Monday, July 30, 2012

Direct Family Medicine: Too good to Be True- So Far

How are we doing with the conversion to Membership-based Direct Family Medicine?  After three weeks of being closed to all insured new patients, we have no takers for Direct Family Medicine.  Several reasons are likely:  My staff may not "buy" it yet, or it's too confusing to quickly tell new patients how it works, or they don't like the concept, or they have insurance and don't qualify.

What do we do next?  Market to a specific group of people who don't want their insurance to include Family Medicine care.  Who are these people?  We aren't sure, since we can only take 200 of them in family units, or about 65-75 families.  We'll figure it out this week.

Our friend, the Center for Innovation in Family and Community Medicine is working on setting up a network such as Health Access Rhode Island to connect like minded practices.  There are at least four Direct Primary Care practices in Ohio so far.

More later.

Friday, July 27, 2012

July 27, 1970 Departure for Vietnam: Memories

Several times today, I reflected on July 27th, 1970- my day of departure from the United States for Vietnam. My wife went with me to Cincinnati, where we said our goodbyes (and may have felt strangely unusual this time with the slight potential of never seeing each other again- pangs of war's effects).  I flew to Oakland, CA then cabbed to Travis Air Force Base, where I reported in to someone and was assigned a flight to Vietnam via Alaska and Kubota, Japan for fuel stops.  Before I left Alaska, I got word of the birth of my nephew, Matthew, who timed his birth on his older brother's birthday (and my departure day), so I remember their July 27 birthdays easily.

I blogged about this subject on the 40th anniversary in 2010 here.

The Vietnam thoughts have many layers of meaning to me.  The War (never declared), flying helicopters (initially from our aviation section- see photo above of our building- in Phu Bai until moving to Danang in Dec., 1970), mostly in areas of I Corps- northernmost military designation of Corps I-IV, friends, playing cards, serving the Army and the nation, planning, solving problems, Operation Lamson 719, OH-58 training in Vung Tau (top photo above) and later instructor pilot training in Vung Tau.

The Bob Hope USO Show (above photo includes Bob Hope and The Golddiggers) flying along the beaches of the South China Sea (two of photos show aerial view and beachfront view of HQ 45th Engineer Group after December, 1970), flying for the 45th Engineer Group to engineering sites (in above photos) and to the northernmost Army outpost in South Vietnam to take "donut dollies" to entertain the troops (Was it to Camp Fuller?  We could see the North Vietnam Flag across the DMZ, by the way) , and R & R in Hawaii with Rebecca (seeing the Don Ho Show).  R & R in Sidney, Australia and a trip to the Sidney Zoo.  On and on with memories, stimulated by hundreds of photos of the experience on my laptop computer.  Coming home, meeting my wife in Cincinnati and going to the zoo.  Trips to "The Wall".  More next July 27th.  Peace to all.

Thursday, July 19, 2012

Soin Leaders Encourage Radiation Safety at Inaugural Medical Staff Meeting

At the "Inaugural Medical Staff Meeting" for the Indu and Raj Soin Medical Center in Beavercreek, OH, Mike Caccamo, Interim Chief of the Medical Staff finished the meeting with  a message about reducing radiation exposure of patients.  He has also served as Chief of Radiology and Chief of Staff at Greene Memorial Hospital in Xenia, OH, sister hospital of Soin, which opened February 22nd this year.

So the radiologist encourages the new medical staff in the new hospital to reduce the use of radiation in alignment with the American College of Radiology guidelines.  He punctuated his message with a graphic showing that one CT scan of the chest equaled 500 chest x-rays worth of radiation.  I posted about that earlier this year here.

In 2010, over 80 million CT scans were performed in America.  The American Cancer Society published an article in February of this year lamenting this development and estimating that medical imaging is generating 28,000-30,000 cancers per year.

But wait, medical imaging also helps to save lives.  Physicians now are being asked to be more sensitive to cumulative radiation exposure of patients each time they order a scan.  Patients with recurrent kidney stones and those with incidental findings of pulmonary nodules on CT scans will be encouraged that their chances of excess exposure are diminishing.

At the same meeting, the President of The Soin Medical Center and Greene Memorial Hospital, Terry Burns spoke privately with me about his commitment to radiation safety.  He has worked to enhance the radiation safety and attitudes of Soin personnel.  These attitude shifts and others are important to the development of the "culture" of the new hospital.

