Category: Direct Primary Care

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!

Direct Primary Care Employer Healthcare

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16 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Direct Primary Care Employer Healthcare. 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 discuss an important healthcare option for employers that takes care of employees while reducing overhead:

Direct Primary Care Employer Healthcare

First, Direct Primary Care (DPC) Explained

Direct Primary Care isn’t insurance. Instead, it’s a unique high value membership that can be offered as a standalone employee benefit or used to supplement high-deductible health plans and catastrophic plans. At its basic level, DPC means the doctor works directly for the patient. No private insurance, no medicaid, no medicare, no middlemen. Since we are insurance free, DPC clinics contract with employers through a membership.

Think Netflix… but for Medicine.

In return for a flat monthly membership of $50 at Beyond Primary Care, the employees and their families are provided with an incredible level of personal care including virtually unlimited office visits, in-clinic dispensing of wholesale medications, and wholesale blood work done at the time of appointment when necessary. 

Discover Who Needs Direct Primary Care

With the advent of the gig economy– which encompasses a range of full-and part-time jobs done by the growing cohort of contingent workers- nearly every U.S. industry will be employing a substantial amount of part-time and contract workers who won’t qualify for traditional health insurance coverage. These jobs include but are not limited to…

  • Real Estate workers
  • Drivers
  • Restaurant workers
  • Custodians
  • Healthcare workers
  • Accounting / Finance professionals
  • Software Development Experts

These are occupations with high levels of non-benefited employees. 

According the the latest 2018 data, nearly 160 million American’s received their health benefits through an employer. But premiums and deductibles are pushing employer-based coverage increasingly out of reach. Additional businesses that would benefit from Direct Primary Care include:

  • Businesses with self-funded health insurance
  • Businesses who see their health insurance premiums going up and up every year
  • Employers concerned about health benefits with regards to recruitment, retention, and workplace wellness.

Why Direct Primary Care Is Important to Employers

On average, employers are spending $6,715 per employee per year for healthcare. Employers are tired of sitting around their board table every year and wondering how much of the health insurance increase is coming out of the employees pocket.

This is important.

Why? With Direct Primary Care the less employers spend on a health insurance plan, the more they can put back into salary or additional benefits. Employers can focus on building community-owned healthcare versus building the archaic insurer-owned healthcare. Employers can take active management of their spending patterns and discontinue relying on the traditional “passive management” approach provided by the ‘BUCAH’ insurances (Blue Cross, United Healthcare, Cigna, Aetna, Humana).

Currently employers have no power over healthcare costs with health insurance as it’s a patchwork in access to your physician and a free-for-all in which the prices of life-or-death essentials like insulin or epinephrine are set at whatever the market will bear. Efforts to check those prices are routinely trampled on by interest groups that hold influence over our lawmakers.

This important.

Why? The goal is to maximize employee health and minimize cost to the employer. Your employees are probably being crushed by out-of-pocket fees and lack of physician availability. Innovate by subscribing your employees (and maybe their families too) as a group to a local Direct Primary Care office. At no extra cost- you will get.

  • deeply discounted prices for blood tests
  • deeply discounted prices for radiology studies
  • generic medications dispensed from the office at near wholesale cost

As example, at Beyond Primary Care, Dr. Jeff O’Boyle can get pretty much any generic medication for my patients at just a fraction of the cost. As example, we’ve had a patient paying $40 a month for a medication at Walmart and pay $8 for three months at Beyond Primary Care.

A Note For Brokers

Direct Primary Care has become a key enrollment strategy to fill the healthcare solutions gap. If you are new to the Direct Primary Care movement, the good news is that Direct Primary Care is an easy sell. Employees need accessible and personalized coverage, and employers are happy with how affordable it is. If you ignore Direct Primary Care during open enrollment, you are leaving thousands of revenue dollars for yourself on the table as Direct Primary Care is a key strategy

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” – Buckminister Fuller

Direct Primary Care Employer Healthcare

Are you ready for some out of the box thinking on benefits? Don’t overcomplicate it. Qualifying for employer healthcare solutions at Beyond Primary Care offerings can be as simple as having at least 5 enrollees, and the cost can be as low as $50 per employee per month. Our clinic eliminates claims, pre-existing conditions, and other complications.

