As someone who has practiced both as a hospital system employee and in private practice, I applaud the exposure of the inequitable payment system in the article “A hospital fee, minus just one thing: a hospital” (Page A1, Jan. 27). The irony is that hospitals can still manage to lose money on some practices while being paid much higher rates.
In private practice we can see and correct inefficiencies without the extra layers of management. In our practice we implemented an electronic medical records system nearly a decade before our local hospital-owned practices, we have phones that are answered by a person, and we work at a pace that allows our patients (and us) to feel good about the care that we deliver. All of this with fees from insurers that are substantially lower than those in the hospital system.
Payment reform in medicine is driving doctors into large organizations dominated by hospital systems to realize so-called economies of scale. Be careful what you wish for.