The Portland Press Herald

When Gladys Curtis no longer could stand the sharp pain in her back earlier this month, she called her doctor.

It was the middle of the night, but Dr. Philip Frederick of Yarmouth picked up the phone, just as Curtis knew he would.

Then, in the days after surgery to fix her spine last week, it was Frederick who called Curtis to make sure his patient was OK.

Curtis and Frederick have the kind of patient-doctor relationship that, while standard a couple generations ago, has become rare in a modern health care industry driven by consolidation, volume and 15-minute appointments.

The personal attention is so important to Curtis that she agreed to pay a $1,500 annual fee to be part of Frederick’s smaller, more exclusive practice — one of the first of its kind in the state.

So-called concierge medicine — charging annual fees for personalized, preventive care — has taken root slowly in larger markets around the country over the past decade. Now it has reached Maine, where dissatisfied physicians and patients are taking health care reform into their own hands.

“It’s like I’m just starting over in a brand-new practice, fresh out of the internship,” said Frederick, a local primary care physician for 26 years who reduced his patient load by two-thirds. “I can take my time with patients. I’ve got folks coming in that I’ve literally known for 25 or 26 years and … I’m learning things about them I never knew.”

Frederick and others say the personalized care model improves health and reduces costly hospitalizations. Some doctors and patients, however, say it is simply the kind of care patients should have a right to expect without having to cough up a hefty annual fee.

Frederick, 54, is the first Maine doctor to join MDVIP, a Florida-based company that has built a network of about 500 concierge medical practices around the country.

Curtis is one of only 600 patients in Frederick’s practice, instead of the typical 1,800 or 2,000. For the $1,500 annual fee, she gets an annual wellness assessment, including tests and counseling that aren’t covered by insurance, which in her case is Medicare. She also gets appointments that last at least 30 minutes and 24-hour access to her doctor — no answering service or on-call providers she doesn’t know.

Frederick launched his new practice a month ago. A second southern Maine physician, Dr. George Gardner, is scheduled to launch his MDVIP practice in Scarborough in January.

MDVIP is not the only concierge care model, but it calls itself the largest and the most affordable network. While MDVIP physicians charge patients $1,500 a year to participate, concierge practices in New York and other cities charge $5,000 or $10,000 a year for the kind of attentive care typically reserved for presidents or wealthy celebrities.

MDVIP receives about one-third of each patient’s fees, which pays for marketing and regulatory support, among other things, said Dan Hecht, chief executive officer of the company.

“What we’re finding is across the country consumers or patients are looking for this type of care,” he said. Doctors, meanwhile, are looking for a way out of the “conveyer-belt medicine,” Hecht said. “Many doctors are just saying they can’t keep it up any more.”

Hecht traveled to Maine in September to help Frederick and his medical staff celebrate their new practice. They all strapped on parachutes and jumped out of a plane together, which Frederick suggested as a kind of metaphorical bonding exercise.

Frederick, who most recently was a physician at Falmouth Internal Medicine, said he was dissatisfied with the pace and care of conventional practice.

“I really realized I was spending most of my day reacting to things. I would take care of the illness of the day, and that was really all I had time for,” he said. “It really felt like I was kind of getting away from my roots. So much time doing sick care, not enough time for preventive care.”

Some say those pressures are especially strong for the growing number of physicians working in hospital-owned group practices.

While he was most recently part of a Mercy Hospital-employed physician group, Frederick spent most of his career as an independent doctor. He said the pressures are the same in both kinds of primary care practices — you have to see enough patients to keep the lights on and pay the staff. Primary care physicians in Maine typically earn $100,000 to $200,000, a fraction of what many specialists earn.

Frederick said he never had a minimum number of patients he had to see in a day, but added that doctors are reimbursed for doing examinations and ordering tests, not getting to know patients and their health.

“I think everyone faces the same pressures in medicine. It’s the same in solo practices as it is in hospital-based practices,” he said.

Since downsizing and launching his new practice, Frederick has made a couple of home visits with patients, something he hasn’t done since the early part of his career. He said he also found an undiagnosed medical problem during a longtime patient’s first wellness screening, a two-hour assessment that MDVIP patients get once a year.

“It’s really going to make a significant difference in her life,” he said.

He is no longer thinking about retirement. “I feel like I’m getting back to my roots. I just feel so re-energized.”

In fact, Frederick didn’t seem to mind at all when Curtis called and woke him up to tell him about her bad back, according to Curtis. She has been a patient of his for more than 20 years, and she said he seems much happier now.

“He was constantly on the go. It was getting to him,” she said.

Curtis also thinks the new arrangement is going to be a good thing for her, and not only because she can get hold of him in the middle of the night. “You get better care in the practice he’s in now,” she said.

Curtis, 76, is not wealthy. The Freeport resident lives on Social Security and is covered by Medicare. Even so, when Frederick announced to patients that it would cost $1,500 to be part of his new practice, she didn’t hesitate.

“I’ve been going to him since 1989. He knows me in and out and I trust him,” she said. “I can talk to him about anything.”

Not all of Frederick’s longtime patients were so understanding about the new fee.

“I am on a fixed income. I’m buying my own health and dental insurance for me and for my wife,” said Harold Larrabee, who was a patient of Frederick’s for 15 years. “So the $1,500 a year, just for a single person, I really couldn’t see that. I could use it toward my insurance costs.”

Larrabee said he is now looking for a new, independent doctor who can provide as much personalized care as possible without any extra fee.

Such practices may not be easy to find, but they do exist, said Dr. Jean Antonucci, a physician in Farmington.

“There isn’t anything bad (about MDVIP), but they are marketing a financial model that I believe all patients are entitled to … without these fees,” she said.

Antonucci is one of a small number of Maine physicians who promise personalized care without fees – a model known as Ideal Medical Practices.

She limits her practice to about 800 patients and stays in business by reducing her costs. She contracts out her billing work and has no staff, which means she takes calls and makes patient appointments herself. She also earns less than a conventional primary care doctor, a choice she made to practice the kind of medicine she believes in, she said.

“I can go slower with patients;, and when I go slower with patients, they get really good care,” she said. “If I churn patients through, I can earn more, but I choose to spend more than seven minutes with each patient.”

Antonucci and others say the MDVIP model probably will be limited here to a small number of practices in southern Maine, where there are more patients with the means to pay an annual fee.

Frederick disagrees. He filled up his 600 slots faster than he expected, he said, and now has new patients on a waiting list to get in. The patients are not wealthy, he said; they simply want to invest in preventive care.

“I really, sincerely believe there is still an unmet demand for this type of personalized care.” Frederick said. “I believe there’s enough interest in this that there will be more.”

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