🔒Concierge medicine grows in CT as healthcare landscape shifts

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Dr. Fausto Petruzziello has been a primary care physician for more than two decades. But over the last several years he saw big changes in the way he was practicing medicine — and not for the better.

He was spending less time with patients and more time on the phone or in front of his computer, filling out paperwork, keeping tabs on federal requirements and wrangling with insurance companies over coverage.

Three years ago, he added staff to free up his schedule so he could focus on high-need patients, but still he wasn't happy.

“It got to the point where it really became unsustainable,” said the Hamden physician. “Not just because of the financials — that's probably the last aspect — but because of the results and the level of service that I could give.”

So last fall, after months of research, he decided to take a leap. He culled his list of patients, which was once as high as 4,000, down to 180 and opened CareMEDICA Elite, joining a growing number of doctors around the country who have switched to a “concierge” or “retainer-based” practice.

The business model typically offers patients longer appointment times, round-the-clock access and other amenities in exchange for an annual fee, typically between $1,000 and $5,000.

Concierge medicine has been around for more than a decade, but has become more popular in recent years as changes in the healthcare landscape — including shrinking physician reimbursements and increased reporting requirements — have led to burgeoning caseloads, shorter appointments, longer patient wait times and a high rate of physician burnout, industry officials say.

Tom Blue, chief strategy officer for the American Academy of Private Physicians, said there are roughly 6,500 concierge doctors practicing in the U.S., a figure that has been growing at a rate of 25 percent a year. Figures for Connecticut were not available, but several physicians agreed the number is growing in the Nutmeg State as well.

“I think the reason is people are looking for more hassle-free care,” said Denis Lafreniere, medical director for the UConn Medical Group and associate dean of clinical affairs at the UConn Medical School. “Providers are very much not satisfied with the current situation, and patients aren't either.”

There are a number of concierge practices across Connecticut ranging from solo shops to franchises such as Concierge Choice and MDVIP. Among the latest are Petruzziello's practice, which opened in Hamden in October, and Concierge Physicians of Westport, scheduled to open in July.

While some think of it as health care for the well-to-do, Blue said many of today's concierge practices have much broader appeal. He said the fastest-growing category of concierge medicine is priced under $100 a month and is geared toward working-age people looking for better preventative and holistic medical care. With the rise of high-deductible health plans, he said, patients want doctors who will do more than prescribe expensive pills.

“That's just a model of care that requires a little more time than insurance reimbursements are compensating for,” Blue explained.

He said concierge membership also appeals to busy professionals who don't want to spend their work day in a crowded waiting room, as well as older adults with high medical needs who make frequent trips to the doctor's office.

Petruzziello, who prefers the term “executive health and lifestyle practice,” charges patients an annual fee of $1,800 for a basic membership, $2,800 for gold membership and $4,800 for platinum. The fee covers services not eligible for insurance reimbursement, such as 24-hour access to the doctor and longer appointment times — half an hour for a sick visit and up to two hours for a “lifestyle evaluation and physical.”

Patients also get extras like health coaching, nutrition and genetic counseling, fitness assessment and training, advanced body composition imaging, a daily supply of vitamins and even discounts at local restaurants and businesses, which are based on membership level. Patients continue to bill their insurance companies for any office visits, lab tests and medical procedures.

Armen Abrahamian, 61, a long-term care planning and insurance agent from North Haven, said being able to spend time with Petruzziello to discuss his health goals without feeling rushed is well worth the additional fee.

“I would almost consider it VIP service,” said Abrahamian. “Making an appointment is never an issue. I've been to their office probably six or seven times and I think the longest wait I ever had was 10 minutes.”

Dr. Paul Guardino said he was among the first to practice concierge medicine in Connecticut, building Personal Care Physicians in Farmington from scratch in 2005 with Dr. Thomas O'Connor, who has since opened his own concierge practice in Bloomfield, specializing in internal medicine and men's health.

Guardino said when he began, few people in Connecticut had heard of concierge medicine and there were only between 200 and 250 such practices in the U.S. Today he runs a successful practice (he recently added a new physician), charging an annual fee of $2,750 in addition to insurance. The fee covers 24-hour access via email, text and cell phone, extended visits and same-day appointments, if necessary. He also does house calls for homebound patients.

With only 300 patients, Guardino said he really gets to know them, and can “put a lot of time into making sure that risk factors for future problems are perfectly managed.”

He said that's something all good doctors strive to do, “but sometimes the system doesn't allow for it. With five to seven minutes for an office visit, it's pretty tight.”

O'Connor's fee ranges from $1,500 for a cardio-metabolic disease evaluation and executive physical to $4,995 for full concierge access, in addition to a patient's regular copays and deductibles. He describes himself as a medical manager, offering a coordination of care he said is lacking when patients rely on walk-in clinics for their medical needs.

“Those physicians, they have to see up to 40 patients per day. I see six patients per day,” said O'Connor. “I'm a board-certified physician. There are no nurses here. When people call, I call them back. When they need to get seen, they are seen.”

Concierge physicians say a big advantage is being able treat common ailments over the phone or Skype, which insurance companies typically don't reimburse. O'Connor told of a patient who texted him a photo of an obvious case of severe poison ivy, saying he had mountain biked into a patch of the poisonous plant. O'Connor was able to call in a prescription for prednisone.

“He's not missing his morning. He's working right down the road,” he said. “Why would I drag him in?”

While it seems like a win-win for doctors and patients, some say concierge medicine is not a cure-all for primary care's ills. “The downside is if you (as a patient) can't afford to play this game, where do you go?” asked UConn's Lafreniere.

O'Connor said he has taken pro bono cases for people who can't afford the fee. But ultimately, he said, concierge medicine is about giving patients alternatives. He said it is no different than people choosing between public and private schools, and added that his monthly fee costs about the same as a night out at a nice restaurant.

“We're not taking care of the rich VIP elite (with fees up to $25,000). That's New York, that's LA, that's Boca (Raton, Fla.),” said O'Connor. “My patients work hard, they make money, they do well and they don't want to have a heart attack and talk to a nurse.”

From a personal standpoint, he said he couldn't imagine practicing any other way. “I feel very satisfied,” he said. “I'm working on projects, I'm calling people back, I'm educating myself, I'm reading. I'm also not stressed. I love my job.”