If you’ve found yourself frustrated with today’s health care system, imagine how the doctors feel! Primary care physicians in particular are drawn to healing people as a calling. That is certainly true of both Anusha Khan, MD and Sheri Kochendoerfer, MD, MT-ASCP, co-founders of Mosaic Theory MD, an innovative new medical practice in Sterling. It is readily apparent that what both women enjoy most in life is taking care of people – helping them get and stay well. Equally evident is their antipathy toward today’s traditional health care system, which they say minimizes patient care and leaves patients holding the bill.
As with many innovators, Mosaic Theory’s founders solidified their determination to change their approach to their profession based on personal experience.
When their medical training took them to the island of Dominica, they were plunged into a situation where they could work directly to heal people who were desperate for medical assistance in an environment that was completely devoid of bureaucratic red tape and health insurance “hoops.” The freedom each experienced in working directly with patients to diagnose their ailments and make medical decisions without outside influences, was life-changing. Both say that the autonomy they experienced in providing personalized, relationship-based medical care to their Caribbean patients was exactly what led them to become doctors in the first place.
Imagine their delight when they discovered that other doctors, similarly motivated, are leading an innovative, grassroots movement called Direct Primary Care. Numbering more than 1,000 nationwide, DPC practices are designed to refocus on comprehensive patient care vs. a pay-for-services model rationed by health insurance. Most belong to the Direct Primary Care Alliance (https://dpcalliance.org/), which organizes an annual conference and helps to educate the public about the differences between Direct Primary Care and the model to which most people have become accustomed.
“We didn't come up with the DPC model all on our own; it was created by doctors so they can focus on patients and give them more time,” Dr. Khan said.
As she defines Direct Primary Care, “We're essentially giving concierge level care but making it affordable.” Instead of signing up to a complex and limiting health insurance plan, Mosaic Theory patients sign up for a monthly “membership” in the practice. For something on the order of $149/month, patients can count on same- or next-day doctor appointments of 30-90 minutes during which time they command the full attention of their physician. In addition to the usual "sick" visit, the doctors offer physician supervised weight management programs, Regenerative Medicine injections for joint pain, aesthetic procedures to treat acne and other skin issues, medical marijuana, hormone therapy, and IV vitamin therapy, all designed to help the body heal itself.
“Anyone who wants a true doctor-patient relationship where we can focus on preventative care as well as dealing with any acute problems, and do that affordably,” is welcome, Dr. Khan says, but our advice would be to act without delay. The partners can provide their patients with a higher level of attention because each physician is voluntarily capping her practice at 500-700 patients each, depending on the acuity of their health concerns. Should the practice grow to outstrip these self-imposed limits, they’ll have to hire more doctors who share their philosophy. Already, they’ve grown so quickly since opening their doors last year that they’re bringing on a nutritionist.
Advances in medical technology have made it possible for a myriad of labs, ultrasound and other diagnostic procedures to be done in-house as part of each patient’s membership. Outsourced services like X-rays, mammograms and hospital-based surgeries may either be paid for out-of-pocket or be covered along with major accidents by a less expensive health insurance plan with a high deductible. If hospital treatment is called for, both doctors are committed to accompany each of their patients every step of the way, monitoring and explaining any and all procedures.
Not being bogged down in a bureaucracy where multiple levels of approvals would be required to purchase the latest technology means that the partner can discuss investments in technology that best suit the needs of their patients. Their EKG monitor is keyboard sized, using Bluetooth technology instead of adhesives, and their ultrasound is literally called a “butterfly” because it’s not much bigger than a human hand. That’s important because more often than not a diagnosis can be delivered and a treatment plan discussed all in the same visit!
What is most compelling about such a system is the belief both Drs. Khan and Kochendoerfer share that being able to spend more time with their patients and being attentive to their overall wellbeing helps immeasurably in diagnosing illnesses and prescribing preventative care. “We have all this training, all of this expertise, but in a traditional practice, we wouldn't be able to use our full skill set just because of time. Often, I would be forced to send patients off to a specialist because I didn’t have time to take care of them,” Dr. Khan says.
What makes it all work is training, transparency and making care more accessible. Both Drs. Khan and Kochendoerfer are internists, and so are attuned to how all the body’s organs work together when functioning properly, as well as what could be wrong when something is amiss. Both have previous careers as skilled diagnostic lab scientists. Dr. Kochendoerfer’s background includes a focus on mental health and how patients’ psychological health may impact their physical well-being.
