Medic207 Posted July 21, 2011 Author Share Posted July 21, 2011 People smarter than me please consider this scenario andtell me if this idea could fly. Suppose a company wanted to reduce theirinsurance costs by charging their employees for the dependant coverage. Currentlythe company pays 100% for employee and dependant coverage, which is about75,000 dollars a month. The ownerfigures if he charged each employee $200 dollars a month to go towards healthcarecosts and he has 200 employees, he would save 40,000 per month. He figures his employeeswill not be happy, so he decides he will hire a PA to work for compay. The PAs jobwould be to be the “companies” provider and would provide primary care to the200 employees + their dependants. Also the PA would provide any employee healthtype needs for on the job injuries and maybe handle the worker’s comp problems.The company agrees to pay the PA’s Supervising Doc. (the rate has not beendetermined, because nobody knows how this will work yet. The supervising docworks for a community clinic 50 miles away. The employees would not pay aco-pay, and the employer will help offset any medical supplies needed to providethis care. Of course the employee couldkeep their current provider, but would have to pay the co-pays. Could this arrangement work? Does the company have to be a ”real” clinic? How wouldrecords be kept? Is this a “closed” practice and does that mean anything? Would the employer be better off contracting with the MD,and would the PA be a company employee or the employee of the MD? (or caneither arrangement work) If the services are to be provided on the company’sproperty, is or could this be considered a house call, or concierge practice? I ask because I have been approached by a company to dothis, they are willing to split the savings. (ie:20,000 a month to the PA)Sounds too good to be true. Is it? Thanks for the input from the smart people. Neither this PA nor the company knows how to proceed in making this happen. I am just now on my journey to figure this out. Link to comment Share on other sites More sharing options...
Medic207 Posted July 21, 2011 Share Posted July 21, 2011 People smarter than me please consider this scenario andtell me if this idea could fly. Suppose a company wanted to reduce theirinsurance costs by charging their employees for the dependant coverage. Currentlythe company pays 100% for employee and dependant coverage, which is about75,000 dollars a month. The ownerfigures if he charged each employee $200 dollars a month to go towards healthcarecosts and he has 200 employees, he would save 40,000 per month. He figures his employeeswill not be happy, so he decides he will hire a PA to work for compay. The PAs jobwould be to be the “companies” provider and would provide primary care to the200 employees + their dependants. Also the PA would provide any employee healthtype needs for on the job injuries and maybe handle the worker’s comp problems.The company agrees to pay the PA’s Supervising Doc. (the rate has not beendetermined, because nobody knows how this will work yet. The supervising docworks for a community clinic 50 miles away. The employees would not pay aco-pay, and the employer will help offset any medical supplies needed to providethis care. Of course the employee couldkeep their current provider, but would have to pay the co-pays. Could this arrangement work? Does the company have to be a ”real” clinic? How wouldrecords be kept? Is this a “closed” practice and does that mean anything? Would the employer be better off contracting with the MD,and would the PA be a company employee or the employee of the MD? (or caneither arrangement work) If the services are to be provided on the company’sproperty, is or could this be considered a house call, or concierge practice? I ask because I have been approached by a company to dothis, they are willing to split the savings. (ie:20,000 a month to the PA)Sounds too good to be true. Is it? Thanks for the input from the smart people. Neither this PA nor the company knows how to proceed in making this happen. I am just now on my journey to figure this out. Link to comment Share on other sites More sharing options...
Just Steve Posted July 22, 2011 Share Posted July 22, 2011 I am not smart. But I do have a question to ponder as part of the equation: In the event that the provider on property is unable to address the employees health needs and the employee is required to seek outside medical treatment, how will the insurance work out? I was a paramedic in the greater Washington DC area for awhile. It was not uncommon to respond to Discovery Channel headquarters or Lockhead Martin's offices and receive a patient from their on property clinical care provider (NP/PA/MD), out of their private clinic. I have also responded to college campuses (non med school affiliated campuses) and received patients from their private clinical care provider...same with the prison system. Perhaps you could google up some of the larger corporations and see if their websites offer any insight of medical benefits that they offer their employees, then reverse engineer it to find out how they manage it? Link to comment Share on other sites More sharing options...