There are no losers with Beyond Primary Care. The employer can attract and keep talented members with great healthcare, reduce absenteeism, and brokers have a gap coverage product that can start paying off right immediately to assist in funding open enrollment. 

Educate Those Employers and Employees

If you think your business or you work for a place that would benefit from the services of Beyond Primary Care, send them a link to this post so that they can join the conversation. Many employers may have only a vague idea of what direct primary care is, believe it’s too expensive, and don’t understand how to introduce new benefits to employees who never had them before. Let’s change that!

You can also contact Dr. O’Boyle directly. I look forward to hearing from you!

Using a Health Saving Account (HSA) with Direct Primary Care

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30 July 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog: Using a Health Savings Account (HSA) with Direct Primary Care. 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 talk about the Health Saving Accounts (HSAs), what they are and how to get one, why they are beneficial for healthcare, how to use it with Direct Primary Care. 

Health Saving Accounts: Explained

Health Savings Accounts (HSAs) are a type of savings account where individuals or families can set aside money on a pre-tax basis to pay for qualified medical expenses. 

Yup, you read that right- PRE-TAX: if you make a dollar and need to spend that buck on healthcare, it is a full dollar you get to use, not some percentage.

How did this come about? Great question- HSAs are designed to offset some of the expenses of a High Deductible Health Plans (HDHP) such as deductibles and copayments. To qualify for a HSA, you must have a HDHP, defined as an annual out-of-pocket deductible of $1,350 for single coverage or $2,700 for family coverage. I wrote a blog co-authored by a financial advisor that details the financial benefits of HDHPs.

High deductible insurance plans allow you to be covered for major “catastrophic” medical problems: eg- hospitalizations, surgeries, etc- in exchange to agree to pay more money out of your pocket for most or all medical expenses up to a certain limit. Once that limit is met, the consumer could expect near 100% coverage.

For 2020, if you have an HDHP, you can contribute to your HSA up to $3,500 for self-only coverage, and up to $7,100 for family coverage keeping in mind the limits can change year to year.

What are Qualified Medical Expenses

Before dealing what is a ‘Qualified’ medical expenses, let’s first discuss what exactly ‘Medical Expenses’ are. According to IRS publication 502, Medical and Dental Expenses, medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These payments include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. 

‘Qualified’ or eligible medical expenses are described by IRS code section 213(d). This list is long and includes:

How having a Health Savings Account is Beneficial

The HSA provides funds that can be used to pay day-to-day healthcare expenses. HSA benefits important to understand include:

  • They are tax-free, meaning contributions go in tax-free and withdrawals are taken tax-free provided they’re spent to cover qualified medical expenses. 
  • HSA don’t require you to do mandatory withdrawals every year, so you can leave your balance in there to stay put or grow until a large medical expense presents itself. 
  • Highlighting the importance of the previous benefit, another benefit is that HSAs don’t have to be used up on a yearly basis. 
  • HSAs can be funded through employers to varying degrees.
  • There are not income limits to contribute to HSAs.

Using a Health Saving Account (HSA) with Direct Primary Care

Like hundreds of other Direct Primary Care (DPC) clinics across the nation, Beyond Primary Care DOES allow our members to use HSA funds to pay for their membership.

The US department of Health and Human Services (HHS) under the Affordable Care Act (ACA) defines DPC as a primary care service, NOT insurance (or a health plan). 

Additionally, the ACA allows coupling DPC with a ‘wrap-around’ qualifying health plan, stating that HHS “Shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home that meets criteria established by the Secretary.” Combining the definition from the HHS (not insurance) with HSA eligibility under the ACA allows DPC to embody the premise of HSA in the patient-centered free market.

If needed by the administrators of your HSA and requested by you (our member), Beyond Primary Care will provide an itemized bill with your encounter dates, billing codes, and medical service fees.

