24-hour 'concierge' medical care for sale
Growing trend lets patients pay for custom services
Growing trend lets patients pay for custom services
The Post and Courier
Dr. Dave Albenberg gives a physical exam to Glennis Anderson, a patient whose family has been with Dr. Albenberg since before he opened Access Healthcare in 2003. Dr. Albenberg practices concierge medicine.
The Post and Courier
Glennis Anderson (left) talks with Dr. Dave Albenberg at Access Healthcare. Dr. Albenberg practices what is known as "concierge" medicine.
A year ago, Leah Kannensohn, 23, awoke before dawn covered in sweat. Her chest constricted and her arms fell numb. The pain radiated up to her jaw.
The College of Charleston student looked up her symptoms on the Internet. "This is ridiculous," Kannensohn thought as she read the classic description of a heart attack.
She called Dr. Dave Albenberg's cell phone, and he met her at 5:30 a.m. at his Calhoun Street office. He gave her an electrocardiogram and a dose of nitroglycerine and drew vials of blood for testing.
Albenberg provides what's known as concierge, or retail, medicine. He offers round-the-clock accessibility for a monthly fee, ranging from $100 to $200, depending on the services included. He does not accept insurance, but patients may file with their providers for reimbursement.
Kannensohn was right. She suffered a heart attack and was hospitalized later that day.
A patient of Albenberg's for three years, she mused, "How would it have played out with no Dr. Dave? I wonder if I would have done something about it."
Albenberg hung out his shingle in 2003. "I knew I wanted to be outside the insurance model, and it morphed into this," he said.
Now, about half a dozen local
doctors have opened iterations of the concierge concept.
Although there is no single business model — some charge annual retainers, others by the service — the desire to leave the crushing pressure of primary practice seems universal among defectors. Traditionally, reimbursement is based on quantity, pushing primary care doctors to see up to 30 patients a day.
In a 2006 article in The New England Journal of Medicine, the American College of Physicians warned that "primary care, the backbone of the nation's health care system, is at grave risk of collapse."
Medical students see the suffering of family doctors and choose other paths. Between 1997 and 2005, the number of graduates who entered residencies in family practice dropped 50 percent, according to the article.
Critics of retail medicine call it "wealthcare," and say it removes doctors from thousands of patients to serve only a few hundred.
"It exacerbates the problem, taking out doctors and have them focus on a population that gets, if anything, over-serviced by the medical community," said David Barton Smith, a professor in the Department of Risk, Insurance and Healthcare Management at Temple University.
Albenberg is unapologetic about the argument that doctors are obligated to care for patients regardless of their ability to pay. He can even foresee raising his retainer fee if that's what it takes to keep his patient load low and his attention to individuals high.
"It's a free market. I'm comfortable with my price, patients are happy, and I'm getting the salary I want," he said.
Concierge medicine is riding the swell of consumer-driven health care, Albenberg said. With the rise of plans such as health savings accounts, in which people put away pre-tax dollars to pay for health care, retail doctors are positioning themselves to reap the system.
Opponents of retail medicine sympathize with the plight of primary care physicians. "They basically want to practice good medicine and spend time with their patients," Smith said. "It's more a symptom of the problem we're having with health care than a solution."
And as that system continues its tailspin, more uninsured patients might find retail medicine their last stop before falling through the cracks. Although the movement began for the super-wealthy, with some doctors charging annual fees of $20,000, now blue-collar workers are seeking fee-for-service physicians.
Dr. Cayce Tangeman of Advantage Primary Care in Mount Pleasant has a hybrid of the retainer model and the pay-as-you-go model. Up to 40 percent of her patients are uninsured, she said. Most of those without coverage are fee-for-service, but some are retainer, she said.
"All of these people are hard-working, earn an hourly wage and have no benefits through an employer," she said. She encourages them all to at least get high-deductible catastrophic coverage.
Kannensohn might soon join the ranks of the uninsured. After spending five days in the hospital with a heart catheter, she was diagnosed with a blood disorder that predisposes her to clots.
With her insurance set to expire in a year, and as an employee of a small-grant consulting company, she must get an individual policy.
To date, several providers have refused to cover her because of her condition. What was once a luxury might become a necessity.
Albenberg said half of his patients have no insurance or a high deductible.
But Kannensohn knows she's lucky. She can afford it.
"It makes me feel really guilty because my parents are nice enough to (help) me. But others can't. It's ludicrous."
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.
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Comments
proud2bme (anonymous) says...
