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Monday, December 10, 2012

New Trend In Health Insurance: Low-Cost Concierge Medicine

In an era of rising healthcare costs, 87-year-old Dr. Russell Dohner from Illinois only charges patients $5 per office visit and doesn't take insurance saying it isn't worth the bother. (AP /Jeff Roberson)

In an era of rising healthcare costs, 87-year-old Dr. Russell Dohner from Illinois only charges patients $5 per office visit and doesn’t take insurance saying it isn’t worth the bother. (AP/Jeff Roberson)

A recent survey of physicians by the consulting firm Accenture found that one in three independent doctors is thinking about no longer accepting health insurance and going into what’s been called concierge care, where they cap the number of patients they see, and patients –who pay them as much as $30,000 a year– get to see the doctor whenever they want.

But Bloomberg Businessweek reports that a new trend is emerging: low-cost concierge care, such as Atlas MD, a family practice in Wichita, Kansas, which charges most of its adult patients just $50 dollars a month for unlimited visits, free medical tests, house calls… you even get the doctor’s cell phone number.

“It makes it very nice,” says co-founder Dr. Doug Nunamaker, “because now I don’t have to bill and code and satisfy an insurance company for reimbursement.”

‘Patient Factories’

Atlas MD, according to Dr. Nunamaker, has two physicians  and one nurse. A neighboring clinic in Witchita has six physicians and 62 employees. Dr. Nunamaker does limit his patient load to 500-600 people, and critics say doctors who do that can select the healthiest patients to keep costs down.

“All of that,” says Dr. Nunamaker when talking about high employee-to-physician clinics, “is to help move patients through, it’s a patient factory.  So you have people to sign patients in, to take them back to the room, to take them back out, the administrative staff, the billers and coders.”

Nunamaker says his tiny staff of three people share a lot of the day-to-day responsibilities: from answering the phones to taking vitals to wiping down the counters. Nunamaker says he’s able to pass these savings on to patients.

Health Insurance As Car Insurance?

But Dr. Nunamaker says most of his patients have insurance, but about 30 percent of their patients are uninsured and otherwise would struggle to see a doctor. He says people should start thinking about health insurance like car insurance, where the patient pays the doctor for “routine maintenance.”

“Your car insurance pays for a car wreck,” says Nunamaker. “It does not pay for gas, or oil, or tires or car washes. But we’re expecting health insurance to pay for surgeries, and cancers, and heart attacks, and medicines, and office visits –all of those things. Well of courses it’s expensive.”

Dr. Nunamaker advises his patients to switch to a high deductible plan. This saves his patients money every month when they come to him for “the sniffles” and broken arms, but they’re covered in case of a serious illness or accident.

Guests:

  • Dr. Doug Nunamaker, co-founder of Atlas MD
  • Devin Leonard, Bloomberg Businessweek reporter

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  • http://www.facebook.com/profile.php?id=100003000884786 Navin R Johnson

    This is an interesting business model.

    • My Toe Hurts…

       I wish they had that here. My local Doc charges me $76 for a nice visit, but I wish he would subscribe to this type of service

  • Cheryl

    What do you think insurance companies will do if the cost of medical care drops too much? I don’t think they would be happy if their profits drop due to losing large numbers of customers dropping their expensive policies.

    • Dr. Doug

      Interestingly, the overhead is less for patients using a high deductible plan matched with a concierge doctor.  We had an entire company of about 50 here in Wichita that went an entire year without filing a single claim.  We saw them in the office fairly often, but the insurance had no overhead on claims since there weren’t any.

      • Cheryl

        Are you saying that if the people with low deducttible plans that cover everything, switch to high deductible policies, that their profits will not drop enough to cause them to use their lobbying clout to legislate the concierge practices out of business or at least force them to charge lots more through regulatory fees.

        • Dr. Doug

          That’s what I’m saying.  Interestingly, trying to prove that to the insurance companies has proved difficult.  We have shown them the data we have locally about increasing profits through high deductible plans but they are just as stuck in the mindset that the Cadillac plans are the only way they will make money.  If you drop overhead expenses, you will increase profitability.  What they choose to do in Washington is another story.  I can’t ever seem to predict what politicians have in mind.

          • Cheryl

            Thank you so much for all the information. I know that as things exist today, we cannot just just do away with insurance companies as we know them. Your plan looks like one that has a huge amount of potential in solving the problems of the uninsured as well as emergency room visits and more that plague our health care. I wish you the best in furthering these ideas. And I will be discussing this with my friends and family. I live in Lincoln County Montana. We are 75% national forest and a lot of self employed. Very few have insurance. We have great medical facilities, but most people don’t go until they’re very, very sick. You know what happens next. I want to see a positive change in this country regarding health care. I do not want to see any more bankruptcies due to medical costs. Thanks again for your work.

          • Dr. Doug

            Hopefully, with enough time and interest, we can spread our model and our passion for returning primary care to what it should be.  These are tough times and we need to make tough decisions about where we want the healthcare of our country to go.  I can assure you though, as a physician, I will do everything in my power to keep our vision for family medicine on the right track.

  • Mike

    Why is health care expensive?  Just the very presence of insurance companies in the health care “industry” causes costs to rise.  And Low-Cost Concierge Medicine is evidence of that.

     Medicine could be reasonable priced (like it was when I was growing up, when we paid the doctor directly), if insurance bureaucracies weren’t red-taping-up the works. 

    The only problem I have with “ObamaCare” is that it keeps insurance companies in the health care business.   We should have kept the Government Option– that might have encouraged insurance companies out of the business.

    • Dr. Doug

      We couldn’t agree more.  We have discounts on medications and labs that are up to 95% off.  We intend to save people more on their meds, labs and insurance than it costs to be a member with us and in fact, we’ve done that with many patients.  All it takes is a little ingenuity and some gentle shrugging (shameless Ayn Rand reference).

  • Zach H.

    As a young man entering medical school next fall, I think this is a very productive way of bringing pre-medical and medical students into the family medicine specialty. Most student are moving away from primary care due to changes in reimbursement for services, ultimately leading to a less lucrative career. With this model of healthcare, not only do physicians get more time with their patients, but they also have the ability to make salaries that are more comparable to other specialties.

    • Dr. Doug

      You’re exactly right Zach.  Dr. Josh and I started this practice with that very thought in mind.  Physicians, when faced with the prospect of high income specialties or high volume clinics, will choose to sub-specialize for the income and lifestyle.  This leaves more and more without PCP’s.  We hope to show that as a family physician, or internal medicine physician, you can still enjoy having a clinic and getting to know your patients.  This is what primary care used to be and can be once again.  If you have more questions, give us a call.  We love talking with medical students about our model.  www.atlas.md  

  • jryan1

    Just discovered One Medical Group, which seems like a nice hybrid.  $200 annual membership gets you a same day visit with your doctor, longer  visits, no waiting, access to medical records and a spa-like office.  And they accept all health insurance!  They have offices across the country and just opened in Boston.

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      Unfortunately, their model is the extra fee in addition to your insurance costs.  So it does little to answer the problem of unaffordable insurance or health care costs.  Also, their costs are quite high if you don’t have insurance. 

  • Eyelton

    I want my money to go directly to healthcare. I don’t want to fund the insurance industry. Insurance companies are profiting off “pimping” out healthcare services to us. If our healthcare payments were not diverted through a profit-driven insurance industry, more money would be available for healthcare, we (the consumer) could see the real cost of healthcare and hospitals/doctors would compete in a way that would be meaningful and more visible.

  • Tncaneoguy

    Down with insurance companies!  Seriously.  

  • Rickw61

    The often quoted “average salary” for a primary care physician is misleading.  Many physicians are part of a practice that pays them a salary, but then they receive a portion of the profits from that practice which can be 2 to 3 times the actual “salary”.   This is never reported as income for the doctor and is a secret the physician community does not want to disclose. 

    • Dr. Doug

      I suggest you try reading this.

      http://online.wsj.com/article/SB10001424052970204603004577271340816194320.html

      Many primary care physicians out there even pull from their own bank account just to make payroll.  The clinic in the article above just barely made enough money to stay in the black and that’s WITH over $300,000 in government stipends and grants.  