HSAs work with the Right Insurance

Many people who talk with me know I don’t hesitate for a second to discuss the unbalanced, non-transparent, maddening administrative business that is health insurance. People know that medical expenses are the #1 cause of bankruptcy in the United States. However, what people don’t realize is that 75% of those individuals actually did have some type of health insurance. Health insurance is the ONLY insurance that bankrupts folks when they use it. 

All insurance, since humans first invented it, was designed for one thing and one thing only… to protect us from catastrophic loss. 

High Deductible Health Plans are designed to protect us from catastrophic loss. When health insurance is used in this way, a significant amount of money can be saved through reduced monthly premiums and a cost-conscious individual can shop around for the best price for office visits, medications, blood work, imaging, and more.

Note: this blog post is not a substitute for tax advice nor does it suggest how to handle your own unique tax circumstances. If you require tax advice, you should seek the services of a competent professional. 

Fish Antibiotics For Humans

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26 January 2020

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 an actual patient of mine about to fish antibiotics for humans, the barriers of obtaining affordable medications, and how to obtain affordable medications.

My Patient’s Fish Antibiotic Story

A kind man in his 30s finds out about my clinic last month saying ‘direct primary care’ is perfect fit because even though he works full time, his employer does not offer him health insurance. He explains his employer is a contractor for a major shipping company (think top 3), but since they are contractors, they are not entitled to the same benefits.

He has been without any healthcare for the past 3 years saying “I can’t afford BlueCross.”

The newly enrolled patient says discovering Beyond Primary Care was serendipitous, because he has been experiencing left ear pain so bad for the past 2 weeks, that he was going to do something about if finally. Curious, I ask what he plan was and he replied he had been reading about ‘fish antibiotics for humans’ on the internet.

Since you don’t need a prescription for that he could avoid the healthcare costs associated with establishing care with a new physician and price of medications at a retail pharmacy.

A Dangerous Idea

Yes, so taking fish antibiotics for humans is a real thing. A quick google search turned up numerous unscientific medical survival guides. I read the reviews for aquarium antibiotics. However, taking medications that are 1) not for humans, 2) not prescribed by a licensed physician and 3) not properly dosed is incredibly dangerous. 

Misuse of any medication can cause serious illness. The medications used for many animals and vertebrates do NOT require FDA approval, so there is no regulation over the manufacturing of the medication that one would take.

I always tell my patients for any medication that they have effects, thus they may have side effects. Additionally, using antibiotics for self-diagnosed illnesses may lead to antibiotic resistance, which ultimately hurts the individual using the medication and society in the larger picture. 

Improving Affordable Healthcare and Transparency

Antibiotics are not necessarily all expensive either. Some large retail pharmacies in the state of Michigan even offer certain types of antibiotics for free (you still need a prescription from a physician). The patient did have an ear infection. Because we are a ‘Direct Primary Care’ clinic, the patient was prescribed AND dispensed the antibiotic from our office at the time of the visit.

The cost of the drug prescribed to this particular patient through Beyond Primary Care was $1.95.

Many of us are accustomed to thinking that we pay health insurance premiums to get access to a lower cost for health care medications — that being the “negotiated rate” or “contracted rate” that the insurance company and the payer agree to in contract talks. But increasingly we are hearing that insured people are paying more than uninsured people.

Additionally, evil organizations out there called Pharmacy Benefit Managers (PBMS- more on them on a later post) are yet another middlemen in our insane medical billing industry that can increase the prices we pay for medications.

No Quick Legislative Road

In late 2019, the current white house administration released new rules requiring hospitals to be more proactive with price transparency by publishing their charges and negotiated rates. Great right? If we go on Amazon, we can see the description, reviews, and price for everything. We expect and demand price transparency with all our other transactions. Same for healthcare now.

However, even within a few weeks of this executive order, hospital systems and insurer across the nation are suing to keep their prices a secret. The hospital systems and insurers know that if their costs become public knowledge, they stand to lose millions of dollars because people will simply shop around for the best market price, something we do for every other service.

Is there an easy solution?

In my opinion, the best advocates for patients to obtain affordable and transparent healthcare are those independent from a large hospital/health system– such as those who operate as Direct Primary Care (DPC) physicians.

