What are the advantages of a Retainer Practice?

1. Comprehensive annual physical exam
2. All routine lab work associated with an annual exam; if needed, EKG and pulmonary function studies, dexa bone density scan
3. Routine immunizations
4. Same day or next day appointments when you are sick or have a medical problem that requires evaluation
5. Unhurried appointments
6. Office visits that are anything but routine; you will be scheduled for 20-30 minute sessions for routine visits depending on your needs
7. All blood work will be drawn in our office; you won't be referred to busy labs for blood work
8. Prompt telephone feedback with labs and radiology tests
9. Telephone calls personally answered as often as possible, virtually no answering machines or voicemail
10. Access to your personal physician, 24 hours/day, 7 days/week, wherever you are; coverage will be provided when your physician is out of town
11. Telephone, fax, or e-mail questions or requests, as you prefer
12. Prescriptions phoned in or faxed to your pharmacy the same day to reduce your wait time
13. No additional bills or paperwork will be sent to you or your insurance company
14. You will not pay a co-pay or any additional charges unless we obtain an unusual immunization, in which case we will charge you our cost only
15. We will all continue our hospital privileges at Howard County General Hospital; when needed, your physician will supervise or personally see you in the emergency room.  If you need to be hospitalized, your physician will personally see you on a daily basis and be the attending physician for your care.  There will be no hospitalist or unfamiliar physician directing your care in a crisis. 
16. Prompt referrals to a select group of the area's best specialists; when time is important, your physician will intervene on your behalf so that you can see a specialist as soon as possible.

There is a limit to the number of patients per physician who can register.  Once that limit is reached, names will be placed on a waiting list or possibly be offered the opportunity to transition to an associate on a space-available basis.  

FAQ

Can you explain how a retainer practice works?

Rather than using insurance, the only charge is an annual professional fee, which essentially covers all physician services.  There are no other bills.  The office does not bill insurance.  This level of service is virtually unheard of these days at any price.

I already have good insurance.  Why would I pay extra to join? 

Even people with excellent medical coverage often find that they do not have access to the medical care they need.  For example, when they call their doctor's office they may be placed on hold or they have to press numbers on a voicemail line to get through.  When they are finally offered an appointment it may not be soon enough or they may not be able to convey to the assistant exactly what their needs are.  They may wait an hour or more in a crowded waiting room to be seen and then feel rushed through the visit before all their questions are answered.  Simple questions are not answered over the phone and they cannot send an e-mail to their doctor when they have a concern. 

What does the professional fee cover? 

It includes all office visits, a comprehensive annual physical examination, routine immunizations (tetnus, diphtheria, influenza and pneumococcal vaccinations), and a thorough panel of blood tests; included on an as-needed basis are EKGs, Dexa bone density scans and pulmonary function studies.  Diagnostic lab studies, outside of your annual physical, will be drawn in the office and sent to the appropriate lab, who will in turn, bill your specific insurance company.

What if I need to be hospitalized? 

Each physician will continue to maintain admitting privileges at Howard County General Hospital.  Your physician will facilitate communication with the different specialists.  Your doctor will not bill you or your insurance company for the time spent at the hospital or the emergency room or at nursing homes.  This is included in the annual professional fee.

I am covered by Medicare.  Can I still see the physicians in Charter Internal Medicine (CIM)?

The Charter Internal Medicine doctors have opted out of Medicare.  Medicare will not cover any portion of the professional fee or any other related expenses.  Medicare patients may, however, sign a waiver acknowledging that they agree to a private relationship with the physicians in CIM  and are welcome to join a practice.  Of course, your Medicare coverage with other doctors, hospitals, imaging facilitates, and laboratories remains intact.   

Is this an insurance plan? 

No absolutely not.  This is simply a plan to see a doctor without the restrictions and frustrations associated with insurance companies, billing headaches, and paperwork. 

I have medical insurance.  Does it matter what kind? 

