Marilen Cawad
07/01/2005
Lisa Frank recalls a letter she received last year from her family pediatrician. It asked: Wouldn’t you like it if your doctor made house calls? “The letter was a formal announcement that he was switching to concierge medicine,” Frank explains, “and if we wanted to keep seeing him, we had to start paying a retainer fee.”
Frank, whose 3-year-old son, Sam, was then a patient of the Pittsburgh doctor, could afford the concierge care, but refused to sign up. “We just didn’t agree with the whole idea.” She believes there are major flaws that need to be addressed in the system, but that concierge health care is not a solution to the problem. In fact, she says, it only makes matters worse by placing an unnecessary burden on other doctors who must then absorb the less-privileged patients.
“We shouldn’t have to go this way,” Frank says. “The medical care that Sam is getting should be the same medical care available to the kid down the street.” For her, the decision to look for a new pediatrician was ethical, not financial.
Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C., believes that the patients hurt by the concierge care model are those who could never afford it. “Superior care for a few comes out of the expense of decent care for others. It means there are fewer physicians to take care of the rest of the population,” he says. The center has observed a declining percentage of doctors accepting new patients who are either enrolled in Medicare or privately insured. Ginsburg says this is an indication that physicians are already in short supply.
In 2003, the American Medical Association issued a report noting that concierge, or boutique, practices raise ethical concerns. Although the AMA is not opposed to the model, it reminds doctors who are converting from traditional practices to facilitate the transfer of their nonparticipating patients, particularly the sickest and most vulnerable ones, to other physicians.
For Frank, transferring to another physician was easy; Pittsburgh is full of pediatricians in traditional practices. But she is worried that if the concierge care model becomes widespread, eventually the “most vulnerable ones” will have nowhere to go.
Rep. Ben Cardin, D-Md., is also adamantly opposed to this model. He argues that concierge doctors are circumventing billing limits, and introduced a bill last year that would prohibit doctors from charging retainer fees to Medicare beneficiaries. “My legislation will ensure that physicians cannot increase their incomes arbitrarily at the expense of seniors who have fixed incomes,” Cardin says. The bill is being reintroduced this year.
“If every doctor started doing this, it’d be the end of Medicare," says Sen. Bill Nelson, D-Fla., who, in 2003, introduced a bill that would deny federal Medicare and Medicaid funding to doctors asking for retainer fees. The Government Accountability Office is also preparing a report to determine the extent to which concierge care is used by Medicare beneficiaries and how it affects their access to covered services.
In a response submitted to the GAO in August 2004, the Society for Innovative Medical Practice Design (SIMPD), a network formerly known as the American Society of Concierge Physicians, insisted that concierge medicine has the potential to address some of the most challenging health care problems. SIMPD believes that a free market can balance and monitor issues of cost and quality simultaneously and without undue influence by special interests and political power brokers. John Blanchard, founder of SIMPD, says that concierge doctors are responding to a demand in the market. “Some patients want a more personalized level of service—that’s what we’re providing them,” he says. “By having fewer patients, we can give them more attention and less possibility of committing errors.”
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