Are you willing to wheel and deal with patients?

Last week, I wrote that healthcare is different--that unlike other businesses, a natural empathy toward patients with high out-of-pocket costs can indeed make asking them to pony up their credit card more difficult than in other industries.

Some patients, however, are increasingly approaching their healthcare bills no differently than they do buying a used car.

"I asked the doctor directly for a discount and she agreed," Shelly Gordon, a 57-year-old with a $5,000 deductible and a $500 monthly premium, recently told the Los Angeles Times, explaining how she got her physician to provide a few routine tests on the house. "Given what I was paying [for individual insurance] and how ridiculous it was, I just got in the habit of asking all my doctors," she continued. For the annual exam discussed in the article, Gordon ultimately paid $225 out of the $350 sticker price.

Not all doctors balk at the notion of patients bidding for healthcare. In fact, some physicians even advertise their willingness to negotiate with patients on websites such as Pricedoc.com, which allows patients to search by ZIP code for a list of doctors and their prices. According to Patrick Bradley, PriceDoc's co-founder, some of the doctors listed on the site even include a "make me an offer" button on their profiles rather than just listing their lowest price.

Consumer advocates urge patients to try go even lower. Steven Findlay, health analyst for Consumers Union, told USA Today that although transparent cost information can be helpful, consumers shouldn't settle for the first price offered. "Unlike traditional retailers, health providers don't usually advertise sales," he says. (Perhaps that's because healthcare doesn't fit neatly on a clearance rack.)

So tell me, are the majority of your tough-to-collect patients hard on their luck or simply playing hardball? With patients booking fewer appointments with you and filling MinuteClinics more, do you feel forced to compete based on price?

Have you or would you negotiate or even barter with patients? Would you recommend the practice to others in your profession--or do you wish you'd never cut the first patient a deal? I know I look forward to learning your take on this topic, and am sure fellow FiercePracticeManagement readers will as well. -Deb