Tennessee —

Doctor, home health agency revives house calls
By: MELINDA HUDGINS, Post Columnist | Sunday, July 24, 2011 7:28 am | Murfreesboro Post |

JULY 24, 2011 – Decades have passed since doctors visited patients at home, but one local physician is bringing house calls back into practice.

Murfreesboro physician, Dr. Jim Garner, has expanded his practice to include house calls for clients of Family Staffing Solutions, Inc. on an exclusive basis, according to company president and CEO Becci Bookner.

“The return of house-call visits by a doctor is welcome and needed by many older people in our community who simply cannot manage the trip to the doctor’s office,” she said. “Clients of our company may now again access the familiar and longtime appreciated service of a doctor’s house calls in the privacy and convenience of their homes.”

Garner is an internal medicine specialist and a lifelong resident of Murfreesboro who has a sincere interest in the health care of community residents, a news release states. He has served in many prominent positions including both the chief of medicine and chief of staff at MTMC, and his philosophy of medical practice combines the foundation of evidence-based knowledge with commonsense and compassion.

“It is our mission to take care of people. The alliance with Family Staffing Solutions will create new and innovative ways to facilitate this mission as the health care climate continues to change and evolve,” said Garner, a graduate of the University of Tennessee Medical School who completed his residency at Pensacola Educational Program.

Bookner added, “Many of our clients who are enjoying the advantages of remaining in their homes, independent, and in charge of their lives have, in the past, had to access their personal physician by traveling to the doctor’s office or to the emergency room.

“Through this strategic partnership with a physician, clients of Family Staffing Solutions can, upon request, now can access Dr. Garner’s staff to provide in-home visits for their primary care medical needs,” she said.

Additionally, Booker said, this new agreement between her company and Garner provides the same level of access to primary medical care as concierge medicine, but without the annual fee.

Concierge medicine offers hands-on care at a price
Written By Getahn Ward | The Tennessean

6:11 AM, Jul. 17, 2011 – At first, Rita Mitchell thought she might bolt from her doctor of 10 years after learning she’d have to pay a $1,500 annual fee to stick with him when he switched to a strategy that trimmed his patient load but promised more hands-on care to those who remained.

The Waynesboro, Tenn., woman was told that she’d get more personalized care, including hourlong office visits, 24/7 access to Dr. James C. Couch III and a detailed annual physical exam.

A year and a half after signing up – and paying the fee – Mitchell believes she’s getting her money’s worth under the model that’s known as concierge medicine.

“I’ve never ever experienced such personal care,” she said recently, recalling a recent 2 a.m. telephone call to Couch, who calmly tried to figure out the source of her severe pain and phoned a drugstore with a prescription she could pick up after the sun came up.

Couch, whose practice is in Mount Pleasant, Tenn., is among a handful of doctors in Middle Tennessee who are practicing medicine in a way that they say removes the pressure of needing to see a ton of patients every day to break even financially.

“It just allows us to practice medicine in the way we were trained,” Couch said. “I strongly believe in prevention and trying to keep small problems from becoming major problems.”

Nationwide, roughly 3,500 doctors practice concierge medicine, according to industry trade group the American Academy of Private Physicians.
Proponents expect even more doctors to join these ranks amid lingering uncertainties related to health-care reform – including reimbursement cuts and expectations that physicians might have to work faster for less money as more than 30 million Americans are added to insurance rolls.

“There’s a big emphasis on auditing and accountability, and a lot of physician practices aren’t positioned to comply with these stringent regulations,” said Avery C. Fisher, chief executive of PrimoCare, a Nashville-based startup that helps practices set up concierge offices and tackle other chores related to health reform.

Under concierge arrangements, patients pay an average of $1,800 a year to stick with a particular doctor. In large group practices, patients who don’t want to do business the concierge way may get shifted to another physician in the group who carries a bigger patient load.

Not everyone sees concierge medicine as a good thing.

Critics point to what they see as ethical issues as physicians make the switch, including possible disruptions in the continuity of care – especially for patients who simply can’t afford to pay the extra fee to stay with their doctor.

“It’s obviously nice for the (doctors),” said Dr. Sidney M. Wolfe, health research director at consumer advocacy group Public Citizen. Physicians are able to see fewer patients while making the same amount of money.

“But the other side is that the patients … can no longer go to that doctor.”
Who’s in the game?
Statewide, nine physicians take part in concierge medicine under the model of Boca Raton, Fla.-based MDVIP Inc., which offers technology, marketing and other support, including patient billing of annual membership fees.

In exchange, MDVIP gets a third of that fee, which patients are able to pay once a year, semiannually or quarterly.

Doctors agree to limit their practices to 600 or fewer patients – and those with MDVIP currently average 400 patients after making the switch. That generally compares with typical patient loads of 2,500 before going the concierge route.

Insurers generally don’t cover the annual membership fee but pay for services covered under their members’ policies.

Right now, a second pair of doctors with the Nashville physicians group Heritage Medical Associates is in transition to the concierge model, which would boost to six the number of Nashville-area doctors linked with MDVIP.

Not everyone stays put.
Dr. John R. Chauvin, who practices in Hermitage and is affiliated with Summit Medical Center, signed on three years ago to practice under the concierge model, but he has since abandoned it. He went back to a traditional practice and being employed by a hospital.

Couch is among concierge doctors who say they’re pleased with the results in terms of patient care, although some physicians say they’ve seen a slight decline in income.

Under the concierge model, Couch averages six patients a day, down from 30 in the old days.

A routine office visit lasts 45 minutes to an hour as compared with perhaps 10 minutes previously. Couch spends up to four hours on the detailed annual physical exams of concierge patients.

The longer physicals are paying off for patients, Couch says. The problems discovered include heart disease, blockage of the arteries in the neck, prostate cancer and diabetes.

“If you can detect these medical problems early, then you (reduce) the complications for the patient and lower the costs to the health-care system,” Couch said.

Blood lab work performed during the thorough exam, for instance, discovered that Mitchell – the Waynesboro, Tenn., patient – had high cholesterol. Other aspects of the detailed exam included heart tracing, vision and hearing tests, and other health screenings.

Brentwood resident Ron Pearson credits becoming a patient of Dr. Edwin Anderson Jr., a Heritage Medical MDVIP physician, with saving his life.

A screening ordered by the doctor after reviewing his medical records as part of his detailed physical found an 80 percent blockage in one of Pearson’s arteries. That prevented a potentially fatal heart attack, he said, crediting concierge medicine and the extra time spent with his doctor as factors that contributed to the crucial catch.

Having about 200 patients now versus 2,500 before allows Anderson to make routine house calls for some patients.

Roughly 92 percent of MDVIP members renew their annual memberships, said Mark Murrison, its president.

Traditionally, doctors switching to concierge medicine have mostly been primary care physicians. But Tom Blue, executive director of the American Academy of Private Physicians in Richmond, Va., is starting to see more cardiologists and others shift to that model.
A difficult decision
When a doctor is moving over to the concierge model, patients face a difficult decision of whether to stay and pay, or switch to another physician.

Madison resident Glenda Snow and her husband decided not to stay with their doctor, largely because they didn’t want to have to pay a $3,000 annual concierge fee.

The younger doctor Snow sees today is less experienced, she says.

For others, keeping the doctor of their choice is worth the price. Bank executive Connie White and her husband recently signed up to stay with Dr. James Jones, who along with fellow Heritage Medical physician Dr. Lee Anna Fentriss plans to move to the concierge model.

White still has questions about all the services involved, what her insurance would cover and whether there will be other costs beyond the annual fee. But the Fifth Third Bank employee is generally comfortable with her decision.

“I want to be able to continue to see a quality physician,” she said.

Sonny Clark, an entrepreneur and resident of Franklin, sought out a concierge doctor five years ago because he didn’t want to have to wait for days to see a doctor. Clark remains a patient of Dr. Charles Daniels, who left a local physicians group last year to set up a concierge practice with the help of Chicago-based Specialdocs Consultants Inc.

“I do think it’s worth it,” Clark said of the $1,500 annual membership fee that he pays today.

The way Mount Pleasant-based physician Couch sees it, a patient’s decision comes down to personal choice and how keen he or she is on prevention.

“If you figure it out, it averages $4 a day,” he said of the $1,500 annual fee for the program. “If you smoke a pack of cigarettes or drink a lot of Starbucks coffee, you’re going to spend that much in a year.”

Paul Grundy, director of health-care transformation at IBM Corp., said models such as concierge medicine could help attract more medical students into primary care and prevent other doctors from retiring out of frustration.

“In the long run, I suspect that it will not have a negative impact on the supply of providers,” he said.

Addressing another issue of fostering a system of medical haves and have-nots cited by concierge model critics, Paul Keckley, executive director at think tank the Deloitte Center for Health Solutions, said a dual system of health care already exists.

Care for people without insurance starts at public health centers or the emergency room, while care for those with insurance starts at their doctor’s office, he said. Often, both sets of patients end up seeing a specialist when necessary.

“There’s a huge opportunity for innovation in primary care,” Keckley said. “Concierge medicine represents an approach, but the medical home and retail clinics are other examples. We’re going to see more of this.”

February 2, 2011
Two Nashville health-care startups aim to fix what they see as flaws in the U.S. system of primary care medicine.

The goal is to satisfy doctors and patients alike, but it will come at a cost for some patients.

By Getahn Ward, Columnist | The Tennesseean

First, there’s startup Dohi|Be Well, whose tagline is: “The doctor’s visit reinvented.” It hopes to raise $4 million from angel investors and others with a goal of opening its first clinic next year.

Under its business model, consumers will pay a $165 monthly fee, or about $2,000 a year, for a basic wellness package that provides access to a multi-disciplinary team of providers — a doctor, nurse/coach, nutritionist, massage therapist and a physiologist or exercise specialist.

Patients also get a wellness exam and a blueprint for healthy living, basic lab work and X-rays, plus four or more doctor visits a year. Patients still might need a so-called wrap-around insurance policy to see specialists outside of the clinic, buy ongoing prescriptions or cover hospitalizations.

Dohi|Be Well doesn’t plan to accept Medicare or private insurance, which will cut overhead costs in half because it simplifies billing and collections, said Susan Siegel, the company’s chief executive officer. She figures the clinic needs a base of 1,500 paying patients to make it financially.

The concept does restrict the type of patient who will be seen, however, by focusing on people who have the money to pay for a level of personal attention, convenience and advice on wellness. Still, Siegel expects to win interest from a variety of people, especially from women between the ages of 30 and 65 when her first clinic opens (likely in Green Hills).

“She (the patient) can stop at Dohi, pick up prescriptions and take a yoga class,” Siegel said, citing that as one type of program to be offered there.

Dr. Judson Rogers, who specializes in internal medicine, will join Dohi as medical director. Four other physicians are considering joining as well.

But to other health-care observers, the idea of paying a monthly fee to get basic health care — and not accepting Medicare or private insurance — raises questions about access.

“To take primary care services, which are a scarce resource, and use it for people who are so wealthy that they don’t even care whether it’s covered by insurance is to convert a necessary service into simply one more luxury consumer good,” said Gordon Bonnyman, executive director of the nonprofit law firm Tennessee Justice Center.

Siegel’s background includes being vice president of operations at worksite clinic operator CHD Meridian and vice president of project development for the prison health-care company America Service Group. She left the prison health-care company a year ago. Siegel expects Dohi’s first clinic location to be profitable in its second year of operation. Two other locations also are in the works for Middle Tennessee.

Meanwhile, Avery C. Fisher, who’s on track to earn a health-care MBA degree from Vanderbilt’s Owen business school in May, plans a startup that also involves some aspects of concierge medicine.

Under Fisher’s Primocare business model, some patients would pay a concierge fee that’s yet to be determined to continue to see a senior physician, while other patients with basic insurance coverage would be assigned to junior physicians fresh off residency. Many concierge medical practices charge around $2,000 a year as an entrance fee for preferred access to certain doctors.
Training ground

Fisher believes all patients would benefit over time, though, because of innovations in technology, automation and making administrative procedures simpler.

“It’s a way to drive innovation into physician practices,” he said.

The idea is to ease the senior doctor’s patient load and provide a training ground for younger physicians. The model also involves enhanced technology, including automatic scheduling of appointments and e-mail reminders.

“Primary care physicians are one of the most overworked and underpaid doctors and they don’t have enough time to spend with patients,” said Fisher, who’s in the midst of fundraising. “That’s what all these innovations in primary care are trying to address.”

Physicians opt to get off the ‘conveyer belt’ by limiting number of patients they’ll accept

By Toby Sells | Sunday, January 16, 2011 | The Associated Press, The Memphis Appeal

Dr. William Weiss now has time to hear his patients’ stories. Personal stories. Medical episodes. Family backgrounds.

“I had a patient today say, ‘I’d love to tell you about this time 20 years ago in a restaurant, but I know you don’t have the time,'” Weiss said. “I was able to say, ‘You know, I do have time. I want to hear the story.'”

Weiss is able to hear these stories because he now sees about 10 to 12 patients a day. He and a nurse practitioner used to see between 20 and 35 patients in his former solo practice.

Weiss is one of a few but a growing number of physicians dropping out of the world of high-volume, “conveyer belt” medicine.

“The way I used to see patients, I always had one hand on the door, ready to go to the next room,” Weiss said. “I caught myself saying, ‘This is not the way to take care of patients.'”

The brand of medicine Weiss now practices has been called many names in its rise over the last decade: retainer medicine, concierge care, direct care, boutique medicine and executive health programs, to name a few.

