The Cincinnati Enquirer
March 18, 2013
Medical practice offers service for flat fees
When doc is always in, patient care wins
By Lisa Bernard-Kuhn
Dr. Jerry Tolbert says he’s gotten back a precious asset that physicians across the country are scrambling to find: More time with patients.
Less than two years ago, the Burlington-based doctor struck out with his son Dr. Gerry Tolbert to open Total Access Physicians (TAP). The concierge-style practice charges patients an annual fee of $900 to provide all of their primary care services, regardless of the number or complexity of visits.
In return, patients get as much face time with their doctor as they want, as well as the physician’s personal cell phone and email address.
“If a patient needs to be seen in the evening, we’ll see them in the evening. If there’s an emergency, they can … call me and get answers to their questions,” said Jerry Tolbert. “It’s a newfangled way for old-fashioned medicine.”
Similar practices, also known as direct primary care, are popping up nationally as physicians look for new ways of doing business in a industry beset by reforms and rising costs.
For now, the model represents less than 1 percent of country’s physicians. But concierge practices grew by 25 percent in 2011 to 4,400 doctors, according to the American Academy of Private Physicians, a membership-based non-profit in Virginia.
For most doctors, “the only way to stay afloat is to see patients in faster volumes, but at some point, the pace of delivering care strips all the satisfaction for physicians and effects the quality,” said Tom Blue, executive director of the academy. “Private medicine is a good alternative for those doctors who want to maintain their independence and financial stability.”
In a nationwide survey of 13,000 physicians, 7 percent said they would consider switching to a concierge model in the next three years, according to The Physicians Foundation, a national doctors advocacy non-profit. Nearly 9 percent of physicians surveyed in Ohio and 3.4 percent in Kentucky said they’d consider the move.
At Total Access Physicians, the group has about 150 patients. The practice recently added Dr. Teresa Koeller, who previously worked alongside Jerry Tolbert at St. Elizabeth Physicians, a division of St. Elizabeth Healthcare that has 290 doctors.
“I didn’t feel like I had control anymore,” said Koeller. “It used to be that if you wanted not to charge a patient for something provided you had that option, but when you lose control of billing and receipts, you can’t do that.”
While private physicians have long been employed by the affluent, new models like TAP are making it more affordable to patients of varying incomes, said Phil Miller, a spokesman for Merritt Hawkins, a national physician recruiting firm based in Irving, Texas.
TAP also accepts patients who want to pay directly for services, rather than a monthly or annual fee. New patient visits are $75, electrocardiograms cost $30 and routine labs are $10. While patients who pay per service don’t get the perk of having a physician on call, it can be a benefit to patients who don’t have insurance or can’t get into their regular primary care physician.
More than half of TAP’s patients do have insurance, although the practice doesn’t bill insurance companies for their services. Instead, they say the cost of their services are included in the annual fee. . About 25 percent of TAPS patients have no health care coverage, including Alexandra Henderson, a 24-year-old Fort Mitchell resident.
“I can always text my doctor and ask him any kind of question,” said Henderson.
Early data suggests patients who see a direct care physician have fewer emergency rooms trips.
Within MDVIP, a national network of 600 concierge-style physicians, Medicare patients saw a 79 percent reduction in hospital admissions, and a 72 percent decline for those with commercial insurance, according to the company. The findings were reported in December in the American Journal of Managed Care. As a result, MDVIP, which has more than 200,000 patients, delivered a health care system savings of $300 million.
MDVIP, a wholly-owned subsidiary of Procter & Gamble, has 10 physicians practicing in Greater Cincinnati. Physicians do bill insurance in addition to an annual fee that starts at $1,500 per patient. That fee covers a “robust, executive style physical,” said MDVIP CEO Dan Hecht, who spent 20 years working with P&G’s health care brands and innovation.
Dr. Charles Eger joined MDVIP less than two years ago. As part of his care, he offers regular “walks with the doc” to help keep his patients active. Other MDVIP physicians take patients grocery shopping to help them make healthier food choices.
“ I feel like I’m in an integral relationship with my patients that’s keeping them healthy,” said Eger.
Cincinnati is a testing ground for MDVIP’s newest venture, Hecht said.
The practice is working with brokers here and nationally “who are going to employers and signing up their employees into MDVIP practices,” said Hecht. “There are a number of employers in Cincinnati who have already signed on, and it’s an area that P&G is getting behind to explore how to bring in its employees.”
Hecht declined to name other companies taking the leap, but said some are covering the full annual fee as part of their benefit packages.⬛
Still, for those consumers that don’t have the extra money, the concierge model isn’t an option.
“In general, doctors who convert to this style are seeing fewer patients overall, which exacerbates the problem we already have with the shortage of primary care physicians,” said Miller. “But in their defense, doctors are tired of being on this treadmill where they are seeing a patient every five minutes.”
At Total Access Physicians, the doctors hope to max out at about 900 patients each. That nearly 1,200 less patients than Jerry Tolbert says he used to see.
“The only way I can give patients the time I feel is appropriate for me is to have a practice model where the patient and I have a relationship,” Jerry Tolbert said. “Not an insurance company. Not a hospital. Just myself and the patient.”
A growing practice
• Concierge practices, also known as direct primary care, are becoming more common across the U.S. Physicians see them as one solution for doing business in an industry beset by reforms and rising costs.
• Patients can pay a flat annual fee for primary-care services or pay per visit.
• The model now represents less than 1 percent of the country’s physicians.
• Concierge practices grew by 25 percent in 2011, though, to include 4,400 doctors, according to the American Academy of Private Physicians, a membership-based nonprofit in Virginia.