Some Alabama doctors now offering concierge care

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TUSCALOOSA, Ala. (AP) — A growing model of health care has now come to Tuscaloosa.

An estimated 5,500 doctors in the United States are concierge doctors — physicians who charge patients an annual fee, usually ranging from $600 to $1,800 a year or more, in exchange for shorter wait times and more access for care.

In Tuscaloosa, Dr. David Fernandez, who has spent the last 15 years in urgent care, began offering a concierge practice in January. Dr. Steve Lovelady, who has practiced primary care medicine in Tuscaloosa since 1987, will convert to a VIP concierge model on May 20.

"With today's health care, there are fewer and fewer physicians who are seeing more and more patients," Fernandez said.

That means physicians in traditional practices may not have a time slot available. In turn, patients wait longer to be seen or must go to an urgent care center or emergency room for care.

"Patients are now deciding their time is important and valuable," Fernandez said.

While a concierge practice means shorter wait times and more access for patients, it also means a lighter patient load for physicians, which means concierge doctors have time to get to know their patients and to focus on preventive medicine, Lovelady said.

A traditional primary care doctor in the U.S. will see between 2,500 to 3,000 patients a year, while most concierge practices keep the number of patients to 600 or fewer.

"I think that every doctor really would like to practice more wellness and preventative medicine," Lovelady said. "Unfortunately our (traditional) model has been to react and treat sick people, rather than focusing on our ability to keep people well."

The annual fee at most concierge practices means an in-depth physical that could take as long as two hours and includes an EKG, blood tests, spirometry testing, body-fat analysis and nutritional analysis. Doctors discuss family history, risks and review a physical workup. Patients who are members of a concierge practice are also usually given cellphone numbers for their doctors.

"They will have a direct line to me and can reach me 24/7, rather than going through the traditional phone-tree system," Lovelady said.

The same is true for Fernandez. Being a concierge patient could mean that if you travel during the week, you can make an appointment with a doctor on the weekend, or even get a house call if it's needed, Fernandez said.

"Again, you are paying for access and paying for convenience," Fernandez said.

Concierge medicine began in 1996 when a former team doctor for the Seattle SuperSonics professional basketball team left his practice and started a concierge service, MD2.

According to Concierge Today, a publication for the concierge industry, the number of concierge doctors in the U.S. has grown from 3,500 in 2011 to about 5,500 in 2013. The American Academy of Private Physicians estimates that concierge doctors serve almost a million patients in the U.S.

But there is no record of the number of concierge doctors in Alabama, according to the Alabama Board of Medical Examiners.

MDVIP, a concierge program that includes more than 700 concierge physicians nationwide, had its first concierge doctor in Alabama in 2004, and now has six MDVIP concierge doctors in Birmingham and eight physicians in Huntsville. Lovelady will be the first MDVIP physician in the Tuscaloosa area once his practice converts to concierge in May.

"We started MDVIP 12 years ago, literally with doctors and patients getting together and saying there had to be a better way," said Dan Hecht, CEO of MDVIP. "Doctors were running faster and faster on a treadmill and couldn't keep up with patients, and patients were tired of waiting 45 minutes to see a doctor."

Tuscaloosa resident Justin Little has been a patient of Lovelady's for the last decade and has decided to join the concierge service.

"(The) thing that appeals the most to me is the preventative nature of the practice," Little said. "It's well worth paying a little extra money up front to go ahead and get a preventative health plan in place. It almost seems to me like it is a reversion to the old way of practicing medicine, when you spent time with your patients and had time to assess individual needs going forward."

While some concierge doctors, like Fernandez, give insurance paperwork for patients to file on their own for reimbursement, other concierge doctors, like Lovelady, file insurance in-office and require co-pays. But the annual membership fee is out of pocket and not covered by insurance.

Despite the cost, it's a growing model of care, and patients renew their membership to MDVIP concierge doctors at a rate of 94 percent, Hecht said.

But the concierge concept is a model of care that could also put pressure on the rest of the primary care system and make availability of care even more difficult for those who cannot afford it, said Dr. Richard Streiffer, dean of the college of community health sciences at the University of Alabama.

"It's going to be a development that will only be reachable by a small subset in the population and not contribute in a meaningful way to solving the problem of our health care system," Streiffer said. "It doesn't address the population with the greatest need, and instead is giving those who already have the access and can afford the access the Cadillac of service."

Most of Alabama is considered in a "health professional shortage area" for primary care, meaning there are not enough primary care doctors either to serve the number of people living in a certain geographic area, or enough physicians to service a certain population of people, like people who are low-income.

According to the Alabama Department of Public Health, Tuscaloosa County has a shortage of primary care doctors specifically for people in poverty. Much of the rest of West Alabama, including Lamar, Fayette, Pickens, Greene, Sumter, Marengo, Hale, Perry and Bibb counties do not have enough primary care physicians for the geographic area — meaning there aren't enough doctors working in rural areas.

If more doctors switch to the concierge model, it could mean fewer physicians trying to treat everyone else, and could make the shortage even worse, Streiffer said.

"We are substantially under-supplied of primary care," Streiffer said. "People have difficulty finding a primary care physician. We are seeing an aging primary care medical staff across the country, and if practices shrink because they are going concierge, it does stand to exacerbate the (lack of) access of care."

In comparison, the only counties in the state who do not have a shortage of primary care doctors are Madison, Shelby, Etowah, Calhoun, Tallapoosa, Pike, Coffee, and parts of Jefferson, Covington, Escambia and Baldwin counties.

Concierge care offered with insurance could also be considered double billing. The Office of Inspector General of the U.S. Department of Health and Human Services has warned that charging Medicare patients an annual access fee to receive care that is already covered by Medicare could be considered double billing.

Although concierge medicine is a growing trend, it's not something that Streiffer expects to be widespread, especially in poor states like Alabama.

"I would guess this will be found in larger cities, like Birmingham, Huntsville and Mobile," Streiffer said. "You have to have a certain level of affluence for this to work. It's not going to serve folks who are inner city or blue collar, the Medicaid or working poor, it's not going to benefit them at all."

But as with Lovelady's practice, there could be some continuation of care. Although he has sent letters to his patients notifying them of the change to concierge service, his practice is also in the process of hiring another physician to work in his practice and care for patients who are not part of the concierge membership.

"MDVIP's commitment to me and to my patients is that no one would be left without good medical care in the end," Lovelady said. "We are recruiting another doctor for the traditional part of the practice."

Continuity of care is important when a physician is making the switch to a concierge practice, Hecht agreed.

For many physicians, the concierge model is an a way to continue working in the medical field.

"We are helping extend a physician's career rather than them leaving the practice of medicine," Hecht said.


Information from: The Tuscaloosa News,

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