Just what the patient ordered: ‘Concierge medicine’ comes to Lawrence
Tom Bryce needs a new doctor.
Bryce, of Lawrence, has been under the primary care of Lawrence physician Dr. Steve Dillon for more than 20 years.
“Dr. Dillon is a fantastic doctor,” Bryce said. “I’ll miss him.”
Why the change?
Dillon is one of two doctors in Lawrence who have joined a “concierge medicine” practice, a model new to Lawrence that has some patients questioning what their health care future looks like in Lawrence.
What is it?
“Concierge medicine” is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. It’s not a new concept: The first concierge medicine practices started in Seattle in 1996, according to Concierge Medicine Today, a trade publication that also runs a research collective on the industry.
Two Lawrence primary care physicians have moved into the concierge realm.
Steve Dillon and Eric Huerter have decided to affiliate with MDVIP, an organization of doctors who follow its practice model. MDVIP doctors charge an annual membership fee that ensures a patient’s 24-7 access to the doctor, ability to participate in a comprehensive wellness program and access to a national network of physicians.
Membership also includes several health screenings for heart health, diabetes and other conditions that are typically not provided during routine care or annual physicals and are not usually covered by insurance.
Doctors affiliated with MDVIP are capped at 600 patients, rather than the typical 2,000 to 3,000 patients most primary care physicians have, which allows the patients on the doctor’s roster to get same-day or next-day appointments or even a house call. MDVIP doctors also spend a minimum of 30 minutes with a patient during an office visit, and the appointment can last as long as necessary, according to MDVIP literature.
The model still requires that patients have insurance, and patients are still responsible for co-pays and out-of-pocket expenses as required.
Geoff Husic, 56, of Lawrence, is a patient of Huerter. Husic said he likes the model because the health screenings included in the membership will give him a baseline for his health now, while he doesn’t have any chronic medical conditions.
“I’m at the age where things could potentially happen,” he said. “I haven’t had any health issues, so I don’t have a baseline. I’ll get these screenings while I’m healthy, then I’ll have a baseline to compare to if something does happen.”
For someone like Husic, who has a job and insurance, he said the switch to concierge medicine was not a difficult decision.
Others in Lawrence are not as comfortable with the change.
Bryce is still with Dillon until his practice switches to the MDVIP model on Nov. 1. But he will be looking for another doctor, he said, because the model isn’t worth the cost for him.
“It just doesn’t make much money sense to me to spend $1,650 out of my pocket when I have health insurance and I can go to another doctor and be seen, you know, and be covered,” he said.
However, his 71-year-old mother is another story.
Bryce said she had a difficult with the decision, because of the length of time Dillon had been their family doctor. But ultimately she decided to stay with Dillon and pay the fee, even though it may mean looking for part-time work to cover the new cost.
“It’s affecting people like my mom, and she is by no means wealthy, but she’s basically said, she’s going to bite the bullet and try it for this year to see if it is indeed worth it, and she’ll see what she can do after that,” he said.
MDVIP declined to make Dillon available to comment, as his practice is in transition to its model.
Huerter’s practice switched to the concierge model this month. Huerter sees the model as a way to provide better care; he can spend more time with patients and give them more individual attention. He provided a list of primary doctors to patients who were not staying with his practice.
And while he said he thinks the annual fee is “approachable” for most of his patients, he recognizes that the change — and the cost — will be difficult for some people.
“I’ve seen that in my patients that signed up,” he said. “I’ve had patients that chose against it who expressed that concern. And I’ve had a lot of patients who I just know are in a tougher spot, but for them, that peace of mind of having that richer relationship, the help and prevention — for their discretionary dollar, they did want this plan.”
Primary care shortage
Even those in the community who are not patients leaving a concierge practice might feel its effects in Lawrence. New numbers show that Lawrence is already short on primary care physicians.
Between retirements and doctors changing focus and practice models, the community is short 11 doctors who provide primary care, said Janice Early, vice president of marketing and communications for Lawrence Memorial Hospital.
All told, there are eight doctors who are retiring, changing focus or moving to concierge medicine in 2015. Steven Bruner and Joy Murphy joined Watkins Health Center at KU; Luis Salazar is joining OrthoKansas full time; Jon Barr, Rodney Barnes and Rodney Bishop are retiring in the fall; and Huerter and Dillon are limiting their patient roster through concierge care.
And the primary care and internal medicine doctors who are practicing in the community share the task of absorbing the patients who will be looking for new health care providers.
