How I Focus on a New Model of Health Care

Mar 4, 2015

How I Focus on a New Model of Health CareAfter working 10 years in a traditional musculoskeletal practice, Dr. Leonard Kaplan started a venture aimed at preventive medicine and wellness. Kaplan, a nonsurgical spine and sports medicine specialist, left a longtime job at Buffalo Spine & Sports Institute to start a concierge medical practice: Osteopathic Wellness Medicine of WNY . Concierge medicine, sometimes called VIP medicine, is a newer model of care where patients pay an annual fee to receive customized care and preventive wellness services. Patients contract directly with the physician, paying out of pocket, versus going through insurance. With annual pricing starting at $2,500, Kaplan will offer four scaled packages ranging from basic wellness to treatment for injuries. All patients will see the doctor, as well as a team of health care specialists including a physical therapist, nutritionist and yoga instructor. It’s a big change that followed years of battling with insurance companies to get his patients the care he felt they needed and deserved.

There are wellness centers where you have a smorgasbord like acupuncture or massage. Here you come in and get an hour with me, then a prescription for the things you need. So it’s the stuff the insurance companies say they want to create but never do. I’ve created perfectly coordinated and comprehensive care.

We have no one else but me seeing the patients here. I was tired of the fact that we were forced as physicians more and more into using extenders because of the reimbursement cuts. What’s happening is we have to see more patients but more of these end up followed by physician assistants or nurse practitioners, which can never replace the physicians’ knowledge base and skill.

For the last 11 years, it’s been a huge thorn in my side, knowing these people are not getting the best service they can get from me, seeing P.A.s for follow-up — not me — and also knowing there was nothing I could do about it. I was a slave to the system. I’ve basically just been biding my time for something that would allow me to do this.

It’s all out of pocket but if you buy a package, a lot of these services are discounted. We’ll give them a statement of services and in some cases they can submit, especially if it’s procedural, they can take it to their insurance company to get reimbursement. But honestly, I feel the contract is between the insurance company and the patient, not between me and the insurance company. This whole system along the way somehow got a little messed up and somehow the physician got stuck in the middle.

Before, 40 percent of my over – head went to staff who just did approvals and authorizations for insurance companies. The amount of time I spent writing rebuttals and writing appeals for denial of care is staggering. In the last 10 years, it was probably a year of my life spent just trying to get care for my patients. I’ve had enough. It’s just not going to happen.

I have around 100 clients who are coming in now, paying a la carte for services I provide that very few physicians in town offer, such as prolotherapy (regenerative injection therapy). I see people from Erie, Pa., from Rochester, Binghamton — I even have a guy driving in from Vermont just paying for that day’s service. For the packages, I would top out at 330 patient package clients. I have six now.

There are other concierge specialty practices, but not here. They’re in Baltimore, New York City, usually bigger places. I’m not the first one to do this by any means — there’s a whole group on LinkedIn.

It’s a different model, offering much, much more. I’ve been crafting this for the last 11 years, just hatching the plan.

We get together and discuss each patient or client, so you get this team approach where you say, “This is what’s going on. Now what do we need to take this person to a greater state of health?” We have this nice catchword, salutogenesis, which means creation of health.

Our mission is to create health, and all of the individuals have an important role to play: the physical therapist for fitness; the yoga per – son, who is trained in mindfulness, addressing stress reduction, med – itation — plus, yoga is a total body workout; and the nutritionist. You can’t not have nutrition if you’re talking about wellness.

It’s a very different model from anything that’s out there and I’m the captain of the ship.

— As told to Tracey Drury, Buffalo Business First, February 20, 2015

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