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In business health care quarterly new doctor offers alternative to fee-for-service model By Tovin Lapan staff writer As individuals and businesses grapple with how they will meet the requirements of the Affordable Care Act that kick in next year, Dr. Samir Qamar wants MedLion to be one of the options. An estimated 55 million people in the United States are uninsured, and starting in 2014, many of them will be required to carry health insurance. Larger employers will start facing penalties if they do not offer coverage to their employees. Qamar opened the first Las Vegas branch of his direct primary care service in March. The doctor is hoping the system gives patients better access to a physician and serves as an affordable alternative to traditional insurance. At MedLion there is no insurance. Patients pay a monthly subscription and each visit costs $10. Qamar has negotiated discounted prices with labs, clinics, pharmacies and others that offer services that his patients will have to pay for out-of-pocket. "The traditional medical practice model, which is a fee-for-service model, is flawed," Qamar said. "It's flawed because you have to charge the patients 'x' amount several times over the course of the day to break even with your office overhead, which can be very high, and to make a profit. That number is about 30 patients a day." Qamar moved from Monterey, Calif. where he had a concierge medical service, providing primary care to people who could afford to pay a premium for house calls, 24/7 access and other amenities. His wife, Dr. Hisana Qamar, worked at a traditional practice. At the end of 2008, his wife's practice lost a quarter of its patients as the recession took hold and rising unemployment meant more people without health care benefits. So Qamar used his existing office to experiment with a low-cost alternative to his VIP service. He stripped out amenities, which could raise the subscription price to as much as $1,000 a month, and focused on providing 4 basic care to the uninsured and underinsured. Qamar decided to move to Las Vegas because he saw a fertile market in the valley with a low ratio of primary care physicians to residents, and because of the low taxes in Nevada. "Between 60 and 70 percent of medical care is primary care. My thinking was if I could make that 60 or 70 percent of medical care very affordable, you wouldn't need insurance for it," he said. The concept is relatively new to Las Vegas, according to Chris Cochran, a UNLV professor of health care administration and policy, but it has been catching on across the country. In January, Dr. Zubin Damania announced a similar plan for a clinic downtown. "I'm intrigued by the concept and I see potential out there," Cochran said. "It will be interesting to see who signs up. It does provide a more affordable option for some people, and I can definitely see middle-income families especially taking advantage of it." Many low-income individuals will be covered by the expansion of Medicaid under the Affordable Care Act and may still lack the resources — time off work, disposable income, travel arrangements — to take advantage of such a program, Cochran said. He did, however, predict that parents seeking affordable family care and better access to a doctor for their children would benefit. One of the promises of the plan is that patients will be able to schedule visits more quickly and, in general, have better access and more personal attention from their doctor. The ability to deliver on those promises depends on keeping the patient load manageable, Cochran said. Qamar said he would not turn away patients with chronic conditions that may require more routine visits to the doctor, and he also plans to use telemedicine — emailing, videoconferencing and phone calls with patients — to make care more convenient and cut down on unnecessary visits to the clinic for such things as refilling a prescription or simple diagnoses. * Minimum number of best news website awards a media company should win before you log on. Leach, Kats, Chareunsy, Coolican, Brewer, Velotta, Spotleson, Bern Pulitzer | Dupont | EPPY | General Excellence | 2 7 M AY 2 0 1 3 20130527_VI15_F.indd 15 | When you bring Weight Watchers Meetings to your work place, you can... expect amazing WeightWatcherslv.com/AtWork � .......... . ...... © Weight Watchers International, Inc., owner of the Weight Watchers registered trademark. All rights reserved. *Offer valid to contact person at New At Work Companies in area only. Minimum enrollments required. 15 5/23/13 2:30:03 PM