The Doctor Is In

And despite its nonconformist approach, the concierge philosophy may be gaining support from the established medical community.

In a 2006 policy statement, the American College of Physicians describes the nation's current physician payment system as "dysfunctional" because it rewards quantity rather than quality and undervalues primary and preventive care.

The organization, which is the nation's largest medical-specialty society, is advocating for changes in the way primary care is delivered and financed.

Among the ACP's proposals is the creation of a revised national reimbursement system for doctors that supports development of the "advanced medical home," a model of patient care that provides more personal attention to patients and some of the financial benefits to physicians that the concierge model of care offers.

By revamping reimbursement, access to quality primary and preventive medicine could be more widely available, not just to those patients who can afford to pay an additional annual fee.

"There are 40 million people with very little access to primary care in this country, so concierge medicine is not an ideal solution for the entire nation," says Lynne Kirk, MD, president of the ACP. "In our advanced medical home model, the patient has a physician practice that provides traditional care and helps coordinate care with other providers. This model is especially helpful in managing chronic diseases."

The ACP maintains that the advanced medical home will revitalize the patient-physician relationship, enhance coordination of care across the health care system and lead to macro system changes.

Priceless Service

James and Amy Rabenstine of Pittsburgh, Pa., believe the concierge fee they pay pediatrician Dr. Scott Serbin is money well spent.

When their daughter Olivia was born in May, everything appeared normal, until mom and baby were discharged from the hospital. It was a Saturday afternoon, and within a few hours the Rabenstines knew something wasn't right. "She didn't hold her food well," James Rabenstine says. "We called Dr. Serbin, and from then on he kept in constant contact."

Olivia's condition worsened, and when Dr. Serbin called early Sunday for an update, he decided to make a house call. "He walked in with his black bag and a scale, examined her and felt she needed to go to the hospital," James Rabenstine recalls.

Dr. Serbin called Children's Hospital of Pittsburgh to alert them of the infant's impending arrival. After conducting tests, physicians there determined that Olivia had intestinal malrotation, a birth defect involving a malformation of the intestinal tract. Emergency surgery was performed, and today Olivia is in good health.

"With a more traditional doctor, we never would have gotten an appointment on Saturday or Sunday," says Rabenstine. "Dr. Serbin is like a hometown doctor or dentist. We can always call him, and he'll be there."

Dr. Serbin's office, Pinnacle Pediatrics, is the country's first concierge pediatrics practice. He converted to a concierge model last year after 20 years in a more traditional setting.

	Say 'Can Ah Afford This?'

"I became disenchanted," Serbin explains. "Pediatrics is extremely high-volume work, and it is fast-paced. I wanted to do better and enjoy myself again."

He was exploring his options when he saw an article about concierge medicine in the New England Journal of Medicine. "It sounded like Nirvana," he says. He spoke to established concierge physicians and attended conferences sponsored by the SIMPD. "What struck me was how many different approaches to concierge care exist, yet the common goal is [always] to offer greater care."

Before converting his practice Dr. Serbin had 2,500 patients; now he has 250. His patients' parents sign a membership agreement in which he promises to deliver amenities like house calls, immediate appointments, no waiting-room time (he schedules a full hour for each patient) and called-in prescriptions.

"The time I can spend allows me to practice preventive medicine," Dr. Serbin says. "My goal is to have the healthiest practice in the country."

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