quote:

ORIGINAL: sloguy02246

FR -

As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.

As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

quote:

ORIGINAL: MasterJaguar01

quote:

ORIGINAL: sloguy02246
FR -
As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.
As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

Every time I post about DPC, invariably someone says, "That sounds like an HMO". And the OP on this thread is experiencing the same thing.
The BIGGEST difference between DPC and an HMO, is the middle man (the Insurance compny) is eliminated. As a benefit from that, the WHOLE fee-for-service model is thrown out the window. HMO's are Primary Care centric, but they are still fes-for-service, and subject to insurance company rules vis-a-vis coverage.
In DPC, you pay one VERY low monthly fee, and have unlimited access to your PCP, REGARDLESS of what services are performed. (And you get to tell tthe insurance companies to fuck off).

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: MasterJaguar01

quote:

ORIGINAL: sloguy02246
FR -
As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.
As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

Every time I post about DPC, invariably someone says, "That sounds like an HMO". And the OP on this thread is experiencing the same thing.
The BIGGEST difference between DPC and an HMO, is the middle man (the Insurance compny) is eliminated. As a benefit from that, the WHOLE fee-for-service model is thrown out the window. HMO's are Primary Care centric, but they are still fes-for-service, and subject to insurance company rules vis-a-vis coverage.
In DPC, you pay one VERY low monthly fee, and have unlimited access to your PCP, REGARDLESS of what services are performed. (And you get to tell tthe insurance companies to fuck off).

What would the motivation be for the PCP to be part if a DPC?

Outside of PCP services, insurance will still be necessary, right?

quote:

ORIGINAL: MasterJaguar01
What great questions! (Well, of course... consider the source) (Aw, shucks. )

To your first question...
The motivations would be:

1) Switiching the model from profit-driven care to patient care. Profit-driven care doesn't necessarily mean more profits. Rather it means tailoring care to generate ICD-10 codes that provide higher reimbursement. A PCP can hollistically provde care for his/her patient with ZERO regard for medical billing.
2) A guaranteed revenue stream, from patients who are paying for HEALTH CARE (not specific health care procedures).

quote:

To your second question.... That is a bit more complex.
There is a concept of DPC verticals, where specialists participate, and the monthly fee is higher for the pateint to include specialty care.. Those extra monthhly dollars are distributed directly to specialists. (Also specialists are free to participate in multiple verticals). There is also one higher tier, o include non-catastrohic care of Hospitalist.
Regarding catasrophic care... The answer is yes... BUT...
The insuurance model completely changes... Instead of health insurance, you can by P&C model insurance. So, the GEICOs the AllStates of the world can participate. You can pick this insurance, theoretically, for $250/month.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

quote:

ORIGINAL: MercTech

It sounds like you are talking about the original model for a HMO that existed before corporations turned HMOs into cash cows.

quote:

ORIGINAL: jlf1961

One problem.

It is simple and makes sense.

So, there is no way in hell the government will stand for it.

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: susie
Get rid of all the insurance companies that raise the cost of your healthcare. Pay a % of your salary into one fund that runs all hospitals in the USA and pays all doctors and specialists. The cost of healthcare will reduce..

That'll just raise medical costs further, though: everybody knows that the only way to reduce the price of anything is by promoting competition between business rivals, which invariably leads to them undercutting each other and offering more services for less money. Such an arrangement has never (for instance) led to corner cutting, a monopoly established by somebody running at a lost until their rivals were driven out of business and then hiking their prices massively once there were no alternatives to using them, competition over who can gouge the most payment for the least services from their customers, or other such marketplace abuses. The invisible hand of the free market sees to it that late capitalism works perfectly to everybody's best advantage without any regulation, particularly when something that should be a public service is being run to make a profit, and any problems are clearly the result of government interference with a system that would work perfectly well if they left the capitalist altruists to do their own thing as they saw fit.

quote:

ORIGINAL: MrRodgers

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: susie
Get rid of all the insurance companies that raise the cost of your healthcare. Pay a % of your salary into one fund that runs all hospitals in the USA and pays all doctors and specialists. The cost of healthcare will reduce..

