Arkansas Physicians Adopt Patient-Driven Models

Published September 13, 2018

The two models gaining ground in the state allow doctors to practice in a more personal setting, treating fewer patients, offering longer appointments, and communicating with patients via text and cell phone after hours.

Arkansas has laws that free doctors and patients in DPC and concierge medicine practices from onerous regulations under the state insurance code.

Avoiding Insurance System

Matt Glans, a senior policy analyst for The Heartland Institute, which publishes Health Care News, says there is a big difference between the concierge and direct primary care models.

“While direct primary care is often compared to concierge medicine, they are not the same,” Glans said. “The true value of direct primary care is its avoidance of the insurance system altogether. Under an insurance-based payment system, primary care doctors face myriad regulations and a slow and costly reimbursement system and overhead that can eat up to 60 percent of a typical primary care practice’s revenue. Under a concierge model, patients pay doctors $1,500 to $5,000 per year for continuous access, and the doctors typically bill patients’ insurers in addition to charging the patient an access fee.”

Innovative and Old-School

Dr. Allan McKenzie, M.D., a practicing physician since 2006, worked for Baptist Health, Arkansas’ largest hospital system, for more than a decade before affiliating with MD-VIP, a concierge-style health care group, last year. He says he sees far fewer patients since adopting the concierge model, which he says is better for patients.

“I began practice [for Baptist Health] in 2006,” McKenzie said. “After a dozen years, I had over 2,700 patients, seeing about 30 patients a day. People were being turned away to walk-in clinics and ERs. I felt like I didn’t know my patients well anymore, and they didn’t have access to me. It was embarrassing and not good for patients. Now, on average, I see eight patients a day.”

MD-VIP physicians are limited to 600 patients, McKenzie says. They work with insured patients but require an annual fee in addition. Adult patients pay $1,650 per year, which McKenzie says helps offset costs for each patient’s comprehensive annual wellness exam, allowing the practice to remain small.

“While it’s progressive, it’s also old-school,” McKenzie said. “It’s been a really neat experience. [Patients] get a lot better preventive service and attention. My annual fee can be paid out of a health savings account or flex spending account. Children of patients come along free until they are 26.”

Less Regulation, Bureaucracy

Glans says the monthly fee associated with direct-payment health care options can help decrease the regulatory burden on providers.

“The guarantee of a set monthly fee removes the layers of regulation and bureaucracy created by the traditional insurance system,” Glans says. “It also allows physicians to see fewer patients and focus more on each patient. Routine tests and procedures are included in most DPC plans, and lower membership fees are often charged for programs that do not provide these additional services.”

‘Wait Time Is Negligible’

Dr. Joel Fankhauser, M.D., practices at Direct Care Clinic of Northwest Arkansas, in Rogers, Arkansas. Fankhauser says the clinic offers many of the same services as traditional doctor’s practices while cutting out the insurance companies altogether. Fankhauser says individuals are generally charged $40 per month, with a maximum amount of $80, and families pay $160. His practice limits physicians to no more than 800 patients.

“We designed our practice in such a way such that people have a monthly fee and they can be seen as many times as they want to,” Fankhauser said. “We can do the same procedures as any primary care office, and our appointments are 30 to 60 minutes apart, so if it’s something complicated we can easily schedule you for an hour, even the end of a day on a Friday if it is urgent or pressing enough. Wait time is negligible.”

When working in a traditional office, Fankhauser felt trapped by the numbers, he says.

“[There were] more and more people on our schedule, so they’d end up going to urgent cares or other doctors or they’d have six minutes in my office,” Fankhauser said. “I could never catch up, and people felt they didn’t have the time to discuss any actual serious medical problems. That’s what we as doctors don’t like about the way the health care system works.”

‘Not an Insurance Company’

Fankhauser says the new health care models are meeting the needs of the increasing number of people who feel strangled by the cost of insurance.

“Insurance is not affordable or not offered by employers anymore,” Fankhauser said. “If you pay 100 percent of a high deductible [plan], all you’re getting is a poorly negotiated group rate. People are having to make decisions on whether to go to a doctor or not, and this is not based on concerns, but ‘Can I afford it at this moment?'”

McKenzie says patients must also explore traditional health insurance plans to obtain necessary coverage for hospitalization and specialized care and procedures.

“There have to be different options for people,” McKenzie said. “You can’t provide unlimited care without a cap.”

“We tell people on the front end, we are not an insurance company,” Fankhauser said. “We are not encouraging you to not have insurance. If you have that option available to you, you should look into having insurance in case you have a $100,000 hospital bill.”