The Doctor Will See You Now ... For An Extra $1,500
A Florida company is at the epicenter of what's called Concierge Care
Critics, including some fellow family physicians, argue the concierge doctors are doing less work for more money. Some are offended by the suggestion that they can't take good care of a couple thousand patients a year.
Kaminetsky acknowledges his personal compensation and that of his office staff increased about 60% after his shift to retainer fees. Medicare pays an internist just over $50 for an average office visit, meaning he might earn $200 a year caring for the average Medicare patient with minor health problems. Now, Kaminetsky, who contracts with MDVIP, makes a little more than $1,000 a year per concierge patient, meaning he can keep his patient numbers low and still earn more money.
Kaminetsky says trying to care for 2,600 patients left him so harried that he spent evenings obsessing about whether he'd cared for everyone adequately. Today, he says, he works just as hard; arriving at the hospital at 7 each morning for rounds. "But now when I get home at night, I'm not worrying about the phone call I left unreturned or the test result that went uncommunicated."
Nelson's press secretary, Bryan Gulley, says his Senate office has received increasing numbers of complaints from constituents in southeast Florida who report being dropped by their doctors. "This type of practice is growing fast, which is just what we were worried about when we first got involved with this issue," Gulley says. "We were afraid senior citizens on Medicare who could not afford concierge care would get kicked out of practices, and they are."
MDVIP requires physicians who join the company to find new doctors for each patient who declines to pay the personalized-care fee.
Kaminetsky says he doesn't see the logic in preventing Medicare patients from being able to purchase an extra level of service that gives them peace of mind and may keep them out of hospitals. "That's a populist soapbox," Kaminetsky says of Nelson's concerns. "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."
Concierge physicians also say it's ludicrous to pretend that different tiers of healthcare don't already exist: Medicaid, Medicare, PPOs, HMOs and the like. "Why should a Medicare patient be able to walk into a plastic surgeon's office and pay for extra services and not be able to purchase an executive level of care from me?" asks Dr. Robert Briskin of Jupiter, who opened the first concierge practice in Florida, VIP Primary Care Associates, in 2000.
Briskin, who maintains both a regular and an executive practice, says he bills Medicare far more in his regular practice. "The factories bill Medicare tons, and the concierge practices bill Medicare a tiny amount," says Briskin. "I challenge the lawmakers to give everyone better access to care.
"I give my patients my cell phone number. Bill Nelson is my U.S. senator. He should give me his cell phone number so I can tell him all this."