Magazine article Clinical Psychiatry News

Insurance Industry Still Wary of Concierge Physicians

Magazine article Clinical Psychiatry News

Insurance Industry Still Wary of Concierge Physicians

Article excerpt

When Dr. Alan Sheff announced that he was switching to a concierge practice, some of his colleagues thought he was crazy.

He'd be flooded with the "worried well" who would call him at all hours of the night, they warned. But a year into the new practice, Dr. Sheff, an internist in Bethesda, Md., said he's only had one call between midnight and 6 a.m. and he wouldn't go back to a traditional practice.

These are the kinds of experiences that the new American Society of Concierge Physicians wants to highlight in an effort to educate the public, government agencies, and other physicians about the role of "concierge" or "retainer" practices.

Family physician John Blanchard is the cofounder and president of the group, which is based in Grand Rapids, Mich., and currently has just 30 members. He did so because he and other physicians saw a lot of uncertainty about setting up these concierge or retainer practices.

"Policy and regulation have not caught up with this model," said Dr. Blanchard, who is also the founder of Premier Private Physicians in Detroit. "It's still being formulated."

And since there's not just one type of concierge practice, the regulatory hurdles vary.

There are three basic types of concierge practices, said John R. Marquis, general counsel for the American Society of Concierge Physicians:

* Limited size, periodic fee. This is the most common practice type. One example, MDVIP, a concierge practice that started in Florida, charges a $1,500 annual fee for an annual wellness exam and annual comprehensive preventive care plan and lifestyle planning. These practices are usually able to participate in insurance and to bill Medicare.

* Larger fee, enhanced access. In this model, physicians generally charge a larger annual fee that covers a patient's medical care and enhanced access. Physicians cannot participate in private insurance or Medicare because this model includes medical services (such as a screening test) in its annual fee at a rate higher than the allowable charges under insurance and Medicare, Mr. Marquis said.

* Fee per visit. In this model, which is fairly new, a physician might charge a $150 access fee in addition to the charge for medical services. Again, physicians can't participate in insurance or Medicare because the flat fee violates agreements to charge only the approved rate for services, Mr. …

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