Do you remember a day when you could see your doctor and your doctor could take care of you? No red tape. No government bureaucracy or insurance company "middle man" telling you which doctor you could see, where you could receive your care, which medications were "authorized" and how often you could receive treatment? Well, that day has returned!
Welcome to the Osteopathic Center for Family Medicine Direct Care Plan. A plan specifically designed for your health and well-being. A plan created to reinstate the patient-physician relationship we all need and deserve. A plan developed to put you back in charge of your health care.
We, at the Osteopathic Center for Family Medicine, are tired of "people" telling you what type of medical care you can receive and fed up with a faceless bureaucracy telling us how to practice medicine.
For more than a decade, I’ve had the privilege of building the kind of relationships with my patients that I believe is at the very core of high-quality, patient-centered healthcare.
To preserve the patient-physician relationship, the Osteopathic Center for Family Medicine (OCFM) has moved to a direct-pay model of care.
What is a direct care practice?
Simply put, a direct care practice is a cost-conscious, cost-effective solution that re-established the patient-physician relationship allowing them to take charge of their own healthcare. No more insurance companies telling you, or your doctor, what can and can't be done!
Increasingly, decisions about your healthcare are being made by special interest groups and faceless government and corporate bureaucrats.
The rules and regulations imposed by the Affordable Care Act (aka Obamacare), other government programs, for-profit insurance companies, and large hospital systems are coming between physicians and patients. They are making it increasingly difficult for independent private physicians like me to practice medicine.
Fortunately, we can work together to eliminate these obstacles—and the unnecessary cost, paperwork, stress, and uncertainty of government and corporate healthcare—and put the focus back where it belongs: on improving your health.
A focus on wellness
To do so, we are offering you membership in our own OCFM Direct Care Plan—a plan designed to provide you and your family with the highest quality, personalized care—and to put you back in control of your medical care.
The OFCM Direct Care Plan is built around your well-being, with my undivided and ongoing attention as your personal physician, at every visit.
At the heart of the plan is Wellness Care, which includes: comprehensive annual examinations, lifestyle evaluation, review of applicable preventive healthcare and treatment options, and a written plan for each member of your family.
Other features of the plan include:
- Access to low-cost medication
- Access to low-cost lab work and medical testing
- Online appointment scheduling through our office website
- Same or following day appointments for acute illnesses or injuries
- Access to your own medical records through a personal “patient portal”
- Access to a library of information to help you better care for yourself and your family
- Chronic disease management
What does all this cost?
Every patient is different. Depending upon your situation, the OCFM Direct Care Plan can significantly cut your total insurance and co-pay costs. Please see the enclosed 2014 plan for prices and options and enrollment form. During the initial 3-month enrollment period, we will be waiving the one-time registration fee of $99.
Please act soon.
Over the next several months, we will be actively withdrawing from all insurance networks. We will provide you with as much notification as possible as soon as your specific insurer informs us of what their last day of coverage will be.
We understand that news of this change may be a shock—and you will likely have questions about our new plan. The Frequently Asked Questions document and OCFM Direct Care Plan description and enrollment form will answer many of your questions.
If you need more information, please feel free to email me personally at email@example.com or call the office, 207-945-5400.
I am humbled by the trust and confidence you have placed in me as your physician. If you are forced to seek alternate healthcare, I am truly sorry for what the Affordable Care Act has done to our relationship and what it will do for your future health and well-being.
Given all the circumstances, we believe that the OCFM Direct Care Plan is the best way forward for our patients and our private practice to preserve both our independence and the personal relationship with each patient that is so critical to high-quality healthcare.
Please feel free to download a copy of our letter to patients for your reference
What impact does the Direct Care Plan have on my existing insurance plan?
Over the next few months, the Osteopathic Center for Family Medicine (OCFM) will be withdrawing from all insurance networks. We will no longer accept any third-party (e.g., Anthem, Aetna) or government (e.g., Medicare, Tricare, Medicare Advantage, Medi-Gap, Medicare Supplemental) insurance plans.
Why is this change necessary?
With the Affordable Care Act (ACA), aka Obamacare, and the daily, sometimes hourly, changes in requirements, we are forced to move to a "direct pay" model to maintain our small private practice and preserve patient-physician relationships.
