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The Opt-Outs: Otolaryngologists extol the benefits of third-party independence

by RIchard Quinn •

Benjamin Asher, MDName: Benjamin Asher, MD
Opt-out date: 2004
Why: “I feel like medicine is all about the doctor-patient relationship and being able to create a healing relationship. By setting up my practice the way I have, it has allowed me to create those healing relationships.”

R. Anders Rosendahl, MD, FACSName: R. Anders Rosendahl, MD, FACS
Opt-out date: 2003
Why: “The current situation is unsustainable. I just couldn’t live under the confines of regulations and rules and penalties. This is why doctors are quitting medicine. Doctors with 30 years of experience are up and quitting because they don’t want to deal with it anymore.”

Michael J. A. Robb, MDName: Michael J. A. Robb, MD
Opt-out date: 2003
Why: “You’ve got to drop any oppressive entity that is interfering with doctor-patient care.”

“For me, and it’s not for everybody, being out of network allows me to provide the best care I can,” said Benjamin Asher, MD, PC, an otolaryngologist in New York City and a member of the Independent Doctors of New York, a group of physicians who work outside of managed-care contracts.

UP-FRONT COMMUNICATION

Dr. Asher launched his third-party-free practice in 2004 because he felt the parameters of Medicare and private carriers would restrict his ability to provide the “highest quality of care.” That decision means new patients get a clear explanation of fee schedules, and Medicare patients are required to sign a form that says they understand that the physician has opted out. If patients have additional questions or fears, Dr. Asher has the time to answer them. His average patient load is around 13 to 15 a day, compared to large group practices where he estimates physicians see two or three times that census. His initial visits with new patients, during which he explains both the conventional aspects of his practice and the alternative approaches he integrates into his treatment, last an hour on average.

Several third-party-free practices have used their websites to post detailed summaries of how their payment processes work. Private practices usually require payment at the time services are rendered, but most maintain the option of allowing payment plans, reduced fees or charity care, all on the provider’s schedule. Physicians note the latter point when questioned about whether they feel the cash-for-treatment model in any way conflicts with the concept of delivering treatment to sick patients in need of help.

“My doors are wide open,” said Michael J. A. Robb, MD, a neurologist and otoneurologist in Phoenix who launched his practice seven years ago. “That’s the beauty of the model. There’s always room for charity in a clinic like this.”