Concierge Medicine: Greater Access for a Fee

AIR DATE: July 9, 2012 — Health correspondent Betty Ann Bowser looks at a new health care trend called concierge medicine that involves offering specialized care for those who can afford the price tag.

GWEN IFILL: It’s a common refrain. Patients say it’s getting harder to see a doctor. And when they do, they feel pressed for time. But for a price, a small, but growing number of clinics offer a more boutique relationship, a model of care that raises questions about equality and access.

NewsHour health correspondent Betty Ann Bowser reports.

MAN: Up. Open.

BETTY ANN BOWSER: It’s 6:00 on a recent Tuesday night in Katy, Texas, and time for a little tai chi.

MAN: Turn the palm down. Press down.

BETTY ANN BOWSER: This is just one of the unusual things Dr. Ramon Solis does for his patients.

Have you ever made a house call?

DR. RAMON SOLIS, MDVIP physician: Yes, I have.

BETTY ANN BOWSER: Have you ever gone to the emergency room to meet a patient?

DR. RAMON SOLIS: I do that all the time.

Do you have that copy for me? Can you put it on my desk?

WOMAN: Absolutely.

DR. RAMON SOLIS: Thank you very much.

BETTY ANN BOWSER: Dr. Solis runs a unique kind of practice, with the help of a consulting firm called MDVIP.

DR. RAMON SOLIS: And tomorrow, we’re ready for the first patient in the morning?

WOMAN: Yes, sir. It’s at 8:30.

BETTY ANN BOWSER: For about $1,500 a year, patients are allowed to join Solis’ practice in return for more face time with the doctor. It’s called concierge medicine.

BETTY ANN BOWSER: What happens if somebody gets sick at 2:00 in the morning?

DR. RAMON SOLIS: It happens, and they wake me up. And you know what? I ask for that.

BETTY ANN BOWSER: Six months ago, Solis signed on with the Florida-based network of about 500 primary care physicians.

DR. RAMON SOLIS: And how are you doing on the Lipitor right now?

MAN: Doing great.

BETTY ANN BOWSER: The consulting firm helped him convert his 21-year-old practice of 3,000 patients to just 400. That means most people can get same-day appointments that last 30 minutes or longer.

Mark Murrison is the company’s president of marketing and innovation.

MARK MURRISON, president of marketing and innovation, MDVIP: Our doctors are primary care doctors and doctors who have really become frustrated with what has become conveyer belt medicine. They’re seeing 30, 35 patients a day. They’re spending less and less time with their patients.

BETTY ANN BOWSER: Linda and Richard Henning have been patients of Dr. Solis for years. When they found out he was converting to a concierge practice that would cost them $150 a month, they were concerned. They are both retired and on Medicare.

LINDA HENNING, patient: Being on a fixed income, basically, we’re thinking, how can we afford this? But, you know, our health is important, because you have nothing if you don’t have your health. You’re gone.

BETTY ANN BOWSER: Linda gets emotional talking about this, because just a few months after signing up, Solis discovered Richard had lymphoma. Overnight, he needed tests, scans and appointments with cancer specialists, which Solis arranged.

RICHARD HENNING, patient: Dr. Solis went the extra mile to make those phone calls to get us in immediately. So the time from concept of having cancer has really moved along so fast.

DR. RAMON SOLIS: With the reduced number of patients that I can see, I am able to return those calls and those labs in a shorter period of time than the typical doctor.

BETTY ANN BOWSER: Solis has also taught Richard some meditation techniques to manage his pain.

There are no firm numbers, but it’s estimated there are between 1,000 and 5,000 concierge practices in the country today. Health policy researchers think the concept is getting more popular. Some of the doctors accept insurance. Others take cash only to avoid having to deal with the bureaucracy of insurance companies.

Most charge big bucks for membership, anywhere from $5,000 to $20,000 a year. But MDVIP saw a market for practices that charge a lot less, about $150 a month per patient. They limit practices to no more than 600 people, but take insurance.

Murrison says 92 percent of patients renew their memberships each year, and part of the reason is the emphasis on preventive medicine, which saves money by keeping people in good health.

MARK MURRISON: Our hospitalization rates are 72 percent to 79 percent lower than when you look at non-MDVIP members. When you look at the Medicare population, it is 79 percent lower than non-MDVIP members in Medicare. And when you look at the commercially insured, it’s 72 percent. So there is a real demonstration that this approach to care works.

BETTY ANN BOWSER: But Dr. Pauline Rosenau of the University of Texas questions claims like that. She says there is no way to know if concierge practices are cherry-picking the healthiest patients and skewing the numbers.

Plus, she worries about the lack of state or federal regulation to protect consumers.

DR. PAULINE ROSENAU, University of Texas School of Public Health: I think they may be selling this to doctors, just like they are selling it to patients. And, in both cases, buyer beware, keep your eyes open, read the fine print before you get involved.

And I worry when we’re basing it on emotion and advertising, rather than the facts.

BETTY ANN BOWSER: MDVIP says its research shows people trust its business model. In five years, membership has tripled to 180,000. The average age of patients is 55.

STEPHEN KELLY, patient: Hi, this is Steve Kelly. I’m a patient of Dr. Burpeau’s. And I was trying to get in for a follow-up to my back problem I was having. Oh, yes. OK. I can be there in about an hour.

BETTY ANN BOWSER: Fifty-one-year old Houston energy analyst Steve Kelly has no reservations about the $1,500 a year he’s spending.

STEPHEN KELLY: I think it’s definitely worth it. I’m 51 years old. I want to stay healthy. I have two young kids. That’s probably top priority in my life right now. So anything I can do to remain that way, I’m all for it.

BETTY ANN BOWSER: Five years ago, when Houston internist John Burpeau became an MDVIP doctor, he was on his way to burnout. He was tired of shortchanging patients with eight-minute office visits.

DR. JOHN BURPEAU, MDVIP physician: I think people are used to the old way and they think doctors the way they used to be. And Marcus Welby and those like him, they don’t exist anymore. They have been driven out business, because to take your time and to spend the time with a patient financially doesn’t — doesn’t work. You can’t run a business like that.

It works out to be about $4.25 per patient per day. It’s affordable. But they have to choose to pick it, and they may be giving something else for it.

BETTY ANN BOWSER: Texas has more uninsured people than any state in the nation, and that fact prompts health policy analysts like Rosenau to question what happens if this concept grows more popular.

DR. PAULINE ROSENAU: Concierge seems so unjust because it’s making more care available to people who are willing to pay more. Our health system has an equity problem to begin with. So many people don’t have health insurance. Here in Houston, it’s 33 percent.

DR. RAMON SOLIS: I’m not here to fix a system, but what I’m here to be is a part of the solution. And part of the solution is to work on preventive measures. We have freedom of choice and we have options. And me, in a small community of Katy, Texas, I’m trying to do my part for my community.

BETTY ANN BOWSER: MDVIP believes its brand of concierge medicine, like Dr. Solis’ practice here in Katy, has great growth potential, especially as baby boomers age.

If the idea continues to catch on, they contend it will also become more affordable for average Americans.


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