Tuesday, October 15, 2013

A Weird Letter From My Doctor

I take good care of myself, but I’m 73, and the best life-style only postpones the inevitable.

I’ve been seeing a cardiologist at the Pacific Heart Institute, a four-man group in Santa Monica. He is excellent. I would be seeing him still but for a strange letter that arrived last month.

Insurance companies and Medicare have been reducing payments, it began, and more cuts are threatened. In response other cardiology groups were merging, lowering the quality of their care. Pacific Heart Institute vowed to maintain its standards. But how to do that while continuing to accept insurance?

The solution was to offer an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For $500 a year I could choose the “SELECT” level. Among its features are priority in appointments, prompt notification of test results, waiver of miscellaneous office fees, a special internet portal, and a customized wallet card with my EKG tracing.

$1800 per year would bump me to “PREMIER” status: same day appointments, direct e-mail and phone access to my cardiologist, and a free vascular risk assessment.

At $7,500 a year (that’s not a typo), the deluxe “CONCIERGE” level gives 24 hour access to my “personal” cardiologist, same day visits, same day tests, and a call from my personal cardiologist to discuss results.

I could check a fourth box. Lacking a title, it merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up.

Paying extra to get the doctor’s attention is routine where doctor incomes are low. It was the norm in the old Soviet Union and remains so in Russia, China, and Eastern Europe.

American doctors are the world’s richest, but they didn’t get that way by ignoring sources of income. If you follow the news, you know that cash-only or “concierge” practices are a growing niche. They’re so popular that professional organizations such as the AMA have set up ethical guidelines. As I wrote on June 27, this seems like setting up guidelines for operating a Mexican cancer clinic, but mine is a minority view.

I’m angry, but mostly I’m frightened about my heart which will require major surgery in the near future. I need to believe my doctor is focused on caring for me, and I thought I had found one. Then he suggested I pay him extra.     

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