Reid B. Blackwelder, MD, a family physician in Kingsport, TN, and president-elect of the American Academy of Family Physicians, says his organization has no specific policies in place around direct pay practices. However, he says a proliferation of the direct pay practice model could create access issues.
"It depends again on how the physicians chose to provide that care," Blackwelder says. "It doesn't mean that it is a good or bad thing. As individuals choose to practice medicine in a certain way and patients choose to find that care we just want to make sure that all patients have access to the right care from the right person at the right time."
The AAFP in its 2010 practice profile found that 3% of respondents practiced in a cash only, direct care, concierge, boutique, or retainer medical practice. Blackwelder remains skeptical that significant numbers of primary care physicians will migrate to direct pay practices.
"We've been hearing for a long time that this is about to take off, but I have also read a lot about physicians who chose that model but it didn't meet their needs," he says.
"I am a little unsure that this is the time we are going to see a breakout just because there is so much economic uncertainty right now that will remain for the foreseeable future. SGR has gotten tapped down for a year but we have a lot of issues about what we are going to do with the [PPACA] and the debt ceiling and other deficits. Given these economic uncertainties it would be a challenging time to boldly go off in a new direction."
Merritt Hawkins' Smith says changes in the healthcare payer market will lure physicians into direct pay practices. "You can take a private practice it and convert it to a concierge practice and make life greatly better for the physician," he says.
"They will become much more prosperous and reduce their business responsibilities by 90% and their employer responsibility but 75%."