I knew this was going to start happening. Doctors are finally saying, enough is enough. Good for them, bad for us. This just goes to show how badly our healthcare is in need of reform.
September 10, 2007 at 5:29 a.m. ( permalink | suggest removal )
drfrank (anonymous) says...
Please be aware that your representation of Dr Aldenburg as available, all caring and knowing was not the case in January of this year when my wife was a a patient of his. I reported via phone call after hrs(part of his telephone consultation service that she had some severe bleeding.) She was pregnant approximately 8 wks.Dr Aldenburg confirmed w/out seeing my wife that she had probably had a miscarriage & To call him if symptoms worsened. Well the standard of care should have been an ultrasound & blood test because there was no miscarriage! For 4 weeks we believed his knee jerk diagnosis until we saw another doctor who confirmed that my wife's was indeed still with child Thankfully we received proper care and have a beautiful baby girl. I believe the approach he is using is just an alternative means of medical ripoff !
September 10, 2007 at 6:38 a.m. ( permalink | suggest removal )
proud2bme (anonymous) says...
drfrank,
thank goodness your wife and child are fine. I hope you sent letters to the proper board as well as to the MD. This is exactly the sort of thing we can count on seeing in the future if changes are not made.
September 10, 2007 at 8:24 a.m. ( permalink | suggest removal )
MsBehavin (anonymous) says...
drfrank, your wife waited 4 weeks before seeing a doctor after being told via phone consultation that she had a miscarriage? That seems odd, but maybe there were extenuating circumstances.
September 10, 2007 at 11:21 a.m. ( permalink | suggest removal )
mac0cm4 (anonymous) says...
You get what you pay for, no?
September 10, 2007 at 12:26 p.m. ( permalink | suggest removal )
LH1230 (anonymous) says...
Why on earth did he not direct her to go to the nearest emergency room with her symptoms? Even a first year medical student knows the signs of a heart attack. That's an awfully big risk to take...
September 10, 2007 at 12:58 p.m. ( permalink | suggest removal )
crankyyankee (anonymous) says...
If the Dems have their way, working people will be picking up the tab for the free health care for all the SUV driving, $100 corn row headed, $75 nail job non-workers who refuse to work for a living but demand the Government take care of them. Then we'll all have Government provided health care just like the VA. Great idea!
September 10, 2007 at 12:59 p.m. ( permalink | suggest removal )
eaw429 (anonymous) says...
If the girl knew the classic symptoms of a heart attack, why didn't she go to the emergency room in the first place?
As for this doctor, my husband and I went to him several times before our new health insurance kicked in, and we both thought he was great. When I had to look for a doctor (again before our insurance kicked in) I found that there are so many doctors in this area that don't allow you to make an appointment at their office unless you have health insurance. I think Access Health is providing a great service without charging too much.
September 10, 2007 at 1:06 p.m. ( permalink | suggest removal )
LH1230 (anonymous) says...
I was suggesting that any physician who hears about that constellation of symptoms should inform an individual to seek emergency treatment immediately. Bringing her into his office to check her out and draw blood (the results of which can take over an hour to return- precious time wasted if her heart muscle was continuing to sustain damage) is negligent.
I have no problem with boutique medicine if one can afford it. Doctors nowadays have so many constraints placed upon them by HMOs and insurance companies that seeking out such an alternative mode of practice is a way to regain control of one's practice of medicine. I agree it is a privilege to those who can afford it (and why should they not? If they have invested in an education, worked hard and have the money to afford it, why stigmatize them?), but then again, it removes them from the pool of patients sitting in another doctor's waiting room, keeping you from being seen on time.
PS Crankyyankee, I adore your screen name (from one Yankee to another).
September 10, 2007 at 1:22 p.m. ( permalink | suggest removal )
crankyyankee (anonymous) says...
Thanks LH, I come by it honestly!
September 10, 2007 at 1:50 p.m. ( permalink | suggest removal )
drfrank (anonymous) says...
To Misbehaven there were no extenuating circumstances other than severe depression from believing we had lost our child. It may have been 2 or 3 weeks all I recall now is that she still felt pregnant and we trusted that the physician had made a correct and informed decision. I'm not a medical doctor. thank you, enough said. lesson learned get a second opinion if in doubt....
September 10, 2007 at 1:58 p.m. ( permalink | suggest removal )
juniemoon1957 (anonymous) says...