That'll just raise medical costs further, though: everybody knows that the only way to reduce the price of anything is by promoting competition between business rivals, which invariably leads to them undercutting each other and offering more services for less money. Such an arrangement has never (for instance) led to corner cutting, a monopoly established by somebody running at a lost until their rivals were driven out of business and then hiking their prices massively once there were no alternatives to using them, competition over who can gouge the most payment for the least services from their customers, or other such marketplace abuses. The invisible hand of the free market sees to it that late capitalism works perfectly to everybody's best advantage without any regulation, particularly when something that should be a public service is being run to make a profit, and any problems are clearly the result of government interference with a system that would work perfectly well if they left the capitalist altruists to do their own thing as they saw fit.

Aside from the facts being today, one is an oxymoron...free market/capitalism and.....

.....altruistic capitalist is a character that doesn't exist.

What I see is this being something that so hits home (kids & family) that we may have just enough democracy to get this completely sanctioned and codified and in the interest of the vast majority of who are also currently...paying capitalists.

Imagine if in say 5-10 years, the other corporatists and capitalist, all in love with money just like their competition, after years of lobbying for it, finally can wash their hands of providing any health care. I am sure you know by now that as soon as corp. America can leave health care all to the employee, they drop it altogether like a hot potato.

Just like so many did under the ACA and everybody of course, driven by faction and what they want to believe...blamed Obama.

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: MasterJaguar01
What great questions! (Well, of course... consider the source) (Aw, shucks. )

To your first question...
The motivations would be:

1) Switiching the model from profit-driven care to patient care. Profit-driven care doesn't necessarily mean more profits. Rather it means tailoring care to generate ICD-10 codes that provide higher reimbursement. A PCP can hollistically provde care for his/her patient with ZERO regard for medical billing.
2) A guaranteed revenue stream, from patients who are paying for HEALTH CARE (not specific health care procedures).

ICD-10 codes? For what? They are getting paid a monthly fee to see a patient, regardless of how many times that patient gets an appointment. Who, exactly, is paying the PCP? Does each patient pay a monthly fee directly to the PCP/Group?

quote:

To your second question.... That is a bit more complex.
There is a concept of DPC verticals, where specialists participate, and the monthly fee is higher for the pateint to include specialty care.. Those extra monthhly dollars are distributed directly to specialists. (Also specialists are free to participate in multiple verticals). There is also one higher tier, o include non-catastrohic care of Hospitalist.
Regarding catasrophic care... The answer is yes... BUT...
The insuurance model completely changes... Instead of health insurance, you can by P&C model insurance. So, the GEICOs the AllStates of the world can participate. You can pick this insurance, theoretically, for $250/month.

I understand catastrophic care insurance is usually quite a bit less.

What happens if, say, I need a knee surgery. I'm not likely to be seeing a PCP that is also an orthopedic surgeon, so when can I increase my monthly dollars to include a specialist? How long do I have to continue those elevated monthly payments? If I'm not paying for the Hospitalist care, I would have insurance to pay for non-catastrophic care?

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: MasterJaguar01

quote:

ORIGINAL: sloguy02246
FR -
As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.
As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

Every time I post about DPC, invariably someone says, "That sounds like an HMO". And the OP on this thread is experiencing the same thing.
The BIGGEST difference between DPC and an HMO, is the middle man (the Insurance compny) is eliminated. As a benefit from that, the WHOLE fee-for-service model is thrown out the window. HMO's are Primary Care centric, but they are still fes-for-service, and subject to insurance company rules vis-a-vis coverage.
In DPC, you pay one VERY low monthly fee, and have unlimited access to your PCP, REGARDLESS of what services are performed. (And you get to tell tthe insurance companies to fuck off).

What would the motivation be for the PCP to be part if a DPC?

Outside of PCP services, insurance will still be necessary, right?

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: MrRodgers

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: susie
Get rid of all the insurance companies that raise the cost of your healthcare. Pay a % of your salary into one fund that runs all hospitals in the USA and pays all doctors and specialists. The cost of healthcare will reduce..

