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