FAQ Coronavirus (COVID-19)

UPDATED: 3/16/2020

This page is constantly being updated as we learn more about novel coronavirus and COVID-19.

Hello NeuCare members,

In light of the novel coronavirus (COVID-19) concerns, health care providers must change the way we provide care to “sick” patients with respiratory illnesses— in fact, all patients—for the foreseeable future. This will be done in a way that provides great care while keeping you, us, and our community safe.

Is it coronavirus?

Inevitably, many people will get sick with some type of respiratory infection in a 3-4 months period. The vast majority of those will be common viral illness or influenza. But, given the potential of COVID-19, we all need to approach things at our clinic a bit differently. These recommendations and measure are meant to help you and us.

Please read ALL of the following as it will answer most questions you have or that may come up. We are happy to answer questions individually where needed, but reading this first will help our staff out tremendously.

IF YOU ARE SICK

Our triage protocol for upper respiratory infections (URI), is outlined in detail below.

The most important parts to are:

1. URI symptoms WITHOUT FEVER.
   
   If you have symptoms of an upper respiratory infection (cough, etc.) and no fever (less than 100.4 F) that is less than 3 weeks in duration, we will recommend home care and that you not come in for an in-person visit to our clinic. This is the same as we currently do for most common colds and suspected influenza, but it is even more important to avoid clinic visits.
   
   

2. URI symptoms WITH FEVER. 
   
   If you have upper respiratory symptoms and/or a fever WITHOUT signs of severe illness (namely, shortness of breath), a nurse or your provider will recommend a telephone visit to ascertain if testing*, treatment, or an in-person visit is warranted. If we determine that you need an in-person visit, the visit will occur in your vehicle in the parking lot of our clinic so as to prevent potential spread and exposure to others. SERIOUSLY, WE WILL SEE YOU IN THE PARKING LOT!
   

   With or without testing, it is advisable you isolate yourself as much as possible for 7–10 days from onset of symptoms. This is especially important with larger crowds (stores, events, etc) and with vulnerable populations. (elderly and/or ill)
   
   

3. URI with FEVER and/or SEVERE symptoms.
   
   Based on what we know thus far, in healthy people under 60, the odds of severe illness (10%) or death (1%) are very low with COVID-19 infections. But, if you have URI symptoms with severe concerns such as shortness of breath, we will likely refer you directly to an emergency room (hospital).

   This is the best course of action with or without COVID-19. Cases of COVID-19 have shown most people who get really sick (require hospitalization) occur approximately 9-12 days after onset of symptoms first appear; much more common in higher-risk people (age 60+ and/or chronic diseases).

REMINDERS ON FEVER

• Fever is 100.4 F or higher measured by a thermometer. (If you don’t have one, get one!)

• “Feeling” a fever (subjective) isn’t good enough.

• There is no such thing as a lower “fever” cutoff based on your baseline temperature.

TESTING WHEN SICK

Influenza or other things. There are many things that are much more likely to cause URI symptoms than COVID-19, namely influenza. If there are enough concerns and a fever, we may recommend a nasal swab for influenza or throat swab for strep. These tests take 1-2 days to result.

Coronavirus testing will be limited for the foreseeable future. We do NOT currently have access to COVID-19 testing but we are working with our lab vendor to confirm the exact specifics (like pricing and where the testing will be available). Hopefully, that will be soon but even when so, we will not be recommending testing for everyone with URI symptoms. We will be making this decision on a case-by-case basis, but the near-term reality is there will not be enough testing nationwide to test every person with a cough.

AVOIDING THE ER

Emergency rooms are not going to perform on-demand COVID-19. So, unless you are having a real emergency, please avoid them at all costs. Overburdening our hospitals and exposing yourself to lots of sick people due to anxiety of COVID-19 is not wise; trust me!

IF COVID-19 IS FOUND IN OUR PATIENTS OR CLINIC

Why are we taking extreme caution to avoid clinic visits?

If an individual enters our clinic carrying COVID-19 (later found by testing), we would likely have to close our clinic for 14 days or longer! Like, completely close….no in-person interactions and exams, prescription pickups, etc. This would obviously be very bad for us and you! (If this were to occur, we would attempt to still offer telephone triage and telemedicine visits but we want to avoid closing our doors, of course!)

Even if we individually get exposed to a COVID-19 case, we will likely need to isolate ourselves (no patient interactions) for 14 days or longer. This would be needed to avoid exposing others, especially our sicker patients.

FINAL THOUGHTS

We have put together these guidelines to prevent the spread of this illness to the most vulnerable around us. We so appreciate your understanding, patience, and effort to keep everyone in the NeuCare family healthy as we all see our routines upended a bit by this virus.

Sincerely,
Dr. Neu

COVID-19 Screening Algorithm

Flu Shot Q&A

Can the flu shot give you the flu?

Flu vaccines are either “dead” (shot) or “inactive” (nasal spray) viruses so they scientifically cannot replicate, infect or spread through the body. However, stories of people getting sick  after getting the flu vaccine - including actual influenza infection - are not crazy talk.

