Shivan J. Mehta, MD, MBA and David A. Asch, MD, MBA
Outcome-based payment more closely aligns payments with what patients want, which is better health rather than more health care. But these approaches remain challenging to implement.
Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.
Is this a conflict over a team member’s practice style or is it a breach professional boundaries? Is it appropriate for team members to make this judgment, or should it instead come from the team leader?
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
Physician behavior that generates a patient complaint and ultimately leads to disciplinary action is both legally and ethically problematic—violating both regulatory rules and professional codes.
AMA J Ethics. 2015;17(5):448-455. doi:
10.1001/journalofethics.2015.17.5.pfor1-1505.
The casebook developed by the Bander Center for Medical Business Ethics provides a comprehensive instrument for teaching medical business ethics decision making by exploring the effects of relevant variables on medical practice and research and reflecting on the values and motives that influence the behavior of health care professionals.
AMA J Ethics. 2015;17(8):744-749. doi:
10.1001/journalofethics.2015.17.8.medu1-1508.
The American Medical Association Code of Medical Ethics’ opinions on physicians’ self-referral and physicians’ sale of health-related and non-health-related products from their offices.
AMA J Ethics. 2015;17(8):739-743. doi:
10.1001/journalofethics.2015.17.8.coet1-1508.