Month: December 2018

Same and Next Day Appointments

As a member, same or next day appointments are the norm, not the exception. You can be sure that you’ll be able to see your physician whenever any health concerns arise.

Relaxed Office Visits

At Nu-Living we limit the number of patients who are members. This way we can practice medicine the way it should be: A doctor and patient interacting in a relaxed, caring, private and personal environment.

24-hour physician contact

Recognizing the need for ongoing care outside of the medical office throughout the entire year, Nu-Living Concierge Medicine patients have direct, 24/7 access to Dr. Terlinsky by phone, e-mail and text message.

Coordination and Advocacy within the Medical System

While Dr. Terlinsky will be able to address most of your health concerns directly, if is sometimes necessary to consult a specialist or get treatment elsewhere. In these cases, Dr. Terlinsky acts as your health advocate, coordinating with other health care providers and helpingy you navigate through the medical system.

In-Office Blood Work

All blood work is done conveniently for you right at the Nu-Living office. There is no need for you to go to make a separate appointment at an outside lab.

Emphasis on Preventative Care

Our primary concern is for your long-term well-being and continued health. We want to not only treat immediate concerns but also work to prevent potential problems down the road.

Comprehensive Nutritional Assessment

Every concierge medicine patient is given a thorough nutritional assessment, and efforts taken to correct nutritional deficiencies and metabolic abnormalities.

Personalized Wellness Plan

Concierge medicine patients are provided an annual wellness plan used to help track progress on long-term health goals..

On-line Patient Portal

Nu-Living Concierge members are given access to a secure patient portal to communicate with Dr. Terlinsky and his staff about prescriptions, the need for medical appointments, important patient status updates, education, and much more.

Phones Answered by Real People

When you call the Nu-Living office, you can be sure that you will reach a live person and not talk to a recording.

All Care Provided by a Physician

You will never be seen by a nurse or nurse practitioner.

Services for basic officie visits, annual history and physical exams and typical medical diagnostic tests such as EKG, chest X-rays, etc., are provided by Alan S. Terlinsky MD PC, a distinct medical corporation which doesparticipate with many insurance companies. Thus, these services are submitted to those insurance companies with which Alan S. Terlinsky MD PC has contracts, including Medicare. Customized Private Physician Primary Care  Program  ( Concierge)  patients are able to use their health insurance for these services. All other enumerated services and amenities comprising the Customized Private Physician Primary Care  Program   are NON-COVERED SERVICES not subject to insurance company or Medicare coverage and  reimbursement. These NON-COVERED Services are included in the yearly fee and are enumurated in detail in the annual membership agreement. This fee is paid to Nu-Living Optimal Wellness and Longevity Center, PLLC (NLOWLC, PLLC) for the Nu-Living Customized Private Physician Primary Care  Program   and its services and amenities. (See below for the breakdown.)

Nu-Living Optimal Wellness and Longevity Center, PLLC is a distinct corporation and separate entity from Alan S. Terlinsky MD PC. Nu-Living Optimal Wellness and Longevity Center, PLLC (NLOWLC, PLLC) has no contractual arrangements with any insurance companies or Medicare. Therefore Nu-Living Optimal Wellness and Longevity Center, PLLC has no obligation to file claims with any insurance company or Medicare and does not provide any documents or codes which are often asked for by insurance companies or Medicare.  The Nu-Living Customized Private Physician Primary Care  Program  does not provide Medical Servcies for which are covered services under commercial health insurance plans or Medicare.

The Nu-Living The Nu-Living Customized Private Physician Primary Care  Program    (Concierge Medicine Practice)  uses new technologies and tests along with extensive screening tools to create a Personalized Wellness Plan, which are features not provided by HMOs, PPOs , Medicare and other insurance company plans. These services and amenities are provided by Nu-Living Optimal Wellness and Longevity Center,PLLC (NLOWLC, PLLC) .

The Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine) fees are not submitted to insurance as Nu-Living Optimal Wellness and Longevity Center, PLLC has no contractual arrangements with any insurance company AND these services are NON-COVERED. The NLOWLC, PLLC and theThe Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine) will provide a general statement of services provided. Some member patients may be eligible for flex accounts or HSAs reimbursements but The Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine) makes no guarantees that any of its fees for its services and amenities will be eligible. The Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine)members should check with their plan administrators to determine eligibility.

The Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine) is not a health insurance entity such as Blue Cross, a PPO or an HMO. The The Nu-Living Customized Private Physician Primary Care  Program (The Nu-Living Concierge medicine) has no insurance company contractual agreements, nor does it have any contractual agreements with any government entity such as Medicare or Medicaid.