So what’s the deal?

There are several plausible explanations for getting “sick” in the winter despite getting a flu shot.

• Other viral illness. Other viruses can cause infections and symptoms that look much like the flu. Many people  self-diagnose themselves with “flu” when it’s actually just a nasty “common cold”. The flu vaccine does not protect against these viruses that cause head colds, bronchitis, intestinal problems, sore throats, etc.

• Strong immune response following vaccine. The flu vaccine causes a low-grade immune response by design; that’s how all immunizations work. The degree of the response can vary from mild (no symptoms) to more severe (resulting in flu-like symptoms for a few days following vaccination).

• Immunity lag time. Your immune system will require about 2 weeks to gain full immunity. During that lag time, it is possible to get infected with a live flu virus.

• Not 100% flu strain coverage. There are 3-4 main subtypes of flu but dozens of strains circle the globe each year that are constantly mutating. Each year’s vaccine is planned on these international trends. This process usually results in 30-80% match for the strains that eventually became common in the U.S., but not 100%.

• Not 100% preventive against infection. Even if you have some immunity to a virus, you can still become infected. In theory, your immune response will be much quicker and stronger - lessening the severity of infection - but you may still become sick.

• Poor immune response. Some people who get the flu shot do not gain significant “immunity”. This issue is complex, but most common in the very young or old, so guidelines now recommend extra vaccine (dose or quantity) in some groups.

Why should you get one at all?

For all the reasons listed above, the current flu vaccine is not 100% protective against getting sick this winter. Our public health marketing effort may have oversold the flu shot in many ways. It’s nowhere near as effective as other vaccines (measles, tetanus, etc.) at preventing illness or death. However, it’s the best available way to lower your risk of contracting the flu, becoming very ill and passing the flu to family and friends. Exercising regularly and eating a well balanced diet does not guarantee you won’t get heart disease or cancer, but I’m not afraid to recommend them either.

A lifetime of care for $5000

Starting October 1, 2013, I will be offering a lifetime of primary health care for a one-time payment of $5000.

As I was bootstrapping open my family medicine practice last year, I read about a creative brewery in Minneapolis who raised start-up capital by selling a lifetime of free beer for a $1000 “membership” at their bar. The Kansas-Minnesota trek prevented me from investing in this brilliant offer, but as a budding entrepreneur, I was inspired.

After resigning to not wait for “the system” to provide my patients better or more affordable care, I started a Direct Primary Care practice fresh out of residency.  We now provide our friends and neighbors comprehensive primary care for a simple, fixed membership fee of $30 or $40 per month per person -- including most routine labs, many procedures, flu shots and more -- and without co-pays, 2 hour wait times, worries about deductibles or the need for insurance middlemen.

Our clinic has grown steadily since starting in December 2011. We are now expanding our services to better care for our existing and future members. Being averse to more debt, the strings of venture capital and the anonymity of Kickstarter, I decided to take a cue from a cool brewery.

We are now offering 20 “Lifetime Memberships” in our practice. This local, crowdfunding effort will help pay for a wholesale medication program, diagnostic equipment (e.g. ultrasound machine) and a few other projects -- allowing us to provide even more value to our members with free or at-cost services.

As a lover of beer, I understand a lifetime of primary care is not as enticing or refreshing as an ever-flowing pale ale spigot. But, considering $5000 would only fund the average person's "middle of the road" health insurance premium for the next 15 months (with access to pay $40 co-pays and for $12 band-aids), it's a bargain. I am hopeful we can find a few folks to support us and our mission.

Insurance against using your insurance

Recently, I had a discussion with a prospective member about how our Direct Primary Care membership model will fit with his family’s health insurance plan. They had a high deductible plan that covered some preventive services at no cost, but not much else before spending $5000 per person per year. Being in the financial industry, he was shrewd in analyzing the “extra” cost of maintaining a membership with us -- versus using his insurance plan rates while paying out-of-pocket for routine care.

The family was relatively healthy, but Dad had high cholesterol and blood pressure that required a few doctor visits and routine labs per year. Mom recently required a plethora of lab tests for what turned out to be lactose intolerance. Little Johnny broke his leg last year that resulted in an ER trip and cast for 6 weeks.

This care totaled up to $9500 in out-of-pocket expenses over the past 2 years. 

After the inquisition, he was quite stunned at the wide disparity in pricing between our fees and his insurance plan “discounts” prices. He encouraged me to create a comparison table to share with prospective members on high deductible insurance.

I took his advice. The table below shows the "typical fee that providers in your area accept as payment from insurance companies" (from a nifty tool at HealthCareBlueBook.com) versus our members price (if any) for the same service. (NOTE: insurance rates can vary widely for a given service and provider, if you can find the information at all!)

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Many insured people want to use their health insurance for all care so they can "maximize" it's worth; to "get more out of it". I never get warm fuzzies when holding my plastic health insurance card, but I get it.

