Sunday, February 09, 2003
Copyright © Las Vegas Review-Journal

Doctor Exclusive

Personal physician services growing amid disenchantment with managed care

A sick Sloane Fischer, 3, gets fussy as Dr. Sal Biazzo, right, of PremiereCare tries to examine her. Sloane's parents, Bob and Suriva Fischer, have access to Biazzo 24-hours-a day. Photo by K.M. Cannon.

When Bob and Suriva Fischer's twin girls get sick, their doctor can be at their home in minutes, even if it's 3 a.m.

If Bob doesn't have time for an annual checkup, that same doctor will come to his office and give him a full medical screening.

And if anybody in the family ever needs emergency care, the physician will meet them at the hospital to treat them or ensure they're in good hands.

The Fischers are one of 10 local families who are forgoing office waits and insurance paperwork in favor of paying for the services of a personal doctor available around the clock. Patients who sign up for the program pay a yearly fee.

"It now feels like we have a doctor in the family," said Suriva Fischer. "It gives us a great deal of comfort to know we can pick up the phone at any time and have a doctor at our house in 15 minutes."

Companies such as PremiereCare, which provides the service to the couple and their 3-year-old girls, have cropped up in several states as patients and doctors are becoming increasingly disgruntled with managed care, said Larry Matheis, executive director of the Nevada State Medical Association.

"The hope is that something like this catches on," Matheis said. "I think it does have a chance, but the question is: Will it become attractive and affordable with working, middle-class people?"

Medical director of PremiereCare, Dr. Richard Green, said yearly fees range from $2,500 for a young, single person to $7,500 for a large family with someone over the age of 65.

"Patients are seen when they want to be seen and where they want to be seen. We'll be there when they need us, not two weeks from now and not five days from now," said Green, an emergency room doctor and former director of the emergency department at Lake Mead Hospital.

Green, who has been practicing in the valley for the past six years, said he got the idea after reading about a similar program. Though the concept is new to Las Vegas, some area doctors do have what Green calls "preferred patients," or patients who are charged more in exchange for extra service.

"I read about a guy in Florida who was doing this and taking care of only 100 patients total. I would see about 100 patients in two days as an ER doctor," Green said. "Our goal here is to have our doctor bored enough so he can go see somebody whenever they need him."

Such companies are an outgrowth of the frustration doctors have with declining reimbursement rates from insurance companies. Las Vegas doctors say these payments have been decreasing for years, making it more difficult for them to meet their increasing overhead costs.

Some area doctors have stopped accepting certain types of insurance or have cut staff and doubled their patient loads in order to make ends meet. Other doctors have stopped accepting insurance altogether and are taking patients on a fee-for-service basis only.

Las Vegas doctor Tony Alamo said he's been thinking about offering a similar service for years, and that reimbursement rates have him considering dropping Medicare patients.

"I've been toying with this idea for years and I think it's the wave of the future," he said. "I'll probably become a nonparticipant of Medicare because we don't get reimbursed enough and there's a tremendous amount of paperwork."

Alamo said the only downside of the concept is that it could create tiers for medical care.

"The good doctors are probably going to start doing things like this and the rest will stay in mainstream medicine," Alamo said. "Not everybody will have access to the best. This is really for those people who go shopping at Neiman Marcus and Saks Fifth Avenue."

Obstetrician Bob Comeau, however, said that doctors in all specialties have an obligation to be accessible to their patients around the clock.

"I don't think patients should pay for this service," he said. "The only thing more they are getting is house calls."

But Green said patients get office calls and pharmacy delivery service as well. They also can call Green directly instead of dealing with an answering service. And, when patients need a specialist or need to go to the emergency room, the company's doctors will accompany them.

He and Dr. Sal Biazzo began seeing patients last week. Biazzo, a family practitioner, said he would rather spend his time caring for patients instead of dealing with paperwork or trying to get prior authorizations for treatments.

"Medicine has become more like a mill, with patients going through on an assembly line," he said. "This is the idealistic version of being a doctor. I get to know my patients."