5/24/2006

 A 'maverick’ turns to boutique medical practice
By Don Klein

Dr. William T. Greer, III, looks at himself in a straightforward way. “I tend to be a maverick,” he says candidly.
 When you realize that he was one of the first medical doctors to operate an out-patient clinic in Ocean City on 10th Street in 1988, then in short order opened other clinics in Ocean Pines, Berlin and a second one in Ocean City; then was among the handful of physicians who helped make Atlantic General Hospital a reality, others might see him as more of a pioneer.  
 

In a little more than a month he will break the mold once again. He will become the first doctor in the area to operate his practice on a membership basis. In other words, if you wish to be one of his patients it will cost you $1,200 a year if you are an adult. And you still will have to pay normal fees for each visit.
 In some places this kind of health service is known as a medical “boutique, concierge or retainer” practice. This is how Dr. Greer will work starting July 1:

The membership fee will include a detailed physical examination and appropriate preventive medicine will be scheduled annually. Also a member-patient when sick can expect to be seen by the doctor the day they call or within 24 hours. The practice will include 24-hour a day telephone coverage and a nurse’s line open to answer questions and for prescription refills. The office will help patients in filling out medical forms and will provide consultations with other health care providers when needed. Other patient-friendly services will be included.

So far 300 of his regular patients have indicated their interest in the program, he says. He intends to cut off membership when his practice reaches 400 patients.

For those who purchase an adult membership, there will be a $100 additional fee for each child in the family. This membership fee will not include the normal cost for each visit to the doctor’s office, payable at the time of visit. Every appointment will incur a fee and for those with insurance, the charges will be paid by the patient to the doctor and his office will submit the forms for insurance reimbursement direct to the patient.

Dr. Greer, 47, said he is being forced into this system because the current medical system is controlled by the insurance companies and Medicare to the detriment of medical providers and patients. They swamp health providers with tons of paperwork, then approve some procedures and not others and provide minimal fees, forcing doctors to take on more patients than they can safely treat. 

The combination of medical decisions being made by insurance companies and pharmaceutical firms; and the high cost of malpractice settlements with large payoffs, makes it difficult for doctors to cover costs without constantly expanding their medical practice, he claims.
 Dr. Greer, who at the height once had as many as 5,000 patients annually, now has half that patient number and expects to cut that down to a workable 400 maximum under his membership program. That should average out to two patients an hour, he predicts.

“Physicians are held to incredible standards by the system,” he says, “to do what is required we need to see a patient every 10 minutes. That’s not enough time in many cases.”  
 Malpractice insurance shot up 70 percent in one 13-month period during 2004-2005, he charged, and as a result “the fear of legal retribution has caused many doctors to order a lot more tests for a patient than often are needed.”

He adds, “The medical profession has done an awful job in policing themselves,” allowing the U.S. to become a victim of a corporate oligarchy that lobbies Congress for regulations that benefit corporations in the medical field and not doctors nor their patients.

“I’m an old fashioned doctor, I don’t belong in such a health care system,” a disgusted Dr. Greer says in explaining why he is changing his practice to the membership style. If he didn’t make this change, according to Dr. Greer, he might decide do something else with the rest of his life.

“My other option,” he claimed, “is to go into another profession or leave this county.” Then he added, “If I don’t do this (change to a boutique practice) my patients will need to find a new doctor anyway (because he might leave the practice). What I am doing now is offering them a option.”

As is the case with any new approach to a traditional matter, there are naysayers. Many medical ethicists, consumer advocates, and government officials express concern over the creation of what they call a two-class system of medicine, with more services and higher quality available to those who can afford the often substantial membership fees required by these practices.

They ask what will happen to the Medicare system if more doctors elect to opt out and attempt to serve an all-cash patient population only. The legal risks with these practices can be briefly summarized. Most of these risks arise when a practice continues to seek reimbursement from Medicare and private health insurance companies for covered services in addition to providing these additional "boutique" services for a separate fee.

Physicians who have begun these practices, estimated at 600 in the country, extol their virtues in glowing terms. They cite the financial and psychological benefits of being free from dealing with the legal requirements and billing nightmares associated with Medicare and insurance companies. Because the number of patients permitted to become members of a boutique practice is limited, physicians spending more time with each patient are certain will increase the quality of care, proponents insist.

An added factor to the despair of doctors in this area  is the low insurance payments for services provided to patients.  Dr. George H. A. Bone, president of MedChi, the Maryland State Medical Society, said at the beginning of the 2006 legislative agenda, that “Maryland is a high cost, high-risk, low payment place to practice medicine...(placing) access to physician services... at risk.”

Maryland ranks at the bottom quarter of states in the level of commercial reimbursement, Dr. Bone said in a December 2005 letter to doctors. “Primary care and surgical specialties are losing veteran physicians who are not being replaced,” he added.

While this presents his patients with a need to make a choice of staying with him or not in the new membership practice, Dr. Greer has already made his choice, “I want to take care of my family.” He said he can not solve the American health care system all by himself but must take the steps to solve his personal needs.
 
                                                                           

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