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Writer's pictureDr. Penny Lane

Direct Primary Care: What does that mean?

My beginnings in private practice were from having first been a Nurse-Midwife and if you're at all familiar with midwifery, you may know that nurse-midwives came to this country from Britain as community care providers. They rode their horses into the community and cared for the entire family. It wasn't until many years later that their scope narrowed to just moms and babies.


While I practiced as a nurse for ten years before becoming a Nurse-Midwife, once I completed my graduate degree, I attended women in their homes, in their most vulnerable moments, and while high level clinical skill was sometimes part of that role, more often I was gently supporting and guiding women along their own journeys. I would educate the families, reassure them of the process, and be mindful that they too were caring for themselves and creating a safe and encouraging environment for momma and baby. I cleaned, cooked, and sat quietly in observance. This intimate experience grew strong relationships and deep trust, not just with mommas, but the entire family, which continued into their postpartum period, birth after birth, year after year.


When I added the entire family to my scope of practice, this model, direct primary care, was an extension of my midwifery care. Now I care for grandparents, spouses, and children into their adolescence and young adult years, as they navigate all life challenges that cross their path. My passion is connection and empowering clients as partners in their healthcare. I want them to lean into self-care, which I believe is true primary care. I want them to feel special and cared for, and within this mindset and model of care, I practice a little differently than what you might be used to in conventional medicine. I think you'll appreciate why.



Make Your Own Decisions


Clients often ask me about decision making. Can they make their own decisions in their healthcare, or that of their child's and will I support them? They also want to know if I accept health insurance. One can not really do both, at least for very long.


If I am going to create space that allows for parents to make decisions that is best for their unique circumstances, but outside the norm, I can't also participate in the third party payer system where choices are minimized. Clinicians have to meet various metrics to maintain full reimbursement, which is already so low visits are exceedingly short and unnecessary tests and referrals are high. Low immunization rates means reimbursement rates plummet for providers, which is largely why so many practitioners will not support families who opt to vaccinate on their own schedule or maybe avoid a particular immunization or all of them entirely. The goal is to do more, prescribe more, refer more, so we can earn more reimbursement within this already taxed system.


Eden Family Practice, LLC is different because we work directly with you. Like you hire your attorney independently so they represent your rights exclusively, without bias, I work for you and have no other interests in mind. I want you to succeed, and I want to take the time to listen and understand your needs. When you call or email the office, it is either myself or my husband, Jeremy, who responds. He helps with the administrative aspect of the practice and all clinical work is done by myself. My clients have direct access to me - nothing comes between me and my clients with regards to decision-making.


Educated in Functional & Integrative Wellness


Eden Family Practice offers full-service primary care, seeing clients of all ages, and I can do this balancing the art and science of healing. My training is in functional and integrative health, as well as conventional medicine. I've been a nurse since 1997 and a clinician since 2007. I've trained with the Institute of Functional Medicine, have additional training in herbal medicine, and I have a long history of fierce client advocacy.


Natural medicine, even functional medicine, is not covered by insurance. Education, herbs, functional tests, even tests to look for pre-diabetes or labs to evaluate complete health prior to having overt symptoms are not covered, but most of my clients don't want to wait until they have overt disease to address their health issues. I don't have to offer you the less effective, more risky option just because it is the cheapest and my contract with your insurance company demands it. My focus is always what is best for you. Not being an in-network provider means I can think outside the box and offer you all available options no matter the position of your insurance company. You'd be surprised what cash prices are when working outside a contract.


When you work within a model in which a third party is paying you and there are pages of contract in how that care will be provided, that is the entire mindset of where your practitioner must remain to provide care. They are told which labs to order, which medications to prescribe, which practitioners to refer and how often to see you. They are told when to order which tests and how long a client must suffer before surgery is offered. More often they don't pay for nutritionists, health coaches, education, therapy of any kind, and anything current (within the last twenty years of research) is too new to be covered. Labs that cost $3 in my practice are as much as $120 in contracted practices, or way worse. Third party payers also mandate wellness screenings and immunizations on schedule. What would motivate a practitioner to learn outside the box if they can't implement it in their practice?


