Tracy Is The 2016 WMS Physician Of The Year

Dr. Mike Tracy is the WMS 2016 Physician of The Year

By Bob Vines
For Wyoming Medical Society

The Cowboy Code of the West holds a prominent space on the wall behind the reception desk at 307Health in Powell. Although all the other walls of the modern Direct Primary Care clinic are adorned with art and photographs from patients and local artists, Wyoming’s iconic Cowboy Code has its reserved spot in direct eye-line of all who walk through the clinic’s door.

Michael Tracy, MD, refers to it often – as a moral guideline and a mission statement for the clinic he shares with partner Robert Chandler, MD. Most of all, it is a reminder of his commitment to the 600 or so patients that have the number to the cell phone that is attached to his waist and the Bluetooth device that could possibly be surgically implanted in his ear.

Tracy, 51, is professional, easy-going and amiable. He is professional enough to easily discuss his visions of the future of healthcare with quiet reason and confidence, void of hyperbole and unfair criticism. He is easy-going enough to take business calls while “getting some line wet” in Northwest Wyoming’s trout-rich waterways. And you have to like a guy who proudly displays an old Powell Panther-signed football along with his copy of Paula Abdul’s Greatest Hits on his bookshelf with a small library of medical and business books.

The Wyoming Medical Society has chosen Tracy as 2016’s Physician of the Year. His willingness to try a new business model and his patient safety advocacy were among the reasons for his nomination.

In a Direct Primary Care (DPC) system, the patient pays a monthly fee directly to the physician and can see their doctor as often as they need. The system bypasses insurance, co-pays and the traditional fee-for-service system. It also includes housecalls and the benefits they may bring.

“I got a really good tip for a house call the other night — a piece of hot, fresh apple pie,” Tracy says.
The doctor was supposed to be mowing the back lawn when he received the call that one of his patients had been stung by several bees.

“I thought it was better to just see him,” he says. “I was able to go, spend some time with him and make sure he was going to be okay and didn’t need to go into the emergency room.”

And have some pie.

Not only does the system simplify healthcare access for many patients, it also simplifies the paperwork flow for the physician. Tracy and Chandler employ a full-time receptionist and a full-time nurse, and both of their spouses work part-time. Tracy says that if they were to operate a fee-for-service system, they would probably have to employ two more full-time employees to manage insurance claims.

Tracy and Chandler left their long-term employment with Powell Valley Healthcare to start 307Health last summer. The new direction seemed a natural progression for the physician ready to start a new chapter in his career.

“The fee-for-service system is cause for such stress for patients and providers. If you really start looking at physician burnout, a big reason is a loss of control over a lot of things that really impact you. I felt that I would rather explore a new model that might invigorate people like me entering their 50s,” Tracy says.

If he needed confirmation that this was the right decision for him, he received it recently when a residency classmate suddenly died at the age of 49.

“Life is short, it really is,” Tracy says. “And you want to make the most of it. So if you find that you are not happy doing what you are doing and you can find a different way to use your skill set, then definitely do it.”

After getting an undergraduate degree from the University of Colorado, he took a couple years off before going to medical school. He worked two years in Aspen as a carpenter’s apprentice and traveled through Australia with a backpack and no itinerary for six months.

He doesn’t regret the time he spent between college and medical school. He said that many of his medical school classmates struggled during their first year directly out of college.

“For me, I just thought about some of the construction work and ranch work I had done and it seemed pretty easy to just sit around, drink coffee and study hard,” Tracy says. “I wasn’t banging nails in 20 degrees and snow.”

After earning his medical degree from CU and completing his residency in Internal Medicine and Pediatrics at the University of Rochester (New York), he worked as a physician in rural Missouri as part of a student-loan repayment program. He and his young family moved to Powell in 2002 when his contract ended.

They quickly acclimated to their new community and he began to build a strong practice at Powell Valley Healthcare, serving on the hospital’s board of directors. He is a past president of the Wyoming Medical Society, serves as an American College of Physicians Governor and has organized patient safety summits in Wyoming.

His wife, Karrie, works at the clinic as a services representative. They have three children. Daughter Anja, 22, will begin post-graduate studies at the University of Wyoming this fall. Son Nicolas, 20, also attends UW. Their youngest daughter Amanda, 18, recently graduated from Powell High School and will attend UW with her older siblings.

The new practice also gives Tracy an opportunity to focus on something as his nest empties.

“I’ve spent so much of my recent life working hard and trying to catch up with my family after work,” Tracy says. “Now, you aren’t catching up with the kids anymore. It has been an adjustment.”

Tracy and Chandler share an office. Tracy likes it. He says it gives him and his partner plenty of opportunities to consult each other. His bookcase features books about biodiversity in the Amazon, the Black Plague and even “Atlas Shrugged.” The aforementioned football was a relic destined for the landfill when Tracy saved it, hoping to eventually find a member of that year’s team to whom he might present the ball.

