As of 1/1/14, who will their patients be? The entire field of prospective patients will be divided into 3 groups.
1. Those with insurance whether they want it or not.
2. Those who are paying fines for being uninsured.
3. Illegal aliens.
Unless the direct pay Doctors can offer incremental value improvements over the entire population of doctors who take insurance, the part of the population which doesn’t want insurance but has been forced to buy it will be in a situation where it costs them more to use the less expensive physician. I don’t think a lot of them are going to want to do that. To open a direct-pay practice will be to lose roughly two thirds of potential patients.