However, at these "discount" prices, I'd argue it's more abuse than maximizing value. 

The cost for us to provide the families health care over the past two years (including membership fees and non-covered fees) would have totaled $2380. He didn't see our membership fees as "extra" any longer. And next year, with our wholesale medication program, we will be able to save Dad $60 per month ($720/year) on his three medicines. 

Maybe Direct Primary Care's best value is as insurance against being further abused by your insurance plan?

New all-inclusive memberships

Primary care for one, simple flat rate

Recently we have changed NeuCare memberships and pricing to be nearly all-inclusive. Memberships will now cover the vast majority of your primary care needs with ZERO FEES or COPAYS -- including unlimited doctor visits (clinic or virtual during regular hours), most routine lab work (including cholesterol, chemistry panel and diabetes tests, and pap smears) and free flu shots. We are also lowering the fees for many services, including procedures, house-calls and after-hours visits.

Our believe our new pricing model will provide members with a better value, convenience and more consistent health care finances. Also, it will allow us to fund several awesome projects, including a new electronic health records system, wholesale prescription medication program (50-80% less than pharmacy prices!), a fitness/weight loss program and some equipment (x-ray, ultrasound and maybe sharks with friggin’ lasers on their head!).

All new members will start with this system immediately. Existing members can transfer immediately, but must transfer to new membership pricing by Jan 1, 2014. See details below. 

New Membership Fees

• Age 29U = $30 per month
• Age 30+ = $40 per month
• Family = $100 per month (Up to 4 kids age 25 & Under, additional $10 each)

 *Effective immediately for new members and Jan 1, 2014 or sooner for existing members
*$50 registration fee for each new billing account (individual(s) or family plan). Waived for existing members.

Included, no cost services

• 24/7 Doctor Access by phone & email
• Unlimited Doctor Visits (regular hours, clinic or virtual)
• Yearly Wellness, Prevention + Fitness Planning
• Unlimited Nurse Visits
• Pharmacist counseling (by email & phone)
• Many labs & tests: Strep, Pap smear, Urinalysis, Pregnancy test, EKG, Cholesterol, Chemistry Panel, Hemoccult stool, Blood Counts, Thyroid (TSH) & more
• Yearly Flu Shot
• Medical Equipment Lease
• Coordination of care with specialists and other providers (referrals, etc.)

New, lower cost fees

•  Procedures = $10 or $20 (for cost of supplies)
• Non-covered labs = Discounted rates of 50-90% (most $10-50)
• House Calls = $50
• After Hours Visit = $100
• Rx Medications = $TBD

Existing members rollover to new plan

Existing members may transfer to the new pricing starting now, but will be required to by Jan 1, 2014. If membership fees have been prepaid beyond your transfer date, any existing balance will be credited towards our new membership fees. You may choose to pay fees 1) Monthly or 2) Yearly with 1 month discount. Either option will require enrollment in our AutoPay system with a Visa or Mastercard.  We will no longer be offering invoicing/billing of membership fees beyond Jan 1, 2014.

Please complete this TRANSFER FORM asap to maintain your membership as active - due by December 1, 2013.

Poison Ivy Myths and Facts

Myth: The poison ivy rash spreads itself through oozing.

Fact: The rash, or discharge from the rash, does NOT spread itself to other areas of the body. The skin reaction is to a chemical called “urushiol” that is produced by the plant. Urushiol is a colorless, odorless oily substance that can stick to anything (skin, clothes, tools) and be spread around to different areas of your skin. Even the timing of that reaction after exposure can vary widely - sometimes by days or weeks - so it appears as though the rash is “migrating”.

Myth: I am allergic to “poison oak” or “sumac” but not “ivy”.

Fact: Poison ivy, oak and sumac are all part of the Toxicondendron genus of plants that produce the exact same oil, urushiol, that causes the rash. Actually, according to the local plant gurus poison oak and poison sumac are not natively found in the wild in Kansas.

Myth: I’ve never reacted to poison ivy in the past, so it’s safe for me to handle it.

Fact: We don’t fully understand why certain people react to poison ivy and other’s don’t. However, anyone can develop (or lose) the immune response at anytime in their life. I have seen many patients have their first poison ivy rash later in life despite dozens of previous exposures.

Myth: Only steroid shots or pills will get rid of my poison ivy.

Fact: Regardless of treatment, most rashes will last for 2-3 weeks. Steroids may help speed up that process by 1-2 weeks if started early. Systemic steroids (oral or injections) can be useful and needed in severe cases - especially if on the face or other sensitive areas. However, steroid skin creams can get the same amount of medication to the affected areas; and without the steroid circulating through the rest of the body.

Myth: Only the leaves of the poison ivy plant are poisonous.

Fact: Every part of the plant contains the urushiol oil. People tend to get exposed more in the summer because people are outside more and the leaves create more opportunity for contact. However, I have seen many cases of poison ivy rash in the dead of winter - probably from the vines of dormant or dead plants.