December 13, 2013 – The mother was frantic that her 5-year-old’s sore throat might be something serious, so she called the family doctor from her car.
Dr. James Pinckney asked for a quick snapshot of the child’s throat. But as he listened to her attempts to take the photo, he became equally distraught.
“Are you driving?” he demanded of the woman. “Would you please pull over and take the picture?”
This might be an improbable situation for most doctors. But for Pinckney, it was just another diagnosis.
“It was crystal clear strep throat,” he recalled of the cellphone image. “I called in the appropriate antibiotic [prescription]. The mom picked it up, and they’re on their way to grandma’s house. That’s efficient.”
From their plush perch above the Park Cities, Pinckney and his partner, Dr. Anthony Lyssy, are attempting to reinvent primary care medicine, one phone call at a time.
This latest incarnation of concierge medicine, called Diamond Luxury Healthcare, opened in June on the upper floor of a University Park office building. The well-appointed suite boasts upholstered furniture, artwork and lots of new technology but relatively few in-the-flesh patients.
The medicine here is often practiced over the telephone, by email or even by Skype. For a monthly fee of $95 to $295 a patient, the two doctors promise unlimited access to their medical skills and advice, in and out of the office.
Their practice is one of dozens in the Dallas area and thousands across the country offering a variety of perks for patients willing to pay a monthly fee. At least 70 local doctors have opted into concierge care, also known as boutique medicine or direct care.
The benefit for doctors is that they can cut the size of their practices, allowing more time for fewer patients, without reducing their incomes.
In Dallas, a concierge patient typically pays $1,500 to $2,000 in fees a year on top of insurance coverage and other medical costs. The fee is supposed to guarantee same-day appointments, access to the doctor’s cellphone number and a comprehensive annual physical.
In this medical model, the doctor assumes the role of a wellness provider, taking the time to motivate, even nag, a patient into a healthier lifestyle. Office visits can turn into counseling sessions about diet, exercise and reducing stress.
“We are service-driven, and we have as much time as we need to see a patient,” said Pinckney, 31, a licensed family practitioner who earned his medical degree at Baylor College of Medicine in Houston.
“We’re done being big-volume primary care doctors. We’re never going to be seeing more than one patient at a time,” said Lyssy, 33, a graduate of the Texas College of Osteopathic Medicine at the University of North Texas Health Science Center in Fort Worth and a certified family medicine physician.
So far, about 100 patients have enrolled at Diamond Luxury Healthcare, the partners said. They hope to attract as many as 700, including children, whose monthly fee is $45.
Stephanie Mahelona persuaded her family of eight to enroll in the new practice, at a combined cost of more than $1,000 a month. She met Lyssy as a patient during his residency at Methodist Charlton Medical Center and eagerly followed him when he established his private practice.
“He got my diabetes under control,” said the 68-year-old Grand Prairie retiree. “We tried different medications, changed my diet and exercise. I don’t need insulin anymore.”
Even though Mahelona and her husband have Medicare coverage, she believes they save money by avoiding the co-payments required by their supplemental insurance. Both feel healthier now, she said.
“I didn’t know I felt bad until Dr. Lyssy made me feel good,” Mahelona said. “And I love his electronic savvy. I can text him questions and get instant answers.”
Unlike many concierge practices, this one operates on monthly fees alone and does not accept insurance, including Medicare or Medicaid coverage. Both doctors encourage patients to get catastrophic insurance in case they require specialty care or hospitalization.
The concierge medicine evolution is tracked by local and national medical societies, but so far the nation’s medical establishment has not taken a firm stand on these practices, said Dr. Todd Pollock, incoming president of the Dallas County Medical Society.
“In many ways, concierge medicine changes the focus of the practice back to the doctor and the patient by taking out the insurance company and the government,” he said.
As a plastic surgeon, Pollock said he understands the benefit of allowing doctors to practice medicine the way they want. He also relies on post-surgical phone contact with his cash-paying patients, he said, as long as the risk is low and insurance is not being billed.
“If you talk to the patient on the phone and it seems obvious what they have, why make them come in to the office if the end result is going to be the same,” he said. “It’s a matter of using common sense.”
Pinckney and Lyssy took a different route than most doctors who are ending up in concierge care.
Usually, a family practitioner or internist will establish a medical practice, eventually amassing several thousand patients over a decade or longer. At that point, the doctor might consider asking the patients to pay a monthly fee for their continued care.
But the fees drive away thousands of patients who don’t want to pay more. Pinckney said he couldn’t stomach the prospect of having to cut his practice down someday.
“Why would I establish a bond with all these people, knowing I was going to cut them off if they couldn’t afford my services?” he said. “That doesn’t make sense to me, ethically or morally.”
For ‘the 99 percent’
Pinckney first glimpsed the promise of concierge medicine as a medical resident at Cedars-Sinai Medical Center in Los Angeles. He was studying general surgery at the time.
One night, a celebrity showed up at the hospital needing emergency care. After being stabilized, the patient instructed Pinckney to call his personal physician — at midnight.
“I called the doctor and explained what was going on,” Pinckney said. “And I was stunned that he didn’t yell at me for waking him up. He even thanked me for taking care of his patient.”
It was an epiphany for a young doctor training in traditional medicine, where patients and primary care doctors don’t usually operate as a unit.
Pinckney said he immediately wanted to find a way to offer concierge care “to the 99 percent of patients, instead of the top 1 percent of super-elite celebrities and politicians.”
When their residencies ended, both doctors began moonlighting in local emergency rooms and urgent-care clinics. It served as a baptism into the frantic pace of modern-day health care.
They were treating endless streams of people, mostly for minor ailments such as colds, flu, cuts and fevers. Patients could wait two hours for just five minutes with the doctor. If tests were needed, the cost would exceed several hundred dollars for a single visit.
“We’d see 30 to 40 patients per shift,” Pinckney recalled. “We know what that means now, and we want to do something else.”
Although their new offices are decidedly upscale, the doctors say they are trying to hold down costs for in-office tests and prescriptions, both of which are extra charges for their patients.
“We can order MRIs at cash discounts of $300 to $500 vs. $3,000 at a hospital,” Lyssy said. “A CT scan is $360 vs. $2,000.”
“These are real prices and real examples,” said Pinckney, who unlocked a hall closet that contained a broad collection of drug samples and prescription discount cards that their patients could use.
“We got into medicine to help people, to make a difference in people’s lives and to reverse disease,” he said. “We focus on healing.”