Will a doctor earn more from original Medicare or from MA

Jan 25, 2008

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  1. OneMorePolicy
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    If a doctor currently sees a patient who is dual-eligible (receiving both Medicare Part A & B & Medicaid), and if the patient switches to an MA-SNP for dual-eligibles and Medicaid fully coordinates with this switch (patient continues to have $0 cost--hope my definitions are clear enough), will the doctor typically earn more $ from the same patient under the original Medicare\Medicaid program or from an MA-SNP HMO arrangement? I'm trying to see if a doctor would have any motivation to encourage their client to switch from Original Medicare\Medicaid to an MA.
     
  2. salpro22
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    Where did you come up with this idea?? You probably want to talk to Rick about this one.
     
    salpro22, Jan 25, 2008
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  3. James
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    Medicare sets the price, so I really can not see the difference. Now I would think it would be easier for a Dr. to fudge a supplement/medicare easier then say a MA provider. Of course that is just off the top of my head, not like there are Dr's taking advantage of Medicare billing!:twitchy:
     
    James, Jan 25, 2008
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  4. Frank Stastny
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    Unless the doctor does not accept assignment the doctor will earn the same amount of money from a patient that has Medicare and a Supp or who has a PFFS plan.

    PFFS plans pay the doctor the amount that Medicare assigns as the value for the treatment. With Medicare and a Supp, Medicare pays 80% of the assigned value and the Supp pays the other 20%.

    HMO's pay doctors differently and the doctor could make a lot more money or less depending on how often the doctor sees the patient.

    I really think it is unlikely that a doctor is going to encourage a patient to leave traditional Medicare. The doctors I know would prefer to have their patients on traditional Medicare.
     
  5. GreenSky
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    All true SNP plans are managed care - either HMO or PPO.

    The doctor certainly would receive more for a healthly patient not seen regularly if that patient was in an HMO. The doctor would receive a monthly capitation which is likely better than fee for service for patient not seen very often. A PPO may or may not pay the same as Medicare.

    If you can find providers with lots of Medi-Medi patients, it may be to that provider's benefit to move the non-utilizers into a SNP HMO. I think you'd have a hard time convincing a doctor that any insurance carrier pays better than Medicare for patients he sees regularly.

    Rick
     
    GreenSky, Jan 25, 2008
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  6. salpro22
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    Based on what specifically?
     
    salpro22, Jan 25, 2008
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  7. Frank Stastny
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    The ease and quickness of getting paid and everyone knows how the system works. I've heard of lots of problems with doctors getting paid promptly by some of he PFFS plans.


    Unless the doctor is with an HMO and only has healthy patients who never make appointments.

    When asked, the doctors I have talked to said they would recommend to any patient that they leave an HMO and go back to traditional Medicare. This once again puts the doctor and the patient in charge of their medical care, not some pencil-neck sitting in an office who works for the HMO.

    When talking about Advantage Plans it is helpful if one will identify which of the Advantage Plans is being addressed. There he a HUGE difference among them. Advantage Plans include HMO, PPO and PFFS plans. It is a whole lot easier to answer questions if the writer will identify which one is being asked about.
     
  8. OneMorePolicy
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    To clarify in case I wasn't clear, this is an HMO (MA-SNP for dual-eligibles). This board discussion seems to say that if the doctor doesn't see the patient often, those doctors might like to see the client become part of the HMO so they could earn the on-going capitation revenue. If that's the case, any suggestions as to which types of practices those are....ie maybe Internal Medicine (I see a lot of those in this provider directory for the HMO).

     
  9. Frank Stastny
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    Maybe it is just the way I'm reading it but it sounds more like you are asking questions about selling the HMO concept to doctors, not insurance prospects.

    If I have missed the point of your question please explain further. I don't understand how an answer to your question will help you with selling insurance.
     
  10. margostl
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    Most of the MDs Iv'e worked with and know will not get involved in steering a Pt. to a particular healthplan, even though the reimbursement from Medicaid can literally bankrupt a Practice. Most will simply have a cutoff to how many Pt.s they acceppt with that plan. Add to that the limited number of specialties the primary provider can refer the pt. out to, (they won't acceppt Medicaid),along with the rejection rate of prescribed medications(pre-authorization forms) needed last week and Medicare/Medicaid becomes a nightmare for primary care MDs. Those should be good selling points to prospective clients of why they should switch. We always cringed when we had to refer Pt.s to specialties due to the fact that you could spend hours on the phone trying to get a provider that was still seeing Medicaid Pt.s
    Hope this provides some insight.
     
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