Just Steve Posted July 22, 2011 Share Posted July 22, 2011 I am not smart. But I do have a question to ponder as part of the equation: In the event that the provider on property is unable to address the employees health needs and the employee is required to seek outside medical treatment, how will the insurance work out? I was a paramedic in the greater Washington DC area for awhile. It was not uncommon to respond to Discovery Channel headquarters or Lockhead Martin's offices and receive a patient from their on property clinical care provider (NP/PA/MD), out of their private clinic. I have also responded to college campuses (non med school affiliated campuses) and received patients from their private clinical care provider...same with the prison system. Perhaps you could google up some of the larger corporations and see if their websites offer any insight of medical benefits that they offer their employees, then reverse engineer it to find out how they manage it? Link to comment Share on other sites More sharing options...
Medic207 Posted July 22, 2011 Author Share Posted July 22, 2011 Just Steve, thanks for the input. I feel that in the event of any "emergency" the patient should be referred to the closest ER. I work in that ER (in this case). These patients will still have insurance and still have coverage for acute care, major medical etc.. Link to comment Share on other sites More sharing options...
Medic207 Posted July 22, 2011 Author Share Posted July 22, 2011 Just Steve, thanks for the input. I feel that in the event of any "emergency" the patient should be referred to the closest ER. I work in that ER (in this case). These patients will still have insurance and still have coverage for acute care, major medical etc.. Link to comment Share on other sites More sharing options...
ATCLATEMTB Posted July 22, 2011 Share Posted July 22, 2011 I remember a lecture session during IMPACT 2010 in Atlanta, which was delivered by a PA doing exactly what you are proposing. Even had the local pharmacy deliver scripts to the office to help ensure compliance. I can not find the ppt, however was able to find the key points from the AAPA website. You might be able to find contact info for the presenter, he might be able to answer most of your questions. I've copied the key points from the AAPA site below. Primary Care in Your Workplace: The next frontier Kenneth K. Wiscomb, PA-C 1. Lowering costs and improving access while both defining and maintaining quality standards remain the biggest hurdles facing our health care system. In order to resolve these issues we need to begin thinking differently about how and where we provide care. 2. The current system is driven by treatment of acute injury and illness with a major component linked to exacerbations of chronic disease. Instead, we should be focusing on better management of chronic disease and preventive services for risk factor reduction. 3. Reforming the third party payer system is only part of the solution. Payers will continue to focus on generating revenue and users will continue to focus on the cost and convenience of their care. Therefore, we also need to change the benchmark incentives for both groups in order to lower overall risk and subsequent cost. 4. Incentives for health promotion and disease prevention provided by the government may be viewed as restrictive, while incentives provided by employers have historically been accepted as being proactive. Employers themselves also have the greatest economic incentive to provide preventive health services. 5. Comprehensive, employer-based health promotion programs linked with onsite primary care services will provide the most immediate paradigm shift in our health care system by improving both access and convenience, encouraging positive incentives for risk reduction, lowering overall costs and improving health outcomes. Link to comment Share on other sites More sharing options...