But the practices all operate similarly. The number of patients is capped (in Weiss’s case it’s capped at 600 patients). Physicians ask those patients to pay a monthly or annual fee, like a membership fee, to the practice. Different studies put the fees between $60-$15,000 but they tend to average between $1,500-$2,000 annually.

In exchange, patients get more face time with their doctor who can use their details (like their stories) to craft a more-personalized course of care for them.

University of Chicago researchers found 756 physicians across the country practicing retainer-based medicine in October. That figure is up from 146 such physicians found in a 2005 study by the Government Accountability Office.

The University of Chicago found practices in all but 11 states, found them to be concentrated in urban areas and found the most in and around Los Angeles, Miami, Washington, and Naples, Fla.

The first retainer practice opened in Seattle in 1996.

By 1997, Memphis internist and surgeon Dr. Greg Laurence said the “third-party reimbursement had so changed the character of the doctor-patient relationship that I could no longer enjoy the practice of medicine, nor could I effectively care for my patients within that emerging system.”

So, over the next three years, he transitioned his practice, now called Complete Medical Care Germantown, to the retainer model. The practice thrived, he said, and while it’s now open for new patients, it does screen and regularly declines new patients.

Patients access as much or as little as they need, Laurence said.

“A patient might see us very infrequently, but when they do contact us at a critical time in the middle of the night or on a business trip, we are able to take care of that acute need, ” he said. “We also have some patients with chronic illnesses that we do see regularly, and we are able to spend enough time with these patients to properly manage their condition.”

Retainer medicine isn’t without its critics. They say the practice could limit overall patient access and create a two-tiered system: for those who can pay and those who can’t.

Mark Murrison, president of marketing and innovation for retainer group practice MDVIP, said the company’s physicians see patients from “all walks of life, from teachers to bus drivers to executives.”

“It all comes down to what you value, what you prioritize,” Murrison said. “For most of our patients, health is a priority for them no matter what their profession is.”

Boca Raton, Fla.-based MDVIP is the nation’s largest retainer-based group practice. It has grown to 450 doctors that see 150,000 patients in the 10 years since its founding.

Weiss is a member of the MDVIP group, though all of its members practice independently. He said he has a full practice, about 600 patients, since he launched the new model in November.

“So far, so good,” Weiss said. “After you’ve done something a certain way for 20 years, it can be hard to adjust but things are starting to run smoother.”

Nashville: Hotbed for Healthcare

Carrie Vaughan, for HealthLeaders Media

July 9, 2010

The healthcare industry contributes nearly $30 billion annually to Nashville’s local economy, according to an economic impact study released yesterday by the Nashville Health Care Council and Middle Tennessee State University’s (MTSU) Business and Economic Research Center.

“Healthcare will continue to be a primary strength that Nashville can build upon from an economic development perspective,” says Ralph Schulz, president & CEO of the Nashville Area Chamber of Commerce, at a press conference announcing the study results.

Healthcare is not only largest employer, but the fastest growing as well, says Nashville Mayor Karl Dean. “We want companies to continue to grow and expand healthcare in Nashville.”

That may not be a hard sell, considering 95% of Nashville Health Care Council member CEOs indicated that having a Nashville headquarters is important to their company’s positive performance, according to a survey of approximately 150 member companies of the Nashville Health Care Council.

“The results show healthcare is a dynamic growth industry with global outreach,” says Murat Arik, associate director of the Business and Economic Research Center at MTSU.

The study, “The Health Care Industry in the Nashville MSA: Its Scope and Impact on the Regional Economy,” examined the Nashville healthcare industry and its economic impact locally, nationally, and globally. It analyzed core clinical providers, which include hospitals, ambulatory services, and nursing and residential care facilities operated locally; and other related healthcare companies, including healthcare services management, managed care, life sciences, and professional services firms that operate on a local, national, or international basis.

Key findings include:

  • The Nashville healthcare industry contributes roughly 210,000 jobs to the local economy.
  • 56 healthcare companies have headquarters in Nashville that generate nearly 400,000 jobs and more than $62 billion in revenues worldwide. (Only companies with more than $500,000 in revenue and at least 100 employees were included in this analysis).
  • There are more than 250 healthcare companies with operations in Nashville, an industry concentration that ranks it above 13 other similar cities including Atlanta, Birmingham, Dallas, Denver, Indianapolis and
  • Louisville, and more than 300 professional service firms such as: accounting, architecture, banking, and legal, providing expertise in the healthcare industry.
  • One in eight Nashville workers is employed by a healthcare provider.
  • The Nashville healthcare industry generated $13 billion in personal income for the local economy in 2008.
  • The average annual wage of the Nashville healthcare industry is $53,000, significantly higher than the average Nashville wage of $39,000.
  • The healthcare industry is also a great philanthropic resource for the community. The healthcare community in Nashville is building a better region, says Schulz.
  • Mayor Dean agrees. “The healthcare industry is part of what makes Nashville great and will continue to play a huge role in its future,” he says.


Texas —

IPO Preview: WhiteGlov House Call Health

July 26, 2011 – Based in Austin, Texas, WhiteGlove House Call Health (WGH) scheduled a $28 million IPO with a market capitalization of $144 million at a price range mid-point of $11 for Thursday, July 28, 2011. The full IPO calendar for the week of July 25th includes 12 IPOs scheduled to raise $2 billion.

CONCLUSION — WGH is a money losing speculative, health care delivery proposition.

WGH’s business model is not yet proven. It’s a combination of a low-cost phone referral service and a more higher priced health care concierge service for a fixed dollar amount per year.

In the current economic climate and because WGH’s breakeven is not yet in sight, it seems product to wait until WGH develops a more health income statement before investing in WGH.

However, the upside could be considerable if WGH can ever get a to breakeven cash flow, which is not going to be in the near term.

WGH believes it provides 70% of the medical services handled in a typical primary care setting. The most notable differences between the medical services WGH provides and those typically found in primary care settings are: x-rays; ultrasound; suturing; retinal, pelvic, genital and rectal exams; advanced cardiology evaluations; and treatment of chronic depression, chronic pain, addiction or pregnancy.

VALUATION — WGHG is range mid-point priced at 21 times sales, 4.3 times book value and – 23 times earnings (because WGH is losing money).

WGH valuation metrics

BUSINESS — WGH says it is a leading service-driven healthcare organization.
By designing and developing a new service-oriented health care delivery system from the ground up that uses the Internet, social media, advanced technology, a membership-based (subscription) business model, and nurse practitioners (NPs).

WGH believes it is able to substantially reduce many of the traditional expenses and complexities of other health care delivery systems and to give the consumer a very high quality health care experience at a fixed price.

RECENT DEVELOPMENTS — On May 1, 2011, WGH entered into an agreement with Americare Services, Inc. to provide WGH members the opportunity for a phone consultation with a doctor, under certain circumstances, instead of an in-person visit from one of WGH’s nurse practitioners. This service will be seamlessly integrated into the WhiteGlove experience. When members contact WGH for medical care,

WGH will determine if a phone consultation is possible and something the member desires or not. If they do,

WGH will schedule the visit with Americare and give them access to the member’s medical history and medical record.

Americare will schedule a phone consultation between WGH’s member, an Americare nurse and a board certified doctor in the member’s state within three hours of WGH’s member’s initial call. After the phone consultation, Americare’s nurse will complete the member’s chart and end the visit.

COMPETITION — WGH has a number of competitors in the large , broadly defined health care marketplace. Sometimes you can get a good idea of what a company’s overall vision is by looking at “competition” as defined in their S-1 filing.

Primary Care Physicians
Competitors in this category include the numerous primary care physicians available in almost every market. Primary care physicians provide primary and chronic care to consumers on an appointment basis in clinics. Primary care physicians have been the consumer’s traditional choice for primary and chronic care and enjoy greater recognition in the marketplace. In contrast, WhiteGlove is a new company whose service model has not been widely accepted.

Retail Clinics
Competitors in this category include retail clinics such as MinuteClinic, Take Care Health Systems, and RediClinic. Many large discount retail stores, drug stores or supermarkets such as Wal-Mart, Target, and CVS operate retail clinics within their stores, providing a level of convenience for consumers. Like WhiteGlove, these clinics are primarily staffed with NPs and offer consumers an affordable alternative to primary care physicians for medical care.

Concierge Services
Some markets offer concierge services where members pay monthly or annual fees to make primary care physicians available for longer appointments and after-hours care. Some concierge services offer consumers the option of seeing a physician in the consumers’ chosen setting. Physicians participating in concierge services typically charge monthly or annual fees equal to or more than the monthly fees that WhiteGlove charges for a comparable service.

Urgent Care Clinics
Urgent care clinics are alternatives to primary care physicians and hospital emergency rooms. Urgent care clinics usually treat consumers on an unscheduled, walk-in basis and are primarily used for injuries or illnesses that require immediate care, but are not serious enough to warrant an emergency room visit. Visits to urgent care clinics are usually more affordable than an emergency room visit, but more expensive than other health care options such as visiting a physician’s clinic.

Emergency Rooms
Emergency rooms provide 24/7 emergency care on an unscheduled basis. Emergency room visits can be very expensive, have long wait times and do not offer treatment for chronic conditions. Nevertheless, emergency rooms are increasingly used as replacements for primary care physicians and other health providers by a significant number of consumers.

COMPETITIVE DIFFERENTIATION — As of June 30, 2011, WGH had 484,000 individual, employer, and insurance plan members in seven major metropolitan markets (Austin, TX; Boston, MA; Dallas, TX; Fort Worth, TX; Houston, TX; Phoenix, AZ; and San Antonio, TX), with plans to expand across the U.S. The company’s ultimate objective is to provide a national service to its members giving them the same, consistent, affordable, high quality health care experience across all the markets it serves.

WGH intends to continue to capitalize on its first mover advantage by expanding rapidly to other major metropolitan markets with the support of advanced technology that enables very cost effective and rapid expansion into these markets.
Service-Driven Approach

WhiteGlove appreciates that there are many primary care and chronic care choices for the consumer. Specifically, the options are primary care physicians or physician groups, concierge doctors/services, retail clinics, urgent care centers, minor emergency clinics, hospitals, wellness centers, and telemedicine services.

We believe WhiteGlove’s Service-Driven approach to health care sets us apart from other health care providers.

WhiteGlove is not a health insurance plan. Health insurance plans: (i) deliver healthcare services to individuals enrolled in the plan through agreements with providers; (ii) have financial incentives for persons enrolled in the plan to use the participating providers and procedures provided for by the plan (e.g. in-network vs. out-of-network); (iii) have deductibles, co-pays, minimum and maximum out-of-pocket expenses; and (iv) assume risk. WhiteGlove has none of these attributes.

Convenient Access
WhiteGlove brings medical care, generic prescription medications, diagnostic tests, and more to its members. While some concierge services will bring medical care to their patients, others simply make themselves available via the phone within a certain period of time. In either case, their service is generally limited to just providing medical care and doesn’t include prescription medications or other incidentals. For all other choices, the consumer has to drive to the health care provider when it works for the provider’s schedule, and then travel around for diagnostic tests, prescription medications, incidentals, etc.

Affordable Fixed Cost
WhiteGlove’s business model is based on affordable fixed cost membership fees and a fixed cost all-inclusive visit fee of $35 (includes most generic prescription medications and other incidentals).

WGH files no claims against an employer’s or an individual member’s health plan. The combination of fixed fees and no claims lowers and caps the overall cost of health care for employers for the services we provide.
For consumers, visit fees are capped at $35 a visit. Most other health care choices are reimbursed based on a fee-for-service model where they charge the consumer and the health plan for every service performed, making health care costs variable and unpredictable. In addition, the consumer spends money on some combination of gas, parking, tolls, multiple co-pays, child care, and incidentals, only adding to the variable cost.

In the case of most concierge services, their annual fee is generally between $1,500-$3,000 per year, which is not affordable for the average consumer. WhiteGlove has a broad scope of care, and believes it provides 70% of the medical services handled in a typical primary care setting. The most notable differences between the medical services WGH provides and those typically found in primary care settings are: x-rays; ultrasound; suturing; retinal, pelvic, genital and rectal exams; advanced cardiology evaluations; and treatment of chronic depression, chronic pain, addiction or pregnancy.

USE OF PROCEEDS — WGH expects to net $24.5 million, assuming an initial public offering price of $11.00 per share . WGH intends to use the net proceeds of this offering for the repayment of $2.5 million in debt, expansion of business to new metropolitan markets, and general corporate purposes.

June 16, 2011 08:28 ET
University General Health System, Inc. Reports 19% Increase in Audited 2010 Net Revenues

Operating Income Improves to $3.8 Million as Net Revenues Reach Record $56.1 Million

HOUSTON, TX–(Marketwire – Jun 16, 2011) – University General Health System, Inc. (OTCQB: UGHS) (PINKSHEETS: UGHS), a diversified, integrated, multi-specialty health care provider, today reported its audited financial results for the years ended December 31, 2010 and December 31, 2009, which were filed on Form 8-K/A with the Securities and Exchange Commission on June 14, 2011.

For the twelve months ended December 31, 2010, the Company generated net revenues (gross revenues less contractual adjustments and discounts) of $56.1 million, which represented an increase of approximately 19% when compared with net revenues of $47.3 million in the year ended December 31, 2009. Operating income improved to $3,863,201 in 2010, versus an operating loss of ($894,383) in the previous year. After deducting interest expense of $4,782,168, the Company recorded a pretax loss of ($918,967) in 2010, which represented an 86% reduction in pretax loss when compared with a loss before income taxes of ($6,444,883) in the year ended December 31, 2009. Following the payment of $300,000 in state margin taxes, the net loss for 2010 totaled ($1,218,967), which was approximately 82% smaller than the net loss of ($6,715,239) that was recorded in 2009 (after payment of $270,256 in state margin taxes).

