Category: Clinic Updates

Breast Cancer Screening in Ann Arbor

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13 October 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Breast Cancer Screening in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the first and highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Saline, Dexter, Chelsea, Ypsilanti and beyond giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to discuss an important healthcare decision females and yes- males need to consider as we age: Breast Cancer Screening

Breast Cancer Screening in Ann Arbor

Breast Cancer

Breast cancer is a cancer that occurs when individual cells in the breast grow uncontrollably. Inside the breast, there are different areas where breast cancer can begin including lobules, ducts, and connective tissue. 

  • Lobules are glands the produce breast milk
  • Ducts are tubes that carry breast milk to the nipple
  • Connective tissue- like the force- is around everything and holds everything together

Why Breast Cancer Is Important

Breast cancer is the second most common cancer among women in the United States, only behind lung cancer. White women and black women get breast cancer at about the same rate. However, discrepancies in diagnosis and treatment exist because black women have a higher morbidity than white women. 

While most commonly discussed among females, breast cancer can actually affect males as well. Nearly 1 out of every 100 breast cancers diagnosed is found in a man. While rare compared to females, it is not to be ignored as males are more likely than women to be diagnosed with advanced breast cancer, most often attributed to a decreased awareness.

In 2017 for the State of Michigan, there were 7,582 breast cancer related cases reported- nearly 119 new cases for every 100,000 females screened. Recent epidemiological studies have suggested that incidence rates for breast cancer has been slowly increasing since 2004. Recent studies have concluded that increases in body mass index (BMI) and declines in the average number of births per woman (both breast cancer risk factors) have likely contributed to the recent increases. 

Breast Cancer Screening

The American Cancer Society (ACS) recommends for women at average risk to begin breast cancer screening at age 45. Women should get mammograms every year until the age of 55, at which point they can switch to every other year or continue yearly screening.

Factors for individuals to be considered average risk include not having:

  • A personal history of breast cancer
  • A family history of breast cancer
  • A genetic mutation known to increase risk of breast cancer (eg- BRCA gene)
  • Has not had chest radiation before the age of 30

It is mentionable that the United States Preventative Task Force (USPTF), another major panel that develops evidence-based recommendations for clinical preventive services, continues to recommend screening starting at age 50 years of age.

Why the difference in Screening Recommendations? It comes back to the harms versus the benefits of screening. Ahh yes, too much of anything can sometimes be fraught with unintended consequences. As example, the sensitivity of mammograms is generally higher in older women because of less denser breast tissue than younger women. However, If you’re reading this blog post, you have already accomplished the awareness for the need of screening. That’s a win, let’s leave it there for now.

Breast Cancer Risk Factors

Risk of breast cancer is due to a number of factors, with the main risk being a women and getting older. Most women have some risk factors. However, most women will not get breast cancer. Other risk factors include:

  • Genetic mutations such as BRCA1 and BRCA2
  • Menstrual history of having periods before age 12 or after age 55
  • Dense Breasts
  • Family history of breast or ovarian cancer in a first-degree relative (mother, sister, daughter)
  • Previous radiation therapy to the chest
  • Lack of physical activity
  • A higher body mass index (BMI)
  • Tobacco use

Breast Cancer Screening Tests

Once risk factors have been determined or a female has reached a particular age, the decision to be screened for breast cancer should be started. Below I discuss the most common types of breast cancer screening we encounter. 

Mammography

This is a low-dose X-ray of breast tissue and currently the gold-standard in breast cancer screening. Early detection of breast cancer by mammography reduces the risk of breast cancer death and increases treatment options, including less extensive surgery and/or use of chemotherapy. 

3D Mammography

This is called Digital Breast Tomosynthesis (DBT) and is actually a combination of multiple breast images, along with 2D breast mammography to construct a 3D image of the breasts She studies have found 3D mammography to be more sensitive, however this is not a wide spread imaging test available to all and may not be covered by insurance. 

Thermography

Thermography utilizes a special camera to measure the temperature of the skin on the breast’s surface. It is based on the ideas that cancer cells are growing and multiplying faster, thus blood flow and metabolism are higher in a cancer tumor. As blood flow and metabolism increase, skin temperature goes up. It involves no radiation.

