Concierge medicine adding providers

Ryen “Hitz” Hitzler left, and Dr. Aaron Frasier opened the Flying Horse Medical Center last month. The owners have applied a concierge model, where patients pay a retainer in exchange for more personalized care. The center includes an aesthetics clinic.

Ryen “Hitz” Hitzler left, and Dr. Aaron Frasier opened the Flying Horse Medical Center last month. The owners have applied a concierge model, where patients pay a retainer in exchange for more personalized care. The center includes an aesthetics clinic.

In the swirling current that is today’s health care industry, some Colorado Springs providers are going against the flow.

Dr. Mark Tomasulo, owner of the soon-to-open PeakMed Direct Primary Care on the east side, and Flying Horse Medical Center owners Dr. Aaron Frasier and Ryen “Hitz” Hitzler have carved their own niche from a health care model rapidly growing in popularity.

According to Maria Todd, CEO of the Denver-based Mercury Advisory Group and author of The Handbook of Concierge Medical Practice Design, the growing model of concierge medicine makes up about 10 percent of practices around the country.

The concept, which normally involves retainer payments to a physician in exchange for increased and guaranteed access, has been catching fire of late, she said.

“There have been more physicians moving to the concierge model over the past eight months than I’ve ever seen before,” said Todd, an international concierge consultant. “We’re seeing a move toward more value-based purchasing by the patient in health care.”

Physicians, she said, favor the model because it offers a smaller patient roster overall, meaning fewer patients are seen throughout the day. Patients win because they have longer, more in-depth appointments with their doctor and vastly improved access, which in turn builds trust and allows for more comprehensive preventive care and diagnoses.

Because of the Affordable Care Act, Todd said, the market has been inundated with new customers, and many primary-care and even specialty physicians are seeing the concierge model as a way to maintain a work-life balance while providing more complete care.

She said the perception that the concierge model is only for the wealthy is inaccurate. Patients are finding far more value for their money through concierge models.

“If you can afford to swap out a ‘venti’ latte every day for your health care, you’re in concierge territory,” Todd said.

Vets bring care to Flying Horse

“Our model is pretty inexpensive. Membership is less than a gym membership,” Hitzler said of the month-old practice at Flying Horse Medical Center. He said patients become members of the practice for about $45 per month and receive 10 percent off their annual fees if they pay all at once.

Membership includes 24-hour access to a physician, same-day appointments and no waiting times. Each time patients come in for services, they pay fair market value as determined by the government-run Centers for Medicare & Medicaid Services.

“A typical visit is $147. You pay that, then we give you a super bill that you can take to your insurance, if you have it, and get reimbursed,” Hitzler said. He said the model allows for circumventing costly insurance plans, which can keep costs down for the provider and the patient.

“We encourage people to carry catastrophic insurance and take the money they save and use it to pay a physician so they can actually be seen,” Hitzler said.

Both Hitzler and Frasier are retired Air Force officers. Hitzler was an F-16 maintenance officer and Frasier was thedepartment head at the USAFA Hospital, where his patient load averaged 3,000, he said. His goal at Flying Horse is 500-750 patients.

“I was spending seven minutes with each patient at the Academy,” Frasier said. “There’s an old military adage, ‘You’re going to do more with less.’ But there’s a tipping point where you’re going to do less with less. And when you do less with less, people get hurt, sick and things get missed.”

Hitzler said the center’s master plan doesn’t include large profits from the medical practice, adding those services are “to keep the lights on.” He said profits should flow primarily from their aesthetics clinic, which is open to the public and provides services such as Botox, Juvederm, microneedling and chemical peels.

Hitzler said the practice already has 50 patients, as many as they expected after being open three months.

“We have had people want to take concierge care for a test drive and have done it for a month and not a single one has left. They tell us it’s the weirdest experience ever because we actually listened.”

“We’re seeing a move toward more value-based purchasing by the patient in health care.” 

– Maria Todd

All-inclusive at the Peak

Concierge medicine’s monthly, quarterly or annual retainer payments sometimes guarantee access to only a doctor’s cell phone number or video-conferencing.PeakMed, which is scheduled to open sometime in August, includes most primary care, such as yearly physicals, lab work, exams and same-day appointments without an additional copay or payment for individual services.

“We’re a concierge hybrid,” Tomasulo said of PeakMed. “There is one very large fundamental difference between us and concierge medicine: Concierge care is usually associated with very high costs and retainer fees. … When you talk about concierge physicians, you usually have a high entry point in the form of a retainer, then the physician collects a copay when the patients see them and then a bill is submitted to insurance. The fundamental difference here is this is a direct primary-care model of practice. We don’t accept insurance, bill insurance or deal with third-party payers.”

Tomasulo said PeakMed is half the cost in traditional retainer fees for a concierge doctor but with all the benefits of concierge medicine, including priority visits and personalized, individualized care.

Tomasulo said insurance laws are taking their toll on family practices.

“It’s burning docs out,” he said. “Insurance over the last 10 years has moved away from what it was initially meant to be. It was for rare, unexpected events in life and it was affordable 10 years ago. Insurance companies now are all about profit, and over the last decade they’ve been putting the squeeze on physicians. This model is a way for doctors to take back control of their profession.”

Unlimited access 

He said access for patients is unlimited and “you could come in every day of the week at no additional cost, if you wanted to. … In a day I’ll see 10 patients at most. That means I can sit with you for an hour at a time and manage chronic disease or focus on preventative health care.”

Fees at PeakMed are age-based — an adult 18-44 years old, for instance, would pay $59 per month. Services include all physicals, 24-hour urgent care, pediatric care, adult medicine, wellness, sports medicine, wound repair and access to an on-site pharmacy, and more.

Tomasulo said his goal is not just to create a successful business, but to impact the health care industry at a local level.

“I’m trying to change the direction of primary care and put affordability back into health care,” he said.

According to both Hitzler and Todd, the Affordable Care Act’s passage brought health care to the masses, but the number of qualified caregivers available to keep up with the 10 million newly insured has not kept pace.

“People being able to receive health care is great, but how many new providers came on? By next year it’s predicted there will be a shortage of 90,000 family practice docs,” Hitzler said. “And one of the worst areas in the United States is Colorado Springs because of people like me, retired military. We’re TRICARE, and TRICARE pays so poorly in reimbursements. [Doctors] have to get them through quickly so they can pay their mortgage.”

According to Todd, shortages of primary-care physicians will rise due to doctors opting for a specialized practice directly out of medical school as well as the transition of established primary care doctors to concierge medicine.

“Traditional practices are filled to the gills and don’t have room now for the patients they have. Now you’re adding people who didn’t have coverage and you have to fit them somewhere on the roster,” Todd said. “Doctors are leaving for concierge practices and keeping maybe 300 patients while jettisoning 3,700 into a world already short on primary care doctors.”

Qualified applicants only

Todd said one critical error many physicians make in transitioning to concierge care is launching without the business acumen needed to operate in a complicated industry.

“[Concierge physicians] pull back on staffing and, for the most part, run the business themselves. … But many don’t realize how long it takes to build a practice,” Todd said. “I have some doctors telling me they already have five or six patients. Contact me in four years when you have 500.”

Todd said the 500 mark for non-franchise concierge practices is the tipping point toward stability, adding some practices never stabilize because they miss the big picture, including conducting market feasibility studies, acquiring social media and marketing skills, and learning to weigh the costs of services against retainer fees.

“Most physicians never learned how to do an activity-based cost analysis,” Todd said. “They don’t know their costs, but they’re providing all these amenities and then are upside down when people try to cash in on them.”