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Two doctors forgo fee-for-service model in new practice

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DECATUR — Two doctors are launching a new family practice in Decatur with a radically different prescription for delivering health care and getting their bills paid.

Priority Health Family Medicine drops the traditional fee-for-service model and Dr. Timothy Miller and his business partner, Dr. Kristin Newcome, will not charge for office visits or bill insurance. Instead, patients will pay a membership fee that buys them “24/7, 365-day” access to the doctor’s office or their physician.

The doctors say dispensing with the fee-for-service model frees them to spend more time with each patient and gives patient easier access to preventive care without worrying about financial headaches such as co-pays and deductibles.

This style of medicine, known as a “concierge” practice, is still small nationwide but growing. There were about 4,500 such physicians coast to coast in 2012 and that number has jumped 30 percent in the past year. While there are few other examples of concierge medicine in this area outside of the new Decatur practice, a major conference to promote this style of care is scheduled in St. Louis for October. It’s called the Direct Primary Care Conference and “physicians, purchasers, payers, researchers, investors, suppliers, policymakers” have been invited to attend to find out how a concierge practice works.

Priority Health Family Medicine will work with a varying fee schedule that starts out at $110 monthly for an individual and rises to $220 a month for a family of four or $238 for a family of five or more; patients will sign a 12-month contract and a sliding series of discounts offer up to 9 percent off the total price for those who pay the yearly fee all at once. Discounts of 4.5 percent and 2.3 percent reward patients who pay semiannually or quarterly.

Miller and Newcome are currently family practitioners with the DMH Medical Group and will leave to open their new practice by early October in remodeled offices at 5160 Hickory Point Frontage Road. The doctors have sent their existing DMH patients notices of their leaving, and those patients get first shot at securing a place at Priority Health Family Medicine. The rolls will then be opened up to the public on a first-come, first-served basis.

The doctors expect they will limit their numbers to about 700 patients each; they say that contrasts with traditional practices where a doctor might have 3,000 patients on their books.

The membership fee covers all office visits, without limit, for everyday maladies and basic tests and procedures such as EKGs, urinalysis, strep tests, pregnancy tests, blood pressure checks, well-child exams, school physicals and some injections. The doctors stress, however, that the new fee arrangement is not meant as a replacement for insurance that patients will still need to cover hospitalization and referrals to specialists and outside testing.

Both physicians say the upheaval coming to the medical system with the arrival of the Affordable Care Act, commonly known as “Obamacare,” was not their primary reason for opting out of the traditional fee structure, although it had an influence. They stress the main appeal of the membership fee approach is that it gives them more time to do their jobs while sweeping away many of the barriers that frustrate the effective delivery of health care when it’s most needed.

“Under the present fee-for-service system and its costs, co-pays and deductibles, routine and preventative care is often deferred and patients may wait until a problem is advanced,” said Newcome, 40. “But with our approach, we remove those barriers and there is unlimited access to care anytime you need it. That means there can be more of an emphasis on health and wellness.”

Rather than feeling threatened, the doctors say insurance companies should welcome the new approach to health care. They claim it will lower industrywide costs by nipping many illnesses in the bud before they can bloom into serious conditions needing expensive, specialist treatment.

“The access to your doctor is the key,” said Miller, 46. “We plan to give our patients our cellphone numbers, and they can call us whenever they need something and we’ll make arrangements from there. But with Dr. Newcome or myself, one of us will always be available on the weekend or after hours.”

The family practitioners might even revive the long-dead practice of making house calls.

“We’ve talked about it and, over the years, I’ve done it and Dr. Newcome has done that for patients at times,” Miller added. “We haven’t figured out yet how to structure that, but we haven’t ruled it out; if somebody needs us to come to their house, we may do that, too.”

Decatur Memorial Hospital said it will miss the skills of the family physicians but wishes them well in their new venture.

“They are very good hospital employees, but at the same time we want to make sure they understand we are very supportive of their endeavors,” said DMH Senior Vice President John Ridley. “We don’t take it personally.”

Ridley also thought the new style of practice would be appealing to patients who can afford it, and that other doctors would watch the business model with interest to see how it works out. “It’s an interesting concept,” he added.

Is the whole Priority Health Family Medicine approach a bold new way forward for American medicine?

Dr. Eldon Trame, president of the Illinois State Medical Society, said concierge medicine has been growing in popularity in the last five or so years. He said a system that gives doctors more time to see patients is appealing, compared to a fee-for-service model where reimbursements are being cut and doctors have to jam in more appointments just to cover their costs.

“There are a lot of doctors getting burned out because they are being forced to see patients faster and faster,” added Trame, 60, an internist based in Belleville.

But he said there are some concerns with stepping outside the insurance fee-for-service model. Stressing that he doesn’t know the details of how the Decatur practice will operate, the doctor said the tendency of insurance plans to require patients to use in-network doctors could pose a problem if a doctor outside the network needs to make a referral to a specialist such as a cardiologist. “The devil is in the details,” he added.

Trame also said the Affordable Care Act is about to open up health care to a lot of new patients, and some areas already have a shortage of doctors. He said the new practice will be restricting the number of patients it serves “at a time when there is more patients to be seen than ever.”

The doctor, however, said the basic problem of physician/patient unhappiness with the current state of medicine won’t go away, and that is what is driving new approaches to delivering and paying for medical care.

“If people were totally happy with the care they are getting from their current doctor, they would not look at a new plan like this,” he added. “And physicians like it (the concierge approach) because it allows them to run their business without having the rat race of seeing five or six patients per hour; now they can see two or three patients an hour and have the time to adequately evaluate things.”| (217) 421-7977


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