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IS IT A CONCIERGE MEDICAL PRACTICE OR ELITISM AT ITS WORST?

The newest rage in medical care is the concierge medical practice. Who would not want to have a concierge? A concierge is there when you need something, takes care of matters for you, makes you feel pampered and special, and provides an excellent, personal service. Most of us are familiar with concierges in hotels where their services are complimentary. They are ready, willing, able and happy to provide information and take care of things for their hotel guests. So, if my doctor is going to create a concierge practice, I think I’m going to like it! Not so fast. In truth, it is not going to be complimentary or for every patient. Most important, it is not going to be free. The new concierge patient must pay a hefty annual fee of a thousand dollars or more per year per person to remain their concierge doctor’s patient. If you can’t or won’t pay, you will have to find another doctor. Yes, it is a pay-to-play practice.

Why are these concierge doctors doing this? Is it for more money? The answer is both yes and no. Concierge doctors will make more money because of this annual fee, insurance payments, and the co-pay. Yes, you still have to have insurance and make the co-pay payment for each visit.

The doctors making this switch are doing so to rid themselves and their crowded waiting rooms of mostly poor, minority Medicare and Medicaid patients. By charging a hefty annual fee, only those who can afford that annual fee PLUS their annual health insurance premiums PLUS the per visit co-pays will stay with them, and those likely will not be Medicare or Medicaid patients. The concierge doctors’ rationalization is that by getting rid of the multitudes Medicare, Medicaid and private insurance patients who cannot or will not pay the annual fee, the doctors will be able to provide “premium services and amenities.” More simply put, they will only have to examine and treat those who have money. Top it all off with the reality that those of us who cannot or will not be forced to pay to remain a patient are given 30 days to find a new doctor.

This does not pass the smell test. There are many things very wrong about this practice:

1. It discriminates against those who cannot afford $1,000 or more, per family member per year to for this service.

2. It discriminates against Medicare and Medicaid patients as they are least likely to be able to afford the pay-to-play game.

3. It might well be illegal because Medicare, Medicaid and private insurance companies contract with these doctors to treat their insureds, and those contracts prohibit the doctors from collecting any more money than the co-pay.

4. It does not matter how long you have been with your doctor when the doctor decides to go concierge on you: Pay-to-play or leave.

5. By paying-to-play, you are promised the attention and care you should have been receiving all along without having to pay any additional fee.

Consider the modern version of the Hippocratic Oath that every doctor takes when they are licensed to practice medicine. Nowhere does it provide that it is permissible to require one to turn a blind eye to or their back on a patient because while he can pay for insurance, he cannot pay an additional, hefty annual fee for the privilege of being his patient. Physicians who transform their practices into concierge, pay-to-play practices are hypocritical of their Hippocratic Oath:

The Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

The doctors fought hard for tort reforms to protect them from all lawsuits and minimize and cap the damages that an innocent victim and their families can recover. They blocked the courthouse door so the innocent victims could not hold them responsible for their negligent acts. Now they block their office doors so their patients who cannot afford to pay-to-play will not clutter their waiting rooms, take their precious time, and prevent them from providing the best possible care to every patient and uphold and honor the oath they took for that privilege. You see, in order to get the protections in place through tort reform laws, they threatened to leave states which would not pass them. It worked. Now, they only want to treat the affluent who supported that legislation to keep their doctors from leaving.

Aiding the concierge doctors in this decision is Congress reducing their Medicare and Medicaid reimbursement rates. The doctors don’t like it, and have decided they don’t want Medicare and Medicaid patients cluttering their waiting rooms and practices. So they remind themselves that they remain a member of their own socioeconomic segment of society, with special obligations only to all their fellow human beings who can afford pay-to-play medicine.