The Doctor Will See You Now ... For An Extra $1,500
A Florida company is at the epicenter of what's called Concierge Care
Gaps in service?
Some believe doctors who charge for concierge care while accepting Medicare reimbursements violate the spirit, if not the law, of the Medicare system, which requires a uniform standard and equal access to care for the nation's elders. Up to now, concierge physicians have been able to keep their Medicare patients by showing their extra fees are for services that Medicare doesn't cover.
U.S. Sen. Bill Nelson, D-Florida, is pushing his Senate Bill 2080, which would prohibit doctors from charging Medicare beneficiaries an annual retainer. The bill hasn't gotten much support in Washington. "We're not against doctors charging an annual fee," says Jon Cooper, Nelson's healthcare counsel. "We just don't think they should be able to charge it to Medicare patients.
"We all pay into the system for our whole working lives," Cooper says. "When you finally reach retirement age, you shouldn't have to pay thousands of dollars more to access quality medical care."
Concierge practices meet American Medical Association ethics guidelines as long as doctors make arrangements for patients who choose not to pay the fee. The 2003 guidelines also specify that concierge physicians can't claim they provide better care: "A retainer contract is not to be promoted as a promise for more or better diagnostic and therapeutic services."
While many insurers continue to work with concierge doctors, some big carriers like Cigna and Blue Cross Blue Shield won't include concierge physicians in their provider networks. "Our contracts cover everything medically necessary, including preventive care," says Dr. Barry Schwartz, vice president of network management for Blue Cross Blue Shield of Florida. "So when they charge extra for things that are medically necessary, they are not living up to that contract."
MDVIP executives, who recently started using the term "personalized healthcare" instead of "concierge" care, say their program is predicated on services not covered by insurance or Medicare, such as special diet, exercise and mental-health screenings. MDVIP general counsel and CFO Darin Engelhardt has traveled regularly to Jacksonville to try to convince Blue Cross executives that his company's model results in healthier patients and lower costs.
|» "I don't think it's reasonable to deny the demand of consumers who want preventive medicine, want nutrition advice, want time with their physician."
-- Dr. Bernard Kaminetsky
As for widening the rich-poor gap, Colton, Kaminetsky and other concierge physicians say their practices look about the same as they looked before they switched, with plenty of middle-class patients paying the fee. (They and most concierge physicians also keep some poor patients who they feel truly couldn't afford the fee.)
"This is a viable choice for many people when you consider what people spend for a cell phone or cable television or an evening out with friends," says Engelhardt. "You could call this extravagant only to the extent that someone paying $125 a month for a cell phone is extravagant."
Colton and Kaminetsky's offices are no fancier than the average doctor's. The waiting room has the standard TV and assorted magazines and health brochures on a coffee table. The big difference is this: Not a soul is waiting. Patients who walk in pick up a telephone receiver and get called back immediately. Between patients, the doctors return other patients' calls and e-mails and take time chatting with specialists about test results.