Dr. Christopher Rao jumped out of his office chair. He'd just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.
He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy. "Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place," Rao told her in September, holding her hand.
"But the reality is, if you slip at home even a little, it could end up in a bad, bad way," Rao told. Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it's also a wise financial strategy.
Rao works for WellMed, a physician-management company whose doctors treat more than 350,000 Medicare patients at primary care clinics in Florida and Texas.
Instead of being reimbursed for each patient visit, WellMed gets a fixed monthly payment from private Medicare Advantage plans to cover virtually all of their members' health needs, including drugs and physician, hospital, mental health and rehabilitation services. If they can stay under budget, the physician companies profit. If not, they lose money.
This model is known as "full-risk" or "global risk" is increasingly used by Medicare plans such as Humana and UnitedHealthcare to shift their financial exposure from costly patients to WellMed and other physician-management companies. It gives the doctors' groups more money upfront and control over patient care.
WellMed, along with similar fast-growing companies such as Miami-based ChenMed, Boston-based Iora Health, and Chicago-based Oak Street Health, says they provide patients significantly more time with their doctors, same-day or next-day appointments and health coaches. These doctors generally work on salary.
A Way To 'Provide Less Care'
Some patient advocates, pointing to similar experiments that failed in the 1990s, fear "global risk" could lead doctors to skimp on care — particularly for expensive services such as CT tests and surgical procedures.
"At the end of the day, this is a way to keep costs down and provide less care," said Judith Stein, executive director of the Center for Medicare Advocacy. Dr. Brant Mittler, a Texas cardiologist and trial attorney who has followed the issue, said Medicare Advantage members should be suspicious.
"Patients don't know that decisions made on their behalf are often financially based. There may be pressure on doctors to cut corners to save money, and that may not be in the best interests of a patient's health," he said.