Posted on 02/01/2007 12:58:57 PM PST by SmithL
On a typical day, five or six patients used to fill Dr. Michael O'Brien's small waiting room, cooling their heels until they got 10 minutes with the Castro Valley physician.
Now, his waiting room is often empty. Most patients get in to see him immediately and have 30 minutes or longer per visit.
"I feel better about what I'm doing," he said.
O'Brien has joined a small but growing number of primary care physicians who have opted for a new form of medical practice, often referred to as concierge, boutique or retainer doctors.
O'Brien prefers "personalized health care."
The approaches vary, but many require patients to pay annual fees of $1,500 to $2,000. A few charge as much as $15,000.
In return, the physicians limit the size of their practices and provide more personalized, preventive care. Many give out their personal cell phone number and promise same-day or next-day appointments.
Under the most expensive options, some doctors make house calls, deliver medication or accompany patients to see specialists.
A 61-year-old internist who has practiced in Walnut Creek for 28 years agonized for months before deciding to switch.
Dr. Ronald Campos has been holding meetings to explain the decision to his patients. When he opens his new practice Feb. 7, he will drop his patient load from 2,000 to no more than 600. The hardest part will be ending relationships with people he has known for years, he said.
"It was the realization that I didn't have enough time for patients," he said last week. "I'm realizing I want to do something better for them."
O'Brien and Campos have affiliated with MDVIP, a Florida firm founded in 2000. They will each charge annual fees of $1,500. MDVIP will take $500 of that amount.
For their expense, patients will receive a complete annual physical, a credit card-sized CD with their medical records, a personal wellness plan, same- or next-day appointments lasting a half-hour or longer, and the doctor's cell phone or pager number with permission to call any time, night or day.
The annual fee does not cover routine medical bills, including most office visits and hospital stays. Those still must be paid by a patient's insurance company, Medicare or other means.
Most patients will pay the annual fee out of pocket because insurance companies and Medicare generally do not cover it.
Nationwide, 300 to 400 doctors now practice some form of concierge or boutique medicine, mainly on the East and West coasts.
The movement grew out of frustration with low reimbursement rates that many physicians say force them to squeeze in 20 to 30 patients per day.
It comes at a time when insurance companies and Medicare provide little money for preventive care while imposing a host of restrictions about what they will cover.
The result: Many physicians say they cannot practice medicine the way they would like.
At age 50, O'Brien operated a solo family practice in Castro Valley for 18 years before deciding in the fall to become an MDVIP physician.
It worried him, he said, that in his typical five- to 10-minute appointments, he could treat the ailment that brought a patient to his office but often did not have time to notice that someone was overdue for a mammogram or a bone density test.
"In the back of my mind, I knew I was missing things," he said.
For Campos, one recent patient drove the point home. During a typical hectic day, Campos spent 10 minutes with a 34-year-old man who came in with a sore foot. A week later, the man hanged himself.
"That emphasized what I don't like -- the fact that I have to hurry, the fact that I don't have that extra time," Campos said.
Both he and O'Brien anticipate they may lose money during the first year of their new practice, but say the change will be worth it.
"This is about quality of life, quality of care, time for patients, and going home and having a good feeling that you've cleared your desk, that you called everybody back, that you took care of everything, and not questioning in your mind did you forget something," Campos said.
The trend is controversial, with critics arguing that it aggravates health care disparities and shrinks the pool of physicians available to treat those who cannot afford such service.
"My initial feeling is that it's sort of outrageous that a doctor would do that," said Dr. Richard Cooper, senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.
"The bad side is you create a two-class society because not everybody can afford that."
Cooper said he is particularly concerned about doctors shrinking their practice to less than a third of its previous size.
"That means you need three doctors to do what one doctor used to do," he said. "So now you've made the physician shortage even worse."
But like many critics, Cooper said he understands the frustrations many doctors feel.
"They're forced by the system to practice the kind of medicine that they don't even think is right," he said. "The bad guy here is the system."
Rather than making the physician shortage worse, Dr. Edward Goldman, the CEO and co-founder of MDVIP, argues that his firm helps to keep doctors from abandoning the profession.
One recent survey found that 55 percent of primary care doctors age 50 and older were contemplating leaving or limiting their practice within the next three to five years, he said.
They are dropping out at a time when aging baby boomers will need them more than ever.
"We're sitting with a looming crisis that very few people seem to be talking about," Goldman said.
He disagrees with those who say his firm helps to create a two-class health care system. The current system is multitiered, he argues, with different rungs on the health care ladder for the uninsured and those on Medi-Cal, Medicare, an HMO, a PPO and top-notch insurance.
MDVIP has 143 affiliated physicians in 16 states serving more than 50,000 patients. Its business is growing by about 2,500 patients per month.
Dr. Chris Ewin, who leads a professional association for concierge doctors, has developed a different model.
Based in Fort Worth, Texas, he charges about $1,400 annually. That entitles his patients to see him as often as they want, without a co-pay.
Unlike the MDVIP doctors, Ewin does not deal with insurance companies or Medicare. If patients need lab work or X-rays not included in their annual fee, they pay for it and seek reimbursement themselves.
For Ewin, this eliminates the middleman, controls costs and avoids mounds of paperwork.
He leads the Society for Innovative Medical Practice Design, a professional association for such doctors, formed in 2002.
"What we've realized is that we've been working for the wrong employer for a long time," Ewin said. "Instead of working for the insurance company or the government, we would like to work for our patients."
Castro Valley resident Dong-Hoon Cho and his wife, Oak-Kyung, pay O'Brien annual fees totaling $3,000. They said they consider the expense well worth it.
