Covenant now offers cash prices for some advanced imaging for most patients

Covenant Health recently announced that they will be offering a simple, cash based price for advanced imaging at their Fort Sanders West Diagnostic Center.  This was my go to facility while in insurance based medicine.  They’ve always been easy to work with and the reports have been good.  So I’m very happy that another imaging center, let alone a hospital affiliated center, has entered the market with clear, cash pricing on advanced imaging.  However, these prices may not be the lowest a patient can get in town and patients with government regulated insurance like Medicare, Tricare, and Tenncare don’t qualify for these discounts.

Part of my job as your physician is to help you sort out the best overall choice for your treatment and testing.  Sometimes the price point is the biggest driver and sometimes the quality is.  However, both always need to be considered.  This is why we offer healthcare without hassles, built for you.

If you are interested in finding out more about the discounts available to DPC members around town and how to best navigate the healthcare landscape, then I invite you to become a member of our program and schedule your first appointment.  We look forward to working with you.

Senator Alexander Advocates for DPC

Tennessee Senator Lamar Alexander discusses on the Senate floor his findings from recent testimony by Dr. Lee Gross, a DPC physician from Florida.

The full hearing for “Reducing Health Care Costs: Improving Affordability Through Innovation” can be viewed here.  Dr. Gross’s testimony can be read here.

Make HRAs and HSAs DPC-compatible

The IRS has an opportunity to clarify HRA and HSA use for Direct Primary Care.  Please take a moment to respond to their request for feedback.

IRS Regulations Comment Section

USA Today: Doctors, providers must provide patients treatment cost information

Trinity Direct Primary Care offers unparalleled price transparency.  Patients always know the cost of care received through our office.  Here are few of the highlights:

  • All office visits, phone calls, emails, and communication with the physicians and staff are always free.
  • All in house labs like strep tests, flu tests, and EKGs are free.
  • Most common labs used to manage chronic issues like diabetes, high blood pressure, and high cholesterol are free four times a year.
  • All other labs are offered at 60-90% discount.  A short list of lab prices is available at Trinity Direct Primary Care Lab Test Pricing Guide
  • Xrays are $30.
  • Advanced imaging like CT scans and MRIs are 60-90% off retail.  We verify the cash price every time we order a test to insure our patients understand the cost before having the procedure done.
  • We have multiple sources for discounts on medications including our own proprietary dispensary as well as knowledge of the best local prices, access to national discount cards, patient assistance programs, and an insurance free mail order pharmacy that offers wholesale or free medications.
  • Access to major surgery centers that don’t accept insurance and offer steep discounts off traditional pricing.

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Health care providers must acknowledge patients’ financial concerns. The path forward requires cultural changes that normalize cost conversations.
— Read on www.usatoday.com/story/opinion/2018/12/03/doctors-providers-provide-patients-treatment-cost-information-health-care-column/2077749002/

Direct Primary Care | Johns Hopkins Community Physicians

World renowned hospital Johns Hopkins is launching a Direct Primary Care program for it’s own employees starting in 2019.

Do you think they’d do something that didn’t make good medical sense?

Do you think they’d do something that didn’t make good financial sense?

Maybe if it’s good for the staff of one of the best hospitals in the world, then maybe it’s good for everyone.

Lower costs, better access, happy patients, happy physicians.

Direct Primary Care | Johns Hopkins Community Physicians
— Read on www.hopkinsmedicine.org/community_physicians/patient_information/direct_primary_care.html

“The Free Market Won’t Work for Specialists…” Except It Is.

Here’s a pediatric endocrinologist in Texas who has opened up a clinic that operates outside of insurance like Trinity Direct Primary Care.

Check out their program and encourage your local specialists to consider doing the same.

Endo4Life

Pre-existing is non-existent with Trinity Direct Primary Care

Trinity Direct Primary Care takes care of you. Pre-existing conditions are not a hinderance to care for us. Providing healthcare is our mission so we don’t charge more for patients with diabetes or hypertension. We don’t charge more if you smoke or have a family history of major illnesses. We just take care of you. Simple as that. Come see the difference. Call 244-1800 to sign up today.

Article: Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring from JACC: Journal of the American College of Cardiology

Here’s a very interesting study that showed a clear stratification of the benefit of statins in over 13,000 patients who had not previously had any cardiovascular disease.  The average age of patients followed was 50 years and they were followed for a mean duration of 9.4 years.  Patients with a calcium score of 0 showed no benefit.  For reference, the calcium score indicates the amount of atherosclerosis in the coronary arteries where lower numbers indicate less calcification and therefore less damage.  Zero is the perfect score and most desirable result.  As the CAC scoring increased, representing more calcification and pre-existing damage, the benefit of statin use in primary prevention increased.  Remarkably, this was irrespective of lipid levels.  In the highest risk quartile the number needed to treat (NNT) to show benefit was only 12.  That is, of 12 patients taking a statin one of them will see benefit in preventing a major cardiovascular event like a heart attack or stroke over the roughly 10 years of measurement.  That’s pretty good.  For the low risk, non-zero group scoring 0-100 the NNT was 100.  One hundred patients would need to take a statin for roughly 10 years to see one patient avoid a major event.  That’s not very good.

