Will a doctor earn more from original Medicare or from MA

[OneMorePolicy]

You're on the money, Frank. I visited the local HMO yesterday (they're a county-only operation), sat down with one of their inside sales rep who I've had an on-going discussion with for a couple weeks about my contacting prospects at local care homes, ensured we were on the same page about soliciting those types of clients, and then he loosely threw out a comment about getting more clients from doctors who are already in their network. We spent about 10 minutes discussing that avenue but he didn't pinpoint why a doctor would be motivated to see their existing client join the HMO. Thus, I'm asking that question here on this board.

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.

 

[GreenSky]

You're on the money, Frank. I visited the local HMO yesterday (they're a county-only operation), sat down with one of their inside sales rep who I've had an on-going discussion with for a couple weeks about my contacting prospects at local care homes, ensured we were on the same page about soliciting those types of clients, and then he loosely threw out a comment about getting more clients from doctors who are already in their network. We spent about 10 minutes discussing that avenue but he didn't pinpoint why a doctor would be motivated to see their existing client join the HMO. Thus, I'm asking that question here on this board.

Frank is absolutely wrong on this one.

A doctor might (and I repeat, might) be motivated to recommend an HMO if he has patients he rarely sees. This is not a question about what the best medical plan would be, it's simply one of dollars.

I have spoken to a number of physicians who are perfectly happy with HMO plans and have no issues with HMO patients.

Medicare remibursement for an office visit is about $45. In California, MA HMO plans capitate about $40 per month. If they are in a dual SNP, the cap rate is even higher.

On a pure monetary basis, would you rather see a patient twice a year and receive $90, or receive about $500? This is whay a doctor might be motivated to move some fee for service patients to an HMO.

Rick

 

[OneMorePolicy]

Good to know those numbers. What types of practices would those doctors be in who rarely see a client? I'm looking at the provider directory and I see many in Internal Medicine, Family Practice, etc. Any suggestions\comments.

Frank is absolutely wrong on this one.

A doctor might (and I repeat, might) be motivated to recommend an HMO if he has patients he rarely sees. This is not a question about what the best medical plan would be, it's simply one of dollars.

Medicare remibursement for an office visit is about $45. In California, MA HMO plans capitate about $40 per month. If they are in a dual SNP, the cap rate is even higher.

On a pure monetary basis, would you rather see a patient twice a year and receive $90, or receive about $500? This is whay a doctor might be motivated to move some fee for service patients to an HMO.

Rick

 

[GreenSky]

Good to know those numbers. What types of practices would those doctors be in who rarely see a client? I'm looking at the provider directory and I see many in Internal Medicine, Family Practice, etc. Any suggestionscomments.

You would be looking for any primary care physicians. It would be helpful if you could find a list of docs that take Medicaid but I don't know how to find them.

A doc might not see a healthy patient but once or twice a year. My guess would be that if the provider is willing to take an HMO, he'll take almost anything.

The key might be the medical group the doctor is affiliated with rather than just the doctor. They get nothing for FFS patients and love to have everyone capitated. If you can get a group to recommend this "concept" to their contracted physicians, you might stand to get a lot of referrals.

Rick

 

[J.R.]

You would be looking for any primary care physicians. It would be helpful if you could find a list of docs that take Medicaid but I don't know how to find them.

A doc might not see a healthy patient but once or twice a year. My guess would be that if the provider is willing to take an HMO, he'll take almost anything.

The key might be the medical group the doctor is affiliated with rather than just the doctor. They get nothing for FFS patients and love to have everyone capitated. If you can get a group to recommend this "concept" to their contracted physicians, you might stand to get a lot of referrals.

Rick

Is their public data available about how much doctors get paid via medicare and medicaid? I imagine you obtained the aforementioned physical visit fee via a business associate, but I could be wrong.

 

[GreenSky]

Is their public data available about how much doctors get paid via medicare and medicaid? I imagine you obtained the aforementioned physical visit fee via a business associate, but I could be wrong.

I got the info on a Medicare office visit because I see the EOB my mother receives. I was told by a doctor about the capitation.

Are you doubting me?

Rick

 

[J.R.]

I got the info on a Medicare office visit because I see the EOB my mother receives. I was told by a doctor about the capitation.

Are you doubting me?

Rick

Don't be dissing me

 

[Frank Stastny]

Frank is absolutely wrong on this one.

A doctor might (and I repeat, might) be motivated to recommend an HMO if he has patients he rarely sees. This is not a question about what the best medical plan would be, it's simply one of dollars.

I have spoken to a number of physicians who are perfectly happy with HMO plans and have no issues with HMO patients.

Medicare remibursement for an office visit is about $45. In California, MA HMO plans capitate about $40 per month. If they are in a dual SNP, the cap rate is even higher.

On a pure monetary basis, would you rather see a patient twice a year and receive $90, or receive about $500? This is whay a doctor might be motivated to move some fee for service patients to an HMO.

Rick

That's a pretty bold statement!

"Frank is absolutely wrong on this one." The definition of "absolutely" is: "With no qualification, restriction or limitation."

I hear you saying that doctors in general prefer to think in terms of how much money they make, not what plan provides them the best treatment options for their patients.

When a doctor is with an HMO the doctor is under strict guidelines regarding tests and treatments that the HMO approves. If the HMO doesn't approve it, the doctor can't do it even if it is best for the patient.

The problems people have with HMO's are well documented. Think I'm "absolutely" wrong on this also? Google HMO Horror Stories and see what comes up.

The doctors I know do not think only in terms of which plan is going to pay them the most money. The doctors I know still care about their patients.

It doesn't surprise me to hear you say that doctors in California think only in terms of how much money they can make.

The last paragraph in your post is an insult to members of the medical profession. That is coming from an insurance agents perspective.

You get doctors to sign a statement saying that they would rather work with a plan that gives pays them more money than one that allows them complete freedom to treat their patients and I will give some credibility to what you are saying.

 

[GreenSky]

Frank -

The title of this thread is Will a doctor earn more from original Medicare or from MA

I was only commenting on the DOLLARS, not the CARE and thought I made that quite clear.

Rick

 

[Newby]

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.

Frank, this is a poll of just one doctor but he says the opposite of what you think.

Friday I stopped in a doctor's office to see if they accept Coventy Advantra Plans for someone who's sup is too expensive but they don't qualify healthwise to change to a less expensive one.

This is a small country doctor who is almost ready to retire. He, his wife and his one staff person all came out to the reception desk to see what I was talking about. I showed them the brochure for Coventry and they just barely knew what it was.

But...they said "Is this like that Humana Gold Plan?" When I told them it was similar but it is the competetor to Humana, they said they wished EVERYONE would go on that plan. Said it is MUCH easier to get your money than Medicare is.

I was surprised to hear it. I wonder if Coventry is as good as Humana at paying doctors and making it easy to do business with them?