For discharge planners, social workers, and care coordinators in Oxford Hills and the Lewiston-Auburn area
Second Mountain Internal Medicine accepts referrals from discharge planners, social workers, and care coordinators at hospitals and facilities throughout the Oxford Hills region and Lewiston-Auburn area, including Central Maine Medical Center in Lewiston and Stephens Memorial Hospital in Norway.
We specialize in patients who are transitioning home from a hospital stay and need ongoing primary care, not just a single post-discharge visit. Our goal is to close the gap that leads to readmissions: a homebound patient with no established PCP, no transportation, and no follow-up plan.
All referral communication is handled by phone or text at 207-492-4642 through our HIPAA-compliant messaging service.
We confirm the patient has Medicare and meets homebound criteria. We typically respond within one business day.
We reach out to the patient and their caregiver directly to introduce the practice and schedule the first home visit.
Dr. Matulis becomes the patient's primary care physician. We coordinate with specialists and communicate with the referring team as needed.
Call or text our HIPAA-compliant line at any time:
All messaging is handled through our HIPAA-compliant service. You can call or text patient information securely.
Nationally, roughly one in five Medicare patients discharged from a hospital is readmitted within 30 days, and a large share of those returns are preventable. The common thread is a broken transition: the patient goes home without a primary care physician who can actually see them, medications get confused, early warning signs go unnoticed, and the next stop is the emergency department.
Second Mountain Internal Medicine is built to close that gap in Oxford County and the Lewiston-Auburn area. When you refer a patient, Dr. Matulis conducts the first home visit soon after discharge, reconciles every medication against the discharge summary, and establishes an ongoing relationship rather than a single check-in. For homebound seniors who have no reliable way to reach a clinic, having the physician come to them is often the difference between a stable recovery at home and a return trip to the hospital.
We keep referring teams in the loop. With the patient's consent, we send a note back after the initial visit and stay reachable for the discharge planner, social worker, or care coordinator who made the referral.
We typically confirm eligibility within one business day and aim to complete the first home visit within a few days of discharge, prioritizing patients who are medically unstable or at high risk of readmission. Call or text 207-492-4642 and we will give you a realistic timeframe for that specific patient.
No. Home health provides nursing and therapy visits under a physician's orders, and hospice provides comfort care at end of life. Second Mountain Internal Medicine provides ongoing primary care from a physician. Dr. Matulis becomes the patient's PCP and can order and oversee home health, provide palliative support, and coordinate hospice when the time comes. We complement those services rather than replace them.
Yes. Many of our patients receive home health at the same time. As the primary care physician, Dr. Matulis signs the plan of care, adjusts orders, and communicates directly with visiting nurses and therapists so everyone is working from the same plan.
That is one of the most common reasons for a referral. When transportation, mobility, or cognition make office visits impractical, a patient effectively has no working PCP. We can take over primary care, or discuss a shared arrangement, whatever serves the patient best. We talk it through with the family before anything changes.
We accept traditional Medicare and many Medicare Advantage plans. Because networks vary, call us at 207-492-4642 with the patient's specific plan and we will verify eligibility before the referral is finalized.
Yes. Living alone is not a barrier. Isolated homebound seniors are among the patients who benefit most from a physician who comes to the home. Where a caregiver or family contact exists we like to involve them, but it is not a requirement for care.
Yes, throughout our Oxford County and Androscoggin County service area, provided the patient meets Medicare's homebound criteria and the facility does not already require an in-house physician. Call us to confirm for a specific facility.
Questions about a specific patient or our referral process? Call or text 207-492-4642. We are happy to discuss whether a patient is a good fit before a formal referral.