While we all agree that we need healthcare reform to reduce medical costs, increase access to doctors, and give patients more control over their medical decisions, Obamacare does the exact opposite by forcing patients to find new doctors, change the hospital where they receive their care, and allow third-party insurance carriers to increase monthly premiums and out-of-pocket expenses.
One broad-sweeping aspect of the ACA has been the creation of Accountable Care Organizations (ACOs). By determining what healthcare providers can participate, ACOs control which doctors you are allowed to see, which hospitals you are allowed to receive care from, and which laboratories, imaging center, physical therapy offices, and other associated healthcare organizations you can obtain services from. Furthermore, ACOs have the right to deny reimbursement for health services that they deem cost too much money, even though you may need these services.
Our regional ACO, Beacon Health, is comprised of Eastern Maine Healthcare, St. Joseph’s Healthcare, and the tax-supported Penobscot Community Health Center. Under ACO regulations, this regional ACO will receive taxpayer-funded Medicare healthcare dollars and determine where these healthcare dollars are spent. Despite our attempts to join the ACO, our participation has been denied. As such, OCFM is not eligible for any of these funds. In fact, the ACOs have excluded participation for all independent physicians and practices.
Are primary and private care doctors becoming extinct?
OCFM is one of only approximately 9% of the primary care offices in Maine that remain privately owned and operated.
The other 91% of primary care offices are owned by large corporations or hospitals. The "big box" chain-branded medical offices are reimbursed at a much higher level by third-party insurance carriers and Medicare services—in fact, they are reimbursed, in many cases, at more than twice the rate paid to small, privately owned offices, such as OCFM. Typically, they are reimbursed at 95% of what they charge whereas small, privately owned offices, such as OCFM are “lucky” to be reimbursed at 25-40% of costs.
What is the impact on Medicare coverage?
Effective on or before January 1, 2014 you should expect to receive Medicare updates regarding the reassignment of your benefits to our regional ACO, Beacon Health.
Effective January 1, 2014, OCFM will begin officially notifying third-party insurance carriers that we are withdrawing from participating in their insurance network. Withdrawal from Medicare will follow; however, since this is a complex process, we cannot provide an exact cut-off date at this time. We will, however, provide a notification to Medicare patients 90 days before this occurs.
Since OCFM opened its doors in 2007, our overhead costs have steadily risen from year-to-year. Medicare reimbursements have not kept pace with the rising costs. Indeed, they have effectively been cut. As a result, providing services to Medicare patients is not sustainable for small single-physician offices, like OCFM. Currently, Medicare reimburses our practice between 8 and 40 cents for every dollar of care spent on a Medicare patient. That is, if they reimburse at all —in numerous instances, Medicare simply refuses to reimburse for services provided. (Just as for-profit insurance companies also often refuse to pay for services provided).
What about catastrophic coverage?
While the Direct Care Plan does not replace insurance for major medical and catastrophic care, it does reduce co-pay and out-of-pocket expenses for many patients. We are able to reduce the cost of basic care because we are eliminating the considerable overhead costs of dealing with government agencies and for-profit healthcare insurance providers
Direct Care Plan can be combined with lower cost, high-deductible plans available from the State Exchange and independent brokers or cooperative plans such as those from Liberty Share, Medi-Share, or Samaritan which provide catastrophic coverage and either fulfill or are exempt from the requirements of the Affordable Care Act.
Does the Direct Care Plan meet the Affordable Care Act/Obamacare requirement to have health insurance?
At this time, in and of itself, no. Although the requirements of the Affordable Care Act seem to change daily, the Direct Care Plan does not fulfill the requirements currently set forth by the Affordable Care Act. It does, however, reduce out-of- pocket expenses for the most common types of care, such as yearly physicals and routine and acute illnesses and injuries.
If I enroll in the Direct Care Plan, will my insurance company cover lab testing, prescriptions, and referrals to other physician?
The benefits you receive from your insurance company are determined by... well, the insurance company, whose sole purpose is to be profitable. They should honor any lab or diagnostic testing, prescriptions and referrals ordered. There is no reason for an insurance company to deny any orders written by a physician. However, in light of their historical behavior, they can, and often do, change the rules every day and make it difficult for you to receive the care you need.
As an alternative, we have partnered with like-minded companies to offer affordable lab and diagnostic testing, as well as prescription medications. We are also building collaborative relationships with multiple specialty physicians to ensure that you can receive the care you require, regardless of the changing insurance company rules.
