What's the difference between a $325 tonsillectomy and a $113 tonsillectomy?
Nothing but $212, according to Ralph Nader's Health Research Group, which yesterday published a listing of customary fees charged by more than 600 Washington area physicians for 12 common operations.
The list, the first in the nation to list fees by physicians' name rather than by area averages alone, shows differences of as much as $1,560 for the same surgical procedure, depending on the doctor.
The list includes the physician's customary fee charged in 1976 to Medicare and Blue Shield, a fee derived by averaging the physician's 1975 charges.
According to Ted Bogue, who prepared the listing, most physicians' fees probably have increased since by about 30 percent. The spread between individual physicians, however, is probably largely unchanged, he said.
The study makes no attempt to assess the quality of the services performed. What is unusual about the study is not the fact that physicians' fees vary for the same operation-all professionals have varying fees for the same work-but that the study was published listing the physicians by name.
According to Dr. Sidney Wolfe, director of the Nader group, "we have never seen any evidence-or even heard rumors-that lower cost operations are of lower quality than higher cost operations. If anyone knows that, they're being irresponsible if they don't come forward.
"The question we would pose is 'why pay more?" said Wolfe. "If so me doctors charge less and there is no evidence their procedures aren't as good, why pay the doctors who charge more?"
While the guide includes at least one physician no longer in practice and at least one no longer alive, the Nader group says it is the first published anywhere to provide such detailed fee information about individual physicians.
According to the guide, Dr. Thomas C. Lee, an assistant professor of surgery at Georgetown University Medical School is tied with three other physicians for the highest charge for an appendectomy- $450.
"It's hard for me to believe that's the highest," said Lee. "I do know that in the last several years several doctors have said to my associate Dr. (Robert J.) Coffey and I, couldn't you push your charges up? You're charging the lowest in the area and you make us look bad."
The lowest fee in the area, $250, is charged by Dr. C. W. Camalier, of the District who could not be reached for comment.
Asked if he gives patients more for their money, Lee said, "I'm not that facetious or that much of an egomaniac. An appendectomy is an appendectomy is an appendectomy."
But Lee said he objected to the information being released as it was because "if I were going to do something like this I'd want to verify those figures. I'd call 10 doctors and see what they charge."
The group of obstetrician-gynocologists headed by Robert T. Greenfield, in Washington, is listed as having the highest fee for an abortion- $500, compared to $125 at the Women's Medical Center, a clinic.
According to Dr. John Niles, a member of the Greenfield group, that fee has since been reduced to$350 because it was set too high originally. Niles, who said he does not perform any abortions himself, said all the group's fees were set by a Philadelphia consulting firm, and many later turned out to be too high and were reduced.
Niles also explained that all his group's abortions are performed in a hospital, under general anesthesia, as opposed to clinic abortions, which are done under local anesthesia.
The Nader group says that if medical bills were paid at the rate charged by the physicians in the bottom 10 percent of the fee range, " $40 million could have been saved in the Washington area alone" in a year. And nationally the saving would be $3 billion, the group says.
According to Al Palmer, deputy director of the Federal Trade Commission's bureau of compliance, the study "is a good way to get this information to the consumer."
The release of such information, said Wolfe, can help reduce medical costs by bringing market place presures to bear on physicians.