My Journey into Integrative Medicine

Jane Snyder, CRNP, begins patient care at CovenantMD on Monday, October 15.  She has already spent many hours with us shadowing, learning our processes, and meeting her new patients through informational sessions.  We are excited to be adding a provider with special training in Integrative Medicine.  I asked her to consider a blog post explaining what I.M. is, and what drew her to it.  Here are her thoughts.  – Patrick Rohal, MD, FAAFP

Just like everyone, I want to enjoy a long, healthy life for myself, my kids, my family and my friends.  Exactly like most of you (I suspect), I google everything.  I use home remedies, and desire the best result with the least possibility of harm.  Sometimes my kids need to take prescription medications.  Sometimes they require deep breathing and massage.  While working in conventional medicine for over 10 years I felt something was missing.  Don’t get me wrong, lifesaving cancer treatments, organ transplants and even antibiotics when needed have saved thousands of lives.  And THAT is amazing!  But, I wanted to reach more people in ways that conventional medicine could not.  This is what attracted me to Integrative Medicine.  This journey has transformed the way I live and take care of myself and my family.  We have shifted our nutrition, activity levels, care for the mind, and our approach to physical ailments.

I am so fortunate to have the opportunity to learn from the best in the Fellowship of Integrative Medicine at the University of Arizona.  I will finish this two-year program in August, 2019.  I have already begun applying I.M. principles to my practice.  As I continue in the program, I look forward to sharing what I know with you. 

What is Integrative Medicine?  The Arizona I.M. program defines it this way:  “Integrative Medicine is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.”

 Here are some key aspects of I.M.:

 *   Patient and provider have more of a collaborative approach to health and wellbeing, as opposed to the more hierarchical relationship that we’ve been used to for so many years in Western medicine.

 *   We examine all factors that influence your health, wellness and illness. These include mind, body, spirit and community.

 *   We emphasize health promotion and prevention, as opposed to a focus on “fixing what is broken.”

 *   When illness occurs, treatments are both conventional and alternative, with a priority on the use of the most natural and the least invasive modalities in order to facilitate the body’s own innate healing.

 *   Integrative medicine is grounded in good scientific evidence.  At times the evidence would suggest an antibiotic.  At other times a more natural herbal product may have equal efficacy.

 I am passionate about those aspects of wellness that traditional medicine has begun to emphasize, like nutrition, movement/activity, sleep and stress.  I am equally passionate about things that are less well known in traditional medicine but that hold the same promise of promoting health and wellness, things like guided imagery, acupuncture, yoga, and herbal products.

Direct Primary Care is a natural fit for Integrative Medicine.  I.M. requires ample time between provider and patient, a longitudinal relationship that emphasizes continuity, and ways for patients to access timely and convenient healthcare.  Joining CovenantMD gives me the chance to be the best Integrative Medicine provider I can be.  I look forward to serving you!

 If you would like to find out more about CovenantMD and Direct Primary Care, email us or give us a ring at 717-287-1983. New patients can sign up for Jane Snyder’s panel by clicking here.  

Introducing Jane Snyder, CRNP

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We are pleased to announce the addition to our practice of Jane Snyder, CRNP (nurse practitioner), who starts October 15.  Jane is a Lancaster native who has been practicing primary care for the past several years.  She is currently doing a fellowship in Integrative Medicine at the University of Arizona, a program which is regarded as the flagship in I.M.  She has already begun applying Integrative Medicine principles to her patient care, and is excited to practice primary care and Integrative Medicine in the context of Direct Primary Care (which affords greater time with patients, more timely appointments, etc).  Jane comes to CovenantMD with her current nurse assistant, Stephanie Zahn, who starts with us in about three weeks. 

What exactly is Integrative Medicine?  Stay tuned!  A blog post about I.M. is coming soon.