Anaphylaxis and Epinephrine

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7 January 2020

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 severe allergic reactions, namely anaphylaxis and epinephrine.

Anaphylaxis

Anaphylaxis is a severe, sometimes life-threatening, allergic reaction that occurs within minutes to several hours of exposure an allergy-causing substance (allergen).

In any body allergic reaction, your immune system will respond to the presence of an allergen (whether food or environmental) by releasing histamine and other body chemicals. These chemicals cause the symptoms of allergies, in their mild form are annoying, such as the runny nose of hay fever (allergic rhinitis) or the itchy rash of poison ivy. 

Unfortunately though, the symptoms can progress and be much worse and involve the entire body. Anaphylaxis is the most severe allergic reaction. In anaphylaxis, body chemicals cause serious skin symptoms, such as hives and swelling, as well as severe breathing problems, such as swelling in the throat, narrowing of the lower airways and wheezing. Anaphylaxis is a life-threatening medical emergency.

The Physical Reaction

There are different shapes and forms of a severe reaction. Symptoms of anaphylaxis usually occur within seconds to minutes of exposure to the allergen, but symptoms can be delayed for several hours.

  • Feeling light headed, faint, difficulty breathing, couching, wheezing, weakness
  • Confusion, anxiety, panic, or a feeling of impending doom
  • Measurable symptoms such as rapid pulse or profuse sweating.
  • Itchy hives, which may blend together to form larger areas of skin swelling
  • Swelling of the lips, tongue or eyes
  • Nausea, vomiting, stomach cramps, diarrhea
  • Paleness, bluish skin color
  • Throat swelling -like a golf ball stuck in your throat, hoarseness 

Treatment

Symptoms of anaphylaxis usually require treatment with epinephrine, by injection. People who have had anaphylaxis can carry a pre-loaded syringe containing epinephrine.

Epinephrine

You have probably heard about this drug before, but some of what you think you know may not be correct.

Epinephrine is safe, and you already have epinephrine in your body

Epinephrine is a naturally occurring hormone. At-rest plasma epinephrine levels are 0.035 ng/mL. It is the hormone that is part of our fight-or-flight response. When you are scared or excited, and also when you are exercising, your epinephrine levels surge, but even when you sleep, there is a little epinephrine circulating in your body. Levels over 10 times that amount have been measured in persons exercising, and even higher than that in people under mental stress. 

The standard adult dose of self-injecting epinephrine (0.3 mg of 1:1000 epinephrine) raises the level of epinephrine in the body from an average of 0.035 ng/mL to about 10 times that amount.  It would require more about 20 such injections to reach a toxic level.

If you were given the injection right now, all that would likely happen is that your heart rate and blood pressure would increase to a moderate degree and that you might feel slightly shaky. Epinephrine is metabolized very quickly, and you would not feel this effect for long.

You Should Not Wait to Use Your Epinephrine

You might hope the allergic reaction won’t be “that bad,” and you might be right, but it’s important to know that a delay in use of epinephrine is linked to poorer outcomes and prolonged hospitalizations.

You Should Not Be Afraid of the Epinephrine Device

The device itself might look big, but the injection needle is not. It’s just like getting a flu shot. As mentioned above, the main side effect you might experience is feeling a bit shaky after using the device.

You Should Go to the Emergency Room (ER) After Using the Epinephrine for Anaphlaxis

You may have been told that you have to go to the ER after using your epinephrine device. That’s not because of the epinephrine; it’s because the allergic reaction probably requires further monitoring. In the past, I have talked about why NOT to go to the emergency rooms. Anaphylaxis is not one of those scenarios. Many patients also need more than one dose of epinephrine for anaphylaxis or other emergency treatments; that may be due to the severity of the allergic reaction or simply because the device was not used correctly (the most common mistake is not holding the device against your thigh for the time required for the full dose of medication to be delivered). So a trip to the ER is the safest thing to do after using epinephrine.

