Concierge medicine gains patients
|Some Capital City residents choose direct care to bypass health care woes|
Recently, Meg Casper did something she has not done since she was a kid: She went to the doctor for a physical.
It wasn't fear of needles, white coats or receiving a devastating diagnosis that had kept her away. Like many Americans who joined the workforce in the 1980s as managed care became standard in employee benefits packages, Casper simply had incentive to avoid doctors' visits—a complex matrix of referral rules and medical and pharmaceutical co-pays. Typically, she waited until an illness or injury became significant to seek care.
“[As an adult] I had never been to a doctor when I wasn't sick,” says Casper, the Associate Commissioner for Public Affairs at Louisiana Board of Regents.
However, when she reached age 40 this year, Casper's priorities changed. “I really wanted to build a personal relationship with a physician,” she says.
So in February, Casper joined the practice of board-certified family practitioner Dr. Cecil “Bill” Lovell III.
In November 2010, Lovell became the first physician to affiliate with MDVIP, a group of internists, family practitioners and other primary care physicians who specialize in preventive, personalized care. Since then, Drs. David R. Carver, Louis R. Minsky, and Greg Ferrara have joined the 540 physicians nationwide who participate in the Boca Raton-based network.
So far, MDVIP has been the only personalized medicine company to enter the Capital City. Offering what some call “concierge” or “boutique” medicine, MDVIP-affiliated physicians enroll patients in their practice for an annual fee in addition to insurance or Medicare payment. Membership ranges from $1,500 to $1,800 per adult. Family practitioners usually treat dependents age 26 and younger at no additional charge.
According to MDVIP CEO Dan Hecht, the additional funds compensate the doctor for time invested in the intensive wellness program. The annual exam begins with a battery of surveys and diagnostic screenings for depression, anxiety, fitness, nutritional status, hearing, vision, arterial flow, pulmonary function and sexual health. A leading-edge diagnostic test pioneered by the internationally renowned Cleveland Clinic provides comprehensive heart and stroke assessment.
Patients also have the option of receiving a noninvasive ultrasound to detect preliminary signs of heart attack and stroke, and/or a DNA analysis to determine predisposition toward certain inherited diseases; both can be performed at a discounted rate.
Benefits of membership also include a portable CD medical record, access to a referral network of medical centers of excellence such as the Mayo Clinic and Memorial Sloan Kettering Cancer Center for complex conditions and, even, care for visiting relatives. Statistics show 75% fewer hospitalizations for Medicare patients and 65% fewer hospitalizations for those patients with commercial insurance. In addition, the company estimates its patient management saves $300 million in Medicare payments per year.
The company boasts a 96% membership satisfaction rate along with a 92% annual patient renewal rate. In a decade, MDVIP has grown its nationwide membership to 180,000.
“It's been a wonderful experience,” says Casper, the associate commissioner for public affairs for the LSU Board of Regents. “MDVIP gives you the opportunity to experience health care in a way that is different from your average personal physician experience.”
Although she's only had two appointments—one for diagnostic testing and another to receive results—Casper is already impressed. “To have 30 minutes [with the doctor] to ask questions, begin to build some baseline data, look at your history and be able to move forward is so super smart,” she explains. “It's about keeping you healthy longterm.”
Besides the in-depth medical profile, the component that was most attractive to Casper is 24/7 direct access to her physician via cell phone or email.
“I think it's pretty shocking in this day and age to have the cell phone number of your physician. Even after hours, you're not going through an answering service,” she explains. “So if I'm in Washington, D.C., at a conference and get sick, [knowing I can call and talk to Dr. Lovell] is a great relief.”
The nationwide travel program also allows Casper to see a physician affiliated with MDVIP anywhere in the country.
“To me, $1,500 is a small price to pay for that level of service,” says Casper. “When I'm sick, being off of work for a week is just not an option. So being able to get in, get diagnosed and get on the road to recovery is really important.”
In her previous experience with doctors' offices, getting back on the road was challenge enough. “If you're there at 7:30, you're lucky if you get in at 8:30,” Casper recalls. “[Dr. Lovell's staff] were on time. They call you by name. You don't feel like a number. You feel like a person. I think in health care that's the way it should be, but it's not the way it always can be.”
