Pulse
Above and Beyond
Concierge care, which seemed to be at high tide just a couple of years ago, may have ebbed in Minnesota.
In November 2004, Entrepreneur magazine named concierge physician services one of 13 hot businesses for 2005.
The model for such services—also referred to as boutique or retainer medicine—is that patients pay a monthly or annual fee in exchange for services above and beyond what their insurance covers. Those may include round-the-clock access to their physician, in-depth medical evaluations, and having their physician accompany them to specialist appointments or come to their home when they’re ill.
Concierge medicine wasn’t invented by some hard-charging MBA; rather, it was the idea of a former NBA team doctor. Howard Maron, M.D., who treated members of the Seattle Supersonics, founded the MD2 program—the first of its kind—in Seattle in 1996. Maron charged an annual fee for providing to the public the same kind of medical services professional athletes received. The idea started to catch on with doctors on the East and West coasts who were looking for an alternative to working under the rules and quotas imposed by insurers and corporate employers.
But the extent to which concierge medicine has caught on is unclear. In its 2005 report to Congress on concierge care and its considerations for Medicare, the General Accounting Office identified 146 concierge physicians in the country.
In Minnesota, Park Nicollet quietly dropped its Compass concierge program last year. Compass, which was launched with a splash in 2002, offered patients same-day access to physicians, a phone number by which participants could reach their doctor 24/7, the ability to spend more time with their physician, and reserved parking for $3,000 per person or $5,000 per couple per year. (The article “Opting Out of Managed Care” in the July 2002 issue of Minnesota Medicine included comments by Allan Kind, M.D., the program’s medical director.)
Park Nicollet officials declined to talk about the reasons for ending the program, but other physicians who’ve offered similar services have a theory as to why the organization might have been reluctant to promote or continue it. One Twin Cities physician who offers a wellness program to patients and asked not to be named said the reason physicians are getting out of or very quietly offering extra services for a fee is that they are concerned about drawing the attention of Medicare regulators. “The question is, What is a covered service? If a wellness plan is considered a covered service, I would be in violation of my contract,” he said.
In 2003, Minneapolis internist R. Douglas Thorsen, M.D., found himself in the crosshairs of the Office of the Inspector General (OIG) for allegedly violating federal rules by having Medicare patients sign a “personal health care medical care contract” and pay $600 a year for services such as “coordination of care with other providers,” “a comprehensive assessment and a plan for optimum health,” and “extra time” spent on patient care.
The OIG contended that the contracts constituted a request for payment for services that were already covered by Medicare and, therefore, a violation of Thorsen’s assignment agreement.
According to a New York Times report, Thorsen agreed to pay a $53,400 settlement and to stop offering the contracts to patients.
“You don’t want to get sideways with the government. If you do, you’ve got issues,” says Dudley McLinn, M.D., an internist with Specialists in Internal Medicine in Minneapolis. McLinn’s practice offered what it called the Senior VIP program until last year. For an annual fee, Medicare patients could purchase a physica l and other services not covered by the federal program. McLinn and his partners have since opted out of Medicare in order to continue offering such services and avoid regulators’ scrutiny. “All across the country, Medicare was getting nervous about things like this,” he says. “You could see the writing on the wall.”—K. Kiser