Would you pay your doctor a membership fee?


For some doctors and patients, this fledgling but growing form of medical practice gives patients more quality time with their doctor. However, for those who can't afford the fee, it raises concerns about equal access to health care.

Dr. Marissa Chilcott is not your typical physician. She spends much of her day on a bicycle in Santa Rosa making house calls. If this were a century ago, she'd be riding a horse and buggy.

"To me, this is just old fashioned family medicine. This is how it should be," says Dr. Chilcott.

She charges $750 per year per patient for her house calls. That's on top of anything not covered by the patient's insurance. Patients who'd rather see Dr. Chilcott at her office must still pay a retainer fee of $120.

She recently joined her father-in-law's medical practice. The two informed their patients about the fee in a blunt letter: "If you do not think that this is reasonable, we are not offended and there are no hard feelings, but we will not be able to be your doctors."

For patients who agree to pay, the feelings are sometimes mixed.

"I wouldn't trade her for anything. She's worth every penny, if I don't run out of the pennies," says Margaret of Santa Rosa.

Another concerned patient wrote 7 On Your Side and asked if the fee is legal. It is, but there are restrictions. Medicare regulations don't allow doctors to double bill -- charging their patients and Medicare for the same thing. Neither do most insurance companies.

"There's a real risk that patients who are the most vulnerable being the ones who would get, as you put it, dumped," says Clarence Braddock, an ethicist at the Stanford School of Medicine.

That's because he says some patients simply can't afford the fee. However, those who can may be willing to pay for increased access.

"I quite frankly can't blame patients for the means for wanting to have a doctor who can give them a little bit more time, who return their phone calls maybe within hours rather than days or weeks," says Braddock.

Some insurance companies don't allow their network of doctors to participate in concierge care at all. But many doctors complain insurance companies don't pay them what their services are worth. The American Medical Association estimates reimbursement rates today are the same as they were in 2001, while costs have gone up 20 percent.

Dr. Chilcott says the low compensation rate means doctors must see four patients an hour just to make a decent living, and that's not what she wants.

"I have an image of a physician that is based in my own experience as a child having a family doctor who knew me, who knew my family, who spent time with us," says Dr. Chilcott.

A concierge care doctor typically charges a membership fee in exchange for increased access to the doctor, such as house calls or 24-hour telephone access.

Congressional investigators reported in 2004 that there were just 146 concierge physicians in the U.S. An association of concierge care physicians estimates that number has increased to at least 1,500. That's a ten-fold increase, but still a small number compared to the total number of physicians in the U.S. That number is expected to grow as doctors search for new sources of revenue and ways to spend more time with their patients.

In its 2004 report, the Government Accountability Office said most concierge care patients paid annual fees of $1,500.

"Is that a problem? For those families, they may not think so. But it begins to erode the overall integrity of the whole system, as more physicians opt out for one kind of practice, leaving the rest of us kind of behind," says Braddock.

We talked to Medicare about Dr. Chilcott and they say in general, it has no objections to most doctors who do the same thing. If your doctor decides to transition to concierge care and you are concerned, check with your insurance company.

GAO (Government Accountability Office) Report to Congressional Committees on Physician Services: Concierge Care Characteristics and Considerations for Medicare

Society for Innovative Medical Practice Design (association of concierge care doctors)

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