That'll just raise medical costs further, though: everybody knows that the only way to reduce the price of anything is by promoting competition between business rivals, which invariably leads to them undercutting each other and offering more services for less money. Such an arrangement has never (for instance) led to corner cutting, a monopoly established by somebody running at a lost until their rivals were driven out of business and then hiking their prices massively once there were no alternatives to using them, competition over who can gouge the most payment for the least services from their customers, or other such marketplace abuses. The invisible hand of the free market sees to it that late capitalism works perfectly to everybody's best advantage without any regulation, particularly when something that should be a public service is being run to make a profit, and any problems are clearly the result of government interference with a system that would work perfectly well if they left the capitalist altruists to do their own thing as they saw fit.

Aside from the facts being today, one is an oxymoron...free market/capitalism and.....

.....altruistic capitalist is a character that doesn't exist.

What I see is this being something that so hits home (kids & family) that we may have just enough democracy to get this completely sanctioned and codified and in the interest of the vast majority of who are also currently...paying capitalists.

Imagine if in say 5-10 years, the other corporatists and capitalist, all in love with money just like their competition, after years of lobbying for it, finally can wash their hands of providing any health care. I am sure you know by now that as soon as corp. America can leave health care all to the employee, they drop it altogether like a hot potato.

Just like so many did under the ACA and everybody of course, driven by faction and what they want to believe...blamed Obama.

Sarcasm, d00d. I thought it was pretty obvious that I was taking the piss out of those notions. (Hence the flying pig...)

quote:

ORIGINAL: susie

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: MasterJaguar01
What great questions! (Well, of course... consider the source) (Aw, shucks. )

To your first question...
The motivations would be:

1) Switiching the model from profit-driven care to patient care. Profit-driven care doesn't necessarily mean more profits. Rather it means tailoring care to generate ICD-10 codes that provide higher reimbursement. A PCP can hollistically provde care for his/her patient with ZERO regard for medical billing.
2) A guaranteed revenue stream, from patients who are paying for HEALTH CARE (not specific health care procedures).

ICD-10 codes? For what? They are getting paid a monthly fee to see a patient, regardless of how many times that patient gets an appointment. Who, exactly, is paying the PCP? Does each patient pay a monthly fee directly to the PCP/Group?

quote:

To your second question.... That is a bit more complex.
There is a concept of DPC verticals, where specialists participate, and the monthly fee is higher for the pateint to include specialty care.. Those extra monthhly dollars are distributed directly to specialists. (Also specialists are free to participate in multiple verticals). There is also one higher tier, o include non-catastrohic care of Hospitalist.
Regarding catasrophic care... The answer is yes... BUT...
The insuurance model completely changes... Instead of health insurance, you can by P&C model insurance. So, the GEICOs the AllStates of the world can participate. You can pick this insurance, theoretically, for $250/month.

I understand catastrophic care insurance is usually quite a bit less.

What happens if, say, I need a knee surgery. I'm not likely to be seeing a PCP that is also an orthopedic surgeon, so when can I increase my monthly dollars to include a specialist? How long do I have to continue those elevated monthly payments? If I'm not paying for the Hospitalist care, I would have insurance to pay for non-catastrophic care?

I really don't understand why everyone still talks about insurance. Every employee pays a % of their wages into a fund. The fund then owns all the hospitals and pays the wages of all the medical staff. Prices for equipment and drugs are reduced due to the monopoly the fund has over purchasing. Why pay a middleman insurance company who are only there to make money?

quote:

ORIGINAL: MasterJaguar01

quote:

ORIGINAL: sloguy02246

FR -

As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.

As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

Every time I post about DPC, invariably someone says, "That sounds like an HMO". And the OP on this thread is experiencing the same thing.

The BIGGEST difference between DPC and an HMO, is the middle man (the Insurance compny) is eliminated. As a benefit from that, the WHOLE fee-for-service model is thrown out the window. HMO's are Primary Care centric, but they are still fes-for-service, and subject to insurance company rules vis-a-vis coverage.

In DPC, you pay one VERY low monthly fee, and have unlimited access to your PCP, REGARDLESS of what services are performed. (And you get to tell tthe insurance companies to fuck off).

The funding model is BETTER for providers, because an insurance company doesn't take a huge chunk out of the funds. The fact that a PCP isn't making money PER VIST, is mitigated by the fact that he has many subscribers that are paying him monthly fees (TWICE what an HMO would pay)and never (or rarely) seeiing him/her.

quote:

ORIGINAL: MrRodgers

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: MrRodgers

quote:

ORIGINAL: WhoreMods

quote:

ORIGINAL: susie
Get rid of all the insurance companies that raise the cost of your healthcare. Pay a % of your salary into one fund that runs all hospitals in the USA and pays all doctors and specialists. The cost of healthcare will reduce..

