As the Upstate – like the nation – grapples with the best way to deliver health care, two nurse practitioners have opened Riverstone Wellness in Easley to provide individualized care without the constraints of health insurance.
The office is a collaborative effort, with one nurse practitioner specializing in internal medicine and the other focusing on psychiatry.
Christina Holliday and Kristina Schafer share a building, a philosophy and a business model. And they say they bonded over their disillusionment with traditional medical practices.
“We were frustrated with the ways that we were being forced to practice medicine. Insurance dictates so much. You get rushed in and out like cattle,” says Holliday, who treats and prescribes medications for patients with psychiatric or mental health issues.
“I want to give a more individualized approach to patients – quality visits and the time that they need. I've always wanted to open my own office,” she says.
Holliday shared her ambitions with Schafer, a colleague and nurse practitioner with a specialty in internal medicine. Schafer was enthusiastic about starting a private practice.
“We just weren't able to deliver the quality of care we wanted,” she says.
The two met while working together at a post-surgical, skilled nursing facility and clicked as people and professionals, Schafer says.
Nurse practitioners, she says, are trained to see patients “as a whole person, not just a diagnosis.”
“You’ve got physical, mental, emotional and spiritual. Somebody can come in with anxiety, and we can treat the anxiety. But what's going on at home? Is that anxiety raising your blood pressure? Are there other issues?” she explains.
Psychiatric & Internal Medicine
Holliday says they see benefits to offering psychiatric care and internal medicine under one roof.
“It builds continuity of care. We share a couple of patients, and we've been able to reduce meds,” Holliday says. For instance, she says, a patient might be prescribed a single drug that treats both gastrointestinal problems and depression.
“That collaboration allows us to keep patients on the minimal number of medicines for the maximum effectiveness,” Holliday says.
They confer on a patient’s care or reach out to other health care professionals, Schafer says.
“Providers who work in offices that take insurance are sometimes required to see upward of 30 patients a day,” she says.
“How are you supposed to stop and call somebody else and say, ‘What do you think about this?’ There's no time in a day for that.”
Primary care physicians in traditional practices may be hindered by insurance companies that require prior authorization for procedures, sometimes refuse treatments, and create additional administrative work, according to the nonprofit Kaiser Family Foundation.
Physicians are also incentivized to see more patients per day – leading to shorter visits, the inability of patients to schedule care when they need it, and burnout among doctors, according to a July article from the American Medical Association.
“The average primary care doctor spends about six minutes with a patient,” Holliday says.
No Insurance Rules
Riverstone does not accept insurance for services. Holliday’s patients pay by the visit. Schafer’s clients can purchase a monthly subscription.
“It’s called direct primary care. And it’s a monthly membership fee. You keep your insurance for anything that happens outside of my office,” Schafer says.
Clients receive an annual panel of lab work and unlimited visits. Schafer says she can call clients with results rather than insisting they return to the office.
“I can take fewer patients than your traditional PCP. And if I have fewer patients, I deliver better care. On their first visit, most people tell me that no one is listening to them. I've got two hours to listen to you, and if that's not enough, we can continue to talk throughout the week.”
Schafer says primary care physicians can have as many as 2,000 patients. “My cutoff is 450. That makes a significant difference in what I can invest in my patients,” she says.
For patients with mental health issues, Holliday says most primary care physicians “do the bare minimum” and refer a patient to a specialist.
“And it will take forever to get in to see them,” Schafer adds.
“We pride ourselves on seeing patients within 48 to 72 hours from their initial contact. We’re not making them wait weeks and months,” Holliday says.
Located at 4891 Hwy. 153, Riverstone Wellness began taking patients in April. In the future, the practice plans to offer red light treatments and vitamin infusions.
Help With Weight Loss
The practice also offers dieting support and weight-loss medications, GLP-1s, such as Ozempic.
“While we have that tool, we provide nutrition counseling, help you be accountable. We are here to provide that extra guidance, be a person to talk to, help figure things out as you go along. Christina helps. It is both a mental and a physical thing to achieve weight loss,” Schafer says.
Holliday says she once went online and ordered GLP-1s. “I never talked to a doctor. I never talked to a nurse practitioner. I answered about three questions. And they mailed me the medicine,” she says.
“I knew how to administer it. But there were no instructions. People are getting this medicine, and they don't know how to properly use it. Where's the education that comes with that?”
Training Nurse Practitioners
Nurse practitioners in South Carolina are registered nurses who complete a master’s or doctoral degree.
Holliday was required to spend more than 670 clinical hours in psychiatric settings before obtaining a state license to specialize in psychiatry. She can diagnose and treat mental health conditions and prescribe psychiatric medications. She does not offer “talk therapy,” but does treat children.
As a licensed adult-gerontology primary care nurse practitioner, Schafer needed 500 to 700 supervised clinical hours in adult and geriatric primary care settings.
Both Schafer and Holliday work with a collaborating M.D.
“He has been available to both of us for any phone call we've thrown his way,” Schafer says.
“Our passion for helping people comes across if people give us a chance. This is not a job; this is a lifestyle for us. We wanted the opportunity to do it the way we wanted.”
For information about services offered at Riverstone Wellness and the fee structure, go to riverstonewellnesshealthcare.com.