Business

ALABAMA: Samuel says … “I’m not looking to make a million dollars. I want to make enough to pay my bills and do the things I need to do, but I do this because I love it and enjoy it.”

By Jonece Dunigan, The Decatur Daily, Ala.
McClatchy-Tribune Information Services
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Sept. 08–One of the people who inspired Kimberly Samuel to start her own health-care revolution in Decatur was a homeless man.

With a bump on his head and bleeding nose, the man told nurses in Huntsville Hospital’s emergency room he was beaten and robbed of his wallet. His skin bulged from a bone in his arm bent out of place.

Although the physicians checked for brain damage, Samuel said they didn’t do much for his broken arm. They wrapped it in a sling and sent him out the door. Samuel, who was completing her clinical training to become a registered nurse, said the physicians turned down the care for his arm because he didn’t have insurance.

“Insurance has almost ruined the way medicine has been practiced these days,” said Samuel, 47, now a certified nurse practitioner. “Physicians are almost forced to do procedures they otherwise wouldn’t do so they can get paid.”

After graduating with a master’s in nursing at the University of Cincinnati in August 2013, Samuel left the hospital and the insurance environment. Last month, she opened A Heartbeat Away Clinic off Sixth Avenue.

Samuel’s specialty: concierge medicine, a practice that’s adding offices at a rate of 25 percent a year.

For $50 a month per individual or $100 per family, patients become members of Samuel’s medical family. They have Samuel’s cellphone number for 24-hour access, same-day appointments and house calls. The membership fee includes annual physicals and general procedures at discounted prices.

The trend is fueled by increasing regulation under the Affordable Care Act, according to Alabama Medical Association spokesman Niko Corley. Corley said the law requires physicians to spend more time digging through the 68,000 codes in the computer for insurance purposes than spending time with patients.

“Some entrepreneurial physicians are seeing this as an opportunity to offer a different model of health care for different types of people,” Corley said. “They are getting back to what they came to medical school for in the first place, which is treating patients.”

The origins of concierge medicine are in Washington state and Oregon during the late 1990s. It is known for catering to a deep-pocket, wealthy class who can pay $13,000 to $20,000 per family annually for personal care.

Samuel is trying to reconstruct the business model to conform to the needs of the middle class by scavenging ways to save money. She took the average price other clinics charged for procedures and cut it 20 to 50 percent. For example, while a standard practice would charge $75 to $176 for ingrown toenail removal, Samuel’s members pay $50. She also negotiates discount prices with The Imagine Center and Open MRI so her patients get more for their money for things she can’t do in her office, such as X-rays.

“Those discounts go toward my members,” Samuel said. “I’m not looking to make a million dollars. I want to make enough to pay my bills and do the things I need to do, but I do this because I love it and enjoy it.”

Decatur resident Lee Weathers came to Samuel after four years of hunting down a local physician in Decatur who would understand her multiple sclerosis. At other clinics, the long wait times and the 15-minute consultations made her feel like a number. When she walked into A Heartbeat Away, the handmade curtains and complimentary coffee gave her a homey feeling.

“It’s like stepping into grandma’s house and knowing that everything is going to be better,” Weathers said.

Collaboration

Although she is licensed, Samuel is required by law to work with her collaborating doctor, Eric Mashburn, every Thursday in his office in Hartselle. He touches base with 10 percent of her patients to make sure she is conducting good medical practices. He is also Samuel’s reservoir of information if she has a question about a diagnosis. Croley said collaborating physicians are a vital part of the concierge medicine model.

“This allows someone who is working in this model to reach a broader reach of people but still have a physician oversight,” Croley said.

The Affordable Car Act required Americans to have insurance by the time open enrollment closed in March. While some insurance companies, such as Cigna, have worked concierge medicine into their plans, many of the larger insurance companies have not.

According to the Wall Street Journal, there is an opportunity for concierge medicine to succeed. Most major insurance plans have a high deductible with minimum premiums for emergencies. Samuel said patients can use the insurance made for catastrophic situations on major things such as kidney failure while she takes care of the flu, colds, cysts and benign lesions.

Qualification

“I wouldn’t try to manage something I am not qualified to do,” Samuel said. “I’m kind of like the gatekeeper. If there is any problem that deals with something I can’t do, then I send them somewhere that can help.”

Samuel has developed a more personal relationship with the 82 clients she diagnosed so far since opening the clinic. She spends 45 minutes with each patient — which is long enough to learn about their reason for the visit, medical history, where they work, how many kids they have and their lifestyle. Samuel said the longer appointment times allow her to get to the root of a patient’s problems.

“I get to know more about the patient that you can’t find out in 15 minutes,” Samuel said, “That’s very relative to diagnosis. If they suffer from depression and anxiety, I can ask them about life at home instead of just handing them a prescription.”

Samuel believes some clients would rather pay the 1 percent penalty off their income taxes next year than pay monthly for insurance. She owned a janitorial cleaning service while she was in school and saw how her workers would save money for clothes, groceries and a college education for their kids. Samuel said being in the concierge medicine business allows her to be the physician they need without emptying their pockets.

“They want doctors to listen to them and make sure you’re not discounting any problems that they have,” she said. “They want to know that you care, and that you’re going to work toward a positive result.”

Jonece Dunigan can be reached at 256-340-2442 or jonece.dunigan@decaturdaily.com. Follow on Twitter @DD_Dunigan.

Source: http://insurancenewsnet.com/oarticle/2014/09/08/a-different-kind-of-care-a-552732.html#.VA3XT2Nnsa4

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