Doctors who make house calls
Concierge medicine offers access, attention but not without controversyMore and more patients are forking over cash for medical services not usually associated with health care plans — physician accessibility and personalized attention.
Concierge medicine, sometimes called boutique medicine, is a business model in which patients pay an annual retainer — separate from the cost of medical services — to their primary care physician for enhanced care. This may mean direct access to the doctor via telephone or e-mail, additional preventative care, and/or more time with the doctor, as concierge medicine practices are usually capped at a much smaller number of patients than conventional providers.
The concept is relatively new, having taken off as a trend about 10 years ago. The Society for Innovative Medicine Practice Design, a professional organization for concierge and other direct care providers, reported an increase in membership from 200 in 2008 to 5,000 in 2009.
The growth may be attributable to patients dealing with the frustration of being rushed through appointments (on average, individuals get less than 20 minutes with their doctor at each visit), and the inability to obtain care when they need it.
A 2009 survey of 1,162 physician appointment wait times (including those in San Diego) conducted by Merritt Hawkins & Associates found the average ranged from 15.5 to 27.5 days, depending on the specialty.
Doctors, too, have been receptive to the new approach.
“It’s no secret that reimbursement by insurance companies and Medicare has dropped over the years,” said Len Jurkowski, M.D., a family practitioner in La Jolla who, after 27 years of traditional medicine, changed over to a concierge medicine practice 2 1/2 years ago.
“Physicians are left with very few choices. You can either try to see more people to remedy that model or you can try to provide care in a smaller model where you see fewer patients.”
Cost/benefit analysis“Concierge medicine is essentially when a physician limits his or her practice size,” explained Pamila Brar, M.D., an internal medicine doctor from La Jolla who launched a boutique practice in January. “It allows patients to get access to care in a way that is convenient and works around their schedules.”
For $2,500 a year, Brar’s patients can contact her virtually any time of the day or night. Instead of caring for 3,600 patients, as was the case before she transitioned to concierge medicine, Brar plans to cap her practice to roughly a tenth of that.
Brar said she made the change because “I felt that I wasn’t able to be there for my patients when they needed me. It’s a frustrating way to practice, and it doesn’t allow you to develop relationships.”
The new model not only allows Brar to spend more time with each patient, but she can participate in their care directly by coordinating referrals and follow-up testing, making house calls, discussing patient issues with specialists, and even accompanying patients to other appointments.
Recently, Brar noted that one of her elderly patients was having trouble walking. She recommended getting new shoes but discovered that the patient did not have anyone to take her to the store. Brar ended up going with her patient to Foot Solutions and picking out new shoes.
“For me to be able to actually help her was so gratifying,” Brar said. “It was being able to care for her like a family member.”
Jurkowski, with a personalized health care network called MDVIP, values the physician/patient relationship similarly: “I get to know them as human beings, not just patients. I see them more for who they are than their diagnostic codes and illnesses.”
While patients may appreciate the accessibility and enhanced care, doctors also benefit from the concierge medicine model. Jurkowski cited decreased stress and a sense that he is providing better care, especially in identifying potential risk factors.
Controversy/conflictAnthony DeMaria, M.D., professor of medicine and director of the cardiovascular center at the UCSD School of Medicine, isn’t convinced this new approach to patient care is an effective solution.
“As a concept, concierge medicine has some positives and it has some negatives,” DeMaria said.
While he readily acknowledged that these patients receive a higher degree of personalized, convenient care, cost is a consideration, as is the impact on those people not cared for by concierge providers.
“There’s an issue if only those who can afford this kind of very special medical care are taken in by these physicians,” DeMaria said. “That leaves all of the other people — the bulk of society — to be taken care of by the physicians who are not being reimbursed as generously.”
He also noted that doctors may be undermining their experience by limiting the number of patients they treat.
And, because concierge medicine only lends itself to primary care providers, not specialists, DeMaria sees its benefits as neutral. “Individuals still have to be referred out, and then they get the same degree of care as everyone else,” he said.
But for patients, the defining factor in whether or not concierge care is worthwhile may be peace of mind.
Of her experiences, La Jolla senior Marlene Matthews said: “Dr. Brar is very intelligent, very kind, and she has been phenomenal to work with. ... She had made a big difference in my life.”
Remodeling the modelWayne Lipton, managing partner for Concierge Choice Physicians, said his company offers practitioners an option that combines conventional medicine and concierge medicine. Under the hybrid model, doctors convert a portion of their practice, which allows them to retain patients who may not choose concierge care while tapping into a new revenue source.
“I wanted to offer my patients highly personalized care,” said Steven Nusinow, M.D., a La Jolla-based physician, “but I also wanted to make sure I could keep seeing all of my patients. Under the hybrid model, patients can choose to remain traditional patients or join the concierge program.”
Coinciding with recent changes to federal health care law, Lipton said the hybrid option is a step in the right direction to address problems in the current system.
To reach Dr. Pamila Brar, call (858) 200-3007.
To reach Dr. Len Jurkowski, call (858) 622-0554.
By the numbersConcierge Choice Physicians, the nation’s largest hybrid concierge medicine company, announced July 15, the signing of its155th physician practice and expansion to 16 states, most recently Missouri, Tennessee and the District of Columbia. According to the company, the milestone marks a 50 percent increase in the number of physicians offering the hybrid concierge model in one year’s time.