WHAT! SHE met him at his office and he did an EKG and drew blood for testing? And the nitroglycerin? And she was admitted later that day! What? No IV? No 02? No cardiac monitoring? No blood pressure monitoring? NO ASPRIN? NO IV NITROGLYCERIN? HOW MUCH LATER THAT DAY? Did he send her home? And then she went to the hospital? You got to be kidding me, right? No clot busters? No where near a heart cath? Patients that have all the "SIGNS and SYMPTOMS" of a heart attack should go to the nearest ER and fast. Don't drive yourself. Call someone else or call 911. "A patient of Albenberg's for three years, she mused, "How would it have played out with no Dr. Dave? I wonder if I would have done something about it." Honey, if you are having a heart attack, and hurt bad enough you would have done something about it. At 23, thats pretty young to have a heart attack and take that risk associated with it without being in a medical facility that can monitor you correctly and administer meds. If you have any idea how dangerous a "fresh" heart attack is, don't go this route. And I agree, for the most part, our health care system is in very bad need of reform. I do not think this is the way to do it. Just think, if Hilliary has her way, nurses will make $5.00 per hour. And then, who will you get to care for you at bedside and give you meds if you do have a heart attack? Adn if you have a a heart attack serious enough, only the most the most viable will get rehab, and of course the wealthy citizens. The working middle class? You'll suffer the most.
September 10, 2007 at 6:25 p.m. ( permalink | suggest removal )
SC_Wahoo (anonymous) says...
Its unfortunate that with the generosity of the Charleston Post & Courier this comment section has devolved to the level that it has with recent postings. I would like to contribute a relevant post with regard to this article and I feel compelled to respond to a posting I find troublesome.
I myself am a patient of David Allenberg's and have been for the past 4 years. I can say without hesitation that he is one of the finest generalist physicians I have ever seen. Those who have posted perviously should take note of this. He is a generalist, not an OBGYN, Child Birthing specialist or cardiologist.
The experience I have had with Dr. Allenberg, his staff and his referrals has been excellent, without exception. I frequently recommend him to my friends, colleagues and family members.
The service he provides is first rate, professional and greatly needed. Finally I have one physician who is watching all of my vitals and has an intimate understanding of my health. He coordinates with experts who are better equipped to assist me with specific health concerns and insures that my mediations are constantly at the correct level.
His office utilizes the latest technologies to insure fast, efficient, thorough and error-free tracking of my health.
Finally I am able to see a doctor who knows my health inside and out and who is able to provide me with advice when needed, referrals when necessary, guidance and constant monitoring. I am certainly receiving a larger benefit from the dollars I spend at his office than those on my health insurance.
Rather than sit in an over-crowded, Russian-esque hospital as little more than a number, I arrive at his light-filled warm, cozy office greeted by a friendly smile, someone who knows my name and a cup of freshly brewed coffee (or chilled, depending on the season).
Anyone who has a problem with Access HealthCare has a serious misunderstanding of their mission and position within the healthcare system. And, I have to say I would seriously question the judgement of anyone who would criticize Dr. Allenberg's performance. For myself, my friends, family and colleagues, the service has been top notch.
September 10, 2007 at 7:36 p.m. ( permalink | suggest removal )
justiceholmes (anonymous) says...
Dr. Dave is a wonderful and caring doctor. My 93 year old mother has thrived with his care. As to his patient care model it is also a wonderful addition to our health care system. Who would not want 24 hours access to a caring physician. I would recommend him and his services to anyone and everyone!
September 10, 2007 at 8:45 p.m. ( permalink | suggest removal )
proud2bme (anonymous) says...
SC_Wahoo,
"Those who have posted perviously should take note of this. He is a generalist, not an OBGYN, Child Birthing specialist or cardiologist."
All the more reason, this young lady, should have been instructed to seek medical attention in the ER ASAP.
If indeed, this is what happened, this lady and her unborn child are very fortunate to be alive.
September 10, 2007 at 10:05 p.m. ( permalink | suggest removal )
kath21445 (anonymous) says...
I worked with Dr. Dave and saw his frustration with the insurance companies dictating health care and his pro-active approach to health care (his office wall was lined with ashtrays from patients who quit smoking). He wants to be able to deliver good health care and I respect him for that.
September 10, 2007 at 10:07 p.m. ( permalink | suggest removal )
JP (anonymous) says...
Dr. Albenberg has achieved more in the past five years than many physicians will in their careers. And I don't mean that in terms of dollar signs. This dynamic physician has taken the initiative to make medicine work for him, his values, and (most importantly) his patients by bringing an innovative and successful medical practice to Charleston.
