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Would you pay extra to keep seeing your doctor?

Jackson County doctor is offering concierge medical service

Dr. Robert Burns, an internal medicine specialist in Pascagoula, explains his new concierge service to his patients during a meeting at the Hilton Garden Inn on Tuesday, May 23, 2017
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Dr. Robert Burns, an internal medicine specialist in Pascagoula, explains his new concierge service to his patients during a meeting at the Hilton Garden Inn on Tuesday, May 23, 2017

It’s not new to medicine, but it’s new to the Coast — concierge doctors.

Patients pay an annual or monthly fee over and above insurance costs to their doctor in order to be his or her patient. What they get are longer appointments, special attention when they’re in the hospital and the ability to call their doctor 24/7.

Dr. Robert Burns, longtime internal medicine specialist in Pascagoula, is becoming a concierge doctor.

He is the second primary-care doctor in Jackson County to make the move.

Instead of treating 1,200 patients, which is what he estimates he has now, he is signing up patients —with the help of Signature MD, a firm that manages concierge practices — willing to pay him $1,500 a year, or $140 a month, for a program that offers them more time with him and quicker, more convenient communication.

“It’s paying for attention,” one longtime Coast nurse surmised.

And in a way, Burns agrees. After all, he said, medicine is about time and relationship. But it’s also about money.

He told a banquet room full of his patients at the Hilton Garden Inn last week he could no longer afford to keep working as he does. He said he is getting older and 55-hour weeks are too much. He said the paperwork required by insurance and Medicare is growing, and because he chooses not to use electronic medical records, his income is decreasing. In order to keep up with overhead increases, he would have to add to an already-heavy patient load.

“We’ve had many fine physicians leave,” he told them. “I stayed, like you.” He also pointed out there are doctors no longer taking new patients.

A rare breed

Burns is a rare breed, even without the concierge designation. He runs his own clinic independently of a hospital, group or clinic system. He says he has kept that practice because he doesn’t want administrators telling him how to see patients.

He said there are doctors whose time is dictated to as low as 11 minutes per patient to make their work profitable.

Time is a big plus under the concierge model, which includes time for preventive medicine, according to the brochure.

He promised to schedule 30-minute appointments, often the same day. When a patient is hospitalized, he would visit, make sure discharge is smooth and see that there’s an easy transition to specialists. Perhaps he’ll make house calls, but he isn’t guaranteeing that yet.

The concierge trend is catching on — 23 percent of doctors surveyed in 2016 said they either already offer concierge care or plan to transition to a pay model in some capacity.

But how will it affect people in one of the poorest states in the country, and in a county with a median household income of less than $50,000?

It’s great if you can pay, some say, but there’s fear that the poor are already being left out of health-care options. And now the Mississippi State Health Department is reorganizing, cutting six of its nine public health district offices to save $12 million a year.

This is planned wellness

With fewer patients, Burns told his audience, he will have time to listen, discuss healthier lifestyles, set out a wellness plan, do a more-thorough and attentive check.

“I want to hear the noise in your neck and prevent a stroke,” he told the group, “or say ‘That was cancer, but we got it all. We got it in time.’”

He and a representative from Signature MD said 20 percent of a medical payment goes to the doctor. And for Burns, it’s even less — Medicare imposes penalties for not using electronic records.

“I could quit or retire,” he said. The other option is to join a big group or hospital.

“I love my patients, I don’t want to lose any of them, but I just can’t do this anymore,” he said. “If I don’t do something different, I’m going to have to stop seeing Medicare patients.”

As an alternative for his patients who choose not to go with the concierge option, he is hiring a nurse practitioner to work out of his office, under his direction. He said he would be available for consultations with that nurse, who could refer patients to him as a specialist.

“I’m trying not to abandon anyone,” he said.

There was no open grumbling at the meeting. Burns is obviously popular with the people who came to listen to his pitch. They came from Ocean Springs, Moss Point, Gautier and Pascagoula. After the meeting there were hugs.

But it was clear not everyone was open to paying more for what is considered primary care. Burns is an internist, a type of primary care doctor who, with his expertise, tends to collect aging patients.

The cost stopped some

Individualized care was attractive. Some signed up right away.

But the cost stopped others.

Mary Board, 69, said she and her daughter see Burns. She listened to his presentation.

“It’s good for people who can afford it,” she said, “but I’m used to seeing a nurse practitioner anyway. We will be seeing the nurse practitioner.”

A husband and wife who own a business were sitting eight rows back in the banquet hall that held more than 230 for the meeting.

He is on Medicare and thought paying a doctor more than what was required was “a racket.” She, on the other hand, said she understood Burns’ dilemma.

“I like the personalized care idea,” she said. “I see his point. Bureaucracy is taking over medicine. I want to keep Dr. Burns. I don’t understand enough at this time, how the bills will be paid, but I’m inclined to join.”

American medicine fiasco

Kathleen Crew, 63, who has been seeing Burns for eight years, said, “I’m not really sure what I think. It’s more money and the cost of my prescriptions has gone up, and now, to get good health care, we have another cost?”

She said Burns had diagnosed a problem for her that might have been overlooked by other doctors, and on another occasion brought in a specialist immediately to take care of an issue, she said.

“Dr. Burns is a good doctor and I know the American medical system is a fiasco. Trump said he would fix it, but he has not. Can anyone take care of it?

“You have to look at your finances. I’m trying to get ready for retirement. Do I need this now?”

Joyce Watzke, 86, said, “I want to stay with him. I think it’s something I can do.”

A woman, 77, said she and her husband, 80, will likely join because of their complex medical history of heart attack and stroke, and she doesn’t want to start over with another doctor.

“I like him, he knows us. At first I said, ‘No,’ but I think I’m going to have to do it. I guess if I run out of money, I’ll just go to (Burns’) house to eat dinner.”

First on the Coast

Dr. William Striegel of Ocean Springs was the first in Mississippi to adopt the concierge model for his practice.

  • He’s been happy in the business for more than four years. “Bottom line, I’ll never go back.”
  • He gets new patients referred from other doctors.
  • He says it’s suited for people with real health issues, something complex that is not in the books.
  • “People who value their time don’t want to spend two hours waiting for a doctor.”
  • “I wait for the patient, he’s not waiting for me. It’s a different philosophy.”
  • There’s more time for emphasis on prevention.
  • “People think it’s all for the rich. It’s not. It’s about how much you value your health care.”
  • There are people happy having a specialist for everything.
  • His said his fee is the cost of a Starbucks coffee a day.

About the doctor

Who: Dr. Robert Burns

Where: 4211 Hospital Road, Pascagoula

Phone: 228-769-9797 or 310-773-1118

Email: SignatureMD.com/burns

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