In regards to radiation, I can certainly appreciate the concern to be less invasive and more natural. However, according to Wakes Medical Campus (Chapel Hill, NC), the total radiation dose for a typical mammogram with two views each breast is about 0.4 mSV. As perspective, they say we are normally exposed to 3 mSV of radiation each year just from our natural surroundings. Additionally, breast cancer screening via mammography is statistically about x20 more sensitive than thermography. Meaning, a radiologist may find a mass with thermography at stage 2, they likely could of found that same mass at stage 1 with mammography- and thus differing survival rates. 

Breast Self Awareness

While monthly self-breast exams are no longer recommended based on increases in rates of false positive, all women should become familiar with both the appearance and the feel of heir breasts. Any changes should be promptly reported to their physician.

Other Tests

Such as breast magnetic resonance imaging (MRI) and ultrasounds are sometimes used on a case-by-case basis depending on risk factors and history of abnormal results. 

Why You Should Have Breast Cancer Screening

At Beyond Primary Care, we encourage females to be proactive about their breast health and work with imaging centers that perform mammography screenings. The Affordable Care Act (ie- Obamacare) requires that Medicare and all new private health insurance plans cover screening mammograms without any out-of-pocket expenses to patients. 

Note: screening mammograms are only covered through insurances. If your initial screening returns and advises follow-up, either a diagnostic mammogram, a breast ultrasound or MRI, working with Beyond Primary Care to determine your out of pocket costs is advised as some imaging price are more affordable without health insurance.

Please contact Dr. O’Boyle directly with any questions or to schedule an appointment to discuss further. I look forward to hearing from you!

Where To Get The Flu Shot In Ann Arbor

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9 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where to Get the Flu Shot in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to update my patients and any prospective patients…

Where To Get The Flu Shot In Ann Arbor

Flu season is just around the corner and according to the Centers for Disease Control (CDC) for the 2019-2020 cycle there have been upwards of 56 million Americans affected by flu-like illnesses resulting in nearly 25 million medical visits, a half million hospitalizations, and nearly 50,000 influenza deaths. 

This is why we advocate for getting a Flu shot before the start of the Flu season- we want to prevent people from going to the hospital and potential serious consequences, i.e- death from the Influenza virus.

The flu shot is a little bit of a booster to remind your immune system what may be coming ahead. A similar process is going on with the coronavirus vaccine trials. The vaccine reminds people’s immune system what that virus looks like, so that when they are exposed they either 1) don’t get the virus or 2) get a very mild case.

Flu and Covid-19

Now more than ever, it is important to get your Flu shot. We do not want to see a Flu season with a Covid season together. Flu and Covid-19 are both respiratory illnesses, but are caused by different viruses. The Flu is caused by infection with influenza viruses, and Covid-19 is caused by a new coronavirus (called SARS-CoV-2).

It is possible to have the Flu and Covid-19 at the same time. At Beyond Primary Care we can test for both the influenza virus and Covid-19 at the same time. 

How can the Flu shot help me?

There are many reasons to get the Flu vaccine each year. Here is a summary of the benefits of the Flu vaccine.

  • Flu vaccine protects yourself from getting the flu
  • Flu vaccine can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults
  • Flu vaccine helps prevent serious medical events associated with some chronic conditions such as heart disease, diabetes, and chronic lung disease.
  • Flu vaccine helps protect women during and after pregnancy
  • Flu vaccine can be life saving in children
  • Flu vaccine has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick

If you’re on the fence about a flu shot, here are five arguments to see if I can change your mind.

Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious Flu illness, like babies and young children, older people, and people with certain chronic health conditions.

What are Flu Symptoms? What Should I lookout for?

Symptoms of the Flu and Covid-19 are similar, which makes it extremely difficult to tell the difference based on symptoms alone. Common symptoms that the Flu and Covid-19 share include:

  • Fever or feeling feverish/chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue (tiredness)
  • Sore throat
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Headache
  • Some people may have vomiting and diarrhea, though this is more common in children than adults

Different than the Flu, Covid-19 may include a loss of taste or smell. While a person typically develops symptoms one to four days after an infection, with Covid-19 typically develops symptoms 5 days after being infected, although time range can vary.

