The small but growing cadre of physicians in so-called boutique, concierge, VIP or premium practices--those that charge retainer fees in exchange for greater access and more- personal care--intentionally limit the number of patients they see.
They soon might get unwanted assistance in trimming their patient populations if influential members of Congress succeed in driving doctors in executive-type practices out of Medicare.
How lawmakers will proceed depends on a yet-unknown policy of the Bush administration. Rep. Henry Waxman (D-Calif.), ranking member of the House Government Reform Committee, "wants to see what their position is before there is any legislative action," says Waxman press secretary Karen Lightfoot.
In a March 4 letter to HHS Secretary Tommy Thompson and Inspector General Janet Rehnquist, Waxman asked for an investigation of possible Medicare violations by MDVIP, a Boca Raton, Fla., company that developed a business model for concierge practices. Rep. Sherrod Brown (D-Ohio), ranking member of the Energy & Commerce Committee's health subcommittee, Rep. Fortney "Pete" Stark (D-Calif.) and Sen. Richard Durbin (D-Ill.) also signed the letter. They requested a response by March 22 but had not received one by mid-April.
Specifically, Waxman says MDVIP's $1,500 annual fee may violate Medicare limits on patient charges. He also questions whether Medicare claims filed by MDVIP doctors illegally understate the true cost of care delivery to patients.
"Further delay will only encourage spread of these practices, raising concerns
of access and affordability in the Medicare program," Waxman writes in the letter.
"Secretary Thompson has not taken a specific position on this," a spokesperson for the Centers for Medicare and Medicaid Services says. "It is clearly illegal to double-bill the program or to bill a beneficiary above the limiting charge for a service," which now stands at 115% of Medicare's fee schedule.
Whether an upfront fee not tied to specific services counts as overbilling is a legal gray area, the spokesperson says.
MDVIP general counsel Darin Engelhardt maintains that the membership fee includes an annual physical exam and other preventive services not covered by
"Everything that is billed is billed according to the Medicare fee schedule," he says. "The concern that has been expressed by Rep. Waxman would deny choice to seniors. We view ourselves as a solution for a small niche of the population that wants to focus on preventative care."
He says Medicare recipients make up about half the patient load at the seven MDVIP-affiliated practices.