ATCLATEMTB Posted July 22, 2011 Share Posted July 22, 2011 I remember a lecture session during IMPACT 2010 in Atlanta, which was delivered by a PA doing exactly what you are proposing. Even had the local pharmacy deliver scripts to the office to help ensure compliance. I can not find the ppt, however was able to find the key points from the AAPA website. You might be able to find contact info for the presenter, he might be able to answer most of your questions. I've copied the key points from the AAPA site below. Primary Care in Your Workplace: The next frontier Kenneth K. Wiscomb, PA-C 1. Lowering costs and improving access while both defining and maintaining quality standards remain the biggest hurdles facing our health care system. In order to resolve these issues we need to begin thinking differently about how and where we provide care. 2. The current system is driven by treatment of acute injury and illness with a major component linked to exacerbations of chronic disease. Instead, we should be focusing on better management of chronic disease and preventive services for risk factor reduction. 3. Reforming the third party payer system is only part of the solution. Payers will continue to focus on generating revenue and users will continue to focus on the cost and convenience of their care. Therefore, we also need to change the benchmark incentives for both groups in order to lower overall risk and subsequent cost. 4. Incentives for health promotion and disease prevention provided by the government may be viewed as restrictive, while incentives provided by employers have historically been accepted as being proactive. Employers themselves also have the greatest economic incentive to provide preventive health services. 5. Comprehensive, employer-based health promotion programs linked with onsite primary care services will provide the most immediate paradigm shift in our health care system by improving both access and convenience, encouraging positive incentives for risk reduction, lowering overall costs and improving health outcomes. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 22, 2011 Moderator Share Posted July 22, 2011 major issue is the amount of payment figure you need 90k min for salary that means about about 90k in overhead (maybe less if no insurance issues) but still a lot more then the 120k that is being kicked around..... figure 20+k to the doc 15k for co portion of payroll taxes and what not..... sounds like you gotta make more money then what is being offered..... of yeah and don't forget you have to have someone to come in when you want vacation.... yeah you want to take vacation.... also the 50/50 split on cost savings is not very good - if the business owner can pocket anything more then 20k he should be happy as it would be a good service to the employe Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 22, 2011 Moderator Share Posted July 22, 2011 major issue is the amount of payment figure you need 90k min for salary that means about about 90k in overhead (maybe less if no insurance issues) but still a lot more then the 120k that is being kicked around..... figure 20+k to the doc 15k for co portion of payroll taxes and what not..... sounds like you gotta make more money then what is being offered..... of yeah and don't forget you have to have someone to come in when you want vacation.... yeah you want to take vacation.... also the 50/50 split on cost savings is not very good - if the business owner can pocket anything more then 20k he should be happy as it would be a good service to the employe Link to comment Share on other sites More sharing options...
Medic207 Posted July 22, 2011 Author Share Posted July 22, 2011 Thanks for the input so far. I have gotten a lot of good emails on this one. Apparently there are "a lot" of PAs out there already doing this, making way more than the "average" salary. PS: I am on my way to get a new keyboard to fix the spacebar problem. Link to comment Share on other sites More sharing options...
Medic207 Posted July 22, 2011 Author Share Posted July 22, 2011 Thanks for the input so far. I have gotten a lot of good emails on this one. Apparently there are "a lot" of PAs out there already doing this, making way more than the "average" salary. PS: I am on my way to get a new keyboard to fix the spacebar problem. Link to comment Share on other sites More sharing options...
Contrarian Posted July 22, 2011 Share Posted July 22, 2011 Simple... Spend a couple hundred dollars to form a PLLC then apply for Tax ID #. (can be done in 24hrs for ~$500) This New PLLC seeks to form and service contracts to provide Acute/Urgent medical coverage to businesses. This PLLC can rent office space from YOU in your home. This PLLC hires manager (YOU) and Medical Director (SP) and clinical coordinator (?Spouse/SO?) and pays all taxes, fees, overhead, gas and vehicle maintainance, health insurance, advertising/marketing, office space, cellphone, Ipads, EMR, etc. The company you mentioned above will then contract with the PLLC (NOT YOU) to provide services. If done this way... you (ummm... the PLLC) can easily hire more SPs and more PAs/NPs PRN and submit bids to private and government orgs to expand to cover multiple sites. YMMV Contrarian Link to comment Share on other sites More sharing options...
Contrarian Posted July 22, 2011 Share Posted July 22, 2011 Simple... Spend a couple hundred dollars to form a PLLC then apply for Tax ID #. (can be done in 24hrs for ~$500) This New PLLC seeks to form and service contracts to provide Acute/Urgent medical coverage to businesses. This PLLC can rent office space from YOU in your home. This PLLC hires manager (YOU) and Medical Director (SP) and clinical coordinator (?Spouse/SO?) and pays all taxes, fees, overhead, gas and vehicle maintainance, health insurance, advertising/marketing, office space, cellphone, Ipads, EMR, etc. The company you mentioned above will then contract with the PLLC (NOT YOU) to provide services. If done this way... you (ummm... the PLLC) can easily hire more SPs and more PAs/NPs PRN and submit bids to private and government orgs to expand to cover multiple sites. YMMV Contrarian Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 Good tips! Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 Good tips! Link to comment Share on other sites More sharing options...
