For international calls the doctor is in the house

By DAVID GULLIVER
http://www.heraldtribune.com

When Jean Weiller felt so sick she could not get out of bed, she called her doctor. Nothing unusual there — that is what most people do.

But most people do not have 9,700 miles — and a 12-hour time difference — between them and their doctors.

Almost a year ago the Bird Key resident was traveling in Cambodia, where she came down with what she believes was food poisoning. They moved on to Vietnam. In Ho Chi Minh City, formerly Saigon, “I couldn’t even get my head off the pillow.”

She and her husband figured it would improve, but by the time they arrived in Hue, it was even worse.

So they called Sarasota to reach Dr. Louis Cohen, her primary doctor. He believed she was reacting badly to a malaria medication, so he took her off that drug and adjusted the dosages of some others. He monitored her progress, speaking to her at least once a day, sometimes more.

When they returned, her husband, Ted, switched to Cohen’s practice.

Such is the attraction of concierge medicine, one of the many labels given to doctors who take on a small group of patients who pay a hefty up-front fee for unlimited access — as many visits as they want, even calls to the doctor’s personal cell phone at any hour.

MORE THAN JUST PERSONAL SERVICE

Locally, at least two practices provide such service: LernerCohen, where Cohen has practiced with Dr. Brad Lerner since 2005, and Private Physician Services, a practice founded by Dr. Carlos Caballero in 2001.

Both practices charge on a sliding scale, with prices starting around $2,500 and rising to as much as $7,500 a year for the oldest patients, who tend to require more time.

That buys more than just personal service. Both practices offer amenities like an on-staff dietitian, and draw blood and perform chest X-rays and EKG tests in the office.

But both practices strongly urge that their patients maintain their insurance or Medicare coverage. Medicare does not pay for concierge physicians’ fees, and by law the doctors cannot “double-dip” by billing Medicare. Concierge physicians’ fees cover only the primary doctor’s services and pay for neither specialists nor hospitalization.

That has led to some criticism, because as medicine becomes more specialized, people get more and more care not from their primary doctor but from cardiologists, urologists and others.

But backers of concierge medicine — who prefer the term “direct practice” — say that is missing the point.

Your primary medical care is like a household expense, said Dr. Chris Ewin, president of the Society for Innovative Practice Design, a sort of advocacy group for direct-practice medicine.

“You don’t use insurance to mow your lawn or do your plumbing,” he said.

People should expect a fixed price for their primary care doctor, and budget for it. Ewin charges his younger patients $1,400 per year, or about $117 per month.

After that, he suggests, people should get a health savings account or a high-deductible health insurance plan to cover major expenses. His group is lobbying for a law making their fees an allowable expense for health savings plans.

He sees the concierge-medicine model — which means less overhead and more revenues for doctors — as a way to get them to stay in primary care, something becoming more important. “With the aging of the baby boomers, who’s going to take care of them?” he said.

The flip side of the question is the other criticism of concierge medicine: Who takes care of the patients who cannot afford it?

SMALL NUMBERS PLAYING

So far, that has not been a problem. Only about 500 of the more than 2 million physicians nationwide have gone the concierge route. Most work in affluent areas near Seattle, Boston and Palm Beach, a 2005 government study showed.

The American Medical Association, a national physicians’ group, found no signs that people had lost access to health care because their doctors switched to a concierge practice.

The group did adopt a set of ethical guidelines, requiring that doctors ensure that patients unable or unwilling to pay fees and stay in the practice receive continuity of care.

Concierge-practice patients seem to be satisfied with their service. Caballero has a waiting list, he said, and Lerner and Cohen are near capacity.

Nationally, more than 95 percent of concierge patients renew each year, according to a Boca Raton company called MDVIP, which oversees a network of concierge physicians.

Concierge doctors say patients appreciate spending more time with their doctor — annual physicals, for example, run 90 minutes or more. They say the attention and an emphasis on prevention add up to better care.

MDVIP claims its doctors’ patients are hospitalized up to 65 percent less often than Medicare patients. But there are no independent studies on concierge doctors’ performance.

For some patients, though, the personal attention makes all the difference.

‘MORE IMPORTANT THAN ANY OF THOSE THINGS’

Bob Black and his wife, Hope, had been patients of Dr. Cohen for 10 years when they learned he was leaving his former practice.

“We were thrilled,” Bob Black said, “because it had been so difficult, not to get in and see him, but to see him for any meaningful length of time. It was impossible to see him for more than 10 minutes.”

The Blacks, both 73, looked at the concierge fees in the context of the rest of their expenses.

“How much are you going to spend going out to the movies, plays and dinners over the course of a year? How much are you going to pay for your car?” he said. “This, it seemed to us, was more important than any of those things.”

Still, they kept their Medicare and a supplemental plan to cover hospitals and specialists. Black cautions that a concierge doctor is not for everyone.

“You don’t do it to save money,” he said. “If you’re sure you’re not going to get sick, you’re wasting your money. Don’t go to Lou Cohen.”

But it paid off for Black this year, when he developed a rare nerve disorder.

“He came out to the house, came to the side of my bed for an hour and a half and talked to me about how I was doing,” Black said.

Since then they have stayed in close contact. “I talk to him normally twice a day,” Black said, with Cohen reviewing medication and responses, and just talking about what to expect next.

Almost always, he said, Cohen calls him first.
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