Megunticook Medicine

Some of the reasons why we switched to DPC to be more effective in caring for our patients.

5 Lessons I've Learned as a DPC Doctor Becoming a direct primary care (DPC) doctor has been one of the most fulfilling decisions of my career. My journey from traditional, insurance-base...

If in doubt about an animal scratch or bite, call your physician.

Raccoon that scratched midcoast woman had rabies People can reduce the risk of coming into contact with a rabid animal by keeping a respectful distance from all wildlife.

Big change in Rockport EMS coverage-

Rockport to cut ties with longtime EMS provider The split between North East and Rockport highlights a growing tension in Maine communities.

Heads up to our Members-> Our office will be closed Thurs & Fri, July 4th & 5th. Have a Happy and Safe Weekend!

Dr. Winkes' 1st day at Megunticook Medicine is Monday! She still has room for new members, but don't delay, we expect her to fill up quickly!

However, Dr. Pierce's patient panel is now closed to new members. He will still continue to accept new adult members of families who have already established a relationship with the practice.

So this new insurance racket apparently means that even when you pay out of pocket, they won't count all of it towards your deductible.

Meet the Middleman’s Middleman - KFF Health News Why are patients facing bigger bills than they expect for out-of-network care? In this episode of “An Arm and a Leg,” the show explains the hidden mechanics of MultiPlan, a data firm that helps health insurers set these rates and make bigger returns.

We had a warm winter and now a hot spring week. Remember to take care of yourself and look out for others during the hot days later this week.

It's going to be very hot Tuesday through Thursday of this week, and possibly into Friday over parts of the area. Here are some heat safety tips.

Maine has a shortage of home care caregivers The percentage of people receiving fewer hours than approved for has increased thanks to demand and workforce shortages.

Many of our patients end up paying out of pocket and getting prices from Maine hospitals is still very difficult.

"Rapper Fat Joe says, "Millions of people are getting robbed."

In a public service announcement by Power to the Patients, he adds that it's "not by the guys you might think. But by hospital and insurance company executives. They crooks."

That's why the Bronx-born rapper is urging officials in Washington, D.C., for price transparency in health care.

Then-President Donald Trump issued an executive order in 2021 that requires hospitals to make public the prices of health services. Then, President Biden signed an executive order instructing the Department of Health and Human Services to enforce it.

But a 2023 report by the nonprofit Patient Rights Advocate found that most hospitals are not complying with those rules."

Fat Joe wants hospital price transparency. Here's how he's fighting for it in D.C. The Bronx-born rapper sits with A Martínez to discuss how he advocates for price transparency and what he wants politicians in D.C. to do about it.

"If we want to have a primary care system in the US, our mainstream health insurers, especially public plans like Medicare and Medicaid, are going to have to stop chiseling and pay primary care providers a LOT more, as well as dramatically simplify the task of their getting paid. They need to stop paying per visit or per test, and begin paying for relationships with patients, including virtual and email/text based interactions, and not burden that transaction with 200 core measures clinicians must submit to justify their existence. They also need to waive copayment for primary care, since those copayments serve as an potent and senseless damper on demand for primary care. "

What the Walmart Exit from Primary Care Means – The Health Care Blog The Business of Health Care What the Walmart Exit from Primary Care Means May 27, 2024 By JEFF GOLDSMITH There has been a lot of commentary on the largest “disrupter” candidate in healthcare, retail giant Walmart, throwing in the towel on their primary care clinic and virtual health businesses. ...

We haven't run into this yet but with many of our patients starting the GLP meds for diabetes, obesity or coronary artery disease each month but very high prices and insurance limits still a big issues, we will soon.

The new obesity drugs work, but it's a dilemma when people have to stop taking them There are lots of reasons people have to stop taking the new weight loss drugs: cost, shortages, side effects and life events. And the weight usually comes back, doctors say.

I'm already prescribing these quite a bit. They are moderately effective for glucose control in diabetes but reduce vascular disease risk by 20% and are very effective for weight loss. However the price and supply of these medications are big problems.

"If just half of the adults in the US with obesity start taking a new weight-loss drug, such as Wegovy, the collective cost would total an estimated $411 billion per year, the analysis found. That's more than the $406 billion Americans spent in 2022 on all prescription drugs combined.

While the bulk of the spending on weight-loss drugs will occur in the commercial market—which could easily lead to spikes in health insurance premiums—taxpayer-funded Medicare and Medicaid programs will also see an extraordinary financial burden. In the scenario that half of adults with obesity go on the drug, the cost to those federal programs would total $166 billion per year, rivaling the programs' total 2022 drug costs of $175 billion.

In all, by 2031, total US spending on prescription drugs is poised to reach over $1 trillion per year due to weight-loss drugs. Without them, the baseline projected spending on all prescription drugs would be just under $600 billion."

“Outrageously” priced weight-loss drugs could bankrupt US health care Prices would need to be dramatically slashed to avoid increasing the national deficit.

Katie Beckett is a MaineCare program that provides medical coverage for children living at home with long- term disabilities or complex medical needs. Katie Beckett eligibility allows these children to be cared for at home instead of in an institution.

