Naples' first concierge medical practice seeks bankruptcy protection

Health care

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Health care

The bankruptcy filing shows creditors holding unsecured nonpriority claims are collectively owed $867,474, while creditors holding secured claims are owed $215,465. Eight employees are owed a collective $42,560 in unpaid wages.

— The first concierge medical practice in Naples has filed for bankruptcy reorganization, blaming part of its problems on a longtime physician who was disloyal, according to court filings.

Naples Health Care Associates filed Chapter 11 bankruptcy proceedings last month, showing assets of $32,222 and liabilities of $1,125,500, records show.

The practice also filed a federal court complaint against Dr. Richard Kravis, seeking an injunction to stop him from breaching the non-compete terms of his employment contract before he was terminated, records show.

Kravis and his attorney, Damien Taylor, of Naples, couldn't be reached for comment.

The founding partner and chief executive officer of Naples Health Care Associates, Thomas Reed, couldn't be reached. The practice has declined comment, according to its attorney, Elinor Baxter, of Bonita Springs.

The concierge medical practice was started in September 2002, bringing to Naples for the first time the "boutique" or personalized approach to medicine that was gaining popularity elsewhere in the United States.

Patients pay an annual membership fee, usually thousands of dollars, to have a more attentive relationship with their doctor, for home or executive visits and after-hour contact.

The kid-glove approach developed because doctors were getting fed up with the managed care environment and patients likewise got fed up with doctors not having enough time to attend to their needs.

The concierge medical practice was started in September 2002, bringing to Naples for the first time the "boutique" or personalized approach to medicine that was gaining popularity elsewhere in the United States.

* * * * *

Patients pay an annual membership fee, usually thousands of dollars, to have a more attentive relationship with their doctor, for home or executive visits and after-hour contact.

Physicians in a concierge practice limit the number of patients they accept so they can spend more time with each patient. Physicians still bill the patients' insurers for covered services.

Today, a dozen or more concierge practices operate in Collier, mostly solo practitioners.

Naples Health Care Associates filed bankruptcy for several reasons, including to deal with Kravis, who the company believes was competing with it while employed, and to renegotiate leases and attract new capital, according to the court filing.

Dan Cholvin, an information technology employee who has worked at the concierge practice for five years before going part time, said Kravis was unhappy and told patients he was going out on his own.

"He told people not to renew their contracts," Cholvin said, referring to patients.

Tensions began running high last year within the practice and continued to escalate, with two doctors leaving abruptly after the bankruptcy filing last month, he said.

The concierge practice used to have around 500 patients and quite a few haven't renewed, their membership, Cholvin said.

Genevieve Galliford, a member for three years, decided not to renew last year. She and her husband's annual fee was $4,000 each, she said.

"I just didn't think it was a team effort," she said, adding that the medical staff insisted she come to the office rather than them coming to her residence.

Cholvin agreed some former employees didn't have patients' best interests in mind, but said the hope is to turn that around with the bankruptcy reorganization.

"It has a lot of potential," he said of the company, adding that a new doctor is coming on board soon.

The bankruptcy filing shows creditors holding unsecured nonpriority claims are collectively owed $867,474, while creditors holding secured claims are owed $215,465. Eight employees are owed a collective $42,560 in unpaid wages.

The concierge practice has offices at 1890 Southwest Health Parkway, Suite 203, off the south side of Immokalee Road. It owes the property owner, a Missouri partnership, $159,310, records show.

A Houston resident is owed $165,000 from a promissory note written last September, and CEO Reed is owed $25,000 from June 2011, and another $37,500 from March 2012, according to the bankruptcy filing.

The practice's gross income in 2011 was $2,526,140 — more than the prior year of $2,341,339, records show.

Kravis was one of the two initial physicians with the practice in 2001 and he renewed his contract in 2006.

On Aug. 31, 2011, he sent an email to Reed that the company had failed to honor its employment contract regarding deferred compensation and other financial matters. He declared his contract terminated and considered himself relieved of all its obligations, but nevertheless said he was willing to stay on a day-to-day basis, the email said.

