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Just What The Doctor Ordered

By Denise Witt (Folsom/El Dorado Style Magazine)

Remember the good old days, when doctors made house calls, even in the middle of the night? What once was taken for granted is now making a slow comeback, at least for those who can afford it. It's called "concierge medicine," and it all began in the mid-1990's, when a former team doctor for the NBA's Seattle Supersonics and medical director for the Portland Trailblazers, Dr. Howard Maron, decided to make available to the public the type of personalized healthcare that basketball players received. Thus was born the first practice of its kind, MD2.

Also known as "boutique or retainer medicine," it is now practiced by a small but growing number of physicians who charge an annual fee to provide premium services such as house calls, visits to the patients office, same-day appointments, coordination of care with specialist, preventive health care and 24-hour access to the physician's home and cell phone numbers.

"It's an attempt by physicians to get back to providing more personalized medical care, " says Dr. Robert (Bob) Nelson, president of Concierge Physicians of California, Inc.

Because these doctors take on fewer patients - 100 to 150 patients compared to the average 2,000 to 4,000 for traditional dooms - they are able to offer more specialized care and personal attention. Many of them do not deal with billing insurance companies, but instead are paid directly by their patients. Annual retainer fees can range from $1,000 to $20,000 a year. However, patients still require medical insurance for catastrophic care, such as hospitalizations. X-rays, lab tests, medication and visits to specialists.

Dr. Nelson says that it is not just the wealthy who seek out such premium care. Others interested in concierge medicine include people with multiple medical concerns, and adult children asking for such services for their elderly parents who are homebound or in assisted living facilities.

Sammy Cemo of Orangevale signed up 91-year-old father, who lives at home in Sacramento, for the service. Meanwhile, Cemo, who has some medical problems of his own, including a severe spinal problem, sought out Dr. Nelson for advice on his shoulder and got the treatment he needed. Now he and his wife are patients, too. "I was impressed by the research Dr. Nelson did for my shoulder. He comes to the house. He's come to my office. He'll go with us to appointments. He makes himself available," he says.

Some may find the idea of charging more for such services to be controversial especially in a day and age when so many are without health insurance of any kind. But patients who have become dissatisfied with the current healthcare system are finding that this arrangement is just what the doctor ordered. A study conducted by the U.S. Government Accountability Office (GAO) found that concierge care arrangements are fine as long as they don't violate Medicare requirements (www.gea.gov).

"It's a lot like paying for private school," says Dr. Nelson. "Public school is available to everyone, but if you'd like to get more individualized attention, you can opt to pay for private school." It's a matter of supply meeting demand.

Today, there are more than 250 concierge physicians in the United States, and the trend is growing. The Society for Innovative Medicine Practices Design (formerly the American Society of Concierge Physicians) was fom1ed to assist physicians who wan! to convert their practices to concierge medicine, focusing on healthcare providers who have a direct pay re¬lationship with their patients.

"Not all concierge physicians provide the same level of service," says Dr. Nelson. While some charge only annual fees, others may charge initiation, monthly or per visit fees.

Among the perks that concierge physicians provide is full access to their home and or cell phones. Patients can call any time of the day or night, a concept that may seem scary to some doctors. But, says Dr. Nelson, '”Many concierge physicians have found that once the barriers to access a doctor for medical care are torn down, people for the most part will respect your time. Because patients know we're available to them, they have the security of knowing that they can talk to their doctor without the traditional barriers." If a patient cuts a finger, or his or her child wakes up in the middle of the night needing medical attention, these doctors make house calls.

Other perks include providing preventive medical care, such as annual physicals, or accompanying a patient to specialists and helping them find different options when facing surgery or other procedures.

Dr. Nelson says he offers his patients travel medical records for when they are on the road. "Using electronic medical records, we can print out a patient's entire medical record on CD, along with EKGs, X-rays and a list of medications that they take, so patients can take their records with them when traveling. This helps expedite medical care and decreases the risk of medical errors," he says, For example, if .a patient were to have chest pains while on a business trip, he says, “these records would give doctors instant access to the patient’s medical history. including their normal EKG when they were not having chest pain.”

Other concierge physicians, such as Q Concierge Physicians in Montery, founded by Doctors M. Samir and Hisana Qamar, include in their list of services making hotel reservations and arranging for transportation for family members during a medical crisis, It's this kind of personalized services that's gaining the attention of those who are able to afford it.

Direct access to a personal physician 24 hours a day, seven days a week, out-of-office appointments, house calls, and personalized one-on-one attention from a physician… it's the kind of service fit for a (Sacramento) King. It’s luxury medical care for the pampered patient.

- Denise Witt