Wednesday, May 18, 2022
HomeHealthDoctor seeks to return to her 'roots': rootsMD direct primary care clinic...

Doctor seeks to return to her 'roots': rootsMD direct primary care clinic marks one year – Verona Press

rootsMD founder Amanda Preimesberger
rootsMD opened at 300 E. Verona Ave. last October
rootsMD founder Amanda Preimesberger
A check-up room.
The waiting area.
rootsMD founder Amanda Preimesberger
The waiting area.
“Direct Primary Care is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third-party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.”
–Direct Primary Care Coalition
When Amanda Preimesberger, MD, opened her direct care family medicine business rootsMD last March, there were two problems she said she was trying to solve – increasingly expensive and impersonal traditional healthcare, as well as not seeing her husband or four boys enough.
What began as a tiny 12-foot by 12-foot single room rented office space off of Whalen Road moved into a brand-new 2,000-square-foot clinic at 300 E. Verona Ave. last October.
rootsMD opened at 300 E. Verona Ave. last October
Preimesberger, a board-certified family physician, is calling her new venture ‘roots’ because that’s what she feels like she’s returning to. She grew up — and still lives — in Mount Horeb.
In high school she was a competitive athlete, which got her interested in sports medicine. She began her undergraduate studies working toward becoming a physical therapist, but ended up going to med school instead.
She spent three years caring for patients at the UW Health Verona Clinic for the outpatient portion of her family medicine residency training about 15 years ago.
She went on to practice at SSM Health Dean Medical Group, and was the primary care provider for many patients from the Verona area.
“Starting a private practice a bit closer to my ‘roots’ felt like the perfect place to come back full circle and start something new with a more community-based feel again,” Preimesberger said. “I needed to get back to the roots of why I got into medicine, I felt like I was getting lost.”
Her practice can care for patients of any insured status or type since she doesn’t contract with, or bill, any insurance for her services. Rather, patients can utilize a membership-based model and pay the practice directly each month.
“By cutting out administrative overhead and other middlemen, we are able to offer longer appointment times, without copays or unclear costs, improved access to the physician that knows the patient best, and pass-through savings to patients with near wholesale cost on labs, many generic medications and independent imaging services,” Preimesberger said. “This is especially helpful for entrepreneurs or independent contractors
that are looking for affordable primary care to pair with their lower premium catastrophic
coverage or health share plan, and patients on high deductible insurance
plans. Medical services are limited to members to ensure timely access to care,
however we do offer many direct-pay office procedures to non-members.”
Some of the services offered include lab draws, rapid strep tests, rapid influenza diagnostic tests, COVID-19 testing, Pap smears, pregnancy tests, and general wellness check-ups and sick care.
Lab work – which is sent to Madison – traditionally comes back in a day or two, but can be rushed when needed, Preimesberger said.
She can also order medications such as for blood pressure or depression. Whether tests or prescriptions – since as a direct primary care doctor, she can order from wholesalers and passes those savings – often better than an insurance copay – onto her clients, she said. She also utilizes GoodRx to do some comparison shopping.
“It feels so good to see people’s jaws drop when I get them their cholesterol medication for five dollars,” she said.
She also maintains a small pharmacy on site with various steroids and antibiotics.
In her procedure room, she can do joint injections, skin and uterine biopsies, intrauterine device placements and procedural contraception, skin tag removal, as well as aesthetic procedures like Botox for a little added “joy and fun.”
Many of those services are available for direct pay prices, without being a member.
Some of her services like a joint injection have a high deductible under insurance and could cost three times as much compared to her direct pay prices, she said.
For now, Preimesberger is just doing it all by herself, but eventually hopes to find a fellow family medicine provider she can trust to come work with her, especially as her membership is really starting to grow.
rootsMD founder Amanda Preimesberger
Though, she’s not totally alone in her big new clinic – she rents out one suite to physical therapist Melissa Roswold, who is operating her business PT Squared LLC in the building two days a week, focusing on preoperative rehabilitation in the lower extremities of runners and athletes.
There is also another spare space to lease out in the building that’s still vacant.
At some point, Preimesberger would like to see psychology or mental health services come to rootsMD, or nutrition services, but said she has no plans set in stone yet.
“Like any startup, you’ve got to get your feet on the ground before reaching for your full vision,” she said.
And that vision is to offer patients more time, better access, and more continuity of care, while saving them money, Preimesberger said.
She often hears an argument against direct primary care is that doctors take on a small patient size. Preimesberger, for instance, until she gets another physician to help her, will cap her members at 400 people.
“People say, ‘we already have a primary care shortage and you are taking care of less people, how does that help?’” she said.
But she sees it as a long game – that ultimately qualified physicians will practice medicine longer because they won’t get burnout under the traditional system, where they average closer to 2,300 patients.
After one year in business, she’s halfway to her goal of 400 patients, which she said is right where she wants to be. She thinks she’ll hit her capacity in another year.
During her 13 years working in the healthcare system, she witnessed “such enormous burnout,” she said, where colleagues were retiring 10-15 years earlier than anticipated.
And in a system where the hospital doesn’t get paid unless there’s an office or telehealth visit, clinicians are on a high-volume schedule to see as many people as possible, thus limiting visits to 15 to 20 minutes, and not scheduling for phone time as it doesn’t generate income.
Sometimes physicians have to refer out for something that they are capable of managing themselves, just because of time limitations.
She said she was expected to spend the same amount of time with all her patients, regardless of a person’s individual needs – whether she was simply freezing a wart, or if an 85-year-old lady had a long list of concerns.
