Sorry to bump an old post. Can you expand on why concierge or cash-based palliative care would not be a good idea?
As a disclaimer, the following is an amalgamation of previous responses to similar questions over the years, so if something looks familiar -- you're not crazy.
You can start your own practice where you are the boss. This has a notable amount of risks to it. Specifically given our patient population and their needs. Unlike the cosmetic practice or concierge PCP practice where you will have the same patients returning for years (decades?) for their botox, coolsculpting, laser XYZ, or general medical care... our palliative patients typically have a short relationship with us by dying from whatever brought them to us to begin with... So with a cash-based practice, there will likely not be a sense of stability to your revenue in the same sense that those other specialties get to enjoy (the cash-based psych patient that has followed with the same psychiatrist for 20+ years).
In palliative, we are essentially a consultant's consultant... you will need Heme/Onc, Nephro, Cards, Neuro, Pulm to be making referrals to you. These fields crave for you to be accessible for their patient's acute needs (not just with open slots for acute needs, but insurance coverage/in-network, etc.) They need to readily ensure you have access to their notes and plans -- and that they have access to your's.
Onc patient in need of palliation for their mucositis? Only a small subset of patients who are using their insurance for cancer-directed therapy is going to be happy about then having to pay cash for palliative services. Why not just use the in-network palliative doc, or better yet the one integrated into the cancer center? Once the Onc gets burned once or twice ("Yeah I tried to go see that Palli-whatever doc you sent me too, but they don't accept insurance!"), those referrals will be dried up.
Direct marketing to patients for palliative services runs risk of attracting patients with questionable motives (i.e. drug issues). You see posts on social media or advertisements in local papers for cash-based cosmetics or family practice -- and the general public knows and understands what they are looking at when seeing those ads. Great majority of general population have no idea what palliative medicine is or means. Many of the patients that are meeting me for the first time, even after being referred by their doc, still don't know what our specialty is walking into the initial appt. They would not be signing up for a subscription-based concierge practice or cash-pay without knowing what their agenda is walking in...
Which brings me to: What is their agenda?
For the patient that loves the concierge model of practice and has already purchased into a PCP/IM doc being their full-time concierge service, those docs are likely not going to want to give up patients... so they will try to appease and prescribe whatever the patient thinks they need.
So as you know, oncologists, surgeons, cardiologists, hematologists, etc make the referrals and are gatekeepers for our patients -- which makes perfect sense. These physicians tend to be protective of their folks and refer to palliative services they know and trust to help in either ongoing concurrent care or taking over care of these patients. I guess there could be a cancer center somewhere out there where they send all their referrals to a cash-pay palliative doc. I haven't seen it. But that doesn't mean it isn't out there somewhere.
Depending on your neck of the woods, there will be different availability of palliative services already in place for hospitals/specialists. On the one hand, if you are in a location with a lot of robust health systems or one main health system (but all the docs in the community are owned by the health system), it will be pretty damn hard. And on the other hand, if you are in an underserved area and the hospital has no formal palliative program (or maybe just a doc/np that does inpatient goals of care discussions), it is wide open for driving your stake in the ground with a private practice. But if you are in an underserved area, how many of those patients are A) going to be appropriate for palliative medicine, B) have the resources/urge to seek those services at a cash-based model?
When there is a lot of competition, many of the patients who will benefit from your expertise are going to be funneled to the palliative teams that already have done good work for that Oncologist (or XYZ specialist). If the docs are all owned by the health system, they will likely not refer to an outsider (per se) easily or ever, for big brother admin is always watching.
This doesn't even bring up the point of having an IDT to deliver comprehensive palliative care to your patients (social worker, psych, chaplain, etc).
The well-meaning business-minded palliative doc might say: "Well, I am going to be different. I want to cater to my patient's needs with a cash-based model, so we won't need insurance dictating care or needing prior auths for my medications. I do not have an IDT, so will just be focusing on physical symptoms in my palliative cash-based practice. Pain is our most frequent complaint... so I will frame my advertisements as specializing in managing pain in my cash-based practice. All the other docs are comfortable prescribing APAP and NSAIDS all day... so I will need to be managing the meds that most other docs aren't prescribing patients already and find those patients willing to pay cash to get these medications, in a way that their insurance wouldn't approve payment of." ..............It just tends to meander into being a pill mill.
If you are thinking concierge or cash-based practice, I would heavily lean toward "no" -- it likely will not go well. But there is no law against it, so while my money is on that "most will fail", there will be some that succeed.