Are Healthcare Company Clinics Opportunity or Competition?

Several Medicare and Medicaid healthcare providers are opening their own clinics to reduce the number of expensive hospital visits that their customers utilize.  The clinics are designed to provide the same care that has been commonly provided in hospitals at the local community clinics at less cost to the insurer than traditional hospital visits.  The clinics are designed to provide care that most doctors' offices cannot provide, such as IV and dialysis treatments. 

Since Medicare and Medicaid plans pay a fixed amount for each procedure, it makes sense for the insurance providers to hold down their costs as much as possible.  The government, both Federal and State have stated that they plan on reducing Medicare and Medicaid payments as one way to balance the budget.  This means that doctors and hospitals will get paid less for the same services and/or the patients will have to shoulder more of the burden fortheir own healthcare. 

Bravo Health, a Medicare Advantage provider, has opened two company run clinics in Philadelphia and one in Boston and are treating its insured patients at no out of pocket expenses to the patients.  They are hiring doctors and nurses to staff the facilities, offering opportunities for healthcare providers in the areas.  Bravo claims that the patients receive as good or better care than they receive in a typical hospital setting, but at less cost.  Bravo estimates hospital stays have declined by about 10 percent among the 20,000 patients living near the clinics.   Bravo doesn't do this by withholding care, said Jason Feuerman, a senior executive for HealthSpring, which acquired Bravo in November.. "It is about driving quality, about driving down the need for unnecessary [medical services] being delivered," Bravo claims to be providing smarter care not less care. 

Other Medicare Advantage plans around the country are buying out existing clinics or opening new clinics in order to hold down their expenses.  These ‘urgent care' clinics offer expanded hours and more extensive treatments than most doctors' offices offer, but they cannot handle severe trauma cases nor provide the extensive emergency room care that hospitals can provide.  The types of services where urgent care clinics can offer better care than a typical doctor's office and at a much lower cost than a hospital ER is minor trauma such as sutures or fractures or common illnesses such as ear infections and heart burn where a full blown ER facility is not required. 

How does this shift toward smaller, community clinics owned and run by insurance companies affect the primary care physicians in the area?  That depends on how you want to work with the insurance provider.  

If you want to retire, you may be able to sell your clinic to the insurance company, who can then expand your clinic and set-up an urgent care facility.  Then you can enjoy life. 

You can offer to set-up and manage an urgent care facility for the insurance company out of your existing clinic facility.  You can offer the insurance company a turn key facility that they can utilize for their plan members and save them the initial start up costs and aggravation usually associated with any start up business. 

You can join them and go to work for an urgent care clinic as an employee.  This may not be an attractive option for an established doctor, but for someone just starting out, the experience and regular salary may be an attractive option. 

Or you can remain a family practitioner, treating your patients as you always have, knowing that Medicare reimbursement will most likely be reduced in the future.  You can still offer the great bedside manner that you always have provided and compete against the large insurance companies for the aging American public by offering more personalized service. 

I know that's what I'll be doing.

For more information please visit http://www.hna-net.com or call 877-311-3338 and obne of our representatives will be happy to assist you.

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About the Author

Since 1993, Healthcare Networks of America successfully built a provider organization for over 17,000 healthcare professionals in all 50 states. HNA's multi-specialty network currently services 4,200 payers and 12.6 million patients nationwide. Healthcare Networks of America was created to organize healthcare providers into national networks. The result of this combination was the negotiation of higher reimbursement, fee-for-service contracts with insurance carriers, PPOs, and other health plan payers. To find out more please vivit http://www.hna-net.com

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