Thank you to Dr. Allison Edwards from KC DPC for her work on a majority of this information.

Good Afternoon,

We are reaching out because we know this is a confusing and anxiety provoking time for many people. As you are likely aware, Massachusetts residents have tested positive for COVID-19 (the illness caused by the novel Coronavirus) and we expect more cases to be identified as testing availability expands over the coming days to weeks. As of earlier today there are a total of 95 presumptive and confirmed cases of coronavirus in the state. Most of the these patients will do very well and will not require hospital level of care.  

As your physicians, we are committed to staying up to date on developments and changes, so that we can provide you with the most accurate and timely information possible.  We are routinely reviewing updates from the Massachusetts Department of Public Health (https://www.mass.gov/orgs/department-of-public-health) and the CDC (www.CDC.gov). If you have questions or concerns, we strongly urge you to visit and utilize these resources. We do not recommend you get your information from social media.  

This is not a time to panic, but we do all need to institute some changes in our day to day lives to try to slow the spread of the virus. Yes, it may be inconvenient, but it is necessary. We may not be able to prevent a large portion of the population from getting this infection, and the majority of people who are infected will do just fine. However, it is very important that we slow the spread so that huge numbers of people are not infected at the same time, which would overwhelm our hospitals’ ability to care for the segment of people who need hospital level care due to severe illness. We ask that everyone practice “social-distancing” and avoid non-essential large gatherings or unnecessary travel, wash your hands frequently, avoid touching your face and stay home if you have a fever or cough. This is the best way for us to ensure that there will be adequate health care resources for folks who do get very ill from the virus.

At Gold Direct Care we are fully committed to caring for our patients in the most evidence-based, safest capacity possible. We want to make sure that you know how we plan to serve you as COVID-19 spreads through our community, so we’ve put together the following information to explain what you can expect from us over the next few weeks to months.

As of today, March 12, we are asking those with respiratory symptoms (cough, shortness of breath, wheezing) and/or fever to first call the office (781-842-3961) or text message your physician.  DO NOT walk-in to the office without first calling. If you walk-in you are potentially putting our staff and other patients at risk unnecessarily.  We will reach out to you for more information and determine the best way and place to evaluate you.  If you have a regularly scheduled visit for a routine, non-urgent issue and you want to cancel in light of current events, please call the office and Lauren will reschedule you. Many issues can be handled over the phone, so we can always arrange a phone-visit between you and your doctor. In addition, no patients will be given an appointment without providing a brief reason for the visit. This helps us from being surprised by someone’s symptoms. Please do not “back-door” us and say you are coming in for a benign reason when really you have respiratory symptoms that should be handled as stated above. When in doubt, call the office and we will triage you appropriately.

The key points of the triage system we have put in place to keep everyone safe are as follows:

    •    If you have mild, isolated, upper respiratory symptoms (runny nose, nasal congestion, post-nasal drip, sore throat), but NO fever or cough, and have NOTbeen in close contact (within 6ft for at least 15 minutes) with someone diagnosed with COVID-19, nor recently returned from travel to a high transmission country (China, Iran, Italy, South Korea and Japan) or the Northwest US, we will recommend home care and that you not come in for an in-person visit.  You are always welcome to schedule a phone visit with Dr. Mancini or Dr. Gold to talk through things.  

    •    If you have lower respiratory symptoms (deep cough or shortness of breath) and/or fever your physician will recommend a telephone visit to ascertain if an in-person visit is warranted.

    •    If we determine that you need an in-person visit, the visit will occur in your vehicle in the parking lot of our clinic so as to prevent potential spread and exposure to others in the office. While this is not how we usually do things, it’s the most effective way to prevent the spread in the clinic.

    •    If you have severe symptoms, we will likely refer you directly to a hospital.  

    •    Currently, we do not have the COVID-19 test kits in our office.  All testing as of today is still being done through the Mass Department of Health. We are working with our lab vendor to confirm the exact specifics of when commercial testing will be available. When testing becomes more readily available we will continue to work with the Mass Department of Health and the CDC to determine who needs testing.  We will not be recommending testing for just anyone with symptoms of respiratory infection; we will make this decision on a case-by-case basis using sound medical evidence and our clinical judgement. 

I cannot be more explicit than this: if our staff comes into contact with someone who is symptomatic and positive for COVID-19, we may be required to be in quarantine for 14 days. As we are a small office, this may lead to a situation where we will have to close for all in-person interactions for up to (and potentially longer than) a 14-day period.  If this were to occur, we would attempt to still offer telephone triage and telemedicine visits.

We are taking an abundance of caution by putting these guidelines in place to prevent the spread of this illness to the most vulnerable around us.  We appreciate your understanding, patience, and effort to keep everyone in the community healthy as we all see our routines upended a bit by this virus.

Don’t hesitate to ask questions or reach out.

