Townshend Doctors Try New Payment Model To Address Costs And Improve Care

Oct 24, 2017

Two Townshend doctors are changing their practice over to a direct primary care model, where patients will pay a flat monthly fee for unlimited primary care. The Vermont doctors hope it will address the challenges of a changing health care insurance industry.

Dr. Ed Mulhern has been treating patients in the West River Valley for 30 years and he says there's been a big shift in how doctors operate their offices.

Across the United States, and in Vermont, local doctors are increasingly joining up with nearby hospitals.

And when that happens, Mulhern says, the doctors become employees in a larger system that puts more emphasis on the bottom line than on patient care.

"It's so expensive to practice medicine in this country right now, and it's often for reasons that maybe don't even have that much to do with the medical profession itself," Mulhern says. "And it's not just the research that's being done, it's the way the business community is running medicine. And they are very much the people running medicine now. It's not the doctors."

Mulhern says small family practices don't have a lot of options, and so when he heard about the direct primary care payment model, he was willing to give it a try.

Direct primary care is being used by doctors across the country; under the model, patients pay a monthly fee, $85 in this case, which goes directly to the doctor.

Mulhern says direct primary care doctors have more time to spend with patients because they don't have to deal with insurance companies. And he says without the financial barrier of a co-pay, patients will see a provider when they're sick or in need. Mulhern says that, in turn, fosters a long-term relationship.

"It's very hard in the present system to be able to sit with your doctor and really get to know each other," Mulhern says. "With direct primary care there's much more quality there in terms of decision making. And there's also a supportive relationship which is very hard to come by in a system that right now is mainly productivity oriented. Relating to people is not a 'doing', it's a being with people."

Andrea Howe has been Dr. Mulhern's patient for 28 years. And over that time, she says Mulhern has provided care in spite of the challenges brought on by insurance companies and finances.
 

"It's so expensive to practice medicine in this country right now, and it's often for reasons that maybe don't even have that much to do with the medical profession itself. It's the way the business community is running medicine. And they are very much the people running medicine now. It's not the doctors." - Dr. Ed Mulhern, Hearth Stone Family Medicine

Howe says she shares the doctor's concern about the future of health care, and that even though she and her husband have some reservations, she wants to support Mulhern's new payment model.

"I feel very strongly that the medical system is broken, and it's using insurance as a crutch," Howe says. "It feels like insurance is starting to dominate the medical system rather than the doctors and the patients, which it's supposed to be enhancing. And so, therefore, I'm going to try this because it completely alleviates that third party that currently is involved in medical care."

Dr. Mulhern is partnering with Dr. Jesper Brickley to open the new direct primary care office in Townshend.
 

Hearth Stone Family Health Care opened this month. Drs. Mulhern and Brickley are working with their patients, and answering questions about direct primary care, which will be the only payment method starting on Jan. 1.
Credit Howard Weiss-Tisman / VPR

Brickley says their patients will need to keep their insurance for catastrophic coverage care and long term chronic medical care.

He admits the new payment model is an investment, and a bit of a leap of faith, for the doctors and the patients.

"I'm used to seeing a patient and having to come up with a certain number of diagnoses so that I can then meet the needs of the insurance system that says we need to be treating a certain number of illnesses," Brickley says. "This is a different way of looking at that, and it's an adjustment for all of us."

Brickley says direct primary care is a little bit like a co-op, where the community pools its resources to support a local medical office.

The two doctors have been reaching out to their patients to give them time to ask questions about the new system.

At the beginning of the new year, they'll serve only patients who sign on to the direct care model.