Concierge Medicine.

Over the past few years, Concierge Medicine has increased in popularity and prevalence. Concierge practices are private medical services that charge an extra/expensive retainer fee to guarantee patients more individualized, comprehensive care, and accessibility. There are different business structures used with Concierge Medicine, namely, hybrid model - in which model physicians provide services to concierge and non-concierge patients, and direct primary care model, in which the practice ops out of federal payors to provision services to only its member patient cohort. For physicians thinking of transitioning to Concierge Medicine, there are a host of legal and compliance issues to consider.

Transitioning to Concierge Medicine.

Our healthcare attorneys are knowledgeable in counseling physician businesses to transition to concierge services while remaining in compliance with Medicare/Medicaid rules, navigating the federal beneficiary carveout doctrine, adhering to private payor requirements and properly following other state regulations, such as state insurance laws. Further, marketing of the concierge services will also have to comply with state and federal marketing rules on physician services advertisement.

If the concierge practice enters into a contracts with a management company for transition, the agreement between the management company and the practice must comply with federal and state antikickback (AKS) or self-referral statutes (Stark).

Ethical Considerations.

Certain ethical issues may arise in the practice of concierge medicine, especially when the practice provides care to a mix of concierge and non-concierge patients. lack of availability of the physician and reduced quality of care to non-concierge patients may lead to ethical concerns and a breach of the standard of care under the state board provisions. Furthermore, ethical issues may arise when the patients do not clearly understand the value and type of services that they will receive at a concierge practice. It is important that all patient interactions and services are designed to adhere to the local standard of care and the state medical board requirements.

Concierge Patient Contracts.

Concierge practices should have written contracts with their concierge patients to delineate the fee the patient will pay and the services the practice will provide. A failure to properly delineate fees and services may violate state and/or federal statutes, such as state misrepresentation in advertisement regulations, board of medicine rules or insurance statutes or CMS conditions of participation. Our attorneys have knowledge and experience in drafting concierge membership agreements to reduce or avoid future litigation, audits or investigations.