KidDoc, any truth to the rumor that St. Jospeh's is doing away with its pediatric department and that they will be joining UPA?
St. Joseph Pediatrics moving to UPA?
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Last: 3 mo ago by dubi
They are going to join the Texas Children's network?
Oh dear God I hope not
Say it ain't so! TCH is out of network for any marketplace plan
Isn't the NICU at Joes already TCH?
Not gonna get better. Marketplace plans are a scam for the patient and the health system.
https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration/
https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration/
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Well, when you are self employed, its one of the few options you have - especially if you want to pay less than $1500/month (which was where our quotes from last fall fell when looking at private plans/PPOs)
Agreed. Need a system where one can get a market cash price for care + mark Cuban cost plus pharmacy + catastrophic insurance (5-10k deductible based on the cash price the patient can get) system. Unfortunately it doesn't exist because of statutory and lack of market reasons. And yes - I'm self employed as well.
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I mean, I wish we could go back to pre ACA, but I dont see that happening.
I will say, we have a marketplace plan this year (first year doing it). It has covered most of our stuff well, but we also opted for a higher priced plan that covers a lot more. And thankfully we did- they covered our ER visit and transfer to TCH (despite being out of network with TCH- which is wild to me, because we have BCBS). However, they won't cover our TCH pediatric opthamologist, and insist that we must change opthamologists outside of TCH, but still drive a lang ass way. We just pay out of pocket for that. Not fun, but only 2 appointments a year- so we pay around $700/year for that.
I will say, we have a marketplace plan this year (first year doing it). It has covered most of our stuff well, but we also opted for a higher priced plan that covers a lot more. And thankfully we did- they covered our ER visit and transfer to TCH (despite being out of network with TCH- which is wild to me, because we have BCBS). However, they won't cover our TCH pediatric opthamologist, and insist that we must change opthamologists outside of TCH, but still drive a lang ass way. We just pay out of pocket for that. Not fun, but only 2 appointments a year- so we pay around $700/year for that.
There are a lot of moving parts at the moment that should become clear in a few weeks but yes the execs at St Jo unilaterally decided to discontinue the entire outpatient pediatric service line. This was not discussed with any other physician or the board just by the executive team.
It honestly makes sense as the model of employed primary care is mostly to guarantee hospital revenue and the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
The St Jo execs did arrange an offer from TCH so that is one of the possible landing spots. We are also in talks and bargaining with a few other interested parties in town. The 5 docs and one NP in our group care for nearly 10,000 patients so we are all trying to minimize any disruption in care as nobody is ready to swallow the work load of 10k new patients in 3 months.
We are all a bit flabbergasted as all of the pediatricians are very high productivity, exceed all the quality metrics, have very high patient satisfaction scores, and have done every silly little thing St Jo/Commonspirit has ever asked and we are just getting axed with no discussion or negotiation and minimal warning.
The marketplace insurance is a problem with TCH and they are aware of it and are actively working to try to get in network with them.
It honestly makes sense as the model of employed primary care is mostly to guarantee hospital revenue and the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
The St Jo execs did arrange an offer from TCH so that is one of the possible landing spots. We are also in talks and bargaining with a few other interested parties in town. The 5 docs and one NP in our group care for nearly 10,000 patients so we are all trying to minimize any disruption in care as nobody is ready to swallow the work load of 10k new patients in 3 months.
We are all a bit flabbergasted as all of the pediatricians are very high productivity, exceed all the quality metrics, have very high patient satisfaction scores, and have done every silly little thing St Jo/Commonspirit has ever asked and we are just getting axed with no discussion or negotiation and minimal warning.
The marketplace insurance is a problem with TCH and they are aware of it and are actively working to try to get in network with them.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Noooooooooooooooo
My kids love you but TCH doesn't take healthshare as an alternative. I also have other issues with TCH which makes me unwilling to use them.
This is a damn gutpunch.
My kids love you but TCH doesn't take healthshare as an alternative. I also have other issues with TCH which makes me unwilling to use them.
This is a damn gutpunch.
KidDoc said:
...the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
Why is the local hospital pediatric scene so...anemic? Have always wondered that.
AggiePhil said:KidDoc said:
...the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
Why is the local hospital pediatric scene so...anemic? Have always wondered that.
Starting any significant pediatric unit would involve specialist working here. The population is too small to support any peds specialist as they tend to see rare patients. Add to that the close proximity of multiple pediatric specialty groups that are just about an hour away and it eliminates the economic viability of starting a local peds hospital service.
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KidDoc said:AggiePhil said:KidDoc said:
...the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
Why is the local hospital pediatric scene so...anemic? Have always wondered that.