How many of you hate your job, but keep punching the clock everyday because you're scared of change? This guy consciously removed himself from a very busy (and successful) primary care practice across town to invent AHC. His decision to do so was seemingly driven by a rapidly deteriorating health payer system, but I suspect his real reason to invent AHC was to bring the fun back into his job - something you all wish you could do. He no longer works for the insurance company; rather, he works for the patient. Instead of pushing patients through the revolving door, now he has time to do things like perfectly customizing a treatment plan with the patient or discussing differential diagnoses with them. He made a leap of faith...one that involves quitting your day job and becoming a part of something really meaningful.
Dr. Albenberg has created a medical practice that is completely consumer/patient driven which is undoubtedly what our health care system ignores. He tirelessly and efficiently works evening and weekend hours ON TOP of a 60 hour work week. His service is top shelf, and his prices are reasonable. Some physicians tell you to bring $400 cash if you don't have insurance and want to be seen. Is his practice perfect? No. Is it a better alternative to the norm? Without a doubt.
Dr. Albenberg is an extremely competent physician, and I am sure Leah's acute presentation could have warranted an express ride to the ER, where she would have waited another 3 hours to see a doctor. She received prompt and proficient medical care by her very own physician in the wee hours of the morning. I dare you to call yours tomorrow morning at 5AM. Oh, that's right...you don't have his cell phone number.
September 11, 2007 at 1 a.m. ( permalink | suggest removal )
sclaires (anonymous) says...
I know that I cannot go to any doctor who does not accept Medicare assignment and my insurance as my income is too low to pay out anything for an office visit. Dr. Allenberg may be a competent physician, but there are two things he should have done and that is to send a patient with chest pain to the emergency room and a patient with vaginal bleeding also to the emergency room. Doctors in emergency rooms will call in specialists when needed but to have a patient with chest pain come into the office first is not the way to go. The same goes with a pregnant woman with bleeding. In both cases specialists are needed to confirm what is going on and to find out exactly what is.
I know that there have been three times when I have gone to the doctor with a high fever and severe pain and both times I have ended up in the hospital right then and there. Then there was one time when I was visiting in Atlanta and I ended up in the emergency room two days in a row. After the second time, I was promptly admitted to the hospital where I stayed for almost two weeks.
If a doctor can't realize that there are times when a patient needs to go immediately to the hospital instead of coming to the office, then I want nothing to do with them.
September 11, 2007 at 1:27 a.m. ( permalink | suggest removal )
eyfigueroa (anonymous) says...
crankyyankee: VA does have a government (taxpayer)sponsored healthcare system. but to compare it to medicaid or any other 'welfare' program is disingenous at best! VA was set up to help those who wore a uniform in service to this nation. Granted, the system has become overbrdened with beauracracy but I DARE you to tell a serviceman/woman who has been injured or maimed that going to VA is tantamount to accepting welfare.
Those same non-working folk out there with a SUV and an expensive manicure who line up for the dole are the ones you should direct your contempt.
Not those of us who have sacrificed health and limb for your freedoms and need to utilize the Veteran's Adminstration's Health Care System.
September 11, 2007 at 11:54 a.m. ( permalink | suggest removal )
JP (anonymous) says...
Certainly there are medical situations that warrant an immediate trip to the hospital. One cannot argue the fact that acute angina is commonly a red flag for an ER visit. That cannot be overlooked. But the truth is that we just don't know enough about the either patient's case to cast fair judgment.
In both cases, a bypass of the primary care physician straight to the tertiary care hospital was demanded. Are you suggesting that we all go straight to the cardiologist when we have chest tightness, or to the orthopedic surgeon every time we sprain an ankle? What role does the primary care physician play in our health? Maybe Dr. Albenberg actually expedited the ER experience by using his hospital privileges and contacting the best specialists in town. Maybe his office has modern equipment suitable for acute care - not just tongue depressors and a BP cuff, like many offices.
The aim of the article was to exemplify how this physician was there for his patient in a time of need. Anybody could simply tell you to go to the hospital. A good doctor knows how to treat a patient and when to refer out when the case is beyond his scope. It is simply a matter of trust from the patient (or lack thereof) that determines whether or not you want anything to do with him. You haven't even given this guy a chance and you've already snatched the rug out from under his feet.
September 11, 2007 at 4:34 p.m. ( permalink | suggest removal )
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