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      02-18-2013, 02:20 PM   #118
rjdoc74
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I am quite well-versed in the changing times and I can't agree on the fee-for-service disapearing unless you are speaking of something different than I am thinking. A surgeon, unless plastics or maybe some uber high profile neurosurgeon or orthopod will not ever be able to do fee for service, however I only see more and more docs, atleast in affluent areas which is where fee for service makes sense, increase. As more docs pull out of the insurance game, more fee for service docs will actually arise and although there will be more of them, they will make a bit less as the increased supply will drive down prices they will be able to charge.
Other then probably PCPs, psychiatry and a few non-hospital based specialties, it is yet to be proven that this system works long term.

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Unless obama mandates that docs have to take a single payer national system which is a ways off, than fee for service (ie not taking insurance) is continuing to grow. The docs doing it will need to either offer something else nobody else is doing (ie house-calls etc) or take a lower fee than they are now given more competition.
Plans to tie YOUR medical license to accepting government insurance are in the works as we speak.

http://www.forbes.com/sites/scottatl...vitably-fails/

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The managed patients will see more and more of the mid-level NP's and PA's with doctors seeing complex or rather playing more of a supervisory role in the primary care sector including OB, neuro, psych etc.
Yes, and this system is and will be working quite well within an HMO based model such as KP.


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However a further division among the fee for service docs will emerge as the one's catering to the affluent still who will be providing either more services or going off of a better reputation to charge a premium "affluent consumer" price point and than the other tier will be the average PCP who will do a fee-based service but really provide nothing more than most people are getting now if they do see a doctor rather than mid-level. Essentially people will have to pay some fee out of pocket to see an actual physician, even if they provide limited other services as in the future people will have a hard time seeing a physician through the insurance system without going through a dense mid-level NP/PA level of service.
Please imagine a scenario where 90% of fee for service patients (PPOs/EPOs, etc.) are forced to convert to some form of HMO-type model. How do you think you proposed system will hold up purely on cash paying patients?
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