A patient who’d recently been in the hospital called Dr. Gene Zito, worried about her symptoms. Had the call come one day earlier, he may have told her to go to the emergency room.

But it came the day that Zito shifted from the way he’d been practicing internal medicine for more than 30 years to a new model.

“I knew I didn’t have 25 people scheduled to see me,” said Zito, with offices in Pittsford and Webster.

So he went to the young woman’s house and spent 30 minutes with her.

Zito said the patient was more comfortable than she’d be in a waiting room, and the house call saved her and her insurance hundreds if not thousands of dollars.

Zito is among a small contingent of primary care physicians nationwide who have started concierge practices. Unlike traditional primary care practices with upwards of 2,000 patients and dozens of appointments each day, the concierge model is limited to a few hundred patients who pay to be part of the practice. Zito contracted with MDVIP of Boca Raton, Fla., and started the practice in late June. He has about 400 patients who each pay $1,500 a year.

The doctor is in

The term “concierge” conjures images of a doctor who provides red-carpet service at the patient’s beck and call. Trade groups describe the model as personalized preventive care and say the focus is on keeping patients well rather than just treating their illness. Critics contend that concierge practices create a caste system by making people pay extra for services that should be part of their care. They also worry that this model could shut people out just as federal health reform is ramping up demand for primary care.

Zito said the new model is a change in primary care medicine by transforming the doctor into a health care coach who can teach patients about healthful behaviors.

Time for a change

As his practice grew over the years, Zito, 62, was finding he didn’t have the time to practice the way he saw fit.

“I needed to be able to know that when that patient walked out the door, I had done the very best for them. I wasn’t feeling that. … That started to bother me. I began to consider alternatives.”

Zito was invited to a seminar in 2010 hosted by MDVIP, which partners with doctors to set up concierge practices. Among the services patients receive are an individualized wellness plan, no waiting for appointments and office visits at least 30 minutes long, and reciprocity with other MDVIP doctors. Children ages 16 to 26 are covered under their parents’ membership.

“This kind of captured my imagination. I couldn’t let it go,” he said.

Practices are limited to 600 patients who have 24/7 cell phone and email access to the doctor. MDVIP offers technology, marketing and other support to physicians once they have transitioned. The company takes $500 of the annual $1,500 patient fee, but it doesn’t manage or own the practice.

Zito went through a four-month transition that included patient education about the new model. MDVIP works with its physicians to identify other doctors in the community who will take new patients. Zito is in partnership with Dr. Marshall Goldstein, who is retaining the traditional practice and took over some of the cases. Zito has arranged coverage with Goldstein and others for when he is unable to physically see a patient. Goldstein did not respond to several interview requests.

Fee for a service

The concierge concept, sometimes called boutique medicine, has been around for a few years. It’s predominantly been in big cities, although about 10 years ago a Spencerport family doctor had a concierge practice. According to Concierge Medicine Research Collective, there are approximately 2,300 verified concierge doctors out of 67,000 general internists in the nation.

A spokeswoman for Concierge Medicine Today said there were 22 concierge doctors in the state. A physician in Syracuse recently started a practice.

Any concerns aren’t with the preventive aspect of the practices, which observers said can have measurable benefits.

Questions have been raised about whether doctors can charge a fee for services that they should be providing, such as round-the-clock access to the practice.

According to the Medical Society of the State of New York, in 2004, the state Department of Health warned that a fee for concierge services could raise legal concerns because charges were being levied for what should be covered under a comprehensive services plan. A spokesman for the DOH said a current opinion has not been issued.

The medical society also reported that in 2000, the state Insurance Department said that physicians could run afoul of regulations if they charged a flat monthly fee in exchange for prepaid services. The department was unable to comment.

Nancy Adams, executive director of the Monroe County Medical Society, said the fees for enhanced services can be a gray area. She said doctors are supposed to be accessible by being on call or arranging coverage, and are supposed to be spending appropriate time with patients who have acute or chronic conditions.

“Physicians, make sure you’re reading the contract and not violating any terms,” she urged.

As for local insurers, a spokesman for Excellus BlueCross BlueShield said concierge practices were being looked at by its legal team.

A spokesman for MVP Health Care said that any services not covered by the standard contract with the insurer are paid by the individual.

Taking the pulse

When she first heard that Zito would be changing his practice, Patricia Edwards panicked. “‘Is this going to be for us or will we have to find another physician?'” she said.

Under the new arrangement, she and her husband, Merton, each pay $1,500. Their children, 24 and 22, are covered under their membership.

“I know we feel fortunate to be able to afford this,” said the 53-year-old Perinton woman.

She is expecting to receive more information that will keep her well and more time with her doctor when she has a concern.

Zito, who has kept his admitting privileges at Rochester General Hospital, visited Edwards the day after her recent hip replacement surgery and has helped coordinate follow-up care.

Marilyn Nelson said the concierge model will provide peace of mind for her and husband Ronald.

“That he will be on call 24/7 is just incredible,” said the 79-year-old Pittsford woman who has several conditions and is uncertain about the effects of health reform.

“I really feel that we’re out in left field with this new health bill,” she said. “This is going to solve a lot of questions we have. It gives us security.”