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Membership Email of November 28, 2010

By December 12, 2010February 21st, 2020No Comments

We hope you had a wonderful Thanksgiving. Dr. Isselbacher and I wish you a great end of Fall and a healthy holiday season. We’d like to briefly inform you about recent improvements in our practice that we believe will offer you even better care and service and discuss a few other issues that we believe will be of interest.


You may have read about a concept called the “medical home,” where the federal government is sponsoring projects to bolster large primary care practices to proactively reach out to their complex patients, call them to check on their well-being, provide remote advice, and even do house calls, usually with nurses. We are hopeful that this general effort will be successful, because it is needed and valuable.

At Orchard Health Care, Dr. Isselbacher and I specifically run such a medical home. Each morning our staff meets and we discuss the list of up to several dozen of our members who are in temporary or extended need of intensive medical contact and supervision. These include members who are about to or recently had surgery, those with temporary significant illnesses, and those with substantial chronic illnesses or frailty. We cross check all data sources using SharePoint software that we implemented a few months ago, to be sure we have a clear plan as to which members need contact or assistance that day and which staff member is to make that contact or provide the assistance. This process is personnel intensive and time-consuming, but immensely valuable.

You don’t necessarily want to be on that short list of members with special needs, but we try, to the limits of our abilities, to assure that there are no cracks for anyone to fall through. And Kate and I continue to do house calls whenever the circumstances warrant.


Most of you, but not all, know that there is an orchard behind Orchard Health Care. I run a 3 acre or so apple and peach orchard in Lincoln that I maintain. It also produces pears in quantity, and various other stone fruit such as apricots, cherries, and plums, and will also produce pluots, apriums, and peentos in the next few years. It gives me an opportunity to commune with nature (the pruning is therapeutic) and drive a large Holder tractor to do the spraying. We donate all the fruit to the Food Project in Lincoln, a charity whose mission it is to provide fresh produce for sale or free to inner-city populations (read Peabody, Roxbury, Lowell) with little access to fresh vegetables or fruit. Their staff and volunteers grow their produce, we largely provide their fruit. Last year we donated about 19,000 pounds of apples, peaches and pears to the Food Project.


You will all receive invoices in early December for the Orchard Health Care membership fees for 2011. The OHC agreement itself is automatically self-extending, so no action is required. For those of you paying by credit card, you similarly need do nothing except to be sure that we have a current, working credit card from you on file. The first quarterly billing will be charged to your cards on December 20. For those paying by check, you should have your invoice in hand approximately December 1. We appreciate your check by December 20 as well.

Our fees increase slightly in 2011, the first change since 2009. The basic individual rate rises to $2800 (an increase of $25 per quarter or $100 annually). Spousal rates remain $1000 less. Children’s rates are unchanged.

We have invested heavily in personnel and better technology to improve our service to you. We believe our slight membership price rise is well in keeping with those investments and the general medical cost rises that have impacted our practice over the past two years.


I was running errands midday Friday and stopped at the Dairy Joy on Route 117 in Weston for a quick lunch. While waiting for my sandwich to be prepared, I noticed a woman in a ski jacket looking into one of the trash containers toward the back side of the building. She looked briefly back at me, and then reached into the receptacle to remove and eat some of the discarded food. I was appalled. How could such need for food exist in the rich western suburbs of Boston, in Weston? I had my sandwich cut in half and walked to her to offer her half, which she accepted with a slight smile.

Then, not wanting to be too intrusive, I went back to my car, but really I wanted to know, Who are you? How could you be hungry? Aren’t you hooked up with any family, agency, or charity to look after you? I didn’t ask those questions at that time, and remain ambivalent about whether I should have.

I still feel somewhat inadequate for not having been more helpful, for having decided not to be intrusive. But I am mostly upset that we as a society have failure of this magnitude in our midst. My work and donations to the Lincoln Food Project from our orchard are precisely to improve access to food and healthy nutrition. This interlude starkly reminds me how deep the need remains.

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