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looking for better preventative and holistic medical care. With the rise of high-deductible health plans, he said, patients want doctors who will do more than prescribe expensive pills. "at's just a model of care that requires a little more time than insurance reimbursements are compensating for," Blue explained. He said concierge membership also appeals to busy professionals who don't want to spend their work day in a crowded waiting room, as well as older adults with high medical needs who make frequent trips to the doctor's office. Petruzziello, who prefers the term "executive health and lifestyle practice," charges patients an annual fee of $1,800 for a basic membership, $2,800 for gold membership and $4,800 for platinum. e fee covers services not eligible for insurance reimbursement, such as 24-hour access to the doctor and longer appointment times — half an hour for a sick visit and up to two hours for a "lifestyle evaluation and physical." Patients also get extras like health coaching, nutrition and genetic counseling, fitness assessment and training, advanced body composition imaging, a daily supply of vitamins and even discounts at local restaurants and businesses, which are based on membership level. Patients continue to bill their insurance companies for any office visits, lab tests and medical procedures. Armen Abrahamian, 61, a long-term care planning and insurance agent from North Haven, said being able to spend time with Petruzziello to discuss his health goals without feeling rushed is well worth the additional fee. "I would almost consider it VIP service," said Abrahamian. "Making an appointment is never an issue. I've been to their office probably six or seven times and I think the longest wait I ever had was 10 minutes." Patients first Dr. Paul Guardino said he was among the first to practice concierge medicine in Connecticut, building Personal Care Physicians in Farmington from scratch in 2005 with Dr. omas O'Connor, who has since opened his own concierge practice in Bloomfield, specializing in internal medicine and men's health. Guardino said when he began, few people in Connecticut had heard of concierge medicine and there were only between 200 and 250 such practices in the U.S. Today he runs a successful practice (he recently added a new physician), charging an annual fee of $2,750 in addition to insurance. e fee covers 24-hour access via email, text and cell phone, extended visits and same-day appointments, if necessary. He also does house calls for homebound patients. With only 300 patients, Guardino said he really gets to know them, and can "put a lot of time into making sure that risk factors for future problems are perfectly managed." He said that's something all good doctors strive to do, "but sometimes the system doesn't allow for it. With five to seven minutes for an office visit, it's pretty tight." O'Connor's fee ranges from $1,500 for a cardio- metabolic disease evaluation and executive physical to $4,995 for full concierge access, in addition to a patient's regular copays and deductibles. He describes himself as a medical manager, offering a coordination of care he said is lacking when patients rely on walk-in clinics for their medical needs. "ose physicians, they have to see up to 40 patients per day. I see six patients per day," said O'Connor. "I'm a board- certified physician. ere are no nurses here. When people call, I call them back. When they need to get seen, they are seen." Concierge physicians say a big advantage is being able treat common ailments over the phone or Skype, which insurance companies typically don't reimburse. O'Connor told of a patient who texted him a photo of an obvious case of severe poison ivy, saying he had mountain biked into a patch of the poisonous plant. O'Connor was able to call in a prescription for prednisone. "He's not missing his morning. He's working right down the road," he said. "Why would I drag him in?" No 'cure-all' While it seems like a win-win for doctors and patients, some say concierge medicine is not a cure- all for primary care's ills. "e downside is if you (as a patient) can't afford to play this game, where do you go?" asked UConn's Lafreniere. O'Connor said he has taken pro bono cases for people who can't afford the fee. But ultimately, he said, concierge medicine is about giving patients alternatives. He said it is no different than people choosing between public and private schools, and added that his monthly fee costs about the same as a night out at a nice restaurant. "We're not taking care of the rich VIP elite (with fees up to $25,000). at's New York, that's LA, that's Boca (Raton, Fla.)," said O'Connor. "My patients work hard, they make money, they do well and they don't want to have a heart attack and talk to a nurse." From a personal standpoint, he said he couldn't imagine practicing any other way. "I feel very satisfied," he said. "I'm working on projects, I'm calling people back, I'm educating myself, I'm reading. I'm also not stressed. I love my job." More Doctors Eye Concierge Medicine In their biannual nationwide survey, The Physicians Foundation asks thousands of doctors from across the country if they plan to switch to a concierge practice of medicine. The number of doctors considering a switch has slowly increased since 2012. Year 2012 2014 2016 % of U.S. Docs Considering Switch to Concierge Medicine 6.20% 6.80% 8.80% Source: The Physicians Foundation H Dr. Paul Guardino (left) heads Personal Care Physicians, a Farmington-based concierge medicine practice, whose modern office space aims to ease patients. P H O T O S \ \ C O N T R I B U T E D GREATER HARTFORD HEALTH • Summer 2017 17