Physician Opting for Concierge

Dr. John Furlow feels it’s time for a change.

Tired of the endless crush of paperwork, rushed appointments, 2,200 patients and the uneasy feeling he’s become a robot, Furlow is leaving his practice at MANA Medical Associates to open his own office.

The idea has been brewing for about three years, he said, but it’s only been recently that the prospect really took shape.

For his transition into what’s known as concierge medicine to be successful, however, he’s taking the enormous step of opting out of private and public insurance. As tedious and time consuming as the paperwork could be, insurance reimbursements were the source of guaranteed income for Furlow, who has practiced medicine in Fayetteville for 13 years.

If he’s to make a living starting in September, when his business officially opens, he’ll have to do so with a patient pool he’s built from scratch.

Furlow, 42, said he’s willing to take the risk in pursuit of the reward — direct primary care for about 800 patients without the dreaded ream of insurance forms weighing him down.

“I can’t do it the way I want to do it in the traditional model,” he said of his practice. “I have to make a change. I can’t be a robot, zombie-doctor.”

 

Fee for Service

Concierge medicine began in 1996 in the Pacific Northwest and has since spread across the country. Located primarily in large urban areas, the concierge model is slowly making its way into smaller markets such as Northwest Arkansas.

The term concierge, also known as direct primary care, refers to a practice in which doctors offer personalized, 24-hour service in exchange for a cash fee.

Under the concierge model, a doctor does not bill insurance providers for reimbursements. Rather, the source of income is the fee, which pays for a standardized set of services such as office visits, basic lab work and annual physicals.

The patient and his insurer — not the concierge doctor — handle any claim beyond the patient-doctor agreement, such as surgery or treatment by a specialist.

Ideally, overhead and clerical work are greatly reduced because the doctor has few, if any, claims to submit to insurers. With less paperwork, doctors can spend more time with fewer patients, and therein is the benefit of concierge medicine.

The average annual concierge fee is $1,500 a year, according to Concierge Medicine Today, a journal sponsored by The Concierge Medicine Research Collective. There are about 5,000 concierge doctors nationwide, up from a few hundred in the early 2000s, according to the Research Collective. Most doctors who practice concierge medicine are in primary care, family medicine, cardiology and pediatrics. 

The Research Collective estimates there are about a dozen concierge doctors in Arkansas, most in the Little Rock area.

 

Out of the Emergency Room

Furlow is touting his new practice on his website, johnfurlow.com, and on Facebook, Twitter and a blog. While he said his business model would evolve as the practice evolves, his opening fee structure is set.

He has three charges for three age groups: 15-39 at $60 per month; 40-64 at $80 per month; and 65 and up at $100 per month. His plan covers an annual wellness evaluation, unlimited office and virtual visits, basic lab procedures such as pregnancy tests and strep screening, and standard medical treatments such as cryotherapy and minor laceration repair.

Key features are longer doctor-patient visits, same-day and next-day appointments, 24-7 availability aided by phone, text and email, and expedited specialist referrals.

Overall, Furlow promises to do his best to keep his patients out of the emergency room, and thus, save money. Furlow said many problems could be solved with a phone call, text or email, and that when the need for acute care does arise, the patient will benefit from a doctor familiar with their health history.

Like all doctors in concierge care, Furlow encourages patients to keep a high-deductible insurance plan for catastrophic events.

 

Niche or Norm?

There’s probably a future for concierge medicine in Arkansas. But the shape of that future remains to be seen, said Herb Sanderson, the AARP’s Little Rock-based associate state director for advocacy. The concept is so new for Arkansas that it’s too early to issue a policy statement or to predict its impact on state health care, he said.

In Arkansas, the AARP — a nonprofit advocate for health care, employment and retirement planning for those 50 years of age and older — represents 325,000 people. While the state’s AARP population is diverse, many live in rural settings and in poverty, Sanderson said.

For those who can afford concierge medicine, the concept might be attractive, but for those who can’t afford it, not so much, he said.

“My guess is that there will be some kind of niche for this, but I would say that the vast majority of Arkansans will not gravitate toward this due to the added expense,” he said.

Those interested in the concierge model should approach it with a healthy dose of common sense.

“Ask what it covers and ask what it does not cover,” Sanderson said.

Furlow conceded concierge is not for everyone. In the last few months he has announced to his patients he is heading out on his own, and if any of those patients still want to have his services, they will have to pay the extra fee. Some have said that’s fine, but others have not, citing the added expense.

“That’s a response I’ve gotten from some people, but I knew that would happen,” he said.

 

On the Horizon

Leaving MANA was not taken lightly. The association includes 74 physicians, a comprehensive array of clinics and an established infrastructure that can handle insurance claims from AETNA to United Health Care.

Officially formed in 2005, MANA is the leading association in the region and the go-to provider for thousands of patients. Furlow had to think long and hard before deciding to leave. Married and a father of four, he knows he’s taking a risk in so doing.

“I’ll have to go out and be more of a marketer than I’ve ever been,” Furlow said. “But I’m willing to take the risk because I think it can work.”

A Conway native, Furlow is a graduate of UAMS who has practiced primary care in Fayetteville since 2000. He was inspired to become a doctor by his father.

Furlow is giving himself two years. If things are working out, then he’ll know he made the right choice. If not, he’ll return to a traditional practice or look for yet another business model.

Furlow might be leaving at the right time. According to The Research Collective, there could be a flood of new customers on the market next year, when the individual mandate for the Affordable Care Act begins.

Under the mandate, individuals must enroll in some type of health insurance plan or face a $95 penalty on their income tax. The Research Collective expects an increase in the number of people looking for coverage. Some, or many, of those people might choose a high-deductible insurance policy with a wraparound wellness plan provided by doctors like Furlow.

 

No Burned Bridges

The administration at MANA is not happy Furlow is leaving, but nor is it bitter. As a practitioner of internal medicine, Furlow is part of a dwindling breed of doctor. Because of market forces, most physicians choose a specialty. All this adds up to a simple fact: Furlow will be missed.

“I was disappointed that we were losing him,” said Jason Wilson, CEO of MANA. “Internal medicine physicians are difficult to replace.”

In evaluating the future landscape of medicine, Wilson doesn’t see the concierge model becoming the norm. To the contrary, he sees more and more doctors opting into large organizations like MANA.

“I don’t think [concierge medicine] will be a larger part of the market than the traditional practice,” he said.

For Wilson, the bigger issue is the Affordable Care Act and how it will affect the health care industry as a whole. Nobody really knows what’s going to happen, he said, but at organizations like MANA, there’s an established infrastructure to manage change.

Solo doctors such as Furlow, Wilson said, face a future of uncertainty as they manage a practice with little or no administrative support.

In September, Furlow and his 13 years of experience will be gone. If in a few years, he happened to return, he would be greeted with open arms.

“We’re not burning any bridges,” Wilson said.