The Problems With Bundled Health Billing

Jason Furman and Bob Kocher claim that because health care is so complicated a single bundled fee based on quality measures is the solution (“A Health-Care Fix That Works, Now Being Rolled Back,” op-ed, Aug. 21). Their approach is one size fits all that is designed to rein in cost and theoretically improve care. This isn’t the solution.

You can perform the same operation in many ways at different costs with similar outcomes because every patient is unique; it’s why personalized cancer therapies are becoming so effective. Believe it or not, doctors spend years training and studying to determine what works best and that alone should dictate care. Money spent has little to do with outcome. Some of the best care has come from front-line trauma surgeons in the poorest neighborhoods.

Get rid of the incentives, pay only for services rendered at a transparent price and give the physicians the latitude to do their job without imposed restrictions. I guarantee the cost will be lower and the outcomes better.

I’ve been a practicing physician for 36 years. I ask Mr. Furman, an economist, how many patients has he treated? How can he have any clue what it’s like to care for people?

The answer to the health-care crisis is simple: a direct-pay cash system and health savings accounts with catastrophic coverage. HSAs put the purchasing power back with the patient. When physicians are freed from the third-party system and are paid directly by the patient, they will no longer need the staff for billing, coding, electronic medical records, compliance, reimbursements and audits. Their overhead will plummet, resulting in lower fees for the patients as they compete for their cash business.
Currently, the patient who pays a set fee for coverage wants his money’s worth so will seek any test or procedure that might be beneficial. The doctor, looking to satisfy the patient and not get sued, will be happy to order the scan or procedure even if he thinks it isn’t worth it. Heaven forbid a doctor could miss something. With a cash system, the physician will be aligned with the patient’s interest and decide with the patient what’s the best and cost-effective way to proceed. It’s been down hill since government and third-party intrusion. More of the same isn’t the answer.

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