IOWA CITY — Throughout his 29 years as an internal medicine doctor in Iowa City, Dr. Richard Larew felt the pressure building.
There were demands to see more patients, meaning he couldn’t spend as much time with each patient as he wished.
“I was trying to find a way to get back to the way we have done things in the past,” Larew said. “There was more time. There wasn’t quite the same pressure to see so many people.”
Larew left hospital practice earlier this year to go into private practice and open Larew Internal Medicine, at 2557 N. Dodge St. in Iowa City.
He’s using an alternative care model called “concierge medicine” that allows him more time with fewer patients — for a fee.
In exchange for an annual retainer, Larew limits his patient count, allowing him time for extended visits and agreeing to be available to patients at any time for any medical concern.
HOW IT WORKS
Larew has about 200 patients on his retainer. Each patient pays about $1,800 a year for the service, or $150 a month.
Larew, who grew up in Iowa City, had worked for Mercy Iowa City’s Towncrest Internal Medicine for 29 years before opening his concierge practice in July.
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Larew’s patients are able to get same-day appointments for acute illnesses, such as influenza, and they have Larew’s cellphone number for questions they might have after hours.
The majority of Larew’s patients are those with multiple chronic medical conditions, such as diabetes and high blood pressure, who he sees every three months. He refers such patients to specialists and tracks their progress.
“That’s not a model they’re accustomed to using,” Larew said. “They just come in when they’re sick. The idea that we would spend a good part of time (during the visit) talking about how they can improve things is a different way of thinking about it.”
Through concierge agreements, Larew believes he is able to provide more comprehensive, proactive care to patients.
Chance to connect
He also thinks the agreements give patients a chance to reconnect with their primary care physician.
“Part of what has always made medicine — and being a physician — a great profession is that personal connection,” he said.
Kathy McCue, 66, of Iowa City, signed up for Larew’s medical concierge service when it opened. Larew had been her doctor for at least 20 years, and she wanted to stay with him.
“I don’t have any big health concerns, but if something did come up, I would like him to be my point person to be able to talk through things,” McCue said.
McCue described Larew as thorough, a good listener and someone who loves educating patients and answering their questions.
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“I think that’s why he transitioned to concierge medicine,” she said. “He loves that part in medicine, and I always said he would be a good professor in that way.
“And, it’s nice to have as a patient.”
Concierge medicine, sometimes known as membership medicine, was created in the late 1990s by two Seattle physicians who wanted to offer more personalized medicine.
Concierge Medicine Today, a trade publication, estimated 5,000 to 6,000 doctors were practicing concierge medicine in 2018, though no database tracks the numbers. The approach inspired a USA Network television series, “Royal Pains.”
The method comes in for criticism because it’s available only to those who can afford the monthly fee, on top of their regular health insurance premiums.
A 2016 study published by the Population Health Management journal found patients’ health care expenditures declined in the third year of participation in concierge medicine programs. Researchers suggested that happens because patients address untreated health concerns and are “caught up” with chronic disease management.
Not much other research exists on the concept.
“No one knows how to measure who’s getting healthier, but do I think that people are benefiting? Absolutely,” Larew said.
“I think we’re achieving what we’re hoping to,” he said. “I want people to have a great experience when they walk in the door, and I want to be able to provide people with that extra time.”
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