Dr. Zwelling-Aamot, who is trained in emergency medicine, said her patients are not compromised by her “round the clock” hours. Her office is next to the hospital, and she always carries her electronic medical records with her. She uses a variety of specialists in the area to cover for her.
This is how medicine used to work, when physicians volunteered at the local hospitals and free clinics, she said.
Not all medical services are provided by these types of practices, however. Dr. Levinson's retainer, for example, does not cover medical care. It pays for 24–7 access to him, “but even if they come to my office for a normal medical visit, I'd bill [their insurer] for medical care provided,” he said.
Initially, Dr. Serbin thought about participating in an insurance group, but Blue Cross/Blue Shield, the largest insurer in Pennsylvania “was not too excited about the concept.” So far, he's enjoyed the independence of having a retainer care practice. “It makes it a lot easier to do referrals,” as a lot of health plans have discontinued referrals for pediatric subspecialists, he said.
Dr. Bliss said he encourages all of his patients to carry a high deductible insurance if they can afford it, at the very least. Those who can't afford insurance can often be included in hospital compassionate care programs.
“We are also working with insurers, encouraging them to create products that carve out primary care so that patients can contract directly with their primary care physician and maintain less expensive coverage for the unlikely but potentially catastrophic costs covered by insurance,” he explained.