Changing Health Care Delivery: Concierge Model Takes Hold

Editor’s Note: This article was originally published in the Inaugural Issue of Alabama Medicine magazine

Time. In today’s crazy world, we seem to have so little of it. Who couldn’t use a few more hours to spend with family and friends hanging out on the weekends? Or a few more hours during the day to check off a couple of items on that to-do list?For physicians and patients alike, time is a precious commodity. Patients find it more and more difficult to take time off work when they feel they need their physician, and physicians’ offices are filled to the brim with patients sometimes waiting hours on end due to overbooking issues having caused massive wait times in the waiting room.

For physicians and patients alike, time is a precious commodity. Patients find it more and more difficult to take time off work when they feel they need their physician, and physicians’ offices are filled to the brim with patients sometimes waiting hours on end due to overbooking issues having caused massive wait times in the waiting room.“I felt as though I was falling short as a physician,” said Dr. Mary Casals of Montgomery. “I couldn’t treat the whole patient the way I wanted to, the way I felt my patients deserved to be treated. But, now I can.”

“I felt as though I was falling short as a physician,” said Dr. Mary Casals of Montgomery. “I couldn’t treat the whole patient the way I wanted to, the way I felt my patients deserved to be treated. But, now I can.”

Dr. Casals, who practices internal medicine and endocrinology, found a way to deliver what she believes is better care to her patients and still find time in her day to spend with family. It’s called concierge medicine, or private medicine. While she’s not the first physician in Alabama to change to this business model, she is the first in Montgomery.

According to the American Academy of Private Physicians, concierge medicine has been around for more than 20 years. A concierge physician delivers patients a higher attention of service, which includes same-day or next-day appointments, 24/7 access and comprehensive wellness plans. This type of attention to patient care comes with a fee, either called a membership fee or retainer, set by the physician.

The AAPP estimates the average patient load a primary care physician carries today is between 2,000 and 4,000 patients, about 25 or more patients a day with appointments limited to 15 minutes or less. With this schedule, patients have little time to ask questions and physicians have less time to educate their patients. This can leave very little room for patients and physicians to develop the trust necessary for a strong relationship, and patients often leave feeling frustrated at what little time they had to spend with their doctor.

While concierge physicians were considered an elite service for the upper class in the early years of the model, these days concierge medicine can be an affordable way families can receive health care on their own terms.

“Education is a large part of the doctor-patient process,” Dr. Casals said. “I wear a lot of hats – counselor, physician, teacher. But it takes time to understand what’s going on with my patients and time also to educate my patients on their disorders. I had to make a change. It wasn’t an easy decision because I knew not all of my patients would make the change with me, but I knew it would be for the best for everyone.”

For Dr. Casals, the change from traditional fee-for-service to concierge medicine began with town hall meetings with her patients to explain what the new model would offer. The initiation fee gives her patients full-time access to her by email and cell phone, nights and weekends as well. They can make appointments easier, or she will visit them at home if necessary. Her patients are responsible for filing their insurance paperwork, but her office does have someone to lend a hand with the claims.

“I didn’t realize just how many patients I had been treating until we held the town hall meetings!” Dr. Casals laughed. “There were a lot of patients! We were surprised at how many decided to come on this journey with us. We wanted to make sure it was well worth the change for those patients, too.”

Aside from the name, Dr. Casals said there were many misconceptions with concierge medicine. First, she said, the name harkens back to a time when the practice of this type of medicine was mostly for the upper class. Second, there’s a feeling that if a physician is dropping patients, then patient care is being affected as well.

Dr. Casals and Dr. David Fernandez of Northport agreed neither tale is true.

Dr. Fernandez, who spent the last 15 years of his career in urgent care, not only felt he needed to offer his patients more options, but he also didn’t like the path he saw medicine itself beginning to take. So, he decided it was time for a change.

“I’ve always felt like I needed more time to discuss my patients’ needs and to see them on a more frequent basis,” Dr. Fernandez explained. “And, my patients felt it was an inconvenience to find the time to make an appointment in an already packed schedule. If we’re trying to get patients back to where they’re taking better care of themselves, how do we do that if we as physicians can’t make the time to properly explain each patient’s situation? The medical system is becoming too impersonal.”

As both physicians began to change the way they practiced medicine, it gave them the opportunity to reboot their practice and provide care the way today’s patient needed – including wellness support, education and preventive medicine. In fact, both physicians feel they have added more services to their concierge clients under the private medicine model than they could have under the traditional fee-for-service they left behind.

For patients, the concierge model might fit a family’s budget better than a traditional deductible. For example, if a family has a higher deductible health plan with a lower premium, having a concierge physician may help them save money.

“We are a society of instant gratification,” said Dr. Fernandez. “Back when my father was practicing, it was easier to see a doctor. Times have changed. There’s more paperwork and more patients today. Making the switch to concierge medicine isn’t an easy decision to make, but I think we will see a lot more concierge physicians in the future.”

Article by Lori M. Quiller, APR, director of communications and social media