Concierge Medicine comming to Chapel Hill

My GP doctor of 18 years and his practice, Chapel Hill Family Medicine, are converting to "concierge medicine", sometimes known as boutique medicine. What this means is that to stay with my doctor, whom I like, it will cost me $1500 per year, $1000 which goes to him and $500 which goes to MDVIP, the company which franchises this service. My doctor will reduce his patient load to a maximum of 600 patients. MDVIP limits its franchises to experienced established practices in high income areas.

What this buys is 24 hour access to your doctor, extended preventative medicine including expanded physical, all you records on a cd.. etc.. or to put it another way, high quality individual attention that should be available anyway.

This really poses an ethical dilemma both for the physician and the patient. What is driving this practice is the increasingly low reimbursements by insurance companies which require increasing work loads which gives less and less time per patient. Primary Care Physicians, PCP, are increasingly stressed and dissatisfied with the current system. In other words this is a prescription that is symptomatic treatment for PCP's and the economically advantage patients at the expense of the rest of the population due to a broken health care system. It furthers the class divide of accessibility to quality medical care.

While as I said I like my doctor and understand this siren song for him as sung by MDVIP, this move disturbs me and it looks like I will be searching for an new physician.




A close friend of mine is stunned by this recent development at Chapel Hill Family Medicine. $1500 per year (not a one-time payment) to stay on her physcian's elite patient list ... another $1500 per year for her husband, both of whom have been patients there for something like a quarter of a century! When she last visited, her doctor somewhat bluntly said that his objective was to reduce his patient load to 600 from several thousand. In the waiting area was a representative of the Concierge group hoping to sell her on the new deal. Needless to say, she was very freaked out.

These physicians took the Hippocratic oath. What happens to long-time patients, many of whom are elderly, who can't fork out $1500 apiece to remain in their care? Will they retain these patients' medical records? This movement strikes me as unethical -- a cushy way for some docs to achieve semi-retirement.


Patients who decline to or can not pay the entrance fee have to find another doctor. The two long time doctors are both going to the concierge model. However there will be one or more doctors in the practice which will continue with the traditional practice and supposedly will take some of those patients. My problem with that is I do not want to go to a practice with a tiered quality of service.

The search may not be easy as not all practices are taking on new patients and for those with long time relationships with their doctor, it can certainly be disconcerting to start anew.

Complete medical records will be provided to the new doctor on the signing of a release. I do not know about record retention and the regulations if one desires that your records be deleted from the old practice.

The world needs more doctors like Dr. Brian Forrest of Access Healthcare in Apex. He doesn't do insurance. Period. Rather, he charges very low cash rates, (which are posted). Reportedly, this allows him to spend a lot more quality time with patients, and see those that really need to be seen. Last time I checked, I think an office visit with him was a very reasonable $45. And, by doing business in this way, he does away with the need for an army of secretaries and paper pushers to maintain the insurance paper trails. So, he's able to do quite well seeing just a few patients. I honestly don't see why more physicians aren't switching to this model. It seems like a win-win for both Dr. and patient. His overhead is only 25% and his collection ratio is something approaching 100%, (a pure pipedream for most traditional practices). Seeing as little as four patients an hour yields $180 hour and he doesn't have to share that with secretarial help or the insurance companies. I wonder how many doctors and PAs there are out there that can't even dream of making that kind of money with their current HMOs.
How many Chapel Hill Family Medicine employees are losing their jobs? One envisions a wholesale administrative switch-out. Maybe not, if Concierge (MDVIP) offers considerable transitional support. Existing (loyal) staff will have to become expert apologizers and Concierge team players... fast. Yuck.

As I have been searching for a new PCP, I found that several were not taking new patients. For those caught up in this situation, do not want to particpate in the concierge program or go over to the non-concierge side of the practice, I suggest starting your search earlier than later.

MDVIP does offer help in the search. However, the company does not have my trust. In fact I asked them to completely remove me form their IT systems. They said they complied. Of course there is no way to confirm their compliance.

My friend is a patient of that practice.  After she attended one of the 3 information sessions, she was totally bummed out.  As someone who primarily depends on Medicare to pay her health care, she is concerned about finding another primary care doctor in the area.  

