Upcoding and misrepresenting clinical information constitute fraud, cost a lot, and can result in patient harm and unnecessary procedures and prescriptions.
AMA J Ethics. 2020;22(3):E221-231. doi:
10.1001/amajethics.2020.221.
Eleanor Fleming, PhD, DDS, MPH, Julie Frantsve-Hawley, PhD, and Myechia Minter-Jordan, MD, MBA
Continued separation of dental and oral health from general medical care generates unnecessary prescriptions and pain management that are neither restorative nor responsive to patients’ primary complaints.
AMA J Ethics. 2022;24(1):E48-56. doi:
10.1001/amajethics.2022.48.
Streamlining US health care business has raised unique privacy concerns. Bills and explanations of benefits contain protected health information that could be disclosed to someone other than the patient.
AMA J Ethics. 2016;18(3):279-287. doi:
10.1001/journalofethics.2016.18.3.pfor4-1603.
The objective is to compare the costs of providing the same level of quality. When resource-use and quality measures are juxtaposed, the resources used to provide the same level of quality can be compared.
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.
Many team members such as nurses and medical assistants have key roles in meeting practice goals but receive little if any performance-based compensation. In part, nursing union rules create a barrier by inhibiting trials of productivity-based pay or shared-risk models.