Month: November 2018

Meet and Greet at Beyond Primary Care

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29 November 2018

Dr. Jeff O’Boyle will host a Meet and Greet at Beyond Primary Care Thursday, December 6th from 5:30 pm until 8 pm. 

Meet Dr. Jeff O’Boyle, check out the personal and all-in-one clinic, and learn what Direct Primary Care offers.

Topics include:

  • How Direct Primary Care works with health insurance
  • What kind of insurance works best with Direct Primary Care
  • How obtaining your medications works with Direct Primary Care
  • How obtaining labs and imaging works with Direct Primary Care
  • How hospitalization works with Direct Primary Care
  • How referrals work with Direct Primary Care
  • Comparing the actual costs of services and products in a fee-for-service system versus Direct Primary Care
  • Dr. O’Boyle will answer any questions you have

BPC Good Eats: Turkey Cobb Salad

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28 November 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Turkey Cobb Salad. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Turkey Cobb Salad
Adapted from: Skinny Taste
Prep Time: 40 minutes
Total Time: 40 minutes

Ingredients for Vinaigrette Dressing
1 tsp dijon mustard
3 tablespoons olive oil
3 teaspoons red wine vinegar
1 teaspoon maple syrup
½ teaspoon salt
¼ teaspoon pepper

Ingredients for Turkey Cobb Salad
4 cups spring mix (or other greens of choice)
4 slices bacon
2 cups butternut squash, cubed and cut into ¾ inch pieces
1 cups dried cherries
4 ounces crumbled blue cheese
1/2 cup pecans
1 cup grape tomatoes, halved
2 tablespoons butter
1 tablespoon sugar
2 eggs
6 oz cooked turkey breast, cut into cubed ½ pieces
Pepper to Taste

Instructions:
1) Preheat the oven to 425F.
2) Spray a large cookie sheet with oil, place on top of a large nonstick baking sheet. Arrange the bacon on top, place in oven and bake for 20 minutes or until crispy.
3) Place the butternut squash on a large nonstick baking sheet, spray with oil, season with salt and pepper. Once bacon is finish cooking, add the butternut squash to the oven, baking for 20 minutes or until tender. Turn butternut about half-way through.
4) In a large skillet over medium-low heat, add the butter. Once melted, add the pecans and coat with the butter. Once butter begins to caramelize- but not burn- add the sugar and stir into pecans for 2 minutes. Remove pecans from skillet, set aside.
5) Add the eggs to a small pot, cover with water, set on stove over medium-high heat and bring to a boil. Cook until egg hard-boiled. Remove pot from stove and place under streaming cold water from sink. Remove shells and slice thinly.
6) Combine the ingredients for the dressing, whisk together.
7) Divide the lettuce, arrange with the bacon, butternut, tomatoes, blue cheese, dried cherries, pecans, turkey,  and eggs. Drizzle with dressing. Enjoy.

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Doctor Visit, Appointment Time, Direct Primary Care, Ann Arbor Doctor, Family Doctor

Exceeding Office Expectations

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26 November 2018

It is fairly easy in exceeding office expectations for the area of customer service, as people have an increasingly low expectation for the service they get at the doctor’s office. It’s normal in fee-for-service office systems to have to wait an hour or more to be seen, and then get only a few minutes of the doctor’s time (if a doctor is seen at all). Many patients often find they half-day off or work or activities, just to be seen. This has left people seeking alternative facilities, such as urgent-care type setting for their ailments. 

What Your Office Visit Looks Like In A Fee-For-Service Office

You likely scheduled a 15-minute time slot. When the doctor’s medical assistant calls you back, you are on the clock. 15 minutes includes everything: time to walk back from the waiting room to the exam room, time for the medical assistant to take vitals (eg- blood pressure, temperature), time for the medical assistant to do the office intake questions. All this, even with the best and fastest medical assistant takes 7 minutes at a minimum. That leaves 8 minutes. 8 minutes for the doctor to do any courtesy conversation (eg- how have things been, what have you been up to since we last spoke), time for the history of illness questions, time for the physical exam, time for discussing what the possible diagnosis is, and time to wrap up the visit by either dispensing medications, ordering laboratory studies, or helping to coordinate your care. By the way, the doctor is going to want to document that visit in your electronic health record. 8 minutes is NOT enough to discuss acute or chronic illness, let alone anything. This results in, at best, frustration. At worst, people avoid care they should be getting.

At Beyond Primary Care, the patient has a much different experience:

  • All days begin with multiple slots open for same-day urgent visits.
  • Patients seldom have to wait more than 10 minutes to be seen.
  • Appointments are 30 minutes per patient but can be extended to meet the needs of the patient.
  • More than one concern can be address at your visit. Come in to talk about your anxiety, but want to discuss that mysterious new rash? That is what we do.
  • Care is often done via text message or phone, reducing the need for coming to the office at all.
  • Late/early office days because health issues don’t always arrive between 9 am – 5 pm and you shouldn’t have to miss work/school/etc to be seen.

