16 ms·

How does this work with institutions like Kaiser? Are their hospitals not technically hospitals? Or are the physicians all technically contractors there?

ConcernedCoder 7y ago
They are all salaried employees, so Kaiser can work from a 'fixed cost' perspective ( as told to me by a surgical nurse ).
- privateSFacct 7y ago
  100% false! That would be totally illegal. California CLEARLY bans hospitals from doing this.
  - ConcernedCoder 7y ago
    I mean, you can even google it like I did, from this page: https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-why-you-might-want-to https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-... "For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
- repiret 7y ago
  There are there different entities that all work together: Kaiser Foundation Health Plan provides medical insurance. The Kaiser Foundation of Hospitals owns all the hospitals. The Permanente Medical Group, Inc. employs all the doctors. The latter is a Professional Corporation, so its allowed to employ physicians to practice medicine, but it doesn't operate hospitals.
privateSFacct 7y ago
California really makes it hard to have everything on one bill because no hospital can hire a doctor. But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc. Kaiser is sort of a funny workaround. The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser) The win for doctors is you really don't have denied claims or the billing pain you might in private practice. CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore. Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think. If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.

ConcernedCoder 7y ago

They are all salaried employees, so Kaiser can work from a 'fixed cost' perspective ( as told to me by a surgical nurse ).

privateSFacct 7y ago
100% false! That would be totally illegal. California CLEARLY bans hospitals from doing this.
- ConcernedCoder 7y ago
  I mean, you can even google it like I did, from this page: https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-why-you-might-want-to https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-... "For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
repiret 7y ago
There are there different entities that all work together: Kaiser Foundation Health Plan provides medical insurance. The Kaiser Foundation of Hospitals owns all the hospitals. The Permanente Medical Group, Inc. employs all the doctors. The latter is a Professional Corporation, so its allowed to employ physicians to practice medicine, but it doesn't operate hospitals.

privateSFacct 7y ago

California really makes it hard to have everything on one bill because no hospital can hire a doctor. But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc. Kaiser is sort of a funny workaround. The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser) The win for doctors is you really don't have denied claims or the billing pain you might in private practice. CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore. Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think. If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.