HEALTH CARE:

For extra bucks, some get perks

Pregnant women who can pay can opt for concierge-style of care

Chris Morris

By Marshall Allen (contact)

Monday, Jan. 5, 2009 | 2 a.m.

Archive of Sun health coverage

A Woman’s Place OB/GYN

When most expectant mothers visit their obstetricians, they don stiff paper gowns.

Platinum Mommies enjoy plush cloth gowns.

Other pregnant women may have lengthy waits in their doctors’ offices and have a hard time reaching physicians after hours with questions.

Platinum Mommies can make same-day appointments (no waiting), and they have their doctors’ cell phone numbers.

And while other moms and newborns may ride home in the family car, Platinum Mommies and their babies are chauffeured home in limousines.

There’s another difference, too: Platinum Mommies pay $3,500 for their VIP treatment.

It sounds sweet for the mothers who can afford it. And the doctors providing it say charging more and taking fewer patients — boutique-style medical care — is essential to their survival.

The strategy is not new to Las Vegas. The MDVIP program, launched in 2004 in Southern Nevada, is the best-known concierge medical organization in Southern Nevada, with 15 participating physicians.

The Platinum Mommies program broadens the concept to the world of obstetricians and gynecologists. Doctors say they’re turning to it because of low insurance reimbursement rates that force them to run high-volume clinics. Charging patients a significant fee over-and-above their co-pays allows them to reduce the workload through attrition, leaving them more time to focus on the privileged patients who can afford to remain with the practice, and who then get pampered.

The concierge trend illustrates how the wealthy can buy better health care. The United States boasts the best medicine in the world — for those who can afford it. But for the poor, the standard of care is far below those of other developed nations. Low income Las Vegans may have never been in such dire circumstances. (University Medical Center, the county hospital that cares for most indigent patients, recently cut its oncology program, leaving low-income cancer patients with no place to turn.)

Three obstetrician-gynecologists — Drs. Robi Burns, Haydee Docasar and Maria Keller — at A Woman’s Place in Henderson created the Platinum Mommies program because they were at their wits’ end, Burns said. She said the problem with the old model was that each doctor was providing 13 office visits over the term of a pregnancy, plus labor and delivery, for about 20 patients a month.

For that almost yearlong commitment per patient, they earned a private insurance reimbursement fee of about $1,400. That income was offset by high overhead, including malpractice insurance and a dozen employees to handle the workload, which included billing about 60 insurance companies, each with its own rules and procedures.

The doctors were working so hard to see enough patients to pay the bills, “we didn’t get to know people,” Burns said. “You hop from one hospital to the next catching babies like you’re using a catcher’s mitt.”

About a year ago the three physicians asked one another: Who’s happy here? Who thinks we’re giving the best care we can give?

“We said we need to either change the way we’re doing it or stop doing OB,” Burns said. “This is not what we got into this field to do. We’re not happy with it. This should be fun.”

The doctors based the Platinum Mommies program on the MDVIP model, Burns said. Insured patient cannot be charged extra for medical care, so they came up with the luxurious perks. But mainly, Burns said, patients are paying extra to get access. They can have unlimited appointments. They can take as much time as they want. They can call anytime on the doctors’ cell phones. Now each doctor sees only about six patients a month.

The hard part has been turning away existing patients, Burns said. And some have not been happy with the change. An expectant mother and existing patient named Jennifer was excited for her initial examination when she called A Woman’s Place about a month ago. But she was offended when the receptionist told her she would have to pay the Platinum Mommies fee or find another doctor. Jennifer, a nurse, said she doesn’t have sympathy for the OBGYNs, who surely knew about the workload and reimbursements when they got into the business. It is “ridiculous” to ask patients to pay for the extra “fluff” that come with the Platinum Mommies program, said Jennifer, who asked that her last name not be used because she works in health care in Las Vegas.

She said the receptionist seemed sheepish on the phone.

“What you’re telling me is that you are weeding out the middle class and that you only want rich patients?” Jennifer recalls asking the employee.

“That’s not our intention,” she recalls the woman saying.

“That is what you will have,” Jennifer says she responded. “Because nobody in their right mind will pay out of pocket. Who cares about a limo ride home?”

Despite a low ratio of OBGYNs to patients in Las Vegas, Jennifer said she was able to find another doctor.

