Letters to the Editor - March 28, 2005

A break for cash-paying patients, but she had her own "unbelievable" OB bill - When a doctor "gives" health plans a discount, it's hardly voluntary - Drug company gifts not proper, whether sterling silver or stethoscope - Mississippi needs more tort reform

A break for cash-paying patients, but she had her own "unbelievable" OB bill

Regarding "Why full price for cash payers but then a break for managed care?" (Letters, March 7): I completely agree with letter writer Michael R. Cavenee, MD, of Plano, Texas, that cash patients should not pay full price.

When I began practice with my husband in 2000, I suggested he join my intended policy of giving cash patients "a break." After understanding my logic of no papers to file for the 65% to 85% return on your total bill, no denials or hassles, and sincere appreciation from your patients, he agreed to join me in the discount policy for cash patients.

The policy is as follows: If the patient is paying or charging to their credit card the total due on the day of service, a 30% discount is applied. If the patient can't pay the total due but agrees to set up a monthly payment plan, a 20% discount is given. More than 85% of our cash patients pay their bill in full at each visit. They are most appreciative of our policy.

After having this policy in place for over two years, we found ourselves on the other side of the fence -- no OB insurance, a high-risk pregnancy necessitating a perinatologist, numerous screening tests and ultimately a cesarean delivery at 31 weeks in a tertiary-level hospital. The price tag was unbelievable. It made us very happy to know we were already sensitive to the needs of patients in our situation.

I realize that some physicians are "employed" and might not have the option of making their own policy. For those who are "owner operators" and do have this option, please consider a policy for your cash patients.

--Michelle J. Banning, MD, Danville, Ark.

When a doctor "gives" health plans a discount, it's hardly voluntary

Regarding "Why full price for cash payers but then a break for managed care?" (Letters, March 7): As a physician who cares for both cash-paying and managed care patients, I can understand the frustration felt by the writer of the letter cited above with the current medical billing system.

I believe the fault lies not with the physician, but with our legislators and the fact that medicine is a business in a capitalistic society. Because physicians cannot unionize and collaborate on managed care and other insurance contracts, we are resigned to accepting what we can for payment to keep our office doors open.

Capitalism requires that physicians be competitive with other physicians or they may not have a practice. We don't "give" a deep discount to insured patients, and we regretfully resign to accept less pay out of fear of not making a living ourselves. I agree that physicians should offer a discount to cash-paying patients, as it increases cash flow, reduces payment time and has a higher per-dollar value than the same amount of money received as payment from an insurer.

I do not believe the road back to control of medicine is through the cash-paying patient. I don't know of many patients who could afford bypass surgery, chemotherapy or a major surgery out of pocket. The road back to control of medicine is through political action, legislative change, a unified voice and good patient care. Only through those avenues will we take the control of medicine back from the insurer and make it truly available to who it is meant for -- the patient.

--Dirk M. Smith MD, Arkansas City, Kan.

Drug company gifts not proper, whether sterling silver or stethoscope

Regarding "Iowa practice draws notice for its 'no-gift' policy" (Article, Feb. 14): A gift is a gift is a gift. That's what I say to Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Assn. of America. Mr. Trewhitt says, "A sterling silver serving tray is not appropriate, but a medical dictionary or stethoscope would be." No, Mr. Trewhitt, it is still not appropriate.

Dorland's Medical Dictionary goes for $49.95 at amazon.com, and a decent stethoscope costs more than $100. If I accept those gifts, an innate sense of human decency compels me to give the drug rep more time on the next visit -- and they are counting on this.

I do not go to drug-company-sponsored dinners at fancy restaurants because I want the freedom to tell any visiting drug rep that I do not have time to listen to a spiel. I would rather get my information from neutral sources.

Drug reps leave us samples of expensive brand-name drugs. There's no point in giving samples of these medications for chronic use (e.g. antihypertensives) to the patient who can't afford them once the samples are gone. Why don't the reps leave samples of hydrochlorothiazide, amoxicillin or other useful dirt-cheap generic medications? Simple: There is no money in it for them!

--M. Dean Havron Jr., MD, Winchester, Va.

Mississippi needs more tort reform

Regarding "Liability premium shock spreads" (Article, Jan. 31): Your article states that Mississippi physicians are a little better off today than in 2001. I disagree!

This state's bill was little more than a Band-Aid. Last year I had a 40% premium increase, and when renewal for my premium was up in November, I was to have another 100% increase. My response was to stop practicing obstetrics. I would love to have the same premium I had in 2001.

Please do not sugar-coat this. Meaningful tort reform for the obstetricians of Mississippi has not occurred. The Mississippi State Medical Assn. must continue to pursue this on a state level, and the AMA and American College of Obstetricians and Gynecologists need to increase the pressure on Congress on a national level.

--Keith Goodfellow, MD, Bay St. Louis, Miss.