After 11 years as part of a group family practice, Michael Iannotti had earned top marks from payers for his ability to demonstrate quality measures, but was frustrated that not everyone in the group shared his zeal for documentation.
"Physicians don't like all these new quality metrics, and the hospitals and government agencies that hire the physicians aren't good at it, either, so they end up losing a lot of money on employed physicians," he says. "I decided to create my own practice and participate proactively to get my quality measures to where they needed to be," he says.
Iannotti also knew that eventually he wanted to own his own medical building and didn't particularly care for the one he was practicing in, so the Lafayette, Colo.-based family practitioner decided to go solo last year. Not only did he go solo, but this fall he's launching a concierge practice in addition to his separate fee-for-service aesthetics practice.
More and more physicians can relate to the need for reinventing the primary-care model. In the most recent Great American Physician (GAP) survey, more than two-thirds of the 1,314 physician respondents say they would consider switching to a direct-pay practice that doesn't accept insurance, they already have switched, or are planning to make the change.
A year earlier, responding to a similar but not identical question, 43.2 percent said they were considering a direct-pay practice and 10.3 percent said they were planning to switch or already had.
The surge is exacerbating an already serious shortage of primary-care physicians in employed situations and traditional fee-for-service practices, says Jim Stone, president of The Medicus Firm, a Dallas-based physician staffing and recruiting firm.
When a physician decides to open a concierge or direct-pay practice, it typically involves slicing off a small portion of patients, creating a service void that either a hospital or practice must back-fill, Stone says. He says his firm has also been hired directly by physicians transitioning to DPC to find physicians willing to take custody of medical records and bring in patients not coming to the new practice.
"In internal medicine we used to have a third of residents go on to specialize in pulmonology or other fields and two-thirds went into practice. Now, the reverse is true and we further slice up the primary-care area with hospitalist, concierge, or other non-traditional models, so it's gone from bad to worse [with regard to the shortage of primary-care physicians]," he says.
WHY THEY LOVE DPC
Physicians working in these new models, however, say they are thrilled to be more in control of their practices, are making more money than in their previous practice or expect to shortly, and are hearing from patients that they love the change.
"I'm no longer beholden to the 'meaningless abuse' model of checking boxes" to fill out payer codes, says Denver family physician Michael Keller, referring tongue-in-cheek to his thoughts on Meaningful Use standards. "It really frees you up again to enjoy the practice."