Founded for the Poor, Mass General Looks to the Wealthy
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.
“Today, even inside hospitals, its [Concierge Medicine] historical fingerprints are centered around access, transparency and relationship – and it is these types of new delivery programs and free market healthcare business models that are rescuing the careers of some of America’s greatest physicians and healthcare professionals. Concierge Medicine Programs and Executive Healthcare Memberships inside Medical Centers and Hospital environments has been happening for over a decade. Virginia Mason’s Dare Center [Seattle, WA] was one of the first in the country years ago. There are a number of reasons why hospital executives and physicians do this. In today’s healthcare culture, the 55-plus audience hasn’t been entirely abandoned, but the advertising aimed at this population segment is simply aimed at maintaining brand loyalty and establishing that the products they love are still good, still function and most likely being improved. These are powerful programs which help maintain brand loyalty and provide care to a population in need of multiple chronic care visits with their doctor.” ~Michael Tetreault, Editor of Concierge Medicine Today
For $6,000 a year (and whatever their insurance pays), patients in its new Concierge Medicine Practice will get round-the-clock access to their doctors (initially, there will be three in the practice), as well as personalized nutritional, exercise and wellness counseling.
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. (Another 6,000, the magazine estimates, are in practices that offer some form of retainer or concierge service.)
“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.
“It’s a significant development, simply because of the name and the prestige,” said J. Catherine Sykes, publisher of Concierge Medicine Today. “To have an organization that has the core values Mass General holds enter this arena adds momentum to the movement.”
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.”
“Health care economics are such, as well as the needs and wants of some different patient populations, that we’re offering this concierge model,” said Misty Hathaway, Mass General’s senior director for specialized services. “It won’t be the right model for everybody, but it will help us generate different sources of revenue in a way to fund the core mission.”
Mass General’s concierge practice will be housed at 50 Staniford Street, a 10-minute walk from the hospital’s main building on Fruit Street, in Boston’s West End. The location was chosen for symbolic and practical reasons.
“We didn’t say, ‘Let’s just open a private office in Beacon Hill and put the Mass General logo on the door,’” said Dr. Jaff, who will oversee the new service. “We wanted the practice to be integrated into the institution.”
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.”
“Some hospitals are investing considerable amounts of money into making their Emergency Rooms into more patient friendly environments,” adds Tetreault. “Others are redesigning pediatric wings to accommodate for extended family stays.
“The challenges of medical center Concierge Medicine programs are very different than those experienced by concierge physicians in private practice,” said Dr. Kirkpatrick. “All hospitals/medical centers have special perks and usually enhanced access to specialists for their donors and patrons, often a special number they can call. Most have an informal private banking approach where there is no established fee, just an expected level of donation. Despite the proliferation of individual concierge practices and now organized networks, Concierge Medicine programs INSIDE medical centers are quite unusual. There may be only 20-25 in the entire country.” Source: Exclusive Interview with Dr. John Kirkpatrick and Concierge Medicine Today, June 27, 2013.
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.
A version of this article appears in print on February 14, 2016, on page F3 of the New York edition with the headline: Hospital Care Aimed at the Rich.