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Two Rutland doctors hope to replace quantity with quality in ‘concierge’ practice.

By Brent Curtis

STAFF WRITER

Drs. Bruce Bullock and Seth Coombs are hoping to do much more with far fewer patients at their primary care practice in Rutland.

The two physicians, who have shared an office in the city for 15 years, recently began informing their roughly 7,000 patients that they will be charging annual fees in excess of $1,000 while dramatically reducing their clientèle to focus on the health care needs of just hundreds of patients apiece.

Such a business move may sound counterintuitive, but for Bullock, Coombs and a growing number of doctors nationwide, switching to what is known as concierge medicine represents the only financially and medically sound option available.

“It’s difficult for a lot of people to understand why we’re getting smaller when it would seem like we would want a larger practice,” Coombs said. “But despite the fact that I’m busier than ever, I’ve had to do layoffs and go further into debt.”

“My options were going broke, becoming an employee in a big company or community health center or retiring early,” he added.

Coombs and Bullock are the only practitioners in Vermont currently making the change to a concierge service, according to consultants and health officials, but chances are they won’t be the last — an eventuality that Vermont’s health commissioner said could have consequences for communities and the state, which is moving forward with plans to create a universal health care system.

By switching to a concierge system, Coombs and Bullock said, the combination of the annual fees — paid in addition to insurance reimbursements and direct payments for visits — and reduced expenses as a result of having a smaller practice size make it financially feasible to continue practicing in Vermont.

But the two doctors said finances were only one factor in changing their practice and not the most important consideration.

Of greater concern, they said, was being able to properly care for patients, who they said were often forced to wait too long for visits that were too rushed.

“There are some complex and value-laden decisions here,” Coombs said. “Health services have become less convenient and caring. Primary care has been compartmentalized to offices, and the patient-doctor relationship itself is threatened. Trust is the focus of my trade. I use it day in and out. If I can’t build it, I’m done for.”

‘Great care’

Under the model Coombs and Bullock are switching to this fall, they will have much more time for patients and will be at the beck and call of those they serve.

For the individuals and couples who pay fees ranging from 1,200 to $2,900 a year, benefits include the cellphone number of their doctor, same-day or next-day appointments as well as walk-in services for some procedures, little or no office waiting room time and amenities such as care for visiting relatives and friends and house calls for those with serious illnesses.

But the doctors said the biggest benefit for their patients would be avoiding serious illnesses and chronic diseases by having a doctor focused not only on treating their health problems but on preventing them.

“Ultimately, this is about providing great medical care,” Coombs said. “That’s what I became a doctor for, but providing great care often falls short under the system we have. It took Bruce and I 15 years to realize that we can work as hard as we want but we’re not protecting our patients from bad health care policy.”

Filling the void

Concierge care is a growing trend in the medical industry.

In 2010, MedPAC, a commission created by Congress that advises lawmakers on Medicare and watches for problems with access, issued a report that found listings for 756 concierge doctors nationally — a five-fold increase from 2005.

MedPAC found concierge doctors practicing mainly in urban and densely populated areas in all but 11 states.

Beneficiary advocates interviewed during the commission’s study said they were unaware of instances where concierge practices created problems with access to care.

However, in Rutland, where a scarcity of primary-care physicians has existed for some time, finding new doctors for the thousands of patients who will no longer receive care from Coombs and Bullock is presenting a daunting challenge.

“It falls to us,” said Grant Whitmer, executive director of the Community Health Clinics of the Rutland Region. “It’s huge. They have a large practice, and it’s definitely creating a significant demand out there.”

Whitmer, whose organization oversees a number of federally qualified health care centers in Rutland County, said the responsibility of filling the void will fall to his group because it has recruited all of Rutland’s new primary-care doctors in recent years.

Whitmer said he’s hoping to add five providers to his group’s primary-care campus on Stratton Road by the end of the year. But with Coombs planning to convert his practice by Oct. 1 and Bullock roughly a month after, Whitmer said there may be a gap of months for some patients seeking a new doctor.

