By Alice Kenny | March 22, 2013 | Dr. Thomas Pellechi arrived at the home of a Greenwich executive before dawn, took the man’s fasting blood work and finished in time for his patient to enjoy his morning meal.
Dr. Edward Kulich brought his black medical bag to the home of a feverish girl on a winter’s night, gave her antibiotics and treated her in time to avoid a rush to the emergency room.
Dr. Sarah Gamble accompanied a sick patient from specialist to specialist to interpret her medical issues and make sure she received the care she needed.
And Dr. Peter Cimino was able to spend extra time with a patient to assess his lifestyle and discuss important changes that would enable him to live more healthfully, with Cimino as a partner throughout his transformation.
Is this a dream? Where can we find doctors like this?
For starters, we need to look for practitioners of “concierge medicine,” individualized care in the comfort of our homes – or sometimes even in the doctor’s office. No central registry of concierge physician exists and while websites and Internet searches may help, most of these doctors depend on word of mouth. “My patients are my best advertisement,” Kulich says.
Doctors participating in the evolving field of concierge medicine offer a variety of services, options and delivery methods. Some work alone and make sure back-up doctors are available if they need to be away. Others work with partners. Some make house calls and maintain offices. Some, as in days of old, consider their patients’ homes their only office, bring their medical black bags with them and accompany patients to specialists and labs when further tests are necessary. And some concierge physicians offer hybrid practices, where most patients are “traditional” but some opt for the higher-level of services they receive as a concierge patient.
All concierge physicians, however, are required to meet the same federal and state regulations regarding medical care as doctors who provide typical in-office care, including rules regarding patient load and access to equipment. While there are no rules on the books unique to concierge physicians, most say that because the number of patients they care for is lower, the quality of service they provide is far higher.
Cimino, a partner with the Fairfield Medical Group who specializes in internal medicine, says he signed on with Concierge Choice, a marketing and service company that advises doctors interested in setting up concierge service, so he could continue to provide high-quality patient care that harkens back to the day before medicine became an industry ruled by insurance companies. Area concierge physicians affiliated with Concierge Choice can be found at www.choice.md.
“The way the system works now, there is really no way for people who need more time and help to get that [from their physician] without entering a concierge program,” Cimino says, adding doctors are forced to increase their patient load in order to stay solvent. “Most patients are set into a standard 15-minute slot, or a 35-45 minute slot for a physical examination. Everybody gets the same kind of cookie-cutter medicine. But we aren’t all robots and some people need more time. [Concierge medicine] allows for people who wish to have more time to be able to get it.”
Doctors who offer this service typically charge an annual retainer. Some charge per visit as well. And many, particularly those with no office staff, do not deal with insurance carriers, leaving that task to the patient.
Cimino says this isn’t an issue for his concierge patients. His hybrid office handles all insurance claims and paperwork. “Many doctors doing traditional medicine who are forced to see more and more patients a day to make ends meet are drowning in paperwork and are at the point where ¦ they have to decrease the amount of hours allotted to seeing patients,” he says, adding that his hybrid practice allows him to keep patient load manageable so he can devote appropriate time to his patients, both concierge and non-concierge.
Dr. Frank Scifo, who retired after 22 years of private practice in Stratford and is now medical director of the urgent care walk-in clinics and multispecialty group at St. Vincent‘s Hospital in Bridgeport, says concierge care reemerged just over a decade ago and really is a throwback to the days before insurance and seven-digit incomes. He agrees with Cimino, saying it arrived in response to what he describes as the “chameleon” of health care, an evolving system pummeled by politics, perspectives and pushbacks from insurance carriers.
Dozens of concierge practices have emerged throughout Fairfield County. They come in handy for everyone from bankers too busy for office visits to children too disabled to leave their homes to those who want their physicians to truly know them and help them get the best care possible.
Pellechi, a Greenwich internist who practices concierge medicine, describes himself as a “one-man band.” He has no office, no receptionist and no nurse. Instead, his cell phone serves as his constant companion.
“It’s like living with a time bomb,” he says. “You never know when it is going to go off.” He visits patients at midnight, on holidays, any time – 24/7, 365 – that they call for care. If his patient’s health worsens, he continues to treat them without raising his fee.
And, similar to many doctors with concierge practices, he remains connected to his patients even during his brief vacations. Pellechi says he’s never away for more than a week at a time, never takes more than two weeks of vacation in any one year, tells his patients when he’ll be away and urges them to call him on his cell phone if they have any medical needs. As associate fills in, if needed.
The benefit, he says, is that the patient care he now provides is what he expected to offer when he enrolled in medical school. Plus he has no worries about co-pays, short office visits or hours spent on the phone fighting with insurance companies. He treats fewer than four dozen patients per year, compared with the thousands he saw in private practice. And his net income is nearly the same.
Annual retainers typically depend on patients’ income and their initial medical needs. They can range from nearly nothing, when doctors choose to treat patients in financial need, to more than $10,000 per year. Cimino’s hybrid practice charges a $2,000 yearly (or $200 monthly) fee. “Some people want to invest in their health,” he says. “Yes, this is a lot, but it’s not a terrible amount. The majority of my patients are factory workers. You would think this is for the rich and exclusive, but it’s not.”
All of his concierge patients receive an annual exam from which he creates a personalized wellness plan. And although he usually sees his concierge patients in his office — time is allotted into each day’s schedule specifically for these patients — they are given a dedicated office phone number as well as Cimino’s personal cell phone for 24/7 access.
Cimino says his concierge patients fall into three categories: informed patients who want to analyze data with him and understand his medical decisions; patients with past health issues who want 24-hour access to a physician; and those patients who want to change their lifestyle and start anew with their physician as a partner.
Kulich, whose pediatric concierge practice, KidsHousecalls, stretches from New York City to Fairfield County, says the annual fee he charges is less than the cost of a pack of cigarettes a day and far less than the cost of private school tuition. It is about choices, he says, not elitism.
Greenwich resident Sarah Derene says this type of one-on-one treatment was the key to her recovery. She felt exhausted all the time, she says, and suffered from mysterious fainting spells. “I was passed to so many specialists that I was at the end of my rope.”
Finally she turned to Gamble. The Greenwich osteopath diagnosed Derene with late-stage Lyme disease. She visited Derene’s home every week, overseeing her intravenous infusions, changing her bandages and taking blood and throat cultures.
“I’m a 100-percent believer in concierge medicine,” Derene says. “I’ll never go to a regular doctor again.”
— Rebecca Haynes contributed to this article.
How to choose a concierge doctor
… for the doctor’s contact phone number. Then call after work hours to find out if the doctor is truly accessible.
… about annual fees and additional per-visit fees.
… whether coverage continues if your health deteriorates.
… whether patients must handle insurance reimbursement.
… about the doctor’s total patient load. (Most concierge medical practitioners have a patient load ranging from two dozen to 200 patients.)
… where the doctor lives (to get an idea how long it will take him to get to your home).
… for patient references.
… which hospitals the doctor is affiliated with.
Concierge Medicine Today (i.e. Concierge Medicine News; Concierge Medicine Canada; CMT; and Direct Primary Care News), is a news and multi-media organization that is the industry’s oldest and most respected national trade publication for the concierge medicine and direct primary care marketplace. Our web site is the online destination for people and physicians to go deeper into the top stories driving the conversation and generating the national buzz about concierge healthcare and direct primary care.