Physician Integration and Alignment
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Physician Integration and Alignment
IPAs, PHOs, MSOs, ACOs, Clinics Without Walls & Beyond
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Scooped by Maria K Todd, MHA PhD
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Can Patients Use Their HSA to Pay for Concierge Medical Fees?

Can Patients Use Their HSA to Pay for Concierge Medical Fees? | Physician Integration and Alignment | Scoop.it

There are essentially four “Concierge” models. As such, the answer is "it depends":

 

Fees for care. In this model the fees charged are directly related to medical care, as described by the IRS, and would generally be considered as eligible medical expenses under the HSA guidelines.

 

Annual Physical. Here a fee is charged for an annual physical, usually comprehensive in scope, that includes no additional non-medical services. The physical is considered to be medical care and would generally be considered as eligible medical expenses under the HSA guidelines.

 

Annual physical plus amenities. Here a fee is charged for an annual physical and some additional non-medical services (amenities). The physical is considered to be medical care and would generally be considered as eligible medical expenses under the HSA guidelines. The amenities (e.g. retainer fess or timely access to a physician) are not eligible medical expenses under the HSA Guidelines. If the Physician group provides itemized billing for the services included, the physical can be reimbursed from the HSA as a medical expense, but the “amenities” cannot. In the case where the physician group furnishes only a global bill with no itemization for specific services, it may be difficult to prove the expense was eligible.

 

Amenities Only. Here the fees collected by the physician groups are exclusively for amenities like retainer fees or guaranteed timely access. These are not medical expenses and as such are not generally reimbursable by the HSA.

 

The rationale is detailed below.

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IPAs or PHOs: Critical Comparison and Contrast

IPAs or PHOs: Critical Comparison and Contrast | Physician Integration and Alignment | Scoop.it

A White Paper by Maria K Todd, MHA PhD

 

Provider organizations such as IPAs and PHOs are often established and sponsored by healthcare providers (e.g., physicians, hospitals and others).

 

They are organized for the principal purpose of bringing previously separate providers together to deliver integrated health services in a managed care environment. 

 

Maria Todd compares and contrasts these for today's market, incorporating the lessons learned from the last merry-go-round in the 1990s.

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A Checklist for Physician Integration Projects

A Checklist for Physician Integration Projects | Physician Integration and Alignment | Scoop.it

Here's a free and useful tool you can use before you call us (or any other consulting firm) to help you build your new IPA, PHO, MSO or ACO. 

 

It's a high-level questionnaire to prepare your new organization's steering committee to get the best value out of your time with your consultant.  It comes from having been through close to 400 of these initial meetings and developing more than 300 integrated groups in the USA and abroad.

 

(yup, these entities are forming worldwide...not just in the USA!)

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Inside the ACO: Pioneers Creating Accountable Care Organizations ...

Free one-hour webinar that examines the forces and factors contributing to the growth of Accountable Care Organizations (ACOs) throughout today's health care landscape. 

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