With Beyond Primary Care, a premium is placed on exceeding office expectations, and again this is done because it’s in the best interest of our clinic, but returning health care to what it once was- focused on patient care. 

BPC Good Eats: Turkey Soup

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20 November 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Turkey Soup. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Turkey Soup
Prep Time: 25 min
Total Time: 3 hours
Adapted from: Elsie’s Good Cookin

Ingredients
1 whole Turkey breast
6 cups vegetable broth
4 cups water
½ cup green onions, chopped
1 cup celery, finely chopped
2 cups carrots, diced
2 cups zucchini, diced
1 tbsp vegetable oil
1 tbsp sugar
1 (15 oz) can tomato sauce
1 cup rice
1 tbsp Dill weed
Salt and Cracked Pepper to taste
Fresh Parsley, chopped

Instructions
1) Place whole turkey in a large pot, fill with water and vegetable broth, add salt and pepper.
2) Place pot on stove and bring to boil, reduce to simmer, and let simmer for 2 hours.
3) Meanwhile place sauce pan on stove over medium heat
4) Prep onions, celery, carrots, and zucchini. Set onions and celery aside in a bowl.
5) Place oil in pan, saute carrots and zucchini until softened but not browned, add to bowl.
6) After turkey has simmered for 2 hours, add all vegetables, dill, and sugar and continue to simmer vegetables for 20 minutes.
7) Remove turkey from pot, bring to cutting board and using two forks, pull turkey apart into strips.
8) While turkey is out, add rice and simmer until done, about 15 minutes.
9) Return shredded turkey to pot, add one can tomato sauce to vegetable rice broth. Allow to simmer 5 minutes.
10) Garnish with fresh parsley, serve

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Cheesy Skillet Pizza, Beyond Primary Care, Dr. Jeff O'Boyle, Ann Arbor Doctor

BPC Good Eats: Cheesy Skillet Pizza

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16 November 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Cheesy Skillet Pizza. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Cheesy Skillet Pizza Pasta
Prep Time: 15 minutes
Total Time: 40 minutes
Adapted from: The Comfort of Cooking

Ingredients:
1 tbsp olive oil
8 oz spicy or mild Italian sausage, casing removed
½ cup mini pepperoni, divided
2 (15oz) cans tomato sauce
½ tsp dried oregano
½ tsp dried basil
¼ tsp garlic powder
8 oz. rotini pasta
Salt and Pepper to taste
1 cup mozzarella cheese, shredded
½ cup parmesan cheese, shredded
2 tbsp fresh parsley, chopped

Instructions:
1) Preheat oven to boil
2) In a large cast iron skillet set to medium-high heat, add olive oil.
3) Once oil is hot, add Italian sausage and cook until browned. Drain excess fat.
4) Stir in ¼ cup pepperoni to skillet with sausage and cook 1 additional minute.
5) Stir in tomato sauce, oregano, basil, garlic powder, pasta, and 1 ½ cups water.
6) Bring to a boil. Cover and reduce heat simmering until pasta is cooked through, about 12-14 minutes.
7) Remove from heat, sprinkle with mozzarella, parmesan, and remaining ¼ cup pepperoni.
8) Place under broiler and cook until melted and golden brown, 1-2 minutes, watching to avoid burning.
9) Garnish with fresh parsley, serve

 

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Health Insurance, Direct Primary Care, Family Doctor, Affordable Healthcare, Beyond Primary Care, Dr. Jeff O'Boyle

A Better Plan- DPC with Health Insurance, Part 2

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14 November 2018

If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. This post is the second of a two-part blog post where I detail how anyone, regardless of their coverage of insurance, would potentially stand to benefit from direct primary care services. Check my earlier blog postings for the first part (and other cool things too… like the recipe for a yummy Chicken Noodle Soup).

You read my first post and have looked at your own insurance or enrollment options, and say “I am paying a lot of money for health insurance.” Maybe you are left wondering how direct primary care can fit in or rather “What kind of health insurance should I purchase with DPC?” I went on a health insurance exchange to give everyone a better idea of what pairing insurance and a membership to Beyond Primary Care would be like.

 

Practical & Affordable
The following slide features a hypothetical family of four, that lives in Ann Arbor, MI. Let’s say the parents are in their 40s and they have two young children. Their household income is $65,600/year, which is the median. This family has a number of things happen in the course of their hypothetical 2017, listed in the left column.  A somewhat busy year medically, but not catastrophic.The family purchases either a gold (high premium, low deductible) plan, a bronze (low premium, high deductible) plan, or a bronze plan paired with Beyond Primary Care ($130 a month for family membership). Then let’s see what each of these occurrences “costs” out-of-pocket under each of the three scenarios, and then add up the total out-of-pocket expenses for 2019 in the last row.

