Family physician Steven Butdorf of Eugene, Ore., was tired of rushing patients through appointments, tired of insurers denying procedures, and tired of paperwork.
"The burden of third-party health insurance reached a point where it just wasn't fun to do it anymore. It was burdensome to do it," said Butdorf, 56. "I just decided I was going to pursue a different path."
On Feb. 1, Butdorf opened Exceptional Health Care, which lets patients pay a set monthly fee in return for specific health care services -- leaving out insurance companies altogether.
The clinic is the first to be certified under a new Oregon law allowing so-called retainer practices. The law, which took effect Jan. 1, requires such practices to register with the state but exempts them from insurance regulations.
Oregon joined Utah, Washington and West Virginia in enacting such laws. Retainer practices operate in at least 18 other states, but those states have no laws expressly allowing or disallowing them, says Norm Wu, a co-founder of Seattle-based Qliance, a retainer-based medical care company. No states prohibit the practice.
Practices in some states have faced challenges from insurance commissioners, leading to the new laws, Wu said.
Retainer practices aren't the "concierge" or "boutique" medical practices that cater to the wealthy. They're designed for people with high-deductible or catastrophic insurance who need affordable primary care, Wu said.
They're also attractive to patients with no insurance, such as Eugene resident Dan Mullin. Mullin, 63, has been out of work for three years and without insurance for two. He and his wife, who has diabetes, were among the first to sign on with Butdorf.
"For someone who does not have insurance but needs a doctor's care, it's the way to go," Mullin said.
Doctors say the arrangement allows them to spend more time with patients, and less time dealing with insurance companies. Patients can receive same-day appointments, longer appointments or more comprehensive annual exams.
Butdorf charges patients $39 to $79 per month, depending on their ages, plus $20 for each office visit. He says he devotes an average of 30 minutes to each appointment, and 60 minutes for an annual physical.
"What I'm doing allows the patient to come to the doctor and pay the doctor without a third party there to set rules and regulations for how we conduct medicine," Butdorf said.
But Oregon regulators warn consumers to carefully consider what they're buying.
"It's important that patients carefully read a practice's agreement to understand what's covered and not covered," said Lou Savage, acting Oregon Insurance Division administrator.
"I think the issue is for patients to really understand what they're getting," says Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a non-partisan research organization based in Washington, D.C. "They're getting doctor visits and some minimum level of diagnostic services. But if they get really sick, they'd better have insurance, or they're going to be bankrupt. This is not insurance in any way, shape or form.
"There are potential downsides for the doctors, too," she said. "They are, on some level, taking on the financial risk of providing whatever services they've said they'll provide."
No one tracks the exact number of retainer practices across the country, but they appear to be growing. A 2005 report from the U.S. Government Accountability Office found 146 retainer physicians nationwide.
In 2009, a report commissioned by the Medicare Payment Advisory Commission compiled a list of 756 retainer physicians.
A 2010 survey of members of the American Academy of Family Physicians found 3% of respondents had some form of retainer practice, up from 1.2% in the academy's 2009 survey.
"I think it's still a relatively minor percentage, but I think they are growing," said Glen Stream, a Spokane family physician who is president of the academy. "I certainly hear more about it from members around the country."
Loew also reports for the Statesman Journal in Salem, Ore.
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