Click each question below to view the answer.
So what makes YourMedicalHome Different?
When we started our practice in 2007, we had experienced Primary Care in many settings; as patients, as well as providers. We were familiar with the experience of calling or walking into a large office and feeling that no one knew us, knew why we were there, or worse yet, that we did not seem to be the main focus of what was going on. Great people, working in systems that just did not work for patients. As Physicians, we felt unable to do all the things we should be doing for our patients. In general, an office that was set up to serve the organizations needs, rather than the patients needs. We call this “Usual Care”. Things that should seem simple suddenly seemed complicated. Things like speaking to someone on the phone, simple communication, getting a refill or scheduling an appointment. Sadly, this is the emerging model of Primary Care, with consolidation into larger practices, with revolving staff and providers, difficult access and fragmented care; what we call “the treadmill”.
We vowed to build a model of practice around your needs. We pledge to add tangible value to your Primary Care Healthcare experience; a value that matters to you.
- We answer the phones, usually by someone who can take care of your issue. All of our providers also answer the phone, so do not be surprised when they do! (We ask staff to wait until the second ring, for fear of ‘spoiling’ our patients.)
- We are small by design. We feel the care we provide starts the minute you walk in the door. We will know who you are when you walk in the door, and why you are here. You will feel like we are working for you. You, after all, ‘hired’ us. We clearly understand this.
- All patients have access to our physician’s cell number after hours. No after hours nurse “triage” phone service. In many instances, we can avoid an expensive ER visit or treat you by phone if appropriate.
- We routinely perform house calls. An important service for our aging patients.
- We personally review all adult records yearly and send a letter regarding health maintenance.
- We encourage and use email extensively with patients, should they wish.
- We were the first local practice to allow and encourage direct appointment self-scheduling online, not just requesting an appointment. We do not feel you should need to ask ‘permission’ to be seen.
- We post our patient satisfaction and quality data on our website. We have nothing to hide.
- We are glad to treat or refill medications by phone, if medically appropriate. We will fax prescriptions to your mail away pharmacy, a service other offices may no longer provide.
- We use an electronic medical record and electronic prescribing. We are big on safety.
- If you are hospitalized at Exeter Hospital, we will come to see you.
- We are glad to fill out forms, generally, we can do this on the spot.
- We spend time watching out for your financial, as well as your medical, health. We do this by being aware of cost-effective, safe practices, whether this is generic medications, or institutions which may provide the highest quality services at a lower cost to you. This is increasingly important in these days of high deductible insurances and escalating costs.
- Most importantly, we have time to spend with you. We do this by restricting the size of our practice, allowing ample time to know you and determine the best course of action with you as a partner.
While other practices may do some of these things, we pledge to do them all. We take this seriously, as our core commitment to every patient.
What if I need you after hours?
Call our office at 418-6310, and the physician’s cell number will be on the answering machine. We have resisted the temptation to turn off our beepers at 5 PM and turn the phones over to a nurse call center, preferring to personally offer phone advice. Don’t hesitate to call. In the rare event, Dr. Worrell and Dr. Bloomer are both unavailable, there will be the number of another physician who will be able to attend to your needs.
What if I miss an appointment?
We have the unconventional notion that life sometimes interferes with Doctors appointments. We will work with you. We are happy to say we have all forgotten things from time to time or had the occasion ‘forgot the kid’s soccer game’, emergency. Go to the game. We can see you another time. Just give us a call.
Will you fax in prescriptions for us? We hear that some offices will no longer do this.
Can you see us short notice?
We strive for great access. If you need to be seen, we will do all we can. We can sometimes accommodate physicals same day, certainly within the week.
I hear that you do house calls?
This continues to be an important service, particularly for our older patients.
What if I need to be hospitalized?
Dr. Bloomer maintains privileges at Exeter Hospital while using the hospitalist service for their expertise in managing your care. If you are hospitalized, we will still come see you and participate in your care. If you are hospitalized, it is important that your ask your admitting physician to call us at the time of admission, so we can be involved and aware from the start.