Dr. Florence Jameson, a long time Las Vegas OBGYN and former president of the Clark County Medical Society, said she wishes the best for the new concierge-style practice.

“More power to them if they can get the patients — especially in this economic climate — to give them $3,500 for services above and beyond global OB care,” Jameson said.

Jameson said OBGYNs using the traditional pay structure are able to provide quality care for patients, but it’s time consuming, and that their workdays can extend into the evening. Patient visits should not be hurried, Jameson said. Each is supposed to last 15 minutes, which she said is plenty of time for an examination and to educate patients and answer their questions.

Jameson, who in her spare time is working to open a free clinic for indigent patients staffed by volunteer doctors, said it’s not in her nature to start a concierge practice. It would be too hard to turn away patients who can’t afford the fees, she said.

“If they’re my school teachers I’ve been seeing for 10 years, I’m not going to say no to them,” she said.

Discussion: 16 comments so far…

By Berno52

1/5/09 at 10:31 a.m.

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Drs. Robi Burns, Haydee Docasar and Maria Keller reportedly based their model on MDVIP. Though that may have been their intent, their model actually bears no resemblance to the personalized health care program developed by MDVIP.
I am the medical director of MDVIP and wish to emphasize that our program is predicated upon prevention and health maintenance. To achieve this goal we utilize electronic services such as online medical records, personalized web pages, wallet sized CD's of medical history, and assessment tools for evaluation of nutrition, exercise, sleep hygiene, mental health and alcohol and tobacco use. We have begun to incorporate cutting edge technologies such as genetic testing.
We offer no heated towel racks, no amenities, and no reservations. We simply practice personalized health care. "Concierge care" is the antithesis of what we do.
By redferret

1/5/09 at 4:03 p.m.

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Kind of disgusting. I mean sure the rich can have what the rich want, but what about the working Joes/Janes. If more medicine follows this trend, the middle class and working class will get shoved out even though they have insurance.
By anthemccresident

1/5/09 at 5:07 p.m.

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Berno, please spare me the spin. In your own marketing materials to doctors, you tout the concierge aspect of aligning with MDVIP. Less patients, more money.

Quite frankly, the reason MDVIP exists is because insurance companies do pay so little combined with high malpractice insurance rates because of the sue-happy society we live in.
By vegasmom

1/5/09 at 6:19 p.m.

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Dr. Docasar was my doctor for a couple of years before she moved up to their new office. I followed her up to the new office and had been seeing her there for a couple of years at the new office. I became pregnant and went to their office all through my pregnancy and Dr. Docasar and Dr. Keller had delivered my daughter in Oct. of 07. When I became pregnant again less than a year later I had gone a couple of times for regular visits before I was informed of the "Platnium Mommies" I was told someone would get a hold of me and tell me what it was. Never did anyone tell me I found out on line. I didn't know the cost I thought one penny over what my insurance covered that I work hard for through my employer was too much. (3500.00 is insane!) I am a high risk patient and was at the end of my first trimester and needed to find a new doctor soon. I was highly offend that these three women only had dollar signs in their heads instead of the welfare of fellow women carrying another life. When I emailed to have my records forwarded so I could see another doctor(a lot of docotors wont see you until you get your records) I thought they would actually help in that process since they were pretty much turning me away because I didn't have or wouldn't pay the extra money. I was wrong a week and a half later I called to inform them that I would come to their office in 2 days to pick them up they said they didn't have them ready or have my request and that I would have to refile for my records and it would take 10 business days. Anyway after back and fourth I finally got my records to my new doctor 3 weeks later! I don't need a limo ride. I don't need endless ultrasound picutes. Your spouse or family member takes you to the hospital anyway what are you going to do leave your car there so you can take a limo ride. I have never heard of something so absurd in my life. I want healthcare my unborn baby deserves not a greedy group of women trying to make more money. I thought I had found a special group of women that I was happy to see and comfortable with. I was very wrong.
By azsk8fan

1/6/09 at 6:53 a.m.

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And if you're uber-wealthy like the movie stars you can even name your kid some god-awful made up name and no one will think anything of it. God help those poor kids as they are growing up - of course if they're going to some private school with a bunch of other uber-rich kids with weird made up names they'll fit right in now won't they.
By azsk8fan

1/6/09 at 7:12 a.m.