    • http://www.facebook.com/profile.php?id=100003000884786 Navin R Johnson

       Very few physicians nowadays are in this type of situation.  There is nothing secret about it, it is just very rare. 

    • doctorfurl

      I’m a family practice physician, worked for 15 years, and I have never even heard of the situation you describe.  There is no “secret”, no extra income, and often it costs us out of pocket to run a clinic during “lean” months.  You are entirely misinformed.

  • My Toe Hurts…

    One Medical is is San Francisco area…  Shame.  Maybe I should move there

  • Dianne

    You completely did not mention the positive impact that nurse practitioners and physician assistants are having on access to primary care. For shame.

    • Dr. Doug

      No offense intended.  NP’s and PA’s absolutely have a role in the access to primary care.  Thee problem is that there really isn’t a shortage of mid-level providers but we are currently facing a worsening shortage of primary care physicians.  If we can’t fix that, there won’t be anywhere for MLP’s to practice.  Most people, though, don’t realize the difference in training.  It just takes a lot longer to train physicians and if we burn them out of primary care faster than we can make them….everyone will suffer.

    • http://www.facebook.com/profile.php?id=100003000884786 Navin R Johnson

       NP’s and PA’s are the primary reason you are seeing fewer doctors in the rural areas.  This trend will continue.  Pretty soon, there won’t be any physicians practicing in rural areas.

  • Jnkmccolgan

    Where can I sign up? both as a practitioner and a patient.  As a board ceritified family nurse practitioner, I burnt out and got out due to the pressure to see more patients in a shorter period of time, it wasn’t worth it anymore, yet I still yearn to use my skills to help others, and would love to work in an office utilizing this care paradigm. And as someone who pays $1200 a month for health insurance and can’t get into see my very overworked family physician, I would love it if he would switch to this model, he wants to provide good care, but the system increasingly ties his hands.
    It is time to bring compassionate care, and healing back to health care, and this is a great start.
    Nora in Oklahoma City..

    • Iselda2011

      Two months after being hired, I quit my first nursing job working at a non-profit clinic serving low-income patients when it soon became apparent that it was nothing more than a “Medicaid mill,” with overpaid executives and lots of lip service about being a “patient-centered” facility. As you probably know, The Affordable Care Act has set aside funds for nurse-led health centers. Perhaps you should consider opening your own clinic that is based on principles proposed by the New Economics Foundation (see  The New York Times’ article by Tim Jackson(http://www.nytimes.com/2012/05/27/opinion/sunday/lets-be-less-productive.html?_r=0).

    • Aaron

      @Jnkmccolgan — Start your own practice! People need you, and the market needs your business to keep the tide rolling on this trend!
      If I were a wealthy venture capitalist, I’d fund you as well as starting my own line of this kind of doctors offices.

  • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

    Thank you all for the interest and questions.  We’ll continue to try to answer the questions as they come in.  Cheers.

    • http://www.facebook.com/profile.php?id=100003000884786 Navin R Johnson

       Hello Dr. Josh, I am also an FP physician considering this model.  How much did demand for office visits go up when you instituted this model?  I have previously worked in a social medicine system (military) and I found the number of office visits skyrockets with this type of model.  How do you keep the visits down?

      • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

        Hi Navin, please feel free to contact us directly for any questions.  But briefly, we’ve been open for about 27 months, nearly full (3 yrs ahead of schedule) and although we have busy days, i have 3 patients scheduled today…a monday…volume is manageable.  Also, the model depends on the doctor taking a lower # of patients, usually 400-600, but our low overhead actually means a higher take home for the physician.  Also, the seamless use of technology allows for many visits to take place by email etc quickly. 

      • http://pulse.yahoo.com/_DPKS3HUGQBPILPIU7IVZSHGXLI Robert_N

        I was wondering whether this would be an issue, particularly for the more popular/recommended offices. For those it might be better to charge a 10-20% lower monthly fee and then a per-visit fee up to an annual maximum. At least then patients actually get that feeling of paying a little something per-service, rather than the “all you can eat” mentality that can ultimately raise costs.

