In the third, called "Premier," they pay $1,800, for everything in "Select," plus e-mail communication with their doctor, same-day visits during regular office hours, priority lab testing and scheduling of diagnostics, free attendance at speaker seminars on cardiovascular issues, and a dedicated phone line to reach an institute nurse.
In the fourth, "Concierge," they pay $7,500 for everything in "Premier," plus direct 24-hour access to a cardiologist via pager, e-mail, text message, plus the patient's PHI cardiologist's personal cell phone, annual personalized cardiovascular wellness screening, night and weekend access to a PHI cardiologist for hospital or emergency services, (regardless of whether he or she is on call) same-day visits with the cardiologist, evening and weekend office appointments and personal calls from the cardiologist.
A spokesman for CMS said that according to an analysis from the Office of Inspector General, concierge fees, such as those set by the Pacific Heart Institute, are legal as long as they are for ancillary services, and not part of routine care.
For internal medicine and primary care, 10-year-old MDVIP now has about 130,000 patients enrolled in 28 states who receive prevention screening and other preventive consults from internists and primary care practitioners, says MDVIP president Darin Englehardt.
These services aren't usually covered by private insurance plans or Medicare, he says. The fees give patients more time with their physicians to plan their care programs, and Englehardt believes that they reduce the need for hospitalizations.
In Santa Monica, Wright doesn't yet know how many patients intend to sign up, or whether the program will be a success in offsetting Medicare fee cuts.
"We'll know in the next month," he says.
But so far, "a very small number have complained. Many have said they understood, and that they 'couldn't believe how little you've been paid.'"