Concierge Medicine Maryland national debate Signal Problem

 

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17 February 2009 Tuesday 10:48 AM EST

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Concierge Medicine Maryland national debate Signal Problem

Fran Lysiak

Oldwick, N.J.



Concierge medical practices have attracted the attention of Maryland, Insurance Commissioner, who said that some agreements specialized care to patients May be considered insurance subject to state regulation. Its consideration is that some insurers in the United States are down their networks, a small but growing number of physicians who receive an annual remuneration from patients in exchange for more personalized care.

Maryland Insurance Commissioner Ralph S. Tyler whether these practices are structured in a way that may constitute insurance. Maryland Insurance Administration held a hearing in December information to address the issue and hear points of view, "said Tyler. The MIA has developed guidelines for the practice of May against the insurance and when it does not, he says. Last month, it released a report outlining the guidelines.

Primary care physicians are awarded to practices offering personalized preventive care because of the frustration of patients with heavy loads - a practice with an average ranging from 2000 to 2500 patients - and because of declining reimbursements, "said Darin S. Engelhardt, president of Florida-based MDVIP Inc., a concierge practice that had begun nearly eight years.

The doctors can spend more time with patients and they have a financial model that is no longer solely dependent on third party reimbursement, "said Engelhardt.

An MDVIP practice is limited to 600 patients and includes a comprehensive program of preventive health care, "he says. MDVIP has increased by nearly 300 affiliated physicians in 26 states, including Maryland and serves 100,000 patients, Engelhardt said. Patients pay an annual fee of $ 1500 for a detailed assessment of risks to physical health and an executive, he said. Each patient receives an individualized plan of well-being, Engelhardt said.

Some insurers, however, are not happy. Last year, UnitedHealthcare Texas dropped four doctors offering concierge care network. When physicians contract with UnitedHealthcare, they agree to certain reimbursement rates for services covered, "said Cheryl Randolph, a spokesman for UnitedHealthcare. These doctors are in breach of their contract because they are members charge more money for services covered, she said. Most of these physicians to provide services are covered, as a physical wellness program and even at home, "said Randolph.

In a statement, Cigna HealthCare has stated that its contracts with physicians' use of network physicians to provide equal access to all persons covered by a Cigna HealthCare plan. The company did not oppose the bid Network Cigna doctors their patients the opportunity to participate in their concierge program, provided that Cigna patients who are unable or unwilling to join the program concierge continue to have access to these physicians.

"However, CIGNA will terminate the contracts of doctors who told us they are willing to accept that patients than those of participants who agree to pay membership fees concierge program," he said.

Engelhardt said MDVIP doctors to remain in the network with most insurance companies in which they participate, and MDVIP maintains "excellent relations" with several national and local insurers.

Tyler said what begins to resemble the insurance would be if a medical practice indicates that, in exchange for a flat fee of $ 2000, for example, that will give a patient with "unlimited and unrestricted access "for the whole year.

At the hearing, two models were considered: the annual assessment model and the service fee model. The withholding of MDVIP practices are associated with a model annual evaluation, according to MIA. "The practice of keeping the annual meeting of the description of the evaluation model does not seem to be engaged in the insurance business," he said. However, following the restraint practices grouped service charges are the insurance model, MIA said.

Engelhardt said he believed that some doctors have put into practice the models of insurance law. "MDVIP is not insurance, the tax is essentially a prepayment for care," he says. The patients retain their existing health insurance, whether commercial or coverage for traditional use, Engelhardt said.

MIA Tyler noted that the authority is limited to the regulation of insurance, but a large and important issue concerns the impact on the delivery of health care. The increase in retainer medicine to pose implications physician work. "When the labor force in primary care is already under strain, the ability to siphon even greater pressure on physicians who remain in the larger system," the MIA report.

(By Fran Lysiak Matso, senior editor, BestWeek: fran.lysiak @ ambest.com)

19 February 2009

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