Tag Archives: New Model Triad Doctor Offers Unlimited Visits For $50 Monthly Fee

Rice University study: When physicians integrate with hospitals, costs go up

7 Sep

The American Medical Association wrote in 5 ways to improve access to health care:

Stabilize individual insurance marketplaces and retain ACA market reforms. The AMA advocates these actions to foster a stronger health insurance marketplace and ensure that low- and moderate-income patients are able to secure affordable and adequate coverage:
• Support expanding eligibility for premium tax credits up to 500% of the federal poverty level. Support providing young adults with enhanced premium tax credits while maintaining the current premium tax credit structure that is inversely related to income.
• Encourage state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections.
• Support the establishment of a permanent federal reinsurance program.
• Oppose the sale of health insurance plans in the individual and small-group markets that do not guarantee pre-existing condition protections along with coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses (with the exception of short-term, limited duration insurance offered for no more than three months).
Address physician shortages. Grow the clinical workforce by expanding the number of available graduate medical education residency slots, expand medical school loan-forgiveness programs, and remove barriers to physician immigration for foreign-trained physicians to practice in the U.S.
Telehealth and remote patient monitoring will become an essential, cost-effective and reliable means to expand capacity in a health system marked by significant and persistent specialty shortages and geographic disparities. Physicians should get assurances that digital health solutions are cost-effective and provide a path to payment.
Increase efficiency of the existing workforce by instituting common-sense medical liability reforms and reducing government and insurance industry regulatory burdens—such as prior authorization—that detract from patient care and increase costs. Also, there should be advancement of new physician-led payment models to achieve better outcomes at lower cost.

https://www.ama-assn.org/delivering-care/patient-support-advocacy/5-ways-improve-access-health-care

One model of health care is associated with higher costs.

Science Daily reported in When physicians integrate with hospitals, costs go up:

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study…. https://www.sciencedaily.com/releases/2019/09/190905161406.htm

Citation:

When physicians integrate with hospitals, costs go up

Date: September 5, 2019
Source: Rice University
Summary:
When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new article.

Journal Reference:
Vivian Ho, Leanne Metcalfe, Lan Vu, Marah Short, Robert Morrow. Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study. Journal of General Internal Medicine, 2019; DOI: 10.1007/s11606-019-05312-z

Here is the press release from Rice University:

When physicians integrate with hospitals, costs go up, Rice study says

JEFF FALK

– SEPTEMBER 4, 2019POSTED IN: CURRENT NEWS

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study.
“Centers for Medicare and Medicaid Services regulators should be wary of the burden that increasing reporting requirements place on physicians in small, independent practices,” Metcalfe said. “In the long run, these requirements may have the unintended consequence of raising health care costs.”
The paper, “Annual Spending per Patient and Quality in Hospital-Owned versus Physician-Owned Organizations: An Observational Study,” was also co-authored by Lan Vu, lead actuarial systems analyst at BCBSTX; Marah Short, associate director of the Center for Health and Biosciences at the Baker Institute; and Dr. Robert Morrow, Southeast Texas market president at BCBSTX.
TAGS: Baker Institute, Economics, Research, RNH, RNhome, Social Sciences
About Jeff Falk
Jeff Falk is associate director of national media relations in Rice University’s Office of Public Affairs.

The Healthcare Transformation Institute listed different models of healthcare.

According to Healthcare Transformation Institute, among models of healthcare are:

