Concierge medicine on call in NoCo

FORT COLLINS – You can call it concierge medicine or boutique medicine or even wealth care, but David Abbey, M.D., calls it the kind of care he always wanted to provide.

“There’s been a lot of changes in primary care in the last 10 to 15 years and more barriers between patients and doctors,´ said Abbey, who with his partner at the Internal Medicine Clinic in Fort Collins, Robert Homburg, M.D., recently switched to the relatively new concierge model. “The (traditional) system seemed to be getting out of control.”

With reduced reimbursement from insurers, many primary care physicians have a financial incentive to see more patients for shorter visits – sometimes for no more than 10 or 15 minutes.

About two months ago, Abbey and Homburg joined MDVIP, a Florida-based national network of physicians whose patients pay a $1,500 annual fee to have almost unlimited access to their doctor. For those patients who sign up, there are no long waits in the office, they can get the doc’s cell phone number, and their appointments are unhurried – up to 30 minutes of doctor face-time.

“I’m finally able to do what I was trained to do,” Abbey said. “A lot of primary care is psycho-social issues and people really need time to sit and talk about their issues.”

Patient Leo Peterson said finding a concierge-style practice was a lifesaver for his wife, Lea, who had suffered a variety of health problems for many years. But that changed when the Petersons found Abbey.

“He agreed to see my wife the next day and admitted her to the hospital,” Peterson said. “He took the time and he was a key to accessing the specialists who got to the root of the problem.”

Peterson said he “couldn’t be happier” with the service provided through Internal Medicine Clinic and MDVIP. “It’s something that’s been needed for a long time.”

Internal Medicine Clinic is one of two MDVIP practices in Colorado, with the other at Lakeview Family Medicine in Littleton. It’s estimated there are fewer than a dozen in the state, although the concept has been spreading across the nation since around 2000.

In 2005, there were about 500 doctors practicing what’s generally referred to as concierge medicine. Last year, there were 10 times that number, according to the Society for Innovative Medical Practice Design, a professional society of concierge physicians.

Growing steadily

MDVIP, founded in 2000, now has 320 physicians in 28 states and is steadily growing, according to Bret Jorgensen, MDVIP’s CEO.

“We’re continuing to round out the networks we’re in and every year we’re adding two or three more states,” he said. “The company is growing rapidly but in an appropriate and controlled fashion.”

MDVIP officials cringe at the term “concierge,” which has a fancy French sound to it and conjures up images of silver-platter care for the wealthy. “We prefer ‘preventative personalized health care’ – that’s the service we offer,” Jorgensen said.

Darin Englehardt, MDVIP’s president, said the original intent of the company was to focus on “proactive care and prevention” to help keep people from ending up in the hospital. That led to the decision to require its doctors to reduce their practices – often at 2,000 patients or more – to no more than 600.

“We came to the conclusion that a practice limited to 600 would allow time for broad-based prevention,” he said.

Jorgensen said limiting practices to no more than 600 patients does not mean a reduction in income for the doctors, who still accept payment from traditional insurers for covered services. “Our physician incomes are as high or higher than they’ve had in the past because of the additional revenue stream (from the annual fee),” he said.

MDVIP works with its practices to find other doctors for patients who don’t want to pay the extra $1,500 for the streamlined care. In addition,  individual MDVIP practices can set their own rules on how they charge patients for that fee. For example, at the Internal Medicine Clinic, adult members each have to pay $1,500 annually but children up to age 25 in the same family get the same service for free.

Abbey said he had to say goodbye to some of his longtime patients to join MDVIP. “The hardest part was in no longer seeing patients I’ve seen for 20 years,” he said. “But for those that stick, you can just see there’s no comparison.”

Not just for rich

Some critics of the new model say it’s aimed at serving the wealthy, but its defenders say that’s not true.

“We run the full gamut from the wealthy down to the blue-collar worker and everything in between,´ said Jorgensen, who notes that about half of the patients seen by MDVIP doctors are enrolled in Medicare.

Abbey said he’s been “surprised” by the group of patients who signed up at his practice. “It’s the full spectrum,” he said. “It seems they’re making a life-value decision.”

And at about $125 per month, the service costs not much more than cable TV, Jorgensen notes.

Leo Peterson said coming up with $3,000 for him and his wife wasn’t easy, but added, “It’s well worth it for the peace of mind.”

And with health-care reform very much on the minds of legislators, doctors, insurance providers and consumers, MDVIP’s Englehardt said he believes there will be a place in a reformed system for the kind of service his company offers.

“Our model is all about patient choice,” he said. “The president is ready to create a model that’s more patient-focused, has improved outcomes and controls costs, and that’s exactly what we do.”

Adds Jorgensen: “We expect to thrive and grow regardless of what comes out of Washington.”

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