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Source: Ventura County Star, Calif.self storageSept. 04--Dr. Jack Padour was burning out.The Ventura internal medicine doctor faced falling reimbursement rates and rising overhead. The only way to maintain his earnings was to see more patients."I knew I was being compromised by seeing patients every eight to 10 minutes just to keep the doors open," he said.Two years ago, Padour changed his practice to a model attracting doctors and debate across the nation.Patients now pay him an $1,800 membership fee that allows him to see fewer people and spend more time with each of them. A roster that once hovered at 2,000 patients is now at 300.The annual fee guarantees an extensive physical, including tests on lung function, vision, heart, anxiety, diet and other aspects of wellness. Patients get Padour's cellphone number. They are guaranteed immediate access and, perhaps most importantly, more time with the doctor.If they end up in the hospital or a nursing home, he follows them there for treatment."If you listen long enough, the patient will tell you what's wrong," Padour said. "The whole diagnosis is in the history, and that's usually what no one has time for."Some doctors call it a concierge practice. Others, frustrated over what they say is a misperception that the service attracts only wealthy patients, prefer "direct primary care" or "personalized care."The forms vary. But in most cases, doctors charge membership fees to provide certain services and specialized care. Many of the doctors, including Padour, continue to accept insurance payment for care not covered by the membership, although some doctors accept only direct payment.Numbers growingA leader of the American Academy of Private Physicians estimates as many as 5,000 doctors nationwide have direct primary care practices, charging fees of $600 to several thousand dollars. A leader of MDVIP, a Florida-based company that runs a national network of membership fee practices, suggested the national number is closer to 2,500 doctors but increasing.A growing number of providers operate membership practices in Ventura County, including seven doctors who have or will start MDVIP practices in the Conejo Valley. Some of the physicians echo Padour, saying they want to spend more time with individual patients because they can provide better care."The status quo just isn't viable," said Dr. Paul Block of Thousand Oaks. "You're forced to see more and people. Overhead keeps going up, and reimbursement keeps going down. Quality of care becomes less of a priority."Block joined MDVIP in 2004. He moved from critical care to treatment focused on wellness and identifying potential problems before they emerge. He said he went from "dealing with the train wrecks to fixing the tracks."Doctor shortageThe model evokes intrigue and concern.Dr. Gary Deutsch is an internist from Santa Paula, not a mathematician. But the numbers draw his attention: Doctors cut their patient loads by far more than half at a time when there's a national shortage of primary care doctors. On top of that, the federal health care overhaul could mean 30 million newly insured people over several years."It's easy to do the math," he said. "There's going to be a lot of patients without doctors."Deutsch sees 20 to 25 patients daily in a practice that encompasses about 2,500 patients. He said he doesn't scrimp on time with patients and can make more time for people who need it.The membership fee concept seems to work for a very small niche of doctors, Deut迷你倉ch said. But it wouldn't pass muster in Santa Paula."There are very few patients who could afford it," he said.No patients are abandoned when doctors join MDVIP, said Dan Hecht, CEO of the 12-year-old company that is a division of Procter & Gamble. Before doctors join, they must find a new home for patients who choose not to pay membership fees.Patient-focusedHecht says MDVIP helps combat the primary care doctor shortage by extending the career of physicians so frustrated with traditional practice that they leave medicine.Block said the membership-fee format allows him to better avoid what he sees as the problems created by the power of insurance companies, pressure to see more patients and federal health care overhaul."I became aware I couldn't change the system but I could dramatically change it for myself and a few people," Block said.Bristling at the notion of upper-crust care for an affluent few, Block said his $1,800 annual fee is less than some people spend on cable and Internet services. He argues the practice provides better care by allowing doctors to focus not on reimbursement or volume but solely on the patient.MDVIP officials say their practices have brought a 79 percent reduction in hospitalizations for Medicare patients.Tony Plaia is a 79-year-old retired insurance agent who had knee replacement surgery. A spine injury means he has 10 screws, two bars and four wires in his neck.He comes to Block because he doesn't have to wait for appointments and the care is focused on keeping him going to the gym, healthy and out of the hospital. He receives a comprehensive physical, a wellness plan and a copy of his health record."It boils down to $5 a day," he said. "I could spend that on a super latte or spend it on MDVIP."If patients need care outside the wellness program covered by the membership fee, Block bills the insurance company or Medicare.Standard insuranceAll but a few of Block's patients carry insurance. Outside observers say people need a high-deductible plan because the membership fees don't cover all health care needs.That means patients pay insurance premiums and membership fees. If they're not insured, they will face fines of at least $95 next year, said Dylan Roby, a UCLA health policy professor. The penalty is part of the federal health care overhaul's mandate that people obtain insurance coverage.The law guarantees that insurance companies provide free coverage of care labeled "preventive." Doctors in concierge practices say many of the wellness tests and treatments covered by membership fees are not covered by the law.The health overhaul stoked speculation that increasing regulation, growing patient loads and changing reimbursement systems would push more solo physicians into membership fee practices. Doctors who have made the switch say the overhaul may deliver them more patients who worry that 30 million more insured people will mean less access.But Joanne Spetz of the Institute for Health Policy Studies at UC San Francisco said growth will be limited by the cost to patients. They don't want to pay more for care, and that reluctance will limit the doctors who make the switch."I think these practices have been growing, but I don't think you see a huge flood of doctors going into concierge medicine," she said. "It's still an absolute minority."Copyright: ___ (c)2013 Ventura County Star (Camarillo, Calif.) Visit Ventura County Star (Camarillo, Calif.) at .vcstar.com Distributed by MCT Information Services文件倉