Epinephrine Cost

You may of heard EpiPen’s manufacturer, Mylan Pharmaceuticals, had increased the price of a two-pack over several years to $600 or more—even for people with insurance. For some families—especially those who needed more than one EpiPen pack to protect their kids during severe allergy attacks—that price was still way too high. As a Direct Primary Care doctor, I have worked towards making epinephrine affordable to my patients, with a 2 pack of injectors costing less than $100. 

Sedera Health + Beyond Primary Care = Premium Healthcare Without Insurance

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19 November 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 Sedera Health, which is a cost-sharing model that can help with that ‘Back End’ healthcare coverage.

To be 100% upfront, myself nor my clinic- Beyond Primary Care, have any special relationship or financial interest in Sedera to disclose. I am simply educating the public and my patients on affordable coverages for those ‘what if’ scenarios.

The American Health Insurance Experience

In 2018, the average monthly cost for health insurance for an individual was $440.00 and for a family of 4 the average cost rose to $1,168.00, per month. That’s $14,016.00 per year. But wait, there’s more. The average deductible for that same family was $8,232.00 with many plans being over $10,000.00. What does all this mean?

Well, if you need any major medical coverage for your family, be prepared to pay about $22,000 in out-of-pocket costs before your insurance kicks in. We can’t afford to get sick anymore. For a large number of Americans and businesses, this is the new reality. Monthly health insurance costs increase every year while at the same time out-of-pocket deductibles have sky-rocketed.

Front End, Back End

You may of heard the terms ‘back end’ and ‘front end’ healthcare coverage before, but what does that mean? 

Front end is basically any, and the vast majority of healthcare services that you would routinely use. Such as a regular doctor visit, needing medications, blood laboratory work, routine imaging, scheduled procedures. 

The back end of healthcare are any surgeries, hospitalizations, or emergent care situations that may arise. Surgeries, hospitalizations, and emergency room care can be inherently expensive. People can go bankrupt from these events. That is why we recommend some ‘back end’ coverage.

However, treating a rash, urinary tract infection, common cold, or doing a well visit is vastly different than brain surgery.

Why are we paying for them in the same manner?

Have you heard of Sedera Health?

So, what is medical cost sharing? There are better options out there for you. Sedera Health is one of those options. 

Sedera Health uses a medical cost-sharing model to challenge the status quo of health insurance that many of us have become so frustrated with. Instead of making payments to an insurance company that do not have your best interests at heart, medical cost-share members make payments to a community fund and those funds are only drawn upon when they are needed. Typically, members can save between 30-50% of what they were paying in insurance premiums and can chose a set amount that they are willing to pay as an initial unsharable amount. This can amount to $1,000s of dollars a year. So, you get lower costs and predictable expenses for those times when you do have major medical events.

Sedera + Small Businesses + Direct Primary Care

Sedera Health offers employer groups of 5 or more a group discount on their cost-sharing for a Direct Primary Care membership. At Beyond Primary Care we believe that great healthcare should be affordable, accessible, and authentic for our members and that is why we have decided to discuss Sedera Health as an option. With your Beyond Primary Care membership you can add Sedera Health medical cost sharing to help cover the back end of your individual health risk with those larger major medical expenses. Then, let your Beyond Primary Care take care of all your primary and preventative care issues and rely on Sedera Health for the other wraparound medical needs for a total healthcare solution.

Final Thoughts

Beyond Primary Care + Sedera are working together to help you on your journey to great health. It’s premium quality healthcare with peace of mind for those ‘what ifs,’ without the high cost of insurance premiums and out-of-reach, out-of-pocket expenses.

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. 

Storytelling in Anxiety and Depression

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12 August 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 serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.S

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. 

Storytelling

We talked about what anxiety is in an earlier post. In this post I am discussing something that is important to me in treating any mental health condition- especially anxiety and depression- and that is storytelling.

Why We Listen

Not only is it a way of relaying information about my patients when discussing care (eg- talking to a therapist to find the best medication), but it is an an essential way I continue to learn at work. It has struck me recently that even more than these obvious examples, storytelling has a direct impact on not only how we understand anxiety and depression (or any disease) but the process of healing itself, from the perception and expectations of the patient to the diagnosis and treatment by the physician. One thing I find myself doing on a daily basis as a physician is listening to patient’s stories. I sit down with them, make myself present, and just listen.