Is it too early to get the Flu Vaccine?

Once the flu vaccine is administered, it takes your body about two weeks to develop antibodies to the virus. The vaccine should confer about 6 months of immunity. So, the earlier the better in terms of administration. We do see the flu start peaking in October with another peak in March every year. 

Reasons to NOT to get the influenza vaccine?

Truthfully the only individuals who should not get the Flu shot are infants younger than 6 months of age or people who experience a severe (life threatening) allergy to a prior dose of a seasonal Flu vaccine.

People with egg allergies just need to be monitored for the influenza vaccine, as an egg allergy is not an absolute contraindication.  A 2012 review of published data, including 4,172 egg-allergic patients (513 reporting a history of severe allergic reaction) noted no occurrences of anaphylaxis following administration of the Flu vaccine. 

This suggests that severe allergic reactions to egg-based influenza vaccines are unlikely. On this basis, some guidance recommends that no additional measures are needed when administering influenza vaccine to egg-allergic persons 

People with a cough or cold can still get the flu shot. 

The Flu shot is an inactivated virus and cannot cause influenza, Flu shots given may cause injection site soreness and pain, redness, swelling, fever, malaise and muscle aches- all of which are usually mild and go away on their own.

Where To Get The Flu Shot In Ann Arbor

Protect yourself and your family (and friends and co-workers) from the Flu this year! To make an appointment with Dr. Jeff, head over to our scheduling link to view our availability. Just as a reminder, we will be offering our patients opportunities to get their vaccines on select Saturday mornings, in which case an email will be separately sent to all Beyond Primary Care members.

Thank you for reading.

  • Dr. Jeff O’Boyle with Beyond Primary Care

High Blood Pressure

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8 October 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to talk about hypertension, also known as High Blood Pressure.

You Feel Normal

A person with painful urination is more likely to accept a diagnosis of a urinary tract infection. A child with with wheezing and shortness of breath is more likely to accept a diagnosis of asthma. People diagnosed with high blood pressure are puzzled, saying “How is this something I have” when you don’t feel any different. Symptoms sometimes validate a diagnosis. However, unlike many other illnesses, high blood pressure rarely has identifiable symptoms. As a matter of fact, you may of heard Dr. O’Boyle forbiddingly warn this is the ‘silent killer.

Is High Blood Pressure Dangerous

You may of heard the phrase ‘benign essential hypertension,’ but rest assured, this is an antiquated term. Much like describing a suspicious skin lesion, we use the words ‘benign’ or ‘malignant’ to describe two completely opposite threats. This is not the case when it comes to high blood pressure. 

I mentioned earlier that high blood pressure uses the alias the ‘silent killer’ because if blood pressure is uncontrolled, complications may include heart attacks, strokes, and kidney failure.

It is a very real threat.

What is Blood Pressure?

When I take a patient’s blood pressure, always with an inflatable cuff around your arm, I express the measurement back to you as two numbers. The number on top (systolic) and the number on bottom (diastolic), for example 120/80. The top number indicates how much pressure your blood is exerting against the walls of arteries when the heart beats. The bottom number indicates how much pressure your blood is exerting against your artery walls when the heart is resting between beats. Both numbers matter. 

The difference between a Normal or High Blood Pressure

I adhere to the clinical practice guidelines set forth from the American Academy of Family Physicians. As you can see from the chart above, a normal blood pressure is less than 120 on the top and less than 80 on the bottom. A definition of high blood pressure starts at a top number of 140 or greater and a bottom number of 90 or greater. 

The Odds

Per the Centers of Disease Control (CDC), 1 in 3 adults in the United States will have high blood pressure. This is why I check your blood pressure, a part of what is called ‘vital signs,’ at every visit. 

How Does This Happen?

Knowing the cause of any disease is helpful. Yet for high blood pressure, I rarely find just one cause. In fact, in medical jargon, ‘essential’ as in ‘essential hypertension’ means ‘of unknown cause.’ There are usually multiple factors at work. Some can not be prevented, such as:

  • Genetics
  • Race
  • Age

Genetic risk is complex and various between individuals as some people have protective genes and others don’t. Some ethnicities have high risks of elevated blood pressure (eg- non Hispanic African American people are more likely to have high blood pressure than other races). There is nothing you can do about it. You also can’t stop aging. 

