After more than 25 years of running a small, independent doctor’s office with a large number of patients on public assistance, the principals of Belfast-based Seaport Family Practice hope to open a new facility that would employ 50 to 60 people and open care to more uninsured and underinsured residents around the county.

The new community health center would focus on primary care, but also include dentistry, physical therapy, mental health and other services not often found under the same roof.

“Just like you can go to a hospital and expect blood tests and X-rays, at a community health center you can expect to have things that come together for your benefit,” said Dr. David Loxterkamp, who cofounded Seaport Family Practice with Dr. Tim Hughes in 1984.

“So if a patient comes in with asthma and it becomes apparent that the asthma has more to do with stress, we can walk the patient down the hall to talk to a therapist,” he said.

As novel as that may sound, the plan hinges on Seaport’s being accepted into a 40-year-old government program, one that would designate the new facility as a Federally Qualified Health Center.

FQHCs had their origins in the late 1960s with Lyndon Johnson’s War on Poverty. Around the same time, a number of young doctors were turning away from the prevailing winds of medical specialization, instead entering the nascent field of family practice, an updated version of the old general practice typified by a doctor with a black bag making house calls.

Loxterkamp, whose father was a general practitioner, was among this new generation of family practice doctors.

Family practitioners delivered babies, performed minor surgeries, diagnosed and treated all manner of maladies that would, in today’s system, prompt a raft of referrals. They generally spent more time with their patients than doctors typically do today, and they were trained to treat patients as inexpensively as possible, which meant they got paid a lot less.

As a consequence, family practices have had difficulty recruiting new doctors, but a renewed interest in the cost-saving benefits of primary care may be changing that.

Under the Affordable Care Act of 2010 the Obama administration has set a goal of supporting 350 new FQHCs around the country by 2015.

Earlier this year, Seaport joined a three-year pilot study conducted by the major health insurance companies in Maine to test a relatively new primary-care model called the Patient Centered Medical Home that focuses on primary preventive care.

“A lot of it is technology-driven. A lot of it is access-driven, and making sure patients have the preventive services they need,” said Loxterkamp. “But it’s somewhat unproven to insurance companies.”

The new study suggests a move away from a reimbursement-for-procedures model that Loxterkamp and others argue has driven up the cost of health care without any clear benefit to patients. The burden for Seaport during the PCMH study, he said, is to prove what 25 years’ experience has taught him — that good primary care lowers health-care costs. Patients get better care, make fewer visits to the emergency room and have fewer unnecessary hospitalizations.

During the three years of the study, Loxterkamp said the practice would get some compensation for pursuing what under the current system has been an unprofitable approach but one that Seaport has taken over the years — ordering only the necessary procedures.

The new community health center would be following in the footsteps of Bangor-based Penobscot Community Health Center, a successful FQHC with which Seaport has partnered for the new venture.

On Sept. 29, Loxterkamp, representatives of PCHC and others affiliated with the proposed community health center held a public hearing at the University of Maine Hutchinson Center for a 100-member audience that included health-care professionals, representatives of social service agencies, city officials, state representatives and a number of candidates for local and state offices.

Loxterkamp traced the history of Seaport Family Practice from its infancy in a space with a buggy electrical system, fumes from the hair salon downstairs wafting through the floor and a fish tank that he said looked like the Dead Sea — “which wasn’t exactly the message we wanted to get out to our patients,” he said — to its present location on Wight Street in Belfast, where the facility currently employs four doctors, several physician’s assistants and nurse practitioners and a small support staff.

Seaport Family Practice has been a Rural Health Center — a simplified version of an FQHC — since 1991. The designation has allowed Loxterkamp and his fellow doctors to see a larger percentage of MaineCare and Medicare patients than a private practice could otherwise afford.

One of the goals of the new health center, Loxterkamp said, would be to eliminate what he called “barriers to access,” including money, but also physical barriers — lack of transportation — and attitudes toward seeking care.

Loxterkamp said he hoped the new community health center would lead to what appeared to be a renewed interest in primary care on the part of government and insurance companies, as exemplified by the push for more FQHCs and the Patient Centered Medical Home study.

The current plan calls for a new building, possibly on Congress Street, that could house the expanded line of services. As an FQHC, the new community health center would be required to have a board, with more than half the members being patients of the practice.

As part of the proposed expansion, representatives announced that Seaport Family Practice and Waldo County General Hospital had developed a memorandum of understanding, with both parties expressing a commitment to preventive care.

“In an ideal world, in Maine, we should probably have one health-care system sitting down with our government and pulling in that direction,” said WCGH Executive Director Mark Biscone, who sat in the front row during the presentation. “And that’s what we hope to do, pull in the same direction.”

The new community health center could include some services, like blood tests and X-rays, that would normally require going to the hospital, but Biscone said there were still many services that would only be offered at the hospital, including oncology, imaging, surgery and hospice.

“It’s really the right thing to do, to work together,” he said.

Loxterkamp, speaking earlier, said the new center would not aim to compete with the hospital.

“We see no need to duplicate good care that is already being provided in the county,” he said.

Seaport recently hired two young doctors and a physician’s assistant, a move that Loxterkamp said dovetailed with the effort to become an FQHC.

Elizabeth Connelly, P.A.C., who was among the new recruits, said she didn’t know about the plan to seek FQHC designation when she started with Seaport, but called it “a bonus.”

“The idea of making everything more accessible for patients is very exciting,” she said.

In keeping with the philosophy of understanding all the conditions that affect a patient, Connelly said working in a rural setting had given her a much stronger sense of the socio-economic pressures that bear on people’s health.

Though the Sept. 29 event was billed as a public hearing, only a handful of those who attended asked questions or made comments at the end of the presentation. One attendee, a Seaport patient, asked if his relationship with his doctor would change, to which Loxterkamp replied, “I hope so. I hope it will get better.”

He went on to say that the new designation made it likely that doctors would be able to spend more time with their patients, and that he hoped to draw patients from other parts of Waldo County.

Penobscot Community Health Center and Seaport Family Practice are jointly seeking a grant that would give the new community health center $650,000 per year for operating costs. Kenneth Schmidt, CEO of PCHC, said the chances of getting the grant were good, given that Waldo is the only county in the state without an FQHC.

Schmidt said if Seaport didn’t get the grant, it would join PCHC in 2011 — a move that would require federal approval, but which Schmidt thought would be easily accomplished.