Imagine texting your physician with a question about a new medication or video conferencing when you become ill while traveling.

How about just scheduling a time for your doctor to come by your house for a checkup?

These services are available in Middle Tennessee, and not just at a premium.

Dr. Charles Marable transitioned to a direct-care model in 2007, distancing himself from a traditional practice that he felt limited his ability to have a complete picture of a person’s health.

Instead of depending on insurance companies for compensation, the Franklin-based doctor deals directly with patients offering two levels of service, a $30 monthly fee for basic offerings or an annual fee of $2,000 for concierge level.

Monthly members get same-day or next-day appointments, little or no office wait time, leisurely visits, physical exams, adoption and sports physicals, travel medicine consultation and direct access to Marable by cell, email, text and video chat.

Annual members get the same level of service as monthly members plus priority scheduling, coordination of hospital care and personal health advocacy. For example, if a patient is hospitalized, Marable goes to the hospital to work with doctors and translates to the patient details of their care.

Marable makes house calls for those who are elderly, on bed rest or in hospice care. Otherwise, he sees patients in his Mallory Lane office.

“The current model is set up so doctors only get paid when they see a patient in the office,” Marable says. “So if you came in and I start you on a medicine and a month later I wanted to see how it was going, the only way I am going to interact with you is if you take time off from work, go sit in my office to see me for five minutes to tell me it is working great. That is silly.”

Instead, Marable says he might text his patient to see how the medication is working and call in a refill without the patient ever having to leave home.

If a patient needs special care, he helps decide what specialists to see and can coordinate the visits, sending medical information in advance.

“There are a lot of misconceptions about direct, concierge care,” Marable says. “There is a perception that it is extravagant and unaffordable for most and only for the wealthy. I would say most working folks could afford my care, but everyone has to look at their own situation.

“Whether they receive their benefits from their job or provide them themselves, what is it worth when you don’t get the care you need? You may have extraordinary insurance, but if you don’t have any opportunity to connect with your doctor when you need him, what is the value of that?”

And while Marable no longer deals with insurance companies for his compensation, he does step in when his patients need an advocate.

“Most of my patients have insurance and they still have to contend with that system, so whether I need to communicate with insurance companies to make sure they get the best care or select the best medicine and hospitals their insurance covers, I will do that,” he says.

He recommends patients have some sort of insurance coverage for services he doesn’t provide, something with a high deductable and low monthly payments that would cover hospitalization.

Of course, doctors don’t need to sever ties from insurance companies to offer more personalized service to their patients.

Dr. Jim Garner of Murfreesboro has recently teamed with Family Staffing Solutions, a personal care company that works with older people to provide personal care and in-home assistance with daily living activities, errands, meal preparation, light housekeeping and transportation to doctor appointments, to provide some of their elderly clients with visits at home.

Insurance is billed, just as a regular office visit would be, and unlike Marable’s model, there is no annual fee.

“I have always made a practice of stopping by and checking on some of my elderly patients,” Garner says. “You could call them house calls, but these will be more official visits. The elderly, once they get confined to their house, it is hard for them to get the care they need.”

It is a service Becci Bookner, CEO of Family Staffing Solutions, has wanted to provide her clients – average age of 80-100 – for some time now.

“We have one woman who is 98, and by the time we take her to the doctor – she is in Nashville and he is in Murfreesboro – it takes four hours to get her dressed and get up there for 10 minutes with the doctor,” she says.

“I have known Dr. Garner for a long time and it was something we kept talking about. House calls are just not something most physicians do anymore, but doctors are starting to think they can do something a little differently to provide for their patients and make their life easier.”

Marable says his unorthodox practice makes sense financially when one considers all the costs associated with practicing medicine. For example, he says doctors spend as much as 20 percent of their overhead costs just trying to get paid.

“They pay billing companies or personnel to try to collect the money they spent doing the job,” he says. “Nobody else does business that way. Doctors are working with their hands tied behind their backs. They are frustrated and burned out and pedaling as fast as they can.

“They are good doctors who mean well but the system is so impossible that I would rather get a job outside medicine than continue in that system that doesn’t allow me to live out my full potential as a doctor.”

Chris Jessey is broker and owner at Health Coverage Today, Inc., an insurance company that helps businesses and individuals find affordable plans and supplemental coverage. She says she is increasingly hearing from doctors who are moving to a cash-only model.

“I am seeing more and more doctors who don’t want to bill insurance anymore and go to cash only,” she says. “I mean tons. Every day I am talking with a doctor who is not going to deal with insurance companies anymore.”

As forward-thinking as this all seems, it has its roots in the past, and not just the family doctor who made house calls but doctors who charged patients directly, with no insurance middle man.

“Young people look at this and are like, ‘Oh my gosh, what would it be like if I don’t have co-pays?’ They don’t know how to function,” Jessey says.

“But people who are older look at it and are like, ‘Well, that is how it worked when I was a kid.’ People shouldn’t be so afraid of this model. I think the biggest driver of health insurance costs in this country is not the insurance premiums but the expenses the insurance companies are paying that drives the premiums. And part of the reason is people aren’t shopping around.”

Changing from something that is so ingrained is scary for everyone though.

“It is complex and there is that uneasiness about changing something that is so little understood,” Marable says. “Some people don’t even know they can pay cash to see a doctor.”

And just because it is available, it may not be right for everyone.

Ken Parkhurst, 80, has been a patient of Dr. Garner’s for 15 years and, despite to being able to drive and having to rely on rides for his monthly visits, he looks forward to getting out and going to the office to see everyone there.

“It is no more than 15 minutes from my house to his office, and I am not in there over an hour, ever,” Parkhurst says. His daughter, Joy Anderton, who sometimes drives him to Garner’s office, would consider having Dr. Garner visit him at home instead.

“He likes to get out and go see the people in the doctor’s office, but when bad weather crops up or he is not feeling well or there are other issues where it is not convenient, I can’t see why Daddy wouldn’t choose to call the office and ask for someone to go to him,” she says. “I don’t know why home visits ever were done away with in the first place.”