CALIF.: OC Doctors Discuss Alternative Practice Models at AAPP Conference

Monday, April 1, 2013 11:16 am | By PNN | As Obamacare is phased in, Orange County doctors, lamenting declining reimbursement rates coupled with greater overheads, are looking for alternative practice models.

The recent 2013 American Academy of Private Physicians (AAPP) conference in Palm Desert offered physicians a chance to compare experiences. A key topic was the benefits of making a switch to concierge medicine.

For Dr. Marcy Zwelling, an Orange County internist with a practice in Los Alamitos, who has been involved with concierge medicine for 10 years, practicing any other way is unfeasible.

5155e867edeb6.image“I need to able to do my job and I can’t see a patient in five minutes or less,” Zwelling said.

Concierge medicine “is just an opportunity to develop relationships with a patient and take care of their medical issues as they arrive,” Zwelling explained.

She added that she charges patients an annual fee of $2,000 for such personalized care.

In concierge or “direct pay” practices, patients pay a monthly or annual fee for enhanced services, including same-day appointments, 24/7 access to their doctor, email consultations and longer appointment times. To make more time for patients, concierge doctors carry smaller patient loads.

After having been in solo practice for 21 years, Dr. Leonard Scuderi, a cardiologist in Torrance, said he was seriously considering making a switch to concierge practice.

Survey Shows Support for Concierge Medicine

He’s not alone. A recent survey of 13,575 physicians nationwide showed that 6.8% of doctors are considering switching to concierge medicine.

Nearly 8 percent of those surveyed were primary care physicians. In California 6.7% of doctors are considering a switch to concierge medicine, according to the survey conducted by Merritt Hawkins.

Doctors who practice concierge medicine say it is more satisfactory, because they can practice the way they were trained, taking time to address patients’ concerns and using their skills fully.

Andrea Klemes, DO, medical director of the concierge medical group MDVIP, presented the results of the studies by MDVIP published in the peer-reviewed American Journal of Managed Care. It showed that this approach to primary care saved $2,551 per patient, due to decreased hospitalizations. It resulted in a 72% to 79% reduction in hospital readmissions for serious diseases, according to the study.

The number of concierge doctors is still relatively small, 4,400 in 2012, but it has risen by 30% in the past year. As Obamacare unfolds, Forbes’ magazine reports that as many as 10% of doctors are considering the switch.

The State of Healthcare

At the AAPP conference, presenters addressed the current state of healthcare and offered solutions to the growing shortage of physicians and the “shortage of health,” as Tom Blue, executive director, AAPP, put it.

Blue said the model of concierge medicine 1.0 had to do with access to care and the shortage of physicians. Model 2.0 is about moving from consuming health to creating health using new approaches and the latest technology as opposed to simply focusing on decreasing the number of patients per doctor.

Dr. Gary Price, president of AAPP, said the more efficient style of practicing medicine under the concierge model creates better results for patients and doctors. There has been no successful malpractice lawsuit against a concierge physician, according to Price, and it translated into lower insurance premiums negotiated for the AAPP members. He also said the concierge model of healthcare delivery, in his opinion, has moved into the mainstream.

It Takes a Team

AAPP presenters talked about the third era of medicine, where patients and physicians think of health as an asset and recognize that it requires team effort, time, and small incremental steps to manage it successfully.

“We are burning money chasing isolated symptoms,” said Blue. “We have acute care mentality.” The idea that we can scare patients into changing their lifestyle overnight, or that we can make doctors change their patients’ behavior if we penalize the physician for not producing a desired quality outcome, goes against human nature, he said. “Behavior does not change overnight just like chronic conditions do not develop overnight.”


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