Frequently Asked Questions

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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.

No problem.

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”

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Your Medical Home

21 Hampton Road, Building 2, Suite 201 Exeter, NH. 03833

Phone: 603.418.6310
Fax: 603.418.6311

Office Hours
Monday - Friday, 8:30am - 5:00pm

Jim, born and raised on Cape Cod, attended the University of Massachusetts School of Medicine after graduating Phi Beta Kappa from the University of Vermont.  He completed his Family Practice Residency in Baltimore, Maryland in 1990, serving as Chief Resident during this third year.  After enjoying private practice for 5 years, he was one of the first Physicians to form CORE Health Services, a large, multispecialty group, serving on their Board of Directors.   After 10 years as an employed Physician, he established YourMedicalHome as an independent, Primary Care Practice, with a vision of the Patient Centered Model of Care.  He maintains privileges at Exeter Hospital, and has served on Medical Staff Leadership of that institution.

Various experiences, including involvement with the Institute for Healthcare Improvement, the Ideal Medical Practices Collaborative, the Dartmouth Cooperative Research Network as well as practicing in a number of different Primary Care Models has provided Jim with a unique perspective into what works, and what does not work, in the Primary Care Setting.  He has found the smaller practice model to be an ideal way to bring innovation in care delivery quickly to where it matters most, the patient.  This can be as simple as a phone system that allows all (including Physicians) to answer the phone, to patient direct online scheduling, to the encouragement of email communication, or to something as ‘old fashioned’ as regularly performing house calls.

Jim believes that excellent and timely communication, easy access and continuity of care are absolutely critical to the care we provide, and believes that all we do should augment these goals.  He enjoys speaking about any issue involving the practice of medicine and greatly enjoys the long term relationships with the patients of the practice, realizing that these insights can be very important in the provision of the care they need, and want.

You may see him jogging, biking or rowing around the Seacoast.  He is married to Casey (see below) and lives in Exeter with Casey and their four children, two girls followed by two boys.

Kareen is an Osteopathic Physician. Growing up in a family of ten children in suburban Boston, she knew that she wanted to be a “Family Doc” since the age of eight. Her background training includes an undergraduate degree in Biology from Saint Michael’s College in Vermont, and a Doctor of Osteopathic Medicine from the University of New England in Maine.  For over 20 years, she has been committed to helping patients achieve better health. Kareen believes that being healthy is a partnership between eh patient and the physician, and is committed to helping guide her patients to a healthier life.  Kareen is passionately interested in preventative care, fitness, exercise and other lifestyle choices that patient make to deal with stresses that contribute to so many illnesses.  She is quick to prescribe lifestyle changes and exercise, and is slower to suggest “fix-it pharmaceuticals” which often only treat symptoms, not their underlying causes.  She has been involved with the developing science of Resiliency Training through the University of Pennsylvania, helping teach these techniques to those in the military.

Kareen lives on the Seacoast of New Hampshire with her husband of over twenty years, Peter.  They are avid cruising sailors, and have cruised from Newfoundland and Labrador, through the coast of Maine, the Caribbean, in Ireland and England, and the South Pacific.  Kareen is committed to physical fitness, particularly enjoys being with her large extended family, reading, photography, travel, amateur woodworking and loves old quilts. Kareen sees patients in the office a couple of days per week, and makes house calls when necessary.  When not in the office, you’ll often find her somewhere on the water!

Casey, a Pediatric Nurse Practitioner, was born and raised near Washington DC.  She received her Bachelors of Science in Nursing from Fitchburg State College, graduating Magna Cum Laude.  She earned her Masters in Nursing from the University of Maryland while working at Children's Hospital National Medical Center in Washington, DC. Casey has more than 20 years of experience caring for children in the outpatient setting.  This experience, coupled with raising four children of her own, gives Casey ample perspective and empathy, with regards to the unique needs of our pediatric patients and their families.

Casey is married to the ‘other’ Bloomer in the practice and enjoys her large extended family, being the 9th of 10 children.  You might also see her running around town, literally. She values spending ample time with all families to address whatever issues might arise.

Susan, a Family Nurse Practitioner, graduated with a Bachelor of Science in Nursing from UMASS, Lowell in 1979. She enjoyed working in a variety of settings including the Greater Lawrence VNA, and during the early 1980s was thrilled to be involved in the planning and development of the hospice program for that organization. While working and raising her children, Sue went back to UMASS to obtain her Masters Degree in Nursing. She has had the pleasure of working for the past 16 years in Family Practice with Michael Lannon, MD, until his retirement in August 2010. She has learned so much over the past 30 years of nursing practice, both from her coworkers and particularly from her patients. Sue believes that listening is crucial to helping people. Sue is very excited to have the opportunity to begin a new chapter here with Jim and his staff – and looks forward to meeting with patients and their families, listening to their concerns and working with them to develop a plan of care to optimize their health. Sue lives on the Seacoast with Tom, her husband of 28 years. They have three grown children and an overgrown Westie. She enjoys being outdoors, walking, hiking, XC-skiing and spending time with her family.

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