There are problems with
PFFS plans for sure but the doctor testifying here is putting plenty of spin on it. The Senator asks him (at about 5:10 on the video) what the major difference was between
PFFS and
PPO and
HMO's. He replies "the
PPO's share some of the extra funds they get from medicare advantage plans with us but the
PFFS plans do not." Let's all guess why they are against
PFFS plans.
Also, he starts off his presentation by saying that the Everett Clinic lost 7 million last year by being in
PFFS plans and then goes on to equate that to not covering costs. We dont know that based on his testimony. A loss of 7 million in revenue just because they would have gotten more from an
HMO or
PPO plan does not mean that they absorbed costs or subsidized patients or the government. One of the reasons why health cares costs keep skyrocketing is because everytime a physican group says that they are taking in less revenue that is supposed to automatically mean that patients are getting less care rather than holding them to follow models where clinics are operating more successfully with few dollars.
His point about the
PFFS plans not requiring data integration, and managed care coordination etc may be valid but so what. You don't get that from a patient with a med supp either but you get by somehow.
The basically strongarmed their patients. They run a massive clinic in Everett, Washington and build up a massive clientele of seniors as part of a little empire built by medicare and medicaid dollars. Then they just tell all the patients that they dont take
PFFS plans so you are sh*t out of luck unless you sign up for a plan which "shares part of the extra funding they get with us."
I think the hard look and criticism of PFS plans is a good thing but I would take a hard look at them too. These doctors bitch about managed care all the way but they know how to play the gravy game bigtime all while they are whining about it. It it is a non-senior with a private insurance, they think managed care limits patient care blah, blah, blah and interferes with choice blah, blah, blah. However, if there is more gravy in an
HMO plan for seniors then they just talk out of the other side of their mouth.
Winter
Who's Not Accepting PFFS 2009
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