As we age, that doesn’t mean we can’t do anything to tackle modifiable factors, such as:

  • Being Overweight
  • Smoking
  • Lack of Physical Activity
  • Stress
  • Drinking too much alcohol

Testing: Cheap and Easy

You know I check your blood pressure at every visit. But if people had the ability to check more often, the more effectively we could manage this condition. Blood pressure monitors are available at reasonable prices (typically $25-50), and can be done in the comfort and privacy of your own home. Just like our subjective feelings such as happiness, sadness, stress, and restlessness, our blood pressure varies throughout the day too. This is why I recommend monitoring blood pressure at home for at-risk individuals multiple times a day. 

Treatment

Discussing the scope of treatment for blood pressure is extensive and always carries asterisks for certain populations. Just like the causes, I always say treatment is multi-dimensional and must be individualized, your classic N of 1 trial.  Part of that treatment may include:

  • Medications
  • Exercise
  • Naps
  • Smoking cessation
  • Diet modification
  • Relaxation techniques

Naps are for babies, right? I love a good nap when given an opportunity. Research has shown people who sleep for 30-60 minutes, typically after a midday meal, had a 5% lower average 24 hour ambulatory systolic blood pressure than those who did not sleep, even when adjusted for age, gender, BMI, smoking status, salt intake, alcohol intake, exercise, and coffee consumption. Something to dream about. 

Keeping Laboratory Costs Low

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10 May 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.

How DPC Practices Keep Laboratory Costs Low

To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics

Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this. 

DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.

Savings from Laboratory Costs

I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer.  She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.

DPC Members can obtain Labs other Doctors Order

DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic? 

Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.

Improve Your Financial Health

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20 April 2019

Dr. Jeff O’Boyle with Beyond Primary Care teams up with Dennis LaVoy CFP® CLU® with Telos Financial to discuss ways individuals, businesses, and families can free up cash flow.

Free Up Cashflow In Your Budget

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4 April 2019

What are some ways to help free up cashflow in your budget? How about healthcare through Direct Primary Care?

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Today, I’m glad to welcome guest blogger, my friend Dennis LaVoy. Dennis and I co-authored this piece about freeing up cashflow through Direct Primary Care (DPC).

Who is Dennis LaVoy?

Dennis LaVoy is the owner of Telos Financial, a fee based, holistic financial planning firm located in Plymouth, Michigan specializing in serving young professionals and families. Dennis is a Certified Financial Planner (CFP®) professional and a Chartered Life Underwriter (CLU®) founded Telos to provide financial advice and uses his experience, knowledge, and expertise to help families and individuals in Ann Arbor, Detroit, and across the country achieve their financial objectives.

He went to school at Eastern Michigan University where he graduated Magna Cum Laude while receiving his degree in Finance. He has worked 10+ years as a financial advisor and opened his own firm, Telos Financial in February 2018. 

We’re going to discuss some of the financial incentives for using a DPC model.

What could using a DPC practice mean for my budget? 

Health insurance coverage is a very personal decision each family must make on their own, considering their personal values, tolerances, geographic location, and needs. Direct primary care is a membership model of health care that works well in conjunction with a High Deductible Health Plan (HDHP), commonly referred to as ‘catastrophic insurance.’ Combining a DPC membership with a HDHP addresses the main drivers of increasing cost in healthcare, such as the patient being seen in a timely manner, being proactive about your health, and ancillary medical costs (medications, labs, imaging). This allows individuals and families to have extra money on-hand every month, often saving thousands of dollars per year. So, if this type of insurance aligns with your values and tolerances, it can mean big monthly savings for your family versus a higher premium insurance arrangement.

How would it work?

Hospital systems and insurance-based clinics have higher costs for many medical services and their prices do not reflect the true cost of services even after insurance negotiations. When eliminating the costs of using health insurance, many patients can find equally effective and far more affordable options for their healthcare needs.