He draws inspiration from the book “Creativity, Inc.” by Pixar co-founder Ed Catmull which focuses on creativity in business and leadership. He also has a copy of Eric Topol’s “The Patient Will See You Now,” and quotes from both books as easily as he quotes the Cowboy Code of Ethics. Whether talking about patient safety, transparency, or the future of American healthcare, he has considered all angles and can easily strengthen his position with an appropriate anecdote or Donald Berwick quote.

He feels the DPC system is the best system to deliver services with the Institute for Healthcare Improvement’s Triple Aim approach in mind. The Triple Aim is a framework developed to describe an approach to optimizing health system performance that simultaneously pursues three dimensions: improving the patient experience of care, improving the health of populations and reducing the per capita cost of health care which is directly addressed in the Affordable Care Act.

The clinic had to convince the Wyoming State Legislature to pass a bill that defines DPC as non-insurance. With assistance from Wyoming House Labor, Health and Social Services Committee Chair Rep. Elaine Harvey, R-Lovell, the bill passed unanimously in both the State House and Senate. The bill allowed the clinic to practice without being regulated by the state’s insurance code.
“The time is ripe for people to try and figure out a more cost-effective way to deliver healthcare to better the experience for the patient,” he says.

Both Tracy and Chandler have been to Washington, D.C., to discuss the direct primary care model with members of Congress and found strong support and interest from both sides of the political spectrum, which is unusual these days.

The clinic resides in a building they own with a local orthodontist. Their patient-friendly focus is apparent in their exam rooms, equipped with height-adjustable exam tables and cushioned chairs. The rooms are large and friendly. Large-screen 4D television sets are hooked through the doctor’s iPhones and iPads. They use the technology to access informational videos on the Internet and can pull up medication information and patient charts across 47 inches.

307Health is a combination of modern office amenities and a more traditional form of physician access that is reminiscent of a day when doctors made house calls. But Tracy is quick to point out that although he sees the similarities with the frontier doctor, there are some major differences with the DPC model.

“It really is a step back in time with the caveat being that a step back in time used to be a pay-for-service system” he says.

When a patient signs up for care with 307Health, they pay a monthly fee on a sliding scale based on age from $30 for patients under the age of 20 to $75 for patients over 65, along with a one-time registration fee of $25 per individual or $50 for a family. In return, patients see their physicians as needed without office co-pays. They also have Tracy’s cell phone number which they are encouraged to use and have options of using other technology such as Skype.

“By doing this with a finite number of people we’ll be able to have the time to be able to take care of these people in the way that we need to,” he says. “The interesting thing about fee-for-service is you have to keep signing people up for your practice because you have to have enough volume to make sure your schedule is full every day. That means you’re going to sign up more people then you can take care of on the high-demand days. And that is why it sometimes takes months to get a doctor’s appointment.”

Six hundred patients seems to be a good number for Tracy right now and he’s hesitant to increase that number until he gets a good feeling about how he can deliver his brand of personalized care.

One challenge that Tracy said faces new DPC clinics is convincing hospitals to view such clinics as partners rather than competition. He points out the need to work in conjunction with hospitals because physicians need access to the hospital’s resources.

“If (hospitals) can view us as a referral source instead of competition it would probably be better for both sides,” Tracy says. “That is how it is evolving. I think there were people that initially viewed us as competition but now they see us sending our patients to them.”

Tracy acknowledges that reforming the current healthcare system is a marathon rather than a sprint, and the key to DPC’s sustainability will fall into the hands of the next generation of physicians – not an easy feat with interest in primary care fading with young medical students who hear job satisfaction is low.

“These guys are thinking about surgery, orthopedic surgery – a lot of things besides primary care,” he says. “Then they find out there’s a model where you might be able to have the relationship with that patient be the focal point of the practice.”

Along with continued promotion of the model, Tracy sees the next step as developing relationships with insurance companies in order to allow the services patients receive from DPC clinics to count toward their deductible.

Over the past year, Tracy has found himself wearing more hats than the letters behind his name would indicate. He is a physician, entrepreneur and a patient advocate. He considers this for a few seconds before saying,

“I like the word ‘advocate,’” he says. “I view it as a partnership with patients. I feel that advocating for patients is something I can do better now than I could as an employee physician partly because I’m really looking out for patients’ best interests along all lines.”

Those lines for Tracy include transparency in cost and service, patient safety, easy and affordable access to healthcare and open, honest communication with their physician.

He refers to the Cowboy Code of the West once more.

“There’s no question that all of those simple principles are so important but they get chucked to the wayside because people are so worried that they are going to get sued,” Tracy says.

Then his phone rings and he politely puts his patient first.