Health Insurance, Direct Primary Care, Affordable Health Care, Beyond Primary Care, Family Doctor, Ann Arbor

Notice that in the last column, the family paid their bronze plan premium ($10,908 for the year) AND the monthly fee for Beyond Primary Care ($130/month, or $1,560 for the year). Despite the extra expense of Beyond Primary Care, they still came out way ahead compared to the gold and bronze plans. This is because Beyond Primary Care offers many types of out-of-pocket savings, including: no visit copays, no additional fee for stitches, and substantial discounts on labwork, medications, and radiology.  These savings help to hedge against using that high deductible.  

 

Tolerance & Values

At some point in your research of health insurance, it no longer becomes analytical but needs to revolve around a conversation about tolerances and values.

What is your risk tolerance? As example, if you pick plan ‘B,’ what monetary hit can your family afford to take if you get ‘run over by the bus?’ Health care in the US, is a service, and it is expensive. What do you value in your healthcare? As example, do you care about longitudinal care? This is where a doctor really knows you and your family. Do you value access to your doctor, or appointments that run on-time?

With Direct Primary Care, patients are paying the practice, so we are very conscious of trying to give a patient their money’s worth. If DPC can give them value (a concept that has become foreign to healthcare) and patients are happy with our care, they will continue to stay in the practice. It’s in DPC’s best interest to do this, so we do a number of things to save patients’ money:

  • DPC offers very low-cost lab testing (using “client billing”), saving people 75 percent or more on labs.
  • DPC clinics dispense medications in the office (legal in most states), also saving people 75 percent or more, and offering a huge convenience to the patient.
  • DPC will find the lowest cost for procedures, X-rays, and specialist services. While many of these are covered by insurance, most people have higher deductibles. So the lower cash prices are very valuable to them (not to mention the value to the uninsured). 

 

Health Insurance can be Expensive.
Insurance is a hedge against financial disaster, not a prepaid healthcare. DPC is not meant to replace insurance, nor does the model in any way encourage patients to drop their insurance. People need a way to pay for the high-cost areas of care, such as surgery and hospitalizations. DPC doesn’t try to address paying those costs.

Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. DPC focuses on decreasing their patient’s need for specialty care, ER visits, and hospitalizations by focusing on health and prevention. Doing so can (and does) reduce the need. With Direct Primary care we are delivering a higher level of care at a known price.

Beyond Primary Care, Chicken Noodle Soup, Real Medicine, Family Doctor

BPC Good Eats: Chicken Noodle Soup

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9 November 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Chicken Noodle Soup. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

 

Chicken Noodle Soup
Adapted from: Original
Prep time: 10 minutes
Total time: 25 minutes + slow cooking time


Ingredients:
6-8 chicken thighs (Or Drumsticks)
6 cups chicken stock
1 yellow onion, diced
4 carrots, diced
6 stalks celery, diced
¼ tsp nutmeg
1 tsp whole peppercorn
2 tsp sea salt
1 cup parsley, divided
1 (12 oz) bag egg noodles

Instructions:
1) Add all ingredients (except for noodles and ½ cup parsley) to slow cooker, cook on low for 8-10 hours.
2) 20 minutes before serving, cook egg noodles separately per package instructions.
3) Meanwhile, shred chicken from bones with fork, discarding bones. Add chicken back in.
4) Place noodles in bowl, add the chicken soup, top with remaining parsley.

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Health Care, Health Insurance, Direct Primary Care

A Better Plan- DPC with Health Insurance, Part 1

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7 November 2018

If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. I often get the question, “How does direct primary care work with health insurance?” This post is the first of a two-part blog post where I detail how anyone, regardless of their coverage of insurance our level of income would potentially stand to benefit from direct primary care (DPC) services. Check my blog post regularly for the second part (and other cool things too… like the recipe for a Dorito Taco Salad, because why not?!).

 

Figure out your Monthly Costs: Known as a Premium
Premiums are what you pay on a monthly basis to be insured. Premiums vary on the type of plan you choose. As example, you’ve done your homework and picked a health plan that costs $150 per month. You are paying $1,800 for essentially an insurance retainer, a cost to keep your insurance active. You’ll need to pay your premium on time every month.

Direct Primary Care has most membership fees are between $50-$100. The pricing for membership fees at my clinic, Beyond Primary Care, can be found here. This gets you full access to your doctor, regardless how many times you need to be seen. You could pay around $600 a year. The cost of a DPC membership is often significantly less than just the cost of having the insurance, let alone using it.

 

Reaching your Deductible
Deductibles are what you have to pay out of pocket before your health care plan kicks in. You may also have different annual deductibles for different types of care (as example: hospital care, laboratory tests, medications, etc). As example, you pick a plan with a $1,000 deductible meaning you are on the hook for all medical bills up to that amount before insurance kicks in.

