* Doctors charge patients a flat annual fee, ranging from $1,500 to $2,000 in Howard County, though nationally the range is broader.

* Patients are offered longer appointments, a state-of-the-art annual physical, easier access by e-mail or phone and home visits. Some practices promise unlimited visits and some offer monthly appointments.

* Physicians encourage patients to keep their regular health insurance in order to provide coverage for diagnostic testing, hospitalization and other specialty procedures not covered by the yearly charge.

* In order to offer more frequent and unhurried office visits, doctors accept fewer patients, sometimes reducing their clientele by 80 percent.

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