Tufts hospital to charge for better care

This December, the Tufts-New England Medical Center (Tufts-NEMC) will become one of the first academic medical centers in the country to introduce a practice known as "boutique care," which offers patients extra services for a retainer fee.

The boutique care practice will be available at the Pratt Diagnostics Center and is intended to make up for the estimated $1 million annual loss the primary care side of the hospital incurs.

General Medicine Associates (GMA), the primary care division, treats many patients who cannot pay for services. Rather than decrease services available, the hospital hopes to regain the money through boutique care.

The ultimate goal of adding the retainer practice, according Brian Cohen, MD, the director of the Pratt Diagnostic Center and one of the physicians who will split his time between the GMA and the retainer service, is to improve current services.

"We want to maintain and expand the adult primary care base [at the hospital] to serve the community," Cohen said.

If hospital officials sign their goal of 1,000 patients to coverage in the Pratt Center this year for $1,800 each, the program will generate enough money to cover primary care losses.

The hope is that the Pratt Center will attract enough patients and become profitable enough to expand the primary care services by several physicians, Dr. Cohen said.

Cohen said that patients who pay for boutique care will receive services that are above and beyond basic healthcare.

They will get a longer physical with wellness and nutrition information, a take-home CD-ROM containing electrocardiogram (EKG) results and other health information for diagnosing conditions that develop when patients are away from their primary doctor. Health-related newsletters, fax and e-mail consultations and cell phone access to a doctor will also be available.

Despite the intentions of hospital directors, some argue that such a service represents an inequity in care.

"Shouldn't they be doing that for all patients?" Derby questioned of the boutique care bonuses. Physicians should strive to provide the best service to all, she said.

"[A retainer practice] raises concerns about how effective overall access will be [at the hospital]," according to Becky Derby of the Massachusetts division of Health Care For All, a nonprofit advocacy group for patients' rights. Derby said it could create a two-tiered medical system, where wealthier patients get better care than those who cannot afford such retainer services.

Officials at the hospital say they have addressed this concern. Four doctors will rotate from the GMA into the Pratt Center one-by-one, so that the primary care practice will miss only one of its 24 total doctors at any given time.

Patients may also discover changes to their insurance programs. According to The Boston Globe, Harvard Pilgrim Health Care has allowed only one retainer practice in its HMO network because they feel that the services offered by such practices should be offered to all patients. They are reviewing the Pratt Diagnostics Center program and will make a decision whether to keep it in their network.

The Centers for Medicare and Medicaid Services are also investigating some of these practices to determine whether they are illegally charging patients for services that should be covered through Medicare and Medicaid.

Retainer services have been gaining popularity with medical centers and individual medical practices in the last few years. Initially, these practices emerged as rare services for the very wealthy.

According to the American Medical News, the first retainer practices charged annual fees as high as $20,000, but these high cost programs are now outnumbered by practices that charge between $1,000 and $1,500 a year and some that offer services a la carte.