Re: Privia Health, LLC

Dear Dr. ************:

I am replying to your undated letter soliciting my participation in a health care delivery plan offered by Privia Health, LLC (“Privia”). As I debate whether to join, I wanted to share with you some thoughts about the invitation.

Two copies arrived with my first name misspelled in a different way on each. I appreciate the fact that the letter was not addressed “Dear Patient”. And enthusiastic as I am about information technology and efficient workflow, I do not expect that these clerical errors bear any relationship to the personal attention and improved record-keeping that Privia promotes as part of its “innovative … membership program”.

I was curious that you make no mention of your somewhat different assessment from a few months ago. However, I recognize this communication is marketing, and you probably did not write it.

Here is my understanding of health care known as concierge medicine: It is a way for doctors to earn more money in fewer hours; you shrink your workday, collect member fees from patients willing to pay, and let go of the rest. The patient receives more access to you in the same way that a homeowner might pay a premium for more security in a gated community.

I would not surcharge clients in my law practice for the ability to reach me by Email or telephone; but there is a corollary to this boutique medicine in the legal realm called the monthly retainer. Clients pay their attorney a fixed amount each month in exchange for priority access, a guaranteed minimum number of hours, or a lower hourly rate. (I would like to have those clients.)

Fear is the inducement when you write me about a “threat” of government control over our health. I wish you had dealt more substantively with the issues involved in our national debate on the cost of health care. But I know that when it comes to sales, rational arguments persuade less than gut emotional appeals. One has only to observe the out-sized impact of buzzwords like “death panels” on our public opinion. (The founder, chairman and CEO of Privia supported Governor Mike Huckabee for president.)

Some of us purchase privilege, and others make money offering it. That’s the American way. We all want to be in country clubs and airline affinity lounges. I have no problem understanding your desire to earn premiums in exchange for providing patients better service.

What exactly, though, does Privia’s “expect more” motto mean for me?

Reviewing the concierge doctor phenomenon in the February 2010 Washingtonian Magazine, Drew Lindsay wrote: “Unlike MDVIP or other concierge doctors, Privia physicians maintain a traditional practice and ask patients to see nurse practitioners for routine ailments.” The Privia chairman, Jeffrey B. Butler, is quoted as saying, “I don’t need a trained, experienced doctor to look in my ear and tell me I have an ear infection.”

Does this tell me I would be seeing less of the doctor and more of the nurse practitioner than I do now? Currently, if I go to your office for a diagnosis, I expect to see you. For Privia’s monthly fee that you divide with them, it appears I would see someone who is not a doctor. It sounds like less personal attention rather than more.

Privia’s introductory rate of $300.00 a year includes six Email or telephone consultations. That is the per-session equivalent of $50.00, which coincidentally is my deductible for utilizing an urgent care facility. Privia’s inducement is that I might receive your diagnosis without leaving home; and after my six conversations, I could have a same-day appointment. That would certainly be an improvement over the existing situation where I do not have your Email address, you do not talk to me by telephone, and appointments are always scheduled days in the future.

I wish I knew whether my approach to Privia is driven more by rational expectation or by fear.

Very truly,