The condition of America’s healthcare system, coupled with deteriorating physician-patient relationships, is sending more medical providers and those seeking their care in search of a new solution. Many are finding it in concierge medicine.
Dr. Steven D. Knope, an internist and sports medicine expert, is the first, and currently only, Tucson physician to offer this type of approach. According to Knope, concierge medicine is a patient-centered practice allowing doctors more time with their patients without the constraints associated with managed care.
  
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"The problem is third party payers are driving the system. There’s no access for patients; they’re spending 8 to 12 minutes with their doctor. The trap doctors get caught in is in a regular system, the only way to keep up is to see more patients and spend less time," Knope says.
This contributes to greater frustration among patients and doctors.
Knope regularly receives calls from doctors inquiring about this new form of medical service; some have even flown in from other states to spend time with him. Their reasons for wanting to convert their practices, Knope claims, are often the same. He hears statements such as, "If I don’t make a change, I’ll lose my sanity, my wife, my family."
Different models exist for this type of practice, Knope explains, but usually the patient pays an upfront annual retainer with no other fees being owed. Knope charges $6,000 per person or $10,000 per couple. This compares to fees in Seattle, he states, of $13,000 per person or $20,000 per couple at MD2, one of concierge medicine’s founding practices. Some other physicians charge a smaller retainer as partial payment and insurance is billed.
"All my patients have health insurance," Knope emphasizes. "This is not a substitute for insurance."
Knope offers same-day appointments, in-depth health assessments, and if warranted, house calls. Patients have 24/7 access to him. Overseeing hospital admissions is part of his service, as is accompanying patients to specialists, even when they’re located out of town. "Not that I get on private jets everyday, but if I have to, I do it, if we run out of care in Tucson. We’ve lost a lot of fine specialists here."
High on Knope’s list of medical priorities is preventive care, including exercise and nutrition. He designs an exercise program that fits each patient’s lifestyle. "I have a gym in my office with two personal trainers. A lot of my patients haven’t exercised in the past and now they’re fanatics. It’s amazing what it does for the health."
He would know. Knope is a four-time Ironman triathlete. He holds a third-degree black belt in Kenpo Karate and is a national speaker on obesity and fitness. He has also served as a physician for the Colorado Rockies during the team’s spring training in Tucson.
Expanding his business is a definite consideration. When he started the approach in 2000, it was at the urging of patients who were disappointed with the level of care they found in Tucson. One patient was familiar with the MC2 practice in Seattle. At first Knope was skeptical, thinking the idea sounded elitist. He launched a pilot program with four patients and a year later it grew to 30. Now he has over 100 patients with room for more.
"I’m carefully looking for an associate. To do this, you need a lot of experience, at least a decade, and know how to deal with people," he says.
A national organization was formed in 2002 to support physicians in this field and those transitioning from conventional practice. Called Society of Concierge Physicians at the time, it became Society for Innovative Medical Practice Design (SIMPD) in 2005.
The change better defines its members’ goals to have "a direct professional, direct and immediate access and a direct financial relationship with his or her patients," states Dr. Thomas W. LaGrelius, president of SIMPD.
Theorganization’s approximately 200 members tend to be concentrated on the coasts, in large states and in urban areas, LaGrelius notes. His expectations for the future of direct practice include the availability of venture capital and a "massive expansion" in the field.
Knope agrees, saying "This movement has grown rapidly since 1996. It’s really taken off and will continue to do so."
The group’s fifth annual conference will be held May 4-6 in Las Vegas and will coincide with the release and kick-off signing of Knope’s second book, "Concierge Medicine: A New System to Get the Best Healthcare," published by Greenwood-Praeger. Endorsed by LaGrelius, it’s the first book on the topic and follows eight years after Knope’s "The Body/Mind Connection," which concentrates on the importance of exercise and nutrition. Knope’s latest book will be available for sale starting in May.
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