‘Concierge medicine’ is drawing doctors, patients — and it’s coming to Lodi

Sept. 27--"My goal is to manage and anticipate your unique health care needs ... you will feel welcomed by the relaxed, individualized attention you will receive from everyone in our office."

Sounds like every patient's dream, doesn't it?

This kind of care, known as concierge medicine, has come to Lodi. The promises above are offered by Dr. Darius Noori, one of the first local physicians to sign up for a concierge approach managed by a company known as MDVIP. Also signing on with MDVIP is Dr. Jim Hoff of Lodi.

The promise of subscribing to MDVIP is alluring to patients, who get personalized care. But it is also attractive to physicians. Typically, they cut their practice loads from between 2,000 and 3,000 patients to 600 patients -- those who can afford the yearly payment -- and generate more than $1 million in the process.

But concierge medicine is worrisome to some physicians and ethicists, who are concerned about the creation of a two-tiered health care system in which the wealthy receive excellent care from select physicians, while others must settle for lesser services.

Through letters, Noori is inviting his Lodi patients to sign up with him through MDVIP at a cost of $1,800 each. (That yearly fee is in addition to all traditional insurance reimbursements.)

The invitation is posted on his profile on MDVIP. Patients will be reaccepted to his practice on a first-come, first-served basis. Those who dawdle could be placed on a waiting list.

The option, doctors say, gives them the opportunity to provide increased patient attention and thus improved health care.

"The doctor makes much more money, but is seeing fewer patients, so intuitively should be able to provide more attention to his/her patients due to the low volume," said Dr. Roberto Contreras, a Southern California medical director who has studied the issue. "Many doctors feel this allows them to practice medicine the way they were taught to practice, but people believe the main downside to be that a two-tiered health care system is created. You have the people who can afford this and those who cannot."

'Put the patient first'

Florida-based MDVIP was founded in 2000 and now has more than 700 private physicians nationwide.

Noori plans to open his MDVIP practice on Dec. 30; Hoff plans to open his on Jan. 31. Hoff's profile lays out his philosophy to put the patient first, provide physical and emotional comfort, and strive for the best care possible.

Neither returned phone calls seeking comment.

They are among the first in the area to join MDVIP; the closest current MDVIP member to Lodi is Dr. Robert Varadym, who practices in Fairfield.

The company guarantees patients office visits of at least 30 minutes, no waiting room lines, and around-the-clock availability to the doctor via email and cellphone to answer questions. Access to other MDVIP doctors outside the state is available. Additionally, personal health care records can be accessed online, and individualized patient web pages are available.

Appointments are also often available the same day.

"Patients usually get more attention and do not feel rushed when they visit the doctor's office, versus a typical, traditional doctor's office that sees patients in, say, 15- to 25-minute increments," Contreras said. "In this model, a patient and doctor can speak and get to know each other, usually with no time constraint."

A two-year study released earlier this month found a model like MDVIP reduces hospital visits and health care costs due to its personalized, preventative focus.

UnitedHealth Group explored preventive health care's ability to improve outcomes by creating a closer, personalized physician-patient relationship and focusing on disease prevention for Medicare patients.

When compared to their counterparts in traditional primary care practices, the 2,300 MDVIP patients studied enjoyed a host of tangible, life-changing and financial benefits. In the first year alone, there was a 20 percent reduction in emergency room visits for MDVIP members, as compared to non-members. The second year of the study saw a reduction of 24 percent, according to the research.

The study also found a 19 percent decrease in the number of inpatient admissions for MDVIP members over the course of two years, when compared to their counterparts in traditional primary care practices.

Ethical considerations

More than a dozen years ago, when the concept of concierge medicine was dawning, the practice drew the attention of Congress. Several of its members grew concerned with Medicare patient complaints that they were being forced to come up with the fee or find a new doctor.

The Health and Human Services Department determined that as long as seniors were not being charged for services covered by Medicare, it was legal.

The American Medical Association has ruled also there is nothing inherently wrong with the approach, as long as physicians switching to "retainer" practices help patients find new doctors if they can't afford to pay for the concierge service.

If no other physicians are available to care for non-retainer patients in the local community, the physician may be ethically obligated to continue caring for such patients, according to AMA guidelines.

The UnitedHealth Group study showed that patients who transitioned with their physicians into an MDVIP model capped at 600 patients, as opposed to the 3,000 patients of the average physician, received better-managed and more preventive care, especially for chronic diseases. They also enjoyed greater health care savings.

"Given that every man, woman and child spends -- without knowing it -- over $8,450 a year on health care, $1,650 is not too hard to swallow," said Dr. Deane Waldman, who sits on the board of directors at New Mexico Health Insurance Exchange and writes a blog about health care reform.

In the long run, he said, costs through companies such as MDVIP might be even lower than with traditional insurance.

"Concierge fees for other things, like labs and surgery, are usually a small fraction," he said.

The MDVIP model was shown to have saved some $3.7 million in reduced medical utilization for the 2,300 MDVIP Medicare Advantage patients over two years, according to the UnitedHealth Group study.

Savings were $86 per patient per month in the first year, and $47 per patient per month in the second, compared with patients who did not join an MDVIP practice.

The implications for older populations are clear, says Dr. Andrea Klemes, the chief medical officer of MDVIP, who helped conduct the peer-reviewed study.

"As more and more people enter into Medicare and Medicare Advantage plans, MDVIP is a great option for patients," Klemes said in a news release. "We have proven that we identify early health risk, utilize more preventive services and have better patient outcomes than conventional medicine."

Contact reporter Jennifer Bonnett at [email protected].

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