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Doctors offering 'concierge' care

A Boca Raton company offers VIP perks for those who can pay a premium. That worries critics.


© St. Petersburg Times,
published July 28, 2001

How much would you pay for your doctor's pager number?

A Boca Raton company is hoping that enough people will want 24/7 access to their physicians to pay $1,500 per year for its version of "concierge" health care.

Among perks for the elite: same-day appointments, a comprehensive physical and home delivery of medicines.

Offering preferred treatment to those willing to pay a premium has been a standard with airlines and hotels. But in health care it has rankled critics who question the ethics and even legality of making such distinctions.

Despite such concerns, personalized health care for the elite has been gaining popularity since emerging in Seattle in the mid 1990s. Fed up with long waits, rushed visits and anonymity among the managed care masses, patients with means are jumping at the chance to become one of the favored few.

Dick Schramm of Boca Raton said when he learned his doctor was opening a concierge practice with MDVIP Inc., the company based in his city, he couldn't wait to sign up.

"I go to other doctors and have to wait an hour and a half for a three-minute visit," said Schramm, a retired basketball coach. "With MDVIP, I paged my doctor at 10 o'clock one night and heard from him five minutes later. I was on my way to the drugstore in 15 minutes."

MDVIP launched its service in March. So far it has about 1,000 members and just two affiliated physicians in South Florida. MDVIP's doctors agree to limit their practice to 600 patients versus a primary care physician's average caseload of 3,000. In return for guaranteeing more personalized service, the doctors receive about two-thirds of each patient's annual fee.

The fee does not affect co-payments, co-insurance or deductibles. Except for the annual physical, patients or their insurers are responsible for all other health care costs.

Andrew Ripps, MDVIP's chief operating officer, said the company's concept is spreading rapidly, with a cluster of doctors in Southern California and the Northeast interested in joining. Ripps also has been talking to two primary-care physicians in the Tampa Bay area, whom he declined to identify.

But not everyone is sold on MDVIP's plan to sell what Ripps calls "white-glove medical service."

"It's greedy, unconscionable and possibly illegal," said Herbert Kleinhaut, a 68-year-old retired businessman in Lake Worth and a former patient of Dr. Robert Colton, MDVIP's first recruit. Kleinhaut filed a complaint with the federal Medicare program after he received a notice from MDVIP telling him to pay up or find a new doctor.

The Florida Department of Insurance is investigating complaints from consumers who say they were dropped from coverage by a doctor for not paying MDVIP's fee.

The American Medical Association's ethics expert, Herbert Rakatamsky, thinks MDVIP's fee violates Medicare rules.

"If you accept Medicare money, you cannot contract to accept money outside the system," he said.

MDVIP executives said its affiliated doctors don't contract directly with patients but rather with MDVIP. They say the fee goes to cover services that would not be covered by Medicare, such as the annual physical.

"Our challenge right now is to educate people what's happening and what's not," Ripps said. "But we remain confident that we are compliant with all applicable legal requirements."

Dr. Bernard Kaminetsky, an internist in Boca Raton, joined MDVIP in June and now spends at least 30 minutes with a patient, compared with less than 10 minutes in the past.

"You get a sense that you've really attended to a problem and it's so much more gratifying," said Kaminetsky, 48, who has been in practice 17 years. "I even paid a house call to a patient who was dying last week. It's been years since I did that."

Kaminetsky said working with a limited caseload -- and a financial cushion to lessen the impact of fewer billings -- has rekindled his love of medicine.

"I was seeing 30 patients a day and on an accelerating treadmill," he said. "It was either do this or leave clinical practice. I don't think the public realizes the depth of physicians' dissatisfaction."

Ira Mandel, a physician who heads a Tampa group focused on improving doctors' practices, said he understands the motivation of colleagues like Kaminetsky but doesn't agree with the solution.

"Doctors are seeing more patients, working longer hours, feeling more hassles from managed care and seeing their incomes fall," said Mandel, president of Quality Partners. "It's understandable that they want to take charge and accept higher compensation for fewer patients, but it's very unproductive. It gives the appearance that doctors are being greedy and catering to the highest bidder."

Instead, Mandel recommends that doctors improve the efficiency of their practices so they have more time for patients. "There are better ways to handle the problem," he said.

That may be, but Schramm, 60, of Boca Raton is convinced there's nothing better than paying extra to get his doc's ear. The retiree said Dr. Colton has helped him keep his weight, blood pressure and diabetes under control.

"They say this program is only for the rich," he said. "And you know what? So be it. How many poor people can afford a country club? This is like joining a country club, and I'm paying $1,500 for the best one in town."

- Information from the Wall Street Journal was used in this report.

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