Carmela Mancini, DO and Jeffrey Gold, MD

For additional information please visit:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://www.mass.gov/resource/information-on-the-outbreak-of-coronavirus-disease-2019-covid-19

Updated Testing Guidelines for More Information

https://www.mass.gov/doc/covid-19-pui-criteria/download

 

This article by Lydia Ramsey was published in todays Business Insider- Employers Could Use Direct Primary Care – and features our friends and colleagues Dr. Vance Lassey from Holton Direct Care in Holton KS as well as Dr. Kim Corba from Green Hills Direct Family Care in Allentown PA. The article discusses how the big three of Jeff Bezos from Amazon, Warren Buffett from Berkshire Hathaway, and Jamie Dimon from JPMorgan have announced that they are trying to fix our healthcare system Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care and they seem to be looking at using Direct Primary Care to build a solid foundation of affordable primary care for their employees. All of those questions from skeptics that I have been repeatedly asked over the past three years such as “why don’t you take insurance?”, “why should I pay twice for healthcare?”  “why should I self-fund?” etc etc. are now being answered by people that have a lot more money and clout than I do. My hope is that maybe now people will not only start following, but also start teaming with a group of renegade primary care doctors across the country that have been doing this model for the last decade because they had enough of the “healthcare cartel.” If you use Amazon maybe you should also consider using a DPC doc.

 

Direct Primary Care is written into the Affordable Care Act as an approved method of receiving primary care as long as it is combined with a catastrophic insurance plan. (Isn’t that how insurance is supposed to work? But I digress.) The ACA clearly defines that DPC is not “insurance” and purchasing a DPC membership alone does not meet the standards of being “insured.” It is required to purchase at least a high deductible insurance plan along with it to be qualified under the ACA. See great article on this here: DPC Clause in the Affordable Care Act

However, on the State level, many legislators, policy makers, and Department of Insurance commissioners want to claim that DPC is the “business of insurance” and should have to pay licensing and regulatory fees. In other words, paying a reasonable monthly fee for all your primary care needs should be regulated no different than Blue Cross Blue Shield, Harvard Pilgrim, etc etc. Having to pay fees of this magnitude would clearly put a small DPC practice like us out of business. We are not “insurance”. We are a primary care medical practice that chooses to work solely for our patients- not third parties- and therefore be compensated by our patients for what we believe is a reasonable monthly fee. About 15 states in the US have now passed legislation stating this as law. Massachusetts is not one of them and has yet to introduce a bill that by stating such protects us and our patients who choose us. We, along with three new DPC practices in MA, are tirelessly working on getting our legislators to listen to us and sponsor a bill.

As the first DPC practice in MA we were contacted by the Massachusetts Department of Insurance when we first opened in January 2015. With our legal counsel we have met with them and corresponded with them on this issue. It has been months of waiting and practicing medicine in an unclear regulatory environment. This weekend, much to my delight, I was contacted by my attorney with a letter from the DOI that has given us the green light to continue practicing medicine without 3rd party interference. (The letter is attached below a sit is a public document.) We are very thankful to Commissioner Daniel Judson and Deputy Commissioner Kevin Beagan for their understanding that what we are trying to do is solely for the benefit of the people of Massachusetts and the primary care doctors who want to care for them in a manner that echoes the “olden days of medicine.” Hopefully there are better days ahead for healthcare in Massachusetts.  (more…)

Because DPC is known for it’s price transparency, this is a list of our most common labs and their prices.  If you don’t see a test on here which you would like to know the price of, don’t hesitate to send Meghann an email at Meghann@golddirectcare.com.

I am writing this as a sincere thank you to the Research Team and Incite Health at the Center for Primary Care at Harvard Medical School for taking the time to visit us this summer to see and hear what Direct Primary Care is all about (Here is link to story: Harvard Medical School Team Visits Gold Direct Care). If an institution of Harvard Medical Schools caliber can get behind this model of care, the potential for growth and implementation is boundless. Hopefully, we showed their team that the simplistic model of Direct Primary Care in combination with an appropriate high deductible/Health Savings Account insurance plan accomplishes everything that the Quadruple Aim is about:

• Lower costs….even for insurers
• Better health outcomes
• Happier Doctors
• All of which lead to the most important goal….HAPPIER PATIENTS!

Hopefully our relationship with their group- as well as other medical schools- will continue to grow as we continue our efforts to get more patients, doctors, employers, insurers, and legislators to buy into an old but new model of care that actually makes sense for all. The top down approach is not working so why not ground up?

Yesterday I did a home visit for one of my long time patients that recently got discharged from a Skilled Nursing facility. She has a very complex medical history and has been in and out of hospitals and rehab facilities over the past few years. She is frail and elderly and getting to her dialysis sessions three times a week takes a lot of energy out of her. So why is it necessary for her to expend a lot of energy and experience pain to physically come in for a visit to see me? The answer is it’s not anymore.

See… in the current medical system doctors and nurse practitioners only get reimbursed by 3rd party payers if the patient physically comes in and meets with the doctor face to face. The doctor sees a complex patient like mine for 10-15 minutes if lucky (or if longer end up an hour behind), and then spends a majority of time documenting and coding the visit in order to get paid. Sounds great for the patient and doctor huh? Not exactly. It doesn’t work and it makes no sense.

