Guidelines offered for 'boutique' medical practices

The Baltimore Sun

Although some physicians who do not accept health insurance could be considered insurance providers, many "boutique" or "concierge" practices can avoid being regulated by state insurance administrators by following market-value guidelines for services they provide and by going over their contracts with the Maryland Insurance Administration, according to findings issued by the agency.

The report, released last month, was prompted by the insurance administration's concerns about some doctors' switching their business models to charge patients an annual, flat fee for services, rather than continue to accept health insurance.

The Maryland Insurance Administration held an informational hearing in late December to learn more about the "retainer practice" model.

Retainer practices, also called boutique or concierge practices, have caused debate in the medical professions. Some doctors say low insurance reimbursement rates make it impossible for them to maintain a financially viable practice, but public health and hospital officials say the decreased number of patients that doctors see under the model will worsen an existing physician shortage.

In the report, the administration concluded that there were two types of retainer practice: the "annual evaluation model," in which the physician agrees to provide a physical exam each year, and a "bundled fee for services model," in which the doctor also offers unlimited office visits.

As long as the annual fee does not exceed the market value of the services in the physical exam, the annual evaluation model would not be considered insurance, the report concluded.

For the bundled fee model, however, the report recommends a number of limitations to avoid being considered insurance, such as defining the services to be provided in the contract, establishing the annual fee using the market value of the physical and limiting the services provided under the annual fee.

In Maryland, insurance is defined as "a contract to indemnify or to pay or provide a specified or determinable amount or benefit on the occurrence of a determinable contingency."

"In the interest of resolving issues before they become problems, the MIA urges physicians and medical practices considering the establishment of retainer practices to approach the matter with care and to consult with the MIA in advance," the report reads.

"And, for those currently engaged in retainer medicine, the MIA encourages these practices to contact the MIA to share their written agreements to be sure these retainer practices are not inadvertently engaging in the business of insurance."

The report was submitted to state legislators, but "at this time we are not aware of any activity this legislative session," said Karen Barrow, MIA spokeswoman.

To view the report, visit www.mdinsurance.state.

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