Is an increase in concierge doctors causing a ‘wealth care’ problem on Hilton Head?

Feb. 08--Robert Schatz moved from Colorado to Sea Pines on Hilton Head Island in mid-August.

It took him until October -- and phone calls to 14 different doctors' offices -- before he found a Hilton Head primary care physician accepting new patients who was not concierge.

The island is experiencing a controversial increase in the number of doctors practicing concierge medicine. Under the membership-based business model, doctors see fewer patients who must pay an annual fee.

In return, patients get around-the-clock access to their doctors via their email addresses and cell phone numbers, longer appointments, same-day or next-day appointments and in some cases, even house calls.

The trend has it critics.

"The way I look at it is: whoever has the most money gets the best care," said Schatz who was quoted between $400 and $1,980 per year to see the concierge doctors he inquired about. His insurance would not cover the annual fee, so he opted not to do it.

Are medical costs pushing patients to concierge care?

The situation could spell trouble for places like Hilton Head where a lack of primary care physicians is already a common complaint among residents.

Worries are growing that as more doctors turn to concierge models and cut down on the number of patients they see, more patients will be left searching for a traditional doctor and have fewer options.

"Inaccessible appointments to area physicians pushes people to concierge offices," Janice Gierer, a Hilton Head reader, told The Island Packet, adding that her premiums have climbed to more than $1,000 each month. "High co-pays along with denial of generic drugs. ... I've never paid so much for so little."

The trend toward concierge medicine is national, according to Michael Tetreault, the editor of Concierge Medicine Today, a trade publication.

Between 10,000 and 12,000 subscription-based doctors now practice in the United States, though the number is not exact, as no registry exists of concierge doctors, he said.

"I think it's been a growing trend for the last 10 to 20 years," Tetreault said. "We've seen moderate growth (in this business model) of about 3 to 6 percent each year. I think it's because when hospitality is a backdrop of health care, it's very attractive to people. The traditional methods of receiving health care today are somewhat challenging to a patient."

Dr. Michael Mayes, a Hilton Head internist who has been concierge since 2014, said he has noticed the growth of concierge medicine locally. Statistics are not readily available, but Mayes said he believes the number of concierge physicians and traditional practice physicians are close to being equal on the island.

MDVIP, the largest membership-based primary care network in the country, has 10 physicians in the Beaufort County area, according to Nancy Udell, director of media relations.

The patients seen by concierge doctors tend to be in their 50s and above, Tetreault said.

So it would make sense that Hilton Head would be seeing an increase in these physicians, as the median age is 50.9 years old, according to town data.

Some see it as an unfair system.

"It's a two-tiered operation," said Mike Silver, a Bluffton resident who spent more than 50 years in health care management. "Those who can afford it and those who have to look for something else."

Why Beaufort County doctors are "going concierge"

Doctors often make the switch to concierge medicine because they are burnt out -- a national problem that has reached such alarming rates that some consider it a public health crisis.

Recent reporting from The Boston Globe found that for every hour a physician spends with a patient, they spend about two hours on the computer, entering information from office visits and preparing prescriptions in less-than-user friendly computer systems.

That's why Dr. Will Petty, a solo MDVIP practitioner on Hilton Head, chose to go concierge.

"I grew up in a small town. Doctors knew their patients personally, were always available and could spend time with them. ... I had been practicing for 14 years in medicine and was becoming disillusioned with it," he said. "You wouldn't believe the difference (going concierge) made."

When doctors turn to concierge service, they often cut down significantly on the number of patients they see each year, often going from thousands to just a few hundred, said Bret Jorgensen, the CEO of MDVIP, based in Boca Raton, Fla.

At MDVIP, each doctor's number of patients is capped at 600.

Petty dropped from seeing 2,000 patients to 540. Instead of 15-minute appointments, they're now 30 minutes or more. He visits his patients in hospitals, nursing homes and hospice.

