‘Concierge’ medicine cuts doctors’ red tape

Honolulu Star-Advertiser (HI)

Nov. 21--For $1,650 a year, Lynn Leong gets to spend two hours detailing her health concerns when she sees her primary care doctor, a stark contrast to the typical 15- to 30-minute office visit.

The 67-year-old part-time teacher is among the roughly 500 members of a concierge medicine practice, comprising a smaller number of patients who pay an annual fee for better access to their physician.

The shift away from traditional volume-based primary care is gaining momentum both locally and nationally as the administrative burdens related to insurance reimbursements and government regulations continue to eat up more of a physician's time. Since 2012 six concierge doctors have opened on Oahu, and two on Maui; two are now switching to the new model of care.

In 2012 Dr. Robert Schiff, a primary care provider for more than 30 years, cut his practice by 80 percent to 500 from 2,500 when he joined MDVIP, a company specializing in concierge medicine. The Florida-based firm with close to 270,000 patients nationwide operates in 44 states and has about 780 doctors and another 100 switching their practices.

"I love it. When do you get to see a doctor for two hours?" Leong said of Schiff, who addressed two pages of her questions and concerns in one visit. "There's several ways to get to the doctor. I have his personal email and personal cell. I used the latter two multiple times, so the response time is sometimes minutes. I'm a part-time teacher, I don't get all these little breaks, so time is really precious."

Revenue is primarily based on the annual fees collected from patients, which means doctors are less reliant on reimbursements from private health plans and government insurance programs such as Medicare and Medicaid, which provide coverage for seniors and low-income residents but don't cover the entire cost of care.

Schiff has gone above and beyond with the extra time he now has with patients, Leong said, recently helping her family research exercise equipment and learn to ballroom-dance in his office waiting room after hours.

"I actually brought some patients into the waiting room and taught them how to rumba, cha-cha and swing. I wanted to get people to exercise," said Schiff, one of the first concierge doctors in Hawaii, who describes his unconventional practice as "fabulous."

"I wasn't sure that I wanted to stay in practice pretty much any longer because of the way my practice had been going. I felt like I wasn't able to take care of patients the way I wanted to," he said. "I was putting out fires all day long. I didn't feel like I was doing a great job. It's been a godsend."

The concierge program fee includes an annual wellness exam that gives patients a blueprint on how to manage their care throughout the year. The comprehensive physical exam is not covered by medical insurance, which still pays for other routine visits and procedures by concierge doctors.

Schiff recently did a wellness exam for a 65-year-old patient with diabetes, high blood pressure, coronary heart disease and chronic headaches, all of which he was able to address.

"In the past I may have been able to address the headache, but never would I be able to go into his other issues. One person cannot physically get all that done. It's just not possible with 2,500 patients," said Schiff, who sees 10 to 12 people a day compared with 30 to 35 previously. "I spent 90 minutes and was able to address all the issues, discuss an exercise program, get him on the proper diet and new medications. It's amazing to be able to spend that kind of time with somebody. They're getting dramatically better care. It's invigorating to do this."

Some health executives are concerned that the increasingly popular shift to a pay-for-access model might exacerbate an already severe shortage of primary care doctors and reduce access to care.

"Physicians are drawn to that model in part because of the ability to focus the attention on health care and not on all the paperwork and the insurance issues," said Dr. Chris Flanders, executive director of the Hawaii Medical Association, a trade organization representing about 1,100 local physicians. "Concierge is maybe an answer (to the administrative burdens), but in a state like Hawaii where there's such a dramatic physician shortage, one of the concerns is the lower patient volume ... would hamper access to care. It's a double-edge sword."

Bret Jorgensen, chief executive officer of MDVIP, said the model is not contributing to Hawaii's doctor shortage and, in fact, is doing the opposite.

"I don't see it as causing a shortage at all because we elongate the careers of these doctors and are such a small piece of the pie. Half of doctors out there want to retire early -- that's exacerbating the shortage," he said. The firm also helps find new providers for patients unwilling to pay the annual fee when a doctor decides to make the leap into concierge medicine so those patients are not left in the lurch, he said.

The growth in concierge medicine comes as the health care industry makes significant changes to the way health care is provided.

The Hawaii Medical Service Association, the state's largest health insurer, is changing the way it pays primary care doctors to a fixed monthly rate for each patient in a practice, whether or not the patient visits the doctor, from the current fee-for-service model, which reimburses doctors based on the number of patient visits. Nationally, the move to this new system -- known as capitated payments -- is being driven by the Affordable Care Act and the federal Medicare program in an effort to improve the population's overall health and contain rising medical costs.

"There's a lot of new burdens around documentation reporting and compliance, so there's a fair amount of frustration out in the world in medicine today in Hawaii," Jorgensen said. "There's probably more anxiety among some of those doctors. Doctors are increasingly concerned about the viability of their independent practices."

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