By Stephen Robitaille - 06/05/00

At first glance, the idea of a Web site where surgeons bid for patients online conjures up visions of Dr. Marcus Welby morphing into a host on the QVC Network.

"You get the tummy tuck, the ginsu knife, AND the bamboo steamer! But that's not all!"

Don't laugh. In what is apparently the first program of its kind in California, Medicine Online, Inc. has launched Bid for Surgery, a Web-based service in which surgeons submit bids to prospective patients for surgical procedures. This has opened a new battlefront in the intensely competitive world of elective surgery.

The service—a kind of eBay for medicine—allows patients to seek bids online for nearly 40 elective surgical procedures such as facelifts, LASIK corrective vision surgery, cosmetic dentistry, and bunion removals. Since its March 6 startup, the Huntington Beach firm has connected more than 400 patients to the procedure—and the surgeon—of their choice, with patients picking from among the 175 area surgeons registered with the service.

But that's not all. Along with each surgeon-bidder's price comes with an extensive list of that individual's qualifications, including medical training, number of procedures performed, and malpractice judgments. Executives at Medicine Online say Bid for Surgery, which is currently free to surgeon and patient alike, represents the future of health care: Informed consumers evaluating cost and provider qualifications to get the best value for their health care dollar.

"It's all about patient empowerment. The patient can actually take control over what's best for them," said Kevin Moshayedi, Medicine Online's chief executive officer. "You don't just go to the first specialist you are referred to-it puts the patient in the driver's seat. We make comparison shopping possible, to compare physician qualifications and get early price discovery."

A New Development in e-Commerce

Medicine Online is one of a handful of companies nationwide that has been developing online capacity for medical bidding and referral services, but appears to be the first bidding exchange to actually commence operations in California.

Elective surgery is a lucrative business in California, with surgeons establishing Web sites and engaging in aggressive marketing tactics to attract cash-paying patients who want to sculpt their bodies anew or buy that brilliant smile they've always dreamed of.

The numbers for cosmetic plastic surgery alone suggest the size and growth of this market overall. According to statistics from the American Society of Plastic Surgeons, there were nearly 133,000 cosmetic plastic surgery procedures performed in California in 1998, the last year for which figures are available. Based on statewide cost-per-procedure averages provided by the Society, Californians paid more than $280 million in surgeons' fees alone for those procedures.

The growth rates in some of these cosmetic procedures are exponential. Nationwide, the volume of breast augmentation procedures grew 306 percent between 1992 and 1998, according to Society figures; in that same time, the number of liposuction procedures grew by 265 percent, while the number of fat injection procedures grew by 223 percent.

Physician Organization Concerned

Physician organizations in California decry online bidding and referral services as unethical and possibly illegal, characterizing them as Internet medicine shows that allow shady practitioners to prey with impunity on unsuspecting patients.

"This is a gross distortion of the traditional doctor-patient relationship. Price should be the last thing you discuss," said Dr. Michael McGuire, president of the California Society of Plastic Surgeons. "Certainly, with elective surgery, cost is an issue, but I have patients who are willing to pay more to get better results. Price is a very poor way to establish a relationship.

"Most of (the surgeons who use online bidding services) are not in this for the public good. They're in this to make a buck. I think it would be your more desperate individual who would be bidding online. That's not your board-certified plastic surgeon, who has gone through all that training, who would want to get into the gutter with this kind of activity."

McGuire said that consumers are at risk in online bidding and referral services because there are no guarantees that the surgeons are qualified to perform the procedures for which they are bidding; there may be inadequate patient screening; and surgeons may receive inducements from these services to participate. "I had a friend of mine who registered with one of these services as a psychiatrist and was able to bid on breast implant surgery," said McGuire, who declined to identify the service.

Society members have approached three state legislators, asking them to request an investigation by the state Attorney General's Office into the practice of online bidding for surgical services, McGuire said.

Astrid Meghrigian, general counsel for the California Medical Association, said that for-profit referral services are illegal under state law, as are any offers of discounted rates for any medical services. "We're just beginning to look at these things," said Meghrigian. "It seems to raise some ethical issues and some legal ones, too."

A New Way to Choose

Medicine Online and its participating surgeons counter that the service, which has a patent pending for its bid process method, is legal and contains substantial patient protections. Medicine Online plays only a facilitator's role in bringing the two together. Medicine Online does not charge for its services, nor does it negotiate or set rates for surgeons. The firm has other e-commerce functions and advertising on its site, which covers the cost of the bidding exchange. Moshayedi said that the firm eventually may charge Bid for Surgery patients a transaction fee.

Medicine Online maintains a 17-member board of advisors, made up of surgeons and physicians in the specialties whose procedures are offered by the service. Moshayedi said that Bid for Surgery provides a wealth of information for patients—information that they often fail to get from surgeons located through more traditional referral systems, and much of which is double-checked by Medicine Online.

To sign up with the service, prospective patients fill out an online form with procedure-specific health status information. The Bid for Surgery site provides information on available procedures, including a description of how each procedure is done, the risks involved, possible side effects, what type of anesthesia is used, and the length of recovery time.

Surgeon-bidders have seven days to submit a proposal, which Medicine Online delivers to the patient. All patient identities are kept confidential and surgeons bidding for a patient's business cannot view their competitors' proposals. Patients then have seven days to schedule a free consultation with the surgeon of their choice. Medicine Online requires an in-person consultation prior to any surgeries being performed.

Along with the surgeon's price, patients get a list of particulars on each bidder that includes:

• Medical training, fellowships, primary and secondary specialties, and board certifications;
• Number of surgical procedures performed in the past two years;
• Malpractice actions in the past two years;
• Confirmation of malpractice insurance for the procedure on which the surgeon is bidding;
• Admitting privileges at hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
• Admitting privileges at ambulatory surgery centers accredited by JCAHO or the Accreditation Association for Ambulatory Health Care (AAAHC), or approved by Medicare;
• Any revocations, sanctions, or restrictions on admitting privileges in the past two years;
• Any voluntary resignations from membership of the medical staff of a hospital or ambulatory surgery center because of pending investigations; and
• Languages spoken in the surgeon's office.

Patient Satisfaction

Bid for Surgery patient Dawn Buchanan, a 43-year-old Orange County billing specialist, said the information package gave her important insights into the cost of the procedure, as well as the quality of care provided by her surgeon-bidders.

Buchanan, who had eyelid surgery performed on May 8, said the service allowed her to see if she could afford the procedure—which she could. She got five bids for the surgery, ranging from $1,500 to $3,000, which she then reviewed with her primary care physician. Her doctor was familiar with the work of one of the surgeons and recommended that Buchanan choose that one, which she did.

"I'm very happy. It was a nice experience to be able to window shop. For those of us like me who are a lay audience and don't know anything about medicine, this was a way to test the waters without embarrassing myself," said Buchanan. "The surgeon is absolutely great, top of the line. I took the list to my primary care provider because I always feel more comfortable with a referral.

"And it made me feel comfortable to get that other information (on surgeon qualifications) because it's equally important for me to know I was not going to, quote, the hatchet man. I mean, this is my face," said Buchanan. "The people who are criticizing this are making it sound like this is some sort of meat auction. It's more to me a way of doing competitive shopping."

Medicine Online

California Society of Plastic Surgeons

American Society of Plastic Surgeons' Plastic Surgery Information Service