Physicians embrace cash-based payment models

Amid shrinking reimbursement rates and growing frustrations with administrative burdens, more physicians are turning to cash-only or direct primary care models. 

"We're seeing a huge evolution of cash-based models because it's a more predictable revenue stream that can be quite lucrative," Sam Patel, MD, founder of medical consulting firm Astra Culture, told Medscape in a Dec. 23 report. 

There is little data to offer firm estimates on the prevalence of direct pay models, though a Medscape survey from 2020 suggests they are used by less than 20% of clinicians. 

In these arrangements, patients typically pay an annual or monthly fee for access to a set menu of care services. This differs from concierge medicine, where practices still bill insurers for certain services and use the membership fees to enhance access and convenience. 

Medical school debt, burdensome paperwork and declining reimbursement are the primary factors driving more physicians to consider cash-based models, according to the report. The option can be appealing for patients frustrated with long wait times to secure an appointment. 

"Patients want direct access to care, and they want price transparency," Dr. Patel said. "For some, paying a doctor $300 for an appointment – and being able to secure one within a day – is well worth it." 

However, the rise of these models raises questions about affordability and equity. While some patients may value the convenience, others may face barriers to care, exacerbating disparities for those unable to afford out-of-pocket costs.

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