But for her rootsMD members, people can email or call with questions at no additional cost.
At RootsMD, she provides each patient 30 minutes minimum during visits and said she has the flexibility to block out more time as needed, as she sees people when they are scheduled.
She used to spend all day apologizing to patients for always being behind schedule at her old job. At roots, she said she gets people in and out – nobody needs to spend half of a day at the doctor’s office.
“There are so many layers of overhead in insurance. Here, everything becomes much more fluid and efficient and people love it,” she said. “Sometimes a five-minute phone call is all it takes to nip something in the bud. It’s been really empowering for me and for my patients to open their eyes to how simple things can be.”
It was the increasingly impersonal care she was feeling forced into providing that led to Preimesberger breaking away from the system to start her own practice last March.
“I was at the crossroads of not feeling too good anymore about my care, my relationships were muddied, you don’t have time for patients,” she said. “I decided I could leave medicine or I could stay and find a way that makes sense for patients.”
Dean Health and Quartz Health have created a local monopoly on health maintenance organizations, Preimesberger said, and she believes around 50% of people are now in some sort of HMO plan, which began taking off in the 1980s. Many other folks are in high-deductible plans with Blue Cross Blue Shield or Cigna.
Others are in a state of limbo, such as people working several part-time jobs who can’t afford insurance, but yet make too much to be on BadgerCare Plus.
Meanwhile, Preimesberger said she can see just about anyone.
“Many don’t know what they will get,” she said. “The $400 your insurance charges you for a rash could provide care here for months.”
After paying a one-time enrollment fee, membership prices are based on age tiers. Otherwise, services are offered for direct pay prices.
She believes her healthcare system can also be a more affordable way for small business owners to provide their employees with healthcare.
“My goal is for self-employed people or small business owners who know the value of taking care of people, but are not in a position to offer benefits — I would love to offer a flat fee for benefits — something I’ve never been able to do in the system.”
Preimesberger said sometimes people in her role are referred to as “concierge docs” but she considers herself more of a blue-collar doctor.
A check-up room.
Preimesberger said local med students are reaching out to her already, to find out more about starting their own direct primary care clinics.
“It incentivizes people to stay in primary care medicine and love it and saves people from thinking about leaving or cutting back,” she said. “I think it can save medicine. We need good people to stay in the game. I want to help other physicians escape and thrive, get that snowball going.”
She sees it as not so much the future, but more returning to the past.
She compared it to when every small town had a local doctor who hung out their shingle.
Healthcare should be about the relationship between the physician and patient, not about insurance companies, she says.
“People are choosing a membership fee because they want a better relationship with and access to their physician,” she said. “Not wait months for a 15-minute visit.”
So why aren’t more physicians going this route?
“It’s a big risk,” Preimesberger admits.
Most medical students are coming out of college with $150,000 to $350,000 in debt.
“If you’re starting a practice from scratch, you can bank on not paying yourself for a few years,” she said. “I may never make what I made in the system, but I need to feel good about what I do.”
Her plan to jump into direct primary care was a two-to-three-year process, she said. She started with taking on extra urgent care shifts to pick up additional income, and is still picking up those extra shifts now. Once she’s paid off her start-up costs, she will stop the side gig work and pour herself into the clinic, she said.
Her husband, a Madison fire lieutenant, also helps by picking up extra fire shifts.
“It takes some sacrifice for sure, but to feel like you got your soul back and you are caring for people how you want to – you can’t put a price on that.”
Direct Primary Care is having its moment right now, Preimesberger said. There are now three membership/direct-pay clinics in Dane County with hers included, while three years ago there was only one.
Across the country, the concept has seen much more growth over the past 18 months, she said, showing that people are seeing the benefits and demonstrating just how frustrated people are with their traditional healthcare.
As more clinics like hers open, she hopes for a reciprocal or synergistic effect that will lead to more access independent specialists for services like radiology, MRIs, endoscopies, and cervical biopsies.
She said specialists like radiologists have been “gobbled up” by the HMO bubble, but that she has found that her patients can drive an hour away for a direct pay MRI and it still saves them money
“I’m hoping as direct primary care grows, it opens the eyes of independent centers,” she said. “It makes sense to bring back access closer to home. If we get our own communities on board, it’s a win-win.”
As her own revenue goes up, she’d consider bringing some of those services in-house to rootsMD.
Initially when Preimesberger bought the lot at 300 E. Verona Ave., she intended to remodel the old home there for her business, but for health and safety reasons, ultimately had to demolish the house and build her clinic from the ground-up.
For two years, a sign outside the rundown house promised an Amish furniture and cabinetry store was coming to that spot, but the project never moved forward, meanwhile the rootsMD health clinic was constructed in just seven months.
Building during the pandemic was a challenge, with supply chain issues and employee shortages driving up prices for supplies like lumber.
One of the most important things for her is that now her four sons, who before didn’t quite grasp what she did for a living, can come see her at work.
“For them to walk in and see what I do — that’s so important to me,” she said.
Having more time to spend with her sons, who are ages 11 to 17, is one of the most important parts of having followed her dream.
“I was done letting the system suck the life out of me, it was all-consuming,” she said. “It’s another major reason I made the shift. People would tell me that their jobs are making them depressed, anxious, and stressed, but they stuck with it because they were getting healthcare benefits. Their job is killing them, and they’re working to pay for it.”
Reporter Neal Patten can be reached at
Mr. Brews Taphouse, which served craft beers and burgers at 611 Hometown Circle, has closed.
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