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09/14/2015 Michael M. Rosenblatt, DPM
Out-of-Network Billing Fuels Provider-Payer Friction (Robert Kornfeld, DPM)
I think we have to split Dr. Kornfeld's most recent letter about "direct patient pay" into separate arguments: He is a well known free- market practitioner who eschews any and all insurance and goes directly to patients to pay. He writes frequently on this subject and contends that neither Government nor private insurers have any right to control your charges for services or professional products.
Government and private insurers have a direct interest in controlling costs of healthcare. Government's interest is reducing the total coast; business in order to make more profits for executives and shareholders. Unlike his substitute-payer adversaries, he doesn't care about costs, with the potential exception of "not driving patients away by over-charging." His view and theirs come from completely different camps, one might just as well be from Mars and the other from the Moon.
Some actuarial studies have suggested the "free- market" system for healthcare does not work for the very reason that there ARE substitute payers, e.g. Government and insurance. They contend that because patients don't have to pay directly, there will always be a force to use more and more healthcare. And surprisingly there are also studies that indicate single-payer Government actually keeps total healthcare costs down more effectively than private insurers. Here's the URL on that one: http://www.peterubel.com/uncategorized/comes- controlling-healthcare-costs-government- outperforms-private-industry/
When it comes to money there will always be friction and arguments. In private practice, I like to call this the "code-dance." We code to obtain more; insurers cut/change our codes to pay less and we both dance back and forth, right and left. An interesting part of the free-market approach of Dr. Kornfeld is that it contains a basic directness and honesty that is irresistible. There is no code dance. The fees and costs for materials "are what they are."
As outsiders get more and more control over what we do and charge, it makes sense to at least consider his approach. But there are characteristics about this practice style that must of necessity include many more "items for direct sale." Practitioners who do this sell more stuff retail.
We shouldn't feel bad about this as Kaiser makes enormous money from sale of "stuff." If you want to go-patient direct-pay, you will have to carry a much bigger inventory for sale than you ever did before. I t may be worth the trade-offs: But there may be an extended period of income reduction. Educating patients to this is a real uphill battle. If you decide to do this, you need extensive extra- training that was not provided in your professional education.
Michael M. Rosenblatt, DPM, (Retired) San Jose, CA
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