Michael R. O'Brien, MD
Generalist Physician
Pediatrics & Internal Medicine
Beacon Primary Care PC
4 Jackson St, Beacon, NY 12508
P: 845.883.8633
F: 845.765.2964

FAQ

What is “Direct Primary Care”?

Direct Primary Care is a medical practice model that centers on a direct relationship between the patient and doctor, which is paid monthly like a cellphone plan or a gym membership.  This care model allows the doctor and the patient to establish a relationship of mutual respect, where the doctor’s time is personally dedicated (“directed”) towards the patients without interference from third parties.   

We start with an annual routine exam, and follow up with personalized health-related guidance that is delivered both in person (either in our office or in your home) AND via electronic communication platforms such as phone/text/email, as desired by the patient and which suits each particular circumstance.  With Direct Primary Care, you’ll have a partner in health with a physician who is there for you and who can provide care based on the best method applicable to the patient’s needs.

What services do you offer, once we establish a Direct Primary Care relationship?

-- Your monthly private fees cover an annual physical exam and thorough check-up (which can take up to an hour) for adults and children, along with patient education and care guidance (with telephone, text, Skype, in-person, or even home visits when appropriate) to assist and guide your health goals.

-- I will also deliver essential primary care, including urgent care for sickness and mild injury such as assessment and treatment, basic suturing/glue, splinting, etc., usually within 24 hours.  My availability is generally easier to meet urgent care needs because of my smaller practice size.  This allows for much more immediate scheduling and direct communication. *

Do you take my insurance? How does insurance work with your practice?

The short answer is: I likely don’t.  I am typically considered out-of-network for most private insurance plans, yet I remain Medicare participatory. *

You’ll find that your monthly fee will typically cover most, if not all, of the care you’ll receive in my office, absent some sort of extraordinary care need.   

Essentially, my practice operates independently from your insurance.  You will need to retain a health insurance plan to cover expenses beyond the scope of our practice, for illness-based costs such as hospitalizations and specialists.

I have a high-deductible insurance plan or a participate in a health-cost sharing ministry like Liberty HealthShare, how does that work with your practice?

Actually, many people with high-deductible plans or in health-cost sharing ministries find that a direct primary care practice, like mine, is a great compliment.  Direct Primary Care keeps out-of-pocket costs somewhat predictable and ensures that you can get the care you need, when you need it, without having to worry about budgeting for each visit or each time we interact.

Do some people actually save money going to a Direct Primary Care practice?

It is possible.   Since I have a small patient panel size, and do not have to answer to the demands of insurance companies, I can take my time directly caring for my patients.  This might help keep you out of high-cost healthcare environments like urgent care centers, emergency rooms, and the hospital.  Although no primary care physician can guarantee good health in all circumstances to all patients, I do strongly believe that higher-connected care models like mine better manage care needs and can potentially delay or may even help people entirely avoid preventable health issues.  Better managed and more personalized primary care could translate into fewer insurance deductible costs and overall savings on health-related expenses. 

What is the price?

Individual Fee         $125/month

Direct Primary Care for one child or adult.

Household Fee         $248/month

Direct Primary Care for all the children and adults residing in a single household.

Why should I pay a monthly fee to my primary care doctor?

You deserve time and respect from your primary care doctor.  Based on the fact I maintain only a limited number of patients, this model of care allows me to offer these benefits to my patients.

We are seeing a trend in the medical practices in our region that is focused on raising profits within our system.  This is being achieved by physicians setting strict time constraints with their patients by significantly reducing their visit times to just ten minutes per patient across the board because of the demands of insurance companies. This is absurd, and you deserve better.

The reason this is happening is that insurance plans only cover care interactions based on “provable medical necessity” and don’t generally support in-depth relationship building between patient and physician over time.  I see this as the foundation of good primary medical care.  The allocated time by insurance for most visits is minimal, often as little as eight to ten minutes on average which frankly is not enough time for proper examination and the result is a lack of carefully designed care.

Insurance plans simply do not pay for patient education, guidance, or routine exams regardless of medical need.  They also do not compensate nor allow physicians to directly provide this care through the various modern communication platforms people normally use which is highly effective in providing physician to patient support for patient health goals.  Insurance plans are trying to reform care coordination and data tracking systems, but the reform models are experimental and lack two vital components: i) a patient personally invested in improved care guidance; and ii) a physician directly compensated for that care guidance and accountable directly to the patient, for the quality of services provided.

Most doctors have multiple contractual relationships with insurance companies and almost none directly with their patients.   Direct Primary Care is the opposite.  My contract is with you, and your loved ones, not some faceless and impersonal bureaucracy.

Direct Primary Care establishes a direct connection between you and your doctor that, I believe, results in a superior care model.

I can allocate much more time than a ten-minute visit.  I have designed this practice in a way that allows me to be your personal doctor.  In order to do this, I must know you, respect you as more than a patient number, and this is achieved by me setting aside my time to you as needed.

Under the direct primary care model, I will not “nickel-and-dime” you for every phone call and procedure.  I will also be under no incentive program with the insurance companies nor will I be constrained by pressure from third parties to send you for tests you do not absolutely require. Thanks to your investment in your own care, based on the personalized annual exam coupled with high-connection health guidance, I am free to just be your doctor, without the chains of red-tape.

