Health-care changes in The Villages leave some scrambling for new doctors

Aug. 12--Don Gott and his wife moved full time to The Villages about four years ago. They found the active lifestyle attractive; having golf carts to drive around was an added perk.

The Gotts were also impressed when the retirement community rolled out The Villages Health in 2012, a model of medical care focusing on community-based, patient-centered primary care at clinics in the community.

"They had a lot of buildup about it," said Gott, 73.

So he and many other Villagers switched doctors and started going to The Villages Health. The system lived up to its quality promises and has gained stellar national ratings.

But starting Jan. 1, Gott can no longer go there unless he changes his health insurance.

The Gotts and thousands of other Villagers received a letter from The Villages Health, notifying them that starting next year, the system would no longer accept original Medicare and traditional Medicare Supplemental policies for new and existing patients.

"This means that as of next year, you will need to be enrolled in a UnitedHealthcare Medicare Advantage plan to remain a patient with The Villages Health," said a letter signed by Tom Menichino, CEO of the system, and its chief medical officer Dr. Jeffrey Lowenkron.

The letter did not provide an explanation for this decision, leaving some Villagers feeling betrayed by what's dubbed the friendliest hometown.

The Gotts and hundreds of other Villagers who have Medicare have a few months to decide whether they want to switch their Medicare plan to a UnitedHealthcare plan or find a new doctor who accepts their existing insurance.

"We're getting as many as 100 calls a day," said Gail Dambrosio, operations manager for Premier Medical Associates, which has two offices in The Villages. "People are looking for a doctor. They want to come in and meet them and see if their health care can be transferred. They're afraid."

The Villages did not respond to interview requests, and UnitedHealthcare officials deferred questions to The Villages, only saying that The Villages Health "is a well-respected health care system, and we are pleased our members have access to it."

Experts speculate there could be several motives behind the arrangement, although it's hard to know for sure.

For one, Medicare is undergoing some changes that impacts how it pays doctors. However, the new provision won't have as much of an impact on Medicare Advantage, "so it's possible that they wanted to get out of some [of those] provisions," said Dr. Joseph Newhouse, John D. MacArthur professor of health policy and management at Harvard University.

Also, what The Villages Health is doing is part of a growing trend, as the health care system moves away from a fee-for-service model toward one that pays for quality and performance, experts say.

"More health plans ... are owning or managing physician offices by controlling which health plans are accepted at the facility," said Wes Fischer, president of the Health Insurance Store in Kissimmee. (Clarification: A UnitedHealthcare spokesman said the company has no ownership or management role in The Villages Health clinics.)

"Over time, more and more Medicare beneficiaries will face similar choices to the Villagers," Fischer said.

Medicare Advantage plans tend to cost less for consumers and can provide better continuity of care for patients, but on the flip side, they have a limited network of providers and drug formularies, and that doesn't sit well with all consumers.

"I go every year to the Mayo Clinic and have them check me out, and I don't want to give up my right to that," Gott said. "This is not for me. I can't give up all those rights."

"This is a hardship on people our age," said Gott.

[email protected] or 407-420-5158

___

(c)2016 The Orlando Sentinel (Orlando, Fla.)

Visit The Orlando Sentinel (Orlando, Fla.) at www.OrlandoSentinel.com

Distributed by Tribune Content Agency, LLC.