Im just trying to think ahead to 20-30 years when the documentation requirements become more and more, regulations continue to worsen, the healthcare system becomes basically two tiered with medicare/medicaid patients going to midlevels, private insurance patients going to physicians. Brainstorming on how the pendulum will swing the other way. Will physicians say fuk it were not dealing with this crap anymore and go concierge? Start their own hospital system somehow that is run by physicians instead of random MBA execs and take private insurance, cash only? Start a system where patients in the community pay in on a yearly basis and get their care primarily at that hospital and no insurance is taken? Something is eventually gonna give, just kinda curious what a good bailout plan could be.
My understanding is it all boils down to if a state is 'Certificate of Need' or not.
Next issue, is having the money to open such a hospital. And get the requisite specialists.
Think from your own perspective, as a private insured patient, why would you want to go to this non-CMS hospital over the local hospital? You will want to know they have the specialists there too you might need.
Another issue, is the doctors will all have to have opted out of Medicare. Not be non-par, but opted out. That comes with a 2 year 'ban' from entering back into Medicare. This means these doctors are unemployable at the usual places for 2 years. That's a big trust leap for most doctors to take, they will need some serious motivation to make that leap.
The reason why the doctors will have to be opted out, is because if a medicare patient shows up at that place, and you a medicare certified doc at facility XYZ (elsewhere), and ignored the contract requirement to be opted out, attempt to charge cash prices of this medicare beneficiary you will get banned from medicare and be required to refund their money. Then this hospital, because it employs a banned medicare doctor will be on the list of 'Do not do business with' that medicare/feds keep track off. Which means DME, suppliers, contractors, etc can't do business with the hospital after that...
Its one thing if an ED doc opens up a very simple urgent care cash only facility on the side, most people aren't going to pay attention or care.
But a full fledged hospital is going to tick off the local hospitals and they will use every tactic they can to micturate in your cornflakes.
There is a good chance that private insurance companies will contract with such a hospital, but there is no guarantee they'll give good rates.
Also, some insurance companies will give these doctors a hard time to be paneled at this new hospital, and won't let them get paneled because they need to have a privileges at a JCAHO/CMS recognized hospital (I experienced this with new psych hospital that was in limbo with contracts until they got certified and essentially they had to do probono care for the first dozens of patients, to appease CMS/JCAHO people to then get the certification to then get the insurance contracts). My privileges at this hospital didn't 'count' in the eyes of some insurance companies.
In some ways the system is stacked against such an environment and almost forces it to be entirely cash and out of network. Until midlevels and other pressures drastically tank the US health care system to the point of being like the UK NHS I doubt there will be a critical mass of people willing to flee to such a facility.
I do believe there is room for niche type 'hospitals' like a 1-2 psychiatrist practice opening up a 5-10 bed unit, or GI docs opening up a 6 bed unit that also has an attached scope suite. With 4 GI doc group, they would likely have enough pancreatitis, Abd pain, etc cases to admit to their own unit instead of the traditional hospital.
The most likely solution is the above poster advocating for a complete cash only opt out dream/lottery funded, flat salary hospital run by physicians.
