LITTLE ROCK — Affordability has been the watchword for health care in past few years. The title of the omnibus federal law passed in 2010 — the Affordable Care Act — bears that out.

Labeled “Obamacare” by detractors, repealing the mandate for health coverage was a major part of Mitt Romney’s campaign for the presidency. Others have defended it as the right thing to do for millions of Americans who could not pay for health coverage.

A decade before the federal law was passed, a new approach to the practice of medicine surfaced.

This variety of patient care costs more on the front end, but its proponents say it offers better primary care, and the patient — as well as private insurers and government programs — can afford it because of subsequent savings.

It has been labeled personalized care, and even concierge care, referring to someone who is at the beck and call of hotel guests.

Boca Raton, Fla.-based MDVIP was founded in 2000 as an alternative to what it calls “conveyor-belt medicine.”

The company said in a recent news release: “Now that the Supreme Court has ruled in favor of the individual mandate in the Affordable Care Act ... more individuals than ever [are] expected to enter doctors’ offices. ... MDVIP is an innovative choice that is driving excellent outcomes and substantial savings to the patient and the healthcare system.”

MDVIP and similar organizations limit the number of patients a member physician can have. When that limit is reached, any of the physician’s clientele who don’t join the MDVIP wellness plan must look for another doctor.

MDVIP sets an annual fee of $1,650 for each patient in the plan, which includes its showpiece annual in-depth evaluation of a patient in a wellness plan and any subsequent visits related to that plan. One-third of the fee goes to the company.

The company limits practices to 600 patients. It is the largest of such organizations, with 565 physicians in 40 states and about 200,000 patients in the program for an average of about 350 per practice. The company says it has had 200 percent growth in the past five years in terms of both patients and doctors.

The lower patient load offers valuable assets for a physician — time and availability. Doctors in the program are on call around the clock and offer same-day or next-day appointments.

Dr. I. Torin Gray of Little Rock is the first doctor in Arkansas to join MDVIP. He apparently is the only one in the state who works with any of the companies that offer such a service.

Gray, 44, said his new practice is “filling up quickly” since he sent out a letter Oct. 22.

The response from patients has been “incredibly positive. They get it,” he said. “It takes time” for quality care. His new approach to medicine will start Jan. 29.

The MDVIP wellness plan covers in-depth preventive medical testing that is not normally covered by insurance.

Gray, who has been a doctor for 14 years, said he expects his income to be about the same as before.

But he said he expects to make gains in the quality of what he does.

“You’ve got to know your patients. When you get through medical school and you’ve got all these ideals. And you get into the business of medicine. That pace gets to where you feel you’ve kind of lost touch,” Gray said.

Jay Menna, 68, a retired instructor in microbiology at the University of Arkansas for Medical Sciences, has been one of Gray’s patients for about two years.

Menna said that he has been “very pleased” with Gray, and that he is “very personable and understanding.”

But because Menna has several chronic conditions, he said he may need to see his doctor two or three times a week, which would be not possible with a physician in a regular practice.

“I don’t like to see it framed as elitist,” Menna said. He sees it as “old-fashioned medicine with a cutting-edge umbrella.” The company says the VIP in MDVIP stands for value in prevention.

Another patient, who asked not to be identified, says more time with the doctor isn’t everything. “I have a multitude of health conditions. With all my co-pays going to all of my doctors, then with all the prescriptions, and with my health-care premium — where does it end? And now the doctor says you’ve got to pay me a membership fee.”

Because Gray is not a specialist, spending more time with him will not be a benefit, the patient said. “I think he’s doing it out of suspicion of Obamacare.”

Gray has been his wife’s doctor for 10 years, the patient said. They’ll switch to one of the two other physicians in Gray’s current group practice.

MDVIP is in part a reaction to a trend of diminishing reimbursement from insurance, public and private, said Mark Murrison, president of marketing and innovation for the Florida company, which now is owned by Procter & Gamble Co.

As a result of reduced insurance payments, physicians need to see more patients, which leads to less time to spend with them.

A recent study published by the Archives of Internal Medicine found that nearly half of front-line physicians already are suffering from least one symptom of burnout because of patient load.

A generation ago, about half of medical school graduates wanted to be general practitioners, Murrison said. Now the figure is in the low single digits.

MDVIP has a 92 percent renewal rate among patients, Murrison said, adding that the fee can be paid quarterly or semiannually.

“The naive assessment is that it is wealth care.” But MDVIP clientele are fixed-income retirees, small-business owners and school teachers, Murrison said. “It’s not defined by what you make. It’s defined by how much you value your health.”

Similar organizations charge anywhere from $5,000 to $20,000 annually.

Murrison said two peer-reviewed studies commissioned by MDVIP will be published this month in medical journals. The studies show a hospitalization rate of Medicare patients in the program that’s 79 percent lower than Medicare recipients in general and 72 percent lower than those with private insurance, Murrison said.

That’s because MDVIP doctors are on call 24 hours a day, which can defuse panic and, for example, nullify a visit to the emergency room, he said.

Additionally, readmission rates for patients in the program are in the low single digits, compared with 30 percent generally, he said.

Dr. Michael Posey, 62, of Memphis had been a practicing physician for 31 years and had been looking for alternatives to the treadmill the profession had become for him.

He had 1,500 patients and little time for each person. Then in April 2011, after a lot of study, he allied himself with MDVIP and now has about 300 patients.

“It was an easy transition for me. The one-on-one relationship with the patient is better than it’s ever been.”

The more extensive annual physical allows for early detection of potentially major problems, thus saving the patient and insurer money.

In one case, a man who had no heart-problem symptoms was found to have an 80 percent blockage in an artery because of plaque buildup, Posey said. A stent was inserted and the man avoided greater problems, he said.

“I feel like I’m able to get a lot more into the preventive end and trying to keep people healthy,” he said.

A tai chi instructor comes in once a week to lead patients through a workout. And some patients go on walks on a nearby “greenway.”

“My hours of work haven’t changed one bit, but I enjoy my work better because I’m able to spend time with patients,” Posey said.

It has been suggested that MDVIP and other such organizations are merely “cherrypicking” patients.

“My demographics have not changed,” Posey said. “I have an over-50 percent Medicare population.”

A lot of doctors won’t accept Medicare patients because of the reduction in reimbursement to health-care providers, he said. “MDVIP welcomes Medicare patients with open arms.

“I have not turned away anybody.”

Business, Pages 71 on 11/11/2012