Boutique Approach to Medicine No Rose Garden For Doctor
Friday, June 27, 2003
BY JONATHAN MAZE
Of The Post and Courier Staff
It wasn’t easy for Dr. David Albenberg to start Access Healthcare, the area’s first “boutique” medical practice.
“I haven’t had a paycheck in nine months,” Albenberg said last month. “I sold two cars. I moved. I sold everything to make this project work.”
So, even though there are many eyes in the health care world trained on Albenberg and his efforts, he doesn’t believe anybody will follow his lead until he’s shown that a practice like his can succeed.
Housed in a renovated 117-year-old house on Calhoun Street, Access Healthcare is different from most physicians’ offices. Albenberg lives on the house’s second floor, sees people after hours and makes house calls.
But the most watched aspect of the practice is that it doesn’t take health insurance. Patients can get a list of the services he provides, be it a simple office visit, a more involved check-up or even minor surgery. It is then up to the patient to win insurance reimbursement. That’s a risky proposition for the practice because the insurer might not reimburse the full amount, or it might not reimburse the patient at all. Those patients might decide to go elsewhere next time.
So far, however, that portion of Access Healthcare’s business has gone better than expected. Many of Albenberg’s patients from his days in a more traditional practice on James Island have followed him downtown.
Another eye-catching part of Albenberg’s practice is his “boutique” services. For a monthly retainer, patients can see the doctor for a broader range of services. For example, for $75 a month a patient can get primary care services, office visits, telephone or e-mail consultations. Another $50 a month will cover lab tests, X-rays and blood studies.
The most complete services will be offered under the practice’s “concierge” plan, in which patients can get more comprehensive exams, unlimited office and after-hour visits and consultations, some lab work and radiology studies.
Boutique medicine is a growing yet controversial trend in medicine. Critics complain that it favors the wealthy, leaving those unable to afford the monthly retainer with less than optimal care. Some believe it shines a bright light on the widening gap between rich and poor.
But Albenberg said that boutique medicine got a bad rap when early adopters of the practice charged what amounted to an admission fee to patients for higher-end services, then continued to bill Medicare.
He believes that many physicians have thought hard about doing what he has done. Doctors are frustrated with the paperwork involved in dealing with third-party payers, both private insurers and government programs Medicare and Medicaid.
Physicians complain that the insurers’ stagnant reimbursements, coupled with the overhead it takes to deal with the plans, takes too much time away from their dealings with patients.
By abandoning insurance and putting a more market-based bent on services, Albenberg believes he can spend more time with each patient because he’ll have less overhead and will spend less time with paperwork.
Indeed, Albenberg is seeing half the number of patients he did at his previous practice.