West Virginia looks at retainer model

A West Virginia physician's retainer practice model, at first viewed as a possible violation of insurance laws, is now being viewed as a way to provide another affordable health insurance option.

Vic Wood, DO, who specializes in ambulatory medicine and runs Doctors Urgent Care, a clinic in Wheeling, W.Va., said government officials are considering creating a pilot program that combines his primary care boutique medicine concept with a wrap-around high-deductible health plan as one of many options for covering the uninsured.

Dr. Wood started a program at his clinic in 2004 where he offered unlimited appointments and x-ray services to patients for a monthly fee, in typical retainer medicine style. He then would direct the patients to an insurance company, which would write an individual policy for services he could not provide, such as hospitalization and visits to specialists.

The clinic also accepts private insurance and Medicaid, for those patients who do have such plans.

The West Virginia Insurance Commission, however, ordered Dr. Wood not to sign up any businesses so it could investigate whether he was selling insurance in violation of state law.

Since then, Dr. Wood has been a regular in government policy-making sessions as he has championed his idea to legislators.

He testified in two legislative committee hearings last year and has been a member of the state's Affordable Insurance Workgroup, which is the committee assigned the task of developing better insurance options for patients.

The group is preparing a report for West Virginia Gov. Joe Manchin that offers several recommendations for addressing the health care needs of the uninsured. Among the suggestions is a three-year pilot program that is built on Dr. Wood's retainer practice-supplemental insurance model.

Many legislators, after hearing Dr. Wood describe the program to them in testimony, compared his model to the way some coal miners received health care years ago. The workers actually would pay a set monthly rate for care from the mining company's physician.

Dr. Wood's model, however, was based more on costs than nostalgia. He started by offering the model to his own employees, which he said cut his own practice's health care costs by more than 50%. He estimated a company could save about 30% in administrative fees by adopting his model.

Dr. Wood said his fees for patients would be $83 per month for an individual or $125 per month for a family. The pilot program, however, could vary depending on the services offered, he said.

"There would be no strict guidelines," he said. "It's going to be more wide open. Clinics can charge what they feel is appropriate."

Questions from the panel about Dr. Wood's model have centered on whether it's fair to charge patients for services they might never use. Such issues will be considered while the panel comes up with its recommendations.

The governor is expected to address some of the work group's recommendations as part of his state of the state address Jan. 11.

"Health care will be a large part of what he talks about," said Lara Ramsburg, a spokeswoman for the governor. "The committee has been working very hard to come up with flexible options."

How the governor decides to proceed could go a long way to resolving the concerns the state's insurance commission had about Dr. Wood's model.

Dr. Wood said the commission never formally followed up with him about his program, but representatives had told him through informal meetings that "they're maintaining their position that it's insurance."

Dr. Wood said he is not marketing his model but that he does sign up individual patients if they ask to join.

Insurance commission representatives also have been involved in the Affordable Insurance Workgroup, which has discussed Dr. Wood's program at length.

Dr. Wood said in order to leave no doubt about the model's legality, however, it would need to be passed as legislation or ordered by the governor.

A representative from the insurance commission did not return several calls seeking comment.