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GREENSBORO — Imagine a world where you can make a same-day appointment, your doctor spends an hour on your annual physical, and he personally returns calls.

That world is here.

But it’ll cost you.

Sometimes called “concierge” medicine, patients pay an annual fee that can range from $600 to as high as $15,000. In exchange, patients receive more personalized care, such as longer appointments and a focus on prevention.

But there are drawbacks: Such practices require doctors to reduce their patient load, which can leave hundreds of patients looking for new primary care physicians. It also can separate patients from the doctors they have trusted for years and present a financial challenge to others.

Despite the drawbacks, the trend, also described as “direct care” or “preventive personalized care,” continues to grow, both locally and nationally.

In January, Greensboro Drs. James Kindl, Peter Blomgren and David Keller switched to this type of care by joining MDVIP, a Florida-based national network of physicians practicing preventive personalized care. They are the first Triad doctors to join MDVIP and are among 11 in the state.

“We think that every patient deserves this kind of care,” Blomgren said. “We think it brings out the best in our abilities to take care of them.”

The $1,500 annual fee allows MDVIP doctors to see fewer patients. Doctors get part of the money, MDVIP gets a share and the rest covers costs for the added features, such as the in-depth physical.

Patient Elsie Jacobs, 67, signed on in part to stay with Keller, her doctor of 28 years. But the concept appealed to her — especially prevention and more time to talk about health concerns with her doctor. She’s paying the annual fee in quarterly installments.

“I like all of the things that they’re going to cover when they do the check, you know, the physical,” she said. “That, to me, is more than you would get in a normal physical. That was worth the $1,500 right there.”

Personal medicine

Traditional primary care physicians might see as many as 40 patients per day and often spend 15 minutes or less with each, health care experts say. That leaves little time to discuss prevention and little room for last-minute appointments.

By contrast, most concierge doctors give out their home and cell phone numbers to offer patients 24/7 access; provide same or next day appointments; focus more on prevention; and require in-depth yearly physicals.

MDVIP’s exam includes personal and family history, identification of risk factors, laboratory testing, EKG and screenings related to mental status, exercise, nutrition and sleep; vision, hearing and pulmonary function testing; and a review of all medication.

The exam takes about 90 minutes, Keller said. Blocking out 30 minutes for an exam was difficult under the old system, where he and Blomgren saw 20 or more patients a day.

Now they each see eight to 12 people per day and can easily fit in more.

Take the recent patient of Keller’s who called complaining of a cough and fever. Keller saw her that day and prescribed medication for pneumonia. Under traditional primary care, she likely would have had to wait a couple of days for an appointment. By then, the pneumonia could have worsened and required hospitalization, Keller said.

More time with patients means getting to know them — and their medical issues — better, Blomgren said. It means heading off issues before they become problems and require costly hospital stays.

“This is the kind of care that physicians were trained to give in medical school,” Keller said. “But with the constraints of the traditional practice model, we can’t do it.”

Broken system

Fed up with insurance ruling his practice, Dr. Thomas LaGrelius switched years ago to what he calls a “direct care” model.

A family and geriatric care physician in Torrance, Calif., he said primary care should never have been folded into an insurance system where quantity rather than quality rules reimbursement for doctors.

Doctors had to increase their patient load to make up the revenue lost as insurers and Medicare reduced what was reimbursed to physicians, said LaGrelius, board chairman of the Society for Innovative Medical Practice Design, a Virginia-based association of concierge physicians.

Started in Seattle in the 1990s, direct or concierge care began growing more rapidly in recent years.

A 2005 U.S. Government Accountability Office report found 146 physicians practicing concierge care.

Today, MDVIP alone works with nearly 360 physicians across the country.

The Society for Innovative Medical Practice Design counts about 300 members. Many more doctors do not belong to a group, LaGrelius said. Several thousand across the country likely offer such personalized care, he said. As dissatisfaction with the current system grows, more will convert, LaGrelius said.

Every time one doctor converts to a reduced patient load, other doctors must pick up the remaining patients. A typical primary care physician sees 2,000 to 3,000 patients a year — sometimes more.

Each of the Greensboro doctors had to reduce his patient load to no more than 600 to join MDVIP. With about 4,400 patients between Blomgren and Keller, that left 3,200 people from their practices without a primary care physician. They worked to ensure those patients had access to another doctor.

The influx of patients from such conversions raises concerns for critics who say concierge care reduces the number of primary care physicians at a time when there aren’t enough doctors going into the field. They worry the costs could exclude the poor, creating a separate class of medical care.

In Greensboro’s case, three doctors reducing their patient load should not be a problem, said Bob Goldstein, executive vice president of LeBauer HealthCare and the physician network for Moses Cone Health System.

Goldstein said that represents a small percentage of primary care physicians here, and the patients should be absorbed into other practices.

But he said he feels sorry for the patients who may have been seeing their physicians for years but must leave the practice because they can’t afford the $1,500 fee or don’t want to pay it.

“I think that’s the unfortunate part,” he said.

Dr. Bernard Kaminetsky, medical director for MDVIP, argues that the switch doesn’t deprive a community of primary care doctors. Some doctors would retire or quit if they didn’t join MDVIP, he said.

Medical students who increasingly have shied away from primary care are once again considering the field because of the preventive personalized care model, he said.

He doesn’t like the term concierge care, which he said conjures images of pricey institutions, such as the Ritz-Carlton.

The annual fee for MDVIP ranges from $1,500 to $1,800 a year, or $125 to $150 a month. MDVIP doctors offer payment plans and many patients use health care reimbursement accounts to use pretax dollars to cover the cost, he said. Health insurance and Medicare also are accepted for eligible costs.

“$125 is a middle class expense,” Kaminetsky said. “It’s a Starbucks a day.”

Patients need to decide what they value more, he said.

Bouts with two forms of cancer left High Point resident Don Darnall, 58, with no doubts about what he values. He researched MDVIP and liked the in-depth care, including the mini-CD that patients get of their medical records.

With his history of cancer and frequent travel, doctors need to get up to speed quickly if something happens to him, Darnall said.

“(That) is a high priority for me,” he said.

He also wanted to stay with Blomgren, who has been his doctor for about 15 years and diagnosed both cancers early enough to get them treated.

Blomgren and Keller, while not ready to retire, had been looking for a change when they found MDVIP.

“We enjoy what we do,” Keller said. “With this model, I think we’ll be able to continue our active practice life for a longer time than we otherwise would have.”

Contact Jennifer Fernandez at 373-7064 or jennifer.fernandez@news-record.com