I am pleased that the Soin medical staff was launched with the cautionary comments of Dr Caccamo.  I'm encouraged that we will have patients who can "Feel Safe at Soin."

Wednesday, July 18, 2012

Medicare Disses Family Medicine on Physician Compare Site

The official government site listing specialties and physicians in them to allow us to be rated (or be "berated") does not include my specialty- FAMILY MEDICINE under "F".

It does list it in a bundle to be found under "P" where you'll see "Primary Care, General Practice and Family Medicine".  Primary Care is not a specialty.  Why would a non-specialty be listed on their pop-up list under"specialties"?  Why can't they get this right?

Check it out:  Go to then search for Physician Compare, where you can enter a zip code and click on their "specialty" list.  I scroll down the list looking after Emergency Medicine for my specialty and don't find it.  Medicare operatives don't know the name of the specialty that is NUMBER ONE IN ANNUAL MEDICARE ENCOUNTERS.  FAMILY MEDICINE IS NUMBER ONE!

Annoyed, I scroll a lot further and find Primary Care, General Practice and Family Medicine as one, bundled listing.  Way to diss us and try to push us aside Medicare.  I click on that disappointing selection and find my father's name:  Arthur Jonas, MD (he was never a physician) after the words Family Practice.  The Medicare people don't list me by the name my patients and everyone else knows:  A. Patrick Jonas, MD.

They don't respect Family Medicine enough to list it separately, they don't know that there is no specialty called Family Practice, and they can't even get my name right for patients to match the Medicare search list with my listing everywhere else on the internet and in the yellow and white pages.

Other than that, they may be awesome, since they are giving people employment, but their misnaming specialties and mis-listing and mis-naming physicians may cause problems for the taxpayers and consumers they are supposed to serve.

Wake up Medicare.  Honor number one by recognizing our identity.  We are the answer to the question.  How do you "bend the healthcare cost curve downward"?

Monday, July 9, 2012

Direct Family Medicine: Our Membership-Based Care is Open for Business

July 1st was our kick off day at Family Health Connections, Inc. in Beavercreek, OH for Membership-Based Direct Family Medicine- our variation on the Direct Primary Care model of care. THIS IS NOT INSURANCE!!! It was on a Sunday when we were closed, but we had already closed the practice to new patients June 30th.  After that date, all new patients (families actually, since we only take families) would have to want a Direct Family Medicine membership and have no health insurance for outpatient care. Currently we have capacity for 65 new families who want membership-based care.  A representative of the family or multiple representatives is asked to attend a brief meeting explaining the business model and our style of practicing Family Medicine before we allow them to sign up- as an entire family unit (defined as a household of related or committed people).

At the meeting with family representatives (or the entire family, if they wish), we will review aspects of our practice that may be helpful to know, such as our Philosophy of Care, Family Medicine as we practice it, definitions of membership-based Direct Primary Care and Direct Family Medicine and the fees for membership-based care and a list of other prices for services not included in Direct Family Medicine.

Since it was the July 4th holiday week and the temperatures soared into Ohio record levels above 100 degrees F and major power failures persisted from a huge storm, no one enrolled as a new family.  We haven't advertised yet, but will test those calling this week who are looking for a new Family Physician with their affinity for Direct Family Medicine.  Based on their responses, we'll learn how best to present the opportunity to them.

It's definitely not for everyone, but it's been known to significantly reduce hospital admissions, emergency room visits and use of advanced technology considerably in the Seattle area.  You're right when you note that the Dayton, Ohio area isn't Seattle and each Direct Primary Care membership practice is different.  The Qliance practices in Seattle are mature in using the membership-based model and have several extra services for a higher membership fee than ours.  As they say on TV, your results may differ from theirs.

