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Patients Soliciting Bids From Doctors Online

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But critics, who agree hospitals' prices are too often inflated, arbitrary and opaque, express concerns about Medibid. They say the service provides little in the way of quality indicators for prospective patients, something hospitals convey by granting a doctor privileges and insurers do by accepting doctors on a plan's roster. Surgery or procedures such as colonoscopies are typically performed in physician-owned outpatient centers, which are more lightly regulated than hospitals and have fewer safeguards for patients. Unlike hospitals, which are required to track infections, outpatient surgery centers are usually exempt from such reporting requirements. And complications are rarely covered under the terms of Medibid.

Medibid "is a phenomenon that is in part being spawned by the absurd, nonsensical and inexplicably unfathomable pricing of American health care," said Arthur L. Caplan, head of the division of bioethics at NYU Langone Medical Center in New York. "Cheap sounds good, but in these auctions you're not getting any information: Was the guy at the bottom of his class in medical school?"

"In the current world you buy the name -- the institutional reputation of a doctor or hospital. Insurance companies or hospitals drop people who have high complication rates or costs due to errors, " he added. "Medical care is not like buying a watch on the street or a hotel room online. The stakes are much, much higher."

Marty Makary, an associate professor of surgery at Johns Hopkins Hospital and the author of "Unaccountable," a 2012 book about hospital quality, agrees. "I have concerns about the lack of good metrics of quality," he said. "How do you know what you're getting?"

Weber says that consumers are competent to make such decisions without relying on a provider directory or the imprimatur of a hospital. "Is there anything that says the Internet is any worse than a Blue Cross directory?" he asked. "Once they choose a physician, we will send them the license number, and there are a bunch of third-party sites" that patients can use to check out a doctor. If a patient is dissatisfied with a doctor after accepting a bid but before surgery, Medibid will repost the query free of charge.

'Free-Market' Care

Oklahoma City anesthesiologist G. Keith Smith, co-owner of the Surgery Center of Oklahoma, was one of the first to sign up with Medibid, which dovetails with his "free-market" philosophy.

"We've been quoting prices for 17 years" to prospective patients, Smith said, "and posting them online for five." About 125 of the center's patients have come through Medibid, for procedures including hernia repair, gallbladder removal and knee replacement.

Although cost may be the initial lure, once prospective patients "look at our Web site and see it's a beautiful, new, 40,000-square-foot facility, they're sold," he said.

Fri, Aug 1 2014

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