No.  The CIM program is not dependent on insurance.  Your insurance is used only for other doctors, hospitals, and tests, etc.  In fact, it is not necessary to have insurance at all to be in the practice though it is strongly recommended for catastrophic problems that can arise. 

I am covered by an HMO.  Can I still join?

CIM physicians are not members of any HMO.  However, you are welcome to join  as long as you know that the professional fee is not covered by your insurance company and that you may still need referrals and approvals through a doctor designated as your HMO primary care physician (PCP).  In some cases we may be able to assist you in requesting these referrals with your PCP's office, but the decision to give a referral is ultimately made by the PCP and the HMO insurance company. 

I am in a preferred provider organization (PPO).  Can I join? 

Yes, while you are responsible for the annual professional fee, you may be able to submit bills to your insurance company for reimbursement.  Since we are not affiliated with any insurance companies, any reimbursement is appropriately yours to keep.  For insurance purposes, each physician is considered an "out of network" physician.  Reimbursement levels are determined by your particular policy and may be subject to an annual deductible. 

I have a flexible spending plan or medical savings account through work.  Can I use that for the annual professional fee? 

Check with your plan administrator and accountant.  By using pretax dollars designated for medical expenditures many patients may find these plans may reduce their out of pocket costs by as much as 30-40%.

Can you explain a Health Savings Account (HSA)?

A health savings account is an interest bearing savings account that allows you to put away tax-free money for your future health care needs.  For example, in 2008, an individual can contribute $2,900 per year and a family, $5,800 per year.

Can I use HSA money to cover my retainer medicine fee?

The IRS web site, which was designed for non-accountants, reads that the simple answer to this question is yes.  There seems to be no reasonable argument that could be made that the medical services offered by a retainer physician are anything but legitimate medical expenses, especially when the law allows you to pay for health care expenses like eye glasses, dental care, and over-the-counter medications using HSA funds.  If you decide to use your HSA money to pay for retainer fees, consult your accountant first.  If you are able to use pre-tax dollars to pay for part or all of your retainer care, you will save even more money than you will save by switching from a low deductible to a high deductible health plan.  For further information, go to www.Treasury.Gov/Offices/PublicAffaris/HSA/.

 **Taken from Concierge Medicine, Steve Knope M.D., 2008.

I have high school or college age children.  Can they be seen?

Yes, children ages 14 through 25 can been seen.  The annual professional fee is reduced to $500 per child if at least one parent is also seen by any one of the doctors. 

How is the annual payment fee paid? 

It is paid by  personal check or credit card. 

Do I need to pay the fee all at once? 

No.  You may choose one of two options:  once a year or twice a year.  The fee changes slightly depending on which option you choose. 

Will I be charged anything beyond an annual professional fee?

No, not usually, however, there are some services which are not covered, such as the cost of more exotic immunizations for travelers to foreign countries, but even then the vaccine would be purchased by the patient (when available) and administered at our office at no additional charge.

This is an interesting concept.  Are other doctors doing it? 

Yes, a small, but growing number of doctors around the country are changing to smaller, more service oriented practices as the intrusions and frustrations of modern medicine become more difficult for patients and physicians alike.  All of the practices charge additional fees for improved services, easier access, and longer unhurried appointments.  This one of the few practices on the east coast that we are aware of that does not additionally charge insurance or Medicare for each visit. 

Can I reach my physician whenever needed?

Yes, your personal physician can be reached 24 hours a day 7 days a week through their office or answering service.  Non-urgent questions are answered via e-mail as time permits.  If your physician is out of town, another physician in Charter Internal Medicine will cover the practice for emergencies and remain in touch with your personal physician.

Do you really make house calls? 

Yes!  All the doctors will continue to make house calls when it is not practical or possible for the patient to be seen in the office and when hospital evaluation and tests are not necessary.  It is very gratifying to see someone in their home environment and it can be a relief to the families of elderly or physically challenged individuals.  When your physician believes a house call is appropriate, it is included in the annual fee and there are no additional charges for this service.