Doctors take 'middle man' out of equation


TOWNSHEND — A longtime local doctor is taking a chance in changing the way his office handles payments and is bringing in another local physician to help.

Hearth Stone will be the name of the direct primary care practice run by Dr. Edward Mulhern and Dr. Jesper Brickley on Grafton Road in Townshend starting Oct. 16.

"Insurance is a lot more costly than the subscription fee we're talking about," said Mulhern, who has been based in Townshend for about 30 years. "This is the way things should be but they certainly aren't right now."

Patients will pay $85 a month for longer visits, more engagement and nearly unlimited access. Day-of or next-day appointments can be made for five days a week.

Hearth Stone expects to offer significant savings on lab tests, radiology and generic medications. With no insurance companies acting as "middle man," the office says costs will be transparent and direct. With more time spent with patients, the hope is that preventive care will keep medical costs down overall.

Besides Hearth Stone, there is only one other direct primary care practice in Vermont — Dr. Alicia Cunningham in Burlington.

Brickley, who has been practicing family medicine at Grace Cottage for more than two years, is an osteopathic family physician who offers acupuncture and osteopathic manipulative therapy. In the direct primary care model, he can offer those therapies at no extra charge. And no approval from insurance companies will be needed.

Although he will end his primary care practice at Grace Cottage, Brickley plans to keep coordinating ongoing and extended care needs with the hospital's medical team. He will also keep working in the hospital and emergency room. Mulhern and Brickley said they expect to "eventually" hire another doctor at their practice.

Brickley, worried about burnout, said he has been spending more time in front of a computer screen than taking care of patients and their medical needs. The most important part of his practice, he added, is "my relationships with my patients."

"The current healthcare delivery model, which relies on an increasingly complex and costly medical insurance system, has become burdensome for both patients and medical providers alike," Brickley wrote to patients in August. "This system has compromised the relationship between primary care doctors and patients, a relationship that is the foundation of ongoing health and wellness. I see the doctor-patient relationship sadly wasting away. The daily need to navigate the medical insurance system and my related bureaucratic responsibilities have eroded my ability to spend the time necessary to provide excellent care to my patients."

On Sunday, the meeting room at Townshend Town Hall was filled with the two doctors' patients for a community forum. Brickley said he had been "really moved" by the way Dr. Bob Backus, who retired from Grace Cottage in March, put the patient first in his practice.

"It really struck a chord with me," Brickley said. "The current health care model tends to have a little bit of a loss of continuity, which I think is really important. It's been in some ways hijacked by the powers that be, largely insurance companies that tend to write the rules for us."

Brickley and Mulhern began discussing these concerns about a year ago. Brickley had seen colleagues deploy the new model with some success in other states.

Doctors on average spend about six minutes with their patients, according to Brickley. Visits with Hearth Stone doctors are anticipated to be 30 to 40 minutes.

"That's our goal, which I think allows for just a more comprehensive, better understanding of what the issues are," said Brickley.

Brickley and Mulhern also plan to be available via phone and email.

"We're not necessarily scripted by an insurance company saying, 'You have to come in and see us,'" Brickley said, noting that a trip to a doctor's office can put people at risk for catching illnesses.

Brickley called the new system "sort of a co-op." He said he hopes to continue to utilize the resources at Grace Gottage such as the Community Health Team, which helps with diabetes management, mental health care, case management and dietary guidance.

"We really want to grow this project and I think it's just really humbling for me to see all you come in and listen to what we have to say," he told forum attendees.

Direct primary care has been around for about 10 years, according to Mulhern. The model's definition came about when the Legislature in the state of Washington addressed a new medical practice wanting to take subscription fees rather than insurance.

"You're paying your doctor directly like they used to in the old days," Mulhern told attendees. "I've been paid in maple syrup and things over time. But you are directly supporting the life and livelihood of your doctors. It's moving all these other things aside. We're sort of doing an end run around big business, around the industry of medicine."

Brickley said insurance is still an important piece.

"This is primary care," he told attendees. "This is not specialty care. The very expensive things are still going to be very expensive and it's important for you to have that [insurance] in your overall health portfolio... This is sort of seen as another layer of primary care. In case anything comes up, urgent care is all included in the membership fee."

Reduced rates will be offered for adult children in families signed up at Hearth Stone, according to Brickley. Each doctor at the office can take up to about 600 patients.

Mulhern believes the new system could catch on in other places. He said Washington, Texas and Colorado have seen more direct primary care practices open in recent years.

"The more people who show they want this sort of thing, the more I think government will pay attention, insurance companies will pay attention and then we'll have something," Mulhern said, later adding, "Word is going to get out. It may encourage other physicians to strike up and start to do the same thing. If we can gain in numbers here in Vermont, more direct primary care systems, then the Legislature is going to have to wake up."

He insisted the lines of communication between his office and Grace Cottage would not be strained with the new system.

"The last thing we want is a wall," he said. "We'll work together."

Current patients of Brickley and Mulhern will have until Jan. 1 to decide whether to subscribe. A website can be found at Appointments can be made to discuss the new system.

Reach staff writer Chris Mays at 802-254-2311, ext. 273, or @CMaysBR.


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