A Conversation With ... Dr. Bill Graham

Bethesda Medical isn’t a typical doctor’s office. Tell me more about your practice.
We are a concierge practice with three employees, and we see about 30 to 40 patients a week. The name Bethesda Medical is a reference to a passage of scripture. It’s the story of a sick man who was near a pool in Jerusalem, called Bethesda. The story goes, he wanted to go into the pool because it was a place where people were healed from time to time, but he couldn’t because he was crippled. Jesus came and healed him directly. The word in Hebrew is a combination of two words – house and mercy. We chose that name as a mission statement.

In terms of the market for health care services, it has been the response of my patients which has confirmed my perception that health care consumers are seeking a more accessible, personalized and unhurried style of medical care. I know of only a handful of physicians in the greater Springfield area who have taken this step.

What makes a concierge practice distinct?
Concierge medicine is a return to a traditional family-doctor type of practice, which is what many primary care providers used to do before the health insurance industry got involved in buying the practices 15 to 20 years ago and hiring physicians as employees.

There are few doctors who are independent, especially in areas where there are large health maintenance organizations, such as here with CoxHealth and Mercy. Concierge is an attempt to get back to those roots, a more personal one-on-one relationship where the patient knows the doctor and where the doctor knows the patient well and spends more time with them. That really is the ideal and the goal of most family doctors, but the reality of today  there is a lot of fragmentation in the medical world right now. A lot of times people have to change their doctors because of their employer.

What are your patient fees and what services does that include?
When patients come in, the initial appointment is an hour, then, after that, at least 30 minutes to an hour for each visit. Rather than a 10- or 15-minute appointment like a typical HMO doctor would have, I spend more time with the patient. The trade off to that is a different kind of a payment system. We have a retainer fee of $300 for an annual period and that includes unlimited office visits. Lab fees are not included, but because of the nature of our practice, we can offer discount rates. The retainer fee is paid by the patient, however, if they have insurance which will reimburse, we can assist with that paperwork.

While your practice style is more of a throwback to models decades ago, how do you incorporate technologies available today?
In our practice, we have email access for our patients. They can email me directly. I also give them my cell phone number and they can text or call me anytime. They are able to get a hold of me right away. I don’t have as many Skype patients in the states, but it depends on the generational age. Where Skype is really helpful is with my patients who are missionaries overseas because it may be difficult to assess them physically over phone, so it’s a better option. For example, I took care of an older couple who lived in Islamabad, Pakistan. I have “Skyped” with them several times. I have quite a few patients oversees because of my missions work.

Is there a need for more concierge practices?
Absolutely, there is a need for more. I think what we are going to see, once the Affordable Care Act kicks in, is that people are suddenly going to find out all the promises that have been made can’t be fulfilled. For example, there are a number of physicians near retirement who are going to retire early because they are tired of government regulations. They are already predicting a shortage of primary care physicians for the number of patients who are going to come online with new health insurance. Patients will be looking for value in terms of a primary care provider because they are going to be paying for it out of pocket.