Listen For Understanding

Think about any instruction list TELLING you how to do something: 
Step 1: take an anti depressive medication, followed by 
Step 2: get 8 hours of sleep a night, followed by
Step 3: walk 30 minutes each day, and so on. 

People may complete the task, but long term learning for long term success from this method is limited. When someone is stuck in the dark hole that is anxiety or depression, it’s hard enough just getting OUT of bed in the morning, let alone doing any number of tasks. Treating anxiety or any mental health condition is not comparable to assembling a piece of furniture from Ikea.

Now, compare this to learning something from a story, where someone has pushed their own human experience and emotion into those tasks. Hearing the struggles, failures, and successes through story are more likely to shape your ability to learn and cope. Understand there are some conditions that we treat through empathy and ability to get to know people at people at a deeper level. The conversation can lend the support you need as you navigate the ‘hard’ in your own life.

Our Stories Are Ourselves

Sharing your story will help you feel better. Why are you not sharing your story? Perhaps you feel embarrassment, fear, resignation? If you do not share your story then those thoughts and feelings are just randomly going through your mind, and you may only be inclined to be reactive towards them when they do pass through… that is randomly.

We use stories to describe to others our needs, and mental health is no exception. It doesn’t make much difference what we leave in and what we take out, what is important is that we tell the story. There is magic in that. It’s in the listener and storyteller- us. And for each and every ear, it will be different. And it will affect us in ways that we can never predict. From the mundane to the profound. You may tell or hear a tale that takes up residence in your soul, becomes your blood and your purpose. That story will move you and drive you. And who knows what you might do because of it.

The Challenge

The truth is today we are not treating everyone we need to who suffers from anxiety or depression, and can not do so if we continue to insist on one-on-one therapy with only an ‘expert.’ If listening to and sharing stories helps people, how can we withhold it? It will be there, doing its thing, whether you want it there or not. To ignore it seems to me to be the least ethical thing one could possibly do.

Mainstream medicine has a challenge: continue to ignore your story and lose you to a subjective fantasy built on the mistakes of our brain, or join you in your life story ensuring you are taking responsibility for your wellbeing while making you central to the care and cure.

Medicare for All Act of 2019

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16 July 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 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. 

In this blog post, I will not discuss my personal political views nor will I use this as a medium for healthcare horror stories, like this sad story, this sad story, or this frustrating story… because we have heard these before. In this blog I will discuss facts of what I learned from 1) attending the EMU hosted event for ‘Medicare for All,’ and 2) reading through all the pages available online regarding H.R. 1384.

Medicare for All 

I recently attended a town hall hosted at Eastern Michigan University (EMU) on Saturday July 13th where Congresswoman Debbie Dingell (Michigan’s 12th District), Congresswoman Primila Jayapal (State of Washington 7th District), State Senator Jeff Irwin (Michigan’s 18th Senate District), State Representative Yousef Rabhi (Michigan’s 53rd District), State Representative Ronnie Peterson (Michigan’s 54th District), as well as Michigan Nurse Association Vice President Katie Scott were all discussing the ‘Medicare for All Act of 2019.’

They were having a discussion about H.R. 1384, the Medicare for All Act of 2019 which is a bill that would establish a national health insurance program to cover all U.S. residents. Currently (as of 7/15/19) the bill has 117 co-sponsors. 

Speaker Panel Talking Points

To start with the discussion at EMU, I always appreciate an elected officials time (especially on a Saturday night) to discuss what impacts our community. Yes, they did start the panel discussion late, exactly 20 minutes- much like an overfilled physicians waiting room. However, much like those doctors we want to see, we can look past that.

To briefly summarize what they discussed, I felt the panel discussion had an overall vibe of a small group rally for the ‘Medicare for All Act’ with very little substance discussed. To be fair, each speaker only had about 5 minutes. However, 5 minutes should be enough time to pitch something they want to sell. And let’s be honest, our elected officials were trying to sell this bill to the room.

