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Robert Cunningham Professionalism Reconsidered: Physician Payment In A Small-Practice Environment Health Affairs, November/December 2004; 23(6): 36-47. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Payment Alternatives

Robert Guzauskas   ( 23 November 2004 )

Payment Alternatives 23 November 2004
Robert Guzauskas, Dentist & Solo Practitioner Mid-County Dental Center, Inc. Send comment to journal: Re: Payment Alternatives rguzauskas{at}earthlink.net Robert Guzauskas	The fee-for-service model is a powerful financial incentive to overdiagnose and overtreat. The outcomes are higher costs, by 30 to 50 percent, and iatrogenic disease. Doctor-caused illness translates to malpractice litigation. Managed care fails because the largest expense on the profit and loss statement of a practice is the doctor's compensation. The doc's take often amounts to over half the practice revenues. And, the doctor/owner can reach into the till at any time for any reason. Today's fee-for-service business model, in the solo practices that make up 68% of medical and 72% of dental practices, provides no incentive for the owner to control his or her personal expenses. Marriage only compounds this problem. The solution is to strike down the current state laws that restrict ownership of a practice to a doctor. These are a monopolistic, unneccessary restraint of trade. Such laws, in 42 states, are no longer in the public interest. Replace the fee-for-service model with a corporate model wherein the providers -- group or solo practitioners -- are on a predictable compensation plan. Note that I am not suggesting a mandatory compensation system, rather a deregulation that would allow non-doctors to hire doctors and better manage managed care. Traditional practices would continue to exist.