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Letter to Patients
My practice is now 15 years old and hopefully is just reaching middle age (with a few gray hairs). Each year, I have to make small adjustments to how the practice functions to keep it financially and professionally sustainable. This is my yearly Healthy Access letter explaining what Healthy Access is and why it's so important for the long term sustainability of my practice. An important change is that there is no "opt out" from Healthy Access this year, but I am committed to helping all my patients afford Healthy Access and to address any questions you may have. Healthy Access is a service that supports a medical model and philosophy that my patients and I agree is important and valuable but that insurance companies don't find necessary or covered and that is why I must ask patients to pay a small fee every year for the service to make this practice, Maitree Family Medicine, sustainable.
Healthy Access is a service of direct communication with the doctor who knows you well 24 x 7 (not just the ability to communicate by email). You can call the office, press option 3, and be transferred to my cell phone at any time, whenever you need me. How many of your friends and family can get their doctor on the phone at all, ever? That is an invaluable service when it's needed and is rarely found in healthcare these days. To make this manageable for me I have to limit the practice size to about 250-300 patients and to make it financially sustainable I have to charge a small fee. The Healthy Access service has other indirect effects you have likely enjoyed such as more scheduling flexibility and longer visits, even though that is not the intention of it, and you won't find these easily at the big and busy practices that don't have a Healthy Access emphasis.
If you have recognized how valuable and rare this service is in today's medical landscape then you probably already feel this is a reasonable fee, and you probably get a great sense of relief knowing I am committed to being available to you for another year (and hopefully many more). If you were already onboard at "Hello", then you can just jump to paying the full invoice for the whole year and know that I very much appreciate you supporting me, Danita and this practice.
Common Questions:
Why is a Healthy Access fee necessary to support this practice model when I already pay insurance?
Without some fee for the Healthy Access service, this practice would either financially fail, or become "big and busy". It's important to make clear that Healthy Access is a service, it's not insurance or a membership or a concierge fee. An invoice will go out to each patient at the end of the month because this service has had a cost to the practice and a value to you even if you did not have any medical needs this last month. If my patients just stopped paying for it, then this small practice and the Healthy Access model would become unsustainable. I have a commitment to make sure the practice is financially sustainable so that you can get the healthcare you have come to rely on.
I don't call or email the doctor, how is Healthy Access useful to me?
Healthy Access can keep you healthy, improves your healthcare experience and improves OUR satisfaction with OUR patient-physician relationship. I get to know you and your unique medical needs and then I'm available to you for urgent and non-urgent issues 24 x 7 almost 365 days a year. It?s relevant to people who have health issues, but just as relevant to patients who are healthy to keep you healthy. I frequently can help patients decide whether their situation is urgent or not and whether to come to the office or not or go to urgent care or the emergency department. When sending patients to the emergency room I can help figure out the fastest way to get seen and begin treatments even before they are seen. If possible I try to help patients avoid the urgent care and ER altogether. Sometimes I can treat a problem over the phone. It can save money and time while providing personalized care. It is valuable to everyone and even healthy patients who think they don't need it. If you believe you do not need this type of healthcare relationship with your doctor, please let us know your specific circumstances so we can understand your situation better and personalize your care.
What do other practices offer when there is no Healthy Access model or fee?
In the big and busy practices, after hours phone calls are forwarded to centralized on-call services(triage-system) that sometimes are out of state and where you speak to a healthcare person frequently with limited medical education and experience who is following an algorithm similar to what you could find on the internet. I have experienced these on-call services and I know they are just barely satisfying the insurance company?s minimal requirements for on-call availability but really are no better than an answering machine that says 'if you are having a true emergency then call 911.' Doctors frequently are not satisfied with their own on-call services either, but when a practice gets to be extremely big and busy, usually the doctors would rather pay someone else to take phone calls after hours and hope it's adequate. The bar for on-call services is set extremely low by insurance companies and many patients are just sent to urgent care and emergency rooms rather than get useful individualized care after hours.
Doesn't my health insurance already pay for Healthy Access?
