A Sign of the Times - Concierge Cardiology

I was reading KHN today, as usual, and I ran across this little story. It seems that a Cardiology practice in California is "fighting back" the proposed Medicare and private insurers cuts in reimbursements to doctors in the Cardiology line of business.
Basically, Pacific Health Institute (PHI) has published a letter to their patients announcing that in addition to what insurers pay them for services, they will require patients to make direct payments to the clinic, on a subscription basis, or face reduced availability of services, starting April 1, 2010.

KHN, describes this as a "vivid example of a phenomenon called "cost-shifting"", which it is, but then KHN goes on to define it as cost shifting from Medicare to private insurers, who would have to raise their premiums as a result: "The premise is that doctors and hospitals charge privately-insured patients higher rates to make up for the lower fees paid by Medicare and other public programs, as well as uncompensated care for uninsured people."

KHN misses the fact that PHI specifically states in their letter that the reimbursement rate changes are not specific to Medicare: "Changing payment policies by Medicare and insurance companies have forced us to reevaluate our practice model", and the requirement for patients to pay more includes Medicare patients: "...we must now charge for uncovered services. You and your insurance (including Medicare) will still be charged for services rendered and tests performed." [Bold font added for clarification]

PHI's subscription plans range from a basic $500 per year to a Concierge plan of $7,500 per year, and they guarantee a menu of services no longer available to non-subscribers, ranging from priority appointments to 24x7 access to a cardiologist.

Also interesting is the list of services that will be scaled back:
"Anticoagulation (Protimes) and pacemaker/defibrillator management will be significantly curtailed and of limited availability."

Of course the actual implantation of pacemaker/defibrillator devices is not on the list of "curtailed services". Those procedures, and a long list of other procedures, are performed by PHI cardiologists at the neighboring St. John's Hospital, which coincidentally is just building a new inpatient pavilion where "[a]ll patient rooms are private and have a 42-inch plasma flat-screen television and wireless Internet access.", amongst other amenities, such as soothing colors and relaxing garden views.

The only cost shifting I see here is the one "shifted" to the patients.