Starting any significant pediatric unit would involve specialist working here. The population is too small to support any peds specialist as they tend to see rare patients. Add to that the close proximity of multiple pediatric specialty groups that are just about an hour away and it eliminates the economic viability of starting a local peds hospital service.
Plus peds nurses as well. It's a specific skill set to work with kids and their parents during illness/injury.
Gotcha. Well this is not the news I wanted to wake up to on a Friday morning. Whatever ends up happening though, we will follow you as long as it doesn't involve moving!
With 4 children's hospitals within 90 miles give or take there won't be pediatric inpatient or surgical specialist doing hospital work here for a very long time.
As for the Obamacare plans and TCH - they have known it's an issue for a long time and have no intention to negotiate any different. They are lying if they say so. They want rates that are 20% or more higher than anyone else gets because they are TCH. Insurance companies aren't going to do that on a Obamacare plan. I'd be shocked if it changes. It's different for commercial plans sold to businesses. Insurance can't sell those to Exxon, etc if they don't have TCH. So they build in a higher overall price to the employer and employee and give TCH their premium.
As for the Obamacare plans and TCH - they have known it's an issue for a long time and have no intention to negotiate any different. They are lying if they say so. They want rates that are 20% or more higher than anyone else gets because they are TCH. Insurance companies aren't going to do that on a Obamacare plan. I'd be shocked if it changes. It's different for commercial plans sold to businesses. Insurance can't sell those to Exxon, etc if they don't have TCH. So they build in a higher overall price to the employer and employee and give TCH their premium.
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We will also follow (even if we cash pay for a bit), but i am NOT a fan of UPA. Everyone i know that goes there say they never see the same doctor, and can rarely get same day or even same week appointments with their listed pediatrician
histag10 said:
We will also follow (even if we cash pay for a bit), but i am NOT a fan of UPA. Everyone i know that goes there say they never see the same doctor, and can rarely get same day or even same week appointments with their listed pediatrician
Which is sad since that's NOT the way they used to be. I used them for kid #1 and they were absolutely fantastic. They aren't close to the same practice they used to be.
histag10 said:
We will also follow (even if we cash pay for a bit), but i am NOT a fan of UPA. Everyone i know that goes there say they never see the same doctor, and can rarely get same day or even same week appointments with their listed pediatrician
We use them and that is not our experience. We have rarely had an issue getting our primary for a same week appointment.
We've seen other doctors if it's a same day issue from time to time. But I expect that from a practice that has a lot of patients. There are only so many hours in a day and they aren't just sitting around waiting on a kid with a fever.
We have been with them for over 20 years and have never thought about changing.
Sad to hear St. Joes still treats pediatrics as poorly as they did 15 years ago.
Stupe said:histag10 said:
We will also follow (even if we cash pay for a bit), but i am NOT a fan of UPA. Everyone i know that goes there say they never see the same doctor, and can rarely get same day or even same week appointments with their listed pediatrician
We use them and that is not our experience. We have rarely had an issue getting our primary for a same week appointment.
We've seen other doctors if it's a same day issue from time to time. But I expect that from a practice that has a lot of patients. There are only so many hours in a day and they aren't just sitting around waiting on a kid with a fever.
We have been with them for over 20 years and have never thought about changing.
Our kiddo sees the same doctor every time we go. We were big fans of TCH, as they saved my kiddo's life, and were happy when UPA joined them. Now, all our records in Houston are on the same system.
KidDoc said:
It honestly makes sense as the model of employed primary care is mostly to guarantee hospital revenue and the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
Seriously?
"to guarantee hospital revenue"?
I guess I'm naive or just don't know that much about big medical practices, but I thought the general idea behind primary care was supposed to be that you have a regular doctor to go to and they can keep you healthy and hopefully out of the hospital.
I also know that some pediatric stuff involves hospitals, and it sucks that people have to drive at least an hour for any of that, but I'd think that just having a bunch of patients coming in all the time for regular visits ought to provide some income for medical practices. I don't know how free well-child visits play into that though. (also not totally positive if that's still the case, but I thought that one of the requirements after ACA was that well child checkups needed to be free). I don't know if the insurance companies get a bill, but I think patients normally don't for checkups.
threecatcorner said:KidDoc said:
It honestly makes sense as the model of employed primary care is mostly to guarantee hospital revenue and the local hospitals provide almost no pediatric care, almost all procedures and hospitalizations are shipped out at this time.
Seriously?
"to guarantee hospital revenue"?
I guess I'm naive or just don't know that much about big medical practices, but I thought the general idea behind primary care was supposed to be that you have a regular doctor to go to and they can keep you healthy and hopefully out of the hospital.