That'll just raise medical costs further, though: everybody knows that the only way to reduce the price of anything is by promoting competition between business rivals, which invariably leads to them undercutting each other and offering more services for less money. Such an arrangement has never (for instance) led to corner cutting, a monopoly established by somebody running at a lost until their rivals were driven out of business and then hiking their prices massively once there were no alternatives to using them, competition over who can gouge the most payment for the least services from their customers, or other such marketplace abuses. The invisible hand of the free market sees to it that late capitalism works perfectly to everybody's best advantage without any regulation, particularly when something that should be a public service is being run to make a profit, and any problems are clearly the result of government interference with a system that would work perfectly well if they left the capitalist altruists to do their own thing as they saw fit.

Aside from the facts being today, one is an oxymoron...free market/capitalism and.....

.....altruistic capitalist is a character that doesn't exist.

What I see is this being something that so hits home (kids & family) that we may have just enough democracy to get this completely sanctioned and codified and in the interest of the vast majority of who are also currently...paying capitalists.

Imagine if in say 5-10 years, the other corporatists and capitalist, all in love with money just like their competition, after years of lobbying for it, finally can wash their hands of providing any health care. I am sure you know by now that as soon as corp. America can leave health care all to the employee, they drop it altogether like a hot potato.

Just like so many did under the ACA and everybody of course, driven by faction and what they want to believe...blamed Obama.

Sarcasm, d00d. I thought it was pretty obvious that I was taking the piss out of those notions. (Hence the flying pig...)

Sure but you know me...I get wordy sometimes.

quote:

ORIGINAL: AtUrCervix

quote:

ORIGINAL: MasterJaguar01

quote:

ORIGINAL: sloguy02246

FR -

As another poster stated earlier, this sounds very similar to an HMO plan.
I was the benefits coordinator at a company in the 90's who offered three different HMO plans in addition to a conventional insurance plan.
Let me assure you that an HMO-type plan will not solve this problem. Those HMO plans created a huge number of employee complaints because the HMO plans repeatedly declared proposed treatments as "unnecessary," and occasionally as "experimental" and would refude to pay for them, leaving the physician and patient to battle it out between themselves.

As noted above, these types of plans pay a network doctor a small, fixed amount every month for each patient who has designated the doctor as their primary care provider. After that, further payments (and referrals to specialists) are very hard to come by. The physician therefore has somewhat of a disincentive to provide a patient with continuing routine care as there is no additional money being paid to the physician, regardless of the number of office visits the patient requires.

Every time I post about DPC, invariably someone says, "That sounds like an HMO". And the OP on this thread is experiencing the same thing.

The BIGGEST difference between DPC and an HMO, is the middle man (the Insurance compny) is eliminated. As a benefit from that, the WHOLE fee-for-service model is thrown out the window. HMO's are Primary Care centric, but they are still fes-for-service, and subject to insurance company rules vis-a-vis coverage.

In DPC, you pay one VERY low monthly fee, and have unlimited access to your PCP, REGARDLESS of what services are performed. (And you get to tell tthe insurance companies to fuck off).

The funding model is BETTER for providers, because an insurance company doesn't take a huge chunk out of the funds. The fact that a PCP isn't making money PER VIST, is mitigated by the fact that he has many subscribers that are paying him monthly fees (TWICE what an HMO would pay)and never (or rarely) seeiing him/her.

I had a DPC...in less than 6 months the feds changed it to a GFL. I tried it (seriously...I gave it my best)...and in LESS THAN ONE YEAR they changed it to a HPL7 (no one asked ME!!!)...with a 3D5B...added to a 7L5!!!

I simply said "NO"....and walked away.

I now have a 6B43/71 and frankly...I've never been happier.

quote:

ORIGINAL: MasterWickedness

I have tried explaining this to Americashire before have I not? But they are a warped lot (by no means all of you) and mental head cases.

In essence, they should have the best health care system in the world as they spend 3 times more of their GDP on health (swiss aside but still twice as much as that lot though) than any other median nation on earth with “free health care”


I wonder where all the money goes?