The Maryland insurance commissioner is weighing whether "concierge" medical care - in which physicians provide comprehensive services for a flat annual fee - should be considered a form of health insurance and thus regulated.
"Our concern is whether the practices are structured in a way to constitute insurance," Ralph Tyler, the commissioner, said after a holding an information hearing on the issue yesterday.
But advocates of the model argued that patients have the right to pay extra for services that are not covered by insurance. They said that although insurance companies may claim to cover physicals and other forms of preventive care, the services are not as in-depth and comprehensive as those that doctors can provide in concierge practices.
"From a practical standpoint, it's impossible to give that level of care" in a traditional practice, said Dr. Ron Sroka, president of the state medical society.
Concierge care, also known as "boutique" or "retainer" medicine, has been growing in popularity as a model of medical practice. Supporters say that rather than accept low reimbursement rates from insurance companies and overload doctors with patients to make up the costs, medical practices can charge patients an annual fee - typically $1,500 to $2,000 - for a package of preventive care services. The services typically include a comprehensive physical, unlimited visits in some cases, and 24-hour e-mail and cell phone access to physicians.
Patients are typically encouraged to keep their traditional health insurance for procedures not covered by the retainer, such as hospital stays, ambulance rides and blood work.
Doctors who use the model say they can afford to cut back on the number of patients they see by hundreds, allowing them to practice medicine the way they were taught to in medical school - with personalized care that isn't dictated by the policies of insurance carriers and rushed appointments.
But some public health officials and hospital representatives say that if doctors continue to switch to the model, Maryland's shortage of primary care physicians will get worse, leaving patients nowhere to turn but emergency rooms.
"The establishment of each new 'concierge' practice can mean that thousands of patients will be searching for new doctors," Dr. Joshua Sharfstein, Baltimore's health commissioner, testified yesterday. "We should expect to see a rising number of preventable hospitalizations as our supply of primary care appointments drops."
Darin Engelhardt, president of MDVIP Inc., a group of more than 200 concierge practices around the country, testified that none of the 25 states in which MDVIP-affiliated practices are located have classified concierge care as health insurance.
He said one major difference between concierge care and insurance is that concierge practices don't assume "risk of loss."The fee covers specific preventive services, but not the medical treatment that may follow.
Tyler said he and the staff of the Maryland Insurance Administration will issue a report on the matter before the legislature convenes next month.