Health

Michigan Medicine program criticized for allowing patients to 'jump the line'

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ANN ARBOR, MI – A new concierge medical care pilot being launched by Michigan Medicine with the intention of enhancing patient access to primary care physicians has drawn criticism from faculty, who claim it’s been used to “jump the line” and has contributed to discrimination against the underserved.

The Victors Care concierge medicine program, which currently is accepting enrollees, is a direct primary care program that charges an annual membership fee in exchange for enhanced access and time with their primary care physician. 

Physicians in concierge medicine practices limit the number of patients they accept to 20 percent of the number accepted in a traditional primary care practice, according to Michigan Medicine, making it possible to devote more time and attention to each patient. 

A Jan. 29 letter from Michigan Medicine faculty to UM Executive Vice President for Medical Affairs Marschall Runge and Executive Vice Dean for Medical Affairs David Spahlinger detailed concerns about the rollout for Victors Care, asking that it “stop recruiting our patients to this program and advertising it as providing much better care than all the rest of our primary care clinics.” 

“As primary care physicians, we struggle on a daily basis to get our patients in to see specialists and to get critical testing,” the letter states. “Instead of addressing this critical barrier for all patients at Michigan Medicine, the implication is that Victors Care will now allow those who pay to jump the line. Some of our specialist colleagues have told us they fear being pressured to fit Victors Care patients ahead of others as they were not asked how they felt about having Victors Care.” 

Michigan Medicine Spokesperson Mary Masson said the Victors Care pilot was developed after requests from patients for a service similar to what exists at institutions across the country, including Massachusetts General Hospital and the Mayo Clinic’s Medallion Program. 

“We’re committed to ethical, accessible care for all our patients and whatever programs we put in place should not diminish that in any way,” Masson said in a statement. “This will not adversely affect the access of other patients to our outstanding health care system.” 

Michigan Medicine is offering founding memberships in the Victors Care program for $2,700 per year – or $225 a month – for anyone who becomes a member on or before June 30. After that, memberships will increase to $3,600 per year – $300 a month – with all founding membership discounts expiring on July 1, 2019. 

Faculty raised additional concerns that the “quality care” label provided through Victors Care implies that regular primary care physicians do not give quality care, with “many” physicians noting the program will “cherry-pick” patients who are more likely to be in good health, the letter noted. 

That could worsen quality measures for physicians outside of the Victors Care program, leaving them with a cohort of “sicker, poorer patients,” the group wrote.

“Taking a physician from regular practice and reducing their patient load to 400 patients will mean that those other 1000-2000 patients will now be moved to the rest of us to assume their care, reducing access to care for all,” the letter states. 

Runge addressed the idea of “jumping the line” during a recent faculty ethics panel forum on Feb. 28, noting that Victors Care is about creating more opportunities for access to healthcare. 

“What we’re trying to create is a system that provides a way to access our healthcare, not bump anybody out of the way,” Runge said. 

According to Michigan Medicine, patients in the Victors Care program are provided with their private doctor’s cellphone number and email address and can schedule same or next day appointments without waiting. The membership fee covers all primary care services provided by Victors Care. There are no copays or deductibles charged for these primary care services.  

The primary care physician in a concierge medicine practice does not bill insurance for services rendered. The patient, however, still carries insurance for medical care outside the scope of primary care. Users are required to pay the Victors Care annual fee even if they do not use their services throughout the year, according to Michigan Medicine. 

Insurance does not cover any part of the membership fee, which is paid directly by patients. Those with Medicare can join the program, but just like private insurance, no part of the fee can be submitted to Medicare for reimbursement. Patients with an HMO are not being accepted at this time, Michigan Medicine indicated. 

UM Associate Professor of Neurology Kevin Kerber said many faculty at Michigan Medicine were surprised to learn of the program, and that he first learned about it after receiving an invitation in the mail to attend a dinner to learn more about joining Victors Care as a patient.  

“My understanding is that even the primary care physicians here did not know about the program until it was being launched,” Kerber said. 

Kerber said while he was in favor of UM hosting the ethics panel, he was surprised the panel did not include a primary care physician, leaving those who attended with more questions than clarity about Victors Care. 

“I am very uncertain as to how this program works to achieve better care since we do not perceive a healthcare problem for people able to pay additional money out of pocket for this type of access,” Kerber said. “I think most people believe the challenge is for people not able to pay extra money for healthcare.” 

Overall, Masson said Victors Care is just one of a number of ways Michigan Medicine is seeking to improve access to and efficiency of the care it provides. 

“Others include use of e-visits when appropriate, opening a new facility in west Ann Arbor and the planned opening of another, in Brighton this fall, which will significantly expand our capacity and access,” Masson said. 

Masson acknowledged that some faculty have raised concerns about the pilot program. 

“We’ve listened to them and are working together to come up with solutions that are mutually satisfactory for the benefit of our patients,” she said. 

According to Crain’s Detroit Business, the Victors Care program is expected to serve about 1,500 patients with more than 100 physicians offering primary care services.

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