Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Medical College of Cornell University, New York–Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

I wondher why ye can always read a doctor’s bill an’ ye niver can read his purscription.”

—Finley Peter Dunne

How many of you have tracked a procedure in your department? I hate this phrase, but it has some applicability here— an “in-depth review”? A study is ordered, it goes here, and then this person does this, and this machine goes “boing,” and then you dictate into a little machine. A check arrives at the end of the month. You know what I mean. I have. It’s educational. Here is the great unknown portion of the process—a bill is dropped somewhere, goes to some person, and they pay you. Therein is the rant. The charge-collection ratio.

Okay, I understand volume discounts, I understand a lot of pricing theory, but here’s what I don’t understand. We have figured out a reasonable amount to be paid for doing something, but we accept A LOT LESS. What is that about? Why are the figures different?

A simple everyday life analogy. You go to the grocery store and want a can of peas. The can of peas is $2.09 (they are real good peas).You take it to the cashier. You set it down on the belt, and when you’re up, you say in a loud and clear voice: “I’ll give you $1.50 for those.”Now, allowing that your cashier is of a reasonably pleasant demeanor, and not up to hitting you with the taser immediately, you’ll likely be told: “Sir, it’s $2.09.” Negotiations are not in order here. You give the nice person $2.09, you leave with peas. You give them anything less and try to leave, you’re photographed, and convicted of a misdemeanor. Try explaining that to the kids.

I’ll tell you what. From here on out, we set and fix a price. We accept nothing less. Why go to the trouble of determining a reasonable value if you immediately settle for less? I’ll tell you this, at the very least getting what I charge would be helpful to my mental health.Sounds draconian, but I think it’s just common sense. The pea analogy—you might really want those peas, and be happy to pay $2.09, but how do you feel about the fact that other people go into that exact same store, see the exact same surly cashier (she DID taser you), and they get the peas for $1.21? You’re upset, right? Me, too. I want my $2.09. Read my bill.

Time to get back to stringing those beads. Mahalo.