“We are pleased to report record net revenues of $56.1 million for the year ended December 31, 2010 and an 82% reduction in net loss when compared with the previous year,” stated Hassan Chahadeh, M.D., Chairman and Chief Executive Officer of University General Health System, Inc. “The Company also generated $3,050,806 in net cash from operating activities in 2010, which allowed us to end the year with $2,291,754 of cash on our balance sheet, compared with cash and equivalents of only $1,640 at the end of 2009.”

“We attribute the significant improvement in operating income primarily to more effective accounts receivable management and an increase in average daily patient census at our general acute care hospital, University General Hospital (“UGH”), which is located near the Texas Medical Center in Houston, Texas.”

“During the first half of 2011, we began to implement a growth strategy in support of our goal of developing an integrated and diversified delivery system in the Houston area, with the expectation to enter new markets in coming years,” continued Dr. Chahadeh. “We opened the emergency room (“ER”) operations of Kingwood Neighborhood Emergency Center in Kingwood, Texas (northeast Houston area) as a hospital outpatient department (“HOPD”) of UGH in April 2011. This was followed by our acquisition in May 2011 of a 15% non-controlling interest in Mainland Surgery Center, a free-standing ambulatory surgery center in Dickinson, Texas, located approximately 20 miles south of UGH. We also entered into a Purchase Option Agreement that entitles us to acquire all or part of the remaining 85% of Mainland ASC prior to April 22, 2014. By acquiring or opening free-standing Emergency Rooms, Diagnostic Imaging Centers, Ambulatory Surgical Centers, Wound Care Centers, and/or similar facilities within a 30-mile radius of a ‘host’ hospital, the remote facilities should benefit from operating under the acute care hospital’s license, while the hospital’s occupancy levels should benefit from patient referrals by the HOPDs. We expect to expand our remote care facilities network further during the balance of the year.”

For additional information, including the Company’s audited financial statements, please refer to the Form 8-K/A filed with the Securities and Exchange Commission on June 14, 2011.

University General Health System, Inc.

University General Health System, Inc. (“University General”) is a diversified, integrated, multi-specialty health care provider that delivers concierge physician and patient oriented services by providing timely, innovative health solutions that are uniquely competitive, efficient and adaptive in today’s health care environment. University General currently operates a 72-bed general acute care hospital near the Texas Medical Center in Houston, two free-standing emergency rooms, and one ambulatory surgery center, with plans for additional acquisitions and/or facility openings in 2011 and future years.

The Company is headquartered in Houston, Texas, and its common stock trades on the OTCQB Exchange under the symbol “UGHS”.

Forward-Looking Statements

The information in this news release includes certain forward-looking statements that are based upon assumptions that in the future may prove not to have been accurate and are subject to significant risks and uncertainties, including statements related to the future financial performance of the Company. Although the Company believes that the expectations reflected in the forward-looking statements are reasonable, it can give no assurance that such expectations or any of its forward-looking statements will prove to be correct. Factors that could cause results to differ include, but are not limited to, successful execution of growth strategies, product development and acceptance, the impact of competitive services and pricing, general economic conditions, and other risks and uncertainties described in the Company’s periodic filings with the Securities and Exchange Commission.

Publication date: 10/05/2010
Texas Doctors Balk at Medicaid Fee Cutback

Written By: Tabassum Rahmani
Published In: Health Care News > November 2010
Publisher: The Heartland Institute

Texas doctors are threatening to stop accepting Medicaid in response to the 1 percent cutback in provider fees that began September 1, and their ongoing frustrations with the Medicaid reimbursement system.

Dr. Arthur Garson Jr., senior vice president for health policy and health systems at the University of Texas Health Science Center in Houston, says he is concerned about the ability of Texas physicians to meet the demands of Medicaid patients. Texas has more than 3.3 million people currently covered by Medicaid, and the state Health and Human Services Commission estimates President Obama’s health care law could add 1.5 million Texans to the Medicaid rolls by 2015.

“There is already a severe physician shortage in Texas, and it could get worse if more doctors don’t accept Medicaid,” Garson said.

Garson notes roughly 15,000 of the state’s 48,700 practicing physicians currently accept Medicaid patients, but many of them are not seeing new patients.

Medical Students Concerned

Garson says medical school students realize year Medicaid reimbursements could be cut. He worries there will be little desire to enter a system about to undergo worsening stresses, with public clinics and emergency rooms becoming increasingly overcrowded.

“Students pay attention to these things, and they begin to look up and see if they can make ends meet or not,” Garson said.

Dr. Kenneth Shine, executive vice chancellor for health affairs for the UT system, said health care institutions must create innovative delivery models to provide care for the growing covered population. The key, he says, is reimbursement.

“State and federal policymakers should be encouraged to maintain and improve Medicaid and Medicare reimbursement rates,” Shine said. “Inadequate reimbursement will decrease the willingness of community physicians to see patients covered by the entities. Institutions cannot afford to care for patients below costs.”

Nationwide Problem, Few Solutions

Garson says a worsening physician shortage will mean fewer doctors in rural areas, and that the poor will find fewer doctors to choose from and more delays in treatment.

“There are other things states can do to help. There are other approaches like the Grand-Aides program here in Houston, a program that is under supervision of nurses where trusted members of the community are trained to serve as liaisons between patients and health professionals,” Garson said.

Garson says the shortage of doctors willing to treat Medicaid patients is not limited to Texas but affects other states as well. He says it will be a nationwide problem under Obama’s law.

“We need more doctors and nurses, not payment reductions. We must train as many as we can, and there still won’t be enough for the coming influx,” Garson said.

Tabassum Rahmani ( writes from Dublin, California.

Mon 6/28/2010 12:23 AM
Pay as you go Physicians develop new payment
models as changes occur

Source: Fort Worth Business Press

The traditional model for health care used to be that patients would pay physicians directly for services given. With the advent of the health insurance industry, though, the traditional model is now for other entities—insurance companies or the government—to pay physicians for services on behalf of patients.

A small number of primary care doctors are turning away from the norm, though, in an effort to cut down on large patient loads and up the financial benefits of providing routine health care. Private physicians, concierge physicians, fee-for-service doctors: Whatever the name, some are adamant that they are a solution to the nation’s primary care and preventative health care crisis.

It’s a common complaint that primary care physicians—be they general practice, internists or family medicine specialists—don’t get reimbursed adequately for the medical care they provide. The lack of adequate reimbursements, plus the daunting student debt young physicians take on, means fewer are choosing to go into primary care, instead going to higher-paid specialties.

With health care reform promising to open access and with the baby boomer generation getting older, the nation is in dire need of more primary care physicians. However, many primary care doctors are switching specialties or retiring because it’s not financially lucrative to provide quality care—there’s no extra reimbursement for good quality care, said Fort Worth physician Dr. James Bohnsack.

Bohnsack practiced in the traditional model for many years, handling close to 5,000 patients (several thousand is not unusual). About a year and a half ago, though, he said he got fed up with making so little money and not being able to offer the quality care he felt his patients needed.

At one point he had practiced with Dr. Chris Ewin, and he contacted Ewin to help him switch his solo practice into a fee-for-care business model, which Ewin himself has. Ewin’s practice, 121MD, is a retainer model, and patients pay him a monthly fee (based on age) to have unlimited access to him. Ewin, who also has a consulting firm he uses to usher physicians through the business transition, worked with Bohnsack (now Ewin’s partner) to make the switch.

“I was intimidated about taking 5,000 patients and making it 500 patients,” Bohnsack said. “ . . .The main thing for me was the quality, how much I could do with the patient.”

Private physicians—there are estimated to be about 2,000 nationwide, represented by the American Academy of Private Physicians—argue that they give better health care to patients because they aren’t limited by insurance companies and that a patient’s money is better spent directly on a doctor rather than on a middleman.

Others would argue that limiting a primary care physician to only 500 or 600 patients isn’t a way to deal with the glut of patients who need physicians.

Ewin, past president of the organization that is now the AAPP, said primary care physicians who switch to a private model can make as much or more than more highly-reimbursed specialist physicians, like neurosurgeons. He envisions a world where primary care physicians have a two-phase career: When they’re fresh off their residencies, they join traditional practices with more experienced physicians, all working together to care for thousands of patients. The experienced physicians, after maybe a decade or so of practicing and earning the trust of patients, then transition out of the practice, taking a small number of patients with them and moving into a financially lucrative phase of their career.

It would be impossible for a new physician to build a successful private model practice without patients who trust him or her, Ewin said, but older physicians who are thinking of leaving medicine or suffering from burnout should be willing to make a change and at least still treat some patients.

“Doctors are afraid to change because they’re making an income, they have kids in college,” Ewin said.

Devon Herrick, a health economist and senior fellow with the National Center for Policy Analysis in Dallas, has written a brief on concierge physicians and said there’s actually a wide variety of various medical practice designs that are focused on cutting out insurance companies or making health care easier for patients.

“I’m seeing a variety of different practice styles,” he said. “ . . . At the really high end, you’re talking about services that you pay $10,000 and they don’t even practice medicine, they just manage your health care. . . . We’re also seeing some innovative ideas at the lower end of the spectrum.”

In the brief, he pointed to a physician who targeted small employers, who were less likely to offer health insurance to employees. Employers would pay $40 a month for each employee, who would then receive primary care. Even though the employees pay out of pocket for diagnostic tests or specialist care, they get discounts negotiated by the physician.

While health care reform will make the need for primary care physicians more acute, Ewin said, there wouldn’t need to be any policy shifts to encourage more private physicians. Instead, grassroots education and a mind shift among physicians is what’s needed. He admits that a private physician does have to be a salesperson, working to convince patients to join his or her practice.

In terms of policy or law, though, what is needed is for the definitions of health care to be opened up more. For example, pre-paid physician services, like Ewin’s, are are currently not included in the acceptable expenditures for health savings accounts.

Bohnsack said he is glad he transitioned out of his traditional practice, saying his new practice gives him more time to work on preventative care and managing a patient’s health, instead of waiting on a patient to become ill to come in to see him (and for him to be paid). The various practice designs physicians are experimenting with are an indicator that quality care is something doctors still want to provide.

“When you’re in the other mode of practice, you’d like to do it, it’s the right thing to do, but you just don’t have the time and there’s no incentive,” he said.

Wed 6/2/2010 11:52 AM
El Paso MD tries new Rx Fewer Patients,
More Medicine

Source: David Crowder

Going to the doctor isn’t much fun these days, and for a lot of physicians, practicing medicine isn’t much fun either.

Dr. Dwayne Aboud, a family practitioner in El Paso for 30 years whose practice has grown to more than 2,000 patients, found himself growing frustrated, with so many to see each day and so little time to spend with them. He has decided to do something about it.

Aboud is the first doctor in El Paso to join MDVIP, a national network of physicians who drastically reduce their practices to focus on personalized, preventive health care.

In April, Aboud’s patients received a letter telling them, “In order to provide enhanced proactive care, I will be reducing the size of my practice to more than 600 patients who may join on a first-come, first-served basis.” He will start making the transition Aug. 10.

“A couple of years ago, a couple of my patients brought me articles about it, and I said the time wasn’t exactly right,” Aboud said.

At the same time, patients began to look for more prevention and preventative care in medicine.

“They didn’t want to have coronary artery disease or strokes or high cholesterol. And this just came along at the right time,” Aboud said.

His patients will pay an annual $1,500 fee, in advance or installments, for a comprehensive physical examination that includes an array of tests not generally provided by insurance plans, as well as a detailed consultation with follow-up visits. Regular visits for illnesses and such will be covered by standard insurance, Medicare or cash payments.

Under the MDVIP plan, $1,000 per patient goes to the doctor and $500 to MDVIP for expenses and technical services to the physician’s office.

MDVIP expects that member physicians will make about the same income with 600 patients that a non-member doctor will make with 2,000 patients.

Since Aboud’s letter went out, he has conducted one informational meeting and had a number of people sign up. He plans two more meetings in June.

While he said he intends to see his existing patients until they find new doctors, switching to the MDVIP-style practice means about 1,400 of them have to go.

“Some of them say, ‘I understand why you’re doing this, but it is not for me,’ ” he said. “I’m sure there’s some animosity out there. They just haven’t come and given it to me in person.”

Aboud knows it’s a gamble.

“This is like any other change, and certainly, I have trepidation and some concerns about whether it will come to an end,” he said. “But I’m confident there are a number of patients who will want this kind of care – whether they are my patients now or not.”

At 61, he wants to practice for 10 more years. But he doesn’t want them to be like the last 10.

“I’m looking at this a little like going home, like going back to the internal medicine I was trained to do and creating the relationship that allow patients to tell you everything that’s going on in a non-rushed, non-threatening environment, like it used to be 15 or 20 years ago.”

Signing up
Sergio Acuña, a 61-year-old insurance broker, has been going to Aboud since 1983 and doesn’t intend to lose his doctor, especially now.

“The lines are only going to get longer,” Acuña said. “We’re short of doctors, and now we’re going to add 31-million patients to the system.”

Acuña and his wife have already signed up.

Dr. Andres Enriquez, president of the El Paso County Medical Society, said he was not aware that Aboud had joined MDVIP, but knows physicians are struggling now and worried about what’s coming with the national health care reform.