If you’re not sure of your cardiovascular risk or want to know your calcium score, set up an appointment with your Trinity DPC physician and we’ll sort it out with you and help you decide the best course of action for your own good health.  Call us at 244-1800 or 980-8551 to schedule your visit.

statins and CAC

Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring | JACC: Journal of the American College of Cardiology
— Read on www.onlinejacc.org/content/early/2018/10/31/j.jacc.2018.09.051

Trinity Direct Primary Care featured in Farragut Press

Trinity DPC Dr. McColl, Kristen, and LainyA few weeks ago I was interviewed by Michelle Hollenhead of the Farragut Press about our practice, Trinity Direct Primary Care.  It was a fun time and a privilege to have our story told.  Her article was published in this week’s edition that was delivered yesterday.

Trinity Medical operates from membership fees, not insurance

Take a minute to check out the story and pass it along to someone you know.  As the Direct Primary Care movement is exploding across the country many metropolitan communities are seeing the benefits of lower cost, better access primary care for individuals, families, and corporations.  Trinity is leading the free market healthcare revolution right here in East Tennessee.  Anyone interested in learning more can contact our office at 244-1800, check out our website at trinitydpc.com, or email me directly at mbmccoll@trinitymedical.net

-Dr. McColl

The consultation

Have you ever seen the Norman Rockwell era oil paintings of physicians at work?  One in particular has always intrigued me. It shows an older male physician at a desk with his patient across from him in conversation.  It’s an image of the true consultation. One where the patient and physician spend a significant amount of time talking about and thinking through the patient’s complaint. I was always baffled by that painting because it was so far from modern medical practice as to be laughable. That is, until I started my DPC practice.

The Country Doctor - Felix Schlesinger

When I completed residency and finished eight grueling years of medical training, I assumed private practice would offer me more control over my daily schedule and workload.  I was completely wrong.  I entered private practice and immediately realized it is akin to drinking from a fire hydrant. The pace is dizzying and unsustainable. Every second of every working day is spent pushing faster because more and more is expected of you.  There is little time for truly thoughtful discussion with your patient and even less time to research a nuanced answer.  I found that whenever I let one of my patient’s down it was by failing to deliver on researching some topic outside of the exam room.  I found that there just was never any extra time for research.  Trinity as a practice fought against this fast paced trend by attempting to schedule more time with each patient and buffering work days with unscheduled, uninterruptible non-clinical days.  By community comparison, we are slow and spend too many days not seeing patients.  But these were the only safeguards I had at trying to maintain a high level of medical care for my patients who needed complex answers to their complex problems.

During the heat of each day, clinical questions would come rapid fire and pausing to think through a harder situation only allows everyone to assume you’re ‘not doing anything’ and are therefore free to help them with their question. Since 99.9% of my job involves nothing other than firing off a few trillion neurons, if you ever see me standing around looking off into the distance then I’m likely working my hardest.

After nearly 10 years in practice I figured the days of a Normal Rockwell era physician thoughtfully discussing the case with his patient were gone.  Thankfully, I’ve seen that turn around since being a DPC physician.

This week for instance, one morning while reviewing my new lab reports I found an unusual and dangerous result on one of my patients. The implications were significant but the therapeutic next steps were not clear. So, without another patient pressing on the schedule, I fired up my modern online medical resources and then sought counsel from some trusted physician sources who have expert knowledge in the area. In the following hour I digested all I found on this disorder, developed a protocol for helping future patients discover their risk, and formulated a treatment plan based on the best medical evidence.  I grew as a physician.  I have more understanding into this poorly known disorder than I did last week.

After my time of study I called my patient and spent another 15-20 minutes talking about the result and explaining what we need to do next.  We discussed the implications it has on their family. As I care for many of their family members I was able to step back and look comprehensively as to how it affects everyone’s health. With permission from my patient, I contacted another family member who the result would also directly impact.  We had another thoughtful discussion and developed a plan of action.

It’s in these moments that I realize the art of continually learning and honing my craft as a physician was being pushed to the wayside by the modern business approach.  I understand now what it means to work with your patient and not simply be present in the exam room with them.  Most all of us went into medical training with the hopes that we would spend our hours with our patients and not on their paperwork.  Don’t get me wrong, there are many exceptional physicians working in the standard medical business model, but most assuredly, they are a dying breed.    I, however, have found a place of deep professional satisfaction in being able to care for the whole of my patient, to grow along with their needs, to develop intricate, nuanced therapeutic plans, to provide comprehensive, family wide care, and to walk with them over the years as we face these challenges together.  Direct Primary Care allows me to be the physician I always knew I was meant to be.