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A concierge approach to medicine

Dr. William M. Healy spent 26 years building a practice of 2,000 patients yet felt that he rarely had enough time amid the paperwork and bureaucracy to listen and think about their concerns.

So he did what a small but growing number of frustrated doctors are doing about job satisfaction.

Healy started charging a $1,650 annual fee and told patients who agreed to pay it that they would get greater access, quick appointments, longer visits, and house calls.

About 400 of the patients last year chose to stay with Healy for what’s called concierge, boutique or retainer-based care.

Patients still need health insurance in concierge medicine. And it is not for everyone. The harshest critics consider it “wealth care” – medicine for those who can afford it.

But to advocates, the benefit is worth the extra cost: spending more time on wellness in a closer relationship between doctor and patient. Both will be happier, the thinking goes, and potential problems will be identified earlier.

“This was the right choice for me and my patients,” said Healy, an internal medicine specialist in Amherst. “I can practice the way I envisioned I would practice. It’s old-fashioned medicine. It’s never going to go out of style, and people want it.”

Dr. Nora E. Meaney-Elman, another Amherst primary care physician, is opening a retainer-based practice in July. Like Healy, she is doing it with the assistance of Florida-based MDVIP, by far the largest concierge medicine firm in the country.

A handful of other physicians such as Dr. Leonard Kaplan, a Northtowns osteopath who specializes in spine and sports care, on their own are keeping some regular insured patients but promising an extra level of service to those willing to pay a fee.

They follow Dr. Ronald P. Santasiero, a Hamburg family physician, who started the first concierge medicine practice in the region in 2010 with SignatureMD, a firm in Santa Monica, Calif.

An estimated 4,500 physicians in the nation practice some version of retainer-based medicine. That’s a drop in the bucket compared with the country’s 897,420 doctors, about 300,000 of whom work in the primary care specialties of internal and family medicine.

But the number is on the rise.

MDVIP, which helps doctors convert to retainer-based practices, has grown to nearly 700 doctors and 240,000 patients since it was founded in 2000. Work is underway to open an additional 100 practices.

“Primarily and initially, the major driver is that doctors are hoping to slow down and take more time with patients,” said Bret W. Jorgensen, chief executive officer of MDVIP. “Patients are also looking for more involvement with their doctors.”

The concept is primed for further growth, Jorgensen said. Indeed, in a 2014 survey of 20,000 doctors by Merritt Hawkins, a physician consulting firm, more than 13 percent said they plan to make a transition to concierge medicine in whole or in part.

Still, only a small portion of interested physicians can make a retainer-based practice work.

An older clientele

Doctors need to amass several thousand patients before converting, so enough patients will choose to pay a fee and support a much smaller practice. Patients need to be willing and able to afford the fees. And, the doctor-patient relationship must be strong.

It should come as no surprise that doctors who can successfully charge retainer fees tend to be older and more established, and they work in wealthier communities. The average age of an MDVIP doctor is 64. Healy is 58. Patients also tend to be older, generally from 50 to 80.

“Interest level among physicians is great, but we’re only able to convert the practices of 10 to 15 percent of those who go through our process,” Jorgensen said.

Healy, a Rochester native, graduated from the University at Buffalo School of Medicine and Biomedical Sciences and started his practice in 1988.

He was approached several years ago by MDVIP, talked with other doctors who had made the switch and walked away impressed with how passionately they spoke about the change in their medical practices. “The biggest difference is the time you have for personalized care,” he said.

MDVIP and its competitors provide marketing, legal and regulatory advice, and also provide technological and billing services. They also assist with the transition, which requires placing patients who don’t pay the fee with other physicians.

MDVIP limits doctors to 600 patients to ensure there are no rushed appointments. For the fee, which can be paid annually or quarterly, patients get Healy’s cellphone number instead of an answering service. They deal only with him – not a nurse practitioner or physician assistant.

He provides an annual wellness exam, with an initial two-hour review that includes tests not normally covered by insurance for patients without symptoms. One evening every week, in line with the arrangement with MDVIP, he invites patients to join him for a walk.

Doctors affiliated with MDVIP avoid the term “concierge medicine,” which is commonly used in the industry, because it comes across as elitist. Instead, they refer to their practices as “retainer-based.”

