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time, that is in [OIG’s] view part of the covered service.” Aside from the legal and regulatory concerns, the potential for upsetting pa- tients with a new fee for services they received all along “is a very tangible downside” that could end up costing a practice more than that fee is worth, says Mr. Barton, who has received such complaints.

If most of the patients excluded be- cause they cannot or do not wish to pay the fee are older or of a particular race or ethnicity, the charge could deny care to a protected class of people and be considered discriminatory. “Or the Texas Medical Board may view it as ‘practice inconsistent with public welfare’ or de- ceptive, and make you come in and ex- plain it,” he warned.

Going above and beyond Nevertheless, some physicians and ex- perts say that, while tricky, finding a way to work in fees can be done right to help a practice financially and better cater to patients. With the help of the Florida-based consultancy MDVIP, Houston internist Steve Rosenbaum, MD, says he is do- ing something different that also allows him more time to focus on his patients at Baylor Clinic. Under the company’s model, patients personally pay a yearly membership fee ranging from $1,500 to $1,800 for ac- cess to an annual, comprehensive well- ness exam, and unlimited follow-ups or telephone consults, for example. Pa- tients’ public or private insurance still covers anything outside of that, like regular office visits or acute care. Years of filing paperwork and chas- ing insurance companies for payments owed took away precious time from pa- tient care, Dr. Rosenbaum says. He even considered becoming an expert witness to make up for lost payments. “But that would have been more time,

and when you are working flat out, you just can’t do it,” he said. “Money is im- portant, but the most precious commod- ity is time. Now I can practice medicine the way I was trained and take as much time as I need.”

Because he spends more time with

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