“We’ve had many conversations every day from (Coombs’) patients, he said. “We’re identifying them so we can call them back. I’m hoping we can put out a letter soon that says by this date and that date we can accommodate you.”

‘I don’t like this’

Coombs and Bullock said they’ve also heard from a number of their patients — most of whom they said supported the doctors’ decision even if they didn’t plan to stay with their practice.

However, Calvin Waitkus said he wasn’t one of those patients.

While a longtime patient at the doctors’ practice, the Fair Haven man said he couldn’t pay the $2,900 membership fee for him and his wife and didn’t know who in the area could afford it.

“Three thousand bucks. That’s three-quarters of our oil payment, most of our car payment, the mortgage payment and definitely all of a vacation,” he said. “This is real money coming out of people’s hides. So here we are between a rock and a hard place with our care and have to find a new provider. I’m 64 years old. … I don’t like this kind of a change.”

Coombs said he has heard from patients like Waitkus and that he hopes to help some patients by providing a “scholarship” to cover their annual fee. He said he planned to move forward with between 20 percent and 25 percent of his patients receiving scholarships.

“Let me answer the question ‘Am I doing this out of greed?’ No one here in Vermont is here for the money,” he said. “Doctors in Vermont make less than almost any other market. If I was greedy I wouldn’t be fighting tooth and nail to stay here. I love what I’m doing, I just want to do it better.”

Will it work here?

But greed or not, the question remains whether a sufficient market for concierge medicine exists in Vermont.

The answer, according to a pair of consultants working with the Rutland doctors, is that Vermont may not be the ideal market but demand for more personal medical care is out there.

“The demographics are quite unlike the other markets we serve,” said Michael Friedlander, a principal with the Illinois-based consulting firm Specialdocs. “It’s really a leap of faith from Seth and Bruce, but we think it will work.”

Friedlander and the firm’s founder, Roberta Greenspan, said that belief was based on a growing portion of the population finding greater value in preventive medicine. The pair also said that the annual fees set by the Rutland doctors were low compared with most others.

“With the baby boomers growing older we’re seeing a change in the way people perceive health care,” Friedlander said. “We’re all seeing the cost of medical care becoming an investment rather than an expense. Medicine is becoming proactive rather than reactive.”

But while Vermont Health Commissioner Harry Chen said there’s nothing wrong with the concierge model of care, he said he did have questions about whether an influx of such practices would reduce access to primary care in an already thin market.

“At some point we will need to ask questions about access and how they will affect things as we go forward in the state with health care reform,” Chen said.

To read the entire article, please click www.ncpa.org/pdfs/081111-Three-Simple-Ways-Medicare-Can-Save-Money.pdf

Regardless of your political positions on Healthcare, as the President and Founder of the National Center For Policy Analysis, John Goodman is a healthcare visionary who is considered the father of the Health Savings Account concept.

To read about John Goodman please click www.ncpa.org/pdfs/JCG_Bio.pdf

The Specialdocs physician/client panel continues to grow. We are currently transitioning physician practices in Vermont, Connecticut, Manhattan, several in California, Chicago and Springfield, Illinois. We recently completed the transition of a cardiology specialty practice at Mass General in Boston.

We always welcome feedback from you… our own extended “medical family”!

Roberta Greenspan, President of Specialdocs Consultants, was interviewed for the article and makes a cogent point, “Concierge care is as much about preventing problems as reacting to problems when they arise…Many times the patient may think that they don’t need care.  But discomfort or symptoms may indicate that an illness or problem is looming.”

To read the entire article, please click  http://blogs.reuters.com/reuters-money/2011/07/18/is-a-concierge-doctor-worth-the-cost/

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• A physician needs to evaluate the various functions that contribute to a successful transition.
• A physician needs to be aware of the obstacles he/she may encounter during the transition process and post transition.

Please click to read the full article.

 http://www.hbnradioshow.com/2011/06/physician-concierge-practices-roberta-greenspan-michael-friedlander/