Physical ailments are approached using all the usual diagnostic tools, but are bolstered by listening to patients the doctors have come to know well. Transparency comes by way of documenting what each procedure and treatment costs, in contrast to tiered packages offered by today’s health insurance plans. Dr. Khan explains, “You may say you have Cadillac-level insurance, but how good is it if you can’t see a doctor when you need to or spend more than 5-7 minutes with them?” she asks.
“You may be paying $500/month for insurance to cover your lab work that actually costs $5. Instead, many procedures are included in our membership, and our patients pay the wholesale cost of outgoing labs and imaging. If you have insurance and want to use it, great – you can use it for those ancillary services, but the meat and potatoes of this practice is the doctor-patient relationship. Regardless of your coverage status, you have a concierge-level doctor here that is affordable, and that’s why you’d choose us.”
“We make patients our real focus and take out the middlemen and all the red tape and nebulous prices in the system,” Dr. Khan adds. “We are transparent about what things cost and we are as inclusive as possible so that, other than the membership fee, you don't have to pay out of pocket. If you do have to pay, it’s literally just a few dollars at a time rather than hundreds of thousands of dollars in surprise bills.”
Accessibility is guaranteed by membership, regardless of a patient’s health insurance status. To be responsive to patients' urgent need, each doctor has seen patients after hours, and coordinated visits to the ER if they’re absolutely necessary. “That’s what we mean by making care accessible, no matter the time or place,” said Dr. Khan. Because both her and her partner’s patients can always reach them by text, phone or email, her daily calendar is only booked with patients who need to see her in person.
That makes for much more effective care than seeing 30 patients a day. “When you get home after a day like that, you have to ask yourself, ‘did I really help 30 patients, or did I just put them on a conveyor belt?” says Dr. Khan. Before establishing Mosaic Theory, “it felt like that episode of ‘I Love Lucy’ where’s she’s forced to put pieces of chocolate in boxes faster and faster until she admits defeat. It feels like the current insurance-dependent system will speed up faster and faster until it crashes. At that point we will be in the perfect position to build it all back up the right way.” Regardless, she adds, “I’d rather provide excellent care to 500 people than poor care to 3,000.”
For example, one morning a Mosaic Theory patient in assisted living called to report he had been injured. Dr. Kochendoerfer was able to go examine him at the patient’s facility, get imaging and medications ordered and coordinate and spend time with family to keep them in the loop on the patient’s care. “In a different system, I would be lucky if I could see them in a couple of weeks or might say, ‘if it’s that bad, go to the emergency room.’ That’s why we love this practice. It lets us be the kind of doctors that we want to be and that we're capable of being,” Dr. Kochendoerfer said.
Internet accessibility to telemedicine also allowed the doctors to help one of their patients who had contracted COVID while studying in Prague. The patient had recovered to the point where she was symptom free, but was barred from travel because she couldn’t prove that she was no longer contagious. “Because I had an existing relationship with the patient and I know what her baseline is, I was able to clear her and fill out all the appropriate forms to bring her safely back into the country,” Dr. Khan said, “And that is priceless.”
In the early days of the pandemic, the doctors conducted rapid PCR COVID tests as a service to the community, and gained many of their first members as a result of just being able to address the myriad questions people weren’t getting answered by their former physicians. Looking back at why the partners chose to launch their practice during a health crisis, neither can point to any single thing that caused them to put Direct Primary Care principles to work in their own practice. There wasn’t one straw that broke the camel’s back; Dr. Khan says it was more like “death by 1,000 cuts,” that led her and her partner to create Mosaic Theory. But they could well be at the forefront of a much bigger exodus. “Doctors are human too, and we went into medicine because we wanted to use the gifts God has given us to help people. The current system would rather we be glorified data entry clerks, clicking on screens and filling out paperwork. That's not patient care.”
“For us, it’s all about value and sustainability. Within the DPC model, we are able to provide tremendous value in care as well as price transparency. The basis of our model is not to make medical care any more expensive than it needs to be.”
When not caring for patients, the doctors may be found giving free blood pressure tests at your local farmer’s market, helping to harvest at JK Community Farm, or offering discounted pregnancy care at a local charity pregnancy center. Eventually the partners hope to be able to donate 10% of their practice free of charge.
Mosaic Theory, MD, 22365 Broderick Drive, Suite 330, Sterling, VA 20166
info@mosaictheorymd.com, 703-952-7641. https://www.mosaictheorymd.com/.