Michigan Medicine faculty call new "Victors Care" elitist, exclusive
Michigan Medicine at the University of Michigan is currently launching Victors Care, a concierge medical care model aiming to deliver tailored health care access to a limited number of patients. These patients will receive specialized, convenient and optimized care with purchase of an annual membership fee to cover primary care services without copays or deductibles.
Though concierge medicine has been practiced at a number of health facilities nationwide — including Michigan Medicine competitors like Stanford Health Care, Virginia Mason and the UNC Physicians Network Carolina Continuity of Care Program — the University will institute the care approach for the first time in April.
Mary Masson, institutional positioning director at Michigan Medicine, said Victors Care is one example of ways Michigan Medicine aims to improve medical care.
“Victors Care is a pilot program, developed after requests from patients for a service similar to what exists at institutions across the country,” Masson wrote in a statement to The Daily. “This is just one of a number of ways we're seeking to improve access to and efficiency of care we provide. Others include use of e-visits when appropriate, opening a new facility in west Ann Arbor and the planned opening of another, in Brighton this fall, which will significantly expand our capacity and access.”
However, this concierge medicine program — often referred to as boutique or retainer medicine — has drawn criticism from University physicians.
In a January letter obtained by The Daily addressed to Marschall Runge, executive vice president for medical affairs, and David Spahlinger, executive vice dean for clinical affairs, faculty members list several reasons for their “deep disappointment in the concept and rollout of the Victors Care Program.”
According to the Victors Care website, services include “24 hour access to the patient’s physician or covering physician via telephone, text, or email, Same or next day appointments, Unhurried visits, A yearly executive style physical examination, Assistance with scheduling tests and specialty appointments, Minimal wait times (and) A written summary report detailing the doctor’s findings and recommendations from the yearly physical.” There are also several bullet points listed for “executive style physical examination.”
The website specifically notes memberships purchased on or before June 30, 2018 will be available for $2,700, or $225 a month, until June 30, 2019. Starting July 1, memberships will increase to $3,600 per year. All memberships purchased will expire in July 2019, when the annual membership fee for all members will become the same. Membership fees are said to cover personalized care, take place of billing insurance for primary care visits and allow the organization to limit the number of patients physicians can treat.
Drawing on the program description, grievances listed in the faculty letter include: being unaware in the content of the Victors Care program invitation letter, video and website; discriminating against the underserved; promotional materials suggesting Victors Care patients will “receive preferential treatment at Michigan Medicine based on ability to pay”; implication that if receiving Victors Care is quality care, receiving care from traditional primary care physicians is not quality; and a concern that Victors Care promotional materials and website recommend care that is not evidence based.
“We ask that the institution stop recruiting our patients to this program and advertising it as providing much better care than all the rest of our primary care clinics,” the letter reads. “Victors Care purports to offer ‘better’ health care to those with enough money to pay a large access fee. The University of Michigan is a public institution and our commitment is to serve the public, not a private few.”
The letter also includes direct quotations from Michigan Medicine faculty, one of which notes: “This reinforces UM as an elitist institution catering to the wealthy.” The letter has since been signed by more than 200 Michigan Medicine faculty members.
Masson, however, claims Victors Care supports equal access to health care.
“We’re committed to ethical, accessible care for all our patients and whatever programs we put in place should not diminish that in any way. This will not adversely affect the access of other patients to our outstanding health care system,” Masson wrote in her statement.
Efforts to contact Runge and program organizer Kim Eagle, an Albion Walter Hewlett professor of internal medicine, were forwarded to Michigan Medicine spokespeople.
“Some faculty and staff have raised concerns,” Masson wrote. “We’ve listened to them and are working together to come up with solutions that are mutually satisfactory for the benefit of our patients.”
Daniel Berland, associate professor of internal medicine, voiced his disappointment in the program.
“We have severe access to care issues at U of M while there’s a local and national shortage of primary care docs,” Berland said. “Having own primary care docs being poached for this program and potentially surrendering hundreds or thousands of patients for whom we have no place in our system does not seem to be a respectable thing to do at a public institution. There are other ways we can raise money. People are angry enough about this that those of us who are not involved in Victors Care wonder if what we’re delivering is ‘loser’s care.’”
Susan Goold, professor of internal medicine and health management and policy, also listed several reasons she was apprehensive of Victors Care.
“Like many of my colleagues in primary care, I have some concerns about it. It’s hard to know exactly how much those concerns are justified or not because it’s not even rolled out yet,” Goold said. “(We need to consider) to what extent this program for people who can pay more will affect access to care for others. … Access to care is often associated with economic well-being, if you will.”
Goold noted, like many of her colleagues, concerns also stem from wondering to what extent this program for people who can pay more will affect access to care for others.
“The idea that someone who is a sort of ‘VIP’ would get better, sooner access to something than someone who’s not, that bothers people from a fairness perspective,” Goold said. “I want to be able to get the patients who really need an urgent MRI or a visit with a neurologist in to see them or in to get that, based on medical need.”
Matthew Wynia, University of Colorado professor of medicine who has done research on concierge care, said the concept of this originally stemmed from overworked physicians looking for a later-in-life career alternative to thousands of patients. Wynia noted clinician exhaustion and early retirements resulting from an overbooked patient load led to this concept.
“If a lot of doctors were to do this, it would really reduce the number of physicians available and we already have a hard time finding primary care doctors,” Wynia said, discussing common objections physicians have to concierge care. “If you’ve got a bunch of primary care doctors going into this type of practice, you lose that capacity and it makes it even harder for people to find primary care doctors, and it further stratifies the health care system — which is already unreasonably, unethically stratified where the wealthy get better, quality care than the poor tend to. … This sort of solidifies that notion.”
With regard to the reasoning behind some medical centers switching to this model, Wynia cited the Department of Medicine at Tufts Medical Center, which uses the revenues from its academic retainer-medicine program to cross-subsidize the rest of their primary care program, circumventing ethical concerns and allowing for increased resources toward those not in the concierge care.
At a Bioethics Grand Rounds discussion recently hosted by Runge and Profs. Andrew Shuman, Reshma Jagsi and David Brown called “Examining the Ethics of Victors Care,” reasons that Michigan Medicine cited for offering Victors Care included patient interest, health care portfolio purposes and providing a “gateway for U-M supporters with interest in providing financial support.”
“(Runge) made it pretty clear that the reason they did is to inspire donations. He said at that event that those donations, he saw, as being an important way to improve underserved, underinsured people. That’s not something that was in the rollout materials,” Goold said. “If that’s indeed the case, the payoff may well be worth it.”
Berland was more skeptical and said he felt there was a lack of transparency.
“They are not going to create Victors Care programs for the underserved,” Berland said. “There’s no contract that says that’s going to happen. We’ve been promised transparency, but I’m not sure that this meeting was fully transparent.”
Ultimately, however, Goold said this issue was the beginning of a conversation to see how programs like Victors Care align with the values of Michigan Medicine.
“Concierge medicine is not inherently unethical. It can be done in better or worse ways; there are guidelines,” Goold said. “This was the beginning of conversation; that is, how can we do this in a way that is consistent with the mission of Michigan Medicine.”