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IT's a shame but some people with a lot of money actually do believe that they are better than someone less fortunate - like how does having more money make you a better person? Sad but true that there are REALLY people in the world who think like that. My mother had a wonderful old saying ..... "Rich or Poor, Young or Old, when we take a S..t (crap) it still stinks the same." I wholeheartedly agree with her.
By redferret

1/6/09 at 9:23 a.m.

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Amen Vegasmom. I've got a question, and maybe it's just that I'm too thick...What's the deal with the $3500. Is that flat rate, per visit, or per month/worse?
By no1fotbalmom

1/6/09 at 2:54 p.m.

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I think everyone is getting this service wrong! Are you a pregnant woman and been to your OB, and left sitting in the waiting room to see him/her for 3 hours or more. Or had a question at 2 am and their answering service gave you this answer, "This is not an emergency we can not page the doctor for you, if you feel it is an emergency go to the ER." Well I have been pregnant and both of these things happened to me during my second pregnancy, high risk pregnancy, on a home pump preventing me from going into labor at 16 weeks. To have full access to my doctor without someone that does not have MD at the end of their name making important decisions or my doctor being to busy delivering other babies to see me at my scheduled appointment time, would've been ideal for me. I wish this service was there when I was having babies, I would of jumped at the opportunity to go with this program. I am a middle class working mother and still would've paid for this service. I look at it as these three women giving up something, to give their patients quality care at any time.
By awpobgyn

1/6/09 at 7:43 p.m.

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Respectfully we feel that we must reply regarding our Platinum Mommies service at A Woman's Place Ob/Gyn. The current practice standard for most OB's is to deliver anywhere from 20-30 patients each month per physician. When pregnant patients call the office with problems/concerns, if the office is too full to fit them in or is closed, patients are often directed to go to the hospital. Many times this occurs because an "on call" doctor is covering their doctor, their doctor is busy seeing other patients or is away at another hospital delivering a baby. This can lead to long waits in the ER or L&D with multiple tests being performed sometimes unnecessarily. We offer direct access to us via our cell phone with as many visits as patients feel are needed. We save families wasted time in a hospital and concerns are addressed immediately either by talking over the phone or by bringing them to the office and if the office is closed we open the office after hours. For patients who are uninsured the cost of an unnecessary hospital visit would be much more than our fee. Yes we have thrown in extras such as a ride from the hospital in a limousine, 3D/4D Ultrasounds and routine ultrasounds at every visit, but this is only to make their experience more memorable and exciting because as women we feel pregnant women deserve a special experience. We have an electronic medical record with 24 hour access to it with the ability to send their records at any time to any hospital (most importantly, we already know all our individual patient's history), there are several visits with a personal trainer who develops an exercise and diet plan for each patient and in-home massages are included because we believe in the benefits of massage therapy for pregnant women. By having a maximum of 5 patients each month who will deliver, we are able to spend 30 minutes or more with every patient at each visit, we have time to evaluate their mental health and discuss any and all concerns as it relates to the pregnancy or otherwise. Many OB's are seeing so many patients that they don't have this amount of time because they are constantly running out of the office or returning to the office from deliveries. It is also distressing as a doctor when you are delivering at one hospital and you are called for an emergency delivery at another and a "Good Samaritan" doctor ends up performing your patient's emergency delivery or cesarean, and hopefully one is available! Are we making more money? No. We have significantly less patients. There are others who charge as much as $10,000- $20,000 for similar services. Most of our Platinum Mommies are from middle class families that have made the decision to invest in their care because of dissatisfaction with the current healthcare delivery system and the strong desire to have their doctor available to them for the delivery. This message is approved by Dr.'s Burns, Docasar and Keller.
By redferret

1/7/09 at 7:36 a.m.

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I'm sorry but the service sounds bloated and ridiculous. On top of that the propaganda you are putting out and approved by your office is also ridiculous.
First off, the fact that you throw in a limo service is... perplexing to say the least considering dad probably drove mom to the hospital. So are they to ferry the car back, or does dad not get to ride in the limo too?
Additionally, how dare you attempt to say your price tag is leveled at middle class people. At this time when money is incredibly tight, $3500 is a lot of dough on top of insurance payments, copays, medicine, and the other sundry charges one picks up in a pregnancy. Not to mention all the money needed to prep the house for baby's homecoming.
By kcb

1/7/09 at 6:39 p.m.

