Category: Direct Primary Care

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

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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.