Medical Professional News

Old Time Medical Practice Medicine Is Back!

Perhaps more than most people, John appreciated the need to be examined quickly. And thanks to a recent trend to help personalize physician care, he got an appointment the same day — but not because of any professional status. John, like any other patient can get a same-day appointment because of practice retainer medicine!

Patients pay a $1,500 annual retainer fee to see them as soon and as many times as they need to. They also make house calls. As it turned out, John was diagnosed with Lyme disease, an infection from a tick bite, and prescribed antibiotics. If not diagnosed and treated early, Lyme disease can lead to severe headaches, muscle pain and serious heart problems.

About a dozen doctors in Maryland and an estimated 600 nationally who won’t take insurance coverage. Instead, they charge a yearly or monthly retainer. Some work out of comfortable medical office, others work out of their homes. Retainer practices — also called concierge, boutique or just plain old-fashioned medicine — began in Seattle in 1996, according to the American Medical Association. Physicians who convert to retainer practices say it solves many problems of primary care.

The relationship has changed in Medical Practice medicine between the physician and patient, It is no longer between the patient and the physician. It is between the patient and the insurance company or third-party payer and there was no longer continuity in patient care. Physicians are not getting adequate reimbursements, so retainer medicine is a decision by the doctor and is a new business model. Maryland receives some of the nation’s lowest insurance reimbursements. Retainer practices in Maryland ‘‘a relatively new trend. I think it is probably still in an upsweep, gaining momentum as established physicians with a set clientele would go for it first.”

Critics of retainer medicine say it provides better care for people who can afford it, but does not help those who can afford the fee, plus additional costs for diagnostics or surgeries. Most retainer physicians charge less than $2,000 a year, which includes one full physical exam. At the high end, physicians in the Seattle charge $13,200 per adult and $20,000 per couple for services in spa like settings, complete with monogrammed robes, slippers and sweat suits. Most family doctors will convert to a retainer-type practice within the next 15 or 20 years, most doctors believe that there is a primary care problem in this country. Doctors have been working for the wrong employer for way too long, the insurance companies and the government.”

Retainer practices, reduces the cost of an MRI from about $1,500 to $500. Laboratory blood analysis that would normally cost $300 through insurance costs $33. Despite the benefits of retainer practices, a spokesman for Aetna, the nation’s third-largest health insurer, downplayed the magnitude of the trend. He said ‘‘we don’t take a position on it,” ‘‘But, in the larger context, we have 774,000 health care providers with the great majority of them as doctors. We also have 4,400 hospitals as members.”

A spokeswoman for America’s Health Insurance Plans, a national association of nearly 1,300 insurers, said physicians refusing insurance usually is not a concern to insurers. However, it does become an issue if a ‘‘boutique doctor” still wants to accept insurance, she said. The physicians must ensure they adhere to the rules of the insurer’s agreement. The AMA has no problem with retainer medicine. ‘‘Retainer practice is consistent with longstanding AMA policy in support of pluralism in the delivery and financing of health care, as well as with policy in support of the right of physicians to freely enter into private contracts with their patients,” the association said in a 2002 study. The association asks for physicians converting to retainer practices not to abandon any of their patients and to try to transfer their non-participating patients, particularly their sickest and most vulnerable ones, to other physicians.