A New Model For The Clinic Begins Spring Of 2022
Hello everyone!
I am writing to tell you about some upcoming changes at the clinic. I hope that by the end of this email, you will have a sense of the new healthcare model that I am implementing and why I am making these changes. You will receive emails with more specifics in the coming weeks. The changes will take effect on March 15th, 2022.
First, it’s important to identify the problems and events that gave me the push to reinvent the way I practice:
Since COVID began, primary care providers like me have been in the position of managing more care due to difficulties around getting people in with specialists and safety risks with referring high-risk people to urgent care or the emergency room. Consequently, many primary care providers that I know are burnt out and overwhelmed.
After a year and a half of this difficult scenario, Blue Cross and Blue Shield (BCBS) started paying the contracted rate for a 15 minute visit even when the visit was a 30 or 45 minute visit. This change primarily impacted primary care providers. In my case, this meant that the amount they were paying me did not cover my overhead for the hour. My billers and I spent hours doing resubmissions and calling the insurance company and nothing was resolved. This has been happening to all types of providers (MD, DO, APRN, PA) who see their patients for more than 15-minute visits.
Forty percent of our patients have Anthem Blue cross and Blue shield so it is not sustainable for the clinic to be paid $5 less than our overhead for visits.
This forcing of shorter visit times is starting with BCBS and Medicare and soon all insurance companies will follow suit. Short visits only allow time for prescribing. I will not shorten my visits because I am committed to finding and addressing root causes of illness as well as helping people understand their conditions and learn what they can do to improve their health.
This situation required us to make a change but it also created an opportunity for me to incorporate my ideas and dreams about health education, group medicine and community wellness projects into a new model of patient care. I researched existing clinic models and found Direct Primary Care, a membership-based model for primary care. This model will give me and members the opportunity to balance problem-focused care with wellness care. Direct Primary Care is the basis of my new clinic structure and I will explain how it works below.
After March 15th, 2022, there will be three options for continuing your care:
Join as a member and pay a flat monthly fee for visits and access to wellness classes, workshops and resources.
Pay cash for visits (you will get a receipt that you can submit to insurance for reimbursement).
If you have Husky, your visits will continue to be covered and you will have access to classes and workshops at no additional cost.
Option 1: Membership
Membership fee of $144 per month
Medically necessary visits with Dr. Rosenberg which will be scheduled in the same way they are scheduled now.
Up to 3 personal email questions per month with Dr. Rosenberg
Same-day scheduled callbacks for urgent matters and routine callbacks scheduled within 2 days.
At least three topic-based group learning sessions per month. These will be hour-long informational sessions with a question and answer period. (See examples at the end of this email)
One wellness workshop per month. Each will be three sessions and will provide participants with the opportunity to learn through experience about their individual bodies and make sustainable steps towards wellness. (See examples at the end of this email)
Members can attend sessions live or watch recordings through the member portal. Members will also have access to the online library of past workshops, classes and events.
Minors will be covered if their parent or guardian is an active member. This takes into account that children should maintain a primary care pediatrician.
Option 2: Fee-for-service:
If you prefer not to use the membership-based program, you can still see me in the office and the fees will be:
$115 for 15 minute visit
$160 for 30 minutes
$220 for one hour.
If you are not a member, I will give you a claim that you can submit to insurance to have these fees reimbursed. Non-member fees will apply to phone calls based on time and email questions between visits will be billed at $10 for each question.
Option 3: Husky Insurance coverage
We will remain in-network with Husky. If you have Husky, your visits will be covered and membership will be included (including adults with Husky/Medicaid).
Access and sponsorships:
If you are facing financial hardship or cannot afford the full membership fee, please let us know and we will work with you to find an affordable price.
If you would like to sponsor a membership so that this healthcare community is accessible to everyone, we will have an option to contribute to the fund for financial assistance. Our clinic will match contributions.
My goal is to make this a community healthcare system that not only addresses disease but also provides every member with information and community support to improve their health. I am bursting with excitement and possibility about being able to do more wellness-focused and community-based care with all of you. You will be hearing more from me in the coming weeks with more information and instructions about how to sign up for membership. Thank you all for your support.
Please email the membership coordinator (my husband who is a website administrator and data asset management professional), Matt at membership@drgwennrosenberg.com if you have any questions or comments about membership. You can also email me at clinic@drgwennrosenberg.com
Sincerely,
Gwenn Rosenberg, ND