Healthcare Delivery Models
Please check back often for updates
ACO
• The ACO Model — A Three-Year Financial Loss?
• Accountable Care Organizations: The Case for Flexible Partnerships Between Health Plans and Providers
• The Collaborative Payer Model
• Continuous Innovation in Health Care: Implications of the Geisinger Experience
• Driving Population Health Through Accountable Care Organizations
• Growing an ACO-Easier Said Than Done
• Grand Junction, Colorado: A Health Community that Works
• Grand Junction, Colorado: How a Community Drew on its Values to Shape a Superior Health System
• Higher Health Care Quality and Bigger Savings Found at Large Multispecialty Medical Groups
• The Hot Spotters: Lower Costs and Better Care for Neediest Patients
• Improving The Coordination of Care for Medicaid Beneficiaries in Pennsylvania
• A National Strategy to Put Accountable Care into Practice
• Predictive Modeling and Team Care for High-Need Patients at HealthCare Partners
• How the Stars Aligned to Make Grand Junction a Success
Care Transitions
• Connected For Health – A Community-Based Care Transition Project
• Improving Care Transitions and Reducing Hospital Readmissions: Establishing the Evidence for Community-Based Implementation Strategies Through the Care Transitions Theme
• Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention
Disease Management
• ICC Asthma Program Evaluation 2007-2009
• German Diabetes Management Programs Improve Quality of Care and Curb Costs
• A Home-Based Diabetes Education Program and Its Approach to Disease Management
• How Direct Primary Care Reduces Primary Care Costs
• At Martin’s Point in Maine, Primary Care Teams for Chronic Disease Patients
• Primary Care Redesign: Delivering a Value Based Population Program for Chronic Disease
• Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine’s “Retooling for an Aging America” Report
• Taking Public Health Approaches to Care in Massachusetts
Medical Home
• American Medical Home Runs
• Changing the Conversation in California About Care Near the End of Life
• Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention
• The ‘GRACE’ Model: In-Home Assessments Lead to Better Care for Dual Eligibles
• The Group Health Medical Home at Year Two: Cost Savings, Higher Patient Satisfaction, and Less Burnout for Providers
• A Health Plan Spurs Transformation of Primary Care Practices Into Better-Paid Medical Homes
• Medical “Extensivists” Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use
• A New Care Paradigm Slashes Hospital Use and Nursing Home Stays for the Elderly and the Physically and Mentally Disabled
• Restructuring Care in a Federally Qualified Health Center to Better Meet Patients’ Needs
• Transforming Physician Practices to Patient-Centered Medical Homes: Lessons from The National Demonstration Project
• Vermont’s Blueprint for Medical Homes, Community Health Teams, and Better Health at Lower Cost
Medication Management
• Medication Adherence Leads to Lower Health Care use and Costs Despite Increased Drug Spending
• Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform
• Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending
Elements of Healthcare Transformation
• Alignment of incentives
• Connectivity among caregivers and patients
• Leadership assessment and development
• Business plans and models
• Metrics and evaluation
• Medication management
• In-home care
ASU Healthcare Delivery and Policy Program
Read about our affiliated program at Arizona State University.
http://healthcaretransformationinstitute.org/page/healthcare-delivery-models

Faith Abubey of WFMY News reported on a healthcare delivery system outside the traditional insurance model.

Abubey reported in New Model: Triad Doctor Offers Unlimited Visits For $50 Monthly Fee:

But a growing number of family doctors say they have found a way to make routine doctor visits cheap and give you better care.
In some cases, you pay as low as $25 a month and still see a doctor whenever you want with no extra costs.
The idea is called Direct Primary Care (DPC).
Think of it like a gym membership.
You pay a monthly fee and you get to go as often as you want.
It’s the same idea.
In this case you get unlimited visits to your family doctor.
Access to that doctor by phone or a secure messaging system — 24/7.
You get same day or next-day appointments.
Discounts on things like labs and your prescription medicine.
All for a monthly fee of anywhere between $25 and $85 a month.
That’s it.
No extra costs. No co-pays. No insurance involved.
If you’re thinking this sounds too good to be true, even the Triad doctor who’s offering it agrees.
“It does sound too good to be true. And I think that that’s the hardest thing about selling people on this model. Because they just don’t understand how it could be that easy,” Dr. James Breen said.
Dr. Breen and his wife, Dr. Dayarmys Piloto de la Paz, who is also a doctor, opened their direct primary care practice just over a month ago in Greensboro.
It is called Vitral Family Medicine.
It is the only clinic of its kind we know of in the Triad.
But according to the Journal of Medical Economics, there are more than 300 doctors’ offices across the country using the same model.
“A lot of people describe direct primary care as do it yourself health care reform,” Dr. Breen said.
He explains that in this model, your doctor visits are longer, patients get better care and there is no red tape from insurance companies about what he can and can’t do…. https://www.wfmynews2.com/article/news/local/2-wants-to-know/new-model-triad-doctor-offers-unlimited-visits-for-50-monthly-fee/266503909

Access to healthcare for the greatest number is an important concept, but as with many things, the devil is in the details. What is the definition, cost and the population defined are questions that are political difficult to build a consensus.

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