No, health insurance does not give me any way to bill them for Healthy Access. It falls under "non-covered" services even though I consider it essential. I?m not required to be personally available to my patients 24 x 7. Over the last 20 years, insurance companies have come to pay 'providers' and practices less compensation for more work, contractual obligations and hoops to jump through. The assumption insurance companies make is that doctors will make a practice sustainable by making the practice bigger and busier and then have you spend less time with your doctor and more time with ANY provider that they have at the office (physician assistant, nurse practitioner). I'm sure you experienced the big and busy medical model at most medical offices you go to and most of us find it dehumanizing and disappointing. Our healthcare policy makers and insurance companies either don?t recognize the value in a doctor being personally available to patients and spending more time with patients, perhaps there are not enough resources to provide it or perhaps it's just so uncommon to have a doctor who is willing to create this type of practice that patients and policy makers can't even conceive of this kind of personalized physician-patient communication anymore.
If you have ANY difficulty affording an extra fee, don't worry because we have found that 95% of patients who report financial difficulties will qualify for a very helpful sliding scale. This is not a concierge practice and I'm committed to not let financial burdens keep you from getting the healthcare you deserve and I'm quite certain that if you find this service worth paying for, you likely will qualify for a sliding scale that brings the price into your budget.
If you have not paid for Healthy Access in previous years, you may be feeling it is unfair to have to pay for it now. I believe there are several possibilities for why you may feel this way but hope to convince you that it would be unfair to not pay for your fair share. I have been agonizing for years over how to be fair to everyone and I believe billing all patients creates more fairness overall.
There are some elements of my practice that are part of the Healthy Access philosophy that you may like and enjoy but don't realize would not be available at another practice without Healthy Access. You always see your one doctor at this practice, you get to see me fairly quickly, and you almost always get ample time with me(even if I am behind schedule). It's also possible or probable that you had individual attention from me off hours and you may not realize that, in essence, someone else has been paying for the extra individualized attention you have been receiving. Although it may seem to you to be unfair to pay extra, it would be unfair to others if you did not pay your share and it's impossible for me to make Healthy Access fair in all cases and to all patients when some patients opt-out. It would be unfair to have some patients opt out but then get benefits paid for by others (unless somehow they consented). But, ultimately the sustainability of this practice style depends on some manner of compensating the practice for services that we provide that we believe are important but that insurances don't value and don't cover. So I have come to the conclusion that the most fair approach is to bill everyone but then provide a sliding scale for financial hardship. That being said, if you have unique circumstances that lead you to feel that your situation requires special consideration, please let us know. It's not possible to create a system of care that is a perfect fit for everyone so I am certainly open to hearing your concerns.
I am committed to continue Maitree Family Medicine with the Healthy Access model and to keep this model financially sustainable for another 10-15 years. Of course, I will have to continue to make some changes and adaptations from time to time to ensure sustainability into the future but the mission will stay the same and I hope to always create a path that includes all my patients to be able to stick with me. Over the years, as private practice revenue falls behind overhead costs I had considered joining PeaceHealth full-time becoming a PeaceHealth employee with Sacred Heart Hospice because of concerns about long-term sustainability of my clinic. Many doctors leave private practice to join large systems and usually they do this for financial security. I have, instead, informed Peacehealth that I will reduce my Peacehealth hours and that I'm not interested in becoming an employee now or in the future. I certainly want to and plan to continue hospice work with Peacehealth, but I want to focus more attention on my clinic and reduce my hospice hours over the next 2 years. I am choosing to do this because it is the right choice for my long term professional balance and fulfillment in practicing medicine but by doing so I am taking a financial risk and making an investment in my patients at this practice.
It would not be responsible to my patients for me to allow this practice to fail financially because I did not bill for services I was providing so removing the "opt-out" option I feel is the best way for me to be fulfilling my responsibilities to myself, my patients and to my employee to the best of my ability. As the owner of a business that is responsible for your primary care, you expect me to make sound decisions for long term sustainability of the practice itself.
I am committed to you and deeply appreciate your support of me and my unique medical practice.
Stewart Mones MD
Maitree Family Medicine
September 2024