I'm also solo family physician, sole proprietorship like many of you. ACO's may ultimately rule the day for awhile, like HMO capitation used to be very popular (before my day in medicine), like the cash payer model was decades before.
I can see full circle swing for those of us that are small and remain small. By remaining "name branded" the concierge practice model might serve some of us well. It will not work in all geographic locales. There needs to be a good enough financial base to attract patients that can afford a $1,000-1,500 retainer fee. There needs to be enough public distaste for what little ACO's and the "big-guys" provide. Under the right circumstances, patients will happily pay this fee in order to keep you the doctor/provider they trust. Patients are doing this all across the country. As insurance companies and the government continue to ruin health care in the nation, concierge practice models will grow and thrive.
Remember, this is America where people want it all. We are a consumer society. People want quality service and they want it yesterday. There are increasing numbers of people who realize the standard quality of care stinks. They want a better doctor, and people call my office by the dozens every day to get into our practice. They can't because we are closed. I do good work and people want to get in. You do good work and they'll want to stay with you.
When the ACO's come to town and the big insurances stop paying me, I'm going concierge. I think there will always be a niche for a name-branded physician/provider. People wear name branded clothing with pride. I have many patients that have a name-branded physician that talk to their friends about me with pride. As long as that type of relationship exists between you and your patients, a concierge model or straight cash based payment model will remain viable.
I believe there will always remain hope. Why? People will always be ill. They will always need health care. And it's impossible for the U.S. government to provide health care to everyone in this country. We can bank on the fact that our government is too screwed up to do anything correctly. They will never fix health care. As long as it remains broken, there will always exist the possibility to go to a straight cash or concierge type practice. My father successfully practiced for 37 years in medicine. He told me there was only one guarantee in this profession..."it will change." 8 years out of residency, I see his wisdom every day I go to work.