Only the child’s income and assets are considered when determining eligibility for Katie Beckett. The parent’s income is needed to see if the child is eligible in another MaineCare category and to determine a monthly premium amount. A child must meet all the non-financial MaineCare requirements for citizenship, Maine residency, etc. and:
• Be under 19 years of age
• Be disabled by Social Security Disability standards
• Live at home with their family
• Have monthly income less than 300% of the Supplemental Security Income (SSI) and resources less than $2,000
• Not incur a cost at home that exceeds the cost MaineCare would pay if the child were in an institution
• Not be eligible for MaineCare in another category • Require a level of care typically provided in a psychiatric hospital, nursing facility, or group home

For more information visit: https://www.maine.gov/dhhs/ocfs/support-for-families/childrens-behavioral-health/katie-beckett-option

"If you're a parent struggling to get your kids' off their devices and outdoors to play, here's another reason to keep trying: Spending at least two hours outside each day is one of the most important things your kids can do to protect their eyesight.

"We think that outdoor time is the best form of prevention for nearsightedness," says Dr. Noha Ekdawi, a pediatric ophthalmologist in Wheaton, Ill.

And that's important, because the number of kids with nearsightedness – or myopia – has been growing rapidly in the U.S., and in many other parts of the world."

Outdoor time is good for your kids' eyesight. Here's why Childhood myopia, or nearsightedness, is growing rapidly in the U.S and around the world. Researchers say kids who spend two hours outside every day, are less likely to develop the condition.

"1 in 5 samples tested for H5N1 from across the country have been positive "

There’s never a good time to drink raw milk. But now's a really bad time as bird flu infects cows Experts say the the danger associated with raw milk consumption may have gone to a whole new level as bird flu spreads among cows.

"The law is a weakened version of the original legislation for L.D. 2271. Some provisions were taken out amid opposition from the medical industry that the bill would have negative financial impact on hospitals’ ability to cover their overhead. That includes a proposed full ban on the facility fees charged at health care facilities that are affiliated with a hospital but separate from the main campus.

Lawmakers also removed a provision that would have barred fees for telehealth patients who do not visit a health care facility.

The legislation that became law Thursday followed a Press Herald investigation into Maine’s medical-billing system that in part revealed confusing medical bills sometimes carry arbitrary and hidden costs, including facility fees that often ran into hundreds of dollars just for receiving treatment in a hospital and that insurance companies often refused to cover."

Bill on transparency about hospital facility fees takes effect without Gov. Mills’ signature The law, a watered-down version of the original legislation, requires health care facilities to post signs to let patients know that facility fees are being charged.

You don't need to drink skim or low fat milk but olive oil is better for you than butter.

Are Low-Fat Dairy Products Really Healthier? (Gift Article) For decades, experts have said that less is more when it comes to dairy fat and health. But recent research has called this into question.

Includes Direct Primary Care membership.

Part-time line cook - food / beverage / hospitality - job employment - craigslist 40 Paper is currently hiring a part-time line cook, some experience preferred but not required. A strong work ethic and a positive attitude are the most important qualities! We pride ourselves on...

If you haven't already, time to treat your yard clothes.

In The War Against Ticks, This Spray is My Secret Weapon Permethrin is like the wall around the castle: It’s always there offering protection and doesn’t need much maintenance.

More reasons why insurance is a terrible way to prepay for routine medical care:

"...Patients hit with unexpectedly large bills sometimes forgo care or cease long-term treatment, and complain that appeals are fruitless. “They basically took away the mental health care I was getting,” said Olivia Henderson, who stopped her therapy sessions in New York when the cost spiked.

MultiPlan’s recommended payments not only push back against known overbillers, but can also squeeze smaller practices. Kelsey Toney, who provides behavioral therapy for children with autism from a clinic in rural Virginia, saw her pay cut in half for two patients. “I don’t want to say, ‘I’m sorry I can no longer accept you,’ especially when I’m the only provider within an hour,” she said..."

Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill. (Gift Article) A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.

We're excited to share that Dr. Adda Winkes will be joining us this summer! She is a great addition to our practice and we look forward to working with her. Please visit our website for membership details. Welcome Dr. Winkes!

Pediatrician Adda Winkes joins Megunticook Medicine Brian Pierce, M.D., has announced that Adda Winkes, M.D., will be joining Megunticook Medicine, a direct primary care practice in Rockport. Winkes graduated from the School of Medicine at Brown University in 1998. She completed her pediatric...

I wasn't aware of this program but it may be worth looking into if you or someone you know qualifies for Mainecare.

We have a number of Mainecare patients in our practice. Mainecare won't pay for direct primary care memberships but they cover other medical care well. DPC members are not required to have a Mainecare paid physician to get services covered.

Mainecare (Maine DHHS) has been much better at helping our shared patients get services than many commercial insurances.

PHIP stands for Private Health Insurance Premium benefit. This benefit can pay your share of the cost of your private health insurance.

How can PHIP help?
👉 If you qualify, MaineCare will pay your share of the cost for your private health insurance (your premium).

Do I qualify for PHIP? You may qualify for PHIP if:
👉 You or someone in your household is eligible for MaineCare.
👉 You are eligible for private health insurance coverage.
👉 You might be covered by the plan as an employee, child, or spouse.

To learn more: www.maine.gov/dhhs/sites/maine.gov.dhhs/files/documents/pdfs_doc/member/PHIP_Brochure_2018.pdf

Or call us at 1-800-965-7476

Take your time. Hopefully, this is the last one for a while.

Lots of heavy snow out there. For those of you who will be out shoveling today be sure to take breaks. It is better to take a little more time to get it all done and avoid injuries from overdoing it.

We found a new use for our former waiting room.

Thanks to the folks at 5iveLeaf Photography for their work this morning at trying to make me look sharp for a website overhaul.