Physicians are shifting to concierge medicine and direct pay, or joining health networks

The private practice of medicine increasingly is disappearing or morphing into concierge medicine, direct pay, or practice through giant health systems, reports the Los Angeles Times.

In Doctors are shifting their business models, the report is that physicians are abandoning private practice, due to pressures from the Affordable Care Act, and turning instead to:

  • Concierge medicine
  • Direct pay medicine
  • Become employees of larger healthcare systems.

The article notes:

In fact, a national survey of 13,500 doctors by the Physicians Foundation, a nonprofit organization representing the interests of physicians, shows that in 2000 more than half were practicing independently. But by 2013, that share had shrunk to a third… Many independent doctor practices — and even group practices — are being purchased by hospitals and insurance companies, as more doctors today wish to be employed rather than running their own practice.

In “direct pay” practices, the article reports, “these may provide unlimited primary care services for a monthly fee that can range from $50 to $150.”

Other physicians are switching to a cash-only medical practice.

Concierge medicine raises several key legal and regulatory issues that physicians must resolve before entering into a concierge medicine practice model. These include:

  • anti-kickback and fee-splitting legal concerns
  • whether the concierge model, as structured by the physician practice, would be considered the “business of insurance” under state law
  • compliance with Medicare laws that affect concierge medicine and direct pay medical practices, if the physician is participating or non-participating (and not formally opted out of Medicare)
  • prohibitions against the corporate practice of medicine
  • privacy and security issues, including HIPAA compliance
  • telemedicine (telehealth) legal issues if the physician is following up by phone, Skype, online, or other than in-person/ face-to-face (including Internet prescribing legal issues)
  • other legal and regulatory issues

Direct primary care raises similar legal issues.

Typically, in concierge medicine, patients pay for luxury medical services and access, where direct primary care (DPC) is a patient-provider relationship, in which the patient purchases primary care directly from the physician, without a physician payer.

These legal and regulatory issues can be addressed by legal counsel familiar with concierge medical practices.

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