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Fee-based clinic to open in March

Tuesday, February 4, 2014

By MICKEY POWELL - Bulletin Staff Writer

A local clinic set to open in March will provide patients an unlimited number of doctor’s visits for an annual fee.

The Integrative Centers for Science and Medicine (ICSM) will run the clinic at the Martinsville Medical Building next to Memorial Hospital. Dr. Noel Boaz, director of the centers, said the clinic has several purposes.

One purpose, according to Boaz, is to help make basic medical care more affordable, especially for people who go to the doctor more than others.

The clinic will enable patients to develop relationships with a primary care doctor, which can benefit their health, he said.

Also, the clinic could reduce the number of people getting non-emergency care from the emergency department at the hospital because they do not have a primary care doctor, Boaz said.

Leslie Smith, spokesman for Memorial’s owner, LifePoint Hospitals, wrote in an email that all area residents should “have a regular and ongoing source of care, as this can prevent disease and disability, detect and treat illnesses or other health conditions and increase the quality of life.”

Patients who are extremely sick or have sudden, life-threatening illnesses still will need to go to the hospital, Boaz said.

Based on information he obtained from the hospital, Boaz said there are at least 8,500 people in the Henry County-Martinsville area who do not have a primary doctor. He thinks the actual number probably is much higher.

Although the clinic is designed to reach those people, it will be open to anyone who pays the fee, he said.

The ICSM Board of Directors has not yet determined the fee, “but we’d definitely like to keep it below $500” a year, Boaz said.

He said the fee essentially will be based on “how much we have to pay doctors to come in” from elsewhere to work at the clinic.

Plans are for the clinic to have two or three doctors, a physician’s assistant, a nurse and an office administrator, Boaz said.

A physician is being recruited to be the clinic’s medical director. At some point after ICSM’s College of Henricopolis School of Medicine starts offering doctor of medicine (M.D.) degrees, scheduled for fall 2015, student doctors will help the director treat patients. In the meantime, the clinic will contract with area doctors to provide assistance, according to Boaz.

The standard fee will cover most care provided at the “ICSM Medical Center” but some procedures, such as X-rays, will have additional charges, Boaz said. Efforts will be made to keep extra charges lower than fees elsewhere for the same procedures, he said.

Because of the standard fee, insurance will not be accepted at the clinic, which should make it attractive to doctors, he added.

Doctors in recent decades have grown frustrated with insurance companies, according to Boaz, due to requirements placed on physicians which increase their overhead costs and force them to see a certain number of patients in one day, which limits the time they can spend with individual patients.

“It puts doctors on a treadmill they really don’t want to be on,” he said.

Despite its intent to make basic health care more affordable, the clinic will not be “a charity clinic,” Boaz said. “Nobody will get treated for free.”

If a patient cannot afford a monetary payment, arrangements might be made for a “time bank” or “payment in-kind” to pay off the debt, he said.

A time bank involves someone using a skill he has to provide a service to the clinic or another organization or person in need, Boaz said.

An example of a payment in-kind, he said, might be a farmer paying off his debt with his crops.

Such payments were common for health care many years ago in rural areas, he said, and the concept is “something our office would look at” if needed.

Traditionally, the philosophy among clinics has been “if they (patients) don’t have money to pay for health care, they don’t get health care,” he continued. At the ICSM clinic, the philosophy will be “you pay us back however you can.”

Asked how many patients the clinic will need to stay solvent, Boaz said ICSM officials will be pleased if it attracts 2,000 in its first year.

Because it will be a nonprofit clinic, it will seek charitable donations and grants to help cover operating costs, he said.

Boaz, who founded the Virginia Museum of Natural History in the mid-1980s, said similar clinics have proven popular nationwide, largely because they have fewer patients. That enables doctors to spend more time with their patients so the overall quality of care they provide is better, he said.

At the local clinic, there will be “a lot of old-fashioned contact between the doctor and the patient,” Boaz said.

For instance, “we’re not going to have a doctor typing on a computer when he or she is supposed to be looking at (examining) you,” he said.

“We’re encouraging patients to come in and see the doctor when they feel the need,” Boaz said.

But that does not mean patients will overuse the clinic, such as by seeing a doctor when they do not have a true medical need.

“People really don’t like to go to doctor’s offices,” Boaz said based on his perceptions during his medical training. When they go, he said, “they have something that’s motivating them pretty strongly.”

Along with treating illnesses, the clinic will focus on preventive care.

“We want to see you before you become sick,” Boaz said.

That way, he said, the doctor and patient together can develop a plan to deal with chronic health problems — high blood pressure or obesity, for example — to try to keep patients from getting sick.

Patients will be expected to stick to their plans, such as by exercising or dieting regularly, or at least try to do so, Boaz said.

If they do not, they may no longer be allowed to visit the clinic, he said.

Patients have a role in keeping themselves healthy, he emphasized, because “doctors can’t do everything themselves.”

 

 
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