A Physician's Toughest Choice: Accept an Offer or Remain Independent?
Wax, Craig M., Medical Economics
Physicians are now forced to make the toughest choice of all: whether to join a government- supported, hospital-run accountable care organization (ACO) or a physician-run, independent, direct-pay practice. The time for fence-sitting is at an end, with the Affordable Care Act now law and exchanges forming to provide mandated insurance or government Medicaid.
Big government and big health insurance have run roughshod over physicians and their established practices, devouring the precious little time we have in the exam room. The patient-physician relationship is at the breaking point.
On one hand, it would be easier to sell out to a big hospital ACO and work set hours for set pay. Limited on call and possibly opting in or out of hospital inpatient work would be possible benefits. Large health organizations have all the legal, insurance, billing, electronic health record system and other information technology, and staff support for a complicated medical practice.
All that government- and insurance-necessitated overhead would detract from the physician's salary and benefits. Doctors would be limited in patient contact time and might have to strive for a "production" bonus for seeing more patients faster to make personal ends meet.
On the other hand, it would be a challenge to convert a medical office to a direct-pay or concierge model of practice. The physician would be fully responsible for his or her call and office schedule. He or she could establish either discount posted cash prices for services or a monthly retainer fee for the "buffet" of services offered by the practice. The doctor would have to assume the financial risk for this model, but that was the case with the previous practice, too. …