Here at Reimbursement Rx, it's our ultimate mission to elucidate the very murky world of physician compensation so that both new and seasoned doctors can gain a better understanding of what is out there and how things actually work. 

We've talked a lot about transparency in the medical industry before; however, when it comes to physician pricing and physician-insurance contracting, transparency is lacking in a BIG way. 

How many doctor offices do you know of that put up prices up on their front desk? How many hospitals have you been to that tell you EXACTLY how much their services are? 

In fact, doctors who are not in the same medical group are not allowed to divulge their fee schedules or their insurance rates to one another, and it's not just out of politeness - its considered against the law to do so!

Say what!?

In the Statements of Antitrust Enforcement Policy in Health Care of 1996, (You can read it in full here, if you are so inclined.), it states (in a very easy to read 142 pages) that it is basically considered ILLEGAL for physicians to discuss their fee schedules and even insurance contracts amongst themselves if they are not in the same medical group and could be considered competitors!

How is that fair? How is that helping free market? 

Let's think about this for a moment:

You are an OB-GYN in private practice and your best friend is a OB-GYN employed by your friendly hospital across the street.  You contract with an insurance company and they agree to pay you a certain amount for your services. Meanwhile, your friend's group (the hospital) contracts on her behalf, yet the same insurance company will likely pay MORE for her services, because the hospital is huge and they have a lot more doctors and can charge the insurance company more than a small private practice. (Why that's the case is a whole separate topic of discussion)

The point is, your friend cannot tell you or anyone else how much she gets paid for her services, so you don't know what's a fair price to charge for your services. While they might be living it up charging much higher fees at the hospital, you might be struggling to keep your practice running and you might not even know there is another way!

Now, very few physicians are actually familiar with the above listed enforcement policy. However, there is still a widely observed unspoken rule that "we cannot talk prices and contracting".  And this is complete and utter BS! 

Name one other industry where there exists such a total lack of transparency.  You won't find one!

If you have two gas stations across the street and one decides to sell gas for one cent less the other one has the right to do the same.  Sandwich restaurants openly compete with each other HAPPILY publishing their prices.  Even a single automobile manufacturer will sell you exactly same brand new car at different prices depending on which dealer you visit, and even those prices are now all easily accessible online.

Yet, it's still taboo to discuss physician pricing and insurance rates. It's beyond comprehension!

We are an industry that can't compete on price, because we don't even know what the prices are. All this silence around prices does is contribute to rising healthcare costs that just keep on rising, so patients have to spend much more on their healthcare without receiving the same increase in their overall health. And it's not like doctors are all getting richer from this increase in costs, either. 

We're not pumping gas or selling cars or sandwiches. It's not that there's anything wrong with those occupations, but our industry handles the most important thing we humans have: our health. If we are going to say that we truly CARE for our patients we owe them more than just saying that we do. 

We really need to re-think our compensation scheme and how backwards the system is, for our benefit as doctors, and more importantly, for the patients that we serve. 

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