Lawmakers Ask Thompson To Investigate Whether ‘Premium’ Health Plans Violate Medicare Rules

Five congressional Democrats have sent a letter to HHS Secretary Tommy Thompson, asking him to "stop the spread of premium medical services," such as Boca Raton, Fla.-based MDVIP, because such programs may violate Medicare rules, the South Florida Sun-Sentinel reports. In a letter written by Rep. Henry Waxman (D-Calif.) and signed by Rep. Pete Stark (D-Calif.), Rep. Sherrod Brown (D-Ohio), Rep. Benjamin Cardin (D-Md.) and Sen. Dick Durbin (D-Ill.), the lawmakers ask Thompson to "issue an immediate finding" on whether it is legal for a Medicare provider to bill the government while charging beneficiaries an annual access fee (Singer, South Florida Sun-Sentinel, 3/5). MDVIP, a doctor group started by two physicians last year, offers patients "more individualized attention" in exchange for an out-of-pocket fee of $1,500 for an individual and $3,000 for a couple. The group accepts Medicare beneficiaries and individuals in PPOs, but all patients have to pay the annual fee as well as any copayment required by their insurance. In return, MDVIP doctors have promised to reduce their patient load from about 3,000 to no more than 600, which would make possible same- or next-day appointments, annual physicals, nutrition counseling and coordination of specialized care (Kaiser Daily Health Policy Report, 6/21/01). The Boston Globe reports that these premium providers, known as "concierge" practices, are increasing. Nearly 400 patients have signed up for a similar plan in Boston, while two more practices with fees ranging from $1,000 to $20,000 have begun operating in Seattle (Kowalczyk, Boston Globe, 3/5). Waxman's letter states, "Further delay will only encourage the spread of these practices, raising concerns of access and affordability in the Medicare program." The Sun-Sentinel reports that Waxman has said that the annual fee "violates limits on charges for services" and violates the False Claims Act by "understating true charges." According to a spokesperson for Thompson, HHS is "continuing to monitor the MDVIP programs" but does not plan to issue a legal finding "in the near future" (Singer, South Florida Sun-Sentinel, 3/5).

Plans Discriminate, Op-Ed Says
Instead of "discriminating against those who are economically disadvantaged" through concierge practices, doctors should "work actively to eliminate discrimination in health care," Dr. Frank Boehm writes in a Nashville Tennessean opinion piece. Boehm, director of obstetrics at Vanderbilt University Medical School and chair of the medical center's ethics committee, writes that while concierge practices "may be a solution for an individual doctor and wealthy patients," it is "not a solution for our society." Furthermore, Boehm questions "who will be left to take care of all the many who cannot pay" if such practices were to become commonplace. According to Boehm, concierge practices "compromise" the recently updated Hippocratic Oath, which states that "doctors must promote justice in the health-care system including the fair distribution of health-care resources and should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity or religion." According to Boehm, "We do not need a medical system in which physicians charge extra for compassionate, personal, thorough and expert medical care." Boehm writes, "I am saddened to think that we have come to a time in medicine where patients have to pay a substantial membership fee to get what many [doctors] went into medicine to give as a routine practice" (Boehm, Nashville Tennessean, 3/5).