February 2002

Editor's Message

By Kristen Pratt Machado

Is Medicine Moving Uptown?
The increasing number of Americans who are without medical insurance is a familiar issue. With numbers on the rise again, the crisis may mandate federal intervention (see related news story on page 11). As the abyss of the uninsured grows, what if physicians stopped treating Medicare patients or even those who are privately insured?

Two Boston-based medical doctors are doing just that, according to a January 15 New York Times article. Steven R. Flier, MD, and Jordan S. Busch, MD, are giving up their internal medicine practices at Beth Israel Deaconess Medical Center, to forge a new frontier with a "concierge" practice. In their new practice, they are charging patients $4,000 per year as a flat fee separate from costs covered by medical insurance. The $4,000 pays for the concierge or "boutique" services: cell phone access to the physicians, anytime, day or night; same-day appointments; house calls for physical examinations; and guaranteed accompaniment to specialist appointments.

The physicians, who previously had a patient load of thousands each year, will now top off at 300 each. And what about the 700 plus who are now without a physician? The article quotes Bennett Feinstein, 68, who must find another doctor because the $4,000 fee is not financially feasible, "I know other people think it's immoral, but there's so many Toyotas and there's only so many Bentleys."

However, Frank A. Riddick, Jr, MD, chairman of the Council on Ethical and Judicial Affairs for the American Medical Association, which has not made a formal statement regarding concierge practices, told The New York Times, "Physicians have an obligation to meet the need of a community. You could do that with 10% of physicians in the area practicing boutique medicine, but if it gets much more than that, then I think you really have to question the process."

Physicians are facing consistently difficult practice issues and they are in for another blow in the form of Medicare reimbursement. January 1, 2002, marked the beginning of a 5.4% cut in the physician fee schedule across the board. Rehab providers are also affected if they are reimbursed pursuant to the physician fee schedule. See "Legislative Watch" on page 46 for an in-depth look at the fee schedule cut.

Times are tough for most health care providers, but is moving medicine uptown really the answer? Is treating only patients who can afford to pay extra fees part of the Hippocratic oath? I don't believe so. The oath includes: "I will practice medicine with conscience and dignity. The health and life of my patient will be my first consideration." Health and life are clearly delineated goals-concierge practices, in my opinion, do not complement the noble aspirations held in the oath.

However, the American health care system needs to change. I understand doctors' frustrations when they are not paid appropriately for their work, when they are pushed beyond their mental and physical well-being for little compensation because this plight has been shared by rehabilitation professionals. But eliminating insured patients because they cannot make up the difference between a paltry reimbursement rate and the actual cost of treatment seems drastic.

I am not advocating a socialized health care system, but rather some good old-fashioned American ingenuity. We must find a way to provide medical care that works more efficiently and cost-effectively. There is a lot at stake-I rue the day that health care becomes equivalent to a Bentley-basically, out of the majority's reach.

—Kristen Pratt Machado is no longer Editor of Rehab Management. Please address any correspondence to Sarah Schmelling, Senior Editor, at cwolski@medpubs.com.

LOOKING FOR EXPERT ADVICE? Experts here are available to answer all your questions! Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER Interactive Media  Archives  · December 2008  · November 2008  · October 2008  · August/September 2008  · Fall 2008 Product Directory  · July 2008  · June 2008  · May 2008  · April 2008  · March 2008  · All Archives  Newsletter  · Rehab Today Resources Classifieds Calendar Consumer Resources Media Kit Advertiser Index EAB Reprints Submit an Article