Clinic coming to Brattleboro eschews health insurance

July 08--BRATTLEBORO -- The Hearth Stone clinic in Townshend, Vt., has about 300 members. They call, text or email one of two primary care physicians when they need medical advice. And if they need to be seen by a doctor, members come for a 30- or 60-minute appointment.

There are no copays; there is no insurance paperwork.

That's because members pay a monthly subscription fee -- much like you would for Netflix or the gym -- to be part of the practice. It's $85 a month for one person and $20 for a child; couples pay $140. The fee grants them unlimited access to primary care, low-cost blood tests and some medications, all sans health insurance.

For Dr. Jesper Brickley, one of two physicians at the clinic, the model makes sense. It allows him to see fewer patients a day -- 7 or so on average -- and spend more time getting to know each one. It also frees up time that would otherwise be spent on insurance-related matters, he said.

The subscription model is better for patients too, he said.

"Insurance in some ways can be a bit of a barrier for people and dissuades them from wanting to connect with the doctor because they are afraid they're going to get a big bill in the end of the visit. In our case, you don't have to worry about that," he said. "You can come and see me whenever you need to."

Hearth Stone began operating last year, and already Brickley and the clinic's other physician, Edward Mulhern, are planning to expand to nearby Brattleboro. The Brattleboro practice, slated to open in September, would be the first of its kind in the town, Brickley said. It would accommodate the 75 or so members of the Townshend practice who already live in Brattleboro, as well as new patients.

The clinic is part of a small but growing trend, operating under a billing model called direct primary care. DPC Frontier, a website that tracks direct primary care clinics, tallied 852 such clinics in 48 states -- four of them are in New Hampshire and two in Vermont. None of the direct primary care practices listed in the Granite State are in the Monadnock Region.

Direct primary care addresses two of the most common complaints of primary care in the United State: Doctors often complain that they don't have enough time to spend with patients, and that administrative tasks cut into their already limited appointment times.

A 2018 study in the journal Family Medicine found that primary care doctors spend more time recording data in electronic medical records than face-to-face with patients. With the average appointment length hovering around 15 minutes per patient, according to a 2007 study in the journal Health Services Research, doctors don't have much time to delve deeply into a topic. That same study found that doctors may touch on an average of five topics, with some issues getting as little as one minute of conversation time.

Short appointments can also affect patients. Darlene Eisenhuth, 60, who is a patient at Hearth Stone, said she often felt rushed in a conventional primary care setting. The South Newfane, Vt., resident said she previously had a primary care doctor in Keene.

Her experience, she said, was akin to a production line: Her doctor would rush through the appointment, leaving her little time to ask questions.

Even so, she was a little hesitant to move to the subscription clinic, she said, especially since her insurance offers what she said is excellent health care coverage. But ultimately, she chose to become a patient because she didn't want to feel rushed.

At the Townshend practice, she said, appointments are as long as they need to be, and though her insurance covers primary care physicians, she prefers to be a patient at Hearth Stone, using her insurance for specialist appointments and blood tests and prescriptions not covered by her membership. At the clinic, she said, she feels like a partner in her own medical care.

One solution among many

Direct primary care bypasses health insurance billing, which emphasizes patient volume, said John Levinson, cardiologist and internist affiliated with Massachusetts General Hospital in Boston. In 2001, Levinson established the first clinic in New England similar to Hearth Stone.

But, he said, conventional primary care doctors can still give excellent medical care to patients. Direct primary care, however, is more convenient in that a doctor can address numerous issues with the patient in one visit. They can also devise a care plan with a specialist and deliver that care, rather than referring a patient elsewhere.

"It's not like you're paying for good care versus bad care. You're paying for easier access (and) making it simpler," he said about direct primary care.

However, he said, like many health care models, direct primary care may be just one answer to the problems faced by primary care physicians and their patients.

Brickley, for his part, said the subscription model helps him give the kind of care he wants to give patients, emphasizing relationship-building and education.

"I try to get to know my patients and understand what their values are and how I can best service them," he said.

Liora Engel-Smith can be reached at 352-1234, extension 1439, or [email protected]. Follow her on Twitter @LEngelSmithKS.

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