Give the doctor a checkup before ordering a house call
The new breed of 'concierge physician' aims high-priced services at the well-off. One is on probation with the state Medical Board.
Dr. House Call -- a.k.a. Dr. Herbert Rubin -- is an example of a small but growing trend in medicine as physicians cut themselves free from insurance companies and enter into direct relationships with patients who can afford more personalized healthcare.
"Accusations have been made," he told me over coffee the other day at a Pacific Palisades restaurant near his home. "I absolutely deny them. They were all false."
No one knows precisely how many concierge practices exist nationwide. Neither the American Medical Assn. nor the American College of Physicians keeps such data, but healthcare professionals peg the number at fewer than 1,000 and growing as doctors seek alternatives amid rising costs and cutbacks in reimbursement by insurers.
In most cases, a concierge physician chooses to limit his or her practice to only a few hundred patients, rather than the usual 2,000 or 3,000. Patients may pay the physician an annual retainer that can run as high as $15,000 or an hourly fee of hundreds of dollars, on top of whatever costs may accrue as a result of treatment.
Critics of concierge medicine point out that such practices generally target the wealthy and create a tiered system whereby people who can afford it get first-class medical treatment, and everyone else gets what they get.
Proponents say concierge physicians offer a legitimate service and charge only what the market will bear.
The American Medical Assn. says what it calls retainer practices "are consistent with pluralism in the delivery and financing of healthcare." However, the industry group also warns that such practices "raise ethical concerns," particularly if they "become so widespread as to threaten access to care."
"All patients are entitled to courtesy, respect, dignity, responsiveness and timely attention to their needs," the association says.
Rubin, 67, has been practicing medicine since 1975. Much of that time was spent in Beverly Hills, where he focused on gastroenterology, or matters related to the digestive system.
Rubin said he decided around 2000 to stop dealing with insurers. They were more trouble than they were worth, he said, and interfered in his dealings with patients.
In 2006, Rubin said, he concluded that it was time to retire from medicine. "It stopped being fun," he said. "I loved the patient-care part. But all the rules, regulations, restrictions -- I didn't want to do it any more."
But after a year pursuing other interests, Rubin said he missed practicing medicine. He saw that many physicians who shared his frustrations with the healthcare system had turned to concierge practices.
Dr. House Call was established about eight months ago. First Rubin set up a website. Then he started sending his brochures to about 15,000 Westside households selected by a marketing firm for their high income or property value.
No prices are listed in the brochure. But Rubin's website, Doctorhousecall.md, says he charges $450 for most new-patient visits, $300 for follow-up visits, $400 for hospital visits and $250 for telephone consultations. "I now have about 150 patients," Rubin said, smiling. "I only need to see one or two patients a day to be in the black."
His face fell when I asked about his troubles with the Medical Board. Rubin described the matter as "billing questions" and called it "ancient history."
The board's accusation says that, among other things, Rubin failed to follow up on a patient he sent to a hospital in 2002 for colitis, a gastrointestinal disorder, and failed to arrange for another doctor to care for the patient while Rubin was out of town.
It says he failed to release a patient's medical records to another physician in 2001 and billed patients and insurance companies for the same treatment. The accusation also says Rubin "billed for tests that were not rendered or were not documented" and "medical visits, a surgery, supplies and X-ray or lab services that did not occur."