Patients may see more nurse practitioners and physician assistants during their visits as medical practices deal with the shortage of primary care doctors, Early said.
Through 2017, the hospital has a goal of hiring five more family practice doctors and six more internal medicine doctors, based on national benchmarks for physicians per population size, Early said.
“Those are difficult numbers to recruit,” she said. “We only got one (new doctor) in this new recruitment class. There were only two internal medicine physicians finishing their residency at KU Med who went into internal medicine as their practice focus.”
Early said Lawrence is in a good position for recruiting doctors. Family ties often lure doctors back to the area, and doctors who were once students at KU often want to return to Lawrence.
“They choose Lawrence for the lifestyle,” she said. “That’s one thing we have going for us.”
Levels of care
Bryce worried that the entrance of concierge medicine would mean a have and have-not system of health care.
“My first impulse is that this is creating a tiered system, because the people that can afford it are going to get first-class service, while the people who can’t afford it are just going to have to take what they can get,” he said.
Huerter said he thought the system already had many levels of care; the concierge model was a way to improve on the care available.
“I think it’s a multi-level system, and has been for some time,” Huerter said. “Within insurance offerings, there’s different levels of care, HMOs, from Medicaid to Medicare, so I think there are multiple tiers.”
Early said all doctors in the area, both in private practice and hospital practice, are trying to take care of their patients in the best way they can.
“We are all working together to take care of patients in the community, but there are sometimes different practices in what kinds of patients they take and what kind of insurance they take.”
Early said the process of changing doctors is stressful, and health care providers are feeling it.
“In our community we have a fixed number of providers, and patients who are looking for new providers; it’s not like we have a lot of primary care doctors sitting around waiting for patients.”
However, Early doesn’t believe people in Lawrence who have established relationships with their doctors are being given a lower level of care.
“In Lawrence, I don’t think we have factory-style medicine where you are out the door, time’s up — I don’t think we have that here.”
Local physician explores new model for primary care
Ryan Neuhofel is not a concierge, nor is his Lawrence medical practice adopting that model for patient care. But Neuhofel is an entrepreneur, and he is introducing yet another model to change how patients receive care from their primary care doctors.
In a practice unique to Lawrence, he has developed a direct primary care practice that operates on monthly membership fees and does not require patients to carry insurance.
He encourages patients to have some kind of health insurance policy, but it isn’t required. He looks at his practice as a simple, efficient complement to high-deductible insurance policies offered by many employers.
“I think about it and my patients think about insurance as, it protects them from an unexpected expensive thing, but beyond that it complicates things more than it helps,” he said.
The practice has a monthly membership fee structure ranging from $30 to $70 a month for individuals and $120 for a family plan. Patients who are part of his practice receive regular visits and many labs and tests as part of their fee. He offers many prescription medications at wholesale prices. He can do many routine procedures, like setting a broken bone or doing a skin biopsy, in his office for an additional fee.
He provides family health care and his patients can typically get in to see him the day they call. His patients have his cellphone number.
Neuhofel had heard of the concept of direct primary care early in his residency, but he decided after practicing for a while to give it a closer look.
“I decided to start with a blank slate,” he said. “I sat down with my laptop and said, if I can strip away medicine to its pure essence, which was me and patients — forget about the whole concept of insurance and co-pays and all of that stuff — how would I arrange that? So I started crunching numbers.”
Neuhofel has about 600 patients now, and is trying to hire another doctor to continue to grow. He thinks the direct primary care model will help alleviate the shortage of primary care physicians in Lawrence.
“The status quo system has certainly been a driving factor to this problem,” he said. “(It’s) really a matter of distributing docs in the right balance of specialities, rather than a true ‘shortage’ of physicians. Keeping existing primary care physicians in clinical practice and attracting med students is ultimately what is required.”
In exploring the business of running a practice on his terms, his practice has evolved. He speaks on the topic of direct primary care at national conferences and recognizes that his ideas have to work within the current system of health care.
“But in some respects I am not waiting around for the system, whether it be Topeka or Washington, to make my patients’ care and my job better,” he said.
Nikki White, patient liaison with TherapyWorks, worked with Neuhofel through Health Care Access, where she served as executive director for 15 years. She recognized the challenges that people have if they lack insurance or have limited provider options through Medicaid or Medicare.
“Maybe they could have afforded Dr. Neuhofel at $50 a month,” White said. “It’s exciting to see (his practice) grow since he was kind of a pioneer in the area, saying ‘Hey, I want to try this in a different way.'”