New concept in care debuts in Leawood

A new medical office in Leawood is part of a growing concept among primary care physicians.

Dr. Michael Catausan has introduced what he believes is the first “concierge” or “boutique” medical practice in Johnson County.

Patients at the office, called Exclusive MD, pay a monthly fee that covers all medical care and services provided there. Rates are $125 a month per adult, and $250 for a family of four. Each additional child is another $30.

No insurance cards, including Medicare, are accepted.

The selling points of such practices are convenience, greater accessibility to the doctor, little or no waiting at appointments and more time with the doctor once in the exam room.

Phone calls can be made directly to the physician around the clock, and even house calls are an option when warranted.

Treating patients by phone or at home does not happen now, Catausan said, because insurance does not reimburse a doctor for services rendered unless a patient walks through the office door.

In addition to short waits or no waits, patients are assured 30 minutes of face time with their doctor at each appointment. If a scheduled visit does result in a short wait, a lounge with comfortable seating, a large flat-screen television, and wi-fi service is available. Free drinks and snacks also are on hand.

“We’re trying to offer a more homey feel and change the way people experience medical care,” said Catausan, who encourages patients and visitors to call him Dr. Mike.

The time savings and greater access are made possible because a concierge doctor sees far fewer patients than in traditional primary care offices. Typically, a physician will see 3,000 or more patients, but Catausan is limiting his practice to 600.

When his maximum patient load nears, he will expand to a second doctor, a woman.

Patients at the office are ushered into a spacious examining room and seated on an exam table that looks and feels more like an overly large office chair that can be reclined. And rather than having to slip into a skimpy peek-a-boo exam gown, patients are provided a pre-warmed robe.

All those things are easy to get used to, but the unique concept can take some convincing. Prospective patients often are skeptical about whether it makes sense for them.

Cost naturally is a major concern and consideration. Those with good medical insurance, after all, gain no benefits from that coverage in these offices.

“We try to educate people on how to restructure their insurance,” Catausan said.

Patients are advised to switch to higher-deductible, or catastrophic care, coverage. Doing so yields enough savings through lower premiums to pay the office fee, Catausan said. The patient also is advised to establish a medical savings account to fill in any gaps, such as the cost for any referral visits to a specialist.

The goal, however, is to keep such appointments to a minimum.

“We try to use specialists correctly,” Catausan said.

His approach is to send patients to specialists for evaluation and to receive a course of treatment. But rather than send them back to the specialists repeatedly for follow-ups, Catausan said he collects information and reports from the specialists and then oversees the treatment himself, while contacting the other doctor periodically to determine whether a change in treatment regimen might be needed.

The first concierge practices were established in the mid 1990s. Many of the patients become enthusiastic proponents of the concept, but the system is not without critics.

One of the more common concerns is that it introduces even more exclusivity to medical care and widens the gulf between the haves and have-nots.

In the early years of such practices that more often was true, Catausan said.

Yearly memberships originally reached $20,000 or more, but those kinds of high-dollar practices are an exception now. Catausan said his charges are somewhat below the national average among boutiques.

The word “exclusive” in his office’s name, Catausan said, was not intended to convey that the practice caters only to a high-income level. It only means that the practice is an exclusive service to those who choose to join, he said.

“The demographic you’d expect us to have would be someone with more disposable income than average. That’s not the case,” Catausan said. “We have patients who were uninsured and who had pre-existing conditions. They called and asked if we could be their doctor. We have patients with a lot of complicated medical conditions.”

But what happens if you are out of town and become ill.

Catausan said if he cannot meet the patient’s need by phone, he either will try to refer them to another concierge practice nearby or a regular physician. Sometimes fellow concierge doctors do not charge such patients.

There are about 5,000 such physicians now in the country, Catausan said.

If an Exclusive MD subscriber is playing host to an out-of-town visitor who becomes ill, Catausan said he will take care of the guest without charge.

Catausan said he would welcome it if more primary care physicians elected to adopt the concept, and he is confident that will happen.

“I’d like to see other practices offer this to spread the news and make it more mainstream,” he said.

In fact, he believes the idea could dovetail nicely with any new federal health care plan that might be adopted.

If the new system provides health care coverage for more people, it is expected to put added demand on primary care physicians. That could be a problem, because fewer medical students are electing to pick that specialty in part because of the heavy patient loads they must deal with. And while some worry that boutique practices mean doctors are seeing fewer patients, Catausan has a glass-half-full perspective on that.

The prospect of lighter patient loads possible in concierge practices, he believes, will be attractive to more medical students trying to decide which specialty to study.

Catausan said he decided to embark on this form of practice because of the need to push patients through as quickly as possible at his previous practice in Wichita.

“I had to make a decision and ask myself, was I really doing anybody justice,” he said.

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