The VIP Treatment

Update: Two more local doctors are in the process of joining the MDVIP network: Dr. Gary LaMonda, and Dr. Lyndell Scoles, both practicing in Columbia. According to the MDVIP website, LaMonda’s new model of practice will begin May 13, 2014—the same date as Dr. Don Delwood. Scoles’ new model of practice will begin June 30, 2014. If each doctor reduces patient count from 2,000 or 3,000 to 600 under the MDVIP model, it could mean between 4,200 and 6,000 patients may need to find a new primary care physician.

When Matt Darrough was a teenager 25 years ago, he fell from a tree while bow hunting, resulting in a spinal cord injury and broken back.  Also, 25 years ago, internist Don Delwood opened a primary care practice in Columbia’s Boone Clinic. It would be several years before the two men’s paths crossed, but eventually Darrough became Delwood’s patient and their journey together began as most traditional doctor/patient relationships do.

However, next month, both men will embark on a new journey into “personalized care practice”, a practice model new to Columbia, but increasingly popular across the nation. Although Delwood describes this new model as a personalized care practice, the press sometimes refers to similar models as “retainer, boutique, direct medical or concierge practices.”

In mid-May, Delwood will have completed the transition from a traditional primary care provider (PCP) practice where he had 2,000 patients to becoming a member of the MDVIP network, where he will cap his patient load at 600, each of whom will pay an annual fee for more comprehensive exams, 24/7 access to Delwood and personalized services.

More time; fewer patients

Initially the biggest change for Delwood’s patients will be paying an annual fee of $1,650; however, included in that fee is the cost of a comprehensive exam, much broader in scope than traditional annual physicals of the past. The wellness exam will be specific to each patient and includes screenings and labs not typically covered by insurance. Furthermore, Delwood will use the results of the exam to develop a wellness plan for each patient.

“I wanted a model of care where my patients stay as healthy as possible for as long as possible,” Delwood says.

The annual fee also includes an MDVIP patient membership, which provides access to a national network of MDVIP-affiliated doctors, as well as referrals to several prestigious medical facilities like Johns Hopkins, M. D. Anderson Cancer Center and Mayo Clinic.

Delwood, and all other MDVIP doctors, are limited to a practice capped at 600 patients. With fewer patients, Delwood will be able to spend more time with patients, tailoring a specific wellness plan for each.

“The biggest issue for me is trying to provide opportunities for the patient to be able to talk about their healthcare in an unhurried way. I was looking for an environment where we could talk without outside influences or other barriers.” Delwood says.

Although Delwood is the first in mid-Missouri, he is one of thousands of doctors across the country flocking to the retainer or personalized care model of practice.

American Medical News reports, “The key drivers of why doctors convert to a concierge practice are they don’t feel they are practicing the manner in which they ought to be in terms of understanding the patient. Many of these doctors want to slow down the pace.”

Darrough, a local attorney, has been Delwood’s patient for nearly 10 years and enthusiastically agreed to the new model.

“Since injuring my back 25 years ago, I literally have seen hundreds of doctors. I was immediately interested in a plan that gets me more acquainted with my doctor,” Darrough says.

Doctors are bound by a code of ethics to provide continuity of care; in essence, not to abandon their patients. Delwood, with the help of MDVIP, developed a four-month transition plan that provides his patients with the opportunity to transition to the new practice or to find them another PCP.

“The response has been very positive,” Delwood says, adding, “Some of my patients were familiar with the concept or had it where they used to live. There has been a high level of excitement.”

Having explained the transition process to nearly 2,000 patients, Delwood believes he will be close to reaching his 600-patient limit. And, he says, he has been getting phone calls from new patients interested in joining the personalized care practice.

“I am taking new patients, but when it fills up it fills up. We’ll start a waiting list,” Delwood says.

Assessing PCP

MDVIP was founded in 2000 by two primary care physicians from Florida who had been practicing for several years. According to Chief Marketing Officer for MDVIP Chris Lillich, “The two had found their practices to be too impersonal with too many patients, and they wanted to get back to their original vision of patient-centered care.”

Since its inception MDVIP and other similar physician networks have enjoyed immense growth and success. Even during the tough economic climate of the last few years, MDVIP has maintained a 94 percent renewal rate year over year.

In addition to the high renewal rate, research studies have shown the new model, with its focus on prevention, has actually saved the healthcare industry millions of dollars.

In 2012, an American Journal of Managed Care article reported MDVIP-member patients, when compared to nonmembers, were readmitted to hospitals 97 percent less frequently for acute myocardial infarction; 95 percent less frequently for congestive heart failure, and 95 percent less frequently for pneumonia. The study analyzed data from the only five states that provide physician-specific data. Within just those five states, the estimated cost savings to the system was $119.4 million in 2010 alone.

Industry reports state between 7 and 10 percent of physicians will be moving to some form of retainer or personalized care model in the next one to three years. There are several reasons for the shift. Nationally, there is a shortage of primary care physicians, creating more patients per doctor. Medical school graduates are not entering the internist or family practice fields, limiting future numbers of primary care physicians. However the most foreboding harbinger on the horizon is the Affordable Care Act, of ACA, which is designed to pump 20 to 40 million formerly uninsured new patients into an already overcrowded system searching for primary care providers. Simply put, demand is outpacing supply.

Although Delwood did not cite the ACA as a factor in his decision, Lillich says it is a factor for many other physicians joining the ranks of MDVIP doctors.

“The ACA is generating a lot of interest in this model; especially with the roll out and confusion this fall. People are looking for different options because of the uncertainty about what the future might hold,” he says.

An article examining concierge medicine in the Internet Journal of Law, Healthcare and Ethics states, “Concierge models accomplish everything that healthcare reform is aiming to do, from lowering medical costs to improving access and increasing the quality of care.”

Still, opponents of concierge, retainer or other personal care models, cite equal access to care as a primary concern.

The future of personalized care practices

It’s true the earliest concierge practices did not accommodate equal access and were intentionally targeted at the wealthy. They had annual fees in excess of $20,000 and seldom accepted insurance. However that original concept has diversified over the years and significantly reducing fees. Many but not all models will accept insurance.

Delwood, using the MDVIP model, will accept insurance and Medicare.

“I’ll still be in the same office. I’ll still be on call at Boone Hospital; I’ll still share call with my group of doctors. I’ll still accept Medicare and traditional insurance,” Delwood says.

Public debate continues on whether the personalized care model excludes the poor. Proponents claim the cost, which is generally less than $5 per day, is affordable.  The real culprit, proponents say is people’s inability to prioritize their budgets to cover the cost of prevention and wellness.

For Darrough, who has struggled with the legacy of a life-altering injury, the decision is simple. He says, “Dr. Delwood is the best doctor I’ve ever had, but there’s only so much he can do is a few minutes. My friends with no major illnesses don’t understand the preventative aspect is huge. Until you’ve been ill, you don’t understand. It’s a no-brainer for me.”