For example, let’s say your family is pretty healthy overall and have a high premium/low deductible health insurance policy that you pay a lot of money towards every month, where your monthly premium is $1,600, or $19,200 per year.* You believe you are not extracting enough value from your insurance, but still want coverage for those ‘what if’ scenarios. 

Switching to a HDHP insurance plan combined with a DPC membership still means you have that insurance for those ‘what if’ scenarios, but now also you have virtually unlimited access to your doctor where they can focus directly on you and not the middleman (insurance companies). Your new monthly insurance premium is $718*, and by enrolling in a DPC practice for as low as $130** a month you will have $750 in savings every month, or $9,000 per year.

*These figures were obtained by providing realistic information to ehealthinsurance.com to compare health insurance rates for 2 adult non-smokers along with 2 children for comparable health insurance plans that are compliant with the Affordable Care Act (ACA), commonly referred to as Obamacare. 

**This figure was obtained by combining the rates for adults and children at Beyond Primary Care, Ann Arbors only direct primary care practice.

Financial Savings and Opportunities

Combining a DPC membership with a HDHP can save families and individuals thousands of dollars per year where this arrangement is appropriate. Because Direct Primary Care provides so much in a membership, it is gaining national attention for the associated cost savings. A testimonial to this national attention is Consumer Reports listing Direct Primary Care as a top five smart money move in 2019 saying “joining a DPC medical practice will give you around-the-clock access to your doctor and could save you money on primary care.” 

With a couple hundred saved each month, that is money you can have working for you- not the health insurance companies. An extra $9,000 may allow you to create an ‘emergency fund,’ pay off loans, or even invest for the future. 

A $750 savings per month could build a substantial investment portfolio over time. I always recommend working with a financial planner to decide how best to invest for your family, but depending on your income, goals, and life situation, you could also save to a Roth IRA, Traditional IRA, or to a non retirement investment account. 

The Power of Compound Interest

$750 per month is a lot of money for many families. Over time, it can be hugely impactful for long term financial. Let’s further play out the scenario in this example and you have a family of 4 and that you were able to invest $750 per month at 7% growth. 7% is an assumption based on a balanced portfolio, as a point of reference, the S&P 500 from 1937-2017 (90 years) averaged 10.4%. Further, let’s assume in this example the family of 4 is two adults aged 30 and they’ll save for 12 years (Let’s say until the kids move on). 

In this example, at the end of 12 years or age 42 for the adults, you would have saved a total of $108,000 and the account would be worth over $175,400! If they didn’t save another dime after that, the account would be worth over $1,000,000 around their age 65 and 3 months. If they were able to continue the $750 per month savings, when they reached age 65, the account would be worth $1,532,591 on a total investment of $315,000. The numbers really speak for themselves and really demonstrate the power of compound interest. 

Why wouldn’t I do this?

DPC is not available locally in all communities. If you do not utilize healthcare services on a regular basis or when you do, you are just looking for one-off visits or one-time services, DPC probably is not the right fit. As always, it is something you have to consider personally.

If your employer provides a ‘comprehensive’ high premium/low deductible policy, DPC may not initially be advantageous. Still, consider bringing up DPC to your human resources leaders and incorporating into your benefits package. A partial, or fully self-insured model in conjunction with DPC has been show to result in a 30-60% reduction healthcare expenditures. 

The views expressed are my own opinions and do not apply to every situation. Your situation may vary so make sure to consult a professional for advice prior to making any decisions.

Conclusion

Financial planning should take into consideration all your needs and wants, review costs and tolerances, and educate yourself about the options. To learn more about financial planning, Dennis LaVoy, CFP®, CLU®, or Telos Financial please check out his website at https://telosfp.com/. If you believe Dennis may be a good fit for your family and you live in the southeast Michigan (or really anywhere), call him today at 734-468-3050.

These examples are for illustrative purposes only, not indicative of any specific investment product. Material discussed herewith is meant for general illustration and/or informational purposes only, please note that individual situations can vary. Therefore, the information should be relied upon when coordinated with individual professional advice.

Dr. Jeff O’Boyle of Beyond Primary Care is not affiliated with FSC Securities Corporation.

