Concierge Medicine: When doc is always in, patient care wins
Lisa Bernard-Kuhn, nky.com, March 17, 2013
Dr. Jerry Tolbert says he’s gotten back a precious asset that physicians across the country are scrambling to find: More time with patients.
Less than two years ago, the Burlington-based doctor struck out with his son Dr. Gerry Tolbert to open Total Access Physicians (TAP). The concierge-style practice charges patients an annual fee of $900 to provide all of their primary care services, regardless of the number or complexity of visits.
In return, patients get as much face time with their concierge doctor as they want, as well as the physician’s personal cell phone and email address.
“If a patient needs to be seen in the evening, we’ll see them in the evening. If there’s an emergency, they can … call me and get answers to their questions,” said Jerry Tolbert. “It’s a newfangled way for old-fashioned medicine.”
Similar practices, also known as direct primary care, are popping up nationally as physicians look for new ways of doing business in a industry beset by reforms and rising costs.
For now, the model represents less than 1 percent of country’s physicians. But concierge medicine practices grew by 25 percent in 2011 to 4,400 doctors, according to the American Academy of Private Physicians, a membership-based non-profit in Virginia.
For most doctors, “the only way to stay afloat is to see patients in faster volumes, but at some point, the pace of delivering care strips all the satisfaction for physicians and effects the quality,” said Tom Blue, executive director of the academy. “Private medicine is a good alternative for those doctors who want to maintain their independence and financial stability.”
In a nationwide survey of 13,000 physicians, 7 percent said they would consider switching to a concierge medicine model in the next three years, according to The Physicians Foundation, a national doctors advocacy non-profit. Nearly 9 percent of physicians surveyed in Ohio and 3.4 percent in Kentucky said they’d consider the move.
At Total Access Physicians, the group has about 150 patients. The practice recently added Dr. Teresa Koeller, who previously worked alongside Jerry Tolbert at St. Elizabeth Physicians, a division of St. Elizabeth Healthcare that has 290 doctors.
I didn’t feel like I had control any more,” said Koeller. “It used to be that if you wanted not to charge a patient for something provided you had that option, but when you lose control of billing and receipts, you can’t do that.”
While private physicians have long been employed by the affluent, new models like TAP are making it more affordable to patients of varying incomes, said Phil Miller, a spokesman for Merritt Hawkins, a national physician recruiting firm based in Irving, Texas.
TAP also accepts patients who want to pay directly for services, rather than a monthly or annual fee. New patient visits are $75, electrocardiograms cost $30 and routine labs are $10. While patients who pay per service don’t get the perk of having a physician on call, it can be a benefit to patients who don’t have insurance or can’t get into their regular primary care physician.
More than half of TAP’s patients do have insurance, although the practice doesn’t bill insurance companies for their services. Instead, they say the cost of their services are included in the annual fee. . About 25 percent of TAPS patients have no health care coverage, including Alexandra Henderson, a 24-year-old Fort Mitchell resident.
“I can always text my doctor and ask him any kind of question,” said Henderson.
Early data suggests patients who see a direct care physician have fewer emergency rooms trips.
Within MDVIP, a national network of 600 concierge-style physicians, Medicare patients saw a 79 percent reduction in hospital admissions, and a 72 percent decline for those with commercial insurance, according to the company. The findings were reported in December in the American Journal of Managed Care. As a result, MDVIP, which has more than 200,000 patients, delivered a health care system savings of $300 million.
MDVIP, a wholly-owned subsidiary of Procter & Gamble, has 10 physicians practicing in Greater Cincinnati. Physicians do bill insurance in addition to an annual fee that starts at $1,500 per patient. That fee covers a “robust, executive style physical,” said MDVIP CEO Dan Hecht, who spent 20 years working with P&G’s health care brands and innovation.
Patients are now learning that they have a high quality alternative to traditional healthcare and can easily find a concierge doctor online. Concierge medicine and direct primary care options will continue to grow as The Affordable Care Act unfolds.