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CEO Corner: Ethical Guidelines in Concierge Programs

Alice Ayres, MBA

Published: 12/22/2022

We all woke this morning to the fourth article in a series published by the New York Times, this time about the concierge practices, mainly at NYU Langone Health. The underlying message of these four articles is that hospitals in the United States should not be granted their tax-exempt status because of practices around bill collection, implementation of 340B, staff ratios, and now concierge programs. AHP is underway on work to underscore the critical role hospitals, and philanthropic support for those hospitals, play in the work of community benefit, which we will publish to the membership in the new year.

In the meantime, should you field questions from your own colleagues about the article, we wanted to address the specific issue of concierge programs by sharing some of the practices and policies we have seen implemented around the country. This is not intended to be used formally (as a media release for example); rather it is designed to help to clarify for us and our colleagues how these programs should and should not be implemented.

First, it may be helpful to set context:

Hospital concierge programs are a type of service offered by some hospitals that provide additional amenities and services to patients. These programs may include things like private rooms and assistance with tasks like making appointments and coordinating care. While hospital concierge programs may offer certain amenities and services that are not available to all patients, they do not provide preferential clinical treatment to VIPs or any other individuals. Nonprofit hospitals are required to provide medical care of equal quality to all patients, regardless of their ability to pay, and to treat everyone equally and with respect. Hospital concierge programs are designed to enhance the overall patient experience rather than providing preferential treatment to certain individuals.

Key components to ethical practices with concierge programs:

Offer the benefits of these programs to all those engaged with the hospital, including staff and their families, volunteers, and others, rather than only to donors. Make sure that these guidelines are clearly communicated across the organization.

Maintain a clear separation between concierge program benefits and the delivery of care and be sure to communicate this bright line to clinicians and the rest of the organization.

Be clear in all communications that those who are a part of these programs:
- Do not receive better quality of care than others
- Do not receive preferential treatment over those in greater need of care in the ER or anywhere else in the system

Set clear expectations around appropriate behavior with these individuals:
- Thank them for their support of the organization
- Treat them with the respect and gratitude that you do your own family
- Care should be delivered in the most clinically appropriate location
- Consider finding ways to identify a donor or other VIP other than annotating the patient record
- If you have identified a concierge program as a donor benefit, consider requiring donors who participate the program to sign a written agreement that states that they understand the triage system and are not entitled to preferential treatment.
- Consider deploying the team responsible for concierge programs to patients with need for special assistance who are identified by clinicians and others

Finally, if you are considering launching a concierge program, or if you already have one in place, AHP’s guidelines for ethics around grateful patient fundraising address the topic in the following way:

“Concierge” (“VIP” or similarly designated) services that are provided selectively to grateful patients who make, or have the capacity to make, substantial gifts may create situations of injustice, inequity, or real or perceived unfairness. Major philanthropic donors often receive special privileges and service enhancements, such as visits from institutional leaders and/or development professionals in clinical settings, coordination of care beyond what is offered to other patients, and amenities such as upgraded hospital rooms and meals. Patients who receive these privileges may welcome them, feel indifferent to or ambivalent about them, or have concerns such as that they diminish their privacy or are unfair to patients who do not receive them.

Recommendation: Provisions of special privileges and service enhancements to VIP patients have the potential for real or perceived inequity in the delivery of medical care based on capacity to give. Institutions should take measures to ensure that all patients receive the same quality of medical care.
Concierge services and other enhancements should be optional for VIP patients.
Institutions should make efforts to ensure that concierge services and other VIP privileges do not negatively affect the meaningful medical outcomes of other patients

We hope this is helpful as you help share with your own colleagues the ways in which we work with patients in an environment that prioritizes the love of humankind.

NEWS /01/28/19