Two exciting days of the Physician Practice Survival Conference just ended. Technologists, futurists, innovation experts and innovative doctors discussed the innovations they are already implementing and what the future may hold. One popular model for the future is horrifying for clinical research. It goes like this: at the end of 2013 the insurance exchanges kick in. Two-thirds of employers stop covering insurance and turn their employees over to the exchanges with a bolus of cash to be applied toward medical care. Employees select cheaper high-deductible plans. They are now incentivized to seek providers who offer efficiencies to cash-pay patients. Providers en masse become cash-pay "concierge" physicians.
The excess office visits currently used to secure insurance payment (perhaps 80% of all office visits) end for these cash-pay patients, now served far more efficiently by telemedicine. Excess office space and the staff that attended to that space and billing are shed from the system. Providers, with more direct patient contact and less indirect risk, shed malpractice insurance coverage. In at least one state you can already essentially self-insure and concierge doctors are doing so.
While this model releases huge amounts of excess physician capacity (the primary care shortage model evaporates overnight), these physicians no longer have excess infrastructure to repurpose to clinical research. The available pool of clinical research sites shrinks dramatically.
It could happen.