Virtual Mentor. February 2013, Volume 15, Number 2: 136-140.
The Code Says
The American Medical Association Code of Medical Ethics’ Opinions on the Physician as Businessperson
The AMA Code of Medical Ethics’ opinions on the physician as businessperson.
Opinion 6.11 - Competition
Competition between and among physicians and other health care practitioners on the basis of competitive factors such as quality of services, skill, experience, miscellaneous conveniences offered to patients, credit terms, fees charged, etc, is not only ethical but is encouraged. Ethical medical practice thrives best under free market conditions when prospective patients have adequate information and opportunity to choose freely between and among competing physicians and alternate systems of medical care.
Issued July 1983.
Opinion 8.054 - Financial Incentives and the Practice of Medicine
In order to achieve the necessary goals of patient care and to protect the role of physicians as advocates for individual patients, the following statement is offered for the guidance of physicians:
Issued June 1998, based on the report “Financial Incentives and the Practice of Medicine,” adopted December 1997; updated June 2002.
Opinion 4.04 - Economic Incentives and Levels of Care
The primary obligation of the hospital medical staff is to safeguard the quality of care provided within the institution. The medical staff has the responsibility to perform essential functions on behalf of the hospital in accordance with licensing laws and accreditation requirements. Treatment or hospitalization that is willfully excessive or inadequate constitutes unethical practice. The organized medical staff has an obligation to avoid wasteful practices and unnecessary treatment that may cause the hospital needless expense. In a situation where the economic interests of the hospital are in conflict with patient welfare, patient welfare takes priority.
Issued June 1986.
Opinion 8.0321 Physicians’ Self-Referral
Business arrangements among physicians in the health care marketplace have the potential to benefit patients by enhancing quality of care and access to health care services. However, these arrangements can also be ethically challenging when they create opportunities for self-referral in which patients’ medical interests can be in tension with physicians’ financial interests. Such arrangements can undermine a robust commitment to professionalism in medicine as well as trust in the profession.
In general, physicians should not refer patients to a health care facility that is outside their office practice and at which they do not directly provide care or services when they have a financial interest in that facility. Physicians who enter into legally permissible contractual relationships—including acquisition of ownership or investment interests in health facilities, products, or equipment; or contracts for service in group practices—are expected to uphold their responsibilities to patients first. When physicians enter into arrangements that provide opportunities for self-referral they must:
Issued June 2009 based on the report “Physicians’ Self-Referral,” adopted November 2008.
Opinion 6.03 - Fee Splitting: Referrals to Health Care Facilities
Clinics, laboratories, hospitals, or other health care facilities that compensate physicians for referral of patients are engaged in fee splitting, which is unethical. Health care facilities should not compensate a physician who refers patients there for the physician’s cognitive services in prescribing, monitoring, or revising the patient’s course of treatment. Payment for these cognitive services is acceptable when it comes from patients, who are the beneficiaries of the physician’s services, or from the patient’s designated third party payer.
Offering or accepting payment for referring patients to research studies (finder’s fees) is also unethical.
Issued prior to April 1977; updated June 1994 and June 1996, based on the report “Finder’s Fees: Payment for the Referral of Patients to Clinical Research Studies,” adopted December 1994.
Opinion 8.132 - Referral of Patients: Disclosure of Limitations
Physicians should always make referral decisions based on the best interests of their patients, regardless of the financing and delivery mechanisms or contractual agreements between patients, health care practitioners and institutions, and third party payers. When physicians agree to provide treatment, they assume an ethical obligation to treat their patients to the best of their ability. If a physician knows that a patient’s health care plan or other agreement does not cover referral to a non-contracting medical specialist or to a facility that the physician believes to be in the patient’s best interest, the physician should so inform the patient to permit the patient to decide whether to accept the outside referral.
Physicians must not deny their patients access to appropriate medical services based upon the promise of personal financial reward, or the avoidance of financial penalties. Because patients must have the necessary information to make informed decisions about their care, physicians have an obligation to disclose medically appropriate treatment alternatives. Physicians should also promote an effective program to monitor and improve the quality of the patient care services within their practice settings.
Physicians must ensure disclosure of any financial incentives that may limit appropriate diagnostic and therapeutic alternatives that are offered to patients or that may limit patients’ overall access to care. This obligation may be satisfied if the health care plan or other agreement makes adequate disclosure to enrolled patients.
Issued June 1986; updated June 1994, based on the report “Financial Incentives to Limit Care: Ethical Implications for HMOs and IPAs,” adopted June 1990; updated June 2002; updated November 2007, based on the report “Opinion E-8143. ‘Referral of Patients: Disclosure of Limitations,’ Amendment,” adopted November 2007.
Related in VM
© 2013 American Medical Association. All Rights Reserved.