Of course there is. Every contract I’ve had allows me to close to new patients, or I would not sign it. At the worst, you limit your panel size when you close your entire practice to new patients.

>>or expectation of a higher level of service by exclusivity.

Whatever level of service they offer is the same to all their patients. They do all their practice on the same basis. They may have a different level of service compared to other practices, but that’s another story.

I forget the name now, it was some sort of managed care, where the monthly payment was called “capitation”. Though strictly speaking, it was partial capitation.

I had three of them at one time.

Actually, I never participated in any fully capitated plans.

Not much difference between your descriptions of boutique and capitation, except one has an insurance company as an intermediary.

The boutique care patient pays both for the “membership,” the privilege of being empaneled and then pays again for care. Whether an outside insurer covers any specific services will depend on the insurance policy and the provisions for out-of-network care. The relationship between the patient and his insurer is just that and nothing more. The insurer does not pay the doctor for anything. The membership fee may include a number of services, annual physicals, immunizations and travel medical consultation, and may leave others to a cash paid as-required basis. That will depend on the particular practice. With the boutique, there is usually a limited number of enrolled patients, which is meant to guarantee a level of service otherwise not available.

In capitation, the practice receives a fixed fee per patient enrolled per period of time which does not vary with the number of services performed, only the time period enrolled. The insurance company pays on behalf of the patient at a rate nominally negotiated between the doctor and the insurer, but usually not. The patient often pays nothing or perhaps a fixed per-visit co-payment. There is no limit on panel size or expectation of a higher level of service by exclusivity.

If a privare individual pays out of his own pocket, a monthly fee to be on the panel of a certain physician or medical group, it’s called “boutique” care.

If an insurance company paid the same doctor a monthly fee for one of their insured to be on the panel of a certain physician or medical group, it’s called “capitation”.

Why is that?