The practice didn't agree with him and so the two parties tried to agree on new contract terms. Kravis rejected new terms offered and withdrew his termination under the 2006 contract and stayed with the group, according to a letter from his attorney.

But last November, Kravis wrote to Reed that he wouldn't be renewing his contract when it expires at the end of this month.

The complaint said he continued to be disloyal to the practice by soliciting patients for his new medical practice while still working there, among other allegations.

By unanimous consent of the practice directors, they terminated him April 12, the same day the bankruptcy was filed in federal court. The complaint against Kravis was filed the following day, records show.

© 2012 Naples Daily News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Comments » 27

Beachglow writes:

No matter what the profession, greed always takes people down.

savethewhalz writes:

Some may be confused with the medical concierge concept. Basically one pays ~3$K for a doctor's cell phone number so that in a medical crisis, the phyisician concierge will advise you to call 911. In less demanding circumstances, such as a scrotal rash, you will be advised to see a dermatologist sometime in the near future. Gotta love doctors.

greathornedlizard writes:

I wouldn't trade my doctor for a dozen of these greedballs.
Find a doctor who is satisfied with a very good living and who also is into his or her profession.

tampacoco writes:

in response to greathornedlizard:

I wouldn't trade my doctor for a dozen of these greedballs.
Find a doctor who is satisfied with a very good living and who also is into his or her profession.

Looking for a good Doctor can you give a name? Thanks

Trexler writes:

(This comment was removed by the site staff.)

wonderful (Inactive) writes:

in response to greathornedlizard:

I wouldn't trade my doctor for a dozen of these greedballs.
Find a doctor who is satisfied with a very good living and who also is into his or her profession.

Saad, really!

Used to be a triumverate: the doctors, the insurance folks and the lawyers.

Doctors practiced their profession and gracious calling and made a good living and garnered respect. They could play golf on Wednesday afternoons and go to conferences, etc. Insurance was reasonable and fairly simple to understand and provided something instead of hype, and honest! attorneys were there to make sure everything was in order and according to law and understood?

Guess who lost out?

Doctors and their patients!

Standby! the best? is yet to come if the entire obamacare bill, now that it has been read, comes to fruition. Add a fourth party: Government Health Commissioners!

Hurry November!

crazyjoedivola1 (Inactive) writes:

in response to wonderful:

Saad, really!

Used to be a triumverate: the doctors, the insurance folks and the lawyers.

Doctors practiced their profession and gracious calling and made a good living and garnered respect. They could play golf on Wednesday afternoons and go to conferences, etc. Insurance was reasonable and fairly simple to understand and provided something instead of hype, and honest! attorneys were there to make sure everything was in order and according to law and understood?

Guess who lost out?

Doctors and their patients!

Standby! the best? is yet to come if the entire obamacare bill, now that it has been read, comes to fruition. Add a fourth party: Government Health Commissioners!

Hurry November!

And guess who won out?

Rick Scott !!!

QueBonita writes:

Lemmegethistr8t....You sent in $4,000.00...and for that you want a house call?????wassamataUUUU?

HAP writes:

But of course they are. Not surprised. Agree, greed, comes back around.

volochine writes:

I'm laughing about this. The business model for concierge doctors calls for the doctors to be on call, like a concierge, 24/7.

The people attracted to concierge doctors usually have a great need to see a doctor everyday. I'm guessing certain doctors do not want to be a concierge.

I also find the financial greed just the cherry on top of Florida's top industry.... medical fraud/medical waste.

voltihs writes:

How do you spell Ripoff? Concierge doctor.

I left my doctor five years ago when the idiot went this route which he's since dropped. You had to sign a contract with a bunch of Long Island "sideing salemen" and were bound by NY state law in the event of litigation.
This an idea for doctors who are regret going into the practice of medicine.

NOYB5 writes:

Concierge medicine is silly. Collect up front for care throughout the year? That incentivizes the patient to seek as much care as possible to take advantage of the money that they spent, and it incentivizes the doctor to see the patient as least as possible.

Capitation health care plans work the same way, with the same negative results.

Instead, the docs should go fee-for-service. Patients pay the doctor in full at time of service, and then the doctor's office can help them file their insurance so that the patient gets reimbursed.

