to discuss this issue and that it is not their intention to put any doctors out of business. Some of the Villages doctors may end up working for the healthcare centers.

5) USF is in the process of putting information together so there will be a lecture coming up to inform everyone just how these healthcare centers will operate.

How to pay a doctor well and make a profit
 

The average income for a family physician is about 150,000/yr per Medscape in 2011 (registration required). Medicare pays 70 per patient for a routine 99213 office visit. The time expectation is 15 mins for that code. So a doctor working at a comforatable pace will see 4 patients an hour. I have no idea where you get the idea that doctors see 8 per hour. I'd love a reference for that. Thus the doctor is generating 280/hr and if we pay her 100/hr she will make 192,000 yr working 40 hr/wk allowing 4 weeks vacation/CME. This allows 180/hr to cover all the fringe benefits and office costs which should be more than adequate as overhead should represent no more than 50% of practice income although in primary care it may slide a bit higher. We are allowing 180/280 or 64%. The doctor is well paid, the practice makes money and the pace of work is fair to patient and provider. Note that we have not assumed any income generated from lab work, EKGs or any other testing. We also though have not allowed for no shows or people who refuse to pay their copays or other income killers. Perhaps the office managers who are on this thread can confirm these numbers

Who is Amy Wixted?

medical care
 

This is exactly the kind of excellent care we get with the University of Michigan Medical Center. the doctors there are so unconcerned with the dollar end of the deal. Our family doctor there says she works there because she doesn't have to have anything to do with billing/profits. Their focus is on providing you with health care, and someone else takes care of the dollars. It works. You get good care for your dollar. I am thrilled that this model might appear in TV.

I didn't know who she was and Googled her name to find the answer to that question. She's the program director for USF Health in The Villages. Her picture was actually in today's paper.

Do I foresee the joining of The Villages Health System and a popular local Medicare Advantage Provider in the not too distant future. Perhaps after the Supreme Court rules on Obamacare? Just supposing !!Hmmmm!!!!

According to the article in today's paper they need another 3,000 surveys to be turned in. So...Villages PL, did you decide to turn yours in?

Probably not because United Healthcare recently purchased Preferred Care Partners.

UnitedHealthcare to Strengthen Service to Florida with Purchase of Preferred Care Partners and Medica Healthcare - MarketWatch

I believe she is the "project manager" or "program director" for the USF health alliance in the Villages.

Thanks for asking.

Well, I've been thinking about it. I have it completed but I have no enthusiasm for it. Granted, I have a little bit better opinion of the health care centers after talking to Amy Wixted but the community is not together on this project anyway. We were told that the purpose, of the focus groups and the survey, would be to see what we (Villagers) want. And presto! We get a plan for health care centers. It may be a good idea but I doubt that it was the result of the focus groups or the survey. So, I believe we were decieved.

In my opinion, they want us to feel as though we have some input but in the end, they are going go give us what they had planned all along. The health care centers were not just thought up lately, were they?

Poor lifestyle habits are so deeply entrenched in our culture that we have all but given up trying to do anything about it, except to attack it from the back end by giving people "better" doctoring. If The Villages was truly on board with making this America's healthiest hometown, they could at least have given us a token sign of it by making some changes in the food they promote on the front page of the lifestyle section. They couldn't even do a little thing like that. So why should I bother sending in my survey? It's not going to change anything.

Actually it WAS brought up in the focus group I was in. The folks in my group were quite positive about it.

Avista, you were too fast for me. I hadn't finished my post yet. :024:

You mean someone suggested putting up health care centers where doctors would spend more time with patients? And as soon as Mr. Morse heard about it he said, "Okay, lets do it!" Just like that?

It's interesting to see that you're an RN who's certified in Gerontology. Guess what one of my suggestions was when it was asked (in my focus group) how we could improve the medical community. I said we could use a lot more geriatricians. Right now, I don't think we have any.

The topic to our group was concerning USF having centers where our health care would be coordinated. I forgot the exact question

Good grief. Looks like "competition" is a dead concept....when can you remember an acquisition of this size being halted by government regulators because of a "monopoly" resulting??

It looks like it would take somebody with the bucks the developer here has to be able to compete with this already too-big conglomerate. If Morse does that, more power to 'em.

The survey was forwarded to us at our other residence, and the cutoff date passed before we could fill it out. Is there now an extension to the due date to get more participation?

You are still being negative with your comments!

Today's paper indicated they would still accept surveys. Said they have 32,000 returned and that the record which they would like to surpass is 35,000.

The offering seems promising to me, especially since other models of health care delivery will still be available.

Whether the concept is being oversold remains to be seen. A rush to condemn the proposal, however, seems premature. Anyone who doesn't like the delivery of medical services under the Villages Health Care Centers model, or who can't afford it or who tries it and is dissatisfied, presumably can simply choose not to participate.

What's so wrong about having another option?

I've got an idea.

Let's wait until it's built.

Then wait until it's open.

Then check it out for ourselves.

Then decide if we want to utilize it. Just like any other business we decide to use.

We can debate about heath care all day long but it won't change a thing about what they are intending to do. As far as I can determine none of my money is being used on this unless I decide to use their services. Right?