Westlake-based physicians Drs. Celina Mankey, Michael Garrett and Mark Carlson have each opened practices within the past two years.

The doctors said they decided the traditional primary care model is not ideal for them, choosing instead to operate concierge medicine practices.

Mankey, Garrett and Carlson said the large amount of paperwork associated with health insurance and the limited amount of time they had with patients steered them away from the traditional primary care model. Such a model includes physicians who are paid a certain amount for each test, diagnosis and procedure through third-party networks.

Known by many other names—including boutique medicine, cash-only medicine, personalized health care, direct primary care and direct-practice medicine—the broad field of concierge medicine typically charges a monthly or annual fee for personalized health care and 24-hour access to physicians without going through a third-party health insurance provider.

Each physician said there was a need for some form of concierge medicine in the Greater Austin area, pointing to an increase in population—from young families to senior citizens—and a rise in the demand for personalized, quality health care.

“I just wanted to be able to have time to get to know my patients and take care of them,” said Mankey, who opened Westlake Concierge Medicine, 1301 S. Capital of Texas Hwy., Ste. C-100, West Lake Hills, in November 2014.

That philosophy was the basis for her internal medicine and primary care practice for patients age 18 and older, she said.

Her patients can contact her by phone, email or text when they have questions or concerns; can reach her after office hours; and are not limited on their number of office visits, she said.

Although Mankey decided she would not accept any form of insurance—instead charging patients an annual fee that starts at $2,550—she said she strongly encourages her patients to have an insurance plan for any medical care they may need outside of her office that requires health insurance.

Her patients—who include young adults, couples and senior citizens—say they are willing to pay for both insurance and Mankey’s fee for her services.

“Dr. [Celina] Mankey’s concierge practice means that she serves as my receptionist, nurse and doctor,” said Sandy Cangelosi, one of Mankey’s patients. “I realized that my medical issues would be better served through a doctor who would know me more personally and coordinate my care. Dr. [Celina] Mankey coordinated my blood work, specialists to see and other tests that needed to be run in developing a plan to improve my health.”

Mankey said she thinks concierge medicine is on the rise, not just in Austin but nationally.

“In many ways, it probably is the future of primary care,” she said.

Direct primary care

Garrett, who opened Direct MD Austin, 5656 Bee Caves Road, Ste. D-205, Austin, in March 2014, said his direct primary care concept is simple and less costly. He charges patients a flat monthly rate that varies depending on age, starting at $20 a month for newborns to 19-year-olds, and he does not accept any form of insurance. The only other fees associated with his care are for blood and urine tests, he said.

With more than 14 years of experience working in the emergency room, Garrett said he felt his services would be better-suited in direct primary care, where he did not have to deal with insurance companies and could give greater attention to patients.

“The [primary care] system has developed in a way [that] I think is not healthy,” he said, pointing out many of the delays and costs in seeing patients at a traditional primary care physician’s office are because of insurance paperwork.

He said he averages three to five patients a day, usually spending an hour with new patients and a half hour with returning patients. He is also readily available to answer patients’ questions, sometimes providing diagnoses remotely.

Garrett said his number of clients is less than what he expected it to be since he opened his practice two years ago, but he is optimistic he will reach his goal of 600 patients in the next two years.

“Our growth has been modest but steady and increasing,” he said. “I think more patients are going to seek it out as the [traditional primary care] system gets progressively more broken.”

“[The concierge medicine model is] kind of like when I first got into the practice,” said Dr. Don Read, president of the Texas Medical Association.

Read explained when he first started in the medical field more than 30 years ago, primary care physicians had the time to get to know their patients intimately. 

In his view, concierge medicine patients tend to be wealthier and want more individualized attention with quick, direct access to medical information.

He said about 2 percent of physicians in Texas practice concierge medicine, and that number has remained constant in the past few years.

An option for seniors

Carlson, who owns Be Well MD, lives in Lakeway and serves patients who are at least 55 years old, traveling to their home for each visit.

He said he traded a career in medical oncology for a focus in geriatrics, moving from Nebraska to Austin and launching Be Well MD in November 2014. He said he encountered several studies that showed a rise in Austin’s elderly population.

“The idea was that the senior population is exploding, and the access to care the seniors had is shrinking,” he said.

Carlson said at a traditional physician’s office, a typical Medicare patient’s visit lasts a couple minutes. With Be Well MD, he said he sees at most five patients a day, averaging one to two hours with a new patient and 30 to 45 minutes with a returning patient.

He has also been able to incorporate telemedicine, setting his patients up with Aging at Home, a service that allows Carlson to track vital signs remotely, perform virtual visits through video sessions, and give patients online access to their medical records and prescription list.

He charges a flat monthly fee of $250 and has an a-la-carte menu of various packages ranging in price from $99 a month to $699 a month.

“I think this is going to grow almost everywhere,” he said about concierge medicine.

Concierge surgery

The model also extends to outpatient surgeries, according to Sean Kelley, the owner of Texas Free Market Surgery, which launched in West Lake Hills in May.

Kelley said he modeled his concept after Oklahoma City’s Surgery Center of Oklahoma, a 32,535-square-foot facility with state-of-the-art equipment where routine, outpatient surgeries are performed by experienced surgeons and anesthesiologists who own the center and do not work with health insurance providers.

Geared toward patients with high deductibles and self-insured employers who want to contract directly with the company, Texas Free Market Surgery lists the prices of each routine procedure on its website.

For example, a surgery for a tonsillectomy costs $2,650 through Texas Free Market Surgery, according to Kelley. The surgeon, anesthesiologist, pre- and post-operation costs and facility charge are all included in the price.

Kelley said the national average cost for that procedure is between $4,000 and $11,000. 

“We’re keeping it simple,” he said. “All were doing is providing an alternative for people that don’t need to be in a hospital but definitely need an outpatient procedure that can be done in an outpatient setting.”