Physicians, patients find value in concierge medicine

12/13/2013 8:50 PM

08/08/2014 10:20 AM

For Michael Scheidt, having a family physician on call has given him peace of mind.

Scheidt has been a patient of Josh Umbehr, Atlas MD’s physician-owner, since about the time Umbehr started the practice in 2010.

His wife – who is now deceased – had a chronic, debilitating disease and wasn’t able to get around easily when they first heard about Umbehr’s practice.

“He could do house calls, and just to take her to do a doctor’s visit was a big deal,” Scheidt said during his regular appointment with Umbehr on Wednesday afternoon.

Scheidt says he continues to see Umbehr at his office at 10500 E. Berkeley Square Parkway because it’s “just so darn cost effective.”

Umbehr, who started the practice just out of residency, says Atlas MD is one of the fastest-growing direct-care practices in the country with about 1,400 members who see the three physicians at practice.

“This is cutting red tape, improving access and lowering costs,” Umbehr said.

A growing model

For some local physicians, the answer to changes in health care has been to start direct-care practices – also known as concierge medicine – where patients pay physicians a monthly membership fee to be able to see a primary care physician as much as they want for things like checkups, basic lab work and management of chronic conditions.

Family practitioner Renae Schuler was considering leaving medicine before she started at Performance Health, 10111 E. 21st St., Suite 106, in April.

But now she says she has more time to treat the root causes of her patients’ ailments instead of just the symptoms.

“It really is a privilege when someone trusts you with their health,” Schuler said. “Being able to build that relationship is old-fashioned. … The relationship is between a doctor and patient, not an insurance company directing care.”

Tom Blue, chief strategy officer at the American Academy of Private Physicians, a professional organization for direct-care physicians based in Glen Allen, Va., says there are about 5,500 private physicians nationwide, which means they have some form of direct financial relationship with patients in the place of or in addition to health insurance.

The number is rapidly growing at about 25 percent each year, Blue says.

It “sort of combines the chaos and uncertainty of health care reform, and as the country approaches cost crisis … it’s becoming harder for independent practices to sustain financial viability when they 100 percent depend on third-party payers,” Blue said.

“They face the choice of going into employment by hospitals or revisiting their business model, and a lot are revisiting their business model.”

Membership fees

The word “concierge” has mischaracterized the movement toward direct care, Blue says, by making patients think that it is expensive.

The average price of direct care nationwide is about $135 each month.

But Wichita physicians are offering the service for less.

At Atlas MD, the membership fees are $10 month for kids, $50 a month for adults up to 44 years old, $75 a months for adults 45 to 64, and $100 a month for those older than 65.

Membership includes unlimited home and office visits, some in-office procedures and discounts on labs.

There are different fees depending on the level of care needed at Performance Health, said James Seberger, a physician who founded the practice about two years ago.

Most membership fees at Performance Health are about $500 each year and include unlimited access to physicians and some lab work.

The physicians can also get prescriptions at wholesale prices, less than what they would typically cost, he said.

Despite the name “concierge medicine,” local physicians think the model is accessible to those with lower incomes.

“The ‘concierge’ term gets people to imply high value, which is good. We want them to feel like they’re coming to a high-quality place,” Umbehr said. “But it also gets them to assume high cost. That’s OK, though, because I can show you my costs are affordable.”

Umbehr says he has several patients who were previously going to safety net clinics. He and the Performance Health doctors say they also have a number of scholarship patients or patients they see free of charge.

Insurance

Starting Jan. 1, nearly everyone will be required to have health insurance or pay a penalty to the government.

The penalty is $95 per adult and $47.50 per child (up to $285 per family) or 1 percent of the family income, whichever is greater, for 2014, according to the IRS, and the penalties increase for the next couple of years.

But direct-care physicians say they don’t think insurance requirements will affect their business model because many of their patients already have insurance or are willing to pay the penalty.

Under common insurance-covered treatment plans, the physician creates a record for each visit, with a billing code for every disease or issue, Seberger said. For every treatment, physicians or their employers are reimbursed from insurance.

But that’s different in direct care, Seberger said.

“This (direct care) model encourages consistent visits,” Seberger said. “In this model, we’re paid to prevent things like heart attacks. … We don’t bill based on a disease code.”

About half of Schuler’s patients have insurance coverage, she said.

“You need (insurance),” Seberger said.

That’s because hospital stays, surgical procedures and MRI’s, among a number of other medical services, aren’t covered by concierge plans.

Umbehr says he also encourages his patients to have some form of insurance.

But “you don’t have car insurance to buy gasoline,” he says.

Seberger said he thinks that premiums and deductibles for insurance will continue to rise and that people will begin to use their plans more like catastrophic coverage, not utilizing health care as much.

Seberger says he recommends that patients have a Health Savings Account or a Flex Spending Account to dedicate a certain amount of money each month toward health care.

“We provide a clear picture of what a cost will be each year, you can include dental by going to your dentist and you can take care of the majority of the things that are going to try to upend you,” Seberger said.

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