Monday, February 15, 2016

qotd: Concierge medicine at Mass General

The New York Times
February 12, 2016
Founded for the Poor, Mass General Looks to the Wealthy
By John Hanc

Can a hospital founded more than 200 years ago to treat the poor also
adopt a form of medicine some criticize as health care for the rich?

The answer may come in August, when Massachusetts General Hospital, the
third-oldest general hospital in the nation, plans to open a concierge
medicine practice.

Based in Boston, the hospital, whose $800 million annual research budget
is among the nation's biggest, is affiliated with Harvard Medical School
and is perennially ranked No. 1 in many categories of U.S. News & World
Report's listings of the country's best hospitals.

Despite its reputation, Mass General — as it is known — was established
in 1811 to care for the city's poor and indigent. Patients in concierge
medicine are likely to be anything but that.

The idea of wealthy people paying doctors a retainer for exclusive
service is not new. With concierge medicine, which was introduced in the
1990s, patients pay physicians a monthly or annual retainer and expect
more personalized care and greater access. "A concierge patient who
signs up for a practice is not only looking for quality care, they are
looking for unfettered access to their provider," said Dr. Michael R.
Jaff, the medical director of Mass General's Center for Specialized
Services and a professor at Harvard Medical School.

There are pros and cons to concierge medicine — or direct primary care,
a similar model — which, according to the industry trade magazine
Concierge Medicine Today, is embraced by about 6,000 doctors across the

"The upside is that it gives more time for patient-physician
interaction, and the data shows that generally the more time a patient
has with a physician, the better the outcome," said Dr. Wanda D. Filer,
president of the American Academy of Family Physicians. "The downside is
that it can be very exclusive and difficult for middle- and low-income
patients to afford. So there's a concern that you'll have a two-tier

In recent years, concierge medicine and similar types of programs have
spread from private practices to hospitals. Mass General's embrace of it
may prove influential.

To critics of concierge medicine, Mass General's foray into the field is
no cause for celebration. "It's worrisome, unless you're rich," said
Pauline Rosenau, professor of public health at the University of Texas
Health Science Center in Houston. As for the hospital's historical
mission, she added, "I'd say it's in jeopardy."

The proximity to the main hospital will give concierge patients easy
access to Mass General's specialists (something not typically offered in
private concierge services). "We've made the institutional commitment
that these patients will get the best of the best at a phone call," Dr.
Jaff said. "So if I call and say I need a general surgeon, they'll have
a world-class general surgeon that day."

As for benefits of the concierge practice for the rest of the hospital's
patients (Mass General has about 1.5 million outpatient visits a year),
Dr. Jaff admitted they were a little less tangible, though still
critical. "With dwindling reimbursement," he said, "there needs to be
other sources of revenue to help us support our mission to the community
at large."

What some call "health care for the rich," the hospital says it
believes, can be one such source.


Comment by Don McCanne

Say it isn't true. Mass General? Concierge hospital? Two-tier medicine?
Selling the front of the queue to the wealthy?

Is the payment of a bribe to gain better health care access access
ethical just because Mass General has given its stamp of approval? They
say the money will help support their mission to the community at large,
but how does pushing the entire queue back by giving the wealthy a
ticket to butt in in front of everyone else help those with low or
moderate incomes?

It gives a new meaning to triage. As we organize the delivery of care
based on need and urgency, we now have a new paramount guideline, "Let
the money in first!"

Under a more egalitarian single payer system, at least the bribes would
not be so flagrant.

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