HHS Announcement Empowers Limited Benefits Plans

Week of June 20, 2011

Federal healthcare reform continues to unfold as the “old indemnity plan” has survived the ObamaCare attack.  Defined benefits/indemnity benefits (as opposed to the unlimited major medical plans with co-pays and deductibles, etc.), is alive and well. And, that is great news!  PDA is pleased to roll-up our sleeves and explain this worthwhile insurance program to its physician members.

A new Government Accountability Office (GAO) report has concluded that regulators have followed objective criteria in granting temporary waivers from the health care reform law, essentially giving a boost to employers with limited benefits plans — or “mini-med” plans — who face large projected premium increases under the law. The law restricts employers’ ability to impose annual limits on essential benefits, which many fear would significantly drive up premiums for employers with mini-med plans and result in the loss of coverage for many of their employees. These plans are quite popular with the American worker.

HHS received 1,415 applications for a waiver of restrictions, and 1,347 of the applications were granted. Some critics have charged that political favoritism was at work in granting so many waivers, but the GAO report found that the granting of waivers was appropriately tied to significant premium increases and projected reductions in access to benefits.

In 2010, Aetna applied for, and received, a waiver from restricted annual limits for all of its limited benefit medical insurance policies, covering more than 430,000 members.  We have to ask if you are seeing those patients or are they seeing the competition?

So, it seems that practicality may have won a round in the fight for independence and choice. Aetna and a coalition of businesses and agents have asserted that the law unintentionally could have caused more than 1 million Americans to lose their health care coverage because the prohibition on annual and lifetime limits would have made coverage unaffordable for them.

This information fits with the strategy of setting up non-managed care products for PDA and the Flagship Physician Network.  These could include defined benefits, direct contracting arrangements and disease specific plans that make more money for the practitioner, cut hassle, and do not require any more work.


EXCITING FLAGSHIP/PDA ANNOUNCEMENT

EXCITING FLAGSHIP/PDA ANNOUNCEMENT

The Flagship Physician Network is pleased to announce that it is ready to initiate its first Community Healthcare Project.  The Flagship has a shared action plan with a DFW hospital to offer direct healthcare contracting to local employers.  The first step in the rollout will be a Flagship and PDA membership drive to enlist additional physicians in the hospital’s immediate community.  This thrust will begin in the next two weeks.

Step two of the rollout will involve soliciting participation of a community employer for “beta-testing” of the program.  This company will act as the cornerstone of the Community Health Plan.  Characteristics of the first pilot program are as follows:

  • Most importantly, everyone involved has a strong sense of community commitment and service. This is going to be a huge success because everyone believes that it will work!
  • Ideal company size is 50-175 employees
  • Experience of unacceptable annual increases in benefits expenses
  • A business leader or owner that interacts successfully with the hospital CEO and physician leaders.
  • Insurance marketers and a back-room services group that wants to do something new and different to stem the rising cost of health insurance, even if there may be kinks to work out.
  • The pilot program employees should reside primarily in the local area.
  • A willingness to change the “good-old-boy network” for a team of doctors and healthcare managers that are going to significantly alter the benefit plan
  • Interest in biometrics, wellness, information technology and the Company Doctor program

For the physicians who participate, the benefits will be quickly apparent.  There will be a flow of patients into their offices with insurance reimbursements at or above the level of the best commercial carriers.  Essentially, those physicians will now have a team of healthcare salesmen working directly for them, bringing in new, desirable business.  The old managed care steering efforts have never worked.  So, the PDA troops will go directly to the employer, and with licensed insurance professionals, go after the business.  

How much will this opportunity cost the participating physicians?  It will cost them only the price of PDA membership.  This is the biggest thrust yet in PDA’s pledge to its physicians to bring more revenue with less hassle and no new time commitment.  Led by Buddy Miers and with physician ownership, PDA is not your old-fashioned IPA!


Let’s Do A Deal

Our message is that physicians need to make more money, with less hassle, and avoid extra work time in the process.  PDA and the Flagship Physician Network exist to serve that objective.  In the words of Buddy Miers, founder of the original Presbyterian JVE, architect of the original primary care group of SPA, and CEO of the Flagship, “It should be about doing good for the patients, having fun, and making money!”

Your Flagship management and physician leaders are constantly being approached with interesting revenue producing opportunities.  We must identify our constituents who have an interest in maximizing their bottom line.  You can try to keep your head above water by simply running faster on the office treadmill, but there are promising options that can have a multiplier effect, compounding the return on your medical skills.

To make a point, the Flagship looks at each broad, booming field and asks, “Are our physicians participating in this growth niche?  Or, do the PDA/Flagship practitioners feed this growing industry with uncompensated referrals?  A great question!

