We’ve had beneficiaries calling our Senior Medicare Patrol (SMP) office about letters from their doctors or medical groups. These letters tell beneficiaries that by paying an additional an annual fee, they can receive better administrative access to their medical group or specific doctor. Charges are anywhere from $200 to $2,000/year.
Is this legal? Callers initially thought this might be a fraud scam. Yet, in doing some investigation, we confirmed with the Centers for Medicare and Medicaid Services (CMS) that this practice of charging an “administrative fee” is indeed legal. Doctors and medical groups are allowed to do this as long as the fee charged is for the services not covered by Medicare. This practice actually started in 1996 and is often referred to as Concierge Medicine or MD-VIP. Some liken it to to an annual health club membership. Certain doctors and medical groups even require their patients to pay this additional fee; those who refuse to pay, are asked to find a new doctor.
Concierge Medicine is actually becoming a nationwide practice and rates of doctors and medical groups offering this have risen 25% between 2011 and 2012. Some common “benefits” offered in Concierge Medicine are:
- More access to one’s own doctor (instead of seeing doctor assistants)
- Ability to get same day appointments
- Extended period with doctors during visits
- Overall greater degree of personalized attention
Two studies fielded by the American Medical Association claim that Concierge Medicine has resulted in:
- a 79% reduction in hospital admissions, and
- better management of chronic conditions.
Yet we and many advocates question the equity and fairness of this practice, as it directly gives wealthier beneficiaries an advantage over those with less resources in terms of accessing quality care.