I remember walking out of a cardiologists office and handing over my credit card to pay. The lady checking me out said "that's OK, we will just bill you after the insurance pays their part." Dumb!

aurora writes:

in response to NOYB5:

Concierge medicine is silly. Collect up front for care throughout the year? That incentivizes the patient to seek as much care as possible to take advantage of the money that they spent, and it incentivizes the doctor to see the patient as least as possible.

Capitation health care plans work the same way, with the same negative results.

Instead, the docs should go fee-for-service. Patients pay the doctor in full at time of service, and then the doctor's office can help them file their insurance so that the patient gets reimbursed.

I remember walking out of a cardiologists office and handing over my credit card to pay. The lady checking me out said "that's OK, we will just bill you after the insurance pays their part." Dumb!

"Instead, the docs should go fee-for-service. Patients pay the doctor in full at time of service, and then the doctor's office can help them file their insurance so that the patient gets reimbursed."
What happens to those that may not have $300 - 500. to pay up-front or a credit card? I had to take out a loan for $3000. to pay for my daughters wisdom teeth extraction. Yes, I finallay did get reimbursed by the insurance, but it took 3 months, and calling the Dr.'s office every week to get them to finally submit the bill to the insurance company. Once they have their full fee, there is no incentive to see that the patient is reimbursed. I guess the Republican plan is if you can't afford it, too bad, just die.....

Jarvis (Inactive) writes:

Concierge doctors are the lowest scum of the earth. They promise to play golf with their clients once a year in exchange for a retainer fee. Hope they all go bankrupt and lose their licenses.

roadhouse writes:

My former doctor went into a "concierge" practice. I got a one page letter from him offering that I join for $3,000 per family member per year. That fee DID NOT include the cost of any medical tests, consultations and testing with specialists, medications or hospitals. The only type of person that would benefit is a hypochondriac or one with a chronic medical condition. And they would be dropped after the first year because the doc would not make any money on this type of patient. The concept is fairly idiotic.

Here4Now writes:

Hey, GREAT picture of " stethoscope on top of medical file"! How long did it take you to Google image that one? I mean, really???

Ghostrider19 writes:

America ranked #27 for healthcare in the world. Another thing we used to be good at, like building railroads, education...but hey no one can deny we are the best at blowing S&*T up.

Concierge doctors a waste of space, in the medical profession. Come on guys don't you remember the Hippocratic Oath...maybe you forgot when you started seeing the dollars, the joy of healing your first patient, the rush of saving a life...Not rushing to a mansion to fix a hang nail. Scum the lot of you, give up your licenses now to someone who really deserves it. Secondly, I see you took your cut, but failed to pay your own staff, the true professional would pay his employees, and then draw for himself. Who would want to work for a clown like this?

Chapter 13, this poor excuse for a business.

Trexler writes:

(This comment was removed by the site staff.)

NOYB5 writes:

Snowbird,

A doctor charges for a service, not a durable good like a car. The price of medical services vary based on the complexity of the case, and the competency of the doctor performing the services. The prices of two identical cars vary only by the profit
margin set by the dealers

In fact, the prices of all services vary by the level of service and the competency of the person performing the service. It doesn't matter if you're talking about renovating a home, getting a hair cut, getting back surgery, replacing your driveway, etc.

Your suggestion that fee-for-service medicine should lead to haggling over price like you're buying a car, is ridiculous.

NOYB5 writes:

aurora,

Why is it your doctor's responsibility to compel YOUR insurance company to fulfill their end of a contract that was entered into by YOU and YOUR insurance company?

Your doctor did not choose the insurance company, did not sign the contract, and does not pay the monthly premiums. In fact, your doctor's only role is to perform a service for which he is entitled payment.

Getting you reimbursed for that payment is not the doctor's responsibility, because he is not the one who entered into the agreement with the insurance company.

As you stated in your post, you were reimbursed for the procedure that you paid for. Yes, i understand you had to wait to get reimbursed. But do you think it would have been more fair for the doctor to wait for the money?

When was the last time that you purchased a service (hair cut, meal at a restaurant, oil change on your car, etc) and walked away without paying for that service at the time of service?

PeopleSpeak writes:

in response to NOYB5:

aurora,

Why is it your doctor's responsibility to compel YOUR insurance company to fulfill their end of a contract that was entered into by YOU and YOUR insurance company?

Your doctor did not choose the insurance company, did not sign the contract, and does not pay the monthly premiums. In fact, your doctor's only role is to perform a service for which he is entitled payment.

Getting you reimbursed for that payment is not the doctor's responsibility, because he is not the one who entered into the agreement with the insurance company.

As you stated in your post, you were reimbursed for the procedure that you paid for. Yes, i understand you had to wait to get reimbursed. But do you think it would have been more fair for the doctor to wait for the money?

When was the last time that you purchased a service (hair cut, meal at a restaurant, oil change on your car, etc) and walked away without paying for that service at the time of service?

I'm getting a kick out of these pro-concierge replies.

The only way patients are best served is in a true free market capitalist system where no single doctor or huge insurance company can hold patients/the market hostage and we have real competition and flexibility. The next best way is single payer medicine. The insurance companies would never stand for the former and government always needs to grow so we're going to get the latter.

Have fun when Washington nationalizes health care and you have to work for a living like the rest of us! Boohoo that you can't afford that $100k car every three years or the Port Royal acreage.

I can't wait to see the smug faces on doctors when we have a single payer system which will save patients money by cutting insurance company and doctor greed and bringing transparency (or at least uniformity) to pricing.

roadhouse writes:

in response to NOYB5:

aurora,

Why is it your doctor's responsibility to compel YOUR insurance company to fulfill their end of a contract that was entered into by YOU and YOUR insurance company?

Your doctor did not choose the insurance company, did not sign the contract, and does not pay the monthly premiums. In fact, your doctor's only role is to perform a service for which he is entitled payment.

Getting you reimbursed for that payment is not the doctor's responsibility, because he is not the one who entered into the agreement with the insurance company.

As you stated in your post, you were reimbursed for the procedure that you paid for. Yes, i understand you had to wait to get reimbursed. But do you think it would have been more fair for the doctor to wait for the money?

When was the last time that you purchased a service (hair cut, meal at a restaurant, oil change on your car, etc) and walked away without paying for that service at the time of service?

Wrong. Doctors do sign contracts with insurance companies to provide services at pre-set prices which includes doing the claims paperwork. While doctors do not sign on with all insurance companies for this service, they do have a contract with the patient to provide accurate and timely information so that the patient can be reimbursed from their insurer.

mkc writes:

"CLASSIC PONZI SCHEME... A BUNCH OF LAZY DOCTORS... PUT THEM OUT OF PRACTICE...

Quietcat writes:

I don't know about the doctors in this article but most doctors went into concierge medicine because they got tired of trying to give a patient an exam in 10 minutes or less because if they don't see a certain # of patients a day they can't make a decent living. The medical field is no longer the cash cow so many people think it is- especially for primary care providers. One of the reasons for the high cost of healthcare is that excessive testing has replaced a skilled doctor making a medical diagnosis based on observation and knowledge of the patient.
Like anything else, you get what you pay for. If you are comfortable seeing a doctor (or more likely a PA or nurse) who is rushed and doesn't have the time to spend listening to you and making a diagnosis or recommendations to help you live a healthier life that's your choice. If, however, you can afford a doctor who is available around the clock, takes time to know you as a person and be there when you need them (even on a Sunday) I think a concierge practice is a reasonable choice.

Quietcat writes:

in response to aurora:

"Instead, the docs should go fee-for-service. Patients pay the doctor in full at time of service, and then the doctor's office can help them file their insurance so that the patient gets reimbursed."
What happens to those that may not have $300 - 500. to pay up-front or a credit card? I had to take out a loan for $3000. to pay for my daughters wisdom teeth extraction. Yes, I finallay did get reimbursed by the insurance, but it took 3 months, and calling the Dr.'s office every week to get them to finally submit the bill to the insurance company. Once they have their full fee, there is no incentive to see that the patient is reimbursed. I guess the Republican plan is if you can't afford it, too bad, just die.....

Payment up-front with the insured person filing their own claim for reimbursement was the way medicine for those with insurance operated for a very long time. Medicare reimbursement to doctors started the change to the current system starting probably in the 1980's. The advent of HMOs with essentially prepaid doctor visits was the next step toward patients being removed from the equation. If you were allowed to file your own claim in the first place the amount of time from submitting it to reimbursement would have been significantly faster.

PeopleSpeak writes:

in response to Quietcat:

I don't know about the doctors in this article but most doctors went into concierge medicine because they got tired of trying to give a patient an exam in 10 minutes or less because if they don't see a certain # of patients a day they can't make a decent living. The medical field is no longer the cash cow so many people think it is- especially for primary care providers. One of the reasons for the high cost of healthcare is that excessive testing has replaced a skilled doctor making a medical diagnosis based on observation and knowledge of the patient.
Like anything else, you get what you pay for. If you are comfortable seeing a doctor (or more likely a PA or nurse) who is rushed and doesn't have the time to spend listening to you and making a diagnosis or recommendations to help you live a healthier life that's your choice. If, however, you can afford a doctor who is available around the clock, takes time to know you as a person and be there when you need them (even on a Sunday) I think a concierge practice is a reasonable choice.

If a primary care doctor sees 30 patients a day that's considered busy.

If they spend 7 hours of their day seeing patients that works out to roughly 4 per hour or 15 minutes per visit. If a nurse/PA can draw blood, take vitals, complete paperwork, etc so this isn't crammed into the 15 minutes with the doctor, suddenly that 15 minutes with the doctor is a heck of a lot more useful and focused on diagnosis and treatment.

Many times a PA can do the job - especially if you come in with a routine problem or are on a return visit.

Ultimately this comes down to greedy doctors demanding a ridiculous income. Is it so bad to make $150,000? Is it so bad that someone who makes $150k - TEN TIMES minimum wage - might be working hard, perhaps over 40 hours per week? These people are in the top 3-4% of earners.

If that poor overworked doctor cut their workload by a third (how many of us would be able to cut our workload by a third and still keep up a house, car, etc) the doc could still pull in $100,000 or more than 93% of all other US earners!

Perhaps in Collier County where we have a bunch of out of touch retired executives that "earned" their promotions by being the last incompetent non-innovative slug standing, $100k is not considered much... But it's DOUBLE the median HOUSEHOLD income.

roadhouse writes:

in response to PeopleSpeak:

If a primary care doctor sees 30 patients a day that's considered busy.

If they spend 7 hours of their day seeing patients that works out to roughly 4 per hour or 15 minutes per visit. If a nurse/PA can draw blood, take vitals, complete paperwork, etc so this isn't crammed into the 15 minutes with the doctor, suddenly that 15 minutes with the doctor is a heck of a lot more useful and focused on diagnosis and treatment.

Many times a PA can do the job - especially if you come in with a routine problem or are on a return visit.

Ultimately this comes down to greedy doctors demanding a ridiculous income. Is it so bad to make $150,000? Is it so bad that someone who makes $150k - TEN TIMES minimum wage - might be working hard, perhaps over 40 hours per week? These people are in the top 3-4% of earners.

If that poor overworked doctor cut their workload by a third (how many of us would be able to cut our workload by a third and still keep up a house, car, etc) the doc could still pull in $100,000 or more than 93% of all other US earners!

Perhaps in Collier County where we have a bunch of out of touch retired executives that "earned" their promotions by being the last incompetent non-innovative slug standing, $100k is not considered much... But it's DOUBLE the median HOUSEHOLD income.

It's pretty obvious you have never owned or run your own business because you have no concept of the meaning of "overhead". For a doctor to "earn" $150k per year would likely require him to bill close to $1 million per year, but probably more. I don't tend to defend the medical profession, but $150k per year, with all of the costs of administration, malpractice insurance, staffing, rent and equipment costs is a pittance. It's much easier to work at Mcdonalds flipping burgers....and earn the median household income, with which you are so familiar.

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