Dr. Charles Whitney opened Revolutionary Health Services as a pilot project with the University of Pennsylvania in 2003. The next year, he took over the practice as an independent physician.
SEPTEMBER 1, 2015 – When Lenore and Martin Bowne renewed their wedding vows for their 50th anniversary in June, their guests included their primary care doctor, a cardiologist and a cardiac surgeon.
“I wanted them to know that they made it possible for me to have that day,” Lenore Bowne said. “If it hadn’t been for them, it would not have taken place. It could have very easily been my burial date. I will forever be indebted to all of them. Especially to Arnie. He took the time. He began the process.”
Arnie is Dr. Arnold Goldstein, the Bownes’ primary care doctor, who discovered an irregularity in Lenore Bowne’s electrocardiogram two years ago that led to her having open heart surgery.
“I am alive because a physician had the time to take a chart and study it, and look for reasons why was there a change (in the cardiogram), when nothing else had changed,” Lenore Bowne, 70, said. “There wasn’t any major significant health change that he knew of.”
Goldstein had that time, she said, because he practices direct primary care.
Often called concierge medicine, boutique or retainer medicine, direct primary care is a physician practice where patients pay doctors a set amount directly — usually monthly or yearly — out of their own pockets. No insurance is accepted. In return, patients are supposed to get more time with their doctors and a greater focus on wellness and preventive medicine.
The model is gaining traction nationwide. Doctors say it’s an answer to frustrations with declining insurance reimbursements that force them to see more patients and spend less time with each one. Under a direct primary care model, proponents say, they can cap the number of patients in their practice while still earning a living.
And patients who support this model of care — like the Bownes — say they’re willing to spend the extra money out of their pockets for better quality care that, in many cases, keeps them healthier — and out of the hospital.
Goldstein and partner Dr. Barbara Shonberg have about 700 members in their direct care practice in Middletown. Goldstein said he joined national direct primary care provider MDVIP after 20 years in private practice because he wanted to spend more time with his patients.
“I wanted the opportunity to practice medicine the way I always envisioned — to deal with the patients, deal with them one on one, spend more time, be a diagnostician, get to know my patients,” he said. “I was trying to do that more, but time restraints became a problem.”
The concierge practice is not without critics. They argue it’s an elitist model that benefits only the affluent people who can afford it and draws primary care physicians from general practice at a time when the number of general practitioners around the country is declining.
The U.S. Bureau of Labor Statistics reported 132,620 family or general practitioners the USA in 2000 and 124,800 in 2014. There were more than 5,500 concierge or direct primary care practitioners across the United States as of 2014, according to the Concierge Medicine Research Collective, a trade group based in Georgia.
While concierge practice models vary, most say they emphasize preventive medicine and wellness through services like routine physicals with health screenings that are designed to identify current problems and stave off future medical issues. Many of these practices say they give patients additional access to doctors by text message or email as well as by phone. Doctors say they’re also better able to respond in an emergency because they have fewer patients in their practice.
And all that, supporters say, makes for healthier patients.
A study by the American Journal of Managed Care showed a nearly 80 percent cut in hospitalization rates for MDVIP patients who were eligible for Medicare, compared to non-MDVIP Medicare patients. The decline was 72 percent among non-Medicare patients over age 35.
The study was conducted using data from patients in five states — New York, Florida, Virginia, Arizona and Nevada — and compared MDVIP patients to those with similar residences, age and third-party health insurance coverage.
“More and more, patients are becoming familiar with these medical options,” said Bret Jorgensen, CEO of MDVIP. “I still think it’s not as widely known as it could be or should be, but it’s getting more widely known. Most of our members join for a couple of reasons: They’re either somebody who’s very proactive and interested in their health, and trying to avoid chronic illnesses, or they’re somebody who’s already a little bit older, has a chronic illness or two or three, and they’re looking for a more personalized care model to help them manage those issues more effectively.”
Direct primary care can even save some consumers money, its supporters say.
