With all due respect to DB, who usually has sensible opinions, this is one subject that I must strongly disagree with him about.

What he calls “administrative fees” have in fact been part and parcel of our traditional billings to patients, whether in the office, hospital, or nursing home.
To separate these items with a view to marking up our bills may not sound unethical or illegal on the surface, but trying to justify these to patients, who undoubtedly would have a contrary view of the situation, would be the harder part. If it takes me 10 or 15 minutes longer to see a patient, because of the time involved in reviewing items like lab and x-ray data and discussing relevant aspects of a patient’s situation, it may be better to boost the level of service, if one can justify it, rather than creating an additional layer of administrative fees that may raise red flags not just from patients, but from insurance companies.

A system that allows administrative fees can also be subject to abuses, with no checks in place to determine whether time was really expended to justify such fees.
That would be an open-ended system where the invitation to tweaking such a system might be irresistible.

This is not to suggest I don’t trust physicians; the more disturbing problem I see here would be the few physicians who can easily exploit the situation to their financial advantage. Through the years, we have learned that all it takes are a few bad apples to spoil the image of the entire profession. When we look at how much fraud takes place in medical practice every year, it is not far-fetched to imagine how things could only get worse with this new concept.

It is interesting that DB has mentioned the example of how lawyers bill their clients as a justification of how we can proceed in a similar fashion without breaking ethical or legal guidelines. I dread the thought of joining such company.
The service provided by lawyers, manifested in their billings, is based almost always on the time they spend to provide such a service; that is not true in medicine, which takes into account other variables such as the number of problems in a given situation, their complexities, medical expertise, along with ancillary and billable services like EKGs, blood work, vaccinations, and so forth. All these things have been built in into the current system we use in creating different codes for services, with each one of them fetching different levels of reimbursements. There is uniformity of the system across the country, making it simpler for insurance companies and the government to use when they pay physicians.

In my years of practice, there have been periodic fights by physicians to increase reimbursements from insurance companies and Medicare. That is not likely to end with the escalating costs of medical care that now constitute close to 15% of our gross national product, with parallel increases in out-of–pocket expenses for patients.

Asking patients to pay extra to maintain our financial health is asking for the impossible, and is not likely to pass muster from the public. We should dread the time when physicians and lawyers share company — at the bottom.