  • jryan1

    It’s also in Boston, NY, DC, and Chicago. http://www.onemedical.com/bos/doctors

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      True, but they are a different model and very expensive without insurance and without our added value.

  • http://pulse.yahoo.com/_DPKS3HUGQBPILPIU7IVZSHGXLI Robert_N

    Sounds like an interesting option, and I suppose it’d depend on one’s situation whether it made a lot of sense. Like how many times you typically visit a doctor. Here at least, someone not covered under an employer can get an individual high deductible plan (not cheap for some, but wise if they can afford it) with reasonable co-pays that aren’t subject to the deductible for 6 visits a year.

    Either way, it’s the treatment of complex and/or chronic conditions that can really hit people financially, since many plans have limitations/exclusions, and a annual maximum out of pocket substantially higher than the deductible.  So controlling costs overall still seems key, and ‘part’ of that might be keeping the model of ~20% coinsurance (or surcharge) for anything other than basic care and vital diagnostics.

    • Healthy Skies

      Helping people purchase health insurance of value is the #1 benefit of the Affordable Care Act (Obamacare) through subsidies for individuals/families and allowing small businesses to group together to negotiate better prices.

      And the ACA has already begun to prevent insurance companies from denying Americans coverage due to pre-existing conditions and will prevent them from being charged more. Not to mention removing both lifetime and annual spending limits. Insurance companies also can no longer drop you if you get sick or too expensive to keep alive. It also is requiring insurance companies to provide more coverage for preventive services without copay (wellness visits and many tests/screenings).

      Not to mention the rebates again, but insurance companies must spend at least 80% of premiums on actual health care services or else policy holders get a refund/rebate/money back. It’ll make sure policy holders are paying for care and not outrageous overhead.

  • mitspanner

    I’m in southeastern Wisconsin. I could go to Milwaukee, Madison, or Chicago for concierge care. Anybody know of any practices in my area?

  • Woodarla

    I guess that concierge providers won’t be accepting Medicaid or Medicare.  Who is going to see these patients if all providers turn to this model?

    • Dr. Doug

      That’s something for Congress to consider when they are looking at whether or not to pass the 26% CUT in medicare reimbursement to physicians in January.  I doubt there are many of you out there that would accept, without a fight, a cut in your salary of 26%.  I can’t feed my family with the money I would get from medicare, not to mention medicaid which pays even less.  It’s not about not wanting to care for these individuals.  It’s not a fault of physicians.  We make our living providing medical care.  If we don’t get paid enough to do that, then we need to come up with a solution.  Our model is one solution.  

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      Hello Woodarla, thanks for the comment.  Actually, we DO see medicaid and medicare patients, we just don’t have contracts with the gov’t for (insurance) payments.  Thus, any doctor practicing with this type of model could see these patient groups.   Also, we are able to offer a better value by saving patients and the system on on the cost of medicines, lab testing, procedures, copays etc… We are actually cheaper than the local gov’t financed safety clinics in town.  We don’t want anyone left behind either. 

  • Tracie O’brien

    I would definitely take advantage of a low-cost concierge care if it were offered in my area.  As a single mother working full time, I pay 50% of my health ins which is about $145 a month.  I have a $40 co-pay.   My insurance doesn’t cover my two teenage sons because I can’t afford it.  Only one of them is covered by a low cost care.  I’m tired of paying for “nothing” really.  

    • http://twitter.com/AtlasMD Dr. Josh, AtlasMD

      Hi Tracie, families like yours is exactly why we designed our model.  Healthcare isn’t expensive, red tape is what is so expensive.  Insurance for cars and houses is (more) affordable, b/c we rarely use it…like insurance was meant to be used.  With out of pocket expenses like you mentioned, we’d be able to SAVE you money each month and improve access.  

