I agree with you about owning your own practice and being your own master. What are your thoughts on opting out of Medicare/Insurance all together and billing patients directly?
I really am interested in not only owning my own practice but not accepting any insurance. I know this is tough and it will take time to get established before making a good income, but I really am determined to do it. I am simply sick of all the middle men (insurance, government, etc) that are interfering with healthcare and I want alltogether to avoid it from the very start (shortly after graduation).
Yes, but where would you plan on practicing? what would be your niche? Is your goal to be in a solo?
It would be extremely difficult to have such a practice model in a saturated market.
In other words, the viability of such a model would depend on the your geographical location, and your competitors. Hence, you would have to be the only one or one of the few providing your services to have the luxury of turning away CMS (medicare, Medicaid) and insured patients. If one or two other guys providing those same services moved in your area, and accepted CMS patients, it would become extremely difficult to survive.
The plastics and dental guys can survive with such a model because enough of their competitors adhere to the no medicaid, medicare patients, plus insurance doesn't cover a lot of the cosmetic work they do. In the field of general surgery and its subspecialties it would be very unusual to find a geographical location where even few are refusing Medicaid, Medicare, or insured patients, also do not forget that increasing amount of surgeons are beginning to be employed by hospitals, this means your competition will extend beyond the other private practice groups, you'll be competing against hospitals who take any and all patients (one stop shops).
How do you plan on establishing your referral base? A lot of private practices make the mistake of thinking they can accept only insured patients and turn away all their medicaid and medicare patients. Any PCP out there would tell you that its one of the quickest ways to lose referrals, they want to know they can send all their patient to one practice and be covered. No one wants the headache of sending all the well insured patients to the practice across town and the non-insured or CMS patients to the other that accepts them. It is a lot more work for them. They want a one stop shop. Some of the groups make up for this by hiring new grads and exploiting them by funneling all their Medicare, Medicaid patients to them, while they take care of only the well-insured patients.
Now your model could work if you had a very specific niche that only you or a few can provide. For example, if you were the only vascular surgeon in your area doing peripheral endovascular work, and also did general surgery like most private practice vascular surgeons, it would be possible to refuse insurance, medicare and medicaid patients for that particular niche but still except insurance for procedures that your competitors can perform. Hence, you can compete with your competitors, and yet take full advantage of your expertise without losing referrals or upsetting PCPs.
Plus I'm not sure turning away insured and CMS patients would be a good idea financially for anyone even if you could maintain a practice despite doing so. You'd be better off hiring billing personel to deal with the headaches, the overhead you would accrue by doing this, will not even come close to the financial loses you would suffer if you opted out of insured and CMS patients.
Honestly, the list of reasons for which your model would be difficult to uphold can go on forever, there are plenty more reason which I simply don't have time to enumerate at this moment.
Maybe Fah-Q can continue.....
while lawyers and politicians decide our fates.
