If you see Lyndell Scoles, a physician who practices internal medicine in Columbia, he might prescribe you a book to read. He might drop by for a house call or use an app to find you low-priced medicine. He might even trim your toenails.
And with an innovative, comprehensive model of medicine, Scoles has time for it — time to respond to the two phone calls, four texts, two photographs and one online message he received from his patients this weekend.
Welcome to Scoles’ world of personalized preventive care, popularly known as concierge, retainer or boutique medicine.
It’s like Amazon Prime or Netflix — but instead of free two-day shipping or “Stranger Things,” you get a doctor.
Originally, “it was one of those things that I felt was too good to be true,” Scoles said of his initial response to personalized preventive care. “What’s the magic potion?”
Patients in this membership-based medical model pay an annual fee for something that a one-time trip to the hospital can’t give: affordability, accountability — and permission to text your doctor on nights and weekends.
Amid the ever-changing landscape of health care in America, Columbia’s concierge scene has grown since 2014 to include three internists, including Scoles, who’ve joined Medical Doctor Value in Prevention, a national network of personalized preventive care doctors.
In this model, patients pay an annual fee between $1,650 and $1,800 — which comes down to between $4 and $5 a day (about the price of a pumpkin spice latte). The fee takes care of services not typically covered by insurance companies, as well as one-on-one counseling with your doctor and no-wait waiting rooms.
Physicians under the MDVIP model accept insurance and Medicare, unlike many direct primary care practices like Liberty Family Medicine and Big Tree Medical Home.
Although words like “concierge” and “boutique” can connote wealth, the local clientele spans many income levels and walks of life.
“I have school teachers, bus drivers, truck drivers, business owners, the elderly, (students),” Scoles said.
Before Scoles switched to this model of medicine, his practice served close to 5,000 patients. Now, he said he takes care of around 800.
In this model, doctors like Scoles have “more time, tools, and availability to invest” in their patients’ care, CEO of MDVIP Bret Jorgensen said.
Before he became a personalized preventive care physician, Scoles only had time to, while taking care of his many patients, fulfill his continuing education units required for doctors in the United States.
Now, Scoles uses downtime in his day to invest in new technologies, read Medical Economics magazine and pursue comprehensive care for his patients. In his smartphone, for example, is the Kardia app — a program that allows his patients who experience an irregular heartbeat to send him a recording of the issue within two minutes.
Scoles also uses GoodRx, an app that allows patients and doctors to search for the cheapest drugs available at local pharmacies. Scoles said the app is like GasBuddy for a pharmacy.
“What we’re trying to do is just provide a comprehensive package so there’s not anything left undone at the end,” he said.
The “cornerstone” of this model is the annual wellness program, a comprehensive physical exam that takes about 1.5 to two hours per patient, per year, to complete, Jorgensen said.
The annual wellness program includes everything in a traditional physical exam and much more, helping patients “sort out the details,” Scoles said.
A week before the exam, a sample of the patient’s blood is tested to determine the patient’s risk of stroke, heart attack, arthritis, diabetes, vitamin D deficiencies and even cancer.
“I’ve discovered several cancers in the very earliest stage, which is before you would formally diagnose what’s happening,” Scoles said.
Scoles customizes his exams for each patient and also provides genetic testing and counseling. One of his tests can determine a patient’s genetic compatibility with his or her medication.
On the day of the exam, nearly every nook and cranny of the patient will be examined and measured: eyes, ears, lungs, arteries, thyroid, muscle mass, fat mass, water mass, bone mass. Scoles has a playground of equipment in his office as part of the MDVIP program that he uses for these exams: a device that can “read the pressure in your eyeball without touching it,” a specialized scale — with an attached handheld wand — that reads body composition, an ultrasound and a bladder scanner.
Patients and doctors in this model “have access to that technology — it’s right at your fingertips, so there are less referrals to hospitals, which translates into savings as far as dollars and cents,” Scoles said.
Within 24 hours, Scoles has prepared a report between 28 and 40 pages for the patient to review and keep. The report is also available through MDVIP’s online portal for patients to access while traveling.
The report leads to a set of yearly goals for the patient — akin to New Year’s resolutions — that the physician will help the patient work toward. Some of the goals may include adjusting medicine, quitting smoking or losing weight.
“Every abnormality on the physical exam is a goal for a patient,” Scoles said. “That’s as real as it gets.”