“When people hear ‘concierge medicine,’ they think rich people, but I have patients with different incomes,” Healy said.

He acknowledges that not every patient may be able to pay the fee, but characterized it as a reasonable price for the access and medical peace of mind – less than $5 a day.

“This is a model where people can choose to join, and they get a wellness program and everything that goes with it. They are consumers in a medical marketplace,” he said. “It’s a choice.”

Advocates view concierge medicine as a remedy for a fee-for-service insurance system that pays mainly for treating illnesses and not preventing them, and that values procedures over the time it takes to manage a patient’s basic care.

‘Intangible aspect’

“There is an intangible aspect to this. It’s about engagement,” Jorgensen said. “Patients who choose this see their doctor as a friend and a coach who is helping them get ahead with their health.”

He cited several studies showing that MDVIP patients, including those on Medicare, experienced fewer hospitalizations and saved the health system money.

Physicians pay MDVIP a flat fee based on number of patients. It’s comparable to the percent of practice revenue – about 30 percent – that other concierge medicine firms charge.

Other physicians still building a practice – and unable to risk a complete conversion – attempt to juggle treating both regular patients and those who pay a fee on top of insurance, or who pay directly for services.

Kaplan, 48, wanted to get out from under the costs and limitations that come with insurance-covered care. But he wasn’t crazy about signing on with a company that would take nearly one-third of his earnings in fees.

So, three days a week, he sees patients who pay out-of-pocket for his concierge services at Osteopathic Wellness Medicine of Western New York, which he established earlier this year in Clarence. Two days a week, he sees patients covered by health insurance at the Dent Tower in Amherst. He looks to continue to grow his concierge practice and eventually open a location downtown. “This is the white-glove treatment, like flying first-class,” said Kaplan, who offers nonsurgical treatment for chronic back and limb pain, osteoarthritis and injury recovery.

Patients who choose concierge medicine tend to like it. MDVIP claims a 90 percent retention rate. “There is a cost, but there is a benefit,” said Dana Dee of Snyder, a patient of Healy’s. She likes the focus on wellness, the offer of house calls, the extra testing and his availability. Dee said Healy doesn’t rush her during an appointment. She suffered a head injury recently on a Saturday. She called Healy, and he picked up the phone right away.

“He’s responsive,” she said.

The first concierge medicine physician in the region, Santasiero, described the experience as generally good. But he sees the concept remaining as a small niche.

“In the eyes of a physician, patients are the same regardless of their ability to pay,” he said. “But for some patients, rich and not as rich, it is worth paying more to get to the head of the line.” Only 140 of his patients chose to pay a fee, and he depends on his Sedona Holistic Medical Centre, which combines alternative and conventional therapies, to help pay the bills.

Santasiero sees concierge medicine as a transitional step to mixed practices such as Kaplan’s and direct-pay primary care, in which patients who don’t have traditional health insurance plans pay a physician for individual services.

Dr. Nancy H. Nielsen, a former president of the American Medical Association, understands the frustration among primary care physicians that’s driving the interest in concierge medicine.

It arises from a fee-for-service payment system that values procedures and scans more than time spent examining and talking to a patient, she said.

“Primary care doctors feel undervalued,” she said. “They feel like it’s ‘Mother, may I?’ with insurers. They feel like a hamster on wheel to see all their patients.”

Dramatic changes

But Nielsen, now a senior associate dean at the UB School of Medicine and Biomedical Sciences, said the payment system is undergoing dramatic changes toward rewarding doctors for value and quality.

In addition, she said, physicians in increasing numbers are adopting same-day scheduling, after-hours access, email communications, unrushed appointments and patient education programs.

“A lot of doctors would say they are doing what concierge medicine says it provides, but without a fee,” she said.

Nielsen also cast doubt on the comprehensive wellness exams offered by concierge practices, questioning the effectiveness of some tests on patients who don’t have symptoms.

She likes that concierge medicine offers physicians a choice of practice styles, but it’s not a choice she would make.

“I hope it does not rapidly grow,” she said. “It can only be for those who can afford it.”

Refresh Editor Scott Scanlon contributed to this story.