  • http://www.facebook.com/people/Ryan-Neuhofel/558505959 Ryan Neuhofel

    I’ve personally known Dr. Josh and Dr. Dough since med school and they are doing great work. I also recently started a low-cost “direct” (concierge) model (also in Kansas!) and think primary care without middlemen can, should and will be much cheaper in the near future. We charge a membership fee of $10 or $20 per month plus upfront, low prices for visits, etc. 
    - Dr. Neu

  • Mem

    I believe there was a major omission in the discussion of the
    “low-cost concierge” health plans.

    The idea conveyed by the report was that through such plans,
    which provide unlimited office visits for just $50 per month, patients could save
    on their regular medical insurance, by purchasing high-deductible (“catastrophic-only”)
    policies that theoretically do not cover office visits.

    One problem with this line of reasoning: at least some high-deductible policies
    already provide low-cost office visits. Mine, for example (with a $5,000
    deductible), throws in a set number of office visits per year at a $25 co-pay
    each. I have no reason to believe my plan is unique, so only a few people with such
    a policy would be motivated to purchase a “low-cost concierge”-style plan in
    addition—those people who for whatever reason require frequent
    office visits. All others would find no benefit for the additional monthly $50
    premium.

    • Dr. Doug

      The benefits are many, actually.  The main one is access to your physician.  My patients always see me with same day appointments, if desired, and the appointments are scheduled for no less than 30 minutes.  We also offer, as mentioned elsewhere, discounts on medications and lab work.  All procedures in the office are included.  On top of all of this, you can call, text, e-mail, etc. your own physician 24/7.  We find that people are more than happy to pay the premium for the long-term savings on everything else.  We fully appreciate people that are happy with their current situation.  We don’t want to force anyone to be a member of our clinic against their will.  So far though, in just over 2 years, we are approaching close to 1000 very happy members.  

    • Mike

       Currently,  I pay $386/mo for a $2500 deductible policy that allows only 3  deductible -waived office visits/year (an office visit here is $300/20minutes).   A $10,000 deductible is $159/mo.    Another $50/mo would still be an improvement.

  • http://twitter.com/jiacits121 Jorge Ismael

    I strongly recommend to all of you to read “The healing of America: A global quest for better, cheaper, and fairer health care” by T. R. Reid. It is an excellent book.

    • Dr. Doug

      If you want to read something, read “Political Malpractice by Stanley Hupfeld”

  • http://www.facebook.com/pamela.wible Pamela Wible

    I have been practicing in a model similar to this. I held town hall meetings and allowed my patients and community to design their own “ideal” medical clinic. Now I work for them. My job description has been written by patients, not administrators. AND no extra fees. I roll outthe red carpet for everyone. It’s VIP without the fee!

    Pamela Wible MD
    Ideal Medical Care – Home

  • http://www.facebook.com/profile.php?id=1412715500 Ed Sodaro

    There appears to be a huge lack of doctors willing to be bullied by moronic thug totalitarian bureaucrats and other democrats.

  • PA-C

    Good for you for finding a way to beat the system. I retired early after 25 years as a midlevel because I couldn’t take all the insurance paperwork/prior authorizations/formularies/coding questions etc that interfered constantly with my ability to provide good care….I do think you are misinformed if you believe midlevels mainly handle sick visits. Most of us had many long-term/complicated patients who preferred that we manage them because we DID spend more than “7 minutes”….but the system does punish us for not seeing “enough” people…..
    Best of luck to you and your fellow MD. Hope it works out….

  • Ross

    We live in Springfield, MO and do not have medical insurance, as it is WAY too expensive for the self-employed. We found a great Dr. that does not accept insurance and handles acute care only. He charges $40 per visit (no monthly fees) and it works out great for our two parent/two child family. He employs one nurse and one office person, is very easy to get an appointment with, yet has a profitable, no-hassle business.BTW, he treats many seniors even though he doesn’t bother with Medicare. We have an HSA (Health Savings Account) that is ideal for us, however, the Affordable Care Act will wipe that benefit out next year. We need more doctors to open up non-affiliated (with hospitals or insurance companies) practices to wean our society off of the government and/or insurance industry.

  • karen

    is there any doctors in michigan under this? We want to sign up!!

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