Will I need to choose a new Primary Care Physician (PCP)?
Yes. As I will no longer be participating in insurance network, you will either have to choose a new “PCP” or be assigned to one by your insurance company.
If I choose not to sign-up, can I still receive my care here?
Of course! We will provide you with a publicly available price list for our services. Payment for these services is expected on the day you receive them. We will provide you a receipt which you can submit to your insurance carrier for reimbursement.
Can you recommend a new physician?
There are some great doctors in our area, unfortunately the systems they work for have a different approach to patient care than I. When I put the DCP together, one of the things I wanted to focus on was the value and sanctity of the patient-physician relationship.
From my perspective, patients deserve to be valued, heard and respected. The patient-physician relationship should be a collaborative one. Patients should not be rushed through a 15 minute office visit, have the latest “gospel” of medical science shoved down their throat or be “pressured” into an intervention they are not comfortable with or have not been educated about.
As such, I cannot provide a recommendation. Not because there aren’t great doctors (because there are), but rather because you deserve more than what is offered by the “big box” organizations. I would not feel right recommending a physician knowing that the environment in which they work does not value the patient-physician relationship the same way I do.
What if I want to simply "pay as I go"?
For a listing of our common office visits and procedures, please feel free to download a copy of our price list.
The Direct Care Plan
The Direct Care Plan has been designed to help alleviate the burdensome and escalating costs of healthcare and provide you with an affordable service plan for continuing to receive high-quality medical care.
The program is built around improving your health and well-being, and assures you of the undivided and ongoing attention of the same personal physician at every visit.
At the heart of the plan is Wellness Care, which includes comprehensive annual examinations, lifestyle evaluation, a review of applicable preventive healthcare and treatment options, and a written plan for each member of your family.
What is included?
Specifically, the plan includes:
- Annual physical and wellness examination, including a thorough review of dietary and lifestyle, detailed review of preventive healthcare recommendations based on current medical research, and a written, comprehensive plan designed to help you achieve the healthiest state possible
- $35 co-pay office visits (per patient), including those for chronic disease (e.g., diabetes, hypertension, chronic lung disease, heart disease, obesity, high cholesterol) as well as acute illness/injury management. Most services required for acute office visits (e.g., EKGs, nebulizer treatments, skin biopsies, laceration repair) are included at no additional cost
- Discounts on most medication (as much as 50% off pharmacy prices)
- Discounts on lab work and medical testing (e.g., cholesterol panels, thyroid testing, metabolic panels). For your convenience, lab tests are drawn in our office and results are typically communicated to you within 48-72 hours
- Access to a growing library of information, including educational handouts and audio and video presentations created from discussions conducted with patients and professional presentations
- Access to your physician...the same physician, at every visit
- Enrollment in out HIPAA-communication tool, Twistle, to securely communicate with us.
What is not included?
Lab work (blood, urine, or biopsy samples) that we must send to an outside lab is not included in the subscription price, but we provide them to our patients at our cost. We use Atherotech Labs for the majority of our blood tests. They give us significant discounts which we pass directly on to you.
X-rays, CT scans, MRIs, colonoscopies, or any other tests that are performed outside of our office. With these tests, we work with facilities that provide cash discounts for patients who do not have insurance coverage.
Consultations with specialists. Like with other services performed outside our office, whenever possible, we refer our patients to independent physicians who are often more willing to work with our patients.
Legal proceedings. In the rare instances where a service such as a deposition is needed, we are happy to negotiate a special rate with your attorney.
What does all this cost?
- Individual: annual discount of $1,250/year (single payment) or 2 payments of $750 (at 6 month intervals). Monthly installments are available on our sign-up page.
- Family (parents and children): $1,750/year (single payment) or 2 payments of $1,000 (at 6 month intervals). Monthly installments are available on our sign-up page.
- Co-pay of $35 per office visit per patient
- One-time enrollment fee of $99
Optional add-on packages include:
- Discounted prenatal package for your growing family ($2,750 per pregnancy, a 50% savings compared to other offices). Membership required. Please ask for detailed information about what is included.
How to I sign up?
Very simple...just let us know! By enrolling in our plan, you are making the same annual commitment to me that I am making to you. You can pay by cash (preferred), credit card, or bank check. Although phone calls and emails are always welcome, you can immediately become a member by competing our signup form.