"Before, I didn't have time to ask questions if the patient didn't bring it up," he said. "Now I ask patients about their stress level, if they're upset (and) how their kids are doing. It's much more of a relationship with a patient than I never had time for before."

Petty's yearly fee is $1,980, which patients can pay annually, quarterly or twice a year. Patients' children between the ages of 16 and 26 are also seen at no extra charge.

What concierge doctors make each year

Concierge physicians can potentially make more than in traditional practices, according to Concierge Medicine Today -- often earning the same as specialists.

Citing a 2014 Medscape study, the publication reports that between 2013 and 2014, a majority of U.S. concierge doctors earned $200,000 or more.

About 51 percent of concierge doctors don't accept insurance, which eliminates a lot of administrative work, according to Concierge Medicine Today. Patients likely still need insurance for prescriptions and other health care costs or emergency health care.

Jorgensen said MDVIP doctors still accept insurance, but cutting down the number of patients makes them "less beholden to insurance." Because of the membership fee, doctors aren't relying on filling appointment slots to earn money. And fewer patients mean less administrative work anyway.

Mayes agreed, and said it's often the hassle of documentation requirements, the declining reimbursement rates from Medicare and commercial insurance and the increase in the cost of doing business that push doctors toward concierge medicine.

"The administrative burden of handling a lot of paperwork has become so involved and cumbersome for so many physicians that ... it doesn't make a lot of business sense," Tetreault said. "The reimbursements continue to decline from insurance and doctors are just finding they're unhappy and aren't as satisfied."

Dr. Petty said it's like cutting out the front office, and with MDVIP, there is help for doctors with billing and keeping records.

"I can really just practice medicine," he said. "I see the patient and the rest is taken care of."

'Wealth care'?

A few years ago, Jorgensen was mountain biking with his son when a minor crash left a few gouges on his son's shin. The two went home, cleaned up the wounds and snapped a photo of the cuts.

Jorgensen sent it to his doctor's cell phone. In two minutes, the doctor told Jorgensen his son's leg didn't need stitches, and he had called in a prescription ointment to help heal the wounds. He also gave him information on how to spot an infection.

"All of that literally took two minutes of time instead of sitting in an urgent care (center) for three hours," said Jorgensen, who is based in San Diego and Boca Raton. "People like myself are really focused on that kind of level of attention and care."

MDVIP was founded in 2000 and currently has 950 physicians serving more than 300,000 patients in 43 states, according to Udell, the director of media relations for MDVIP.

Jorgensen said it's a misconception that this level of care is unaffordable. And MDVIP keeps away from terms like "concierge medicine" because it "conjures up images of 'wealth care.'"

Jorgensen said there are some non-MDVIP concierge doctors around the country that charge up to $20,000 a year. That, he said, is not the norm.

Annual membership with MDVIP costs around $1,580 to $1,800, or around $130-$150 each month, according to Udell.

"Although concierge physicians started out as doctors to the 1 percent, over the years, the movement has taken a decidedly middle-class turn," according to Concierge Medicine Today.

However, the publication notes, patients of concierge physicians "skew upper middle class, with typical household earnings between $125,000 and $250,000 a year."

The additional fee is a hurdle that should stop doctors from going concierge, say critics.

"It's a violation of (doctors') Hippocratic oath," said Silver, the Bluffton resident who worked in health care management. "It's a copy of the way in which lawyers have retainers. But medicine is not law."

Karl Engelman, a retired professor of medicine and internist who lives in Sea Pines, said some patients will be left without doctors as the concierge trend continues to grow.

"I think inherently, it's a bad system," Engelman said. "(When I practiced medicine) they were a patient, not a check book. And that's the way medicine is supposed to be."

He said the access fees concierge doctors charge are "admission fees" that patients pay to get in the door. Medical care costs come on top of that fee.

At the same time, Engelman said he understands the desire to get immediate, personalized care that is often unavailable at traditional doctors' offices.

"I'm trying to see an internist that I've never seen before, and his office told me his next available appointment for a new patient is in September," he said. "When you're 85 (years old), you may not be here in September."

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