Reverse Auctions for Pathology Near

“I really need to adjust my fee schedule.”

I recently read with interest a post by Dr. Bruce Friedman over at labsoftnews.com about “Online Bidding for Best Price for Orthopedic Surgery with Medibid” and the business model of medical tourism within US facilities through a service called Medibid.

Neither of these are actually new ideas in terms of consumers selecting products and services at the lowest cost while getting the best quality.  This of course is different than Priceline in the sense it is not an airplane seat or hotel room on short notice but your health.

Nonetheless, this eliminates several current issues with healthcare, namely, transparency in pricing, affordable quality access and choice without dealing with in- or out-of-network issues with payers and physicians can set their rates and receive a fee-for-service at the time of service rather than dealing with charge masters, “allowable” rates and finally claims processing & payment from payers.

For self-pay patients or employer-sponsored plans that subscribe to services such as these (without actually requesting a bid for this post) I gather one can shop and choose who, when and where they are going to have their joint replacement or colonoscopy or imaging study and at what price after associated travel costs.

It is similar to “destination medicine” as if you were to travel to a cancer center or other prominent medical center for second opinion or affirmation that the care you are receiving locally is consistent with best practices with insurance approvals and contracted rates removed.  You decide how much your care is worth and where by whom while the provider does the same through a bidding process to match buyer and seller in an open marketplace for those on both sides of the equation to get what they want from the deal.

Pawn Stars for Physicians.  Everything has a story and a price and you never know what is going to come through that door.

It starts to beg the question what happens to the biopsies collected from those colonoscopies and surgical pathology specimens removed at the time of surgery.

Can pathologists bid on how much they will charge and think is reasonable for a biopsy read or a read out on your hip tissue or hysterectomy?

“Dr. Kiley how much did we pay to have this biopsy read?”

And where does this lead pathology and pathologists? Health to the highest bidder? Or the lowest bidder? Does this look like a pawn shop where you haggle over more or less than someone is willing to pay or accept or does this look like award to the lowest bidder in contracting terms (assuming the deliverables are equal in terms of turn around time and accuracy).

Again, without knowing all the details of the bidding process it can start to sound like a bit of a slippery slope.

Truthfully, this has already happened at the hands of pathologists, driving the price down to bargain basement prices.  In the wake of the biopsy technical reimbursement cuts announced 2 years ago this November, I came across a message board with the following statement to clinicians with client-bill or in-office relationships likely (name of company making claim intentionally omitted):

If your pathologist is unwilling to reduce his/her fee-for-service, Company X has arranged with a very large, multispecialty pathology group to provide non-Medicare diagnoses for $17/biopsy.

Note: Current reimbursement rate for a professional read on a biopsy is $38.33.

The claim when on to say “the group would pay for shipping of slides and install a link to their computer system for results” and it applies to states that are not direct bill states for Medicare with a CAP link of most current listing of states at that time.

This could look like “Name that Diagnosis” and folks bidding on “I can name that diagnosis for $15” or “I can name that diagnosis for $10.” The Pathology Blawg had a post on a $10 read per biopsy from November 2012 for additional thoughts on this.