Area doctors switch to fee-based practice

The term concierge has a new meaning for several thousand patients treated by four doctors at Mid-Atlantic Family Practice.

Letters sent out in early November offered patients an opportunity to sign up for a new wellness program on a first-come, first-served basis in order to stay with their doctor – all for a pricey annual fee.

The fee coupled with the process of finding a new doctor has upset many longtime patients including Lewes-area resident Joseph Haney.

“I never thought my doctor would up and turn away his patients for an $1,800 fee,” said Haney, 63. He and his wife have been patients at the practice for 20 years.

Together the couple would have to pay $3,600 a year on top of $12,000 in insurance premiums and copays in order to stay with their doctor. “I truly believe no doctor is worth that kind of money,” Haney said.

Mid-Atlantic doctors Jeffrey Heckert, Mark Sordi, Gregory Bahtiarian and Erin Lavin are reducing the number of patients they serve as they transition into an MDVIP-affiliated practice.

Bahtiarian said joining with MDVIP will allow him to practice medicine they way he always envisioned, with a focus on wellness and prevention in addition to diagnosis and treatment.

“The MDVIP model, especially its Annual Wellness Program which the membership fee covers, enables me and my patients to dive much deeper into all aspects of their health and better identify risk for cardiovascular disease, diabetes, depression and other conditions. We’ll partner to create a wellness plan throughout the year that will help them avoid illness and reach their healthcare goals. Research shows that patients in this model are less likely to end up in the hospital or the ER, which is one of my primary goals as a physician,” Bahtiarian said.

Katherine Hauch, practice administrator for Mid-Atlantic, said the practice mailed about 7,000 letters to patients, and the signings are going very well. Each doctor will have no more than 600 patients, and once the maximum is met, she said, there will be a waiting list.

“While we are still early in the transition, the physicians are humbled by the positive response they’ve received. All four doctors are well on their way to filling their practices,” said Hauch, speaking on behalf of the practice. “It is important to note that our priority is to provide continuity of care for patients who choose not to join. We are bringing in an additional clinician to the practice starting in January and will be able to retain some patients within the group. We will also refer patients to other select primary care providers in the community, both hospital-based and in private practice.”

Haney said he and his wife have already found a new doctor, and they are in the process of setting up a new patient appointment. “We were concerned with a mad rush out of there because I have no idea how many people are in the practice,” he said.

The Millsboro office of Mid-Atlantic Family Practice notified patients in October that the office would be closed Dec. 1. Hauch said the practice has been impacted by COVID-19, like many small businesses in the community, and they have had to streamline operations.

Haney said he and his wife loved Mid-Atlantic because it was always so easy to make appointments or be seen by a doctor when they were sick. Now, he said, the practice has turned into a pay-to-play operation that will only benefit people who can afford it.

“To pay $3,600 to walk in his office every year, it just makes no sense whatsoever,” Haney said.

Concierge services

The transition is expected to be complete as early as the end of the year for some of the Mid-Atlantic doctors, said Bret Jorgensen, chief executive officer of Florida-based MDVIP. Carrying 600 patients is typical for MDVIP doctors, but those numbers can vary.

Opening in 2000, MDVIP celebrated its 20th anniversary this year, now operating in 44 states with 1,100 participating doctors.

While Jorgensen understands the annual fee can be an issue for some patients, he said the benefits far outweigh the costs, with smaller practices allowing for more personalized attention to patients.

“It's a model that works for the doctor and patient,” he said.

Patients receive a comprehensive annual exam for a proactive approach to medicine, which can reduce future medical costs because problems are caught early. This preventative approach reduces the high cost of hospitalized care by 70-80 percent, Jorgensen said, and for those who are admitted to a hospital, the readmission rate is also low.

“We manage care to keep patients out of high-price situations such as hospitals,” he said.

When additional medical care is needed, Jorgensen said, partnerships with Johns Hopkins Medicine, the Mayo Clinic, and the Cleveland Clinic – to name a few – can provide second opinions, specialized care, or expanded treatment.

Another benefit includes reciprocity with other healthcare systems for patients who travel or who may need medical care when away from home. Those with children ages 13-26 can also have them seen by a doctor under the plan at no additional cost, Jorgensen said.