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Florence Jameson is my OB, and her advocacy for consistently superior medical care for *all* women is one of the reasons I've been her patient for 15+ years. I'm about to give birth to my first child, and I can't imagine having to find another doctor midway through my pregnancy because of some elitist change of policy like this one. Dr. Jameson knows me, knows my history, and has my absolute confidence because she has always made it abundantly clear that her goal is to make sure that women receive quality health care--no matter how much they are able to pay. Perhaps these three doctors are experiencing success and positive feedback from the patients who are interested in this sort of practice. Perhaps someday, they will be of a mind to offer quality health care to all women, instead of just self-identified VIPs.
By johnevegas

1/7/09 at 7:43 p.m.

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"I'm sorry but the service sounds bloated and ridiculous."

I dunno ferret. It seems to me that all this stuff is optional. If people are able and willing to pay, then I don't see what the problem is. After all, this is a city built on pampering people. Why does that have to stop of Ceaser's front door?

Come to think of it, this might be a good way to get people to come here for medical care. I am in a business that can provide such services to travelers, and have been approached by medical professionals before about similar things. Their clients want it.
By ALS80

1/7/09 at 8:16 p.m.

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Platinum Mommies is by far the best! I am a mother of two undergoing my third pregnancy, but first this is my first experience with Dr. Robi Burns of 'A Woman's Place.' Dr. Burns, and the platinum mommies program has exceeded my expectations in everyway. I have access to my doctor that I have never had with any other physician, which includes personal phone calls, text messaging, no waiting at the office, ultrasounds at every office visit. I was offered a nutritionist consultation, massage therapy, snacks at my office visits, and even same day appointments with the doctor. This V.I.P. service is well worth it! Some might say the price is high, but in the current state of decreased reimbursement for physicians, doctors only have a couple of choices. That is, they can see tons of patients, have long waiting times, and limit their patient contact time to a minimum, making the patients less happy. However, with this VIP medicine, both doctor and patient can each be happy. I am more satisfied with this pregnancy than my previous two, and I am sure Dr. Burns is happy knowing her patients are just a text message away. My family is not rich by any sense, but when it comes to high quality medical care, I was happy to participate. Platinum mommies is an +A!!!
By 702ron

1/8/09 at 9:36 p.m.

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I were referred to this doctor by a friend that just delivered with her. She was not required to do this program. Had a great experience. Me on the other hand...read on.
Our first visit was normal. I met the doctor, did an ultrasound and had a blood test. I was then called in for a second visit because there were more tests required, and sent to get more tests. The third visit was a typical pap, etc. this visit was when I met with the "OB coordinator", which was the salesperson for this platinum mommies program. This is where the nightmare began...
During NONE of these visits was it mentioned to me that they would not be able to deliver my baby if I didn't participate in this program. It was always presented as an optional program that was an add on package, not a requirement. Not until I was called back to see if I was going to participate in this program, was I told that it was a mandatory. When I asked why I wasn't not told it was mandatory, the receptionist said "well, its on our website" and they would "be happy to release my records"--How nice of them!! I now, at 17 weeks, had to find a doctor that wasn't completely booked. They also have still not released my records...maybe next week??
Look, I understand that some people want to pay extra for additional services...there's all kinds of suckers out there. What I don't understand is why I wasn't told about this on the FIRST VISIT!! Were they trying to get me to like them first? She asked if I could borrow the money from family or something. Don't you think if I was going to borrow money, it would be for the BABY, not the delivery!! They took me into a consultation room, which was one of the treatment rooms that had been converted into a "pitch" room. Was this a timeshare presentation? Was I taken on a test drive before we went inside to talk about the numbers?? I thought it was a doctor visit!! (by the way, my insurance and I were charged for this visit) Shouldn't this treatment room be used for what it is intended, treating patients? maybe then they could help people for the same price everyone else does.
I also thought that I pay for ridiculously priced insurance so that I get good health care from good doctors. I didn't realize that it was now required to pay more to have a doctor that answers her phone or performs required services. She talks above about how you don't get a lot of these things for "most OBs". Well, what about the ones you do get them from? Do you think they charge for being there for their patients? Don't you still bill the insurance for the visits anyway? And then get the extra money for...what? Is all of this really worth $3,500.00(which, by the way started at 5,000.00 but she was going to give us a deal!!)
As far as Im concerned, this should be all presented up front and made optional. This actually makes you a TERRIBLE doctor, not a better doctor because you see less people...etc.
By kworldtea

1/13/09 at 2:58 p.m.

