Concierge Practices in Greater Boston

C oncierge or 'boutique' practices, otherwise known as Fee for NonCovered Service (FNCS) -style practices, are the response of some primary care physicians to a flawed health care system where health care services are treated like any other commodity despite an unfair disparity in negotiating power, health insurers do not reimburse them for work they do that does not involve face-to-face patient contact, cognitive services are vastly undervalued compared with procedural services, and there is no financial incentive to excel at what you do. In short, regulatory interference with the supply-and-demand market economy by which the prices of virtually every other good and service available in modern society is determined. The basic concept of a concierge practice is that physician limits the size of his practice and thus the daily volume of patients seen as well as the overall amount of unreimbursed work that physician and staff need to do. Thus, more time and attention can be focused upon each patient and the practice can operate more at the patient's convenience than would otherwise be possible. For example, standard appointments with primary care physicians might be 15 to 20 minutes. Appointments in the concierge practice can be scheduled for 30 to 60 minutes or more, extra time that will be spent on nutrition counseling and other preventive services. An annual comprehensive physical examination may last even longer. Since there are less patients to be scheduled, there are more appointment slots, and thus, perhaps appointments can be scheduled at the greatest convenience of the patient. Evening and weekend hours may be available. Patients who join concierge practices can usually contact the doctors directly by cellphone or pager 24 hours a day, and can obtain prompt consultations by telephone or e-mail. Waiting areas and exam rooms tend to be more lavishly furnished; there may be more ancillary staff available to assist with administrative and clinical needs. Physicians may make house calls or communicate more closely with specialists. To compensate the physician for the lower volume (and lower gross revenue),each patient is charged an annual fee. These fees vary widely from practice to practice.

Wayside Health Associates is not a concierge practice. Although we fully agree with the underlying motivation and reasoning behind them, are equally frustrated with the inequitable behavior of insurers and provider organizations and support their existence and success, we are personally uncomfortable with the elitism that is inherent in such a tiered arrangement. We have concerns that, as such practices become more commonplace, there will be fewer doctors for patients who cannot afford the access fee. This situation is bound to worsen considering the growing manpower crisis in the primary care workforce we are now experiencing.

Since we are not a concierge practice, we cannot provide the level of service described here. We are professionals and your health care advocates for our patients - we are pledged to providing the level of service our patients need. However, we will not necessarily provide the level of service our patients want. To do so within the current health care system would be economic suicide. If you are willing to pay to bridge this gap, we suggest that you consider joining a concierge practice. For your convenience, we have listed several of them below:

Jeffrey Bass, MD
Martin Solomon, MD
1180 Beacon St # 1B
Brookline, MA 02446
(617) 278-1700

Jordan Busch, MD
Steven Flier, MD
Personal Physicians Healthcare
1244 Boylston St, Suite 306
Chestnut Hill, MA 02467
(617) 731-0058

Jeanine Carlson MD
Brian Cohen, MD
Steven Spector, MD
Harry P. Selker, MD (a med school classmate of mine!)
Pratt Diagnostic Center
Tufts-New England Medical Center
Proger Building
Boston, MA 02111
(617) 636-2800

David Fairchild, MD
Tufts-New England Medical Center
Proger Building
Boston, MA 02111
(617) 636-1083

Rushika Fernandopulle, M.D., M.P.P.
Pranav Kothari, M.D.
Renaissance Health
61 Massachusetts Avenue
Arlington, MA 02474
781-643-6080

William Goldberg MD
300 Mount Auburn St #409
Cambridge, MA 02138
(617) 491-0108

Richard Goldman, MD
Access MD
873 Worcester Street
Wellesley, MA 02482-3714
(781) 416-5200

Ronald M Katz MD
1180 Beacon St #8A
Brookline, MA 02446
(617) 734-2433

John Levinson, MD
15 Parkman Street
Suite 475
Boston, MA 02114
(617) 726-5578

Jeffrey Silver MD
25 Boylston St #311
Chestnut Hill, MA 02467
(617) 738-6885

Harold Solomon MD
25 Boylston St #308
Chestnut Hill, MA 02467
(617) 731-7774

Barbara Stewart, MD
1400 Centre Street, Suite 206
Newton Centre, MA 02459
(617) 630-9800

In 2005, five members of the Democratic caucus of the Massachusetts House introduced legislation (House Bill 3032) that would have effectively put an end to concierge practices in this state. While the Bill was never enacted, it shows the leanings of at least some political elements in Massachusetts. The Bill contained two identical parts, one aimed at physicians on HMO panels and one at physicians on PPO panels. The PPO part required that any contractual arrangement between a PPO and a physician contain "a provision prohibiting the provider . . . from charging an access fee" to a person covered by the PPO. This provision would have prevented physicians from charging patients a flat fee and at the same time billing a PPO. This was aimed directly at the FNCS model, as it condemned a periodic fee "regardless of whether such access is bundled with other membership privileges or amenities."