Medicare Compliance & Reimbursement

... but growing trend could lead to crackdown.

The government isn't likely to crack down on "concierge care" any time soon, if legislators heed one agency's advice.

Doctors thinking about charging patients for extra services such as same-day appointments or 24-hour personal access to docs can take heart from a new report from the Government Accountability Office (GAO-05-929). Congress had asked the GAO to study the relationship between Medicare and concierge care, in which physicians charge patients extra for services that Medicare won't cover.

The GAO found that because relatively few physicians are providing concierge care it's unlikely to cause access problems to Medicare beneficiaries. Concierge care is mostly a bicoastal phenomenon, and physicians charge anywhere from $60 to $15,000 per year for the service, the GAO says.

While the GAO says that concierge care "does not present a systemic access problem to Medicare at this time," the agency left open whether the services could pose such a problem in the future. The agency also noted that some physicians would like more guidance from the Department of Health and Human Services on concierge care. HHS has said in the past that concierge care is acceptable as long as it doesn't violate any Medicare rules, and as long as doctors don't charge patients for services that Medicare covers.

The HHS Office of Inspector General caused a stir in March 2004 when it issued an alert saying that one physician, in particular, had charged patients for services such as coordination of care and health assessment, some of which Medicare also paid for.

The GAO report seemed "pretty harmless," says Allan Jergesen, an attorney with Hanson Bridgett Marcus Vlahos & Rudy in San Francisco. Providers who were hoping for more guidance will be disappointed, but at least the GAO didn't warn about problems with concierge care.

The GAO's message boiled down to: "It doesn't seem to be broke, so don't fix it," says John Marquis, an attorney with Warner, Norcross & Judd in Grand Rapids, MI. Congress had asked for this report to see if a legislative fix was needed, and the GAO didn't call for one.

The GAO identified 146 concierge physicians nationally, and it's not clear whether 500 or 1,000 concierge physicians would have been enough to worry the agency, notes Marquis.