Debbie Dingell

To start with Congresswoman Debbie Dingell’s talk, it was heavy on current healthcare disparity statistics in the US. She did offer some brief talking points such as “We are going to a single billing system that will eliminate a lot of costs.”

The bill claims savings of $500+ billion annually from reductions in costs of billing and administrative costs.

As you can see below of the graph of physicians and administrators from 1970 to 2009, administrative costs are having a major impact on healthcare spending. 

I am curious to see how exactly they will implement this administrative cost savings. Does this mean simply cutting back (i.e.- firing) extra staffing? Those are jobs too. Many physician offices utilize administrative staffing such as front desk receptionists, a dedicated phone staff, nurse triage staff, laboratory staff, billing staff, imaging staff, medical record staff, transcription staff, and office management. 

Primila Jayapal

Congresswoman Primila Jayapal was next. Seattle, you should be proud, you elected a great official. I would be proud to have her represent me if I were there. I was impressed because I felt she actually covered more substance in her discussion than any of the other speakers regarding the ‘Medicare for All Act.’ She states the act will have four components:

  1. Cover Everyone ( Dr. O’Boyle likes this )
  2. No copays or deductibles and be able to go to any doctor or hospital you want to.
  3. Comprehensive coverage including primary care, vision, dental, substance abuse, mental health, maternal care, and more.
  4. Control costs.

Yay! Some material I can work with. Then congresswoman Jayapal says with these ‘controlled costs’ we will pay 14% less then now. WHAT! 14% ?? So that MRI, instead of being $1,400 is now $200 less? That colonoscopy that is billed at $5,000 is now only $4,300. This cost savings is not significant nor will it move the economic needle of medical costs.

Reading through H.R. 1384, I could honestly find only one section (616): Payments for Prescription Drugs and Approved Devices and Equipment that discussed any effort to reduce healthcare expenditure.

Has she heard of Direct Primary Care (DPC)? Does she know I can get a member an MRI for $300, or a colonoscopy for $700? Direct Primary Care is moving the needle on medical cost economics by saving our patients anywhere from 50-90% off of insurance billed costs.

Jeff Irwin

Michigan State Senator Jeff Irwin spoke next. Again, a good speaker. He discussed how doctors are fighting insurance companies over billing and how much a wasteful system this results in. Senator Irwin did say something I believe is important when discussing healthcare: speaking about what people value in their health and healthcare coverage. But, nothing that added any insight on the actual bill. 

Yousef Rabhi

State Representative Yousef Rabhi discussed efforts from a Michigan effort to start universal healthcare plan called ‘MiCare.’ In an acknowledgement of supporting information to Representative Rabhi, he did discuss how he plans to fund MiCare through a vote of the people in Michigan for progressive taxation. Yet, to be fair to the audience, I felt his talk was a bit of a curve ball as all other speakers were focused on the federal bill and not the state bill. 

Ronnie Peterson

State Representative Ronnie Peterson added some personal stories about his history of fighting for racial equality and now fighting for healthcare equality. Again, his talk was touching but added no material onto why or how the ‘Medicare for All Act’ would work.

Katie Scott

The last speaker was Katie Scott, the vice-president of the Michigan Nursing Association. From her talk, I was able to pick out that she was an Intensive Care Unit  (ICU) nurse. Again with the story telling theme of the night, she gave a personal narrative of high prescription drug costs and how that impacted her. 

I absolutely love what nurses do and think their roles are critical towards healthcare. However, ICU nurses and the need they fill are vastly different than what primary care doctors see and what a vast majority of people experience when we think of and utilize healthcare. 

If the elected officials pushing for the ‘Medicare for All Act’ want to be serious, they need to get feedback and collaborate with the primary care providers out there already making changes in their communities. Instead of pushing for town halls on why we need change, Direct Primary Doctors are having town halls in communities on how we are already changing healthcare to improve patient access, improve price transparency, and reduce out of pocket costs on everything from office visits, medications, imaging, speciality care, and laboratory studies.

Keeping Laboratory Costs Low

admin

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.