For sale: body scans, boutique care & second opinions - Retail Health Care

Physician Executive, March-April, 2003 by David Ollier Weber

(One Boston group, Partners, carefully excludes patients from its online specialty consultation program if they live in one of the six states where licensing laws do not explicitly permit physicians to consult across state lines.)

In-office sales are a no-no under the AMA code of medical ethics, points out Frank Riddick, MD, FACPE. A pediatrician might provide bike helmets at cost, but ophthalmologists can't dispense glasses. And even though promoters tell doctors they can make $100,000 a year or more pushing neutriceuticals, that definitely represents a conflict of interest, Riddick declares. Patients may feel under pressure to buy, he explains, and they may suspect that the doctors are really placing their own profit motive before the patients' best interests.

And yet, group practices are doing sales all over the place, Riddick says. They have subsidiary hearing aid centers, weight-loss clinics, cosmetic centers and the like, "And AMA rules for physicians don't apply to hospitals," he adds.

As for retainer practices, where doctors offer special contracts to patients guaranteeing greater access and plusher amenities in return for payment of a membership fee, the AMA's Council on Medical Service concluded last year that these are in line with the organization's "long-standing policy in support of the rights of physicians to freely contract with their patients" and of "the rights of individuals to request and receive all services they are willing to pay for."

That latter argument sticks in the craw of some traditionalists, however. "How, then," challenged one, "does that make medicine different from the oldest profession?"

And there is still a straight-and-narrow to adhere to, Riddick emphasizes. Physicians can't simply dump those of their patients unable or unwilling to pay up front when the practice switches to a boutique care model. Failure to make sure those patients get fair warning and are booked up with another good doctor is a serious ethical breach.

Indeed, physicians must also make it clear to their retail clientele that a customer service fee does not buy quality. That's something every patient is entitled to in every physician encounter. And each doctor, the AMA says, is expected to shoulder a share in providing uncompensated care to society's needy.

Just how solid the legal and regulatory ground under boutique practices may be is also questionable. The services provided must be strictly beyond those covered by insurance or Medicare if they are not to fall afoul of balance billing restrictions, the AMA cautions. And some in Congress want the Centers for Medicare and Medicaid Services to rule boutique practice out of bounds.

Given all that, Riddick is one who is skeptical about the prospects of retainer medicine.

"I don't think this is the wave of the future," he says. "It'll work in some communities, for some physicians, in some practices... and God bless 'em. As far as franchising the concept is concerned, my take is that it's not going to be the greatest thing since sliced bread. It's more likely to be the Phycor of the 2000s."