Spokane Valley physician assistant Kevin Bichler prefers spending an hour getting to know a patient, a model he says is getting lost.
Six months ago, he and his wife opened Optimal Healthcare, a family medicine practice they say is aimed at slowing down the appointment pace. At 12418 E. Saltese Road near Pines Road and 16th Avenue, the practice now has 250 patients and is growing by 10 to 15 new clients each week.
“With new patients, we spend an hour, and with follow-ups, we usually have them in for 30 minutes, or 45 minutes,” said Janice Jordan-Bichler, a nurse. Some follow-ups with complexity will go longer.
“I like it because I get to know patients a lot better,” Bichler said. “I’m the kind of person who likes to talk to people anyway. We find out about their families, their hobbies.”
The couple left jobs at Community Health Association of Spokane and remodeled the 1970s-era former dentist’s office to create five exam rooms and a waiting area. They bought some of the equipment, including exam tables and an EKG machine, on Craigslist.
“We put every nickel we had into this,” he said. “I pulled my retirement into this.”
Jordan-Bichler, 55, will test in August to requalify as the practice’s second physician assistant, a role she held before doing health administration work. Optimal also has one full-time medical assistant. Bichler, 49, graduated from the University of Washington physician assistant program in 2009.
The Bichlers encourage patients to email or text them any time, and they take walk-in patients. The office phone forwards to a cellphone after 5 p.m. For a few urgent medical needs, Bichler has driven the five minutes from his house to meet people at the office.
Operating a physician assistant-owned practice is allowed under state regulations as long as clinics follow the requirements of the Medical Quality Assurance Commission, a state panel with members appointed by the governor, said Donn Moyer of the Washington state Department of Health. The state Health Department does not track how many such clinics exist, but Moyer said he’s aware of them, especially in rural areas.
Among the state rules is that the clinic have a “delegation agreement” with a physician who consults with the practice and checks the charts. At Optimal, Dr. James Mullen is that physician.
However, Bichler currently is the only health care professional who examines patients, makes diagnoses, prescribes medications and performs minor procedures. “When I was with CHAS, I’d have to push people through and you’d get that 10, maybe 15 minutes,” he said. “My problem was I’d talk to the patients, then I’d go home for two or three hours to catch up on my medical charting. That was the huge burnout for me.”
Since opening, Bichler said other Spokane-area health care professionals have expressed interest in working at Optimal, if the business continues to grow.
“We have providers coming in all the time looking for jobs, from multiple clinics,” he said. “They want to slow down too. They don’t want the 25-patients-a-day model.”
Optimal Healthcare accepts most health insurance plans now, or patients can pay a flat $50 office visit fee. Sports physicals cost $40.
Launching the practice hasn’t been without pitfalls, though, and after months of losing money, the couple said it finally hit profitability in April. Early missteps with insurance requirements in order to receive provider payments meant lost income. They spent thousands of dollars on an electronic medical records system that never materialized, until finding an efficient free model.
“With insurance, you have to follow the rules to the T,” Jordan-Bichler said. “For the first two months, we didn’t get paid at all other than the $50 straight fees. We chalked it up to a learning experience.”
Bichler said his volume of medical appointments varies by the week, but he doesn’t see more than 10 to 12 patients a day. Optimal Healthcare also offers well-child exams, immunizations and physicals. Jordan-Bichler has training to do exams and DNA sampling in sexual assault cases.
Bichler said medical clinics run by mid-level practitioners – nurse practitioners and physician assistants – could become a norm as more people seek care under the Affordable Care Act. Just over half of Optimal Healthcare’s patients have enrolled under ACA’s rules for state Medicaid called Apple Health.
“A lot of physicians are quitting or retiring,” Bichler said. “They’re being burdened with more in what was already a burdened profession.”
Jordan-Bichler said support from others has helped get the clinic off the ground.
“Our accountant has so much faith in us, she’s working for free,” she said. “Someone who is in marketing is volunteering his time. Our biller right now is working for free. This is our passion.”