Physiatry Practice Management Resources

Christine Wiebe Fed up with the pressures of managed care, a small cadre of physicians is forming "concierge"-style practices that offer top-notch accessibility and service - at a price.

Imagine getting in to see a doctor the same day a medical problem arises, or being able to call the doctor's cell phone at any hour for a consultation or prescription. Imagine a primary care physician accompanying a patient to a specialist's office in order to coordinate their care, or actively managing a patient's weight-loss program.

About a dozen or so doctors in a few pockets of the country are working to make that version of medical utopia a reality. Fed up with the harried and depersonalized approach demanded by managed care payers, a small number of doctors have formed new "concierge"-style practices that offer that a high level of accessibility and service.

The services offered through these practices don't come cheap, of course. Physicians are able to offer them by reducing patient loads and charging extra service fees. Although the medical concierge trend is still fairly new, these doctors have been successful enough that they are spreading their vision across the country, enlisting other doctors to follow their lead.

Meanwhile, critics have lobbed harsh accusations of greed and elitism at this physician cadre. They argue that America should be closing the widening gap between the insured and the 40 million uninsured, rather than adding yet another tier of medical care.

"It's adding an obscene third level to the way we deliver health care in this country," declared Martin Solomon, MD, a prominent Boston internist and instructor at Brigham and Women's Hospital. He was solicited by the largest group, called MDVIP and based in Boca Raton, Fla., but he remains unpersuaded.

"I did not go into medicine to just take care of rich people," he said.

Doctors involved with these special-services practices take issue with that characterization, however. In fact, the prices and range of services vary considerably, from the most exclusive, called MD2 (pronounced MD-squared), which costs $20,000 a year per couple, to the more affordable services of MDVIP - "the cost of a latte a day," as backers like to say.

Serving Different Clienteles
There's a reason why the price of latte is bandied about: The medical boutique trend started in Seattle, where a daily expenditure for coffee is considered the norm. Founders of MD2 believe they were the first to design and promote a boutique practice in 1996 that provides first-class service to an elite clientele. In 2000, they opened the first "franchise" across town, and are planning to expand across the country.
"Most of these patients are incredibly mobile people, with multiple homes," said Duane Dobrowits, chief executive officer. The company is in discussion with 30 practices across the country, seeking to build a network that could provide services wherever its clients travel.

An annual retainer paid by patients covers the costs of all primary care, but they are expected to carry insurance for hospitalizations, he explained. Physicians care for a maximum of 50 "family units," and they do not deal with any managed care restrictions or insurance claims. "We simply don't go there," he said.

Dobrowits is unfazed by charges of elitism just because the company provides special services to its clients.

"There is a niche of people who want this access," he said. "These are the same people who send their children to private schools. We're simply filling that demand."

Although the MD2 clientele is undoubtedly wealthy, other service-oriented practices are catering to the middle class for much lower fees. Services range from priority phone lines to broader preventive care, and clients still carry medical insurance and are responsible for co-pays and deductibles, in addition to the annual service fees.

"Patients interested in our practices are definitely different than the ones paying $20,000," said Ed Goldman, MD, president of MDVIP, a group of eight Florida doctors that charges $1,500 a year for non-insured services.

"By charging for these services, we're able to generate enough income to reduce the patient size of the practice," he explained. Patients wait less than two minutes on average for their appointments, which usually are scheduled the same day they call.

Doctors have enough time with patients that they can focus on preventive care, which is only given lip service in most traditional practices, Dr. Goldman said.

"I see this as being a niche for patients who are interested in preventive care and for physicians who are interested in providing that," he said. The group is planning to expand and eventually could include 100 or so doctors nationwide. Doctors who have expressed interest in joining tend to be older, locally prominent and pro-active in preventive care, "and they are not happy with what they're doing now," Dr. Goldman said.

Physicians wishing to join must close their existing practices and start over, with no financial guarantees and with severed ties to the majority of their patient population. Some patients have complained about being "abandoned" in the process, and have even complained to Medicare officials, prompting probes by state officials and legislative debates.