“The insurance companies have inundated us with so much paper work, and we have to jump through so many hoops,” Enriquez said. “Most of our time is filled with filling forms.”

Whether El Pasoans will opt into a $1,500 plan remains to be seen, he said.

“There may be a lot of families willing to pay a little more to get that preventive care,” he said. “If he is about to sit down and spend two hours with you and do excellent preventative care, there might be interest in doing it.”

Enriquez said about one-third of El Pasoans are uninsured now, but the new health care law will require almost everyone to carry insurance – and give them access to the system.

“Where are they all going to go? We don’t have doctors to see them,” he said.

MDVIP has 400 members, making it the biggest medical concierge service in the nation. Its website lists 32 doctor members in Texas, 49 doctors in Florida, where the service started, 53 in California, 17 in Arizona and none in New Mexico.

MDVIP and similar physician groups are criticized as elite services that might make doctors feel better but create problems by shoving so many patients out the door.

MDVIP’s medical director Dr. Bernard Kaminetsky said the program is a way for older physicians to stay in medicine and to enjoy the last years of their practice while giving their patients, especially older ones, the kind of attention they need but rarely receive.

“Essentially, in the conventional model with the number of patients that doctors have, it is impossible to render preventive services, and preventive services make a huge difference in health costs,” Kaminetsky said.

MDVIP doctors also analyze their patients’ nutrition, exercise, sleep patterns and emotional well-being and work with them on modifying bad habits, such as smoking, alcohol use and the abuse of drugs, including prescription drugs.

“We also do various screens for latent illnesses using state-of-the-art tools, perhaps genomic testing, non-covered services to detect heart disease,” he said. “All of this is part of a true preventive care model where you are assessing patients for disease.

David Crowder can be reached at (915) 587-6622 or at

Posted on May 18, 2010 at 10:31 PM
Updated Wednesday, May 19 at 12:08 AM

Health care reform laws prompt surge in ‘concierge medicine’

By Janet St. James | WFAA

SOUTHLAKE — Few physicians can dedicate the time and attention to patients that Marcus Welby MD famously did in that 1970s television series.

Dr. Robin Hall in Southlake does.

She’s part of a booming health trend called concierge care.

In soothing spa-like surroundings, Dr. Hall provides medical care 24-7, house calls, same-day appointments at the patient’s convenience, and more.

“If I diagnose someone with cancer, and they want me to, I will go with them to the oncologist office to ask questions on their behalf that they may not think to ask because that’s a very emotional diagnosis,” she said.

For this VIP care, Dr. Hall limits her practice to fewer than 200 patients. Each pays an annual membership fee, starting at $2,000 cash.

She does not take Medicare, Medicaid or private insurance. Patients, however, can use those health plans to fill prescriptions or see a specialist.

Despite that out-of-pocket expense, concierge care is in high demand because of health care reform.

“I do think that as more and more people are insured and there’s less and less time for people to be seen, more and more people will seek this out,” says Dr. Hall of “Because more people are going to be insured, it’s going to be even harder to access care in a timely manner. If individuals already think they have to wait to see a doctor — not only just for the appointment, but in the waiting room, too — that may increase.”

In fact, ten potential patients have scheduled a tour of her upscale Colleyville office this week, which has most of the same medical amenities as a traditional family practice.

Most of her incoming patients are not the affluent elite, but from the middle class, who want to select a personal physician before health care reform limits choices for them.

There are now about 5,000 boutique medical practices in the country. More than 1,000 opened within the last year, according to the Society for Innovative Medical Practice Design. Many more are expected in coming years, as health care reform laws take effect.

Under the law, Americans will be required to carry insurance, but physicians won’t be required to accept it.

Debbie Wessel has insurance, but was sick of being treated like a number in a large family practice.

“We never had the one-on-one relationship with the doctor,” Wessel said. “We never saw the same doctor twice in a row, and they just were not familiar with our charts.”

It’s a situation she suspects will become worse as millions more suddenly-insured patients crowd waiting rooms.

Critics say boutique medicine will only exaggerate the health insurance crisis. Many doctors may leave traditional family practices — widening the gap between the affluent and the poor.

Dr. Hall cut her practice to about one-fifth of what it once was so she could provide better all-around care.

She may not be Marcus Welby, but she believes health care is headed back to the future.

Posted May 18, 2010 at 9:21 p.m.
Texas doctors dropping Medicare patients

By Emily Peters / 325-676-6776

Hundreds of doctors in Texas are dropping out of the federal health care program for senior citizens as physician reimbursements for Medicare decline, but Abilene’s elderly report they haven’t felt the impact quite yet.

More than 300 Texas doctors have stopped serving patients with Medicare in the last two years, including 50 in the first three months of 2010, according to the Houston Chronicle, which compiled the data for a report published Tuesday.

The drop-offs follow years of declining Medicare reimbursement from the federal government. Doctors are now facing another potential 21 percent cut in 2010 in the amount of money they will receive for treating each Medicare patient. Congress has voted three times to postpone the cut, which is now set to begin June 1.

Big Country doctors haven’t started a trend of dropping Medicare service, but many have started restricting the number of new Medicare patients they take, said Dr. Maureen Trotter, a private pathologist and president of the Taylor-Jones-Haskell County Medical Society.

“Some physicians are saying they have to wait for one Medicare patient to move to a different city or a different world before they can accept another,” Trotter said. “Right now, they’re not making any money off them with their office costs and overhead.”

Abilene’s Dr. Austin King allows his office to only accept three new Medicare patients each week. Fortunately, patients don’t wait longer than two or three weeks so far, he said.

“We started this in the past year when it looked like the government was possibly going to reduce reimbursements 21 percent,” Austin said. “If you get too many Medicare patients, you can’t make it financially.”

Instead of dropping or limiting Medicare coverage, some Abilene clinics are making cuts elsewhere in attempts to continue offering the program.

The Abilene Diagnostic Clinic laid off seven workers in early April, partially because office costs rise as Medicare reimbursements dwindle, said Lisa Blackwell, the clinic’s human resources director. She added that the office has also has adjusted supply orders.

“Our doctors are not going to stop seeing Medicare patients,” Blackwell said. “That’s why you have to get creative with other things.”

The increase in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified the state’s Medicare carrier they would no longer participate, up from seven in 2006. The numbers grew to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 doctors to drop out in 2010.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

U.S. Sen. John Cornyn said the inability of Congress to reform Medicare is leaving “seniors without access and breaking the promise we made to them.”

“The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn.

Despite the Texas trend, a group playing poker at the Rose Park Senior Citizen Center Tuesday said they have not yet encountered problems finding Abilene doctors to take their Medicare coverage, but they would face tough times if they couldn’t rely on their government benefit.

Carol Parrott found a specialist in the last year to give her monthly shots to help macular degeneration in her eyes, and she’s not sure what would happen if Medicare didn’t cover it.

“I’d have to take it out of my savings until it was gone,” she said.

Mary Steed said in recent years, she has been a patient of multiple doctors who retired. She doesn’t want to be searching for a new doctor in an era when many are reluctant to sign up new Medicare patients.

“When I started going to the doctor I see now, I made sure to ask him if he was going to be around a while,” she explained. “He said yes.”

Trotter said Big Country patients are at an advantage because many have built long-term relationships with their physicians, who are unlikely to cut them off.

However, she said she expects many doctors won’t have a choice if Congress allows the 21 percent cut.

She said an uproar would be imminent.

“I think the Tea Party would pale in comparison to disgruntled senior citizens because they make up a large group that votes,” Trotter said. “I don’t think they throw bottles on the street like Greek youth, but they vote and they write letters to their congressmen, and those congressmen would get some letters.”

This article contains information from the Associated Press.

May 17, 2010, 11:02PM
Texas doctors opting out of Medicare at alarming rate

By Todd Ackerman | Houston Chronicle

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”

More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions.

The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.”

The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.
Not cost-effective

The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.”

“You do Medicare for God and country because you lose money on it,” said Culpepper, a graduate of the University of Texas Medical School at Houston. “The only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.”

Ending Medicare participation is just one consequence of the system’s funding problems. In a new Texas Medical Association survey, opting out was one of the least common options doctors have taken or are planning as a result of declining Medicare funding — behind increasing fees, reducing staff wages and benefits, reducing charity care and not accepting new Medicare patients.

In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent.

The impact on doctors has not been lost on their patients. Kathy Sweeney, a Houston retiree, twice has been turned away by specialists because they weren’t accepting new Medicare patients. She worries her doctors might have to drop her if Medicare cuts go through and they can’t afford to continue in the program.

“I’ve talked to them about the possibility,” said Sweeney, who sent her legislators a letter calling on them to fix Medicare. “They’re hanging in there as long as there’s not a severe cut, but just thinking I couldn’t continue doctor-patient relationships I built up over years is disturbing. Seniors should be able to see the doctors they want.”

The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large.

Congress would overturn the cuts, but their short-term fixes didn’t keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they’ll net $290. If the scheduled 21.2 percent cut goes through, they’d net $72, effectively an 83 percent cut since 2001.

The issue caused the Texas Medical Association to break ranks with the American Medical Association and oppose health care reform efforts throughout 2009. Then TMA President Dr. William Fleming said “reform is doomed to failure” without Medicare reform and called Congress’ failure to devise a rational payment plan “an insult to seniors, people with disabilities and military families.”
No surprise to senator

U.S. Sen. John Cornyn, R-Texas, said he isn’t surprised by the new opt-out numbers, allowing that Congress’ inability to reform Medicare is leaving “seniors without access and breaking the promise we made to them.”

“The problem has been how to eliminate the cuts without running up the deficit,” said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the Senate for not passing a House bill that would have provided a longer-term Medicare fix. “There hasn’t been the political will, but we really have no choice but to fix it.”

Cornyn acknowledged the task is daunting. The Congressional Budget Office recently estimated that eliminating scheduled Medicare payment cuts through 2020 would cost $276 billion.

The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state’s Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out.

Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move.

“I’ve been in practice 24 years, and a lot of my patients got old right along with me,” Culpepper said. “It’s stressful to tell them you’re leaving Medicare and they’re responsible for payments if they want to stay with you. You feel like you’re abandoning them.”

Prevention, personalized care focus for local doctors’ new practices
Boynton, Dodson will limit number of patients they serve

By Elaine Marsilio | Posted February 5, 2010 at 5:43 p.m.
Corpus Christi, TX |

For an upfront fee, these doctors are at your service anytime


Houston Concierge Medicine can save and give you time.
Concierge Medicine is available in Houston to provide personal premium health care.

READ MORE | October 26, 2009

October 22, 2009 | NPR News:
Age, Gender Skew Group Health Care Rates


Southlake, TX (PRWEB)
Concierge Medicine Takes Front Seat with Health Care Reform Uncertainty

July 8, 2009 :: FULL STORY | ShareThis

Concierge Choice Physicians Expands Into Delaware, Virginia and Texas
July 7, 2008 | FULL STORY | ShareThis

1,000 Doctors Adopt Concierge Care
Posted by admin in Health Care on Mar 28th, 2008

READ BLOG | ShareThis

Utah —

May 16, 2011
More Patients Turn to Doctors
on Retainer

by Carolyn Campbell |

Back in the good old days, the family doctor could be reached anytime, day or night, and often visited sick patients in their own homes. Well, those days are long gone, as we all know. A trip to the doctor now involves an often hard-to-get appointment, a long stop in the waiting room, insurance forms, co-payments—all for a quick 10-minute consultation.

The situation is frustrating for all parties, and some doctors are cutting ties with insurance companies and slashing their patient loads in an effort to recreate the “good old days” of medicine. It’s a movement called retainer-based medicine—or concierge medicine—and more doctors, and their patients, are opting in.

Private Practice

Dr. Wes Wylie practices in Provo and is affiliated with ModernMed, Inc., a national retainer-based medicine company. Wylie’s patients pay a monthly fee and in return receive quick appointments with no waiting time, access to the doctor’s cell phone and email address, and even home visits on occasion.

Dennis Chambon, a patient of Wylie, says he can usually reach the doctor by phone in five minutes. “It isn’t his assistant who answers. I always talk to the doctor,” says Chambon, who owns Vertec Tools, Inc. Chambon, a patient for two years now, has phoned Wylie about two dozen times. When he arrives for an appointment, there is no waiting time.

“While my ModernMed membership is an extra expense that some people would consider a luxury, I wanted to have ready access to the best doctor, and I feel I’ve accomplished that,” says Chambon “My confidence in him is the greatest thing, and my insurance pays for everything he prescribes.”

Dr. Jami Doucette, CEO of ModernMed, explains that within the retainer-based medicine concept, patients have a more direct financial relationship with their physicians than they do within the regular insurance model. Patients pay a monthly, quarterly or annual fee for services the physician provides.

At ModernMed, Doucette says that a patient pays about $125 per month to subscribe. “It’s about $4.19 a day—less than a cable bill and about the same price as drinking Starbucks coffee regularly. We feel it is affordable for almost everybody who cares about their health and well-being.”

In return for the payment, patients receive “24/7 access to their physician’s cell phone and email, same day/next day appointment guarantees and no waiting in the waiting room. Many such practices don’t even need to have a waiting room,” says Doucette. Retainer-based patients also receive house calls or workplace visits, total care coordination and an annual executive physical with lab work. “That physical sets the tone for the next year to help the physician and patient as a team,” says Doucette.