Direct Primary Care provides you with with primary care services without government or insurance involvement. Your membership to a DPC practice does not influence your deductible. As example, you see your DPC doctor because of a mysterious symptoms. That visit was covered by your membership. When a person goes to a traditional fee-for-service practice, they won’t know the cost of care upfront, and labs and medications are potentially much more expensive than we offer. The predictability and transparency of cost is what makes DPC appealing.

 

Understanding the Relationships between Premiums and Deductibles
If you are healthy, you may want to dish out as little money as possible on the monthly premiums (to keep more in your own pocket), but still have coverage in case of an accident, sudden illness, or life change. Be aware, the less you pay for that monthly premium, the higher your annual deductible. Some folks may want a low deductible, but your premium will be thousands of dollars a year.

Direct Primary Care offers these healthier people improved access to care. Just because you are assigned a doctor by your insurance doesn’t actually mean you get to see your doctor, let alone in a timely fashion. DPC does not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor.

 

Co-Insurance
This is a fixed percentage of your medical bill you share with your insurance company once you have reached your deductible. As example, you have a 80/20 plan. This means if you have a doctor visit after you reached your deductible, and their fee is $150, you are on the hook for $30 while your insurance covers the rest. You still have your copayment though.

 

Out-of-Pocket Maximum
This feature is just as important as premiums and deductibles, and is a term for the total amount your insurance plan will require you to spend on medical care in a single year. If you reach this amount, your health insurance will cover the rest of your care. Note, you may have reached your deductible, but are below your out-of-pocket maximum, you will still be required to pay some of your health care costs.

 

Seeking Transparency in Health Care Costs
No wonder health insurance is so frustrating and confusing for most people. Using automobile insurance as a parallel, health insurance has done the equivalent of paying for gas, oil changes, windshield wipers, and other car repairs in addition to covering collision and liability. Using insurance would allow these things to have artificially set prices which are unreasonably high (since it’s covered by insurance). The cost of your routine maintenance would go up, and insurance could dictate what shop or gas station you could go to for service. But in reality, consumers are already motivated to do those things and will pay out of pocket to maintain their car so as to avoid needing to use their auto insurance at all.

Health insurance is suppose to be a hedge against financial disaster, but people are seemingly are using insurance to cover every ache, pain, anxiety, and pill resulting in artificially inflated prices. How can a outpatient clinic charge $600 for 1-hr procedure? Or $90 for a generic medication? Because unlike bananas, Americans and most doctors have NO idea what an one hour procedure or generic medication should cost- and ultimately how much they will be on the hook for- until they decide to get it done. For better or worse, this has created a demand for transparency among individuals. Direct Primary Care can help fill that void. Check back soon for part 2 of this blog post.

Cold and Sinus Infections

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2 November 2018

Cold and Sinus Infections invariably go hand-in-hand with winter. Snow isn’t bad for a month or so, and living in Michigan I do tolerate brief stretches of freezing temperatures. But for complete honesty, my favorite part of winter is that it always ends. Yet, for those days and months with freezing weather, everyone tends to huddle inside together and germs and viruses are increasingly spread. This can lead to the common cold or sinus infection.

 

Fortunately, the possible solutions for people with an infection have never been better. Now, before you rush to get antibiotics, consider some important points from this well-written piece:

 

  • Between 90-98 percent of sinusitis infections are viral and won’t respond to antibiotics.
  • At least 200 viruses can cause the common cold. None will respond to antibiotics.
  • Only 5-10 percent of sore throat cases in adults are caused by strep throat.

 

Remember that coughs ad other URI symptoms can take between 7-21 days to resolve. The average duration of a cough is 18 days. You may just have to be patient. But do NOT get discouraged! The goal during this time is symptomatic care.

 

What can you do for symptomatic care? Ahem, FREE ADVICE!

 

  1. Minimize exposure! I am not talking about locking yourself in your house until winter ends, but keep washing your hands or using hand sanitizer as frequently as possible.
  2. Contain that cough and/or sore throat. Studies show that honey that is either by itself or mixed with a liquid works just as well- or sometimes better- than leading (and drastically more expensive) anti-sore throat/cough medications. Honey can safely be used in any children > 1 yr old.
  3. Nasal Steroids. When symptoms are bad enough to need a daily medication, these medications do a great job on reducing overall inflammation in the nasal cavity.
  4. Dunk your head in the ocean! Ok, just kidding. We are in Michigan. But make your own saline rinses and use the suction bulb as I detailed I while back.
  5. Hydrate. Your body will interpret hydration as fatigue. With all that mucous you are producing, you need to replenish it.
  6. Antihistamines. These are what most people think of as ‘allergy medicine.” While they aren’t quite as effective as nasal steroids, they act more quickly and usually work well.