While the politicians have been endlessly debating ObamaCare, RomneyCare, and Maine’s own Dirigo Health, a Falmouth medical clinic has been making some of its services more affordable to uninsured patients for years.
 
In a twist on the age-old practice of bartering, patients at True North Health Center earn office visits with their doctors by performing services like housecleaning, tutoring, or shoveling snow. It is not a direct swap. Rather, patient and practitioner are both members of Hour Exchange Portland through which they acquire “time dollars” by doing work for other members. They then use that currency to acquire services for themselves.

“We started this collaboration with the Hour Exchange pretty much when we opened our doors about ten years ago,” says Sorcha Cribben-Merrill, marketing manager for True North. “It has evolved with the needs of our patients and practitioners.”

Members of Hour Exchange Portland, which was founded in 1995, offer a wide variety of services, from dog walking to cooking. Jobs are valued equally, regardless of their market value — that is, a member who gives an hour of his time can receive an hour of any other member’s time. True North was the first healthcare practice to participate in the program, and it remains the only one whose practitioners include doctors trained in conventional medicine.

True North is anything but a conventional practice, however. In addition to several MDs, DOs, and registered nurses, its staff includes a healing touch practitioner, a naturopathic doctor, an acupuncturist, and a massage therapist. Moreover, the non-profit practice is not contracted with any insurance companies, which means doctors can spend as much time with their patients as they deem necessary. “A typical initial visit is one to one and a half hours, and there are no external limits on how many sessions are needed for a particular diagnosis,” Cribben-Merrill explains.

True North’s approach to billing is an extension of that philosophy, Cribben-Merrill says. Insured patients submit their own forms for reimbursement. Those who are uninsured or under-insured work out a payment plan with their practitioner; for some, that may mean paying with time dollars.

“It’s a fantastic opportunity to receive good quality healthcare,” says Lindsay Bushnell, of Brownfield, who uses time dollars to pay for her own doctor’s visits, as well as her husband’s and son’s. And what service does Bushnell offer through Time Exchange Portland? Health care. Bushnell is a midwife. “It feels really balanced to me,” she says.

A Maine Public Radio piece about True North’s unusual payment arrangements this past fall produced a ripple of reports by other news media, including the CBS Early Show, as well as a satirical riff on healthcare politics by Stephen Colbert, who suggested absurd ways that terminally ill patients might earn time dollars.

Colbert is right, of course — bartering has limitations — but that doesn’t make us any less impressed with the flexibility of True North’s practitioners and patients when it comes to noncritical care. Too bad their creative practicality isn’t infectious.