Casper is not alone in that perception. “We're seeing more growing demand across the country,” says Hecht. “Patients want to focus on wellness and prevention. They want to have a strong relationship with their doctor and somebody who can coordinate care if they need it.”
These days, patients and physicians are increasingly frustrated with the bureaucracy, expense, fragmentation, inefficiency and inaccessibility of the nation's health care system.
While many uninsured Americans use emergency rooms because primary care remains unaffordable, the insured often “doctor hop” because seeing the same physician for every visit is inconvenient or not feasible.
Unless they have a chronic condition that requires constant monitoring, patients have trouble finding—much less maintaining a relationship with—a doctor who understands their medical history, manages their health proactively and ensures they receive appropriate care in a timely fashion.
Furthermore, “Our country and our state are both experiencing a perfect storm of spiraling medical inflation coupled with poor patient care outcomes and an obesity epidemic that's driving chronic disease through the roof,” declares Blue Cross and Blue Shield of Louisiana in a recent statement issued in response to questions from inRegister. “Louisiana was recently ranked 50th [the worst] in the nation in overall health indicators. Experts are predicting doctor shortages in primary care, general surgery and other key specialty areas, and Medicare cuts seem likely.”
Those factors and the demise of the physician-patient relationship have been a source of disillusionment and dissatisfaction for doctors as well. Caught between high overhead and decreasing reimbursements, many primary care physicians juggle 2,500 patients just to keep their practices afloat.
“The national average per routine primary care office visit is about six minutes,” explains Lovell. “Most primary care physicians would like to do a better job of prevention and wellness, but [they are bound by] time constraints.”
To make sure they have time to spend with each individual, physicians affiliated with MDVIP agree to limit their practice to no more than 600 patients.
“Folks who just blossom may have been patients who were more difficult before,” Lovell says, “because I didn't have time to deal with all their questions.
“Now, I welcome that. I have time for 30 minutes' worth of coaching. Patients hear you better when you spend more time with them, and they're more likely to change their lifestyle.”
After deciding to convert his practice to the MDVIP model, Lovell held a series of educational forums and invited all patients to remain with the practice. Some left because they were unable to afford the membership fee; others were simply skeptical of the new approach to medicine and chose to find another conventional practice.
Per MDVIP's protocol, Lovell made arrangements for those individuals to transfer their care and medical records to colleagues with the capacity to accept new patients. Initially, 400 patients made the transition to MDVIP, and an additional 30 have since returned to Lovell's care. The practice's adult patient population hovers around 550 and ranges in age from 32 to 88.
Not everyone is enamored with personalized medicine. Critics view the practice model as elitist, alleging decreases access to the country's shrinking number of primary care physicians and encourages doctors to treat only those who pay a premium.
But Lovell disagrees. Because many families spend routinely $200 on monthly cable TV, Internet or phone packages, he believes decisions to join his practice for $125 a month usually come down to more than money.
“It's really a value judgment. Where are you going to get the biggest bang for your buck?” says Lovell. “Is this important to you? Do you really think you can alter your wellness and your health in the future?”
Furthermore, the increases in paperwork and reductions in reimbursement have already prompted physicians throughout the country to limit or completely eliminate Medicare and Medicaid patients from their practices. Unfortunately, many doctors who pursue independent, cash-only, fee-for-service practice have a difficult time keeping up with regulatory issues and technology.
Some personalized practice advocates contend the model has the potential to expand the nation's cadre of primary care physicians. By providing a viable business model that values the physician-patient relationship over a volume-run practice, the concept might attract more medical students to internal medicine or family practice.
While it has been a long time coming, the personalized medicine concept is only one of the new models that seek to remedy the nation's health care woes.
“As people become more and more disenchanted with the way health care is going, we'll see more of these kinds of options,” Lovell says. “[This model] is really in line with what the health system wants to look like—with better physician-patient relationships, more prevention, less hospitalization and some cost controls, which are secondary to prevention and wellness.”
Editor's note: This story has been changed since its original publication.
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