Price Controls and the Old-Fashioned Doctor

No paperwork, no insurance, no privacy forms, no computers

Letter to The WSJ.

"Regarding Devorah Goldman’s op-ed “The Doctor’s Office Becomes an Assembly Line” (Dec. 30): The main issue in the decline of private doctors’ offices is the imposition of price controls. Since the Centers for Medicare and Medicaid Services (CMS) instituted an arbitrary formula called RBRVS for establishing the value of physicians’ services, prices have been rigidly controlled.

With CMS, doctors by law may not charge more than Medicare and Medicaid allows. Pay for doctors’ services in independent offices have been held down, forcing doctors to sell out to hospitals. Private carriers pay doctors more than CMS, but they enforce de facto price controls by following RBRVS and making take-it-or-leave-it provider contracts with doctors.

Patients are now hostage to big-box, hospital-owned providers and clinics. The doctors work according to their employment contracts, which hinge on pleasing the “suits” of the administration, their diktats and their practice guidelines.

I recently retired from a small independent practice. The office personnel answered the phone with a human voice. The secretary, medical assistant and bookkeeper were longstanding employees who got to know each patient by name. The doctor actually listened, took the patient’s history himself and did physical examination. But I practiced with the heritage of two parents who had been GPs in the old style. Now deceased, they are still remembered and revered in the community they served.

Tom Gumprecht, M.D.

Seattle"