Despite ethical concerns, concierge medicine pampers patients
December 14, 2010
By Laura Geggel
In the early hours of the morning following a surgery, 71-year-old LaVerne Yoss broke into a cold sweat and started shaking.
Though already in the hospital and surrounded by medical staff, she opted to call an offsite physician — internal medicine doctor Leland Teng with the Virginia Mason Hospital and Medical Center’s Lewis and John Dare Center.
Within 10 minutes, Teng returned her call and spoke to the doctor on her floor. They agreed her fibromyalgia — a condition causing pain and tenderness in the joints — was likely acting up, and they asked Yoss how she handled her fibromyalgia flares.
“I said, ‘I get down under my comforters and wait.’ They said, ‘Get some blankets and tuck her in and get her to bed,’” said Yoss, who also received medication and soon felt better.
Yoss, an Issaquah resident who recently registered for the concierge medicine program at Virginia Mason, said she always calls her doctor when she feels unwell.
“I wanted that feeling of feeling safe with Dr. Teng,” she said.
When she is sick, she calls him. If she has a specialist appointment, he goes with her and asks questions about her options. He also calls her son and keeps him informed about her condition.
Concierge medicine is “like going to Nordstrom,” Teng said.
Concierge medicine began in Seattle in 1996 with a group called MD2, and has since spread across the country. Doctors, tired of seeing hundreds of patients every week and only spending 15 minutes with each, opted to downsize their patient load and optimize the amount of care they could provide.
Nowadays, dozens of medical facilities across the region offer concierge medicine. Swedish Medical Center has a program called Premiere Health and some Evergreen-affiliated physicians practice it. Medical Arts Group in Issaquah is making the switch soon.
When he had a practice on Northwest Gilman Boulevard, Dr. Larry Greenblatt said he would see about 30 patients every day. When the Issaquah resident switched to concierge medicine in 2003 and moved his practice, Care Medical Associates, to Bellevue, he cut his load to between three and nine patients daily.
With his old practice, “I got progressively busier. I felt like I was on a hamster wheel,” Greenblatt said. “I felt like I was doing a disserve to my patients and I was making them wait. It just wasn’t right.”
Instead of spending a few minutes with patients, Greenblatt said he spends upwards of an hour, giving physicals to his patients and answering their questions. Like many concierge doctors, he gives them his personal cell phone and e-mail, so they can contact him at any hour of the day.
“I can call Larry right now and get an answer within five minutes,” Issaquah resident Ron Shew said. “I’ve been out of town and called and got a prescription or a doctor recommendation. When you’re sick, you want to get fixed. I don’t want to wait around for a week.”
Of course, this 24/7 access comes at a price.
Membership to the Lewis and John Dare Center annually costs $3,000 for an individual and $5,000 per couple. Additional services are charged to insurance. Any money unused by the program goes back to Virginia Mason to support other patients.
While Teng said the cost is a large “chunk of change,” he said it is less expensive than putting elderly relatives in nursing homes, which can run at least $5,000 a month.
Greenblatt annually charges $1,680 for an individual, $3,060 for a couple and $540 for children. If a service is provided in-house, the membership cost covers the care. Out-of-house care, like sending blood work to a lab or an X-ray to a radiologist, is charged to insurance.
“It’s kind of like belonging to a club or a gym,” Greenblatt said. “If I belong to the Sammamish Club, I pay $100 or whatever a month and I can go as much as I want.”
Whether the rates are high or low, the fact that concierge doctors charge extra raises ethical concerns for some.
“Right now, concierge care is a movement by a small group of physicians who want to be able to get paid more for taking care of fewer patients,” University of Washington family physician and Chief Medical Officer Peter McGough said.
Though he said the current healthcare reimbursement system is broken and primary care doctors are underpaid, he said he doesn’t think concierge medicine is the answer.
If a doctor changes his practice into one offering concierge medicine, “for patients who can’t pay are then told to go somewhere else, that is close to patient abandonment,” McGough said.
“People who actually need health care more often have fewer resources,” he added.
A new advancement in medicine, called patient-centered medical home, allows patients to have more access to their doctors, like Group Health Cooperative’s move to encourage patients to send their medical questions via e-mail to doctors. Surveys show that patient satisfaction increases when medical access is more available, McGough said.
Though he is paying extra, Issaquah resident Dick L’Heureux said he likes having that access with Greenblatt.
“If I didn’t have this kind of care, I would probably tend to hold off on talking to my doctor,” he said. With Greenblatt, “I don’t feel awkward about this thing is too small to talk to him about.”
Laura Geggel: 392-6434, ext. 241, or firstname.lastname@example.org. Comment at www.issaquahpress.com.