For concierge doctors, practicing in a model that completely reverses the traditional paradigm, the difference in chronic care can be profound.
Editor's Note: Treating chronic conditions in concierge medicine will be the topic of a free April 20 webinar, brought to you by Medical Economics and Specialdocs Consultants. Click here to register for this learning experience!
As most physicians will attest, treating patients with chronic disease in a traditional fee-for-service practice model can be a challenging experience, leaving all involved frustrated and unsatisfied. The culprit as always is lack of time - unsurprising in an environment where providing patients with even a bare minimum of preventive, chronic disease and acute care would require an impossible 26.7 hour workday for primary care physicians.1
For concierge doctors, practicing in a model that completely reverses the traditional paradigm, the difference in care can be profound. From initial diagnosis, a concierge physician has time to listen, advise and shepherd patients through years of highly variable individual trajectories of disease flare-up and progression. We share some notable success stories from Specialdocs-affiliated concierge physicians below.
At Lown Cardiology Group, a Boston-based concierge medicine practice, Alyson Kelley-Hedegepeth, MD treats patients with afib, ischemic heart disease and congestive heart failure. As with many chronic conditions, ideal care begins with an in-depth evaluation to understand risk factors and root causes, and continues with frequent check-ins, direct contact between visits, and ongoing treatment and support.
“Once the diagnosis is made, patients need to recognize the condition is permanent and will never be resolved or go away,” she says. “However, the more we understand both the driving factors and address triggers for recurrence, the better opportunity we have to reverse symptoms and stabilize disease so that patients experience long periods of feeling great.”
Educating her patients on lifestyle changes that can greatly impact their disease course requires time and dedicated attention, according to Kelley-Hedgepeth. “Obesity, inactivity, sleep disorders, diabetes, alcohol consumption and unhealthy eating patterns are all modifiable factors that are key to managing conditions like afib,” she says, “but can’t even begin to be thoroughly discussed in a standard 15-minute visit. We can spend an hour or more – whatever is necessary to explore and effect real change.”
For example, a plan of lifestyle changes for a 77-year-old obese man who experienced afib symptoms daily proved highly effective. He lost weight by following a healthy diet, took short walks every day, started CPAP treatment for obstructive sleep apnea and eliminated regular alcohol consumption. “He is now feeling great and has not experienced any afib symptoms in months,” reports Kelley-Hedgepeth.
Preventive testing for patients at high risk of heart failure due to family history, hypertension, diabetes or coronary artery disease is another best practice at Lown Group. “Early intervention can have a significant impact on symptoms and progression,” she says.
For example, when a 52-year-old patient with mild heart dysfunction who had previously experienced a heart attack was treated with blood pressure and cholesterol medications and followed a tailored exercise routine that included daily walks, the results were outstanding. “He lost 20 pounds, considerably increased his exercise tolerance, and says he feels younger than he did 10 years ago!” exults Kelley-Hedgepeth.
Arguably the most compelling case for taking time to focus on preventive screening can be made for managing coronary artery disease, the number one cause of death worldwide. “We look for subclinical disease in asymptomatic patients to find this chronic condition before symptoms develop,” emphasizes Kelley-Hedgepeth. “When patients question why they need medication if they’re feeling fine, we explain that a combination of treating lifestyle factors and medications can significantly minimize their risk and enable them to live for years without a cardiac event.”
She describes a 74-year-old patient referred to Lown with an abnormal calcium score who benefited greatly from a candid discussion and personalized plan. “She was pre-diabetic and needed cholesterol-lowering treatment, but because she was an avid exerciser who eschewed medication, no one encouraged her to take it. By working with me and a nutritionist she has reversed her pre-diabetes, agreed to take cholesterol medication, and added muscle mass with an enhanced workout routine,” says Kelley-Hedgepeth. “Our goal is for her to pass away at an old age - with coronary disease - and not from it.”
Mayes DuBose, MD, a geriatric specialist who founded Carolina Concierge Care in 2019, routinely helps his elderly patients manage multiple chronic conditions, but there’s nothing routine about his approach. The care he provides is deeply empathetic and personal, built on rock-solid relationships with patients and families nurtured assiduously over years.
For example, the recent referral of a patient with lymphoma to an oncologist for a biopsy was just the beginning of a complex, time-intensive journey compassionately navigated by Dr. DuBose. Speed bumps were smoothed and detours avoided with lengthy phone calls and visits to help manage everything from alternate transportation arrangements to and from the procedure, evaluation of how the patient’s other chronic conditions including diabetes and hypotension would impact outcomes, and extensive discussion to overcome the patient’s reluctance to receive needed radiation treatment.
“If you deal with this kind of situation in a traditional practice, you either gloss over some essential parts or realize you’ll be hours behind,” says DuBose. “With concierge medicine, you don’t have to make that choice.”
He’s also thankful for the time to evaluate and counsel patients for mental health issues like depression, a condition that has become far more prevalent since the pandemic. “Most primary care physicians have at least some training in this, and the ability to counsel patients you know so intimately is invaluable,” he explains. “However, consultative counseling is poorly reimbursed, so a referral is often made to a psychologist or therapist as a way to better manage time, which is always in short supply with a traditionally-sized patient panel (1500 or more). Now I only make a mental health referral when it’s really needed, not because I didn’t have the time to handle it well.”
Advance care planning is another area where Dr. DuBose’s guidance is frequently sought, especially by patients in early stages of dementia or other illness that places them at higher risk of losing their decision-making ability. “These are conversations best had with both the patient and a close family member, and they shouldn’t be rushed to conform to a pre-determined time allotment,” he says.
A recent encounter provided fresh evidence of the genuine value of the smaller, more personalized practice model fundamental to concierge medicine. “My patient was exhibiting signs of dementia and wanted to make his family aware of his ultimate desire for a natural death,” relates DuBose. “Together we reviewed his dementia evaluations, MRIs, and current memory issues, and with his daughter present, discussed in detail an advance care plan that would ensure his wishes would be accommodated. His daughter was exceedingly grateful for the guidance, and my patient was so appreciative that he was able to advocate for himself. I can’t imagine a better or more rewarding way to practice medicine.”
REGISTER HERE to learn more about treating chronic conditions in concierge medicine from Dr. Alyson Kelley-Hedgepeth and Dr. Mayes DuBose at the Medical Economics/Specialdocs webinar on April 20th at 8 pm ET.
Terry Bauer is the CEO of Specialdocs, and Mindy Kolof is the public relations specialist for Specialdocs. Since 2002 Specialdocs has worked to transform physicians’ professional lives with a change to its industry-leading, sustainable concierge medicine model. The company provides all the essentials and support for a successful concierge medicine practice throughout the transition process and well beyond.