Quality Care

Some physicians may be turning to retainer-based medicine, but it is not a model that most practitioners have adopted, says Michelle McOmber, CEO of the Utah Medical Association. “Most Americans utilize health insurance or are covered by a government plan if they qualify for it. Within the typical insurance model, a care provider gives care to a patient and a third party pays for most or all of it,” she says. “Within the retainer-based model, the provider and patient make arrangements without the insurance company in between.”

McOmber says that such a practice allows a physician to spend more time with the patient and be more accessible on a daily basis, depending on how they structure the fee-based model and how many patients they take. Additionally, the concept “puts the care back into the hands of the patient and physician,” removing the third-party insurance company from healthcare decisions.

The traditional insurance model is a volume-based incentive model, where physicians get paid based on the number of patients they see or the number of procedures they do. “This incentive is not in the best interests of the patient or the physician,” says Doucette.

Because retainer-based physicians typically see about eight patients a day, compared to the 20 to 30 patients a day in traditional practices, more time can be spent addressing patients’ needs and concerns. “There is more focus on prevention, wellness, early detection and chronic disease management along with the episodic sick care,” says Doucette. This enables the physician to provide higher-quality care in terms of early detection and chronic disease management.

Doucette explains that the retainer model “is a quality-based incentive model where physicians have the incentive to provide the appropriate amount of care with incredible customer service in an effort to retain the patients in the practice.” He adds, “In some aspects, it is a return to old-fashioned medicine, where the physicians had time to develop very strong relationships with the family and the patient.”

However, McOmber clarifies that retainer-based medicine is normally primary care or well care. “It usually covers things that are routine. The specialty side—with conditions such as heart disease or surgery—doesn’t necessarily fit in with what you are paying for in maintenance services. Patients still need insurance for hospitalizations, big tests, surgeries and specialists.”

Doucette agrees that membership in retainer-based medicine does not replace the need for insurance, and adds that most members subscribe to retainer-based medicine and also purchase health insurance. He himself maintains a $5,000 deductible on his insurance and pays for his retainer-based medicine membership with a health savings account. “I am paying less for my premium and membership than I would pay if I had a $2,500 deductible.” He says that ModernMed’s physicians will coordinate care with a cardiologist or specialist, “and once the patient is in the hospital, their insurance kicks in.”

Policy Perspectives

While retainer-based medicine is emerging as a trend, McOmber isn’t sure that it will work for most people—particularly as the ultimate effects of health reform are still unclear. “Some physicians could make a living doing [retainer-based medicine] and decide they are tired of all the paperwork, regulation, insurance companies and government, and it just comes down to the care,” she says.

While health reform is still an unknown, Doucette says, “There are a couple of different retainer models and they fit very nicely into reform as it stands right now. It is difficult to know, however, exactly what will be implemented given the back and forth in Washington.”

Dr. David N. Sundwall, who served as executive director of the Utah State Department of Health from 2005 to 2010 and is currently a professor of public health at the University of Utah School of Medicine, views retainer-based medicine as a legitimate, if somewhat elitist, attempt on the part of some doctors and providers to streamline the current process and provide more personal care to patients who are willing—and able—to pay for it.

From a public policy perspective, Sundwall has mixed feelings about retainer-based healthcare. While it does have benefits for patients and physicians alike, “My frustration is that these concierge systems only see those people with means and do not participate in care for the poor,” he says.

“We in public health are trying to get doctors to participate in Medicaid for the poor and Medicare for the elderly. But that doesn’t pay as well as traditional insurance. As a public health official, I worked hard to get doctors to see Medicaid and Medicare patients, because it is absolutely critical for people to have access to timely healthcare,” says Sundwall. But retainer-based medicine simply leaves those patients behind.

“I understand its appeal to patients and physicians. Ideally, it allows the doctor to treat the patient as a person, to have enough time and be compensated adequately for what they need,” he says. However, “it is kind of an elitist sort of thing, because it [only] benefits the doctors and people who can afford to pay.”

On the other hand, Sundwall says he is not opposed to retainer-based medicine and views it as a legitimate response to a healthcare system that has become “clogged up with paperwork and regulations…a complicated, complex and costly system.”

Doucette agrees and adds that retainer-based medicine actually creates healthcare consumers who are better informed about the true cost of care. “The current system is pretty convoluted. The patient pays a premium to an insurance company who acts as an intermediary, and the true cost is lost to the patient.” Because of the direct financial relationship between the patient and physician within the retainer-based practice, “patients end up being true consumers and customers of healthcare.”

Utah News from the Daily Herald Newspaper | the Daily Herald | Local News
Increasing doctor shortage leads to new health care providers

Heidi Toth – Daily Herald Daily Herald | Posted: Monday, February 21, 2011 12:02 am

The doctor is in.

That doesn’t, however, mean you can get in to see him anytime soon.

The signs of an increasing primary care shortage are already apparent: appointments for non-acute physical conditions are scheduled out weeks in advance, more doctors are moving to concierge medicine, in which patients pay a fee every month not to see the doctor, but just for the option to go to the doctor.

The aging baby boomers combined with health care reform, which will put an estimated 35 million people onto health insurance and thus into doctors’ offices, plus the lack of doctors in less lucrative fields like family medicine or in rural areas of the country are coming together in a health system perfect storm to create a doctor shortage. More medical schools are not being created and established schools are not significantly increasing in size.

All of that leads to many Americans calling for a physical, a strep test or an aching back or knee and instead of seeing a doctor, seeing their physician’s assistant or nurse practitioner.

“It’s here to stay,” Dr. Neil Whitaker, the chief medical officer for Intermountain Healthcare’s urban south region, said of these advance practice clinicians.

Nurse practitioners and physician’s assistants go through graduate-level programs to certify at these levels, have controlled substances licenses, can perform procedures like suturing and setting a broken bone and do many other tasks that a physician can. In Utah, nurse practitioners can operate independently, but physician’s assistants work with a physician. The doctor remains the patient’s primary caregiver, even if the patient normally sees the PA.

“It’s getting more and more understanding in the community of what a physician assistant’s role is,” said Troy Bitters, an orthopedic PA at Utah Valley Orthopedics and Sports Medicine.

It’s also becoming a more and more popular career choice. The number of PA programs has doubled in the last 20 years, he said, while the number of medical schools have stayed fairly static. Instead of PA school being the backup for medical school, those who can’t get into a PA program because they are so competitive become doctors instead.

Some PA programs are as competitive as Harvard’s medical school, Brooke Braun with the American Association of Physician’s Assistants said.

Bitters chose PA school over med school because he was 30 and had a young daughter at home when he decided he wanted to go into medicine. Had he gone to four years of medical school, followed by a four-year residency and possibly a fellowship, his daughter would have been 18 by the time he was finished with his training.

As a PA, he diagnoses and treats patients, sets up treatment and care schedules, prescribes medications and assists in surgery. However, the physician with whom he works reviews patients’ charts, performs the surgeries and is available should a patient need more in-depth care than Bitters is qualified to give.

Many patients have said they like seeing him because he is able to spend more time with them.

Nurse practitioners are similar, Whitaker said. At Intermountain hospitals, they are required to work with a physician, but nurse practitioners can do certain procedures and assist with other procedures, they can see patients, even for a first visit, and they can prescribe medications and monitor patients.

For specialists like cardiologists, having a nurse practitioner or PA at the office essentially allows the doctor to be in two places at once; he may be at the hospital’s catheter lab while the nurse practitioner is at the office monitoring patients.

In non-hospital settings, nurse practitioners frequently become physicians’ partners, Whitaker said; that is less expensive than having a physician partner, and nurse practitioners can do just about all the tasks a doctor can do in the primary care setting. This is especially true in rural areas, where the shortage is even more pronounced.

This allows more people to be seen without overloading doctors and usually is more cost-effective; Whitaker said insurance companies reimburse care by advance-practice clinicians at about 80 percent of a doctor’s reimbursement rate.

At a time when a family doctor is becoming a hot commodity, having that kind of access is important to consumers.

So that may resolve the numbers shortage into the future, but when patients want access to their doctor, they want that access to include good medical care. The question then becomes if these advance practice clinicians provide that care and if consumers are satisfied with the substitution.

“There’s probably room to say that many patients might voice a preference if they understood,” Whitaker said. “They don’t always immediately know if the provider they’re seeing in the office or hospital is a non-physician. But many patients are happy with the care they get regardless of who’s providing it.”

Research has shown that adverse outcomes in hospital settings, such as mortality rates, length of stay and having to go back to a hospital, are similar among patients of doctor and advance practice clinicians.

Bitters said he has known patients who don’t want to see him but want to see the doctor. Chris Crockett, the office administrator at Utah County Medical Associates in Payson, which has several doctors as well as two nurse practitioners, said patients there see a doctor at least once a year.

Mason McMullin, a Woodland Hills resident, said he would prefer to see a doctor anytime, but especially when he’s being diagnosed. The doctor has greater expertise, he said.

Even patients who trust their nurse practitioners want access to their doctor. Jodie Goodman, of Springville, said she routinely sees the nurse practitioner at her doctor’s office, and she doesn’t mind that. In fact, she prefers the nurse practitioner, who is able to spend more time with her at appointments. However, she wouldn’t use a nurse practitioner as a primary care provider, and when she goes in with a major issue, she expects to see the doctor.

“I would not want to go to a nurse practitioner for something that I felt was serious,” Goodman said. Back pain or a sinus infection, yes, but “if I thought I had cancer I would go to the actual doctor.”

Virginia —

Monday Q&A: The accidental acquisition
[Partner MD]

By Al Harris | |

July 18, 2011 – Eight years is all it took for Linda Nash to build her business to a point where a deep-pocketed buyer wanted a piece of the action.

Nash founded PartnerMD, a concierge medical practice, in 2003 with one doctor and 40 patients.
Today the practice has 4,000 patients and nine doctors spread across offices in the West End, Midlothian and McLean.

The company’s clients pay an annual membership fee and in exchange receive around-the-clock attention, even getting their doctors’ cell phone numbers with permission to call them anytime, day or night.

The company also takes care of the region’s top executives, with corporate contracts to provide primary care to the top brass at Capital One, Brink’s and Dominion, to name a few.

PartnerMD also has a new owner, as the company announced last week that Markel Ventures had acquired it for an undisclosed sum. BizSense caught up with Nash to talk about the deal.

Below is an edited transcript.

RBS: What is the idea behind PartnerMD?
Linda Nash: Health care is very hard to deliver based on the issues that doctors have. A typical doctor has 4,000 to 6,000 patients. It is a production model: They have to see more and more patients to make a better living.
We have a lower ratio, where each doctor sees no more than 550 patients. It makes things much easier for the patients, and it is a better experience for the doctor.

RBS: How much does it cost?
LN: First, we still work with your insurance, and you have your own co-pay. It’s like your regular doctors office, but we have a membership fee.

The membership fee is $1,900 annually, which is roughly $160 a month.

RBS: How did the deal with Markel come about?
LN: It came about accidentally. Markel is one of our corporate clients, so we got to know a lot of the principals. I met Tom Gayner [president and CIO of Markel] at a conference in Charlottesville and just started talking and that’s how it came about.

RBS: So you weren’t actively looking for a buyer at the time?
LN: No, we weren’t running a process. In the life of any entrepreneur, you get your company to a certain level and you start thinking about succession.

I was 76 percent owner of the company, and I wanted PartnerMD to go on indefinitely. Markel was the perfect solution. They follow the Berkshire Hathaway model, which is to buy companies and keep them and allow the owners to continue running them.

RBS: Is there any plan to expand?
LN: Absolutely. We would like to expand regionally. We want to have a larger presence in Northern Virginia. We are looking at the Ashburn area. We would like to move into Virginia Beach and perhaps Raleigh and into the Carolinas.
It is such a wonderful model for physicians and patients. I don’t see any reason that we can’t expand it now that we have stronger backing.

RBS: As a business that offers its services at a premium, did you experience any difficulties during the economic downturn?
LN: We were very worried about it at the time, but we did not even see a hiccup. We didn’t lose any corporate clients, we kept our retention rate of 95 percent, and the business continued to expand. Between the three offices, we continued to take on 50 new members a month.

RBS: Does the federal health-care overhaul have any potential effects on your business?
LN: What will happen with medical care in the future, as wonderful as it may be for society as a whole, there will be a lot more people entering the system: 32 million newly insured and 36 million people entering Medicare.
At the same time, most primary care and internal medicine doctors are boomers, and they are retiring. There is a crisis brewing where we are going to be 100,000 doctors short. It will be very hard for people to get the type of medical care they are used to.

There is a beautiful opportunity for us there to expand and help other people get this kind of care.

Markel acquires PartnerMD concierge medical service

By John Reid Blackwell | Richmond Times Dispatch

Published: July 14, 2011 – Markel Corp. has added a locally based provider of concierge medical services to its growing investment portfolio.

The Henrico County-based specialty insurer announced Wednesday that its Markel Ventures investment subsidiary has acquired PartnerMD LLC. Financial terms of the deal were not disclosed.

Started in Richmond in 2003 by Dr. James Mumper and Linda Nash, PartnerMD provides concierge medicine, a type of membership health-care service in which patients pay an annual fee for enhanced care that includes disease prevention, health maintenance and around-the-clock access to a physician.

That type of medical service is a small portion of the overall health-care industry, but it is growing, Mumper and Nash said yesterday.

“Even with the financial troubles in the last couple of years, we have not seen a hiccup in terms of new members,” said Nash, the company’s CEO.

PartnerMD’s practice has about 4,200 individual and corporate clients. It has nine doctors and a staff of about 55. Its main office is at the Bon Secours Heart Institute at Reynolds Crossing in Henrico, and it also has offices in Midlothian and McLean.

