After one year, a private medical practice is finding success with a subscription model that takes insurance companies out of the equation and gives patients more time with their doctors.
Dr. Ed Mulhern and Dr. Jesper Brickley started the direct primary care practice Hearth Stone Health in Townshend in October 2017. Now, they’ve expanded into Brattleboro.
“We’re lucky this place kind of presented itself,” Mulhern said inside the new office at 11 University Way #6 in Brattleboro.
The secondary location opened in October. Mulhern works out of the Townshend office and Brickley spends time between both offices.
They expect to hire another health care provider in April.
“Whether that’s a nurse practitioner or doctor isn’t 100 percent clear at this point,” said Mulhern.
Mulhern knew that with the retirement of Dr. Robert Tortolani, about 1,200 patients were going to be looking for another doctor in Brattleboro. But first, he wanted to take care of Townshend, where he spent about 30 years in private practice and Brickley had worked at Grace Cottage Hospital.
Brickley “was attracted to starting direct primary care long before I heard about it,” said Mulhern, who liked the concept because it gave him plenty of time to talk with patients. “There was an unhurried atmosphere.”
Mulhern said his “healing-focused” practice looks at both pain and suffering. The latter is considered to be a mental process.
“To take this in,” Mulhern said, “you need the listening ear first and foremost.”
He said conventional medical practices tend to look at patients like they are fixing a machine that has broken down.
“That has generated the need for super efficiency, cost effectiveness and so on and so forth,” he said.
Doctors now spend about 50 percent of their time filling out paperwork, said Mulhern, having watched requirements from the government and insurance companies “tighten” over the years. At the same time, he saw prescription prices rise while doctors increasingly opted to work for hospitals rather than open their own practices.
At Hearth Stone, patients 20 years and older pay $85 a month and children 0 to 19 pay $20 a month. An adult dependent 20 to 26 years old pays $50 a month and children up to 19 years old with no adult member pay $50 a month. There is no copay for routine follow-up services or urgent care.
Hearth Stone’s website says patents get urgent care services within normal business hours; “comprehensive” annual physical exams that last 40 to 60 minutes and touch on medical, nutritional, mechanical/osteopathic and biopsychosocial health; chronic care management; coordination with specialists, hospitals and other providers; select generic medications and lab orders and radiology at cost; and “virtually 24/7 access” to providers via email, text and phone calls.
Mulhern said he was happy to have Brickley share a practice that works the way he has practiced over the years. He hopes it will continue when he retires.
“The needless administrative burden has dropped substantially,” Brickley said. “It’s much, much easier. The billing and doctor’s notes, up until the last 10 years I would say, have been steadily shifting closer and closer to almost exclusively to the goal of satisfying a billing perspective. So now, the information in my notes is unrelated to billing in any way, shape or form.”
Mulhern said private practices cannot make enough money to sustain themselves financially when they have to file all the insurance billing information.
“The income you get just doesn’t work,” he said.
Brickley said electronic records keeping has demanded more time from doctors as the billing standards changed, and that time is being taken away from the patients.
Hearth Stone can book appointments for anything.
“We’re not trying to compete with the way medical care is generally dispensed through the medical centers,” Mulhern said. “It’s just a whole other type of medicine. I think it accomplishes the same thing in terms of getting the proper prognosis and treatment and what not.”
Mulhern came up with the concept of “healing studies” while working with maternity patients years ago and incorporates it into patient visits now. Essentially, the idea is that the solution to suffering is to change a person’s thinking.
“But as you can imagine, changing perceptions takes time,” Brickley said, and that can be challenging to do in a 15-minute appointment.
Mulhern estimates most visits at Hearth Stone last an hour or more. Ultimately, he wants each provider at the practice to have about 600 patients.
The doctors at Hearth Stone aren’t telling patients they don’t need insurance, which is helpful for paying for medications. Financial benefits are felt most by people with “regular insurance,” said Mulhern, so not Medicare or Medicaid.
Familiarity is important at Hearth Stone.
“Generally, we like to get a 12-month commitment, the idea being this is a long-term relationship,” he said. “We want to get to know people and we want to provide the best care to them.”
The most challenging part has been explaining how this new method of health care delivery works.
“But I think people in general see some issues with the current system as well so in many ways I think patients are looking for other ways at getting their health care needs met,” said Brickley.
Mulhern agreed. He said it will take some time for people to see how the practice works.