Wouldn’t it be nice to have your doctor’s cell phone number at your fingertips? Better yet, wouldn’t you love for him to return your call within minutes?
For the right price, such service can be yours. Boutique, or “concierge,” medical practices offer premium care to patients willing to cough up the big bucks, with annual fees ranging from $900 to $20,000.
In exchange, patients get same-day appointments, round-the-clock physician access, leisurely visits, house calls, home drug delivery and other perks. Some doctors even accompany patients to specialists and travel to see them if they get sick away from home.
Patients pay the annual fee, and all deductibles, co-payments and co-insurance are the responsibility of patients or their insurers.
The concept of premium care at a cost began in Seattle in the mid-1990s. Just a handful of such practices exist, but the idea is gaining support, and franchises are planned for cities across the country.
It’s no wonder these practices have taken hold. Doctors are frustrated, squeezing more patients into their day to make up for lost income due to declining reimbursement. Patients are fed up with long waits for appointments, rushed visits and delayed return phone calls.
Under this new model, doctors can afford to spend more time with fewer patients. They claim they can better serve patients and encourage wellness and prevention. They also have more time for continuing medical education, research and family life, not to mention higher incomes.
Before Dr. Bernard Kaminetsky contracted with MDVIP, a boutique practice in Boca Raton, Fla., he saw 2,600 patients a year. Now he sees 600 and knows them all.
“If I see my patients in the supermarket, I ask how they’re feeling,” he said. “I know what drugs they’re taking. Because I have more time with patients, I’m learning things about them I never knew. I ask why they never mentioned something before. They say they didn’t think I had time to hear about it.”
Patients who sign up with MDVIP pay $1,500 a year. Two-thirds goes to the physicians. For the fee, patients get a comprehensive physical exam, leisurely consultations, same-day lab tests, no-wait appointments and round-the-clock physician access. Test results are reported promptly.
Doctors such as Kaminetsky, 49, are looking for ways to get back to the basics of practicing medicine.
“I was extremely frustrated with the direction my practice was taking,” he said. “It was apparent that spending time with patients, being accessible, restoring the intimacy that existed years ago is in a downward spiral.”
Since contracting with MDVIP, Kaminetsky’s life has changed. “I’m putting in the same hours, but there are many qualitative differences. I’m not harried at the end of the day. I can take messages as they come in and not have two hours of phone calls ahead of me each night.”
But critics say this new level of medical service is accessible only to the wealthy, making it unethical. And longtime patients who can’t pay the additional fee or are unwilling must find a new doctor.
Some say it’s illegal.
These practices are under investigation by the federal Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) to see whether they illegally charge patients for services also covered by insurance or Medicare.
Boutique practices say their fee goes toward services not covered by Medicare, such as the annual physical.
The Florida Agency for Health Care Administration recently investigated MDVIP and found no fault, Kaminetsky said.
When Shirley Jacobowitz of Boca Raton heard her practice might start charging a membership fee, there was no question she and her husband, Bill, would sign on.
“I was already a patient of Dr. Kaminetsky,” Jacobowitz said. “I wanted to stay with him no matter what.
“The care is something I had 50 years ago when I was young,” she said. When her husband became ill while golfing, she called the practice and was told to bring him right in.
“It’s so comforting to know that if we have a medical problem, we can reach him immediately. Before we couldn’t get past the operator.”
“Residents are graduating with crushing debt,” Kaminetsky said. “With the current system, I have to see 30 patients a day to have a financially viable practice. That’s not the kind of doctor I want to be and not the way I was trained to practice.”
