Winter is upon us. The leaves have fallen to the ground, decomposing into rich fertile soil with the help of these wonderful organisms! If you venture out into the forest at this time of year, you may see plentiful colonies of mushrooms of many kinds. These helpful fungi work to accelerate the breakdown of organic material, draw nutrients to the areas in which they live, help to clean up contaminated soils, and can sometimes be edible and medicinal. Simply amazing. A family favorite is the puffball, providing endless amounts of joy and satisfaction for little mushroom foragers.
These edibles are extremely high in B vitamins, second only to meat! They are also high in essential amino acids/protein, potassium, zinc, and fiber. Of course, not all mushrooms are created equally. To get the most out of your mycelium, try adding oyster mushrooms to your meals. These specimens are extremely digestible and are also known for their cholesterol lowering properties (possibly due to the high fiber content). Button mushrooms commonly found in the grocery store, are very low in the nutrient department, but do provide some beneficial fiber.
The medicinal work of mushrooms is also a fascinating subject. These forest helpers have been the subject of much research in the areas of immune support and modulation for individuals struggling with cancer and autoimmune disease. The honey mushroom, used as an anticonvulsant and nervous system modulator, is one of the oldest living organisms!! Biologists discovered a single colony of a honey mushroom species that covered all of 37 acres!
These creatures are all around us, quietly doing the good work of keeping our ecosystems in balance and our forests healthy. But you don't have to be mushroom identifier to enjoy their nutritional and medicinal properties. Many people are cultivating gourmet mushrooms right in their backyard with the help of mushroom plugs grown by companies such as MoTown Mushrooms, conveniently located in Morrisville.
It has come to our attention recently, that a number of our naturopathic colleagues have recently been subject to lengthy audits by certain private insurance companies. This is an unpleasant, yet expected and routine part of holding insurance contracts. What is not fine is that these practitioners are being asked to pay back large dollar amounts for services provided that are deemed investigational by the insurance plan, yet are well within the scope of practice of an ND. Dollar amounts that would put any small business out of the business of providing healthcare. Here is the link for BCBS's investigational procedures list: http://www.bcbsvt.com/wps/wcm/connect/5d3a083d-51b1-4fbc-bf0a-a2df1c29f69c/investigational-med-policy-09.2016.pdf?MOD=AJPERES . Of note on this list is herbal/botanical medicine, craniosacral therapy, detox programs, essential oils, and specialty stool analysis tests. Therefore, for example, any patient visit that is done where herbal medicine is discussed or recommended, is subject to insurance payment take backs in an audit. That would be a large percentage of our visits as herbal medicine is a beloved tool.
The naturopathic community of providers has responded in the formation of a task force and pursuing support of the overseers of insurance plans within the state of VT to institute change in policies. It is our desire to practice naturopathic medicine in the way we have been trained and are passionate about! The analogy of the therapeutic ladder comes to mind, where the lowest rungs of the ladder of intervention are diet and lifestyle measure, i.e. detox programs. A step up are homeopathics and herbal medicines as effective and least toxic to our system. A large number of these therapies are not only double blind placebo researched but have been used clinically and effectively for hundreds of years. It is against the philosophies and principles of naturopathic medicine to practice in any other way.
It is therefore that we seek to find alternatives to living with the fear of costly audits and controlling oversight into a personal and sacred relationship with our patients. We seek freedom for patients and practitioners within a less than ideal third party insurance payor system. And we seek a way for increased access to us for those who live with high deductibles and out of pocket premiums.
In Comes Direct Primary Care
"Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers, payers and policymakers across the United States. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider which is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by focusing on five key tenets:
1. Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at longterm health and wellbeing. DPC practices have extended hours and alternative appointments such as phone, skype, or text visits.
2. Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. DPC patients have the right to transparent pricing, access, and availability of all services provided in the practice's DPC package.
3. Elimination of Fee-For-Service: DPC eliminates undesired fee-for-service(FFS) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services (and whatever else is included in the practice's DPC package).
4. Advocacy: DPC providers are committed advocates for patients within the healthcare system. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients serving as patient guides.
5. Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higher-performing, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease."
~Direct Primary Care Coalition
Please stay tuned as we create a proposed DPC care package for interested clients. Please ask us questions about this new model! We want to hear what your healthcare and financial needs and interests are!
Other Office Updates
1. One big official welcome for Grace Corapi, our new front desk assistant!! Grace has joined the team at SNFW and we are so glad to have her! She brings warmth and positivity to the office in addition to being newly trained as a wilderness EMT, yoga instructor to-be, and a snowboard instructor. So many talents! She is excited to meet you all and help out in any way she can to make your healthcare experience a healthy and healing one. Please see her pic and bio on the providers page.
2. Thanks to the entire team at SNFW, we have completed our medical home review and passed at the highest level III for medical home certification. Reviews are every 3 years and we continually strive to improve our policies and procedures in house to keep and exceed these national standards.
3. Randomized patient questionnaires! May already be in the mail. As part of the above process, we ask for your feedback on how we are doing.. and we listen. Last review showed that there was a need for higher level of communication with specialists, so we invested time and effort into incorporating an EHR system so we could track referrals and make sure your specialists have the information they need when you go for your appointment. We look forward to hearing from you to see where our next growing edge may be.
4. New lab services offered. We have partnered with Mercy Diagnostic Laboratory to provide you with better lab pricing (at no cost to you if you have insurance! really!) and better customer service with faster lab turn around times for most standard tests. We have had positive feedback from practitioners and patients alike thus far. One step closer to providing more affordable healthcare.
We hope you are enjoying our new space. It was a labor of love to create and we have so enjoyed being able to spread our wings a bit. Apologies for the length of this newsletter, so much to cover!! We leave you in these uncertain times with this, a song of hope and healing and strength. Enjoy..
SNFW Practitioners and Staff
Angela Robens ND, RN