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Thank you Marshall Allen for writing this article.

I was a patient of Drs. Burns and Docasar when they practiced at Women's Specialty Care. (used to be Women's Wellness Center). The doctor that delivered my baby, Dr. Kenneth Jones, from the same practice, has now apparently joined forces with A Woman's Place although their website does not mention him. Nonetheless, I am pregnant again and scared. Finding good doctors in Vegas is like climbing Mt. Everest in high heels.

When I first called A Woman's Place, I was directed to their website to read about this Platinum Mommies program. I asked the receptionist if joining the program determined my acceptance as a new patient. She answered yes. When I asked the cost, she failed to answer. Instead, she told me a coordinator would call me back with the details. It's 24 hours later and I haven't received a return call. Through this article I see the cost is $3500. Thanks for the info.

So what do we patients do? I understand the insurance nightmares and can sympathize with the doctors. Dr. Burn's quote regarding long waits and the inaccessibility of doctors are true. Women's Wellness did in fact fit that bill. However, even if I can afford the cost of their new program, I am not sure I want to. It feels like extortion.

At the same time, returning to Women's Wellness or Specialty Care, whatever they call themselves these days, doesn't seem like a good option either. Their new website sites 14! providers. Where is the service there? Patients undoubtedly are cycled through like cattle.

So my question is this, does anyone know of a good option? Where can we go where we will be treated well and not be personally condemned because of national insurance policies or tort reform? Does anyone have any recommendations for a good OB?

Thanks, Kim
By shekaye1

4/2/09 at 7:25 p.m.

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I would NOT suggest Dr.Docasar to anyone. I was a patient for yrs & saw again this yr for the LAST time. I've been expressing my pain for the last 3 yrs or so..she made me feel it's normal--of someone my "age"...which is just now 34. I tried to tell her it was not...was affecting my life, work, keeping appts, my mental state, etc.. FINALLY, I agreed to HER only answer. Birth control & a bottle of Prozac. I went to a fertility clinic 2 months ago to have eggs frozen--figuring birth control was indefinite. The fertility doc(Eva Littman)said NO to birth control--let's FIND THE PROBLEM & fix it. I'm happy to report I have a laproscopy scheduled to fix my problem. Dr.Littman did the ultrasound herself(Docasar never did--always a nurse)--found a damaged left tube with lots of fluid built up--def needed surgery. Dr. Docasar makes you feel like you're over-reacting--birth control/Prozac is the answer for everything. I knew better. I'm someone who would barely take medication after surgeries...and this pain has turned me into someone who now gets any kind of Loritab, Percocet, etc..from friends--I slowly began to take more & more...I started smoking pot at times. I've never smoked pot--can't stand drugs...esp pot...do not like the way it makes me feel--so sluggish& unmotivated & sleep as soon as I smoke it(probably because I take several puffs & over-do it to escape the pain).. Don't misunderstand me--the times I actually take any pills or smoke is only about HALF of the time I hurt. I FEEL like a junkie, as I rarely even took Advil for a headache...but I def am not. I make it thru many, many cramps with nothing to help every month. It's just that after a few days & non-stop pain---my insides will be sore, my head feeling like I am a mental patient, etc...like I don't care to live--it is such a low feeling that I'm willing to take or smoke about anything.

I hope that people will read this and will refuse to stick with just one doctor for very long if they aren't taking a real concern for your health. I WOULD NOT recommend Dr. Docasar at all after my experience. I would, however, recommend Dr. Eva Littman!! She is a FERTILITY doctor that cared enough to help fix my problem. I was there to have EGGS FROZEN & my side comment of having pain & going on birth control was only a comment made as to why I was there to pay her to freeze my eggs. She could have said ok...and moved fwd with the procedure I was there to pay her to do. She did not. She CARED. She said..let's FIND THE PROBLEM. I feel so good about that. What a GREAT lady!! I hope someone reads this for a good referral to Dr.Littman and one NOT suggesting Dr. Docasar. Bottom line: LISTEN TO YOUR BODY and GET 2nd OPINIONS!!!