Are You Ready To “Name Your Own Price” for Surgery?
Thirty years ago, professional fees charged by physicians and attorneys were not negotiable. Attorneys even used so-called minimum-fee schedules to price their services, and routinely charging less was considered unethical conduct. It is still rare for physicians, dentists and other health care providers to advertise their fees, although lately some advertisements are appearing for cosmetic or elective services such as cosmetic dentistry and laser vision correction, i.e., procedures that are usually not paid for by health insurance plans. Negotiating fees for health care services has been the exclusive province of insurers or other payors such as employers. A variety of sources have produced brochures giving advice on “how to choose a physician,” and such brochures never discuss cost issues beyond advising consumer/patients to see whether a respective physician accepts the patient’s insurance in partial payment for professional services rendered. Even discussing fees with physicians has been culturally taboo.
Now e-healthcare via the Internet is challenging the notion that consumer/patients should not consider fees charged when selecting a physician or dentist. A new web site, http://www.medicineonline.com/, allows prospective patients to search for and select physicians and other health care providers to perform elective, aesthetic procedures including cosmetic surgery, cosmetic dentistry, laser vision correction surgery, and podiatric surgery. Patients seeking surgical services do not “name their own price” using the priceline.com model. Instead, Medicine on Line (MOL) allows prospective patients to solicit bids for surgery using “reverse auction” technology. In a reverse auction, a prospective purchaser advertises a need for services or products (in this case, surgical health care), and individuals willing to provide the services or products “bid” for the right to provide such services or products. With MOL, the health care providers are minimally screened. Physicians must provide MOL with a professional license number, a Drug Enforcement Administration registration, and an office practice address, but MOL does not verify credentials.
MOL provides descriptions of a variety of cosmetic procedures. For example, a prospective patient interested in blepharoplasty (eyelid surgery) clicks a hyperlink to information describing the procedure, risk factors, side effects, length of time required to perform the surgery, type of anesthesia ordinarily utilized, length of time for recovery, etc. Under the MOL business model, patients receive a free face-to-face consultation with one or more physicians under consideration, and either the patient or physician may reject the surgery without obligation. Although MOL currently does not charge either patients or physicians, eventually it plans to charge patients for its service. MOL may have decided to charge patients rather than physicians to avoid ethical and legal prohibitions against physicians paying referral fees or splitting fees with non-physicians.
A patient or any other payor of health care services should never choose a health care provider solely on the basis of cost. However, this does not mean that cost should not be a factor in deciding on a particular health care provider. Although the Internet presents many problematic issues for patients such as confidentiality of patient-identifiable information and the accuracy of medical information provided, it nonetheless offers the potential to lower the cost of some health care components such as pharmaceuticals. There is no guarantee that prices bid by participating physicians through MOL will be lower than prices charged by other physicians in the same locale. It is also unclear whether physicians will embrace the concept of bidding for patients. For now, MOL is a pilot project operating primarily in southern California. However, if it is successful, other competing websites will undoubtedly open for business offering consumer/patients the option of “naming their own price” for surgery.