Thursday, August 28, 2014

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Frustrated by an ungainly system, more Valley physicians turn to the “concierge” model. Translation: couture health care.

For much of her career as a practicing cardiologist, Dr. Anne-Marie Feyrer-Melk essentially kept one hand on the doorknob during patient visits. She had to. Falling fee reimbursements from insurance companies had forced her to reduce patient appointment times from 30 minutes to 15 minutes. It was a matter of livelihood.

“When we were looking at having to reduce what’s called the patient encounter down to eight minutes, I threw up my hands,” says the Scottsdale doctor, playfully known to her patients as Dr. AM/FM.

The frenzy of patient visits stymied Feyrer-Melk’s efforts to practice preventive care, which involves discussions about nutrition and exercise, along with disease screening. There wasn’t enough time. After one of Feyrer-Melk’s patients survived a heart attack, the patient grabbed the doctor’s arm, asking, “Why is it now that I’ve had my first heart attack that everyone is warning me about the next one?” The patient wanted hope and instead received dire warnings to stay alert for part two.

“I couldn’t afford to maintain the current practice,” Feyrer-Melk says. She began contemplating alternative careers, but first, she attended an American Academy of Private Physicians conference. There, she learned about concierge medicine, which allows patients to contract directly with doctors.

Three years ago, Feyrer-Melk decided to try it. “I had nothing to lose.”

Adopting the concierge medicine model allows physicians to opt out of insurance networks and limit the number of patients they see. Patients pay an annual membership fee that varies by practice, typically ranging from $1,500 to $10,000 or more. Services include unfettered doctor access through email, text and phone, lengthy office visits and same- or next-day appointments. Concierge patients maintain their health plans to pay for laboratory testing, hospital procedures and specialist visits, but the membership fee covers annual physicals and other basic services. While patients who can afford the care welcome the model’s emergence, skeptics consider it elitist and worry it could reduce the number of physicians available to see low-income and middle-class families. Although data are limited, early studies show the model could reduce health care costs and improve outcomes.

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