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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