Concierge medicine takes off

Reno physician Bryan Young's business plan projected that a concierge medicine program might enroll as many as 400 members within its first two years.

Two years? Try two weeks.

Branded as "Premier Care" by Renown Medical Group, the closely watched concierge medicine program has been so successful that a second physician, family practitioner Quinn Pauly, M.D., has come on board.

And within a couple of weeks of his arrival, Pauly had 80 patients who were enrolled in the concierge program.

Patients enrolled in Premier Care pay a monthly fee $55 a month for people aged 55 or older, $35 a month for those under 55 that provides premium services such as quick responses to e-mail questions, longer office visits and shorter waiting times.

Along with the monthly fees, patients or their health-insurance providers pay the normal costs of office visits or other services.

Essentially, Young says, Premier Care members are paying for improved access to their physician. Pauly and Young take calls from patients 24 hours, seven days a week Young took a satellite phone with him while camped in a remote area and pay close attention to their e-mails.

Patients rarely wait more than a few minutes to see a Young or Pauly, and their visits typically last twice as long as those with most physicians.

That's a level of access that's simply not possible in a traditional medical practice, in which doctors often have more than 2,000 patients and average about 400 office visits a month

"To over service, you have to limit the practice size," says Young.

Beginning about a year ago, he began working his internal medicine patients he had about 2,300 at the time to make the transition to other providers if they didn't want to enroll in Premier Care.

"There is a certain amount of angst involved with cutting your practice from 2,300 patients to 500 patients," Young acknowledges.

Financially, the transition is approximately a wash, he says, as the monthly fees paid by Premier Care members make up for the reduced number of office visits.

But Pauly and Young say they find deeper personal satisfaction working more closely with a smaller group of patients whom they know well.

For instance, Young says he now can take the time to visit patients in the hospital, rather than turning their care over to a specialized hospitalist.

"If my patients are sick, I want to see my patients," he says.

One patient who encountered medical problems while traveling in Europe communicated via e-mail with Young, and the physician felt comfortable with the process because he is well-acquainted with the patient's history.

"We serve as doctors," Pauly says. "We want to be active participants in their healthcare."

The addition of Pauly and his family practice to the Premier Care model will begin addressing questions about whether families are willing to devote a portion of their monthly budget to a concierge fee.

Internal medicine, the specialty in which Young launched Premier Care, generally draws older patients.

Launched in Seattle in 1996, concierge medicine nationwide today ranges from the membership model developed by Renown Medical Group to expensive $20,000-a-year retainers in which physicians make house calls at offices and vacation homes.