We will be performing site maintenance on our learning platform at learn.aaos.org on Sunday, February 5th from 12 AM to 5 AM EST. We apologize for the inconvenience.


Published 6/1/2007

Payment issues strike a chord with readers

This letter is in response to those concerns expressed by Dr. Doug Nuelle in the March/April issue of AAOS Now. He articulates well the frustration all of us feel. The individual practitioner is defenseless in a marketplace controlled by the government and large insurance companies.

I have a modest proposal. We all know individual stories of doctors dropping all insurance and going back to the way it was when Dr. Nuelle started practice—billing the consumer for the services they provide and letting the consumer deal with their insurance company. How are these practices doing? How did they do it? Are their consultants available to help you should you decide to do this? How do you prepare your patient population for this move?

The role AAOS Now can play is as a clearinghouse for this kind of information. Who are the consultants? What are the lessons learned by those who have done it? Is this for me now?

In my opinion, just having this dialogue on a national level would go a long way to helping us in our negotiations with insurance companies. The Academy does not have to advocate a position. No money needs to be spent.

Paul D. Parsons, MD
Franklin, Tenn.

Editor’s response:
A clearinghouse for information is just what AAOS Now is designed to be. In fact, the May issue included a “Sound off” column by Thomas J. Grogan, MD, who did just what Dr. Parsons suggests—he dropped all insurance contracts. You can find the article online at

I see again where pay for performance is growing. I am sorry to see the country falling for a pretty slogan. The only “pay for performance” program that works is one where the patient judges the performance—this is called free enterprise. All other programs operated by third parties are just “cost containment” programs in which the customer (patient) loses his or her choice of the services he or she receives. (Imagine that conversation with your patient. “No, I’m sorry, your opinion doesn’t matter; the government has decided what is best for you!”)

“Pay for performance” is just one more step to allow third parties to set up rules and regulations that must be followed to get paid for taking care of patients. Establishing and monitoring it adds more bureaucracy, which must be paid for by someone. It takes time away from patient contact to administer and totally removes the patient from any choice in his or her own care. So tell me once again why we should encourage this “cancer” to grow?

David Hubler MD
Ada, Okla.