I also know that some pediatric stuff involves hospitals, and it sucks that people have to drive at least an hour for any of that, but I'd think that just having a bunch of patients coming in all the time for regular visits ought to provide some income for medical practices. I don't know how free well-child visits play into that though. (also not totally positive if that's still the case, but I thought that one of the requirements after ACA was that well child checkups needed to be free). I don't know if the insurance companies get a bill, but I think patients normally don't for checkups.
"Free" well child checks are one of the best ways to push productivity for pediatrics, they pay more than ill visits. Basically you are paying for it through your insurance whether you get one or not it just changes if the insurnace gets to keep that money or does it get sent to the doc.
The execs claim the clinic operate at a loss and they pay docs more than they would make in private practice but the accounting they use is pretty wonky and it is difficult to believe.
Private practice is an option for any doc but you really need group power or you have to bow to any demands the big insurers make. Also medicaid does not pay well if you are in private and most of our most interesting and needy patients are medicaid kids (syndrome kids, rare diseases, etc).
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Quote:
Which is sad since that's NOT the way they used to be. I used them for kid #1 and they were absolutely fantastic. They aren't close to the same practice they used to be.
Yes, they are.
That is from someone that still uses them and would change practices without hesitation if I thought they weren't top notch.
Stupe said:Quote:
Which is sad since that's NOT the way they used to be. I used them for kid #1 and they were absolutely fantastic. They aren't close to the same practice they used to be.
Yes, they are.
That is from someone that still uses them and would change practices without hesitation if I thought they weren't top notch.
No, they aren't. I used them for 10 years starting 31 years ago. I gave them a go when I moved back 7 years ago. It's much easier to notice differences when you haven't been continuously using a service.
The doctors are still great. Billing and office staff, nope. It's okay that we have a difference of opinion about them.
Quote:
It's much easier to notice differences when you haven't been continuously using a service.
That statement doesn't make sense.
A person that has used a service consistently doesn't have the ability to see a drop in service or differences in service if that were happening?
If there was a consistent drop in service, a person using it on a regular basis would start getting irritated at continual issues and look to make a change.
As far as the billing, we have had one major issue in almost 25 years of using them and is wasn't their fault. It was BC/BS putting in the wrong code. When we called UPA, they took care of it and we didn't have to do a thing.
I'm not sure what you experienced to say that they are worse or there is a drop in service, but we are fortunate to have the insurance to choose any pediatrician in the area and have never been given a reason to shop around.
Edit: I didn't mean to use that laughing face.
Changes can happen gradually enough that you don't notice them. Just like a person who lives with a dementia patient doesn't always see the extent of the decline.
If there's longer between your interaction with a business or a person, you can more easily see the things that have changed.
If there's longer between your interaction with a business or a person, you can more easily see the things that have changed.
When a physician goes to work for a hospital - TCH, St Joe, BSW or anyone else - they lose the control over their office staff and billing. It's highly likely that the revenue cycle is outsourced by the hospital, and even if it isn't it's totally out of the doctors hands. Same thing about front and back office staff, staffing levels, qualifications for employees, and more.
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I'm aware. I've got over 20 years in healthcare now. That's why I'm upset that KidDoc may be forced into this.
More options than ever. Private practice , direct patient care, locums, Hospitalist…. the end of the day choosing to work for a hospital provides advantages and disadvantages. This is one of the disadvantages….
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EBrazosAg said:
More options than ever. Private practice , direct patient care, locums, Hospitalist…. the end of the day choosing to work for a hospital provides advantages and disadvantages. This is one of the disadvantages….
The problem with those totally valid models is medicaid. I am devoted to my medicaid population spiritually and intellectually but it is not financially sustainable outside of specific state approved structures.
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Totally understand and appreciate. Only viable Medicaid model is FQHC clinic. When the government established a system that pays the FQHC $192 per visit in 2025 when a private practice or hospital employed doctor gets $40 for it's the government that has made the decision for you. You don't get a say in it. The government has said they don't want anyone outside a FQHC providing primary care to Medicaid patients. Doesn't matter what they say - their actions say it all.
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No. This is just not the case. We have used them for 15 years. All 4 kids.
EBrazosAg said:
Totally understand and appreciate. Only viable Medicaid model is FQHC clinic. When the government established a system that pays the FQHC $192 per visit in 2025 when a private practice or hospital employed doctor gets $40 for it's the government that has made the decision for you. You don't get a say in it. The government has said they don't want anyone outside a FQHC providing primary care to Medicaid patients. Doesn't matter what they say - their actions say it all.
That's insane. No wonder a lot of private practice doctors won't take Medicaid.
aggiesed8r said:
No. This is just not the case. We have used them for 15 years. All 4 kids.
Its constantly posted about on the BCS Mom's page, and I have tons of friends who also say its the case for them.
Glad its not the case for you, but it is an incredibly common complaint these days.