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Health Care Reform:

Health Insurance & Affordable Care Act

Patients Soliciting Bids From Doctors Online

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Roughly 6,000 doctors or surgery centers and a handful of hospitals, most seeking patients from abroad, have registered as "bidders"; physicians pay a fee ranging from $50 to bid on one request to $250 to bid on many. Once a bid is accepted, Medibid bows out, and patients work out arrangements with the doctor. Many bids are a package deal, covering the facility fee, the surgeon's charge and anesthesia services. Patients pay the bidder in full, upfront and in cash or by credit card.

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?"

Fri, Aug 1 2014

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