Nu-Living patients explain why they have chosen to enroll in Dr. Terlinsky’s concierge medicine practice.

The Healthcare Mess

Doctors and patients are expressing great dissatisfaction with the medical care system. Patients are dismayed by delays in obtaining appointments, visits that start late, unreturned phone calls, harried office staff, obstacles in obtaining prescriptions, and hurried doctor visits that don’t fully address their concerns. Patients feel their medical needs are ignored as doctors rarely have time to counsel them or answer important medical and health questions. Increasingly, patients are attended to not by doctors but by nurse practitioners or physician assistants, where visits are disorganized, impersonal “factory assembly lines” during which no one appears to actually know the patient’s name or provide “old-fashioned“ personalized care.

Why is this happening?

Reimbursements for primary care services by managed care, Medicare and Medicaid are rapidly declining while internists, family physicians and primary care physicians are faced with concurrent mountains of new non-paid administrative tasks. Things have reached a tipping point where primary care doctors are concluding that their practices are not economically viable unless they see a large volume of patients for brief 5-7 minute office visits. These visits leave little or no time for complex medical problems, counseling about preventative strategies and careful examination, diagnosis and treatment. As a result, the number of physicians selecting internal medicine or family medicine careers dropped 27% between 2002 and 2007. The problem is exacerbated by a shortage of physicians that is expected to reach 124,000-159,000 physicians by 2025. This does not include another 25% projected shortfall on account of the passage of universal healthcare coverage. The projected growth of the U.S. 65+ age group through 2025 will be 4 or 5 times the growth of the number of physicians during the same time period.

The Concierge Medicine Solution

In 1996, Seattle doctor Howard Moran concluded that the only way he could provide high-quality medical care was to attend fewer patients each day. He asked his patients to pay an annual “retainer” fee in exchange for highly focused, individualized medical care. Concierge medicine was born. Concierge medicine is an intensified, patient focused relationship between a doctor and his or her patient wherein the patient pays an affordable fee for improved access and high-quality individualized medical care. This personalized medicine is as affordable as a cell phone or cable TV. Concierge medicine returns to the old days of medical practice where the doctor-patient relationship was most important while providing the modern miracles of advanced medical care.

I have been a patient of Dr. Alan Terlinsky for about 15 years. Dr. Terlinsky has two characteristics that attracted me to his practice and have kept me as a patient all these years. The first is that I have always regarded him as extremely knowledgeable, in both depth and breadth, and works very hard at keeping current with the state of the art in medical advances. Secondly, I have always been extremely impressed with the time and attention he gives to his patients. He stands head and shoulders above doctors I have know in listening to and informing his patients. He has never put his patients “on a treadmill,” trying to see as many patients as possible in any given day.

The Theory Behind the ACO

The PPACA, The Patient Protection and Affordable Care Act, has enabled the creation of so-called Accountable Care Organizations. These organizations are designed to create partnerships between various components of the healthcare delivery system including physicians, hospitals, health insurance companies, government health insurance, pharmaceutical companies and just about everybody involved in providing care to a patient. The idea is to create an organization that will provide comprehensive, coordinated and seamless medical care to patients, which will provide high quality care based on what is known as Evidence Based Medicine and is also cost effective. These organizations will be expected to provide patients with immunizations, nutritional education, medications and everything that guidelines from Evidenced Based Medicinerecommends for optimal patient care for disease prevention and chronic condition management. The key component is that the ACO will receive a lump sum payment, from a government insurance plan like Medicare or a commercial insurer, to divide among the various parties caring for the patient including primary care physician, specialty physician, radiology, durable medical equipment suppliers, pharmacists, the hospital etc. If the ACO provides quality care based on metrics set by the government or insurance company and saves money on the estimated average cost for the patient’s condition, the accountable care organization will receive a bonus to distribute to various providers of service including the physicians. Physicians will no longer receive a fee for each service they perform, but will be given some sort of basic payment per patient similar to HMO capitation.

The ACO will be given a specific pool of Medicare patients, at least 5,000, to care for in a comprehensive fashion and will strive to produce theoretical savings from the estimated cost of the care for these 5000 Medicare patients. As you can see there will be a fair amount of government estimations of the cost for caring for these patients. Savings are achieved, in theory, by promoting preventive medicine, coordinating care and utilizing other means to keep patients healthy and avoid unnecessary hospitalizations.