So here's part of the deal: (Modified from Dr Synonymous June 26th post which was written mostly by  Sonia Bennett, MPH)

hWhat is Membership-based Direct Family Medicine?
Direct Family Medicine (DFM), a Family Medicine version of membership-based Direct Primary Care ( refers to care that is directly offered to patients without involvement of traditional insurance.  It is not health or medical insurance.  It allows people who do not have insurance to have access to medical care through a membership.  It is a way for patients to have a regular source of medical care, develop a relationship with their family physician, and work together to maintain their health and manage acute illness and chronic conditions.  The physician-patient relationship is the foundation of family medicine and DFM allows those without insurance to have access to such a relationship and medical care.

v  Who is membership-based Direct Family Medicine for and how does it work?
DFM is for people without insurance or people in career-transition who may temporarily be out of insurance to be able to receive medical care through monthly payments.  It is also for persons with a high deductable health savings account (HSA) in some states.  After enrolling in DFM, patients can have access to family medical care.  People with insurance or Medicare are not eligible for DFM.

Type of fees
Infant (0 to 1yr)
Child (1yr to 17 yrs)
Adult (18 yrs and ove
Monthly Membership
$60 ($720/yr)
Co-payment per visit

v  Do I need insurance to enroll in DFM?
No.  DFM in our practice is for uninsured patients initially and, later, for patients such as those with a high deductable health savings account (HSA) or who may be in between jobs.  Many who wish to cover their catastrophic medical costs with insurance, but keep their family medical care out of it will enjoy DFM
v  What services are included with Direct Family Medicine?
Preventive services, sick visits, chronic disease management (asthma, diabetes, high cholesterol, hypertension, hypothyroidism, depression, etc.), Saturday appointments, after-hours on-call physician access and other services listed in this Summary of Services are covered by the monthly fee.

Services that are covered by the monthly membership fee:
Services not covered by the monthly fee:
Visits for general wellness and preventive care from infancy to maturity
Hospitalizations.  We admit our patients to a KHN hospitalist group in the Kettering Health Network 
Infant, child, adolescent health (well-child checkups, school physicals, sports physicals)
Other Specialist care.  We want patients who are willing to relate to the KHN medical staff.
Women’s health (annual checkups, pap smears, family planning discussion, menstrual issues, menopause, sports injuries )
Outside laboratory procedures such as pathologic exams of removed tissue, X-rays, heart monitors, etc.
Men’s health (sports injuries, prostate problems, erectile dysfunction)
Some immunizations and injections (vitamin B12 shot)
Acute sick care for all ages including routine office tests (urinalysis, strep test, pregnancy test)
Prescription medications. Blood tests
Chronic disease diagnoses and management (hypertension, diabetes, heart disease, high cholesterol, depression, thyroid diseases, asthma)
Surgeries and surgical procedures
Flu shot and injections for some infections
Obstetric procedures
Skin health (acne, rashes, skin cancer screenings)
Newborn Nursery Care
Ear, nose, and throat health (ear irrigation, strep test)

Musculoskeletal problems (arthritis, joint pain/stiffness, back pain)

Gastrointestinal problems (GERD, diarrhea, vomiting, Irritable Bowel Syndrome)

Stress and psychological problems (anxiety, grief, situational reactions, depression)

Brain related problems (dizziness, headaches, pain, fibromyalgia, numbness)

Weekdays and Saturday morning office hours

After-hours emergency telephone access

v  Is there a co-payment?
Yes.  Co-payment for every membership-based visit is $20.

v  Is there a registration fee?
Yes.  The registration fee is $80 for adults and $40 for children (0-17 yrs) and establishes care with a family physician.

v  What are the monthly fees?
Monthly fees are $60 for adults, $60 for infants (0-1yr), and $50 for children (1-17 yrs).

v  How do I pay the monthly fees?
You can pay by direct deduction from checking account, credit card, or debit card on the 25th day of the month
v  How do I cancel membership?
You can cancel anytime with, written notice, effective at the end of the month.
v  Can I re-enroll in the program at a later time if I cancel?
Yes.  You may re-enroll after a 6-month wait for up to 2 times but you will have to pay the registration fee each time you re-enroll.  Re-enrollment will also depend on whether we are accepting new DFM enrollees at the time.

This type of program, when combined with government approved hospitalization insurance, so far is included in the "insurance exchanges" of the Affordable Care Act, just reaffirmed by the Supreme Court Decision.  As the insurance offerings are developed for the exchanges in each state, we'll know better what will actually be available to Ohioans.  We are hoping that a state as large as Ohio will easily have a wide variety of insurance offerings through the exchange that will fit with Membership-Based Direct Family Medicine.

More later.