So that brings me to yesterday.  Since I no longer have to see 20-25 patients a day like a machine, I now have control over how I practice medicine and the type of care I provide. By contracting solely with the patient, I can drive 2 minutes to my patient and see her at her home. I spent 70 minutes with her and her children. We reviewed her discharge paperwork, her multiple medications (trying to taper her off a few), and discussed any current issues or concerns they had. I then wrote a brief note documenting the plan and emailed the specialists involved with her care to update them as well. The focus was and is solely on THE PATIENT. All of her and her families questions were answered and we have a solid plan in place to prevent her from ending up back in the hospital- a place she dreads and I don’t blame her. Now we can work as a team to be proactive rather than reactive. We can work towards solid pain management, reduce unnecessary medications and testing, and keep her home where she is safer and more comfortable. Her quality of life is significantly better because her care is better.

And what did I receive in return? A great deal more than $30 or her monthly fee of $125.  After 8 years of caring for this woman I got to see her in her ideal setting- her home. I got to learn about the little toy animals she keeps as her hobby. I saw her family in action taking car of her and making her quality of life the best possible. Carpets have been removed so she doesn’t trip with her walker. She has a bell so she can ring in the middle of the night if she is in pain or needs something. And now she has her physician capable of coming to her and spending over an hour with her to make sure she is heard and cared for with dignity. So I got a lot more….I got to be a doctor. Not a bad value proposition for the two core people that make medicine tick- the patient and their doctor.

So today I spent an hour speaking about Direct Primary Care to 1st and 2nd year medical students at Tufts University that are interested in Family Medicine or Primary Care in general. It was a great experience to see students engaged and interested in pursuing a field of medicine that desperately needs young, bright, and energetic minds. They asked intelligent questions and hopefully learned that there is hope on the horizon for primary care. There is a currently a shortage of good primary care physicians across the country, but especially here in Massachusetts. We need to fix this and the only way to do so is to make Family Medicine palatable, financially rewarding, and most importantly gratifying by focusing on patient care. Read this article from 2013 for more information: http://www.beckershospitalreview.com/hospital-physician-relationships/primary-care-shortage-dire-in-massachusetts.html

Direct Primary Care, in my opinion, is a way to build off the positives of our healthcare system and simultaneously remove the bureaucracy and red tape of insurance that does nothing to help patients or control costs. We have a solid foundation to work off of, but we have to modify it without scrapping the whole construct. DPC does this. It allows insurance to be used the way it was intended to be used- for catastrophic, high cost events or illnesses.

In my hour with them today, I hope I was able to show the students that if we keep fighting the good fight and do the right thing, maybe someday DPC will become the norm rather than the exception. I hope the more than 200 patients we have enrolled already can attest to the value and quality of this old, yet new, model of primary care.

As Albert Einstein once said the definition of insanity is doing the same thing over and over again and expecting a different result.

We’ll be hosting a number of sessions in the coming weeks to give you a chance to visit the new office of Gold Direct Care in downtown Marblehead. Please stop in to see the office and meet our team.

There are two types of events planned:

OPEN HOUSE – All are welcome. Open to the public, no RSVP needed.
Come see the new office, meet Dr. Gold, and learn more about Gold Direct Care. Snacks and refreshments will be served.

Three open houses:
– Monday, Feb 23rd, 4-6pm
– Wednesday, Feb 25th, 4-6pm
– Friday, Feb 27th, 4-6pm

INFORMATION SESSIONS – Space is limited. Please RSVP for a specific session via email or call 1-800-939-1850, Ext 1.
Dr. Gold will give a detailed presentation on Gold Direct Care, including Q&A for patients, employers and local businesses.

Four session times:
– Tuesday, Feb 24th, 12-1pm and 4-6pm
– Thursday, Feb 26th, 12-1pm and 4-6pm

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All events will take place at the new office of Gold Direct Care at 123 Pleasant St, Suite 105, Marblehead, MA. Our office is the front-right corner of the new building that houses the Warwick Theater and Palmer’s Restaurant. There is ample parking behind the building, and you can enter directly from the door adjacent to the parking lot.

Meghann is the nurse and office coordinator at Gold Direct Care.

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“Hi, I’m Meghann Dunn. I was born and raised in Florida and moved up to Massachusetts about six years ago. I have always wanted to help people throughout my life, and have been volunteering at food banks and homeless shelters since I was young. When I moved to Massachusetts, I found my passion for helping others could be realized through becoming a nurse.

My hobbies include playing and coaching soccer, hiking, kayaking, and reading the occasional horror novel.

I am excited for the opportunity to work with Jeffrey Gold because I truly believe in his vision. I fully support anyone who feels everybody deserves access to quality healthcare. Being able to be a part of a family care setting, where there is more of a direct relationship between patient and healthcare providers, will give me the opportunity to understand my patient’s individual needs.

I  am proud to join Gold Direct Care and I look forward to working with you and yours.”

We’re thrilled to announce the opening of our new office!

Construction wrapped up last week, and we’re still working on stocking the supply cabinets, but the office is open and we’re seeing patients.

Update: Open houses scheduled for February.

When you first visit Gold Direct Care, you’ll immediately notice that we’re different from the typical doctor’s office. Read more about what makes a Direct Primary Care Office special.