Archive for November 2015

The cost of primary care, Part 2

In this next installment on understanding the cost of primary care, I’m going to present an example involving the cost for a typical child to receive care for sore throat symptoms.  As in the last example, I’ll try and show the cost of care for those with high deductible insurance, those with no insurance, those going to a retail healthcare outlet, and those enrolled in the Direct Primary Care program.  I hope to highlight the real cost of each program.

Jon is the typical 6-year-old boy.  He loves to play LEGOs with his dad and chase his dog in the back yard.  He recently started 1st grade and still hasn’t mastered good hand washing.  He can do it when he’s reminded but it’s easy to forget.  Last night he told his mom that his head was hurting but didn’t have a fever.  When he woke up this morning he was burning up.  His mom measured a fever of 102F and found his tonsils were swollen and red.  Jon didn’t want to eat the pancakes his mom made for breakfast because his throat hurt too bad.  It turns out that one of his friends at the last birthday party developed similar symptoms and were diagnosed with strep throat by their pediatrician.

Let’s again consider the four scenarios in turn.

If Jon’s parents bring him to Trinity Medical Associates and have a High Deductible Health Plan (HDHP) then
Office visit (99213) charge: $85
Rapid Strep Test charge: $15
Total charge: $100
The insurance negotiated price is about 80% of charges so his parents will pay $80 out-of-pocket by using a HDHP insurance.

If Jon’s parents bring him to Trinity medical Associates and have no insurance then
Office visit (99213) charge: $85
Rapid Strep Test charge: $15
Total charge: $100
Trinity offers the same 80% negotiated rate to self-pay patients if they pay in full at the time of service so his parents will a pay $80 out-of-pocket if they don’t have insurance.

If Jon’s parents seek out care from a retail clinic provider then
thankfully for these more simple problems the pricing is much easier to figure out.
The Little Clinic posts prices as follows:
Sore throat focused visit charge: $85
Rapid Strep test charge: $20
Total charge: $105
So his parents will pay $105 out-of-pocket if the go to this retail clinic and have a HDHP or no insurance.

If Jon’s parents have him enrolled in Trinity’s Direct Primary Care program then
they owe nothing more than the $30 per month membership fee.  In fact the $80-105 they spent seeking care elsewhere would cover 2.6-3.5 months of membership.  So by spending the same amount of money on membership they could be seen for this episode of strep throat and any other episodes of strep throat for over 3 months.  It includes all the other phone calls and emails and follow-up visit that might be needed to sort through these symptoms as well any other problems.

What happens when Jon’s parents have questions after the visit?  What happens when they need to know the dose of Motrin, or when he can go back to school, or why Jon suddenly developed rust-colored urine and his ankles are swelling?

Primary care needs to be about the ongoing issues of your life.  Doctors and patients need to be able to have a continual conversation about their life and health and concerns.

No one can predict the future, so we all need a good plan to have the right people by our side when trouble comes.  Trinity’s Direct Primary Care program is one way we hope to make sure we can stay by your side through the troubles of your life.





DPC presentation and open forum schedule

The next two Direct Primary Care presentations will be at 10am on November 21st and December 5th in the main lobby of Trinity’s Fort Sanders West office.

Please feel free to attend if you would like to learn more about Direct Primary Care and the program offered through Trinity’s Hardin Valley and Maryville offices.

Each presentation is about 45 minutes and then offers a question and answer time.




Well I know I’m tired, but we do have three young children in diapers and I’m not sleeping well.  It’s probably just normal exhaustion.”

My wife’s explanation certainly made sense, but it was so easy to check a thyroid level that we went ahead anyways.  And low and behold, it showed that besides her “normal exhaustion” she was also hypothyroid (having an underactive thyroid gland).  Once this was treated at least some of her exhaustion eased up.  The rest had to wait until our kids (eventually seven of them) were all sleeping through the night.

So how does hypothyroidism usually show up?  It has many symptoms, most of which are very non-specific.  They include fatigue, dry skin, cold intolerance, constipation, weight gain, hair loss, depression, and menstrual disturbances.

And what causes it?  Worldwide iodine deficiency remains the foremost cause of hypothyroidism.  But in the U.S. where iodine intake is adequate, autoimmune thyroid disease (also called Hashimoto’s disease), is the most common cause of hypothyroidism.  In Hashimoto’s disease one’s own immune system is slowly attacking and knocking out their thyroid gland.

Hashimoto’s disease sometimes also shows up with temporary throat pain, full-out exhaustion or painless thyroid enlargement.  If left untreated long enough (rare in the U.S.), hypothyroidism can eventually lead to myxedema coma where a person exhibits marked fluid retention, slowed mental status and even heart failure.

If you’re one of the legions of folks who are fatigued and perhaps struggling with weight gain, the odds are it won’t turn out to be hypothyroidism.  But then again, it’s easy to check and if it really is hypothyroidism then you have something you can readily treat and improve.  The most commonly recommended blood test is called thyroid stimulating hormone (TSH).  If your thyroid is going low, the TSH will go the other way and be abnormally high.  If that turns out to be the case, thyroid hormone levels and thyroid antibody levels can also be checked to define the type of hypothyroidism.

About the only type of hypothyroidism to still have a normal TSH is something called euthyroid sick syndrome or nonthyroid illness.  In other words, if a person has some other severe illness their thyroid may partially shut down until they begin to recover.  There is some controversy as to how to treat these cases but the main approach is to treat the underlying severe illness which then allows the thyroid to recover on its own.

For being such a small gland, perched like a plump butterfly at the base of the front of the neck, the thyroid exerts an amazing amount of control on the rest of the body.  So if you’re getting symptoms suggesting that your chubby butterfly is getting sluggish, get a blood test.  It’s easy and it may allow you to only have to wrestle with “normal exhaustion.”