
Meanwhile the Providers, who were approached by carriers
they were familiar with found themselves asked to take lesser pay for services,
since the ACA shaved the margins of the carriers, added taxes to support the
Act, and wrote into law greater risks, Benefits, and caps to Administrative
costs. This has caused the Providers to
make one of three business decisions:
retire, group to reduce their overhead, or limit their practice and set
an acceptable annual income.
One manner to do the latter was to incorporate into
Accountable Care Organizations, which I have written about in the past, but
which are essentially the grouping of hospitals, General and Specialist
Physicians and even ancillary personnel and services, accepting set fees and
performance measures, which they distribute among themselves.
A second choice and one that grew more than 25% in 2011 and
probably more in 2012, is what is termed Concierge or Direct Patient Care
practice. An easy way to think about
this is that a Physician decides on a workable number of patients he can
provide personal care to, and pares his practice to that number. For the most
part these are Internal Medicine or Family Practice doctors, but there are
commercial groups, such a One Medical
in NYC, the Bay Area, Washington DC, and even in LA and Orange Counties, and MDVIP, primarily on both coasts.
Fees vary widely, some as low as $195/year; others perhaps
$5,000 annually. This is explained for
the most part by whether the doctor continues to bill for services (or expects
the patient to submit to a carrier) or whether most services are provided with
no copayment.

For the physician advantages include: a feeling of better
contact with the patient, fewer forms and less third-party regulation, a more
predictable income and in some cases, a path towards retirement. This latter is an attraction that is
influencing dentists and even Pediatricians into the concept.
Whether this alternative is a good choice for you is a
matter of personal choice. The
controversy on the issue is that it would seem to establish a two-tiered
healthcare system, benefitting the wealthy. The fact of life is that as the
weaknesses of the Affordable Care Act become more evident, the choice to
physicians may become moot.
In my next post I will convey why seeing the play Matilda made me think of my wife Mary in
a new light. I hope you'll join me.