Contrarian Posted July 23, 2011 Share Posted July 23, 2011 The goal of the PLLC is to make/show a MAX profit of and only pay taxes on $1000-$5000/yr. The rest of the money should be ALL spent on overhead. Link to comment Share on other sites More sharing options...
Contrarian Posted July 23, 2011 Share Posted July 23, 2011 The goal of the PLLC is to make/show a MAX profit of and only pay taxes on $1000-$5000/yr. The rest of the money should be ALL spent on overhead. Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 Thanks I get it. What I dont know is do I have to apply for any special licenses to provide these services... CLIA, Health Dept, etc.. Or is this covered by the SP? I wouldnt think so since he works for a RHC in another town. There would only be about 200 young families maximum, and most of the services provided would be for things such as coughs, colds, cuts, physicals. Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 Thanks I get it. What I dont know is do I have to apply for any special licenses to provide these services... CLIA, Health Dept, etc.. Or is this covered by the SP? I wouldnt think so since he works for a RHC in another town. There would only be about 200 young families maximum, and most of the services provided would be for things such as coughs, colds, cuts, physicals. Link to comment Share on other sites More sharing options...
Contrarian Posted July 23, 2011 Share Posted July 23, 2011 CLia: If you order and perform any Labs ClIA will be involved... but from what you describe, you can do most with CLIA-waived testing. A simpler way to do this would be to contract with a lab to do your testing and electronically send the results to either your internet fax or EMR. Going this route could get you substantial discounts. FOr example, we do Drug screen UAs on 100 patients every week at one of my jobs. To test for buprenorphine, the clinician must order a specific test to look for it as the common 9,12,15 drug test do not look for it which is why its a popular drug to abuse. Oedered individually, each buprenorphine test would cost use $223... but since we contract with them and have good volume, each test only costs a additional $9. Maybe PAMAC will chime in with this info since he/she is the Lab professional... Link to comment Share on other sites More sharing options...
Contrarian Posted July 23, 2011 Share Posted July 23, 2011 CLia: If you order and perform any Labs ClIA will be involved... but from what you describe, you can do most with CLIA-waived testing. A simpler way to do this would be to contract with a lab to do your testing and electronically send the results to either your internet fax or EMR. Going this route could get you substantial discounts. FOr example, we do Drug screen UAs on 100 patients every week at one of my jobs. To test for buprenorphine, the clinician must order a specific test to look for it as the common 9,12,15 drug test do not look for it which is why its a popular drug to abuse. Oedered individually, each buprenorphine test would cost use $223... but since we contract with them and have good volume, each test only costs a additional $9. Maybe PAMAC will chime in with this info since he/she is the Lab professional... Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 From what I can tell.... I could get a waiver for the UAs and accu-checks. I do not think I need anything for just drawing blood, as I would use a contract lab for the results. The potential SP has no problemswith this practice, but offers little in way of "setting it up." So..I am still seeking input, thanks for the information so far. services that would be potentially offered on site: Physicals (DOT, sports exams) on the job minor emergencies Sick call (coughs, colds, etc..) immunizations ??? Link to comment Share on other sites More sharing options...
Medic207 Posted July 23, 2011 Author Share Posted July 23, 2011 From what I can tell.... I could get a waiver for the UAs and accu-checks. I do not think I need anything for just drawing blood, as I would use a contract lab for the results. The potential SP has no problemswith this practice, but offers little in way of "setting it up." So..I am still seeking input, thanks for the information so far. services that would be potentially offered on site: Physicals (DOT, sports exams) on the job minor emergencies Sick call (coughs, colds, etc..) immunizations ??? Link to comment Share on other sites More sharing options...
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