By Mike Klein
Four years ago Lee Gross saw the medical sands were shifting. His insurance-based primary care practice near Sarasota, Florida was in danger of extinction unless Gross and his physician partners developed a different strategy. Medicine, it seems, was also no longer much fun.
“Any physician will tell you a lot has changed in medicine in the last ten to fifteen years,” Gross said this week in Atlanta. “The paperwork gets absolutely crazy. You’re basically no longer interacting with patients. You’re just a cog in the wheel doing what the insurance companies are telling you to do.”
Gross also saw a real possibility that his entire medical business model would vanish. “Independent practices are becoming dinosaurs. All the practices are being gobbled up by large corporations,” Gross said. “I am the last independent practice in my community. They’re all gone. I’m the only one left.”
Epiphany Health is the lone survivor, Gross said about his practice, because four years ago it added a concierge care option, choosing not to discontinue taking insurance, but giving those clients who had the resources and the interest an option to contract directly for primary care and bypass insurance, except for catastrophic care policies that cover the worst things that can happen to anyone.
Today concierge care patients represent 10 percent of Epiphany Health’s volume but they produce 50 percent of take home revenue. What’s good for the practice is also good for those concierge clients: the practice charges $80 monthly for an individual, $150 for two persons and $175 for a family of four. There are no Medicare-enrolled concierge care patients to avoid running afoul of complex federal mandates.
Gross was in Atlanta to participate in The Institute for HealthCare Consumerism Forum and Expo, and to also keynote the Public Policy Foundation’s monthly Leadership Breakfast at the Cobb Galleria Centre. Gross also works with the Docs4Patient Care Foundation that advocates for expanded health care personal freedom and access to quality care for all Americans.
Gross and Epiphany Health moved toward concierge care at approximately the same moment in history when President Obama was forcing his health insurance expansion plan that has reduced choices, threatened care and increased costs – especially pharmaceutical $$ — for tens of millions of Americans.
“What we’re learning with the roll out of the Affordable Care Act is that health insurance and health care are two completely different things,” Gross said, “but somehow we have the opinion that if somebody has health insurance they have health care. That’s not true.”
In the Epiphany Health model concierge clients receive routine blood lab work, vaccinations, annual wellness exams, 25 office visits, pap and PSA tests, colon cancer screens, electrocardiograms and even their annual flu vaccines for no additional charge beyond their monthly fees.
“It’s sort of like joining a health club,” Gross said. “When you pay your monthly fee at the health club you don’t pay to use the fitness equipment, you don’t pay to use the sauna, you just utilize the services but your monthly fee doesn’t change.”
Epiphany Health has contracts with partners to provide complicated procedures like nuclear stress tests, chest CT scans, carotid ultrasound and colonoscopy. Operating on cash payments that bypass insurance Epiphany negotiated rates that are two-thirds or lower what non-concierge patients are charged.
Gross said that last year the average family of four paid $1,800 per month for health insurance. The cost for Epiphany Health enrollees is about ten percent of that astronomical number. He noted, “If you can afford cell phone service or cable television at your house you can afford this.”
Here is the Dr. Lee Gross’ complete presentation to the Public Policy Foundation: