New doctor in town offers alternative to traditional fee-for-service model Monthly subscriptions plan touted for providing access for patients, low overhead for doctors

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.

Exhibiting a good sense for timing, Qamar opened the first Las Vegas branch of his direct primary care service in March. The doctor, who originally started the company in California, 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 sitting in his Summerlin office, which doubles as his exam room. “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 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,” Qamar 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 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, example, refilling a prescription or simple diagnoses.

“The care for (chronic) patients is not expensive to us, to the extent that if it’s medication that’s needed, it’s paid for by the patient,” Qamar said, emphasizing that he works to find affordable providers for his patients. “It never gets expensive for us, and in fact we welcome chronic patients.”

Qamar, who will operate the Las Vegas clinic with his wife, estimates his overhead is cut between 30 and 40 percent in comparison to a traditional practice because he has none of the paperwork burdens that result from working with insurers.

Under the Affordable Care Act is a provision that allows for a “qualified direct primary care medical home plan” that meets certain criteria to qualify as an acceptable health plan for the health care exchanges. Also, to meet the requirements of the Affordable Care Act, a patient could carry a high-deductible insurance plan for catastrophic emergencies and then use MedLion or a similar clinic for their primary care.

While the subscription fee would not apply to the deductible on a catastrophic insurance plan, Qamar said, the patient’s payments for lab work, X-rays and other services would apply.

Radio City Pizza, which opened downtown in March, is planning on offering a health plan through MedLion to its 35 employees.

“With insurance costs as high as they are, I think this a great plan to give to your employees,” said Janett Cule, Radio City Pizza accounts and human resources manager. “It’s cost effective for the company and for the employees, and it gives them something they can use.”

The Monsoon Group, a Las Vegas nightclub consulting and event production company, is paying for the MedLion subscription for a few employees and has worked out a deal with the clinic for plans it’s offering to subcontractors such as models, hosts and dancers.

“A lot of subcontractors in Las Vegas are looking for benefits and with Obamacare kicking in, this is an awesome alternative,” said Robert Casillas, Monsoon Group president. “A lot of people who work in nightlife aren’t full-time employees. … It’s a billion-dollar industry that doesn’t traditionally offer benefits for employees, and this is a good way for people who can’t afford traditional health care to have some peace of mind and access to a quality primary care plan.”

The basic subscription fee is $59 per month for adults, $39 for seniors and $19 for dependent children. If a patient subscribes for less than one year, there is a registration fee. There is also a re-enrollment fee to discourage people from taking advantage of the program in spurts.

In addition to Las Vegas, there are MedLion practices in four California cities, and new ones opening in Philadelphia, Tri-Cities, Wash., Fort Wayne, Ind., and Miami. Qamar said within three years he would like to have four MedLion clinics in the valley. He even approached Mayor Carolyn Goodman and Las Vegas about opening a branch downtown.

“If he’s providing quality, affordable care, then downtown absolutely would be a viable place,” Goodman said. “There’s an influx of people moving into the community for the first time, and more Zappos people are on their way. We have a lack of primary care in Las Vegas, and something that addresses the need for quality care that’s affordable is something we want to follow through on.”