The article below, appeared in the November 28th, 2005 issue of the Columbus Dispatch:

Alternative to assembly-line medicine spreads
Monday, November 28, 2005
Misti Crane
THE COLUMBUS DISPATCH

They're too busy to break for a midday doctor's appointment and unwilling to wait days or weeks for one that doesn't interrupt work.
They're sick of waiting in a room full of hacking germ spreaders and outdated copies of Ladies' Home Journal.
They want extra attention, office calls, house calls, the doctor's cell phone number.
The name varies, depending on whom you ask: concierge, boutique, retainer, subscription.
But the game essentially is the same: A doctor takes an annual fee in exchange for providing more attention. For the doctor, it's a deal that offers more than money.  It provides freedom from the constraints of traditional practice, including the pressure to see dozens of patients a day.
It's a small sector of the health-care system inching from both coasts into the heartland.
Since June, Dr. Ronald Miller has been giving it a go in Columbus. His professionally decorated office is library-quiet, its soothing green paint fresh, its leather armchairs usually empty. He has about 40 patients and when they call, they're in and out. He charges $2,000 per year for most patients.
Dr. Miller is looking for more business and recently bumped up advertising, but he doesn't plan to take on more than 300 patients.
"It is expensive, but it just depends on what your needs are, I suppose," said Hamish Baird, one of Miller's first patients.
Baird lives on the Northwest Side and is vice president of a small clinical research company. At 34, he's young for an executive, but not so fresh-faced on the ice. The guys in his intramural hockey league play hard, and that means Baird gets hurt every couple of months.
When he first rang Miller's office, it was for a hyper-extended thumb.
He was on his way out of town and tired of waiting a couple of hours or more at urgent care for a doctor to bandage his injuries. He saw Miller within an hour.
Concierge doctors charge from $60 to $15,000 a year, with more than half charging between $1,500 and $1,999, according to an August report from the Government Accountability Office, the investigative arm of Congress.
Most bill insurance for covered services, but they don't charge co-pays no matter how many times a patient sees them in a year.
Not everybody is a fan.
"It's a symptom of the broken health-care system that this sort of thing is happening," said Dr. Elisabeth Righter, president of the Ohio Academy of Family Physicians.
Her organization doesn't have a position on concierge practices, but Righter shares the concerns of critics who worry about the creation of a two-tier medical system, one where the wealthy get premier care.
"The underinsured, the poor, the elderly.  I don't think any of them end up going to a boutique practice, unless they have enough money to do it," Righter said.
That said, the Dayton doctor understands that financial constraints - higher malpractice insurance premiums, low reimbursement from insurers - can limit doctors’ ability to provide the kind of service patients want.
The Government Accountability Office report found 146 practices in the 25 states and analyzed 112 doctor surveys. Cities with the highest number were Seattle and Boston.
On average, the doctors have 491 patients under their care, compared with 2,716 before they went into concierge practice.
As long as the practices are small in number, they won't threaten access to health care, the report found.
Dr. Molly Katz, president of the Ohio State Medical Association and a Cincinnati gynecologist, sees plenty of room for concierge practices, as long as they don't grow to the point that they make it hard for people to find doctors.
"The more choices people have, the better. If this meets the needs of certain patients that can afford it, fine. And if it meets the needs of the physician, that's good too," she said.
Doctors have been responding to financial and scheduling pressures in a variety of ways. Some have started charging for things like phone consultations and calling in prescription refills. Others offer services such as laser hair removal and Botox shots.
Dr. Miller left his traditional group practice a few years ago.
"I essentially got disgusted with squeezing people into the 15-minute office visit. I literally couldn’t do it anymore.
"I would go home at the end of the day saying, Did I do that? second-guessing myself."
Dr. Doug Magenheim, who has had a concierge practice in suburban Cincinnati for more than two years, says job satisfaction was the main reason for making the switch.
"I talk to specialists on a regular basis. I make house calls when we need to make house calls. I've met a patient coming off an airplane. I've been to the hospital before the ambulance has shown up for sick patients."
Miller is hopeful this venture will keep him in private practice. He had been working as a doctor who only sees patients within Riverside Methodist Hospital. So far, a fair number of his patients come courtesy of Russ Bundy, president and chief executive officer of the American Pan Co., a commercial baking-supply company with its headquarters in Urbana.
Bundy, a believer in preventive medicine, negotiated a $1,500-a-head rate for about 30 of his managers.
"So often, you call a doctor and it's three weeks or a month away before you can have an appointment," said Bundy, who lives in Bexley.
"We travel the world, and I don't have a lot of time to make appointments with doctors."
Bundy wants his top people to see the doctor regularly. If something serious is going on, he wants it caught early.
"It's a great investment for me and our company," he said.

mcrane@dispatch.com 

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