Give me time

Dr. Pflueger, formerly director of the chronic kidney disease program at the Mayo Clinic in Rochester, Minn., where is an associate professor of medicine, said patient visits used to take 90 minutes, but this has since been whittled to 60 minutes and then 30 minutes. When he set up his concierge practice, he decided to continue the practice for which Mayo is famous—comprehensive diagnostic workups— on his own timeframe.

Each day he sees 5 or 6 patients for a full consultation and 10 or 20 patients for 30-minute visits. Instead of having patients follow the typical disease progression of moving from dialysis to transplantation, his goal is to improve kidney function or halt progression in patients. Dr. Pfleuger said he is able to do this for more than 90% of his patients.

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Dr. Richman used to see 25 to 45 patients in a day and now sees about 8. He said he would rather spend time at a late appointment or weekend visit at a hospital, sometimes without reimbursement, than see more patients.

“It just seems like we have more time,” Dr. Richman said. “We are seeing far fewer patients, but are spending more time with them. There is so much less red tape, I can’t believe how much more time we have to spend with patients.”

Better care

Dr. Richman said his new practice is more comprehensive than his traditional one. Instead of just telling a patient he needs to quit smoking, now he spends time educating patients on why smoking is bad for an erection or their bladder. He also has more time to go into pros and cons of tests and various treatments; consult with other doctors involved in a patient’s care; and do more lab testing and overall health screening.

“I’m not a primary care provider, but I am looking for other conditions and overall health risk factors that could be causing sexual health problems,” Dr. Richman said. “I can educate him and tell him he needs to accomplish goals like losing weight, and I can send him to a nutritionist or personal trainer of if there are relationship issues.”

Moreover, Dr. Pflueger pointed out that in concierge practices patients typically get to see a highly qualified physician who takes the time necessary to address and treat the patient’s needs and health conditions, and not a nurse or practitioner, as this has become the “new” standard in the capitative system. Furthermore, under the “new” capitative system, many patients see their physician only 5 minutes or less, and care becomes suboptimal. Dr. Pflueger himself has a broad clinical and research background. He was the principal investigator of several research trials, published numerous research papers, and is a nationally and internationally recognized speaker.

Hybrid practices

One option that allows physicians the best of both worlds is a hybrid practice. Wayne Lipton, managing partner of Concierge Choice Physicians based in Rockville Centre, N.Y., said this works best for specialists with low turnover and a stable patient base requiring ongoing care.

Lipton said anywhere from 3% to 10% of a practice takes part in the concierge model and the remainder are traditional patients. Concierge patients usually pay an annual fee that gives them an hour of defined time for a consultation, typically four to five times throughout the year. Physicians can block a day or time a day during the week to see these patients aside from their traditional practice.

Lipton said there is often a greater consultative and advocacy role created, built around non-covered services. The physician becomes a core provider who patients can go to for advice and education, often learning to manage secondary and tertiary effects of the core disease.

“The hybrid model will tap into a private source of revenue that can be married to the current approach to healthcare,” Lipton said. “It keeps doctors from throwing up their hands and saying they are not going to play anymore.”