Was a family medicine doctor for a big Ministry for almost 20 years and believed that we were trying to keep patients out of the ER and reduce costs because that is what they told us, but couldn't figure out why they would fill our panels so full that we could possibly see all of our patients and they were perfectly happy to send them to the ministry owned urgent cares that seemed to send everyone to the ER, I thought maybe they didn't understand the implications of their policy but now it seems they designed it to work this way to increase revenue. Excellent you tube Dr. Bricker
Hi Dr. Bricker: For doctors to go into Direct Care Practices, the financials got to work. Could you hace a podcast to cover the minimal monetary amount and patient volume for a 3-doctor primary care practice? Some similar models are also fine. Thanks a lot.
Thanks Dr. Bricker. Excellent insights as always. It’s mind blowing that we have incentive systems that are designed to make the system less efficient and cost effective AND make the population sicker. We need to rethink how to align the incentives so hospital systems also win when people are healthier and demand on the system is lower…
Another great video. I begin to wonder what CMS Innovation Center is doing - why didn’t they come to promote Dr. Bricker’s contents? 😂 One question: there are a lot of Urgent Care centers around. The visits to urgent care centers, are they counted as ER visits?
From a clinical perspective, this sounds great - lower ER admissions and hospitalizations. But obviously from a financial perspective, it is terrible for revenues (although reviewing how much profit they're actually making regarding service margin is another factor). How do you think we can get these incentives better aligned in the future?
Can you do similar analysis for fee for service oriented primary care practices that are unaffiliated with multispecialty health systems? E.g., a standalone internal medicine or family medicine practice.
Thank you for another excellent video! I agree that non-FFS models are great for decreasing healthcare expenses, especially for employers. I am curious about the difference in health care costs incurred by an employer if they have an employee with a serious medical condition (ie, cancer) that requires expensive, specialized care that exceeds good primary care. Would it still be more cost effective for the employer to offer that employee a non-FFS health benefit or a conventional employer-sponsored plan with a commercial payer? Would the commercial payer increase premium costs for an employee like this?
For complex specialty care like oncology, direct contracting with a particular hospital system and oncology physicians is what some employers are doing (e.g. Walmart with Mayo Clinic).
I'm not sure I follow how primary care loses money for hospitals. If I go to my PCP, and they refer me to a gastroenterologist for a colonoscopy, doesn't that increase money to the hospital that performs the colonoscopy? Unless the plan is an HMO plan where the hospital/clinic is owned by the insurance company, the PCP has little if any financial incentive to not refer me for the procedure.
They would refer you to an independent ASC or endoscopy center with a gastroenterologist who is not affiliated with the hospital… less expensive for the patient out-of-pocket That is the incentive. Thank you for watching.
@@ahealthcarez ah yeah usually if my doctor refers me I just tell them where I think they should refer me to, since I know which places already have me in their chart.
Good question. The ACO would not apply to the patients with commercial insurance… just as Medicare. Question would be… who are the PCPs the commercial patients are seeing. The hospital PCPs will just bill them fee for service and refer to specialists, boosting their revenue and increasing healthcare costs.
Was a family medicine doctor for a big Ministry for almost 20 years and believed that we were trying to keep patients out of the ER and reduce costs because that is what they told us, but couldn't figure out why they would fill our panels so full that we could possibly see all of our patients and they were perfectly happy to send them to the ministry owned urgent cares that seemed to send everyone to the ER, I thought maybe they didn't understand the implications of their policy but now it seems they designed it to work this way to increase revenue. Excellent you tube Dr. Bricker
Hi Dr. Bricker: For doctors to go into Direct Care Practices, the financials got to work. Could you hace a podcast to cover the minimal monetary amount and patient volume for a 3-doctor primary care practice? Some similar models are also fine. Thanks a lot.
Thanks Dr. Bricker. Excellent insights as always. It’s mind blowing that we have incentive systems that are designed to make the system less efficient and cost effective AND make the population sicker. We need to rethink how to align the incentives so hospital systems also win when people are healthier and demand on the system is lower…
#Agreed. Thank you for watching.
Its called the medical loss ratio in the ACA
Another great video. I begin to wonder what CMS Innovation Center is doing - why didn’t they come to promote Dr. Bricker’s contents? 😂
One question: there are a lot of Urgent Care centers around. The visits to urgent care centers, are they counted as ER visits?
Seems like the more dysfunctional primary care is, the more money the entire system can make
Thank you Dr. Bricker.
Can you point out the source that references 5% hospitalization?
Sources in video description. Thank you for watching.
From a clinical perspective, this sounds great - lower ER admissions and hospitalizations. But obviously from a financial perspective, it is terrible for revenues (although reviewing how much profit they're actually making regarding service margin is another factor). How do you think we can get these incentives better aligned in the future?
Hospitals need to run their own health plans/Medicare Advantage plans, receive premium and take risk.
Is that what HMO’s / Kaiser Permanante does?
Can you do similar analysis for fee for service oriented primary care practices that are unaffiliated with multispecialty health systems? E.g., a standalone internal medicine or family medicine practice.
Thank you for your suggestion.
Thank you for another excellent video! I agree that non-FFS models are great for decreasing healthcare expenses, especially for employers.
I am curious about the difference in health care costs incurred by an employer if they have an employee with a serious medical condition (ie, cancer) that requires expensive, specialized care that exceeds good primary care. Would it still be more cost effective for the employer to offer that employee a non-FFS health benefit or a conventional employer-sponsored plan with a commercial payer? Would the commercial payer increase premium costs for an employee like this?
For complex specialty care like oncology, direct contracting with a particular hospital system and oncology physicians is what some employers are doing (e.g. Walmart with Mayo Clinic).
I'm not sure I follow how primary care loses money for hospitals. If I go to my PCP, and they refer me to a gastroenterologist for a colonoscopy, doesn't that increase money to the hospital that performs the colonoscopy? Unless the plan is an HMO plan where the hospital/clinic is owned by the insurance company, the PCP has little if any financial incentive to not refer me for the procedure.
They would refer you to an independent ASC or endoscopy center with a gastroenterologist who is not affiliated with the hospital… less expensive for the patient out-of-pocket That is the incentive. Thank you for watching.
@@ahealthcarez ah yeah usually if my doctor refers me I just tell them where I think they should refer me to, since I know which places already have me in their chart.
Do you think this pressure will cause hospitals to switch their primary care payment structure away from fee for service?
One can always hope. Thank you for watching.
So how is that affected if the hospital system owns the majority of PCP’s in an ACO?
Good question. The ACO would not apply to the patients with commercial insurance… just as Medicare. Question would be… who are the PCPs the commercial patients are seeing. The hospital PCPs will just bill them fee for service and refer to specialists, boosting their revenue and increasing healthcare costs.
It helped a lot
Hello i am phermacy tecnaiain and health care so intrested