ILLINOIS: Special Docs, Roberta Greenspan helps doctors off the managed-care treadmill

By Karen Berkowitz~Sun-Times Media

HIGHLAND PARK, IL | JULY 18, 2013 — Most patients would be shocked if their physician handed out a personal cell phone number, or took patient calls placed on weekends or in the middle of the night.

But patients expect — and get — that kind of attention from physicians who have adopted a “concierge” model for their practice, according to Highland Park businesswoman Roberta Greenspan.

For the past 10 years, Greenspan’s firm, Specialdocs, has helped physicians make the transition to a concierge model, which affords doctors more time with patients by upending the compensation structure. Patients pay the physician an annual retainer, often between $1,600 and $2,400, for a dimension of care not covered by insurance.

Patients typically have higher expectations when paying a retainer, Greenspan explained, but physicians are able to meet those demands with new-found time from seeing fewer patients. Under the direct care model, patient loads of several thousand are lowered into the hundreds.

As a physician liaison at Highland Park Hospital in the 1990s, Greenspan said she saw firsthand the toll that managed care was having on practitioners.

She saw doctors treading harder to see more patients in order to keep up with rising overhead and lower compensation rates. She saw doctors becoming disillusioned because the practice of medicine was nothing like they’d imagined when they entered medical school.

So at age 60, Greenspan launched a consulting business that has grown into a national enterprise. The firm, led by Greenspan and her partner, Michael Friedlander, has guided about 100 physicians through the transition.

“I really heard from physicians their tales of woe and how health care was changing in the 1990s, when managed care came into being, and how that impacted on their incomes,” said Greenspan. “They had to keep up with the times and outfit their offices with state-of-the-art equipment. They needed well-educated employees and support staff. So what that meant was that their overhead was going up but that their income was going down.

“The quality of care had to decline because when you are seeing more patients in less time, you can’t possibly continue to provide the same standard of care,” added Greenspan, now 70. “You don’t have time to do the same research when problems are presented. You are exhausted. What I was beginning to hear … is the impact that this was having on physicians, not just professionally, but personally. If the physician is concerned that he doesn’t have enough time and he may make mistake; he wants to get home to see his daughter in a play; he has 25 phone calls to make and his office hours don’t end until 7 p.m., that is a recipe for disaster.”

Greenspan is quite particular in her selection of clients, because success in the concierge medical field requires the physician have strong interpersonal skills. She added that the doctor must be motivated by a desire to provide more personal care, not just make more money.

She doesn’t believe physicians can do justice to concierge medicine in a hybrid model, where some patients pay the retainer and others don’t. Specialdocs’ clients move entirely to the concierge model, though she also insists that physicians offer scholarships to patients who are unable to pay the annual fee.

Like many other states, Illinois doesn’t allow concierge physicians to apply the retainer to services that are covered by insurance, even if reimbursements cover only a fraction of the cost.

Most concierge physicians practice internal medicine or family practice, though some specialists who function as primary care providers for patients also have chosen the model.

Greenspan believes patients regain a sense of dignity under the system.

“Every visit is on time; you are not waiting,” she said. “If you are ill and come in the morning, you are always able to be seen the same day. And I don’t mean ‘squeezed in.’ I mean seen in a relaxing comfortable visit,” she said. “You are not seen for five minutes with a practitioner saying, ‘Tell me your problem,’” but is rushed because five more people are waiting.

“When patients call at 10 o’clock on a Saturday night, they get their doctor on his cell phone — not an answering service, not a doctor who is covering for the weekend. It is their own doctor. He knows them. He doesn’t have to go back to a computer and say, ‘I see here that three years ago, you had pneumonia and we prescribed Cipro.’

“When you have that number of patients,” she said. ”You know your patients.”


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