The Concierge Doctor Is Available (at a Price)

article from nytimes:
LAST October, Barbara L. Allan, 57, received a letter from her family physician, Dr. David Rosenberg, asking her for $1,500 annually to remain a patient. He would be offering longer appointments, with no waiting, and giving out his cellphone number for after-hours calls. Ms. Allan would be one of just 400 patients, the letter said, and she would have his help navigating the local health care system. Dr. Rosenberg said he was switching to a concierge practice to maintain the highest quality of patient care.
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Marc Serota for The New York Times

Barbara L. Allan, president of a research company in Florida, tried using a concierge doctor to save time, but switched because he didn't offer some routine services.

To her, it was an attractive pitch. "I was tired of going in for routine things and waiting an hour and a half," said Ms. Allan, who is president and chief executive of SRA Research Group Inc. in Jupiter, Fla. She recalled walking out of the doctor's office two or three times when he made her late for a meeting.

As the nation's health care debate focuses on the broader picture - rising costs and those without insurance - a small but growing number of doctors are shrinking their practices and asking patients to subsidize their decisions. The annual costs of these "concierge practices" can range from around $1,500, as in Ms. Allan's case, to $20,000 for some practices in places like Seattle and Key Biscayne, Fla.

Health care experts say consumers should consider various factors, as well as the additional costs, in deciding whether to go to a concierge practice. If the patient has a chronic illness, for example, the readily available care from such a practice may be important.

Even as the popularity of concierge practices increases, some are facing regulatory hurdles and skepticism. Insurance companies are reviewing some physician contracts after receiving consumer complaints about charges for services they thought were covered.

The Office of the Inspector General, part of the Department of Health and Human Services, said that it received information about one concierge physician who offered his Medicare patients a comprehensive health assessment, for which they would pay out of pocket; but the government said that this was a reimbursable charge. The physician, whose identity was not disclosed because it would have violated federal privacy law, paid a fine, agreed to a settlement and stopped offering concierge contracts, the Office of the Inspector General said.

The office said that it then issued an alert, in March 2004, to all physicians participating in Medicare, telling them that they were liable if they charged for expenses that were already covered by the federal program.

Critics of concierge medicine call it elitist. Thomas William Mayo, an associate professor of law at Southern Methodist University who writes about legal and ethical issues in medicine, said, "It creates an explicitly tiered medical system based on ability to pay."

Proponents disagree. Michael L. Blau, a partner at McDermott Will & Emery, a law firm in Boston and the co-author of "Developing and Managing Physician Networks" (Thompson Publishing), says the doctors are putting their practices on the line to deliver what they believe to be quality care.

Having a concierge physician generally means entering into a personal contract. Because many such practices are new, health care experts advise consumers to find out what the annual fee covers, what the contractual obligations are and what is covered by insurance. They also recommend learning what hospital the doctor uses and whether insurance covers a stay.

Prospective patients also need to know their alternatives if the physician leaves the practice before the contract expires or if they have a complaint about care or services. In most states, health insurance is regulated by a state insurance agency. But because concierge practices are contractual agreements, a consumer may need to contact the office of the state attorney general in a contract dispute.

Concierge practices are "totally unregulated with no oversight," said David Barton Smith, professor of health care management at Temple University in Philadelphia. "You're putting up a fairly large sum of money," he added, "and there isn't really any assurance you are going to get your money's worth." He said his 90-year-old mother left a concierge physician in Key Biscayne who wanted $20,000 annually to continue to treat her.

Dr. Smith also says that just because a concierge network or doctor offers a certain level of service now, that could change if its business model shifts.