So what does this mean for current patients of CovenantMD, and for those on the waiting list?  Each of our patients is assigned to one provider/nurse pair.  Dr. Rohal's panel is currently closed to new patients, but Dr. Mellinger's panel is open (we've been using the waiting list to pace her growth).  We ask you to consider the following:  

  • Any current patients of Dr. Rohal and Dr. Mellinger who would like to switch over to Jane may do so when she begins in October.  Please let us know now, however, if you would like to make that switch.  This helps us to anticipate Jane's workload when she begins. 
  • Any patients that are currently on our waiting list, and who have been given a timeframe for admission to Dr. Mellinger's panel of after October (as we have been telling our most recent additions), may potentially have that timeline moved up if they elect Jane as their primary care provider.  Please let us know if you would like to do this.  
  • Any current or potential patients who would like a 30-minute info session with Jane can give us a call at 717-287-1983 and we can arrange. 

Questions?  Just reply to this email, give us a call, or patients may use Passport or Spruce. 

We're excited for the future!

CovenantMD Receives Small Business Award from SCORE Lancaster/Lebnanon


Yesterday, I was privileged to accept a Small Business Development Award from SCORE Lancaster/Lebanon. Through SCORE, I have been privileged to work with a mentor, Hugh McMaster, who has guided me through the inception of CovenantMD in 2015 and its growth along the way. I shared the stage with six outstanding innovators and entrepreneurs, owners of Beck Care Managers, The Candy Factory, The Fence Experts, and VITA of Lancaster County. The following is the text of my acceptance speech. -- Dr. Rohal

Thank you, SCORE, for this great honor.  Thank you, Hugh, for guiding me and my business endeavor along the way.  And congratulations to my fellow award winners.  It’s an honor to share this stage with you. 

My story has many similarities to the others you’ve heard and will hear today.  I too had staked out some segment of our society to make my mark.  In my case, it was as a primary care physician.  And I too was dissatisfied with the status quo and yearned to make a better way.  There had to be a better way to DO primary care.  I found I was working on a treadmill, seeing 20-30 patients a day, and all the while feeling like I was delivering a product that treated patients as commodities.  And as for my patients, they suffered from long waits to see me.  They only had 10-15 minutes to spend with me.  I could never predict how much the lab tests I ordered, or the medications I prescribed, would ultimately cost them.  I was continually asking myself what happened to the vision I had of the general practitioner before I entered medical school?  When I’m talking about CovenantMD in the community, I often show a picture of Marcus Welby, and say that is my vision for primary care. 

I was not the first doctor to implement the Direct Primary Care model.  DPC has demonstrated a lot of success in other markets around the country.  But when I first heard about it in 2007, when I had just graduated from my family practice residency, I knew this was the wave of the future, and I dreamed of someday opening my own DPC practice.  Now fast forward to March of 2015.  By then I had experienced eight years working in busy primary care practices.  I was tired and disillusioned.  But meanwhile, with the passage of Affordable Care Act six years before that, and with skyrocketing health insurance premiums and high deductibles becoming a mainstay, Direct Primary Care had hit its stride.  I knew then that it was time to put flesh on the bones of my dream of a DPC practice.  But “dreams” only get us so far.  I know I needed to actually start a business.  And how does a family doctor do that?  They didn’t teach me that in medical school.  I knew I needed lots of sound business advice.  And that’s what I got, and what I continue to get, through SCORE.  And the amazing thing is that its free.  When I came to my first meeting with my mentor Hugh McMaster, CovenantMD existed only as a rough draft of a business plan.  In that first meeting, we revised my business plan and we planned next steps.  Through subsequent meetings, Hugh guided me through the ins and outs of hiring employees, and helped me to stay true to the mission of my practice while growing.  Apart from these tangible benefits, I always walked away with some intangibles.  Like reassurance -- at first that I wasn’t crazy for attempting this endeavor in our local market, and then later, and even now, that I was still on the right track. 

At our opening in January 2016, after 4 months of marketing, we had 77 patients, it was just me and my nurse, Hannah, who is here today.  Just two weeks ago, we signed up our 1000th patient.  We now have two full time doctors and two full time nurses.  At the turn of this year, patient sign-ups began coming in too fast, so we had to start a waiting list, and this list is currently out to October.  We are working on plans to expand the practice.   We have been blessed with success so far, and SCORE has been there every step of the way. 