Jorgensen said he was not sure whether Mid-Atlantic reached out to MDVIP first or vice versa. While acknowledging the Lewes area has a significant population of retirees, he said MDVIP does not seek out communities based on the residents’ age. “When we assess a market, we're assessing both the doctor and the market, and consumer interest,” he said.

Most MDVIP members range in age from 50 to 80 with nearly half on Medicare, Jorgensen said, but there are others that serve younger patients such as those under 40. He said he was unaware of young patients who may have sticker shock over the membership fee.

Jorgensen also said he is familiar with the recent trend toward lower reimbursements by Medicare for services, but that is not a factor in partnering with a doctor or medical practice. And because of the annual fee, he said, MDVIP tends to have no Medicaid patients.

Still, he said, patients run the full economic spectrum. “We focus on trying to make sure it is affordable, personalized healthcare, and even though it's an incremental cost and we're very aware that not everybody is willing or in many cases able to spend the money, those who prioritize their health are often willing to do it,” Jorgensen said.

In the end, he said, the COVID-19 pandemic may be having the biggest impact on the relationship patients want with their doctors.

“Clearly, people are much more actively interested in having a closer relationship with their doctor,” Jorgensen said.

Personalized plan

Eight years ago, Dr. Uday Jani, who runs Shore View Personalized Medical Care, went to a personalized service, similar to concierge, so that he could spend more time with his patients.

“I was the first one to go, the only one in Sussex and Kent counties,” Jani said.

Going from a practice of more than 2,000 patients to one with about 300 has made a huge difference in the amount of time he can spend with a patient. Treating the whole person instead of one particular problem, and taking the time he needs to improve a person's wellness is what he's after.

“I made the change, and I'm happy, and I wouldn't change it around at all,” he said.

With training in nutrition, and homeopathic and functional medicine, Jani said he tries to keep his patients off medications if possible.

“I wanted to mix it up for my patients, have medicines where needed, do mind and body work, change the diet, lose the weight so you don't need six pills,” he said.

Patients are also assured continuity of care instead of a piecemeal approach. In many practices, Jani said, a patient may see several doctors, then might end up at a walk-in clinic for treatment. His personalized approach focuses on the patient so there are no gaps, he said.

Jani charges a $1,750 annual fee for patients over 45 with a $400 reduction to $1,350 for patients under 45. He is not part of a group concierge service such as MDVIP, but with a phone call, he said, he can get his patients into top-notch healthcare facilities such as Johns Hopkins for treatment.

With the extra time his personalized service has allowed, Jani said, he can commit to a patient's health. He also has more energy from not seeing so many patients a day, giving him time to research, educate and manage his patients' health.

“It's about taking care of the patient,” he said.

Dr. Scott Hammer has the same mind-set. He began practicing medicine in Delaware after completing his internship and residency in North Carolina, and in 2006, he opened Southern Delaware Medical Group with a partner in Milford. The practice became an MDVIP affiliate in 2019.

“[I] evaluated the ability to get to those things that I went into primary care to do, beginning with connecting with people, preventive care, preventive medicine, and it looked like the right model for me and my patients as well,” he said.

Hammer said he was seeing 30 to 40 patients a day, and now it's more like eight to 10. “Much better as far as being able to spend the proper amount of time with people,” he said.

With a total of 600 patients, Hammer said, he is still putting in the same amount of hours but with greater focus on his patients. A wellness exam includes vision, hearing, mobility, heart health, sleep, weight management, and emotional well-being. An extensive lab panel and diagnostic tests focus on preventing heart disease, diabetes and other disorders.

Once the results are in, the doctor and patient go over them in detail, and develop a health plan moving forward. This includes prevention, nutritional plans, and exercise.

Hammer says he couldn't be happier with MDVIP.

“It's been a real blessing. It's meaningful care; it's personalized care,” he said. “With the pandemic, people are valuing that relationship knowing that whenever they call or email, there is someone to answer their concerns.”

That's exactly what Dottie Burke was looking for.

“This is how medicine was practiced when I was growing up in the 1950s,” the 74-year-old said. “I like the fact that if I need anything, I can send him a text or an email and get a response immediately.”

The Milford resident said she was the first one to sign up with Hammer when the practice became MDVIP affiliated. Keeping the primary care physician whom she knew and trusted far outweighed the annual $1,800 membership, she said.

“I have peace of mind knowing he's my physician,” she said. “It is top-notch healthcare. I think this is the way of medicine in the future.”