Hire Your Own Private Doctor Some doctors in the area can provide you with home visits and 24/7 availability — and it’s less expensive than you think By Deborah Jeanne Sergeant
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ant a doctor who really knows you and offers 24/7 availability or even house calls? These options have become reality as physicians reinvent how they provide care. A few doctors in the area have begun offering alternative ways to deliver care, and not just because they want to enhance their patients’ experience. As margins grow thinner and thinner in the healthcare industry, many providers take on additional patients to receive adequate reimbursement from insurers. Since they can’t add more hours to the day, this means that each patient receives less time during visits. Physicians in general also have little opportunity to develop a close patient/ doctor relationship. If they increase the number of visits they schedule, they must work longer hours, which affects their quality of life. All of these factors add up to less satisfaction for doctors and patients. Some have turned to offering retainer-based care, sometimes called concierge medical care. Robert C. Cupelo, an internal medicine physician who owns and operates a self-named practice in East Syracuse, believes that affiliation with MDVIP for the past five years has helped him solve the problem. He initially practiced with a group affiliated with MDVIP and for the past two years, he has been solo. Through his affiliation with MDVIP, a patient-centered wellness program headquartered in Boca Raton, Fla., he can link to top specialists nationwide to consult on tougher cases. MDVIP is not insurance, but he participates with insurance and bills them for services delivered on-
site.
Cupelo offers an out-of-pocket program that begins with a physical which lasts an hour, instead of the usual half hour with just 15 minutes provided by a physician. The physical includes comprehensive screening and lab work to help assess patient health and benchmark vital numbers. “You have more time to really make a personal connection with patients and spend more time with them in the office,” Cupelo said. The $135 monthly fee includes follow-up wellness visits. His patients don’t have to wait for care, and they have 24/7 access to him via phone, email or text message. As a courtesy, he sees the children up to age 26 of an adult with MDVIP membership for a routine visit. Most patients can schedule a visit to occur within two days. Part of the reason he can accommodate them is that MDVIP limits his patient load to 600. Many traditionally practicing physicians serve 2,500 or more patients. He employs two part-time RNs and a secretary. Maintaining a small staff and facility helps reduce his overhead so he can keep the membership fee low. MDVIP also pays for electronic recordkeeping, which Cupelo said saves him a lot. “You get a sense of satisfaction,” Cupelo said. “When you cram 25 people into an afternoon, you don’t feel you’ve done your best job.” Physician R. Paul Ferenchak owns My Country Doctor in Lafayette, a retainer practice. His patients pay $100 a month for comprehensive family care, which includes 24/7 access, more face time with the doctor
Physician Joseph Barry, an internist and geriatrician with Preventive Medicine Associates in Camillus, has operated the practice as a hybrid since January 2015. He sees patients at his office and make house calls as well. He said he feels he’s “the Wegmans of medical care. I want no checkout lines, everything to be fresh, and everyone to be happy.” Page 14
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • November 2016
Physician R. Paul Ferenchak owns My Country Doctor in Lafayette, a retainer practice. His patients pay $100 a month for comprehensive family care, which includes 24/7 access, more face time with the doctor and in most cases, a standard visit and follow-up visits that extend to an hour or more. and in most cases, a standard visit and follow-up visits that extend to an hour or more. Ferenchak practices from an office in his home. He employs no staff and gives his cell phone number to his patients. He works with providers of diagnostic testing, such as labs and X-ray providers to pass along savings of up to 50 percent to his patients. He doesn’t participate in any insurance plans because “billing accounts for 40 percent of what diagnostic experts charge. With direct care, they can reduce their charge.” He chose to offer direct care because he wanted to spend more time with patients instead of only the 10 to 15 minutes he could spare to boost the number of visits he needed. “Physicians are forming mega groups to spread out the cost of maintaining their practice because it’s gotten so expensive with lowering reimbursements and all the regulations,” Ferenchak said. “To avoid fines for the various government programs, you need a special person to do this. You can end up going bankrupt.” He feels he has returned to an old style practice where he can take his time in treating patients and making house calls as needed. “It makes practice fun and rewarding,” Ferenchak said. “I have so many associates that are on the edge of retiring or abandoning. The level of frustration and disquietude is incredible. The health system we have
used to be the best. Now it’s ranked 27th in the world. Many third world countries are listed better. Something has to change. My hope is direct primary care paradigm helps.” Physician Joseph Barry, an internist and geriatrician with Preventive Medicine Associates in Camillus, has operated the practice as a hybrid since January 2015. “I like the model better,” he said. “If people want to be seen, they can see my nurse practitioner. If there’s an issue, they can see me.” After 25 years in practice as a physician, he didn’t feel fulfilled. He accepts insurance, but patients pay an annual fee of $1,800 for ease of access, direct phone or email access, and extended visits. “I can visit with them longer to talk about wellness, diet, sleep and stress and if they want to work on any of those four,” Barry said. “Communication is much improved with my model.” He affiliates with Signature MD and has privileges with four area hospitals. He can visit patients while they’re in the hospital, order diagnostic work and make house calls as needed. Though he makes less money than before, he’s content, feeling like he’s “the Wegmans of medical care. I want no checkout lines, everything to be fresh, and everyone to be happy.” To comply with the Affordable Care Act, patients must also take part in a qualified health insurance plan.