 It certainly seems to me that this kind of shift in medical practice might be what finally makes the average American wake up and realize that our health care system as it currently exists is propped up with toothpicks.  it cannot sustain itself in its current form.  When it costs more for health insurance for your family than it does to rent your apartment or buy your car, something has got to give.   

And the entire premise of tying your insurance to your job is just untenable.   I am meeting more and more people 50+ who have been downsized, exhausted their COBRA coverage, cannot find another job with benefits, and cannot afford individual coverage at any kind of reasonable price.  They are willing to pay, but not 2 or 3 thousand dollars a month.  And yes, that is how much it costs for many of them to buy a comparable  individual policy, especially if they've had any kind of health condition, even one like simply taking a recurring prescription medication.

Anita, I did not attend one of the information sessions since I had already made up my mind. However, I was under the impression from my research that these sessions are similar to attending a condo or time share sales pitch. Was that your friend's experience?

She said it was slick.  They had her name already pre-printed on a contract application to join the new practice--it had her name, address, phone number, etc etc, and they gave it to her when she walked in.  They had a name tag for her.    She said there was a bit of a "hurry up before it's too late"  air to the proceedings--that once the 600 slots were gone, they were gone.  Join now before it's too late.   (a la time share).

.  At one point my friend  said someone said something to Dr. Guiteras to the effect of--I have been with you since you opened.  Is there any provision for someone like me, who has been part of your practice for a long time. What happens to me?

 She  said that Dr. G did not know what to say, was visibly flustered by the question.    She said that Dr. G's presentation had the air of true sincerity, that he said he had been struggling with this decision but that he wanted to practice medicine the way he thought it should be practiced, and the current patient load just didn't allow him to do that.   

 She said she wanted to ask him but didn't, what this arrangement would do to the bottom line of his practice.   Would it be better, worse, about the same? 

She left thinking that MDVIP was a pretty slick marketing machine and that the docs were in an uneasy alliance with the group because they see the end goal as practicing better medicine for the patients who will be part of the "elite 600."     She also said the 1500 also included an executive physical that would be used to put together a comprehensive plan for your future health care.  

Anita, thanks for the reply. From what I understand, given enough people sign up, revenues should rise and costs should decrease. Of the 1500/year 500 goes to MDVIP and 1000 goes to the doctor. If both of the doctors get their 600 patients then that is a base of 1.2 million gross revenue per year into the practice. Insurance reimbursements are in addition to those revenues. Of course with less patients, revenues for insurance reimbursements decrease. MDVIP is not insurance. The fee is a retainer.

Costs should decrease administratively due to the decrease in the number of patients. In the end, it should be more money with less stress. For the doctors, the attractiveness of this arrangement is understandable. I believe both doctors are sincere. But I wonder if this is sort of a Faustian arrangement.

It would be interesting to know how successful they are in signing up patients.

While I'm still fuming over this development, which does not affect me directly, I predict both doctors will retain 600 patients each. This "elite" population will include long-time patients (20+ years) with complicated medical histories, and comfortable Chapel Hill / Fearrington retirees. I fall into neither category; but If I had to change doctors right now, I'd be in a panic. All it takes is one year of rapport-building with a physician to benefit from that relationship! How many cancer survivors want to change family physicians? How many diabetics? Here's my fear: many hundreds of people will stay sick or get sicker in this picture.
It would also be interesting to know the profit margins of MDVIP. However, they are a private corporation and do not have to open their books. They do have a private equity firm that has invested in their business.

I, like many of you, am also a patient of Chapel Hill Family medicine. During my last visit Dr. G, with incredible discomfort, announced his decision to change his practice as described above. He said that he currently has 3,500 !!?? patients and that has left him with little time to practice medicine the way he believes it ought to be practiced. He also said that under the current GP system doctors are forced to be MBA's rather than just doctor's and they are bad MBA's.

I didn't attend the sessions to learn more about the change in practice as I simply can't afford the additional expense per year and had made up my mind. With that said, in some strange way I am happy for both Dr. G and Dr. F. They are both incredible doctor's who have served our community for over 30+ years and deserve to be treated better by the system. I don't think they are doing this for financial reasons as they have both been practicing medicine for 30+ years. We should be careful to not blame them for a broken health care system as they certaintly have served their time to our community. It's time for us to start actually demanding real health care changes from our legislatures and president.


