Local doctor aims to reinvent patient care, payment with new medical practice – Salisbury Post

SALISBURY — The pandemic has been an inflection point for many Americans.

People have changed career paths, moved and reshuffled their priorities — or at least cleaned out their garages.

Dr. John Bream, who was overseeing the emergency department at Novant Health Rowan Medical Center when COVID-19 spread to the U.S., found himself at a similar crossroads.

“I think COVID exposed a lot of the warts within the health care system,” Bream said.

While Bream would love to see an overhaul of the way America’s doctors and health care institutions treat and charge their patients, he’s decided to start by opening his own practice.

Bream has moved out of the emergency room and into the world of primary and urgent care. He opened the first Bream Medical office at 721 Grove St. in Salisbury last week. Bream is joined at the practice by physician assistants Zack Briggs and Alfonso Rodriguez. Bream plans on opening two more locations, one in Edenton and one in Stokesdale, in the coming months.

“The one thing I can help with is at Bream Medical, you will never be denied service because you might have COVID or you haven’t been vaccinated or anything along those lines,” Bream said. “I believe in treating all patients, no matter what, to the best of my ability.”

Dr. John Bream, right, and Zack Briggs stand outside of the newly opened Bream Medical office. Photo by Chris Jones Photography.

It was a primary care doctor who first piqued Bream’s interest in medicine. Bream still has fond memories of visiting his family’s physician, Dr. Vetter, in his hometown of Hamlet, North Carolina, a town of about 6,000 near Rockingham.

“Everytime I went there it was awesome. I loved him and it was a great experience,” Bream said. “I had this phrase: Dr. Vetter makes me better. I always wanted to be like Dr. Vetter.”

Bream was also inspired by his grandmother, who worked in home health care.

“That’s where the health care gene comes from,” Bream said.

Bream stayed close to home for college, studying biology and history at East Carolina University. He earned his doctor of medicine from ECU as well. During his medical residency, Bream moonlighted in emergency departments across the state. He thrived on the up-tempo, ever changing landscape of the emergency room.

“I enjoy that fast pace and I enjoy doing a little bit of everything, but not in particular doing one thing all the time,” Bream said. “I may see 30 patients in a shift and not ever see the same thing.”

Following his residency, Bream worked in emergency departments in Albemarle and Monroe before eventually being hired as the assistant emergency department director at Novant Health Rowan Medical Center. He became the full-time director in early 2017, stepping in to oversee a bustling department.

“Leading the emergency department at Rowan was challenging,” Bream said. “I think, as people in the community know, Rowan is a busy emergency department. When I was directing, we were seeing over 50,000 patients per year. This is a very high acuity area, meaning there are a lot of sick people in Rowan County.”

Bream said his team was able to make meaningful gains, improving in quality of care and patient satisfaction metrics. When the pandemic started, a hectic emergency department initially became much quieter. Even with  fewer patients at first, but stress was at an all-time high.

“It was changing every day,” Bream said. “As director, I was involved in all of the meetings for planning and there was a lot going on at that time. It was a stressful time to be director because there was so much to do, but so much unknown.”

Meanwhile, Bream’s wife was nearing the end of her pregnancy. He remembers using the family’s outdoor shower before he stepped foot inside their home after a shift and not wearing his wedding ring to work — small precautions that seemed big when there were so many unknowns about COVID.

During his wife’s pregnancy, Bream experienced the health care system from the perspective of a patient. He was astounded by how little his insurance covered when it came to hospital bills. That got his wheels turning.

“There’s a better, more efficient, cost effective way to do medicine that works better for patients outside of the traditional insurance model,” Bream said.

Bream also became concerned about the way some health care professionals were treating, or not treating, patients. In particular, Bream said he was appalled by those who have turned away patients because they tested positive for COVID or have not been vaccinated.

“I started seeing a lot of patients outside the emergency department with acute COVID, because a lot of providers wouldn’t see them,” Bream said. “There are things you can do for patients outside of telling patients to go to the ER if their lips turn blue or they have shortness of breath.”

Bream seeks to address both of his key concerns, cost and patient care, through a subscription medical plan. For $150 a month, a patient gets one primary care visit, one urgent care visit and 24/7 access to their provider. Bream believes paying directly for services can save patients money in many cases.

By utilizing telemedicine, Bream said he can provide services to patients outside of the normal 8 a.m. to 5 p.m. workday and can keep costs lower. Bream plans to limit the number of patients he takes on to ensure his staff can spend more time with them beyond the typical 15-minute appointment. Patients who visit Bream can expect appointments to last closer to 40-minutes, he said. Bream said he’s also seeking to lighten the financial burden on patients by doing in-house lab testing without markups.

Bream said he will focus on more preventative and holistic medicine, and won’t be afraid to think “out of the box” when it comes to caring for patients.

By providing better, preventative care through the subscription model, Bream is seeking to keep patients from having to visit the hospital and incur a large bill.

“The goal of that service is that you have such good access to your provider that we should be able to prevent a significant number of hospitalizations,” Bream said.

Bream Medical will accept patients with conventional insurance plans and those who have no insurance at all, in addition to those who elect to join the subscription model.

More information about Bream Medical can be found online at breammedical.com.

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