Why should you pay for your doctor?  Simply because the reliability of a regular income directly from a community of patients, allows the physician to focus primarily on simply being the community’s doctor.   That’s what I’m trying to build here in Beacon.

When can I call you?

Obviously, if you are having a medical emergency, call 911.  Otherwise, call me:  I’m here for you.

Call me, day or night: I’m your doctor.

Will I have to pay additional fees for office visits?

Usually not. My practice is considered out-of-network for most private health plans, although I am Medicare* participatory.  With the exception of more involved care interactions or needs, I will rarely need to bill you, or your insurance plan, separately for anything beyond what your private monthly fees already cover—the annual routine exam and health guidance based on that exam.

What about medications and specialists?

You are responsible, either out-of-pocket or through your insurance plan, for the costs of any medications, referrals to specialists, or imaging/diagnostic testing.  One of the advantages of a direct primary care relationship is that I will work with you to reduce the number of medications you need to take, down to the absolute minimum that is safe and healthy.  I will work closely with you to minimize the need for high-cost specialists and testing, except when absolutely necessary.  Since I have time to work with you in an in-depth and one-on-one fashion, I can manage many things that other primary care doctors would refer to specialists.

Will you do home visits?

Yes: when it makes more sense for me to come to you than for you to come to me, it is only the right thing for me to do.  We can discuss your care on a case-by-case basis.  If you live in Beacon, NY, I do not charge a travel fee.

What is included in the monthly fee when I become a patient at Beacon Primary Care? Do you have examples of what types of services I would receive over the course of a year?

This depends on your individual health needs. In the annual physical exam and check-up, I will work to address all your essential primary care needs on an individualized basis, based on your personal health circumstances, lifestyle, chronic diagnoses or conditions, along with your values and desires. Therefore, the full extent of the care I will provide for you is completely personalized and includes communication and follow-up care that specifically addresses your individualized needs.

While each patient’s situation is unique, below are some examples of the range of services different types of people can expect to be included in the monthly fee at Beacon Primary Care.  Most of these services are provided by Dr. Michael O’Brien himself, but occasionally colleagues working for Beacon Primary Care PC will provide specialized skills and services, all included in the same fee.

Examples:

The first year of life for an otherwise healthy, full-term infant:

-- Ten well checks (including the prenatal visit) recommended by the AAP Healthy Children Guidelines, performed in your home (no additional charge for residents of the city of Beacon; however, outside of Beacon there is an additional travel fee).

-- Four breastfeeding counseling sessions with a certified lactation counselor.

-- Communication via telephone, text, email, video chat (Skype or FaceTime), in-office personal visits or in-home personal visits for questions or concerns about your child’s health.

-- Open, frank, thoughtful, gentle, respectful, and caring discussion about the pros and cons of childhood vaccination and immunization schedules, and how your individual family relates to this societal public health issue with Dr. O’Brien to help you and your family decide how to approach the development of your baby’s immunity.

-- Being part of a community of families who are proactive about how we approach the medical and health needs of our children.

An otherwise healthy adult woman:

-- An annual physical that addresses all your essential primary care health needs, and any necessary follow-up care needed to address these issues.

-- An annual well-woman check with pelvic and breast exam performed either by Dr. O’Brien or a local midwife who works closely with our practice, either individually or together.

-- Open, frank, thoughtful, gentle, respectful, and caring discussion about the pros and cons of the various and often conflicting guidelines and information regarding breast, cervical, and ovarian cancer screening and prevention with Dr. O’Brien to help you decide how to individualize your approach to women-specific cancer screening.

-- Open, frank, thoughtful, gentle, respectful, and caring discussion about women’s sexuality and sexual health, including personalized discussion of gender identity and sexual orientation as it may relate to your personal health, with Dr. O’Brien, the nurse midwives who work with our practice, or both.

-- Detailed communication to convey your annual exam and related health guidance with any necessary gynecological or women’s health specialists.

-- Being part of a community of people who are proactive about how we approach the medical and health needs of women.

An otherwise healthy adult man:

-- An annual physical that addresses all your essential primary care health needs, and any necessary follow-up care needed to address these issues.

-- An annual well-man check with prostate (if clinically indicated) and testicular exams performed by Dr. O’Brien.

-- Open, frank, thoughtful, gentle, respectful, and caring discussion about the pros and cons of the various and often conflicting guidelines and information regarding prostate and testicular cancer screening and prevention with Dr. O’Brien to help you decide how to individualize your approach to man-specific cancer screening.

-- Open, frank, thoughtful, gentle, respectful, and caring discussion about men’s sexuality and sexual health, including personalized discussion of gender identity and sexual orientation as it may relate to your personal health, with Dr. O’Brien. This can include internal medicine approaches to sexual and erectile dysfunction with both non-prescription and prescription approaches, and the prescription of medications if needed.

-- Detailed communication to convey your annual exam and related health guidance with any necessary urologic or men’s health specialists

-- Being part of a community of people who are proactive about how we approach the medical and health needs of men.

*Beacon Primary Care does participate in Medicare. All services that are specifically covered by Medicare will be billed to Medicare and the patient will be responsible for any co-pays and deductibles that apply to those services. The annual physical and communication program described above is NOT a Medicare-covered service and will be billed separately, and may not be submitted to Medicare for reimbursement.

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