Dr. David Li’s question was both strange and welcomed.
When Amy Heilshorn took her two young daughters for their first appointments with the local family doctor, among the questions Li asked her was how happy the girls generally are.
"I’ve never had a doctor ask that before," Heilshorn said. "He cares about the holistic health of the person."
Li (pronounced "lee") does a lot of things most doctors don’t do. He charges patients an annual fee that allows them unlimited office visits without an insurance copay. In fact, his practice doesn’t deal with insurance claims at all.
Patients typically can get in to see him the same day they call – or the next. Appointments can last 30 minutes or longer. Li can devote more time to each patient than most doctors because he plans to limit his practice to 1,000 to 1,200 patients – about one-third of the standard patient load.
"We believe our model is the future," said Li, who in early 2014 opened an office at 10020 Dupont Circle Court, Suite 140, on the city’s north side. "We not only treat your disease, we work together with patients. We try to make them not (get) sick."
About 4,400 similar practices exist nationwide, according to a late December blog posting on the American Academy of Private Physicians’ website. The academy is an Indianapolis-based professional association for doctors with concierge, boutique, direct pay or retainer practices.
Only about 3 percent of U.S. physicians use that payment model, according to a 2014 survey by Medscape, part of New York-based WebMD Health Professional Network.
An official with the Fort Wayne Medical Society was unaware of any local practices that are similar to the one Li is launching. A recent search of www.privatephysicians.com found several concierge practices in the Indianapolis area but none in northeast Indiana.
A model practice
The business model has even more variations than it has names. Some practices file insurance claims, and some don’t. Some charge fees per visit, and some don’t.
The cost also varies greatly, with some practices charging thousands per person and others charging fees based on a patient’s age.
Li charges $800 for an annual adult membership – or $69 a month. Payments can be made monthly, quarterly, semi-annually or annually. The second adult family member pays $700 a year. Children younger than 18 can be added to the plan for $500 each.
He recommends that patients buy high-deductible health insurance coverage in case unexpected – and expensive – treatment becomes necessary. Li believes the savings from paying lower premiums are typically enough to cover his annual fee.
"We’re an affordable version of concierge medicine," said Li, a Chinese national whose given name is Tai Wai.
Li graduated from the Medical College of Jinan University in June 1990 and was a doctor in practice in China, where he also did clinical research for two years. He moved to the U.S. in 1998 and after receiving additional training applied in 2011 for a license to practice medicine in Indiana. Li declined to reveal his exact age, but his licensing application places it at 49.
Li launched his boutique practice, Premier Medical Home, early last year after becoming frustrated by the limited time he could devote to each patient. Some doctors see 30 to 40 patients a day, sometimes for as little as 10 minutes each, he said.
As a doctor on staff at Dukes Memorial Hospital, a Peru hospital owned by Lutheran Health Network, Li had only enough time to treat symptoms rather than delve into ways to prevent illness. To make matters worse, his patients often had to wait four weeks for an office appointment with him.
"Everybody hates that situation. Even the doctors themselves hate it," Li said.
After researching various options, Li spent the past year building up his local practice while continuing to treat patients in Peru until November. A non-compete agreement restricts Li from establishing a new practices within 25 miles of Dukes.
Lutheran Health spokesman Geoff Thomas said concierge practices have thrived in some big cities. But, he said, attentive care is also available here in more traditional office settings.
"To their credit, physicians and midlevel providers in our medical groups already strive to offer some of the benefits found in the boutique model such as same day/next day appointments – but with less out-of-pocket expense for patients," he said in a statement.
Lutheran Medical Group is among the Fort Wayne-based health care provider’s medical groups.
Establishing a practice outside the mainstream might not be easy, Thomas said.
"The success of a concierge practice in this area could ultimately hinge on several factors, not the least of which is whether it can recruit enough patients who are willing to pay more out of pocket for service they may only use once or twice a year," he said.
The personal factor is also at play.
"Patient-physician relationships are important," Thomas said, "and the providers in our medical groups that make up Lutheran Health Physicians strive to create one-on-one relationships with their patients."
A Parkview Health spokesman didn’t provide a comment.
As of mid-January, about 100 patients had signed on with Li. Among those are the Heilshorns, who were looking for a primary care doctor after moving to Fort Wayne, and at least one patient whose doctor had recently retired.
Li’s practice has its limits. He has to refer patients who need surgery or other specialized care to other doctors. But he favors physicians who are willing to offer patients a discount when they pay in cash.
Li encourages patients to have high-deductible health insurance in case of medical emergency, such as a burst appendix, and use him as their primary care doctor.
One of his patients recently needed a shoulder X-ray. Li was able to negotiate a $10 price for the imaging procedure.
Li prefers not to prescribe drugs, but when he does, patients can buy them from the practice at wholesale prices. His holistic approach to wellness includes diet, exercise and herbal remedies.
He uses longer appointments to teach patients exercises that help alleviate symptoms of some chronic conditions, including chronic obstructive pulmonary disease and diabetes.
Li, who accepts all patients regardless of pre-existing conditions, encourages people to lose weight and get healthy. But he isn’t a magician.
"If you’re really, really not willing to work," the program won’t work, he said.
Li is the only doctor with the practice now, but he expects two more physicians to join in the next year. Although various doctors have expressed an interest in the practice, some have to wait out terms of their non-compete agreements with local health care providers Lutheran and Parkview Health.
Eventually, Li would like to operate a clinic that is open six days a week with appointments available until 7 p.m. Now, his office is open on Monday, Tuesday and Thursday, but patients can call in from 9 a.m. to 7 p.m. Monday through Saturday.
On days when he’s not in the office, Li calls patients to discuss their symptoms and see whether he can diagnose the illness over the phone and call in a prescription, if necessary. If a phone call doesn’t do the trick, he’ll see them at the office the following day.
Li eventually wants to open clinics in other parts of Fort Wayne.
Heilshorn, 36, had never heard of the concept before receiving a flier from Li’s practice last summer.
"Normally, that kind of advertising wouldn’t work, but they hit me at the right time," she said.
The mother of Bailey, 8, and Zoe, 6, moved to Fort Wayne early last year with her architect husband, Billy Heilshorn. The family has catastrophic medical insurance, but they needed a plan to provide discounted office visits, prescriptions and tests.
Amy Heilshorn contacted the practice with a list of questions.
"They just were so open and met with me several times," she said. Li "doesn’t rush me. He makes sure I get all my questions answered."
Mike Walton, who lives outside Leo-Cedarville, has been a patient of Li for four or five months.
The 59-year-old was looking for a new doctor after his physician, Dr. Bruce Guebard, retired. Walton attended a networking meeting where Li’s practice was discussed. Walton didn’t flinch at the $800 annual fee.
"It was dramatically less than the medical insurance I was having to pay," he said.
Several things appealed to him, including the $99 charge for a full blood work-up, unlimited office visits, and rarely having to wait more than five minutes to see the doctor once you arrive for an appointment.
Walton, who works for a Maryland-based human resources consulting firm, is generally healthy. But his family has a history of diabetes.
He likes Li’s holistic, preventive approach to medicine, which is similar to Walton’s former family doctor.