PARTNERMD: Concierge Pediatrics Practice Growing

As the conversation ends, Smith reminds the mother about the online Learning Library service that her patients’ families have access to as part of their membership in Partners in Pediatrics, Smith’s concierge pediatrics practice. Parents can go to that website, where information is vetted by a leading children’s hospital, instead of going to Google’s information free-for-all, Smith said.

It’s a typical example of Smith’s availability to her clients — parents who are willing to pay a fee not covered by insurance to have greater access to their children’s pediatrician.

For the monthly fee, about the same as an average monthly cable bill, children and their parents get longer appointments with no waiting, 12-hours-a-day telephone access, same-day sick child appointments, Skype consultations and secure email access.

Concierge Medicine or boutique medicine for adults has been around for years. Henrico County-based PartnerMD, started in 2003, has carved out a niche in that domain by offering enhanced access to a physician for an annual enrollment fee.

While enrollment fees are not covered by insurance, the services the doctors provide, such as well-child or well-adult checkups and vaccinations, usually are, subject to network restrictions and regular copays, deductibles and co-insurance.

About six years ago, Smith left a group practice to try to bring the same option to young patients, opening Partners in Pediatrics on Monument Avenue in the fall of 2008. Instead of seeing five to eight patients per hour in the group practice, she sees eight to 15 patients a day in her concierge practice.

“The Monument Avenue office was an experiment,” said Smith, who has practiced medicine for more than 20 years. “Would it grow? Could we make the business model work?”

“We are scaling the model,” Smith said.

Partners in Pediatrics recently moved to a larger office and is planning to add another doctor, said Smith, owner of the practice.

Nationally, concierge pediatrics practices are few in number and vary in services offered and practice models.

Dr. Edward Kulich, president of the American Academy of Concierge Pediatricians, said he is aware of about 30 to 35 such practices. Kulich’s New York practice, KidsHousecalls, does just that — house calls. Other practices are office-based. Some don’t take any insurance; others do.

“Some people would actually say that any practice that charges any fee whatsoever outside of an insurance copay is a concierge practice,” Kulich said. To others, any practice that offers additional services would be a concierge practice.

“Some people would stretch that definition to someone who only makes house calls or who doesn’t take any insurance. I know one practice takes insurance 100 percent but has an access fee. Some don’t have any access fee. They don’t take any insurance, and it’s just fee-for-service,” he said.

Kulich has been practicing concierge pediatrics for about six years. His patients include the wealthy to families that stretch their budgets to have his services, he said. He limits his practice to 100 to 150 patients.

“This is very new uncharted territory for doctors and insurance companies, and there is not a lot of regulation,” Kulich said.

“I don’t know exactly where it’s going to go. I don’t know if it’s going to explode to be the next big thing in health care. I personally doubt it. … There’s only a certain amount of people that will be able to afford this type of thing or be willing to pay for it especially when insurance has gotten a lot more expensive and mandatory,” he said.

In the adult world, concierge medicine is growing but remains a fraction of office-based practices.

PartnerMD, which was sold to Markel Ventures in 2011, has a few pediatric patients, usually older teens who are cared for by PartnerMD family medicine doctors.

“We are not a pediatric practice, but several of our members want the more attentive, personal care that we provide for their children as well, and our physicians certified in family medicine provide that care,” said PartnerMD spokeswoman Courtney Moyer. “Typically, we see more children in the middle school, high school or college age.”

Moyer said there are differences in amenities available for child memberships, driven largely by health care needs that tend to change and increase with age.

Smith said the extended trial period gave her time to test the concierge pediatrics concept. There are practical issues to consider, such as how much pediatric vaccine to keep on hand for patients. Vaccine is expensive and has a shelf life.

Also, as a solo practitioner and mother of four, Smith had to determine how much time she would be available; it would be impossible to offer around-the-clock access. She provides telephone access 12 hours a day. After hours, Smith trades on-call nights with another board-certified pediatrician so patients always have access to a doctor.

The model, she said, is family-friendly. Longer appointments allow her to do more patient education.

“There is more time to teach. Years ago, I began to teach children how to tell their own health story. Usually by (ages) 8 to 10, kids are engaged and more comfortable in the doctor-patient relationship,” Smith said.