By opening a concierge medical practice, Dr. Larry Kaskel is trying to return to his roots in medicine

“Soul-sapping.” That's how Dr. Larry Kaskel describes the way he had been practicing medicine.

There are other words he uses to describe his conventional primary-care practice under the umbrella of a large health system, but they're not much better. Demeaning, humiliating and shameful stand out.

So, he decided, at age 61, to do something about it.

On July 1, Kaskel broke away from the exam-room computer, broke away from the insurance companies — well, mostly — and went into concierge medicine.

Now, when he talks to other concierge doctors, the conversation goes something like this: “Aren't you glad you did this?” they will ask him.

“Yes, it's amazing,” he answers.

The decision

The way he was practicing medicine before was anything but amazing for him.

It was basically doctor as data entry clerk, he said. He was talking to the patient but entering information into a computer. He would get paid $59 or $79 depending on how he coded the visit.

“Every visit I'm thinking about how to charge this patient. And I didn't like that. I didn't like that at all,” Kaskel said.

He developed “an inner conflict” because of the emphasis on administrative concerns over medicine.

“This is the result of low-level, simmering anger for the last 10 years of working for a large health system,” Kaskel said.

Kaskel decided to make the move when he saw some colleagues start a direct primary care practice in Northbrook, Thrive Internal Medicine. He was “envious of their ability to escape the health system and practice medicine the way it should be.”

He's not alone. According to the Direct Primary Care Coalition website, “about 1,600 (direct primary care) practices in 48 states provide peerless access to great primary care to over 300,000 American patients.”

There are different models of concierge care, and Kaskel chose direct primary care like his colleagues in Northbrook. He has a medical office in Bannockburn, called myMD Direct Primary Care, with two exam rooms. He is proud of the tasteful art and rugs in the office and the relaxed atmosphere they promote. He wasn't going for the typical sterile medical office.

Another room is used by a massage therapist. A psychologist often comes in to see patients there too.

“I'm really just trying to re-create what medicine was 30-40 years ago where there was a relationship between the patient and the doctor,” Kaskel said. “The (patient) pays the (doctor) for his time, and the doctor provides personalized attention and spends as much time as necessary and is not really obsessed or bothered by how to code or how to bill that visit so that the insurance company pays the doctor.”

His role models are a couple of TV characters from way back, Marcus Welby and Hawkeye Pierce from “M*A*S*H.”

“I think I'm kind of a blend between the two of them,” Kaskel said, meaning he likes to sit and listen, and he injects a little humor into the conversation, having fun with the patient to build a relationship.

That requires time, and Kaskel didn't have it in his former assembly-line practice.

“I think concierge medicine is really just a throwback to how it was, and unfortunately there is a surcharge that goes along with that to get high-quality care and time,” he said. “And that's just not available in the current health systems. There's no time. You get 15 minutes and that's it.”

How DPC works

It used to be that Kaskel had 1,800 patients. Now, he has 60, estimating he has been adding about one a day since opening July 1. He plans to cap his new practice at 180 patients.

“I think I can be a much better physician for 180 vs. 1,800,” he said.

Other concierge physicians in the area have as many as 400 patients, but Kaskel decided that was too many for him.

“I'm not doing this to get rich,” Kaskel said. “I am financially comfortable. I could retire if I wanted to, but I'm not ready.”

Patients join his practice by buying a membership, just like they would at a health club, but the pricing is based on age. Patients 18-30 years old pay $1,200 a year. Patients 30-45 pay $1,800 a year. Patients age 45 and older pay $2,400.

“I like to think it's less than a Frappuccino a day,” Kaskel said.

Insurance still plays a role for concierge patients for specialty care, bloodwork, and tests such as MRIs and CAT scans. Kaskel has admitting privileges at all the nearby hospitals.

His typical patient is a 50-year-old male “who cares about their health,” he said. The typical patient might have one or two chronic illnesses such as high blood pressure or diabetes. He wants to be able to see his doctor the day he calls for an appointment. He wants to be able to communicate with his doctor the day he decides he needs to. He wants prescriptions called in to the pharmacy right away.

Kaskel even gives patients his private cell phone number. He said it hasn't been abused yet.

Is it worth the money for his patients? Kaskel puts it this way: Many of his patients have wealth managers, professionals they pay yearly to manage their wealth.

“I think of myself as a health 'wellth' manager,” he said, and what's more valuable than your health anyway?

“It's extremely popular once they experience it, but some people are still hesitant to pay me an additional fee because they feel their insurance should cover everything and it's not of value to them to have a longer visit with a doctor,” Kaskel said. “And I think they just can stay angry and dissatisfied with their current health system, yet this is available, and it is not priced for just rich people.”

Kaskel is done with being angry. That “soul-sapping” feeling is long gone too.

A sporting change

After three years of writing business columns, this is my last. The Daily Herald has shifted me to sports editor. The Suburban Business section is in the good hands of Assistant City Editor Madhu Krishnamurthy.

As always, thank you for reading and for supporting local journalism.