So what exactly is Direct Primary Care and CovenantMD?  DPC has one main tenant, and that is that health insurance, though it is needed to help protect us from the high cost of medical uncertainties, nevertheless is a poor way to pay for the less expensive and common things we know for CERTAIN will happen.  I think we’re no longer paying for health insurance, but for prepaid healthcare.  By the same logic, imagine handing Geico a boatload of your money and asking them to pay for your gas and your oil changes.  If you did that, I doubt they would continue saving you 15% or more on car insurance.  And you’d have to drive around forever to find your in-network gas station. 

Direct Primary Care asks the question, what is possible if our patients pay for their own primary care?  At CovenantMD, our patients pay us a monthly fee, from $20/month for kids up to $85/month for seniors.   A young family can enjoy comprehensive primary care for about the price of cable.  They then reserve their health insurance for the uncertainties.  Our patients enjoy unlimited visits without copays, that includes office, home, and worksite visits.  We offer them same or next day visits and extended time with the doctor.  We are on call for our patients 24/7, including evenings, weekends, and holidays.  Procedures are free, including stitches and skin biopsies.  We offer discounts on medications that we dispense from an in-house pharmacy.  It’s not unusual for patients to leave our office with a supply of a chronic medication that costs them $2/month.  And we offer comprehensive annual labwork for $14.  These same four tests typically cost $300 in the “system.”  How are we able to offer such substantial discounts?  Well, amazing things can happen when a doctor is not bound by insurance contracts.

And from the doctor’s side, and from the nurse’s side, Direct Primary Care is a dream come true.  We now see only 5 to 10 patients a day, allowing us ample time to make our care patient-centered instead of disease-centered.  And we cover a greatly reduced patient panel, which gives us the opportunity to know our patients well.  Because there no third parties involved, we no longer have to calculate esoteric codes in order to facilitate that third party paying for the visit.

We’ve certainly seen individual patients and families embrace this model, but we have also seen businesses embrace it.  CovenantMD partners with 13 local businesses to provide primary care for their employees.  These range from a business of five employees that offers us as their only health benefit, to larger businesses that pair our services with a high deductible health plan.  More recently, we’re helping a large employer plan a nearsite Direct Primary Care clinic for its employees and family members. 

So we’ve seen happy doctors, happy nurses, happy business owners, and most importantly, happy patients.  We’re discovering anew the patient/doctor relationship. 

Again, thank you Hugh, and SCORE, for your continued help along the way.  If there are any budding entrepreneurs that are here today, if you have a dream or an idea that can improve even a little facet of our society, I would encourage you to pursue that dream, and get good free advice from SCORE along the way.  Thank you. 

Informational Session on Monday, Dec 5

Informational Session on Monday, Dec 5

Come find out about CovenantMD and Direct Primary Care.  We offer same and next-day appointments; cell, text, and email access to your doctor; after hours, weekend, and holiday coverage, and discounts on medications, labwork, and radiology.  We're reclaiming the doctor/patient relationship!  Direct Primary Care pairs well with high-deductible health insurance plans and sharing plans.  We are also a great option for small business owners feeling the squeeze of rising health insurance costs.  

Sharing Plans and Direct Primary Care

Sharing Plans and Direct Primary Care

On Saturday, a married couple who are business owners signed up for CovenantMD.  They emailed us shortly after signing up, and I would like to share with you some of their comments (used with their permission):  “Our new rates came in from the Affordable Care Act with a whopping price tag of $23,925/year premium, $9,000/year annual deductible, and a $14,300/year maximum out-of-pocket.  That said, if we continue with regular health insurance, we would lose our business."

Health Insurance and Direct Primary Care

Health Insurance and Direct Primary Care

Yesterday, opened for “window shoppers,” those that would like to get a preview of health insurance rates prior to the Exchange opening for purchasing on November 1st.  Let's crunch some of these numbers and see how much money we can save if we pair a high deductible plan with CovenantMD.