The company is known regionally for its executive physical exams offered for individuals and companies.

Mumper and Nash plan to stay onboard to continue to run the business.

Markel’s financial help will enable PartnerMD to pursue more growth opportunities. “We would like to grow regionally,” Mumper said.

Nash said the good thing about Markel’s backing is that the specialty insurer has a “measured” approach to growth.

“We want to grow, but we only want to grow if it makes sense,” she said.

A Markel spokesman could not be reached Wednesday night.

“We’re very excited about PartnerMD joining our group of companies,” Markel President and Chief Investment Officer Tom Gayner said in a statement released by PartnerMD. “It has an outstanding reputation among its members and in the community, and it is a winning model for the future of health care.”

Markel has acquired or bought majority stakes in several other Richmond-based companies in the past year.

In January, Markel acquired a majority interest in Diamond Healthcare Corp., a privately held company that manages behavioral-health programs, including one for chemical dependency.

In December, the investment subsidiary bought a majority interest in RD Holdings LLC, a nationwide retail intelligence service based in Henrico.


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In U.S., Employer-Based Health Insurance
Declines Further
Percentage of uninsured adults edges up slightly

By Elizabeth Mendes | Source: GALLOP | June 23, 2011

WASHINGTON, D.C. — Forty-five percent of American adults reported getting their health insurance from an employer in January through May of this year. This is down from 45.8% in 2010, and has been steadily declining since Gallup and Healthways started tracking health insurance sources in 2008.

The issue of health insurance in the United States is far from fading into the background. Currently, 26 states are seeking to overturn the new healthcare law in court. At the same time, nearly every state is scrambling to figure out to how to fund and implement the law amid tough economic times and congressional lawmakers are debating the future of Medicare and Medicaid. The confluence of these issues makes who is covered and how they get their coverage more relevant than ever.

There are two major forces that are affecting where Americans get their health coverage: One is President Barack Obama’s Patient Protection and Affordable Care Act and the other is high unemployment and underemployment. As only certain parts of the new healthcare law have been implemented, the latter issue appears to be the more influential one at this time, with steady declines since 2008 in the percentage of Americans who get their health insurance from an employer.


Principal Medical Group Provides Patient Care
at Local Hospitals

Source: NewswireToday

JUNE 24, 2011 – Principal Medical Group announced today that David J. Jones, M.D., a primary care physician with the practice, has expanded his services and is now affiliated with Inova Fairfax Hospital and the Virginia Hospital Center, Arlington.

“Patients are my number one priority and having privileges to treat them during hospital stays is very important,” said Dr. Jones. “This is another good example of how concierge medicine provides personalized, comprehensive care to its members.”

Before joining Principal Medical Group, Dr. Jones provided medical care to acutely ill hospitalized patients while working as a hospitalist. In this role, Dr. Jones recognized the importance of primary physicians being involved in a patients care while they are in the hospital.

As a leading primary care physician in Northern Virginia, Dr. Jones received his undergraduate degree from the University of Maryland in economics in 1989 and his doctorate a decade ago from Ross University School of Medicine. His internship and residency training was completed at Maimonides Medical Center in Brooklyn, N.Y. Dr. Jones is board certified by the American Board of Internal Medicine. Dr. Jones applies his training, communication skills and personal approach to the patients at Principal Medical Group, a concierge medical practice.

About Principal Medical Group, P.C.

Principal Medical Group ( is a primary care medicine practice located in the heart of McLean, Va. As concierge medicine physicians, Principal Medical Group offers the highest level of care, with same-day appointments, comprehensive, preventive services and 24/7 access. Through its membership model, patients receive personal attention from top doctors during unhurried appointments that start on time. This enables Principal Medical Group’s physicians to partner with patients to manage complex medical conditions, as well as acute care.

By Dan Parsons | June 11, 2011 | Daily Press
Gloucester doctors open new office to provide 24-7 care
New office opened last month on Main Street

GLOUCESTER — Along with the bucolic rolling farmland that draws people to Gloucester County, it would seem appropriate to find a physician who, like an old country doctor, is dedicated the art of healing, still makes house calls and knows each of his patients by name without the aid of a chart.

A doctor who meets that description can be found in an old bank building at 6909 Main St. in Gloucester Courthouse. Dr. Ronald Haggerty and his partner, Katherine Beamer, a board-certified family nurse practitioner, opened Direct Access Internal Medicine in that location last month.

As the name suggests, the pair designed the small private practice around the idea that their patients could receive personal, comprehensive care in a friendly and familiar environment whenever needed and upon request if necessary.

“Our goal is to be much more accessible than the average physician,” Haggerty said Tuesday during an interview in his office. “The essence of high quality medical care is time. Usually you just don’t have the time to sit down and listen to the patient, to do some research if necessary and have a good conversation about everything that may be affecting their health. We want to be able to provide that.”

Originally from Michigan, Haggerty studied medicine at Wayne State University in Detroit before serving his residency at the Naval Medical Center in Portsmouth. After a six-year active duty stint in the U.S. Navy, Haggerty went into private practice in Chesapeake.

In 2004, he moved to Gloucester to join Internal Medicine Associates, then moved to Riverside Walter Reed Hospital, where since 2006 he is chief of the hospitalist program.

The experience leading hospital-based doctors led Haggerty to his current path, though he and Beamer still work part-time for the hospital while they establish their private practice.

“As a hospitalist, you don’t really have the ability to follow your patients,” Haggerty said. “You see them when they are very sick at the hospital for a few days, you get them over an acute illness, then send them on their way. You don’t see them again unless they get sick and come back to the hospital.”

Their new practice is a hybrid between a fee-only “concierge” clinic, where patients are seen anytime for anything, and a traditional private practice that would normally have between 2,500 and 3,000 patients, Haggerty said.

Ultimately, they’re looking to have about 800 full-time patients, perhaps 1,000, who would pay an annual fee for 24-7 access to Haggerty and/or Beamer. They promise a 30-minute minimum consultation for existing patients and a full 90-minute initial consultation for new patients.

Instead of waiting in line at an emergency room, both Beamer and Haggerty promise to be available 24 hours a day all week long.

“We will always be available,” said Beamer. “We have each other to rely on, so there should not be a day in the office where we cannot see a patient.”

Beamer, who goes by “Kacki,” was born and raised in King and Queen County. She studied nursing at the Medical College of Virginia, where she also obtained a master’s degree. She worked at Riverside Walter Reed in Gloucester for 18 years before joining Haggerty at Internal Medicine Associates.

The practice is growing slowly but steadily, both said. As they add patients to the roster, they also intend to add services.

While Haggerty works with most insurance providers, he also plans to offer a suite of services aimed at keeping his patients healthy instead of simply treating them when ill.

“We want to offer comprehensive preventive care, especially cardio-vascular health services, like fitness assessments and body-composition analysis,” Haggerty said.

“We also want eventually to hold some educational seminars or something like that on nutrition and dietary health.”

The practice also provides patients with online access to their own digital medical records.

But, most importantly, “We want to get to know our patients,” Beamer said.

Direct Access Internal Medicine

Opened: May 29, 2011

Physician: Dr. Ronald Haggerty

Nurse Practitioner: Kacki Beamer

Location: 6909 Main Street, Gloucester

Phone: (804) 824-9153


Principal Medical Group Employee Earns Student of the Year Award
Sanford-Brown College awards Demetria Stubbs with top honor


PRLog (Press Release) – Jun 08, 2011 – Principal Medical Group announced today that medical assistant Demetria Stubbs earned Sanford-Brown College’s Graduating Student of the Year award and will be placed on the President’s List. Stubbs will be presented with the award during the school’s August commencement ceremony when she receives her associate degree in applied sciences with a focus on medical assistance.

After earning a grade point average of 4.0 for two consecutive semesters, Stubbs is happy to accept this certificate of achievement and begin her career with Principal Medical Group in McLean, Va. David J. Jones, M.D., a primary care physician with Principal Medical Group, recalls how Stubbs stood out among multiple candidates for the job. “Demetria is sharp, thoughtful and patient-centric. From the time we met, we knew she would be a great asset to our concierge patients,” said Dr. Jones.

When notified of her accomplishment, Stubbs says she was proud to see that people truly believe in her. “I feel very honored as this award marks a milestone for me.” With a bright and successful future ahead, Stubbs recognizes “hard work most definitely pays off.”

# # #

Principal Medical Group is a primary care medicine practice located in the heart of McLean, Va. As concierge physicians, Principal Medical Group offers the highest level of care, with same-day appointments, comprehensive, preventive services and 24/7 access. Through its membership model, patients receive personal attention from top doctors during unhurried appointments that start on time. This enables Principal Medical Group’s physicians to partner with patients to manage complex medical conditions, as well as acute care. Learn more about Principal Medical Group and concierge medicine at

Principal Medical Group Showcases Award-Winning Logo
Gold Hermes Creative Award Goes to Northern Virginia Concierge Medical Practice


PRLog (Press Release) – May 25, 2011 – Many companies use their logo to illustrate who they are and what they do. This is especially true for Principal Medical Group, P.C., which created a logo to communicate its vision for a new model of healthcare. Today the medical practice announced its logo earned a “gold” in the Design and Logo Category in the Hermes Creative Awards for creative professionals.

“Our team wanted a logo which conveyed that comprehensive medicine is made up of multiple building blocks, which together create a strong foundation for patients,” said David J. Jones, M.D., a physician with Principal Medical Group.

Administered by the Association of Marketing and Communication Professionals, the Hermes Creative Awards recognize outstanding work in the industry while promoting the philanthropic nature of marketing and communication professionals. There were more than 4,400 entries from throughout the United States, Canada and several other countries in this year’s competition. Entries came from corporate marketing and communication departments, advertising agencies, Public Relations firms, design shops, production companies and freelancers.

A complete list of winners can be found on the Hermes Creative Awards website at

# # #

Principal Medical Group is a primary care medicine practice located in the heart of McLean, Va. As concierge physicians, Principal Medical Group offers the highest level of care, with same-day appointments, comprehensive, preventive services and 24/7 access. Through its membership model, patients receive personal attention from top doctors during unhurried appointments that start on time. This enables Principal Medical Group’s physicians to partner with patients to manage complex medical conditions, as well as acute care. Learn more about Principal Medical Group and concierge medicine at

Wealth Matters
Putting Your Doctor, or a Whole Team of Them,
on Retainer
By PAUL SULLIVAN | Published: April 29, 2011 | Source: NY Times

Five years ago, Steven L. Glazer, an internal medicine doctor in Norwalk, Conn., told his thousand patients that he would no longer be able to care for them because he was going to focus on only a dozen, wealthy patients who could pay his annual fee.

With that he entered the world of concierge medicine, a growing subset of medicine where patients pay doctors anywhere from $1,500 to $25,000 a year to receive personalized attention and care. (Dr. Glazer said he was paid toward the top of this range.) In most cases, patients presume that in an emergency their concierge doctor will push them to the front of the line to see a top specialist.

Even as more people are struggling to pay medical bills and being rushed through office visits with their doctors, an elite group with money has another option: exclusive medical care, around the clock and anywhere in the world, including on a yacht or private plane.

One of Dr. Glazer’s clients, for instance, has had his yacht outfitted with a system from Guardian 24/7, a company in Leesburg, Va., founded by former White House doctors that advertises itself as offering “medical protection previously available only to the president of the United States.” The company’s “ready room” will allow a doctor trained in the system to perform basic medical care remotely if something should go wrong while the patient is on the high seas.

“There is very little that we can’t do with the triage room on their yacht,” he said.

The cost of Guardian 24/7’s services ranges from $6,000 to $12,000 a month, plus an additional $700,000 for one of the company’s top-of-the-line “ready rooms” installed in a client’s home, yacht or airplane, said Jonathan Frye, chief executive.

While it is difficult to determine how many people are served by this more personalized care, the number of doctors who have moved to this new model has risen fivefold in the last five years. And that raises questions about medical care in America. For those who can afford it, what do they get for their money? Is it worth it? And for the rest of us, who cannot afford this level of care, is it fair and ethical for doctors to be doing this? Or is concierge care contributing to the growing gulf between the wealthy and everyone else?


Concierge medical care is nothing new. In places like Florida, with a high concentration of Medicare patients, some upper-middle-class retirees pay extra fees so they can see a doctor when they need to.

MDVIP, which has 450 concierge doctors in 34 states, charges patients $1,500 to $1,800 a year. Their doctors are each limited to 600 patients, whereas, the company says, most primary care physicians serve at least 2,000 patients. It says appointments with doctors “start on time and last as long as necessary” and can usually be made the same day or the next one. The company’s fee is for the extended care and comprehensive annual physical and wellness plan, but its doctors still bill the patient’s insurance company for procedures.

The international, around-the-clock programs take concierge medicine to a different level. Their primary goal is to offer an extra level of oversight to make sure that participants are getting the proper level of care whenever they need it.

Dr. Miles J. Varn, chief medical officer at PinnacleCare Private Health Advisory, which charges annual fees of $1,500 to $25,000, said the starting point for all patients was a complete review of all health records with an emphasis on finding gaps in care.

“We have physicians who look for omissions of care or deviations from standard care,” Dr. Varn said. “That record travels with them around the world.”

In promoting themselves, the plans say their doctors know each patient’s health conditions intimately and are able to discuss it with another doctor anywhere in the world.



Despite reports about the decline in the number of family physicians and the increase in the hours the remaining ones work, many wealthy people are reluctant to pay extra for health care.