People can fulfill the Affordable Care Act’s requirement of having health insurance by paying for the least expensive, highest-deductible plan, then paying for direct primary care for regular doctor’s visits. The drawback to this strategy is that they risk paying thousands out of pocket if they have an ailment that’s bad enough to require hospitalization.
Hospitalization, as well as certain lab tests, physical therapy and specialized care such as cardiology and gastroenterology aren’t covered by the concierge practice fee. Patients still have to rely on medical insurance for those procedures, or pay out of pocket.
Under the ACA, insurers are being encouraged to consider direct primary care as an innovative payment model that could help save money. It’s also being adopted by some employers, primarily on the West Coast, as a way to provide affordable medical coverage to employees.
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Doug Kolton, 55, said cost wasn’t the issue when he decided to stick with Dr. Steven Horvitz, who transitioned from a regular practice to a concierge practice in 2008.
“I’m more comfortable talking to him and he never rushes you out,” Kolton said. “I’ll spend a half hour, 45 minutes talking to him about the issues.”
Horvitz said he switched because he was frustrated with the bureaucracy and extra paperwork associated with dealing with insurance companies.
“The insurance companies and the government regulations were hampering my ability to do my job,” the physician said. “And my job is not to be nice to the insurance (companies). My job is to treat patients.”
Horvitz’s Moorestown, New Jersey, Institute for Medical Wellness charges $69 a month for an individual, $115 for two people, or $130 for a family of up to five, with a discount if the patient pays for the entire year up front. He doesn’t accept any insurance, although patients who are insured may be able to cover his services as out-of-network visits.
“I don’t look at it (financially),” said Kolton, 55, of Cherry Hill, New Jersey. “I look at it — at my age especially — (as) the familiarity between him and myself. I like that rapport.”
Dr. Charles Whitney opened Revolutionary Health Services in Upper Makefield as a pilot project with the University of Pennsylvania in 2003. The next year, he took over the practice as an independent physician.
“When Penn offered me the opportunity, I was like, sign me up,” said Whitney, who earlier in the summer opened a second office in Buckingham. “A passion of mine has been preventative medicine. I was able do to things I felt the right way.”
Whitney said the practice started out slow, but demand has picked up as patients discovered there’s value to the care. His 300-some patients pay $175 a month, or $300 for a couple.
“Back at the beginning, people weren’t used to paying out of pocket for their medical care,” he said. “The culture wasn’t there, and frustrations hadn’t been as bad as they are now. People are finally realizing that, $150 to $180 a month is not an expensive endeavor. People pay way more than that for their cellphone.”
For Tom Carroll, the investment has been worth it.
“For me personally, it’s really helped me understand the whole importance of heart health and cardiovascular health,” said Carroll, 66, whose wife, Christine, and son Tom Jr. also see Whitney. “I’ve learned so much I didn’t know about the way it works, how blockages work, how cholesterol works. I’ve lowered my blood pressure by taking his advice, without any medication whatsoever.”
Carroll said he views Whitney’s fee as a deductible he would have had to pay if he had private insurance.
“I’d rather pay my fee this way, to stay healthy in my later years, rather than wait until I get sick and pay the money and have a big copay,” he said. “If you’re healthy and can remain healthy as you age, to me, that’s the investment I’m making right now. By spending this money, I’m investing in my future, in the hopes that I’ll have an independent, healthy life as I age.”
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The Bownes, who are both retired and now live in Cape May, New Jersey, together pay about $3,000 a year for Goldstein’s care. They also have Medicare and a group health policy through Martin Bowne’s former employer.
Lenore Bowne said cost wasn’t a concern, but even if it was, they would still have found a way to pay for the care as an investment in their health. Other than the surgery she had two years ago, she said she has been able to stay healthy and out of the hospital, despite chronic conditions such as high blood pressure, elevated cholesterol and a thyroid issue.
“Maybe you don’t go out and have as many dinners, or buy as many clothes, or take as many trips,” she said. “When you think about it, especially when you get to be a certain age and you have certain medical conditions, if you don’t value your own health, nobody else will. The system is not going to help you out.”
Former staff writer Sharon Lurye contributed to this report.