The Problem with ACOs

Critics of the ACO system are concerned that there seems to be an emphasis more on accountability than the care. One of the ways that quality will be measured is comparison of the cost of care from one doctor to another. If two physicians treat a case of back pain and get the same result the quality is not necessarily the same because one physician may have spent too much money in treating the patient. An MRI may not have been necessary for the patient to recover from a minor back strain. Therefore there will be pressure on physicians to avoid overtreatment and overspending. Established protocols will set an arbitrary amount cost target, for a particular condition, required for its care. The physicians who are able to provide effective care at lower costs will likely be the ones to receive bonuses. Physicians may also shy away from treating complicated patients or noncompliant patients who may require more care increasing the ACO’s expense. Risk is only shared by the providers of the care, not the patient themselves. Many doctors are dubious about putting themselves at financial risk with patients who have no incentive to follow medical advice or to change to more healthy lifestyles.

Critics of the ACO system are concerned that there seems to be an emphasis more on accountability than the care.

Many physicians are skeptical of this sort of partnership arrangement between physicians and hospitals or health insurance companies. Physicians who are employed by the health insurance companies or hospitals to work in ACOs dominated by the funding from the insurance company or hospital will have very little say when it comes to the finding quality and costs. It also remains to be seen whether physician directed ACOs will survive without deep capitalization pockets. Many feel that ultimately ACOs will either be hospital or insurance company owned and operated.

Saving Money at the Expense of Quality Care

Many feel that ACOs are not primarily interested in quality as much as they are interested in saving money.

When it comes to deviating from established treatment protocols. Many feel that these organizations are not primarily interested in quality as much as they are interested in saving money. If the doctor’s salary or bonus is dependent upon strictly following “cookbook medicine” protocols, what will happen if a patient has a condition that requires spending more money that is allotted? This sounds very reminiscent of the HMO experience of the 1980s, which the public soundly rejected when it was clear that there were financial incentives in place that clearly put the physician and the patient in conflict of interest. It is hard to see the difference between the HMO financial incentives for physicians of the 1980s and the ACO financial incentives created by the PPACA.

What could this mean for the doctor-patient relationship?

If the patient does not realize that their physician is seeing them as part of an ACO, what will happen if that patient comes in complaining of chest pain? Their physician may think to themselves, ”Hmmm, this 43-year-old woman who is complaining of some substernal chest discomfort could have a cardiac condition or heartburn.” The protocol from the ACO suggests that she has low risk factors and therefore should not be given a stress test and quality dictates she should be empirically treated for heartburn with over-the-counter medication. Since the physician is focused on efficient care, he may elect to follow the ACO conservative low cost protocol. On the other hand, a personal physician knowing this patient very well may have a different take.

Suppose she is a patient who rarely complains of anything. Knowing this, an astute physician with many years of experience may reason that it is important to rule out a serious condition first such as an impending heart attack even if the odds favored the heartburn as the cause. A patient who puts their trust in their physician to do what is called for, may be taken aback when the physicians judgment is influenced by how his ACO employer views his decision to deviate from the ACO protocol and order the expensive heart stress test. Suppose the physician had a similar case earlier and chose to do the stress test, which was negative. Now faced with another similar situation, not wanting to cause further damage to his cost profile, the physician may be even more biased towards conservative care. Who would want to be a patient of a physician who was under pressure to avoid spending money on tests that turn out to be negative? Furthermore the physician does not inform the patient that his or her judgment could be also influenced by the bonus system involved with the ACO. The patient cannot read the physician’s mind.

The Nu-Living Concierge Medical Practice

Contrast this situation with how Dr. Terlinsky would care for a patient in his Nu-Living Concierge Medical Practice. Dr. Terlinsky has only one concern with this patient: is she in danger of having a heart attack? Does she need to be hospitalized? Should I have a cardiologist see her tomorrow? Moreover, if the next patient Dr. Terlinsky sees has another problem, should Dr. Terlinsky worry that his decision on the previous patient could place limitations on his approach to the next patient? The traditional relationship between the doctor and the patient provides for the doctor to do everything his knowledge, skill and perhaps his gut instinct tells him to do the benefit of the patient. There is no room for the doctor’s personal gain or threat of personal loss to influence his decision. Patients are likely to learn about this change in the relationship between their doctor and themselves under an arrangement such as the plan for an ACO. It goes without saying that Dr Terlinsky pledges not to participate with any ACO, similar to his decision to avoid participation in the old capitated HMOs.