Doctors and hospitals posing as charity cases? It's nauseating Yet some doctors and hospitals are responding to the reform law with outstretched palms and brother-can-you-spare-a-dime pleas for more money from patients. Evelyn Stern, 75, of Brentwood has been treated at UCLA Medical Center for the last few years and always has appreciated the hospital's gleaming facility and state-of-the-art resources. "They don't seem to be hurting for money," she told me. So Stern was more than a little surprised to receive a recent solicitation for voluntary donations from the hospital's Division of Geriatrics. It included a helpful form with boxes to check for contributions of as much as $10,000. Patients donating at least $1,000 will be listed as "Friends of Geriatrics" and will be invited to a special "donor recognition event hosted by doctors and key faculty members." "I get it if the L.A. Philharmonic sends you a letter to support the orchestra," Stern said. It's a little peculiar when you get such a letter from someone you rely on for your well-being. It's hard to imagine UCLA Medical Center giving preferential treatment to a financial "friend" of the hospital. At the same time, some patients might wonder whether there could be repercussions for not ponying up a little baksheesh. Dr. David Reuben, head of UCLA's Division of Geriatrics, defended the fundraising effort. "With federal research dollars and state funding more and more scarce and an aging population, philanthropic support is crucial to fulfilling our mission," he said. Roxanne Moster, a spokeswoman for UCLA Health Sciences, said the letter was worded to "ensure there can be no perception that donors are given any different level of care or treatment than non-donors." If so, I didn't see any explicit reference to such a sentiment. I did see, though, where the Division of Geriatrics says it's launching a new online service, "and an endowment will enable us to name it after you or any person you choose." There's no question that Obamacare can make things tougher for healthcare providers. Tens of millions of new patients are entering the system, many with Medicaid - Medi-Cal in California - coverage that limits reimbursement to doctors and hospitals. Dr. Dike Drummond, whose Seattle company, TheHappyMD.com, focuses on reducing physician burnout, said many doctors are bracing for "a tidal wave of new patients" and financial pressure to see as many as 30 patients a day to make ends meet. As a result, he said, an increasing number of doctors are abandoning the conventional insurance system and are switching to so-called concierge practices. Such practices enable doctors to see fewer patients, but those patients are often required to pay steep annual fees - separate from their medical costs - in return for more comprehensive treatment. The upshot is a two-tier system in which those who can afford quality healthcare pay for the privilege, and everyone else settles for long waits to see overworked doctors or, if the doctor is too busy, a nurse practitioner. "As a doctor, I might feel a pang of guilt about making a change like this," Drummond said. But it's my life, and I want to practice medicine the best way I know how. Other doctors are trying to walk a middle path. Dr. Jeffrey S. Helfenstein, a Beverly Hills cardiologist, recently sent a letter to patients saying, "I am sure you are all aware of the changes in medical reimbursement to physicians that are contracted to Medicare and other common insurance carriers."