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15 Health Law. 1 (2002-2003)
Concierge Care: Back to the Future of Medicine

handle is hein.journals/healaw15 and id is 155 raw text is: THE ABA HEALTH LAW SECTION H EALTH H LAWYER IN THIS ISSUE Concierge Care: Back to the Future of Medicine? .............. 1 Managed Care Organizations and Their Liability for Treatment Decisions ............ 8 Litigation After HIPAA's Patient Privacy Regulations .... 14 2003-2004 Health Law Section Leadership Group ....... 20 Volume 15, Number 5 August 2003 CONCIERGE CARE: BACK TO THE FUTURE OF MEDICINE? Robert M. Portman, J.D., M.P.P Jenner & Block Washington, D.C. Introduction Physician incomes are being squeezed from all directions. Medicare and private payors are decreasing reimbursement for physician services at the same time that physicians are facing increased practice costs, including higher malpractice premi- ums, costlier medical supplies, and rising overhead. Greater administrative burdens, delayed payments, and claims processing hassles from managed care have .put even further pressure on physician incomes. As a result, physicians typically feel compelled to treat greater numbers of patients just to break even. They complain of not having enough time to spend with each patient or their own families. A relatively small number of physi- cians have responded to increasing economic and time pressures by offering a select number of patients the opportunity to pay a fixed annual fee in exchange for what is commonly referred to as concierge care, or boutique medicine. ' These retainer practices generally provide premium services and amenities, in most cases to a drastically reduced number of patients, in addition to services covered by Medicare and private insurers. Concierge practices may make most sense for primary care physicians and specialists that have ongoing interac- tions with their patients. Significant questions have been raised about the legality of requiring payment for such care and refusing to treat patients that either cannot afford or choose not to pay the extra cost of concierge care. Both the Centers for Medicare and Medicaid Services and various state agencies are looking closely at the propriety of concierge practices. Physicians interested in pursuing this alternative practice approach should be sure that the form of concierge medicine they intend to prac- tice passes legal muster in their state. What is Concierge Care? For a fixed annual fee, concierge practices offer a small group of patients special services and amenities that are no longer (or never have been) provided by most busy medical groups. These services typically include, among other things: priority/same-day/extended/ Saturday appointments * nicer, less crowded waiting rooms * 24-hour pager or cell phone access to physician house calls or other care outside the office, including accompanying patients on visits to specialists continued on page 3

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