More Providers Turning to ‘VIP’ Care with Annual Membership Fees

The AP/Charlotte Observer and Knight Ridder/Richmond Times-Dispatch this weekend explored the rising trend of physicians charging patients annual membership fees in exchange for guarantees of personalized care, a "controversial" practice that some say is unfair to those who can't afford "VIP medical care." The doctors practicing this type of care say that the membership fees, which run in the thousands of dollars, allow them to reduce their patient load, spend more time with patients and remove themselves from the "skimpy pay and bureaucracy of managed care." For instance, patients of Miami physician Dr. Robert Cava pay $1,500 to $3,000 per year in return for Cava's home and cellular phone numbers, "same-or-next-day appointments and no-rush consultations." Since switching to the new model of care, Cava's patient load has dropped from 6,000 to 130 (Knight Ridder/Richmond Times-Dispatch, 8/25). Dr. James Alexander, a Charlotte physician, said, "People are buying access. As health care becomes more assembly-line and less personalized, there will be people and there will be companies who will purchase access and individualized care above and beyond what the insurance company provides" (Linn, AP/Charlotte Observer, 8/26).

Legal and Ethical Concerns
The growth in VIP care, however, troubles many health advocates, who have raised questions about its legality. The Centers for Medicare and Medicaid Services (formerly HCFA) is investigating whether the Boca Raton, Fla.-based MDVIP's membership fees violate Medicare and Medicaid rules, and Sen. Ben Nelson (D-Fla.) is considering proposing legislation that would bar providers who charge membership fees from receiving Medicare and Medicaid money. Kenneth Goodman, co-director of the Program in Business, Government and Professional Ethics at the University of Miami, said that "gold-card medicine" should have no place in the health system. "I don't want a physician to be able to resign as my physician because I can't afford to pay their membership fee. It's too bad that if you are not able to pay the freight, you get an inferior product. It works for selling soap, but it doesn't work morally well for health care," he said (Knight Ridder/Richmond Times-Dispatch, 8/26).