Importantly as well, is advocating for my clients in school systems, with therapists, with emergency room staff, with home care or even social services. I do have your back and will be your support through unexpected challenges, including helping navigate educational plans for your children, working with emergency room staff in the event of injury or illness, supporting you through emotional and mental overwhelm, and digging deep into the underlying cause of any dis-ease. None of this is covered by your health insurance. This is VIP service.


Most importantly though, for both of us, is that not accepting insurance means my time is valued and reimbursed. We can sit and talk and in that alone there is healing. We can partner through every step. Within the insurance model, clients are moved in and out the door as if there was a conveyer belt. The average visit in conventional medicine is six minutes in the primary care clinic. Reimbursement is about $40 to $60, no matter the cost billed, and that must cover every single member of the team, from the front desk personnel to the nurse, the business managers to the clinician.


Many clinics see 40 clients a day, per provider just to make ends meet. Nurse practitioners in primary care are often seeing 20-35 daily and are always being pushed to see more. Their pay is often less than what they made as a bedside nurse which is why turn-over rate is so high. This is not a model I enjoy and it is not one you are likely to be really heard, or one where practitioners can work at addressing underlying causes of dis-ease. If you want a different experience, you'll have to step out of the conventional model. If you want a practitioner who works for you, than hire a direct primary care provider and bill your insurance for reimbursement or use your health savings account, and use your insurance for labs, diagnostics, or any necessary hospital fees.


Partner in Your Healthcare


Your health reflects what you do consistently, so I'll draw the map and guide you on the course towards healing. Knowing and applying are two very different things though. Our body and our mind like familiar, so we easily fall back into old habits and it can be really hard to adapt new practices when we are overwhelmed. I have a few tricks here, but community and consistency is key. We have a plethora of opportunities for clients to come together and support one another, but there aren't short cuts if you truly want life long vitality. You will have to make your health a priority.


Nearly thirty years of experience has helped me hone my craft, but I have also created a plethora of educational courses so you don't have to pay for consultations to get every little morsel. I am happy to do that though, and sometimes initially, when clients are completely overwhelmed, we do meet more often and I can guide you through, step-by-step, just like my ballroom dance instructor does in teaching me the tango. Soon, though, you'll be better able to navigate with less one-on-one instruction.


This is a small practice, and I don't have huge overhead so I have time to focus on you, and give you the attention your particular case deserves. You will never wait on hold or have to tell your story to three different people. Most of my clients have my cell phone, because if I can't trust you with my cell phone, we probably aren't a good fit anyway. Connection. Trust. Mutual respect is my focus. Care is provided either in your home or via telemedicine or phone. Same day or next day appointments are almost always available.


We are transparent about our prices. No concierge fees. No membership fees. Pay me for my time, which after the initial, new client visit, our annual wellness visit is only $210 and $65 for simple problem visits. No insurance interference. Apply that to your deductible or pay with your HSA. No copays. No monthly billing. No long-term commitment. No missed appointment fee; we are all doing our best. Most of our clients find our cash prices are less expensive than what they pay even using their insurance, but you decide. Visits are 60 minutes.


Full Scope Practice


Nearly thirty years in healthcare and almost twenty as a clinician. I can offer the entire family comprehensive exams, including well child exams, neonatal care, and women's health exams. Sports physicals, gynecologic exams, chronic disease management, acute illness and injury treatment, as well as lactation support and evaluations for autism and ADHD. We can dig into underlying causes of disease across the spectrum of mental health disorders, autoimmune disease, gut issues and metabolic or endocrine diseases. I am versed in medical detoxification and epigenetics, as well as functional medicine testing, somatic therapies, and trauma. Of course, I can also offer pharmaceutical therapies, diagnostic testing, and referrals to specialists.


Labs can be done at Solaris in Nicholasville, or any laboratory of your choosing when billing to your insurance but you will have to coordinate to get results back to our clinic. We do have low cash prices for labs which we will discuss before we draw your blood. Historically, the prenatal panel was $1,200 for a cash client at the local hospital. We charged $72. It is truly shocking how high these labs are marked, but when you work in a model that accepts third party payment, you do have to find dollars wherever you can. Our pricing is straight-forward and transparent.


If you want a primary care provider who works for you, and has your best interests in mind, then give us a call.


We'd be happy to extend a free, 15-minute get to know you discussion via Zoom or schedule online at your convenience.

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