FAIRBANKS - A Fairbanks doctor has decided he must begin charging his patients a retaining fee to see him.
Starting in January, Dr. Richard Burger's patients will be asked to pay a $100-$300 per year retainer fee just to be seen. The fee, which isn't covered by insurance, will help offset declining insurance company reimbursement and increased costs, Burger said.
State regulators have said there's no problem with the fee. But patient advocacy groups in the Lower 48 are keeping close watch on the trend and are lobbying against it.
"In general, there's concern about what this is going to mean about access to doctors," said Becky Derby, senior policy analyst for Health Care for All, a Massachusetts-based patients' advocacy group. "What happens if other doctors do the same thing? Who is going to be left to take care of people who really can't afford to pay that extra amount?"
Burger, who is not accepting new patients, said his patients who can't pay can apply for an exemption, and patients on Medicaid, are automatically exempt. The doctor serves about 700 area residents in his internal medicine practice, Arctic Internal Medicine, which he opened in 1987.
"I'm not happy at all or proud about this," Burger said of the fee. But he said it will pay for services not covered by insurance, including telephone calls, telephone prescription refills, scheduling consultations, e-mail communication, copying medical records, after-hours care and filling out insurance forms.
"There's no way that a doctor can get reimbursed for that time," Burger said. "Can a lawyer get reimbursed? Yes. Can an accountant get reimbursed? Yes. This happens to me at least 10 times a day - five-minute interruptions."
Burger has modeled his retainer fee practice after the GreenField Health Systems, a clinic in Oregon that charges patients a $350 yearly access fee. Dr. Charles M. Kilo is chief executive officer of the clinic. He said the fee helps pay for time spent communicating with patients through the Internet and on the phone.
Burger expects about 80-90 percent of his patients to remain with him despite the fee. Donna Brewer, a patient for the last 10 years, is among them.
"I don't know anybody that goes to him that would want to give him up as a doctor," she said. "I guess I feel like he gives patients so much more time than any other doctor. Some doctors see you for 10 minutes. They charge a lot for 10 minutes. He'll give you an hour or more. You feel like you are really cared for by him."
Sheila Finch, a patient of 10 years, agreed. "I'd rather not pay it, but I'm going to because I don't want the hassle of looking for another internist," she said.
The American Medical Association seems to have signed off on the access fees. The association's House of Delegates established ethical guidelines for doctors "providing retainer services" in June of this year, according to an e-mail from Ross Fraser, AMA spokesman.
The guidelines state both doctor and patient must be clear about the terms of the retainer fee contract. Doctors whose patients decide to leave the practice rather than pay the fee should not charge a fee to transfer medical records.
If no other physicians are available to care for nonretainer patients in a community, the physician may be ethically obligated to continue caring for such patients, according to the guidelines.