Don't contract with insurers
Regarding the article about the Philadelphia-area healthcare market in the Nov. 2 issue ["Coping with tough markets: Doctors battle a health plan monopoly"], you fail to mention a very important and feasible option for these doctors. It's an alternative that I am working toward
and believe many doctors will be choosing over the next decade: opting out of insurance contracts altogether, and converting
to cash-only practices.
Lucy E. Hornstein, MD
Valley Forge, PA
"Doctors battle a health plan monopoly" assumes that these Philadelphia-area doctors are beholden to the insurers. The current
path of reduced reimbursements is simply untenable. A viable alternative in a stressed market is for doctors to terminate
their contracts and provide care on a fee-for-service basis. We are engaged in this approach at our practice. We lose some
patients, but gain others who appreciate the services we provide and are willing to pay out of network. We no longer have
to deal with insurance reimbursement, or in billing the insurance company for that matter. Our fee-for-service strategy keeps
the issue of reimbursement strictly between the insurer and the patient. And guess what? We get paid right away, in full,
by the patient. It pretty much puts the power back in the hands of the doctor. The worst thing a doctor can do today is contract with an insurer!
Jeffrey Mendelssohn
Practice manager
Castro Valley, CA
Free, unbiased medication information
Although pharmaceutical representatives can be viewed as a resource for desired drug information, as noted in "What drug rep
visits cost you" [Aug. 3], limitations on their use include the current scrutiny of physician interactions with pharmaceutical-industry
reps, the potential for bias, and the restriction of their information to the FDA-approved labeling for their product. Many
institutions, including Stanford University Medical Center, are adopting policies that limit industry interaction to minimize
any actual or perceived conflict of interest. A noncommercial, pharmacist-operated drug information service can be a useful
alternative that still offers the personalized approach of an industry representative.
Physicians seem to be unaware that drug information centers exist. The primary goal of the service at Stanford, as with most
of the pharmacist-operated drug information services operating out of hospitals and universities, is to improve patient care
by providing objective and unbiased information for drug-related questions. Many of these centers, including the one at Stanford,
are open to healthcare professionals in the public arena as part of their commitment to community service.
I hope the next time your readers consider accepting a detailing appointment because they have questions about a drug therapy,
they will think about utilizing a drug information center instead. A list of centers is printed in the back of the Physicians' Desk Reference.
Anna M. Wojas, PharmD
Stanford, CA
Do reps influence doctors?
The "Physician Payments Sunshine Act of 2007" is motivated by a perception that physicians who accept gifts from drug reps
are corrupt ["Perspective: Will your free dinner appear online?" Oct. 19]. This is completely false.
The reasoning is this: Doctors say they are not influenced by gifts from reps; pharma companies spend billions of dollars
on gifts to doctors; pharma companies aren't stupid. Conclusion: Gifts influence doctors. But influencing a doctor to prescribe
your drug might simply be convincing the doctor to prescribe the drug that is best for his patients!
The only gift I accept is lunch. I'm not going to take time out of my busy day to talk to a rep without lunch in front of
me. I am certainly influenced by what the reps say, since they present me with educational information which helps me treat
my patients more effectively.
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