"I'm in the office seeing patients about 10% to 20% of the time, and the rest of the time I see patients in their homes," says Dr. Schleider, a board-certified family practice physician who is based in Manhattan.
With black bag in hand, Schleider is a throwback to an era when physicians had time to get to know their clients personally and patients didn't feel rushed through their appointments.But this doctor delivers tradition with a modern twist, for along with the classic bag, he arrives at his patients' homes armed with the latest medications and equipment, including portable X-ray and EKG machines and a laptop he uses to view radiology films. Dr. Schleider takes customer service to an even higher level by encouraging his patients to contact him directly, 24/7, for routine and emergency care. "I treat my patients like family. They have my cell phone number and can call me anytime," he says. Dr. Schleider is among a growing number of physicians who are turning to concierge, or boutique, medicine as a way of improving the health care experience for both their patients and themselves. "I wanted to not see 50 patients a day, be happy as a physician and make a good living, so I opted for a boutique practice," he explains.
First-Class AidThe concierge movement, which has emerged in the past decade, aims to provide quality primary and preventive health care through the establishment of a direct financial relationship between the physician and the patient. In this system, patients pay an out-of-pocket monthly or annual fee to the doctor and become "members" of the practice -- and depending on the provider, additional charges for procedures or tests, or even coverage under a traditional insurance plan, may be required. In exchange, concierge physicians promise to deliver high-quality medical care and a level of personal service virtually impossible to find in most health care settings today. There are various concierge practice models. Dr. Schleider's practice,
A Weakened SystemIn the eyes of many physicians and patients, the traditional health care model, as exemplified by Medicare and health insurers such as UnitedHealth, is broken. To control their costs and stay competitive, for-profit health insurance companies continue to lower physician fees while raising the price of individuals' premiums. The Medicare picture looks equally bleak -- the federal government is expected to reduce Medicare reimbursement to physicians by nearly 5% as of January 2007 as part of a series of cuts that could total 37% over the next 9 years. And to offset costs of the increase in Part B spending, Medicare beneficiaries' monthly premiums are expected to rise at least 11%. Ultimately, these costs and other factors all contribute to a significant decline in both physician and patient satisfaction. To keep their practices viable, physicians today must see many more patients than in the past, and this increased quantity impacts quality of care -- often allowing doctors to only address a specific condition vs. a patient's overall wellness. Internist Garrison Bliss, MD, is board chairman of the
Priceless ServiceJames 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,
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