At ages 70 and 66, they remain healthy but realize they may develop health problems. For now, they like not having lengthy waits to see O'Brien.
"Money is not that important when I'm thinking about my health and my wife's health," said Cho, a retired real estate broker. "Regular doctors are too much rush, rush, hurry, hurry."
"This is like my own private doctor," he said. "He pays attention to us and gives us plenty of time. We feel like we are VIP patients."
The Government Accountability Office studied concierge doctors in 2005 and concluded their numbers remain too low to affect access to health care. Federal officials said they will monitor the trend.
The dean of UC Berkeley's school of public health said physicians need better rewards and incentives for providing high-quality, cost-effective care.
"The hope would be," said Stephen Shortell, "that fewer physicians would see the need to work outside the insurance system in order to get fairly compensated or to have the kind of practice they would like and the way they would like to treat their patients."
Reach Sandy Kleffman at 925-943-8249 or skleffman@cctimes.com.
CONCIERGE DOCTORs
• For a list of those affiliated with MDVIP, go to www.mdvip.com or call 866-696-3847.
• The Society for Innovative Medical Practice Design lists its members at www.simpd.org.
My wife's doctor went this route and now we pay that annual fee so she can see him.
If we get HillaryCare, or ObamaCare, expect a lot more of this. Unless the legislation bans it.
(It won't. Our rich politicos will always want to insulate themselves from the consequences of their benevolence - they'll make sure they get to keep their own private doctors for a price. The rest of us, well we can sit in the waiting room for two hours in order to have a quick five minutes with the harried government doctor.)
Ping for later - since my doctors are heading down this path.
"Both he and O'Brien anticipate they may lose money during the first year of their new practice, but say the change will be worth it.
Hmmmm....600 patients times $1000 equals $600,000, plus what they collect from the insurance companies. How high could malpractice insurance and office rent be?
This is going to infuriate the Socialized Medicine types. People are paying for superior service. This is not acceptable, since an equally bad level of service is an inalienable right to all Americans (and people who happen to be in America), don'tcha know...
Most of these types of docs do NOT deal with health care....you pay up front.....YOU get any insurance bennies.
Rest assured that it will be banned. As you may recall, one of the provisions of Hillary! for President!!!'s 1994 Health Care scheme was to make it a crime for doctors to perform medical service for a fee outside of the government plan.
The rich and powerful will protect their access in other ways, like they do in Canada and the UK. If you are on a special list, you get access to the best doctors with no wait. Everybody else must get in line.
If this cost could be paid with a HSA, it might be a cool alternative, given the taxes savings that occurs on the final $1500 or $2000 of income.
I wonder how he'll lose money. He's going to have 600 patients. He's charging them $1500, of which he gets $1000, for a total of $600,000. But the coverage doesn't include standard medical treatment like physicals, so if each patient came in once a year for a physical, the insurance companies would pay him another 50 bucks per patient for that, or around 30,000 a year.
He'll probably only need one nurse becuase business is slow. Probably only needs one administrative person, because there will be few forms to fill out.
Seems that he should be able to make money. Maybe the first year he loses because it takes him that long to get up to 600 patients and he has expenses he has to unwind.
Kaiser Medical essentially does this by hiring their own doctors. Kaiser costs 1/3 of other insurance, and people I know who use them love them (I don't use them because my doctor is not part of their plan).
Oh, give it a rest! I am so tired of radical egalitarians who insist that everyone be tied to the lowest common denominator.
Besides, how many people could not afford $1500 a year for health care? I daresay that most of the so-called poor in this country spend more than that on luxury items. For those who are truly needy, charities could pick up the tab.
I'm fairly certain that the $1,500 only puts you on the doctor's list. Actual services are over and above that amount.
People have been accustomed to paying zero for healthcare for awhile. I saw that in PA the teachers went on strike to avoid a $20 co-pay.
Also when talking about how much money this brings in - do not forget that most doctors have med school bills of $250,000.
Sign me up, I have Type 2 Diabetes and would love this level of service.
My current contribution is $98 a month for my insurance, so $1500 isn't so bad to me.
You are right. The two-class concept is carp. This is a new concept. Depending who gets in on it, rates could drop. Add this to the medic stops or whatever they are called that have set up shop in Wal-Mart and Target and I think we will see better quality and more affordable health care. I would love a health savings account that would let me shop for a fee-for-service or retainer doctor and fee-for-service or retainer specialists and do away with anything but catastrophic insurance.
Thank you for posting this article. I am currently a Family Medicine Resident after workig for the Army in Primary Care for 15 years. I am seriously thinking of starting such a practice when I finish and am very interested in this kind of information.
What now needs to be done is to keep track of medical errors made in the course of day to day practice and compare the performance of the concierge practice with other practices in the area. If there is a statistically significant error reduction, then that would speak volumes. In any event, what I've observed is that annual insurance premiums rise, copays rise, reimbursement to physicians decreases as the copay increases to keep totals steady. The costs to patients and employers are not explained by reimbursement.
Where is the money going?
/sarcasm
Yeah, I'm wondering how high his overhead must be given the simplifying circumstances, but I'll take his word on it.
If you're an OB/GYN in the west, malpractice is upwards of $200k per year. You MUST REMEMBER THAT REIMBURSEMENT FROM INSURANCE DOES NOT INCLUDE SUPPLIES. So, everything your doc uses on you to sew you up may cost him $1k and he gets reimbursed only for the vist (say 20-30 dollars for 15 minutes for medicare).
YES!!! And by the time docs are in practice their interest on the $250k loans has accrued and its closer to $300-$400k.
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