Diana Moore learned the news through the neighborhood grapevine. Her family's primary-care physician of seven years would no longer accept Moore, her husband and daughter as patients - unless the family paid a $4,500 annual fee.
The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearly fee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals.
Known as "boutique" medicine or "concierge" care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it.
"Primary-care doctors are seeing 30 to 40 patients a day - that's too many," said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. "It's not about the money. It's about having the time to spend with your patients to keep them healthy."
But critics argue that concierge care will exacerbate Maryland's primary-care doctor shortage and force thousands of patients who cannot afford the new fees to be dropped by their physicians. And they say it creates two health care systems: one for those who can pay and another for those who cannot.
"Shouldn't we redesign the care delivery system so that everyone has this kind of access, rather than just those who can afford it?" said Pegeen Townsend, a senior vice president at the Maryland Hospital Association.
Still, as patients weigh the possibility of paying higher costs, some say they understand the bind physicians are in.
"I was so incredibly disappointed, but I can see why they're doing it - the system is so broken," said Moore, 51. She received a six-page letter notifying patients of the shift, complete with a list of frequently asked questions and a "retainer fee agreement" to be returned with a check or credit card number.
An estimated 8,000 to 12,000 people could lose their primary-care doctors this year in Howard County alone, estimates Victor Broccolino, president and CEO of Howard County General Hospital. He said at least eight physicians, including the five at Charter, have told theospital of the change in their practices.