Let us get quite specific with on example, there is an exploding long term care continuum that reaches from LTACs and skilled nursing to rehabilitation and assisted living.  Just this one pool of opportunities represents major potential to upgrade physician earnings.  “The assisted living industry is a growth industry,” said Gene Warren, a Phoenix-based expert on the economics of retirement.  “It was almost nonexistent in the early 1990s, while today the industry is estimated to have annual revenues of $36.8 billion with a projected annual growth rate of 4.2 percent.” Yes, $40 billion and climbing.

We have zeroed in on a 16 acre property that is zoned for assisted living and within walking distance from the new Methodist Hospital in Mansfield, Texas. The community is much like Southlake and Frisco in demographic excellence. A group of physicians could invest in a “REIT” which is a real estate investment trust. This is a corporate structure that eliminates corporate income taxes. In return, the REIT must distribute 90% of the income from property profit to the shareholders. So, a group of our practitioners could fund the REIT that leases the property to an operating healthcare facility and have no “Stark” liability. There is more to the concept, and disclaimers always rule, but this is a model that the physicians can support and enjoy a very strong return-on-investment! We may facilitate a deal with investors from Florida or Colorado.  It is a shame that the ROI is not yet directed to PDA physicians. Would this interest you?

When you are ready for an upgrade, call PDA/Flagship Medical Director, Daniel S. Karin M.D., a call at 972-484-5888 or email dkarinmd@flagshipnetwork.com.

PDA is an independent physicians association that strives to generate new revenues for its practitioners, eliminate hassles, and not require any more time. The organization contracts with commercial managed care payers, Medicare Advantage Programs, and Medicaid opportunities. Current new business development is directed at Employee Retirement Income Security Act (ERISA) contracts, i.e., Direct Contracts to employers and Department of Defense healthcare programs. Day-to-day operations issues at the physicians’ offices relating managed care are supported by PDA resources. PDA colleagues provide medical marketing to grow practice revenues and profitability, full service insurance benefits including medical malpractice, and interim healthcare operations management. The Chairman and board of directors are independent physicians. Bylaws equally include nurse practitioners, physician assistants, nurse anesthetists, podiatrists, and other allied health professionals. Through various marketing and contractual means, PDA is engaged with 780 practitioners in seventeen counties.

 


Opportunities

DOING GOOD FOR PATIENTS, HAVING FUN AND INCREASING REVENUES

The independent physicians are toiling away in this ObamaCare world.  Paperwork has increased, consultation reimbursement is evaporating, and the pressure to practice assembly line medicine is unrelenting.

Our message is that physicians need to make more money, with less hassle, and avoid extra work time in the process.  PDA and the Flagship Physician Network exist to serve that objective.  In the words of Buddy Miers, founder of the original Presbyterian JVE, architect of the original primary care group of SPA, and CEO of the Flagship, ”It should be about doing good for the patients, having fun, and making money!”

There are opportunities for physicians that are ready to fire out.  The challenge is to get above the daily noise and do some strategic planning.  You take care of other people’s needs daily, but it is also necessary to give attention to your own wealth-building.  And please keep in focus that the best investments will always relate to your primary skill as a physician.  The investment in medical education is the best investment you’ve ever made.  Continuing to invest in your medical career remains the most efficient use of your investment dollar.

Your Flagship management and physician leaders are constantly being approached with interesting revenue producing opportunities.  We are going to identify our constituents who have an interest in maximizing their bottom line.  You can try to keep your head above water by simply running faster on the treadmill, but there are promising options that can have a multiplier effect, compounding the return on your medical skills.

To make a point, the Flagship looks at each broad, booming field and asks, “Are our physicians participating in this growth niche?  Or, do the PDA/Flagship practitioners feed this growing industry with uncompensated referrals?  A great question!

For just one example, there is an exploding long term care continuum that reaches from LTACs and skilled nursing to rehabilitation and assisted living.  Just this one pool of opportunities represents major potential to upgrade physician earnings.  “The assisted living industry is a growth industry,” said Gene Warren, a Phoenix-based expert on the economics of retirement.  “It was almost nonexistent in the early 1990s, while today the industry is estimated to have annual revenues of $36.8 billion with a projected annual growth rate of 4.2 percent.” Yes, $40 billion and climbing.

And, there are several other healthcare sectors to focus on, some for primary care physicians and some for specialists.  When you are ready for an upgrade, give PDA/Flagship Medical Director, Daniel S. Karin M.D., a call at 972-484-5888 or email dkarinmd@flagshipnetwork.com.