South Bay doctors offer personalized "concierge" health service, including house calls, in an effort to give patients more time to interact.
By Lee Peterson
Daily Breeze January 9, 2006 [Excerpt]
The day before Christmas Eve, Dr. Tom LaGrelius' office was closed. Or it was supposed to be. About 12 calls from patients to the darkened medical practice were routed to
LaGrelius' mobile phone and, in answering them himself, the Torrance family physician said he realized two of them needed to be seen by a doctor -- one for the flu and one for a quickly spreading skin infection. Rather than send them to a hospital emergency room and a likely wait of several hours, he arranged to meet them at his office and give them the care they needed with no waiting. That kind of access was available because LaGrelius is converting his office to a "concierge" or "boutique" practice, where for an annual retainer of $1,800 for an individual, patients have access to LaGrelius generally whenever they need it. The official launch was last week, but LaGrelius has been phasing in his concierge practice for several weeks.
He's joining a movement among doctors who want to practice medicine without a stopwatch ticking as they struggle to empty a packed waiting room each day. They say they want to get back to a good-old-days style of health care when doctors had time to interact with patients. "Most primary care doctors are seeing 30 or more patients a day and they are really rushed, and they don't have enough time," LaGrelius said.
Dr. Marcy Zwelling-Aamot, a Los Alamitos internist, started up her concierge practice a year and a half ago, and feels that it has allowed her to save lives. "When you have time, you can make better decisions. You can be there when it's timely. Your patients get what they need when they need it," Zwelling-Aamot said. Being there sometimes means making house calls. It can mean accompanying patients to visit specialists. Or sitting in on surgeries. Recently, Zwelling-Aamot was observing an operation on one of her patients when the surgeon discovered a tumor. She got on the phone to the pathologist and the other specialists who were needed, and stayed through what turned into a major procedure. When the patient awakened, Zwelling-Aamot was able to reassure her that the extensive work, while unexpected, was necessary. Zwelling-Aamot described herself as "thrilled" to have switched to concierge medicine because of the freedom it has given her. "It's not a get-rich-quick plan. Am I happy? More because I feel I can do my job," said Zwelling- Aamot, past-president of the Los Angeles County Medical Association.
Longtime community physicians who convert to concierge practices are generally trimming down patient rolls from about 2,500. LaGrelius has set his maximum at 600 and Zwelling-Aamot's is 500. They each have about 450 at this point. The first concierge practice was started in Seattle in 1996. They've been popping up mostly on the East and West coasts ever since. In 2004, there were 146 concierge physicians in the United States, according to the U.S. Government Accountability Office. There are still only a handful in the greater Los Angeles area.
According to the GAO report issued in August, concierge practices charge
anywhere from $60 to $15,000 a year per patient, though most are in the
$1,500 to $2,000 range. The fee depends on the level of service provided,
though nearly all seem to offer same or next-day appointments for nonurgent
care, 24/7 telephone access, and extended office visits, according to
the GAO survey. Doctors who convert to concierge practices talk about
taking back control of their practices in an era of Medicare cutbacks
and insurance companies playing hardball. Doctors say they have had to
take on more and more patients just to stay even. Concierge doctors say
that because they offer better access, they can save patients from making
trips to ERs, and thus save the health-care system money.
William G. Richardson, a longtime patient of LaGrelius' who did sign up, said for him it's more about continued, rather than additional, access to a doctor for whom he has nothing but praise. "It's worth it," said Richardson, a 79-year-old retired electrical engineer. "As you get older, I think it's more important to have access to physicians."
"I've been with him so long, I just couldn't envision going with another doctor at this point in time," said Carol Matthews, a 61-year-old Realtor and longtime LaGrelius patient. "Good doctors are hard to find."
Legally, doctors who start concierge practices have to be careful about what they present as their services. They cannot charge for what will be reimbursed by Medicare, for example. They cannot say that they are giving "better care" because
it has not been scientifically proved that such practices offer better
care. Rather, what they typically include is an annual physical, uncovered
by Medicare and many private insurance plans. But mainly, what concierge
doctors provide is access, lots of it. And they can keep in constant touch
with specialists, and sometimes even accompany patients to see specialists
-- even if they are out of state.
As they
convert to concierge practices, physicians are counseled to take care
to find new physicians for those patients who choose not to pay the
retainer. Roberta Greenspan of Specialdocs Consulting Inc., a Chicago-based
firm that advises doctors on how to open concierge practices, said it
takes a certain kind of doctor. "It's more than just clinical skill, it's who you are -- do you have a reputation for being a kind and compassionate physician, as well as having the clinical expertise and credentials? It's who you are as a person," Greenspan said. Because it's not for everyone, she doesn't foresee a huge rush into the concierge practices by doctors. "For a good many years ahead of us, there will be enough traditional primary care practices. There will be enough primary care physicians who can manage those patients who opt not to be a part of a concierge practice," Greenspan
said.
It's not about money, Greenspan said. Given the overhead, staffing costs and malpractice insurance, the business end of the practice is very costly, she said. Another thing Greenspan points out is that concierge doctors typically carry "scholarship" patients who do not pay, but still get the services. Greenspan insists that her clients offer some scholarships based on need.
LaGrelius, for example, will have 50 scholarship patients.
Ultimately, advocates of concierge care say it eventually will attract more young people to practice medicine, especially primary care. "I would argue that the market will bring more physicians to the table," Zwelling-Aamot said.
