Kevin P. Casey
A couple of years ago, Orange Cab driver Jagjit Singh, who lacked medical insurance, flew to his home country of India for a hernia operation, for which he paid $300 rather than the $16,000 he would have been charged in the U.S. Recently, Singh joined Qliance, a new boutique medical practice in downtown Seattle set to open on July 23. In fact, he says, so did roughly half of Orange Cab's drivers after hearing Qliance's pitch at the company's offices one day.
Singh is not your typical patient of a boutique medical practice; he earns about $50 or $60 a day—far less than the CEOs and other wealthy types who tend to pay the monthly, out-of-pocket fees that boutique (or concierge) practices charge for on-demand access to their doctors. That's because Qliance is not your typical boutique service. Indeed, it doesn't even like that term, which it says smacks of elitism.
Rather, Qliance's target demographic is the working poor and uninsured. It does not accept insurance, instead charging between $39 and $74 a month for an individual, depending on age. (The older you are, the more you pay.) That fee covers most of what encompasses primary care, including office visits, phone consultations, common X-rays, and some procedures and lab tests. Other tests, including those for cholesterol, diabetes, and blood count, will be offered at close to cost, for $7 to $17.50 each.
Qliance's monthly fees are a fraction of those charged by upscale boutique practices. For instance, MD², a Bellevue-based boutique practice that opened 11 years ago as the country's first, charges an average of $1,250 a month.
"I think this kind of care should be available to a substantial population of America," says Dr. Garrison Bliss, the guiding force behind Qliance. Ten years ago, Bliss helped convert his practice, Seattle Medical Associates, to a relatively affordable version of the boutique model, charging $95 a month. But he felt that wasn't low enough. He also wanted to create a larger practice from scratch that could be expanded. Hence, Qliance plans to quickly open a second practice in the suburbs south of Seattle, where many working poor live, and then expand throughout the state and possibly throughout the country.
"We're using Washington state to prove how effective this model can be," says Norm Wu, the company's CEO.
"Our purpose," adds Bliss, "is to reinvent the way medical care is practiced." He believes medicine has become a frustrating, joyless affair for both doctors and patients, who are squeezed by insurance companies into harried 15-minute visits. By getting insurance out of the picture, he contends, doctors can make more money, while at the same time serving patients better.
Critics, however, warn that Bliss is promising something he can't deliver. "I would urge a high degree of skepticism on this," says Stephen Tarnoff, associate medical director of Group Health Cooperative.
Bliss and Wu are seated in a small Qliance conference room, attempting to answer the question of how their practice will be able to offer rates that are so much lower than the average boutique firm. "It's magic," says Bliss, a wiry 57-year-old with a playful look in his eyes.
Wu, a genial, gray-haired businessman who has worked for a variety of high-tech companies, then sets out to explain the economics of the venture. For starters, he says, there's the saved expense of eliminating insurance from the picture, as doctors typically have to pay several staffers to handle the complex paperwork required by insurance companies. Secondly, Wu says, the clinic will be open seven days a week, 12 hours a day, from Monday through Friday. That should mean more visits—and thus more revenue per week—than the average doctor's office.
Qliance also counts among its providers not only doctors but nurse assistants and practitioners, who make less money than physicians. Each of an eventual four nurse assistants or practitioners is paired with a physician in a team that will be responsible for 1,400 patients. That's a lighter load than the typical primary care doctor, they say, who, because of increased productivity demands, is expected to carry 2,500 to 3,000 patients. Because Qliance providers have fewer patients, they can spend more time with each of them, booking 30-minute visits instead of 15, and offering same or next-day appointments.
Still, Qliance's practitioners will have far more patients that those of MD², whose doctors cater to just 50 families each. And Qliance won't offer the kind of perks, like house calls, 24/7 access, and hand-holding at the office of specialists, that MD² and other high-end boutique firms do.
"If you ask patients what they want, they don't necessarily want a silver tea set in the front room," Bliss says. "They want to get hold of providers when they need one; they want to be seen when they're sick."
But to Group Health's Tarnoff, Qliance represents more of a threat than other boutique firms because it has scaled back perks that are typical of higher-end outfits. It is nothing more, he believes, than a "basic primary care" service, but one for which patients have to pay out of pocket. "People who are going to get this are going to have to pay twice," predicts Tarnoff, once for their monthly primary care fee and once for the insurance they will still need for specialist visits and catastrophic care. If this model catches on, he says, many insurance companies might eventually stop covering primary care altogether.
In fact, Qliance's founders say they would welcome such a change. They compare primary care insurance to car insurance that would cover such routine work as an oil change. State Insurance Commissioner Mike Kreidler, among others, disagrees. "If we see a scenario in which primary care is abandoned by health insurers, then we would start to have second thoughts about what this is doing to the whole system," says Kreidler. "There are a lot of uncertainties as to what the effect of this is."
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