Vision meets reality for chronic conditions

As most physicians will attest, treating patients with chronic disease in a traditional fee-for-service practice model can be challenging. It is perhaps inevitable in an environment where providing a minimum of preventive, chronic disease and acute care adds up to an impossible 26.7-hour workday, according a 2023 study titled “Revisiting the Time Needed to Provide Adult Primary Care” published in the Journal of General Internal Medicine.

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For doctors in a concierge medical practice, the difference in care can be profound. These physicians have time to shepherd patients through years of highly variable individual trajectories.

At Lown Cardiology Group, Alyson Kelley-Hedgepeth, M.D., begins with an in-depth evaluation to treat her patients with chronic conditions such as atrial fibrillation, ischemic heart disease and congestive heart failure, followed by ongoing, frequent check-ins and support.

Education on lifestyle modifications such as diet, activity and sleep, requires time and attention, according to Kelley-Hedgepeth. “These are key to managing chronic cardiac conditions but can’t even begin to be thoroughly discussed in a standard 15-minute visit. We can spend whatever time is necessary to effect real change.”

For example, lifestyle changes helped a 77-year-old obese man with daily recurrences of atrial fibrillation. “By losing weight, walking regularly, treating his sleep apnea and eliminating regular alcohol consumption, he has not experienced afib symptoms in months,” Kelley-Hedgepeth says.

Early intervention for patients at high risk of heart failure is another best practice, according to Kelley-Hedgepeth. A 52-year-old patient who had previously experienced a heart attack was subsequently prescribed blood pressure and cholesterol medications and a tailored exercise routine. “He lost 20 pounds, increased his exercise tolerance and says he feels younger than he did 10 years ago,” she says.

Screening for coronary artery disease in asymptomatic patients is also essential. Kelley-Hedgepeth describes a 74-year-old referred to Lown with an abnormal calcium score: “We were able to reverse her pre-diabetes, lower her cholesterol levels and add muscle mass.”

Mayes DuBose, M.D., a geriatric specialist who founded Carolina Concierge Care in 2019, routinely helps his older patients manage multiple chronic conditions, but there is nothing routine about his approach. The care he provides is built on relationships with patients and families nurtured over years.

He recalls the complex journey of a long-time patient with lymphoma. DuBose smoothed speed bumps and avoided delays with lengthy phone calls and visits to help manage everything from transportation arrangements to the biopsy procedure, evaluation of how the patient’s other chronic conditions would impact outcomes, and extensive discussion to overcome the patient’s reluctance to receive treatment.

“If you deal with this kind of situation in a traditional practice, you either gloss over some essential parts or realize you’ll be hours behind,” DuBose says. “With concierge medicine, you don’t have to make that choice.”

DuBose also has time to provide guidance on advance care planning with patients and family members. He shares an encounter with a patient exhibiting signs of dementia and his daughter.

“ His daughter was exceedingly grateful and my patient appreciated the ability to advocate for himself,” DuBose says. “I can’t imagine a better or more rewarding way to practice medicine.”

Terry Bauer is the CEO of Specialdocs, and Mindy Kolof is the public relations strategist for Specialdocs. Since 2002 the company has worked to transform physicians’ professional lives with a change to its industry-leading, sustainable concierge medicine model. Specialdocs provides all the essentials and support for a successful concierge medicine practice throughout the transition process and well beyond.