Direct Primary Care, Tuna Salad, Beyond Primary Care, Dr. Jeff O'Boyle, Ann Arbor Doctor

BPC Good Eats: Tuna Harvest

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7 December 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Tuna Harvest 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.

Tuna Harvest Salad
Prep Time: 15 minutes
Total Time: 20 minutes
Adapted from: Damn Delicious

Ingredients:
4 (2 oz) cans tuna in water, drained
1 cup greek yogurt
2 teaspoons lemon juice
2 teaspoons dijon mustard
½ cup carrots, diced
½ cup green onions, diced
½ teaspoon garlic powder
Salt and Pepper
4 leaves Bibb lettuce
2 apples, sliced
1 cucumber, sliced
1 (16 oz) package baby carrots
1 (16 oz) package raw almonds
1 lb red grapes, seedless

Instructions:
1) In a medium bowl, combine tuna, yogurt, lemon juice, dijon mustard, carrots, green onions, and garlic powder. Season with salt and pepper to taste.
2) Place lettuce leaves into meal prep container. Top with tuna mixture.
3) Arrange apples, cucumbers, baby carrots, almonds, and grapes around tuna mixture.

Direct Primary Care, Affordable Healthcare, Beyond Primary Care, Ann Arbor Doctor

Direct Primary Care Doesn’t ‘Cherry Pick’ Patients

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4 December 2018

I recently met a doctor and self-proclaimed underserved medicine wonk who bellowed that DPC doctors ‘cherry pick’ healthier and wealthier patients, leaving the the vast majority of individuals without care and fewer doctors to choose from. Nothing is farther from the truth- Direct Primary Care is not concierge medicine. I wanted to scream (I didn’t) that this perception whereby accepting a patient’s insurance somehow improves access to health care. I wanted to point out how the health care services this doctor was providing relies so heavily on third-party reimbursement systems, costs for their medical care have likely gone up. But in the end, the before-mentioned doctor was so entrenched in the health care insurance matrix, I could only use their misconceptions to help educate others.

Direct Primary Care Doesn’t Cherry Pick Patients

Direct Primary Care doctors run their own business so that we can do what is right for a change in health care; Treat individuals the way everyone wants to be treated by giving patients the time and peace of mind they deserve. We have transparent pricing on the care for our memberships, and do not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor. Our plans work great for anyone at any level of insurance or for individuals at any level of savings and income.

  • No insurance? Whether you have a family, or are a single working mother whose employer doesn’t offer insurance, Direct Primary Care is a great option. We provide the vast amount of medical services needed, there are no surprise bills, and contacting or seeing your doctor doesn’t mean you will have to miss work or school.
  • You have insurance but a high-deductible? Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. I talked about a better plan- Direct Primary Care with Insurance earlier. Direct Primary Care 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.
  • Have good, or even great insurance? Direct Primary Care universally recommends all patients have insurance. But having insurance does not mean access or longitudinal care. Having insurance without proper access is tantamount to rationing. With Direct Primary Care, we will exceed your office expectations in getting you in for your appointment with the same provider who knows you and your health- every visit.

Direct Primary Care wants to work for you. 

Opening My Clinic, Beyond Primary Care

My goal with opening a direct primary care practice was to make healthcare more affordable and accessible to everyone in the community. I have worked in the fee-for-service system, up-billing every visit to maximize insurance reimbursement (remember, costs are passed down- ultimately to the patient). I remember the conversations about patient’s prescribed blood pressure medications that cost $100 a month, and how I felt powerless to offer alternative ways of obtaining more affordable medications. I know the gut-wrenching decisions I had to make in cutting short a conversation about a patient’s knee pain because I was already a half-hour behind, offering them to return for a subsequent visit two weeks away.

At some point, my job as a family doctor in the fee-for-service system felt more like just a title and salary. After spending the better part of a decade in medical school and post-graduate training, I wanted my role as a doctor to have value. Value for providing my patients with unparalleled access to care. Value for providing my patients with transparent pricing on health care services and helping them navigate the system when needed. Value for sitting down with my patients, spending the time with them that is needed, and being there. That is the value in Beyond Primary Care.

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. 

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.