For those of you that don’t know, there is a new trend inmedicine these days — it’s called going “Non-Par.” Non-Par simply means “Non-Participating.” When a physician goes Non-Par, it means that he or she is no longer participating in certain insurance reimbursement schemes. What this means is that a physician will no longer accept insurance or even Medicare. I know that sounds crazy, but it is happening.

Physicians are frustrated with the payment mechanism in the United States. When you bill out $250 for an office visit, the insurance pays you $60. In the old days, the insurance companies paid out a lot. The lowest payer was Medicare. However, as the elderly populations has swelled, Medicare has dropped reimbursements to all-time lows. Insurance companies have gotten smart and decided to match Medicare payments. Why should they pay more for a service that Medicare pays less for?

Physicians, being the poor businesspeople we are, didn’t balk but kept receiving the lower payments. It has gotten so bad that in most major cities such as San Francisco or New York, physicians cannot afford to make a living there. The ones that do are the ones that take cash for things such as Plastic Surgery, Dermatology and Skin Care.

Now there is a backlash in some areas. Doctors are fed up. They need to see a ton more of patients in order to pay for overhead. They are working like dogs and running hard in the rat race. Some of simply backed out and informed their patients that they can only see patients who can pay cash or can pay the difference of what insurance does not cover. For example, if their surgery costs $4,000 and the insurance can only pay $2,000, the doctor asks that the patient pay the $2,000 difference.

Some are saying that this is unethical. Others are saying that this is simply doctors fighting back. They are not trying to gouge their patients — they are simply trying to make a living.

It’s tough to say whether this is a fad or the start of a trend. Going Non-Par is not sustainable for generalists because there are simply other doctors that patients will go to see. Many specialists cannot do it either because there are too many specialists. But if you go out to a rural area, you’ll find that a specialist can call the shots and go Non-Par.

From a patient’s perspective this is bad. It limits choices of care. However, some could argue that going non-par separates those doctors that want to care for patients regardless of patient socioeconomic status, versus those doctors that only want to treat high end paying patients.