How does billing work?
We are currently contracted directly with Anthem Blue Cross/Blue Shield and Harvard Community Health Plans. Many of our patients have insurance with other carriers. Just because we do not have a contract with them, does not mean you cannot, or that we cannot take care of you. Please see the section under insurances under the INTRODUCE tab of the website for detailed information.
Do I have to come in for an office visit for all refills?
No. Only if it is clinically important that you do so.
So how can you do all this and stay in business?
(Thank you for taking the time to read this response. We feel it is important for our patients to understand the business climate in which we must currently (unfortunately) operate.)
Many of our patients ask us why there is a trend toward larger primary care practices, owned by larger and larger organizations. They also ask us how we are able to remain viable as an independent office given all that is happening in healthcare these days. These are great questions, and important questions, because the model of care in which you receive your care, impacts the care you receive. Let us explain.
The current healthcare payment system rewards what we term “usual care”. Or more accurately, “usual care” has evolved to optimize (take advantage of) the current payment system, while leaving primary care physicians and patients increasingly frustrated. This “usual care” model is generally built upon a concept we call “the treadmill”; large offices, many exam rooms and providers on roller skates; phone trees, after hours call centers, a heavy reliance on computers, and the notion that “providers” are easily “interchangeable”. Studies have shown that this does not necessarily result in higher quality, nor better patient satisfaction. (Can HIT Lower Costs and Improve Quality. RAND Research Brief 2005. J. Wasson et al, JAMA 1984; 252:2413-2417)
In “usual care”, the more quickly a provider can see you, the more the organization will make. This is called “productivity”. Most all employed physicians are compensated on productivity, rather than quality or patient satisfaction. Payors currently reward this type of behavior, by (for example), paying the same for a 20 min. physical as for a 40 minute physical. Additionally, larger practices can usually negotiate for higher fees; in our view, more money for less time with you. To top it off, insurers generally do not compensate us for all the work we do on your behalf. Many practices simply decide to provide the minimal expected/required. Most insurers would correctly admit that Primary Care is under-compensated by their plans. Meanwhile, despite the “treadmill” productivity model, essentially all primary care practices owned by large organizations (generally hospital owned systems) lose money. This ‘deficit’ is made up somewhere else in the organization. (AMGA 7/27/2010) As an independent entity, we do not have that “luxury”. We must balance our own books. We work only for you.
We are determined to avoid the “usual care” model of care. We refuse to compromise on things we feel are essential, such as access, continuity, time with you and ease of communication. We find that small organizations can remain focused on those services that are important to you, something that is a great challenge in large organizations.
So where does that leave smaller, innovative practices like ours? With a problem. How do we do all the things listed on the prior page, do them well, and still pay the bills when the payment system is stacked against us? We ask for a yearly “noncovered services fee”. Our patients repeatedly tell us they do not want us to drift toward “usual care”, most having already experienced primary care through a large organization. They also acknowledge the tangible benefit we are able to provide, as well as the broken reimbursement system. They recognize this added benefit to all in the practice, by compensating us a reasonable yearly fee for services that are generally not covered by their commercial insurance, our “noncovered services fee”.
But this sounds too good to be true?
- It is not. We may be swimming against the tide of Primary Care, but we are stronger for it. Our best references are our patients. Some responses to our survey asking ‘What can we do to improve your experience at YourMedialHome?
- “You cannot improve on perfection”
- “We love the service…pinch me, I must be dreaming”
- “ Thank you for the most thoughtful (and longest) consultation and exam I’ve ever experienced! I felt several years younger after I left, confident that I could safely put to rest some long-standing concerns…”
- “Everything is wonderful! You are the best run, nicest medical office we have used”
- “Make me 60 years old-otherwise I shall remain dissatisfied!” ( a 78 year-old patient..we are working on it)
- And our personal favorite. “Serve free lobster rolls at noon”