You've probably read about the new "boutique" physician practices. Each patient who desires to be a part of this type practice is charged an annual fee in addition to the charges incurred for visits, hospital calls, and other usual and customary charges. Recently, a front-page local story was picked up by the Associated Press for national circulation. The article, "Doctors Return to Old-Fashioned Care," reported:

Two Louisville doctors long for the days when physicians made house calls, developed bonds with their patients and didn't have to battle HMOs over what care they could provide. Their [physicians'] new "boutique practice" will reduce their number of patients by about 90%. The remaining 10% will get exhaustive physicals, 24-hour access, same-day appointments and, tender loving care. Patients will pay an annual fee of $4,000 for an individual or $6,000 a couple...In Seattle, one practice reportedly charges families $20,000 and provides heated towel racks, marble showers, and personally monogrammed robes. - Louisville Courier Journal, August 22, 2002, p. A1.

So, this is the old fashioned care we all remember?

Physicians have a responsibility to complain about the invasive way payers and regulators interfere with their practice. Home care professionals are experiencing the same problems and stand beside these physicians in fighting this invasion. But, the answer is not to tell people that this is old-fashioned medicine-none of us are that ignorant.

In the United States, healthcare as a right, not a privilege, is the foundation of our national policies and the basics of Medicare and Medicaid. Americans accept that the rich can buy bigger houses and cars, but are we all going to sit still for this "boutique" approach to the healthcare crisis?

The bottom line is money-we have progressed to a level where medical technology can improve the quality of life and extend years. The Administration and Congress must address this crisis by understanding what healthcare really costs, not just by saying it's the professionals who are the problem.

Likewise, professionals in all delivery settings must jointly spread the message to the public that this is a complex issue. Already physicians are rejecting beneficiaries because Medicare payments have been decreased beyond reason. Where are the 90% of patients who once relied on these two physicians going to go for care?

Home care organizations have been successful in communicating with Congress and regulatory agencies about what's really happening. All health professionals should create ways to tell our patients, communities, and legislators the ways these cuts are affecting everyone.

One last point to consider. Currently home care patients receive:

* 24-hour access to a nurse;

* same-day appointments, if needed;

* tender loving care; becoming empowered to care for themselves; and

* coordination with community resources to help increase their quality of life.

Should we pursue charging an extra $4,000 per year so we can add monogrammed towels and warm robes when we provide personal care?