Put your doctor on retainer? [Telegraph-Herald (Dubuque, IA)]

Kelly McMahon likens her practice's newest payment model to those used by fitness centers.

Pay a monthly subscription and see your health-care provider without the necessity of a co-pay or traditional billing.

"We started this about two months ago

because we had a lot of patients with either no health insurance or only catastrophic plans," said McMahon, nurse practitioner and owner of Women's Wellness Center and Westside Medicine.

McMahon also accepts traditional health care insurance at her medical practice, which includes four nurse practitioners, a counselor and internal medicine physician Dr. Douglas Schmid.

The payment model is based upon a concept called concierge medicine. Originally, the concept involved people paying a fee to keep a physician on retainer for their medical needs. More recently, the concierge medicine concept offered an alternative for providing care to uninsured or underinsured people.

Concierge practices, also called "retainer" practices, represent a small portion of American health care.

A survey by the physician resource Medscape found that the percentage of physicians in a concierge or cash-only practice increased from 4 percent to 6 percent during the past year.

The American Medical Association does not endorse specific health- care payment models, but it has a policy addressing concierge or "retainer" practices. The AMA says such practices "support the right of patients to freely enter into private contracts with their physicians." However, the AMA also cautions physicians to "take care to ensure that conversion from conventional fee-based practice to retainer practice does not conflict with their ethical obligations to patients."

A Florida physician, Dr. Gary Price, is president of the American Academy of Private Physicians, an organization that supports concierge or "direct" medical practices.

In a statement, Price explained that such a practice responds to customers and their needs.

"Which is why we have evolved many variations of our model to serve every type of community," Price said.

At McMahon's practice, patients can pay a one-time $99 initiation fee, then monthly costs that range from $59 to $85 and are based upon a patient's age. The membership fees are not reimbursable by health insurance companies and cannot be applied toward insurance deductibles.

"It's like a fitness center membership," McMahon said. "It comes right out of your checking account or your credit card."

McMahon's practice requires a one-year contract - similar to some fitness clubs - and a $99

re-enrollment fee should canceled members wish to rejoin.

Under such a plan, McMahon saves money on traditional billings and patients know they can visit the doctor without handing over a co-pay. The membership plan covers primary care, preventive care and disease management. McMahon's practice does not provide specialist, hospital or emergency care but does refer patients to specialists.