January 24, 2008
Get the doctor’s attention—for a fee
(Page 2 - Previous Page)The first modern concierge practice was established in 1996 by Dr. Howard Maron, a former team doctor for the Seattle Supersonics, who prefers the term "highly attentive medicine" to describe the services first offered by his company MD2 (or MDSquared), which has gone nationwide with franchises in Chicago, Portland and San Francisco.
The difference in cost between practices typically depends on the number of patients seen, with higher rates being charged by offices that have a smaller clientele. Whereas the average practice sees between 3,000 to 4,000 patients, the number at a concierge practice varies from 100 to 1,000.
In a 2005 report, the Government Accountability Office listed 146 concierge practices in the United States. In 2007, Newsweek reported that there are about 250 concierge physicians nationwide.
The concept is so new that the AMA has yet to begin tracking how many practitioners have adopted this approach. And The Society for Innovative Medical Practice Design, a nonprofit organization that encourages a direct financial association between health care providers and patients, lists 10 concierge doctors in Southern California on its simpd.org Web site.
The average patient who visits a concierge doctor is typically the head of a large company who doesn't have time to sit in a waiting room or doesn't want to be seen visiting with a doctor. And most patients who can avail themselves of a concierge physician are typically delighted with the service they get.
Daniel Khani, a 65-year-old former radiologist who currently works in real estate and has health insurance, says he opts for concierge medicine because he likes the full attention of his doctor, Raphael Darvish.
"I have a doctor that is personally involved with my case, somebody that I can trust ... somebody that when I go there I don't have to wait two hours to see," Khani said.
Darvish, a 30-year-old internist, founded his Brentwood-based Concierge Medicine/LA (CMLA) in 2004. The fourth-generation doctor with an master's in business from UCLA says that traditional practices have become like factories, with dreary offices of empty correction-fluid-colored walls and bland furniture, long wait times to see a doctor, not enough time between the patient and doctor during the visit, and issues with insurance.
At CMLA, patients enter a day-spa atmosphere, with an expected short wait in a room that features organic hues of grass and wheat, floral artwork and chocolate furniture followed by a promised unhurried visit with Darvish or a colleague in a similarly decorated room. The office has a five-person support staff whose duties include taking care of appointments, helping patients with prescriptions and refills, coordinating care outside of Los Angeles and scheduling preventative tasks.
Darvish says that he is trying to get rid of the negative associations people have with visiting doctors by devoting time to listening to his patients.
"I'm able to cater their treatment and cater their care more toward them ... more sensitive to what problems they are having," he said.
Concierge doctors like Darvish say these types of visits and physicals allow them to have a real understanding of the patient and their background. With this knowledge, the doctors feel they can find illnesses early on and take preventative steps.
And while there are ethical question about concierge physicians not reaching as many patients, both Darvish and Fuchs say they devote time saved by their practice to giving back to the community. Darvish volunteers at the Venice Family Clinic weekly, and Fuchs teaches UCLA residents and treats indigent patients at the clinic's Simms/Mann Health and Wellness Center twice a month.
Ultimately, concierge medicine is centered on the individual, according to 39-year-old Dr. Benjamin Ansell, who serves as director of UCLA's Comprehensive Health Program -- a concierge-style daylong physical exam program not covered by insurance and similar to Minnesota-based Mayo Clinic model for business executives.
"It's built on putting the individual's need at the forefront rather than falling somewhere where they can get lost," Ansell said.
And while a patient like Khani would rather not have to pay a fee for the more personal attention, he feels he's getting his money's worth.
"Anytime I have any questions or have to have a consult or if I need to go see a specialist, my doctor is there for me," he said.
For more information:
UCLA Comprehensive Health Program
Society for Innovative Medical Practice Design
AMA on Retainer Practices
Our Zack, the Doctor!
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