As administrative burdens and costs associated with the practice of medicine continue to grow, many physicians are wondering out loud whether now is the time to make the leap to cash-only concierge medicine.  In its purest form, concierge medicine is a model where patients pay a recurring cash fee (e.g., monthly or annual) for expedited/enhanced access to medical and wellness care.  There are many possible variations on this concept ranging from a cash fee-for-service model to a hybrid model where the physician accepts cash for some services (non-covered) and bills insurance for others. 

While the concept may sound incredibly tempting, physicians are advised to proceed with caution.  To be sure, there are a host of legal considerations - most of which have to do with Medicare and commercial insurance contractual issues.  These are particularly tricky in a hybrid model where the distinction between covered and non-covered services is critical. 

There are, however, many business considerations that should be carefully evaluated before making this leap. Among other things, the practice needs to be in a market that will support a cash-only practice. Patients who get decent coverage through their employer's plan and only have to pay minimal copays/deductibles may be reluctant to pay more. Some patients may be willing to pay for concierge level care but how many of those patients will you need to sustain a practice?  How will the practice operations and cost structure change under a concierge model?  How will the physician's lifestyle need to change?

While concierge medicine may be a great fit for a handfull of doctors, it's likely not a feasible model for many.  If you are considering making this change, be sure to do your homework first.