I do not disagree with your post. And I wish both doctors well. The problem with the concierge approach is that it makes the overall problem worse. All those patients who are not able to, do not wish to or wait until it is too late to join up, will have to go somewhere. There are not enough PCP's to go around and many are not accepting new patients.

On a side note, I had MDVIP remove all my information from their data bases. I wonder if providing patient information to this company without explicit permission was a violation of the HIPAA laws.

It certainly sounds like providing patient information information to MDVIP without express permission might very well be a HIPAA violation. I would suggest that this be further investigated - not to punish the doctors whom everyone speaks well about, but to insure that if this is a HIPAA violation that MDVIP is not doing this with other doctors as well. Having your personal health information, as well as other information such as SS numbers, on a company's computers without your knowledge seems like an incredible privacy violation that I think anyone would be extremely concerned about. I think it would be fair game, however, to ask the two doctors how they reconcile this with their obligations under HIPAA before I would go any further. There may be a valid explanation but certainly none is readily apparent here.
 my husband, who is not a CHFM patient just got a solicitation to come in for a 30 minute consult about the practice with one of the doctors.  I know Roger (my husband) has not been an active patient there for at least 15 years.   We have another primary care doctor. 

For those in the same boat please notice:

I found a new PCP and went over to Chapel Hill Family Medicine to have my records transfered. I filled out an authorization form and at the bottom of the form it indicated there would be a charge. I talked with the office manager and she agreed that the records should and would be transfered without charge.

I missed the following story in the DTH:


I asked Bruce Wilks at Carrboro Family Medicine if they're going to do what Chapel Hill did. He said ABSOLUTELY NOT and they're appalled by that decision. He added that MDVIP has been courting them for years. Very candid. I don't know if Carrboro is taking new patients. It's a busy practice -- I'm there a lot -- but runs like clockwork. The Chapel Hill practice where my mother was a patient (Furman) always seemed rather hectic and crowded.

The CHH published the following puff piece on CHFM's conversion to MDVIP.

It is amazing that the DTH managed a more balanced approach in their story.

The following guest column was published yesterday in the CHH. I included it here instead of a pointer since registration and CHH subscription would be required to see the column.


Serious issues in concierge medicine move By David Richter :

Guest columnist The Herald-Sun Jun 11, 2008

An article in the May 27 issue of The Chapel Hill Herald ("MDVIP model allows physicians to focus more on care) told of the move of Chapel Hill Family Medicine, CHFM, to MDVIP, or concierge medicine. However, the article did not discuss the serious issues raised by this move.

For full disclosure, I am an 18-year patient of CHFM who chose not to participate in this transformation.

In this health care model, each individual patient pays an annual fee, in this case $1,500 per patient per year, in order to receive services from their doctor. This fee is not insurance and the patient and, if insured, the patient's insurance company are billed for all visits and services in addition to the annual fee. This additional fee is not insignificant to most people and the problem is multiplied with families.

The reasons for this model speak to the many problems of our current health care system. Both doctors in CHFM, Dr, Furman and Dr. Guiteras, participating in MDVIP are excellent caring doctors and I empathize with their choice.

The current state of our health care system has forced primary care physicians, PCPs, to see more and more patients in order to maintain their practice as reimbursements from insurance companies are continually reduced. This means that PCPs get to spend less and less time with each patient. PCPs rightly complain that it gets more and more difficult to practice the quality of health care that they would like to be able to provide. In fact, new doctors are shying away from becoming PCPs. This new model allows a PCP to reduce the number of patients in the practice and therefore give each patient more time and in theory better care. It becomes easy to understand the siren call of the concierge model.

However, the concierge model is a response to the current state of our health care system and not a fix. In fact, if this model were to gain popularity it would make the situation worse except for higher-income patients who could better afford the additional fees.

