LEGAL | OREGON
Letter To Oregon Insurance Commissioner RE: Senate Bill 86 & Proposed Rules From Attorney John R. Marquis.

By John Marquis, Contributing Legal Writer

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October 24, 2011 - I would like to take this opportunity to offer a few comments about the above Proposed Rules. I understand that a hearing is to be held on October 25th and that the last day written comments may be received is November 1st.

I was one of the co-founders of the national concierge physician organization now known as the American Academy of Private Physicians and have been practicing concierge medicine law for almost ten years. I have advised many physicians around the country in their efforts to establish concierge medicine practices.1

There are fundamentally only two forms or models of concierge medicine, and it is very important, particularly when contemplating SB 86, to recognize the difference.2 By far the most common form of concierge medicine is the so-called “fee for non-covered services” model. (The “non-covered” term refers to services that are not covered by Medicare.) In this form of practice, the physician typically offers only non-medical “amenities” (such as 24/7 direct phone contact with the physician, same day or next day appointments, and the like). It is often the case that the list of services offered by these practices also includes an annual wellness physical. In exchange for the periodic fee, these amenities, and often the annual physical, are available to the patient.

The other basic model or form of concierge practice is the “fee for care” model, now typically called a “direct practice.” The distinguishing element of this model, and for our purposes here it is a very important distinction to keep in mind, is that in exchange for the flat periodic fee the physician provides to the patient, as the need arises, whatever medical services she is capable of providing. For instance, an internist could have patients who are paying her a monthly fee in exchange for whatever internal medicine services they may need. No third-party or other physician services are offered, only those that can be performed by the physician (herself) accepting the fee. The patient cannot expect to receive services from surgeons or other specialists just because the patient has paid the internist.

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