Dr. Varn said more than half of the company’s members were in a program that costs $10,000 a year, or about $800 a month — on top of whatever private insurance members may have. “How much do you pay to have your lawn mowed every year?” he asked. “Why wouldn’t you pay to get the same advice on your health? People think having great insurance means having great health care and that’s not the case.”

Beyond personalized primary care, the main selling point for high-end plans is access to top specialists when needed. Yet it is difficult to determine just how much shorter the wait is for the specialist.


Beyond that, these companies argue that they help members locate the right doctor, something they would have more trouble doing on their own.


Unlike professions where money is a primary goal, doctors are obligated by their ethical code to provide care for people in need. This becomes an issue when their practices are confined to the wealthy, and it elicits complaints that concierge medicine caters to the elite.

“This isn’t fair,” said Dr. Carlin, who worked as refugee camp doctor and in an emergency room before starting World Clinic. “I’m a small solution to a vast health care problem.”

The American Medical Association’s policy on concierge care — or what it calls retainer practices — states that it is part of the “pluralism in the delivery and financing of health care.” But the A.M.A. also says these retainer practices “raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

But some of the doctors involved in these practices argue that some variation will eventually be available to people who are not wealthy. “The solutions we’re developing right now are very expensive ones, but they’re going to migrate down to even the poorest people in the world,” Dr. O’Mara said.

He said one of Guardian 24/7’s members had underwritten a project to make a ready room mobile and put it in a free medical clinic in Northern Virginia. The company hopes that top specialists can be available remotely at the clinic.

Others were less sanguine about the shift to concierge medicine. “My response has been helpful to me and my patients, but it hasn’t addressed in any meaningful way the larger policy issue,” Dr. Glazer said.

And that is the bigger issue: whether these services for the wealthy can be translated to make the medical system better and more efficient.

April 3, 2011
Concierge medicine’ stirs Medicare worries

WASHINGTON, D.C. APRIL 3, 2011 — Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services and, in return, you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.

But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.

The spread of “concierge medicine,” in which doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge between the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.

Medicare recipients, who account for a big share of patients in doctors’ offices, are the most vulnerable. The program’s financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary-care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.

If concierge medicine goes beyond just a thriving niche, it could lead to a kind of insurance caste system.

“What we are looking at is the prospect of a more explicitly tiered system where people with money have a different kind of insurance relationship than most of the middle class, and where Medicare is no longer as universal as we would like it to be,” said John Rother, policy director for AARP.

Concierge doctors say they’re not out to exclude anyone but are trying to recapture the personal connection shredded by modern medicine. Instead of juggling 2,000 or more patients, they can concentrate on a few hundred, stressing prevention and serving as advocates with specialists and hospitals.

“I don’t have to be looking at patient mix and how many are booked per hour,” said Lewis Weiner, a primary-care physician in Providence, R.I., who’s been in a concierge practice since 2005.

“I get to know the individual,” Weiner said. “I see their color. I see their moods. I pick up changes in their lives, new stressors that I would not have found as easily before.”

Making the switch can also be economically rewarding. If 500 patients pay $1,500 each, that’s gross revenue of $750,000 for the practice. Many concierge doctors also bill Medicare and private insurance for services not covered by their retainers.

Patients and family members say the fee is worth it.

Linda Popkin lives in New York, far from her 97-year-old mother in Florida. With their mother in a concierge practice, Popkin says she and her siblings have direct access to the doctor as needed.

“If one of us calls the doctor, he calls us back,” she said. “We are involved in all the decisions. We definitely have peace of mind that Mom is seeing a doctor she can speak to if we have any questions. I’m sure you’ve heard the horror stories about people calling the doctor and they can’t get in for three weeks.”

Popkin’s mother didn’t lose her Medicare. She’s still covered for medications, specialist visits, hospitalizations and other services. But she has an additional level of personalized attention.

For now, there may be fewer than 2,000 doctors in all types of retainer practice nationally. Most are primary-care physicians, a sliver of the estimated 300,000 generalists.

The trend caught the eye of MedPAC, a commission created by Congress that advises lawmakers on Medicare and watches for problems with access. It hired consultants to investigate.

Their report, delivered last fall, found listings for 756 concierge doctors nationally, a five-fold increase from the number identified in a 2005 survey by the Government Accountability Office.

At a meeting in September, several members said concierge medicine appears to be fulfilling a central goal of Obama’s overhaul — enhancing the role of primary care and restoring the doctor-patient relationship.

Yet the approach envisioned under the law is different from the one-on-one attention in concierge medicine. It calls for a team strategy where the doctor is helped by nurses and physician assistants who handle much of the contact with patients.

John Goodman, a conservative health-policy expert, predicts the health-care law will drive more patients to try concierge medicine. “Seniors who can pay for it will go outside the system,” he said.

Doctor brings new idea in
healthcare to Suffolk

By Aggie Dowd | Published 5:41pm Saturday, January 15, 2011
Special to the Suffolk News-Herald

Norfolk has it, Williamsburg and Virginia Beach have it, and now Suffolk has it. Dr. Christopher Dowd has opened Cornerstone Private Practice on Bridge Road, bringing to North Suffolk an innovative choice in medical care – concierge medicine.

Also known as private medicine, direct care or executive health care, concierge medicine harkens back to an era when doctors practiced a more personalized kind of medicine. In those days, doctors had fewer patients, more time to spend with them, and thus an awareness of the details of their lives. The relationship between doctor and patient was not only professional; it was personal, as well.

This is what Dowd has in mind for his new practice.

“My experience in healthcare in Hampton Roads over the last decade has included the entire spectrum of care, ranging from traditional office practice to hospital care, from caring for young children to caring for long-term and skilled nursing care patients,” Dowd said.

“As a result, I have seen a lot of what’s good in medical care, and a lot that needs improvement. Cornerstone Private Practice enables me to provide the kind of care that I think every patient deserves.”

Dowd, who is board certified in both internal medicine and family medicine, had his first practice in Courtland, spent several years as a hospitalist in Portsmouth and Chesapeake and is an assistant professor at Eastern Virginia Medical School. He is married to Cynthia Corliss and lives in Suffolk with their five children.

He said that establishing a practice that addresses the problems of modern-day medicine has been his dream.

Concierge medicine has been compared to private education. Patients pay extra to get more of their doctor’s time, as well as services that are not traditionally covered by their health insurance, such as comprehensive exams, increased accessibility, longer and on-time office visits and enhanced preventive care.

Concierge medicine is popping up all over the country. It has been reported in cardiology, pediatric and dental practices, as well according to Concierge Medicine Today based in Atlanta, GA. Since 2004 in fact, Tufts Medical Center in Boston has offered its patients a choice between a traditional general medical care practice and a retainer-based practice.

“This kind of medicine has been called a lot of things,” Dowd said. “But it is best described as personal medicine. I believe it is the best way to provide comprehensive, whole-person health care tailored to the individual.”

Cindy Payne of Suffolk is one of Dowd’s patients. She is enthusiastic about Cornerstone Private Practice.

“I have been getting physicals every year since I was 25, and I’ve never had one like I had at Cornerstone,” she said. “Dr. Dowd went way beyond what any other doctor has ever done. I had every test imaginable – he even noticed that I have receding gums! He examined every little reflex, every little part of me! And he took the time to explain everything.”
Payne is a vivacious, red-haired, 60-year-old grandmother of five.

“It’s a time-clock thing,” she said of the difference between Dowd’s practice and other doctors. “Before now, I never could take the time to explain all my issues to my doctor. The visit with Dr. Dowd was longer than I’ve ever had, and I think that’s good, because he was getting to know the whole me and not just my symptoms.”

Payne said she believes that a lot of medical problems happen because people “don’t know how to verbalize some things, or they don’t even know that some symptom they’re having is important. Dr. Dowd takes the time to listen for such red flags so that he can deal with them before they get bad. I think that’s what people are looking for in a doctor.”
Dowd said that his practice will focus on preventive and proactive care, and helping patients achieve a healthy lifestyle.

Doctors who offer concierge medicine limit the number of patients they accept so they have more time for each one. The patient load for a traditional primary care doctor is typically between 2,000 and 4,000 patients. Dowd said he will only accept about 10 to 20 percent of that number, which will allow him time to offer enhanced services, such as direct phone and email access; same-day response; flexible appointments, including priority same-day and next-day; online scheduling; on-time care; and advanced diagnostic evaluation and testing.

Cornerstone accepts insurance for traditional, covered services. Dowd said, “For those services covered by a patient’s insurance, we use insurance; our fee covers those services that are not covered by insurance or Medicare.” He added, “The idea is to get insurance to work for the patient, rather than the patient – and their doctor- being completely controlled by the insurance company.”

Cosmetic facial surgeon concentrates on
medicine, marketing

Published: November 30, 2009 | Full Story
Richmond Times-Dispatch |

Concierge medicine: The wave of the future or just a high-end luxury?

October 12-22, 2009 | Washington Business Journal
By Melissa Castro | Staff Reporter


Fed up with a business model that could barely keep the lights on, Sandy Ibrahim left her job as a McLean primary care physician in March 2008, bringing her stethoscope and a handful of patients to a new practice less than a mile away.

By joining PartnerMD, Ibrahim hopped aboard a burgeoning trend in medical care, one that is pulling back from the breakneck pace of many modern medical practices. At PartnerMD, Ibrahim is now a concierge doctor — a cross between the lawyer you keep on retainer and the Marcus Welby M.D.-like doctor who lives mostly in your imagination. Yes, in a pinch, Ibrahim makes house calls.

“A few people from my old practice followed me here to this practice, and I didn’t even recognize them,” she said, sheepishly.

That’s hardly surprising, given the 2,000-plus patients Ibrahim was juggling at her old practice, where high volume had to make up for low insurance payments. By relying primarily on annual membership fees paid by each patient, PartnerMD and other concierge practices aim to carry just 20 percent of the patient load the typical family practice has.

Despite the hefty fee — as much as $4,000 for true white-glove treatment — Partner- MD’s patient rolls include horse farmers, teachers and homemakers, along with CEOs and at least one former head of state. (Wisely, Ibrahim declined to identify the political leader, but let’s just say her eyes widened, her breath quickened and — she says — her heart started racing when she discussed the thrill of working with this person.)

PartnerMD got its start in Richmond in 2003, when entrepreneur Linda Nash fell off a horse and couldn’t reach her doctor. “A light bulb went off for me,” Nash said. “I realized that modern medical care left much to be desired.”

PartnerMD opened the McLean office, its second location, in April 2008. Locally, it competes with a few other concierge-type
practices, including Virginia Hospital Center’s executive health program in Arlington, The David Drew Clinic in Chevy Chase and Executive Healthcare Services in Reston.

In exchange for the annual fee, which does not apply against most insurance companies’ annual deductibles, PartnerMD’s patients get intense personal attention. Tim Massick, a vice president at Ernst & Young LLP, came to PartnerMD’s McLean
office as he approached his 50th birthday — after decades of eating burgers, downing Cokes and having no idea how to monitor and improve his health.

“I was fed up with traditional doctors, who would just take my blood pressure and temperature and say, ‘You’re fine — get out of here,’ ” Massick said. “Yes, I knew burgers were bad for you, but now I know why they’re bad, and they’ve given me guidance on healthier habits.”

PartnerMD patients coming in for an “executive” level physical, like Massick got, are greeted in the spalike lobby by name, escorted to a suite where they can wait and work in private (using the provided computers and phones) and then whisked off by limo to a panel of outside and in-house specialists who run a daylong series of tests. While that executive physical fee can run as high as $4,000, the basic annual membership is $1,900. It includes a scaled-down physical and personalized attention such as 24/7 phone and e-mail access to the doctor and same- or next-day appointments. (Memberships for spouses and children run lower.)

Dozens of area companies, including Ernst & Young, General Dynamics Corp. and Capital One Financial Corp. provide the executive physical for key employees. Concierge medical practices have increased tenfold over the past four years, resulting in at least 5,000 such practices now, compared with just 500 in 2005, according to the Society for Innovative Medical Practice Design, which projects that by 2012 there will be 17,000 concierge practices.

The society’s chairman, Dr. T.homas LaGrelius, said those numbers are a “guesstimate,” based on a 2008 Physicians’ Foundation-sponsored survey of 300,000 primary care doctors. In that survey, nearly half the respondents said that in the next three years they plan to reduce the number of patients they see or stop practicing entirely.

Primary care physicians “hate their professional lives and can’t make a living,” LaGrelius said.

PartnerMD’s practice has grown every month since its opening. It enrolled 60 patients in September 2008 — more than in any other month — even as Wall Street was crumbling at an alarming rate.

PartnerMD now has 346 patients in the McLean office, up from 169 last year, and plans to bring on a second doctor in January.
As the recession lingers, the practice has continued to add patients while still holding on to the ones already enrolled. PartnerMD has a 96 percent retention rate, according to its chief operating officer, Anna McKean.

Combined with the Richmond office, the practice expects to pull in $6.5 million in revenue by the end of this year, while operating at a 10 to 20 percent profit margin.

Although the business model does not rely on insurance, PartnerMD — like 80 percent of all concierge practices — accepts most insurance plans and does not ask patients to pay the difference between the amount billed and the amount reimbursed.

“The insurance companies do reimburse us, but it’s peanuts,” Ibrahim said. “But even if it’s 2 cents, we just accept the 2 cents and move on.”

Although the McLean office was designed for three doctors, Ibrahim is the only general practitioner there at the moment. Once a second doctor joins and builds a full patient base, the McLean office will break even each month, even before taking insurance reimbursements into account.

