AMA Establishes Guidelines for ‘Boutique’ Care

MANAGED CARE August 2003. ©MediMedia USA

Physicians who have grown fed up with managed care to the point where they’ve set up “boutique” practices have gotten a lot of publicity in recent years — but not much guidance. Until now.

The American Medical Association for the first time established new ethical guidelines for doctors who opt to engage in boutique, or concierge, care.

“Retainer practices provide an opportunity for patients to develop a more personalized relationship with their physician,” says Leonard Morse, MD, the chairman of the AMA’s council on ethical and judicial affairs. “But physicians should also make sure that all patients, including those who do not pay retainer fees, continue to receive the same quality of care.”

Setting up a boutique practice doesn’t let physicians off the hook for providing urgent care, if it is needed. In addition, physicians are obligated to continue caring for HMO patients if those patients are unable to find other network doctors in the area. There should be no fee for transferring the medical records of patients who do find other doctors, the AMA says.

Here are some of the other AMA guidelines, which the organization adopted in June:

  • Patients have the freedom to select and supplement insurance for their health care on the basis of what appears to them to be an acceptable tradeoff between quality and cost.
  • When entering into a retainer contract, both parties must be clear about the terms of the relationship and must agree to them. Patients must be able to cancel a retainer contract without undue inconveniences or financial penalties.
  • Physicians must always ensure that medical care is provided only on the basis of scientific evidence, sound medical judgment, relevant professional guidelines, and concern for economic prudence. A retainer contract is not to be promoted as a promise of more or better diagnostic and therapeutic services.