A Weird Letter from My Doctor

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

I was seeing a cardiologist at the Pacific Heart Institute in Santa Monica. He was excellent. I would be seeing him still but for a strange letter I received.

Insurance companies and Medicare have been reducing payments, the letter began, and more cuts are threatened. In response other cardiology groups were 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, according to Pacific Heart Institute, was an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For an extra $500 a year I could choose the “SELECT” level. Among its features were 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 (whatever that is…).

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 that merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up. It didn’t say he would consider me a cheapskate, but why wouldn’t he?

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. This strikes me as similar to setting up ethical guidelines for operating a Mexican cancer clinic, but mine is a minority view.