Concierge care’s proponents have an eye on the health care reform debate on Capitol Hill, but they don’t expect reform to change the way they do business, partly because any system that underpays and overworks primary care doctors will result in demand for this type of alternative.

“I would like to think this model is what health care will be eventually,” Ibrahim said. “This is what it was when I was growing up, and what I thought it was when I went to medical school. The joke was on me.”

Source: Washington Business Journal, Oct. 2009

SIMPD invited to go to Washington, DC and work with the Alliance for Patient Access

June 24, 2009 :: FULL STORY

MDVIP Launches Preventive Medicine Pilot Program For Uninsured In Northern Virginia

June 23, 2009 :: FULL STORY

Concierge Choice Physicians Expands Into Delaware, Virginia and Texas

July 7, 2008 :: FULL STORY

Washington State —

Doctors Try New Models To Push Health Insurers Aside

By Michelle Andrews | Posted: March 7, 2011 07:01 PM | ShareThis

Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs. Now some medical practices are sidelining health insurers entirely, instead charging patients a moderate membership fee each month. The approach gets a nod in the health-care overhaul law. But not everyone agrees it’s the right way to go.

Seattle-based Qliance Medical Management’s three clinics typically charge a patient about $65 a month for unlimited access to the practice’s 12 physicians and nurse practitioners. (Fees vary depending on the level of service and the patient’s age.) Office appointments last up to an hour, and clinics have evening and weekend hours, with e-mail and phone access to clinicians as well. Routine preventive care and many in-office procedures are free; patients pay for lab work and other outside services “at or near” cost, and they get discounts on many medications.

The average $700 to $800 per patient that Qliance receives annually in membership fees is up to three times more than a doctor in a standard insurance-based practice might make per patient, says Norm Wu, the company’s president and chief executive. “So we can have a third the number of patients and get the same revenue per clinician, but with much less overhead,” he says. The approach, he says, allows Qliance to funnel more money into the care itself – through longer office hours, for example, or better diagnostic equipment.

Bruce Henderson joined Qliance when its first clinic opened in 2007. Although at the time he had health insurance through his job, Henderson, now 63, was soon laid off. Now he pays Qliance $79 a month for primary care and carries a catastrophic medical plan with a $10,000 deductible, for which he pays $225 a month.

Henderson has high blood pressure, high cholesterol and Type 2 diabetes. Working with his Qliance doctor, he switched to lower-cost medications and reduced his monthly out-of-pocket costs from $500 to $100. He goes in regularly for blood work and exams to keep his diabetes in check. Periodically he also has early skin cancers removed and last month was in three times for a cyst removal. “The doctors will sit there with you as long as you need them to,” he says. “They don’t rush in and out.”

A 2007 Washington state law encourages “innovative arrangements between patients and providers,” such as direct-pay primary care.

There are 15 other direct-pay practices in Washington state, according to a 2010 report to the legislature from the state’s insurance commissioner. Some are more conventional “concierge” practices, which are aimed at well-to-do patients, charging as much as $850 a month for personalized, high-touch services. But the biggest growth is in practices that charge fees in the $85 to $135 range, according to the report.

Although Washington state may be a hotbed of direct-pay activity, primary-care physicians in many other states are offering similar services. At Access Healthcare in Apex, N.C., for example, members pay $39 a month plus $20 per visit for unlimited primary-care services, says the practice’s founder, Brian Forrest. Having run the subscription-based practice for 10 years, he is now expanding and expects the first franchises to open this summer.

Forrest, a physician, says that half of his clients have insurance, with their typical copayments for primary-care visits averaging $35 to $50. “For lots of insured patients, it’s actually cheaper for them to see us,” he says.

Washington state’s representatives in Congress and its governor, Chris Gregoire (D), successfully pushed to involve direct-pay practices in the federal health-care overhaul. Under a provision in that law, insurers selling plans on the state-based insurance exchanges that will open in 2014 will be allowed to “provide coverage through a qualified direct primary care medical home plan . . . .”

As envisioned by Qliance, direct-pay practices like the one it operates will link to custom “wraparound” health insurance policies that would pick up where Qliance leaves off, providing specialist care, hospitalization and the like.

“What we’re inventing here is a new relationship between primary care and insurance,” says Garrison Bliss, chief medical officer for Qliance Medical Management. Patients would essentially have two monthly health-care fees: one that they’d pay to a doctor’s office for their primary care and another they’d pay to an insurer for all their other care. Providing better primary care should reduce insurance claims for emergency care and hospitalization down the road, Qliance’s Wu says.

This idea raises a host of questions, policy experts say, including how direct-pay primary-care practices could charge monthly fees for preventive care services that under the new law are supposed to be provided free.

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn’t work very well, Robert Berenson, a fellow at the Urban Institute, says “it doesn’t make any sense” to provide primary care outside the health insurance system. “This is not going to work for a lot of patients who can’t afford the out-of-pocket subscriptions.”

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

Health Care Reform Irony: Thousands Could Be Denied
Low-Cost Coverage

By Dr. Garrison Bliss | Posted: December 2, 2009 04:12 PM | ShareThis

If offered the choice, how many of you would sign up for access to a primary care physician 24/7 for a flat monthly fee of $49-$79 per month? Imagine — no more lengthy waits for a doctor to see you and no more dealing with insurance companies for routine, preventive care. That sounds pretty good, doesn’t it?


Seattle Voices Inteviews Garrison Bliss, MD

September 16, 2009 – Dr. Garrison Bliss is a board certified physician with 30 years of practice in primary care. He is a past president and chairman of the Society for Innovative Medical Practice Design and a leading voice for patient-financed medicine in the US.


Washington Doctor on Fox Business Channel

JUNE 17, 2009 – A New Plan for Health Care: Dr. Jay Parkinson and Dr. Garrison Bliss on the idea of promoting the concierge care.



Health Care For The Rich Will “concierge medicine” hurt or
cure the health care crisis?


September 24, 2009 :: By Mischa Benoit-Lavelle :: READ STORY

Medical home model saves money, boosts quality, study finds cutting patient loads and making visits longer were also found to ease burnout rates for physicians

September 14, 2009 :: FULL STORY partners with Qliance, Anchor Medical Clinic and Guardian Family Care in continued effort to make health care
more accessible.



Emerging Washington State Health Care Model Secures $7.5 Million in Venture Capital

July 7, 2009 :: FULL STORY

Comments on the HIStalk Practice Interview with Garrison Bliss, MD

February 3, 2009 :: FULL STORY

Concierge medicine an “affordable option”

April 15, 2007 :: FULL STORY

Concierge medicine gaining ground: competition forces medical center into ’boutique’ business – Innovation

Sept. – Oct. 2002 :: FULL STORY

Concierge Medicine Expands Into Washington State

*States that have existing concierge practices include: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New York, Ohio, Oklahoma, Oregon,Pennsylvania, South Carolina, Texas, Virginia and Washington.


Wisconsin —

As Interest in ACOs Wanes, It’s Time to Do the ‘Next Right Thing’
Written by Steve Ronstrom, CEO, Western Wisconsin division of Hospital Sisters Health System | May 23, 2011

Source: Becker’s Hospital Review

Like many other hospitals, we had been seriously considering implementing an accountable care organization. It seemed like the right thing to do to meet the needs of patients. The purpose was to make healthcare more efficient by integrating hospital care with that of physicians and other outpatient providers.

But now — like many other hospitals, as well — we have dropped plans for an ACO because the proposed regulations are too complex. However, we have not given up looking at the future or pursuing “the next right thing,” which would incorporate many of the objectives of ACOs without actually becoming an ACO.

To do this, we need to go back to our fundamental goals, which are meeting the needs of the patient and moving toward integration of health services. Hospitals also face the same challenge as before — to become more efficient, because there will be funding cuts. Here are a few examples of the steps hospitals can take to do “the next right thing.”

Focus on patients. As hospitals readjust their goals, the guiding light should be meeting the needs of patients. We should start reexamining the patient experience and match it up with our delivery system. Nationally, the healthcare system is beginning to recognize the positive influence of patient experiences on quality. We need to engage in more patient outreach, such as making sure medications are used, educating patients on compliance and providing support. The goal should be patient literacy.

Study community needs. Paying attention to the needs of the community is fundamental. In fact, this is an obligation for non-profit hospitals such as our own. Our non-profit status brings with it a fiduciary obligation to the community. We need to keep trying to gain the trust of patients and the community at large. With this in mind, our two hospitals have launched a new strategic plan, “Imagining the Future: 2016,” engaging community members in helping create our five-year strategic plan.

Partner with payors. Many hospitals and other providers are working with Medicare Advantage plans to improve efficiency and quality. Providers have also begun working with private payors to create ACO-like arrangements. As part of the deal, hospitals can tap into payors’ rich database for metrics, such as how many times patients have seen their physician or whether the patient got her mammography on time. The hospital might have some of this information but it is not as integrated as the data payors have.

Get physicians engaged. Everything I see and hear is about the need to engage physicians. As hospitals employ more physicians, they will need help from us to be more effective. Hospitals need to train physicians on how to operate within the organization and to get decent payor contracts. We also need to streamline management of employed physicians. Instead of managing 100 physicians separately, it’s more efficient to organize them into several groups. Hospitals are also setting up medical director agreements to get independent physicians into leadership roles and creating comanagement agreements with them.

Create physician-led systems. Hospitals need to go deeper than just making deals with physicians. Physicians should be involved in the highest echelons of hospital leadership and help us create our strategic vision. It’s essential to bring physicians into the mission itself and create physician leaders. In the future, physicians will be expected to carry the strategic vision of the hospital or health system. This means more physicians becoming hospital CEOs or working in close partnerships with non-MD CEOs. Making these arrangements successful means choosing the right physicians for leadership roles.

Adopt the medical home. Under the patient-centered medical home, each patient is given a personal physician, providing first-contact, continuous and comprehensive care. The physician assumes responsibility for either directly providing the patient’s healthcare needs or arranging care with other qualified professionals. This is a critically important step between going from pay-for-procedure to pay-for-population healthcare.

Help physicians find new models of care. As hospitals and physicians move closer to each other, physicians should still be encouraged to be innovative and entrepreneurial. For example, more physicians are getting involved in “concierge medicine,” which involves charging patients a direct fee and dropping out of Medicare and private insurance. Our health system is also starting to place family physicians at the worksite as a way to help employers reduce emergency and urgent care visits, lower absenteeism and improve employees’ overall health status.

Another worthwhile innovation is putting ancillary testing and other outpatient services in the same building with physician offices. This is convenient for the patient. The physician office building can also be a hub for other activities such as expert-led groups on behavior-changing regimens like weight-control. Our hospital is involved in planning a physician office building that will include a gym along with several ancillary services. Since 80 percent of the public does not go to a gym, this could be an important step in improving patient wellness.

Improve IT. Hospitals need to keep growing their IT systems. IT has to be linked to outpatient centers and physicians’ offices and plugged into insurance information. The data needs to be mined to give physicians information on how to make clinical improvements, which requires a great deal of software to organize the information.

Continue working on centers of excellence. A lot of people are predicting that all tertiary care will go to nationwide centers such as Mayo Clinic, which is only 100 miles away from us. But I believe there will always be a demand for locally grown tertiary care as long as it is of high quality and has sufficient volume. The amount of volume, however, does not have to be as large as some people think. For example, we have expanded our neurosurgery service into full-spectrum neurosurgical care. This involved making substantial investments in state-of-the-art technologies, including two “smart” operating suites equipped with advanced intra-operative imaging and 3-D mapping capabilities.
Put UR front and center. It’s time to take utilization review out of the basement of the health system and put it into the executive office. With new requirements like reducing readmissions, UR tasks such as discharge planning are more important than ever. Hospitals need to improve relations with rehab centers, nursing homes and home health agencies for the whole continuum of care. These decisions need close collaboration with the C-suite. The UR director should be in the hospital’s leadership group and the UR department should be regularly reporting to the CEO.

Create new delivery models. As pressures mount to lower costs, we need to come up with innovative models to deliver care. For example, the least costly venue for care is the patient’s home, so it is important to find ways to monitor patients in the home. Home-monitoring technology has been progressing rapidly and we need to take advantage of it.

Steve Ronstrom has more than 25 years of hospital leadership experience, having served for the past 12 years as an executive in the Hospital Sisters Health System. He is currently president and CEO of the Hospital Sisters’ Western Wisconsin division, which comprises 344-bed Sacred Heart Hospital in Eau Claire and 193-bed St. Joseph’s Hospital in Chippewa Falls. Learn more about Hospital Sisters Health System.

Froedtert physician to open concierge medical practice in Mequon ModernMed
office is first in Wisconsin

August 5, 2008 :: FULL STORY

West Virginia —

Price Transparency: It’s Not Just For Patients Anymore!
Posted by admin in Health Care, Ohio on Oct 29th, 2007


1 reply »

  1. I just read that a house call is a visit to the home of a patient or client by a doctor or other professional. In some locations, families used to pay dues to a particular practice to underwrite house calls. In some books, it says, in the early 1960s, house calls by doctors were 40% of doctor-patient meetings. By 1980, it was only 0.6%. Reasons include increased specialization and technology. In the 1990s, team home care, including physician visits, was a small but growing field in health care, for frail older people with chronic illnesses.The reasons for fewer house calls include concerns about providing low-overhead care in the home, time inefficiency, inconvenience. Yet, there are more and more doctors who like the idea of no office overhead. Also, it can provide safe access to care by people who are ill. Today, house calls may be making a revival among the wealthy through concierge telemedicine.

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