To HMO or Not to HMO

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Health maintenance organization (HMO) is one of the ways our patients avail health care.

In most hospital settings particularly in bigger tertiary hospitals, HMO comprises a great percentage of patients. Sometimes the numbers may reach half or even more of those availing services.

Engagement in HMO as a health service provider is a personal decision you have to make. In some outpatient ambulatory set up, it becomes part of the arrangement. So, To HMO or not to HMO?

Lets take a look at the pros and cons.

PROS

1. Provides a steady stream of patients. This is helpful for start ups who are building their patient base.
2. It can be a source of referral. If the patients like you, they can tell friends and relatives, with HMO or not.
3. For pediatricians who offer other services other than consult like vaccination, patients are more likely to avail of your other services once you have engaged them in regular consults.

CONS
1. Fees maybe smaller than your regular consult or professional fee for in patients depending on where you practice.
2. Payments may take months. But if it is consistent, eg. every two months, then it becomes a cycle that evens out. If it becomes unpredictable,then the amount the HMO owes you becomes bigger through time.
3. You need to fill out forms for documentation. You will be required to submit these forms and provide summaries in order to be paid your fees.
4. You need to keep files and reconcile which services rendered has been paid or not.

But HMO or not, our patients deserve the same quality of care.

To HMO or not to HMO? What do you think? Please comment below if you can think of other pros and cons. If you find these information useful, please share or like us on facebook.

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How to Apply for HMO Accreditation

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Health Maintenance Organizations remain to be one of the major means patients access health care. As a service provider, you
can apply to be affiliated with HMO as long as you agree with their terms and conditions including fees and payment schedule.

If you are in a multispecialty clinic who accepts HMO, the arrangement is made by the clinic so you can accept patients who will use their HMO.

If you have a clinic of your own, you can apply and course it through their offices or clinics located in hospitals where you are affiliated.

I asked different HMOs about their application procedures. Requirements for most are similar which may include:

Letter of intent
Medical school diploma
Medical Board certificate
Specialty or subspecialty board certificate
Copy of PRC card, PTR (professional tax receipt),
Official receipt, TIN, VAT registration, Philhealth registration as a health provider

The HMO sends you a contract which stipulates the terms of your engagement,fees, payment,and documentation. The contract can be for inpatient or outpatient or both. Once approved, patients who wants to avail of your services will be given a form by the HMO each time they make an outpatient consult. This is the form you will fill up and include in your documentation so the HMO can pay your fees. For in patient, hospitals are given a list of accredited doctors. If you are in the list, patients can be admitted under your service using their HMO. Payment for your fees may range from 1 to 6 months.

photo credit: Stuart Miles/freedigitalphotos.net