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Dr. Michael Mignoli recalls spending eight to 15 minutes with patients during exams when he ran his small, primary care practice for 22 years. He admits to having only enough time to treat the biggest issue before moving on to the next patient.Now, he says it is not uncommon for him to spend 1 1/2 hours with a patient during an annual exam at his Lone Tree practice, Vanguard Primary Care. His availability to thoroughly evaluate an individual is the result of his practice’s transition into concierge medicine in October.“When you only have eight to 10 minutes, you figure out the Band-Aid for the biggest thing that is bleeding,” Mignoli said. “In this model you are able to address everything, not only all the problems and all the complaints of a patient, but also take it a step further and do a deeper dive into prevention.”Concierge medicine is a retainer model of medical practice in which patients pay an annual fee to have access to a primary-care practice.“Medicine in the past 40 years has really evolved to the negative,” said Terry Bauer, CEO of Specialdocs Consultants, an Illinois-based company that helps doctors transition into a concierge practice. “Physicians have become almost manufacturers. Concierge medicine gets back to the way medicine and primary care is intended — focusing on the patient and their whole personal wellness.”Of the nation’s 275,000 primary care doctors, between 8,000 and 10,000 doctors practice some kind of retainer membership, said Bauer, who has been researching concierge medicine since 1999.From what he has studied, retainer medical practices grow approximately 15 percent a year.Bauer sees the model providing not only preventative care — saving a patient from future health problems — but also quality post-situation care, giving a patient with the care needed to make a full recovery after an event like surgery.“If a doctor has more time and is more satisfied in his or her work, patients will receive better care,” Bauer said. “It is good for the doctor, it is good for the patient and it is good for the United States in terms of cost reduction.”As insurances reimburse less for medical services, Mignoli said it is becoming less viable to operate an independent primary care practice. Shifting his practice to a concierge model, he said, was the best business move.“Health care is costing more and more,” Mignoli said. “There has been pressure from government and insurance companies and patients to cut costs, and this is how that is being done. One of the consequences of that is that it is impossible to continue a small primary-care practice.”In the Highlands Ranch and Lone Tree areas, Mignoli knows of six other concierge medical practices. He believes more small health-care providers will make the switch in years to come.“The number of practices that I know of has increased remarkably over the last 10 years,” he said. “It really is one of the few options for a small primary-care practice to remain as that kind of practice.”At Mignoli’s practice, an annual fee of $2,100 covers office visits, lab tests, selective vaccinations and a comprehensive wellness exam. He does not accept insurance.Time and access are the most important parts of a concierge practice, Mignoli said. To ensure that he can provide an excess of those components, Mignoli sees far fewer patients than the average practitioner.The average concierge medical practice will see an average of 300 to 600 patients, 20 percent of what average practitioners shuffle through their office, Mignoli said.Patients have Mignoli’s personal cell phone and can contact him after hours and on weekends. He will travel to a hospital or visit a home if a patient cannot make it to his office.“The reason that I did this was that I believe patients deserve to have a deeper level of relationship with their physician,” Mignoli said. “I make less money now than I did before, but I am happier and my patients are happier.”Marie Degennaro, a patient of Mignoli’s for more than 10 years, decided to stay with Mignoli when he made the transition.“He is so caring and so knowledgeable,” Degennaro said. “He always answers my calls — I can always get in to see him. He spends a lot of time with us and answers all my questions, no matter what they are.”Mignoli’s office, located at 9218 Kimmer Drive, Suite 106, sees patients from Castle Rock, Lone Tree, Parker, Highlands Ranch, Centennial and Denver.“I feel more like a doctor than I ever have before,” Mignoli said. “I feel like I am doing more patient care as opposed to chart care.”
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