MDVIP was founded about seven years ago by Edward Goldman, seeing the opportunity to take economic advantage of the current problems in our health care system. In 2005 Summit Partners, a venture capital firm, invested in MDVIP, convinced of the profit potential of this new business. Of the $1,500 annual fee, the doctor receives $1,000 and MDVIP $500. If both doctors sign up a maximum 600 patients each, that brings a base gross revenue of $1.2 million into the practice and $600,000 into MDVIP. The base new revenue flow allows the CHFM to reduce its patient load. It is expensive to run a practice.

MDVIP is recruiting established PCP practices around the country in high income areas where the demographics are conducive to this type of practice. With this health care model, buying health care becomes like buying an airline seat. Most people will sit in coach while the few that can afford it can sit in first class. This is fine for airline travel, or theater seats, or country club membership, but should this be the way we deliver heath care? In fact, the other doctors at CHFM will stay on the older model which means different patients walking through the doors at CHFM will experience different levels of care depending on which side of the practice in which they are enrolled. Is this appropriate?

In the U.S. we spend on average twice as much per patient on health care than other industrialized nations with worse outcomes. Our infant mortality rates are also worse than most other industrialized nations. We are not spending our health care dollars wisely. The concierge model does not help solve the U.S. health care problems. If, as the original article says, that each of the CHFM doctors had 3,000 patients for a total of 6,000 patients, then at least 4,800 patients recently had to seek new PCPs. The other doctors in the area had to pick up this work load. How did this model help those patients and the other area's PCPs?

I personally found several practices not accepting new patients. Imagine if more and more practices signed up with MDVIP. It might be good for MDVIP and Summit Partners but not for the rest of us. There are certainly some ethical questions that concierge medicine raises. In the U.S. health care is already not delivered equitably and costs keep rising. The concierge MDVIP model further magnifies the problem.

David Richter is a resident of Pittsboro.

Good job, David, especially the part where you implicitly accuse the Herald of glossing over the real issues.  CHFM's eye-catching ad in CHN made me wonder if they're not making their 600/per PCP quota.  Is that a contractual stipulation?  Did MDVIP pay for the ad? 

I would have liked to see a harder emphasis on the ethical aspects of CHFM's decision.  I'm surprised nobody has sued them by now.  There are lives at stake.  People are going to die either because their doc is off limits, or because their medical records are lost in the void.  Serious stuff.  


Catherine, the CHH article was obviously a puff piece, very common from both the CHH and CHN. That is why I had submitted the column.

I do not subscribe to the N&O and they do not deliver the CHN down here in Pittsboro. I do subscribe to the Herald. Therefore I did not see the ad and do not know if there is way to find it on-line.

If MDVIP and CHFM are advertising then I suspect you are right in that they did not hit their quota. I am not sure there is way to confirm that. Who is paying for what I am not sure. I do know that MDVIP did invest heavily in their IT infrastructure but what is in the contract between CHFM and MDVIP I do not know. I understand that MDVIP does do the billing.

In my research I have not seen much in the way of legal action against the company. There is some controversy whether or not the fee violates Medicare rules but the current administration does not see a conflict.

I am sympathetic to the doctors desire to limit their number of patients in order to provide top-qualilty health care to their remaining patients.  I don't understand, however, what is the role of MDVIP?  Who is MDVIP and what services do they provide to the doctors or to the patients for their 600K per year?

Joe, I suggest you go to MDVIP's website to better understand their claimed role with patients. As far as their services to doctors, my guess is they provide administrative (including billing), IT support, marketing and associated materials etc...

My evil twin thinks MDVIP serves its members (PCPs) by providing a sort of maid service.  They do the billing.  They provide IT in the form of instant medical records.  (This is not a new concept.  The UNC Hospitals network serves many local providers in the same way with on-line xrays, clinic notes, operative reports, etc.  Carrboro Family Medicine is linked in.)  They do a Concierge Medicine splash in local papers -- free advertising.  They ease their PCPs into semi-retirement by reducing their patient loads in an organized fashion. 

I've commented in the past that I fear for the long-term employees of a practice like CHFM.  By taking over the administrative burden (billing = insurance claims and such), MDVIP supplants the on-site staff member who gives a shit about this or that patient's ongoing care.  It's not only the docs who ostensibly care; there's a whole team of care-givers backing them up, and these people will lose their jobs.  


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