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$800 bid for a nose job, going once
Jeff Pasternack
First it was bidding for collectibles out of someone's attic on Then people were able to bid on computer supplies at Next came Fortune 100 companies placing complex legal work up for bid at Was there any doubt that patients would post to a web page that they needed a nose job and that physicians would place bids on the work? Did you ever imagine that your office would publicly offer a 99203 for $100 to anyone visiting a web site? How about something only described as "Limb Lengthening" for $10,000? Anyone? Anyone?

Maybe yes, maybe no, but at web sites like and, this is definitely so. Here's how it works on People who want surgery will post their information on the company's Web site. Participating physicians will then have the opportunity to bid for the privilege of performing that surgery. The winning physician is then placed in contact with the patient to schedule an appointment and its off to the surgical suite.

There are many compelling issues with respect to bidding for services in this fashion. Once you move beyond the initial gut-check reaction to this type of commercialization and commoditization of medical services, ask yourself this: is this any different than negotiating with insurers for access to their rosters? Furthermore, many of these services are for patients who are paying cash. When was the last time you collected $100 cash for a 99203?

Several physicians interviewed by a variety of media outlets were scornful of the service. Bob Kurson, a staff reporter for the Chicago Sun-Times obtained comment from Dr. Joel Frader, a pediatrician and associate professor of medical ethics and humanities at Northwestern University Medical School for a story that ran on January 9th.

Frader says, "The essence of virtually all patient care, including cosmetic surgery, is the development of the relationship of trust between patient, physician and even the patient's family. This focus on price might make those relationships suffer."

I wonder if this statement isn't more appropriate for the pre-HMO era. Patients have already abdicated their responsibility for paying for their own health care in exchange for a $10 co-pay. From the patient's perspective, the focus has been on the price of their insurance as being a determining factor in which physicians they will see; it's been this way for the past 20 years or so. From the physician's perspective, the focus has also been on price: if a physician doesn't like the reimbursement rates an insurer is offering, the physician declines to be a participating provider.

Considering that society is still in the very early stages of the Information Age, there's no telling what the impact on a physicians bottom line will be by attracting patients through web-based services like and What is clear, however, is the answer physicians give when asked if they would rather take $100 cash from a patient for a 99203 or file a claim for $100 with an insurer: "I'll take the cash."

Jeff Pasternack is the president of Dynamic Consulting Group, a franchise partner of 1-800-GOT-JUNK? and author of the TechnoPeasant Review.
If you have questions or comments about this column, please write to him at