Kentucky “Concierge” Medicine: Personalized Health Care

By John Varga, M.D.March 2, 2013 —  Imagine a medical practice designed to not only take care of you when you’re ill but also to provide the ultimate in preventative medicine.  One where your entire history (medical, surgical, dietary, exercise, alcohol, tobacco, stress, sexual, family/genetic) is reviewed in detail regardless of the time it takes.  One where diagnostic tests can be ordered based on their merit instead of the possibility of them being reimbursed by your insurance policy.  One where all of this information can be summarized and personalized specifically for you.  One where a plan of action can be formulated, taught, and followed up to completion.  This is the idea behind our new retainer-based internal medicine practice, OneMD.

My partner, Dr. Mark Wheeler, and I have long been frustrated with our inability to practice truly preventative medicine.  It has not been for a lack of desire or effort, but rather because the current medical system is not designed to promote prevention.  It is instead constructed to treat patients after they become sick.  Because of dramatically increasing overhead (including skyrocketing malpractice premiums) as well as declining reimbursements (Medicare payments to physicians have gone down 4-5% each of the last two years), physicians are forced to increase their patient load to anywhere between 3000 and 5000 patients each.  Primary care physicians are therefore forced to prioritize caring for the acutely and chronically ill, leaving very little time to attend to preventative issues.  This only snowballs into more medical problems since they cannot be addressed in their infancy.

Consider the following:  17 million Americans have diabetes, 102 million have a total cholesterol over 200, 50 million smoke, 60% are overweight, and over 60% are not regularly active.  Obviously not all illness can be prevented but certainly a great deal can be, and should be.  The reason it isn’t can be partly explained by time constraints and poor reimbursement.  Current patient loads don’t allow for much time to counsel each patient and make it difficult to clear space for adequate follow up.  Counseling for obesity, exercise, and smoking cessation is insufficient, and medications for obesity and smoking in general are not reimbursed.  Is it any wonder the Surgeon General has said obesity is the number one health concern in America?  Yet the current medical system is incapable of addressing it.

The current state of medicine has everyone frustrated and perplexed:  patients, physicians, office staff, hospitals, nursing homes, employers, and politicians.  In our case, at the end of the usual long day in the previous system, we would find that everyone was unhappy.  Patients were unhappy waiting two weeks to get an appointment and then up to 90 minutes in the waiting room just to see us for 5-15 minutes.  Our staff was unhappy because the patients were upset with them and we were running behind and stressed.  Our families were unhappy because we were never home, and when we were, our frustrations were evident.  We wondered if there wasn’t a better way.

Enter OneMD.  Dr. Mark Wheeler and I have had the opportunity to develop what we believe is the ideal practice:  from the physical office space to the patient flow to the ancillary services.  The entire emphasis is on providing premium service for our patients and putting the “health” and “care” back in healthcare.  By charging an upfront fee, we are able to maintain a total of only 600 patients between two physicians.  This allows us to spend much more time with our patients:  performing an annual complete physical exam more detailed than those performed at the Mayo Clinic, allowing same day appointments with no waiting, enabling 24/7 access to the physicians who can personally return calls promptly, and insuring personalized service that we were unable to provide in the past.  Patients have a physician to help them navigate the healthcare maze of referrals, overrides, and precertifications.  Sure we obviously still take care of sick patients, but we are also now able to devote more time to those that put staying healthy at a premium.  Both patients and physicians are happy and fulfilled.

We in Louisville have been blessed in the past with excellent healthcare, in some instances world-renowned healthcare.  Physicians in our area work very hard within the system to provide the very best for their patients, but they are constrained by the current healthcare crisis just as we have been.  We in no way mean to belittle the diligent efforts of our colleagues who are struggling through the current system.  Instead OneMD is offering an alternative to those patients that put their health at a premium.  Our practice is not going to solve everything that is wrong with healthcare, but it certainly provides a venue for the delivery of medical care that allows ample time for prevention as well as treatment of problems in a comfortable, relaxing, and satisfying environment.

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John Varga, M.D.,  has been an internist in Louisville for over 11 years.  He plays golf and is an avid runner.  He has run 4 marathons as well as numerous mini-marathons and was a varsity tennis player at the University of Kentucky.  He can be reached at his office at 899-7163 or by e-mail at


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