Ethical considerations for Physicians?

The desire and need to have a better healthcare delivery system has necessitated implementation of a number of regulatory mandates and adoption of healthcare IT. This requires physicians to make considerable amount of investment in their clinical setups to obtain the required level operational efficiency and subsequently to avoid the risk of punitive actions by the government in the event of failure in compliance. All this has resulted in making the existence of independent medical setups very tough. The jobs of physicians now go beyond just patient care and involve understanding the implications of regulatory norms and changing their working styles so as to abide by them. In order to avoid the pain of dealing with so many factors, which are generally looked upon as nothing by hindrance to their core work of providing care, and risk profitability, physicians are actively getting into agreements with larger provider setups and picking up a payment method with suits their deal. It helps them avoid to a large extent the headache of keeping their clinical setups updated with evolving regulatory norms and making sizable investment in healthcare IT. All this is automatically taken care of by the larger organization they enter into a contract with. Physicians thus have all their energies to focus on their primary area of work and draw financial benefits based on the agreement they hold. This is where there is a need for them to be proactive and take into account ethical concerns around those financials incentives, offered as a part of financial arrangements, which influence their clinical decision making.

Capitation is a popular payment arrangement model, comes in different variants and can potentially result in offering cost effective and efficient care. However, there is a lot of scope for conflict in such systems too. The onus lies on physicians to guard against those. It starts right from the time they are about to get into one such agreement. Two factors which they should never compromise on are the quality of care and the range of services they offer. While arriving at a rate-of-capitation the existing conditions of enrolled patients should also be taken into account. While evaluating plans, they should look at the size of the plan and the duration; both of which should be large to bring in more predictability. Physicians generally get concerned when treatment expenses go beyond predictable limits. It has a possibility of influencing their behavior since outcome generally results in a financial loss for them. Stop-loss provides a good option to handle such situations. Finally, the sanctity of a physician-patient relationship needs to be kept intact. Although it is an obligation on the part of the physicians to consider and meet the broader needs of a patient population, in order to achieve it, they have to focus their energies into every one-to-one relationship that they share with their patients. Any financial reimbursement system which acts as an impediment to this has to be avoided or worked around at any cost.

Health plans generally tend to set expectations for physicians which are not always easy to meet. For e.g. it could be in the form of a steep utilization rate which is difficult to achieve or making physician payment dependent on so many factors that it is next to impossible to get a good deal without affecting clinical behavior. All health plans have financial incentives. Physicians should keep a few things in mind before entering into a contract with any plan:

• large incentives generally make it difficult for physicians to turn down but more often than not require them to make commensurate compromises on clinical standards
• show more preference towards those types of incentives which are applied across broad physician groups
• advocate increase in the time-duration over which incentives get determined. It helps in negating the impact of fluctuations in utilization
• prefer those plans which have a large pool of patients
• avoid agreeing to a tiered system of incentive/penalty payout
• advocate for a stop-loss provision as a solution to handle outliers
• ensure that patients are informed about financial incentives which could affect the level-of-care that they receive.

Physicians should always urge for incentive programs which do not just primarily focus on utilization, efficiency and cost reduction. On the contrary, they should emphasize on those which lay importance to quality-of-care and patient satisfaction as well. Physicians ought to be given flexibility to accommodate the varying needs of patients. No incentive plans should tempt them towards selectively treating healthier people and avoiding the high-risk ones in order to improve their own and their groups’ chances of gaining financially. Creating custom solutions for your healthcare practice can help you immensely. Healthcare software development companies can assist you in this.

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Emerging method of healthcare – Telemedicine

There seems to be a strong feeling amongst people in the field of medicine that we are at the beginning of a new change in which telemedicine, broadly defined, will become an essential part of mainstream healthcare. This will ensure that patients will be able to receive the appropriate care, at the appropriate site, by the appropriate provider at the appropriate time – all this will be done avoiding duplication and reducing waste. Thus Telemedicine is expected to move to the forefront of medical efforts for any improvements to be made in care efficiency and quality. It is a common thought shared by experts in the field of healthcare that telemedicine now should be considered an integral part of the system and used in conjunction with other information technologies like electronic and personal health records to derive its maximum benefits. Thus every new healthcare program or initiative has to be approached with a telemedicine angle in mind. As more people understand the value technology brings to virtual health efforts, the use of telemedicine will become more widespread.

The things mentioned above may sound very logical and something which should be done without wasting time for the obvious benefits that it stands to offer. However, there are quite a number of impediments to be faced. For instance, quite contrary to the belief that this approach is a new one, this field has been around for almost 50 years now. One of the major reasons for its slow progress has been the right amount of push which has been missing from the government for most of the part of the last two decades now. There is a complete lack of a roadmap or a strategic plan. This is because the industry has no assigned governing bodies overlooking its operations and roll out like the ones supporting electronic health records. The Meaningful Use development incentives do not include Telemedicine under its fold even in its third and last stage. Although there are bodies which have openly claimed to promote wider adoption of telemedicine to expand care to remote areas, improve care and cut costs, there has not been a solution figured out to handle the reimbursement part of the puzzle. Researchers conducted had predicted close to 2 million patients worldwide standing to gain by 2017 by the adoption of telehealth. At the same time independent experiments conducted have shown this approach not to make any significant difference in treating patients suffering from chronic conditions. Also, the treatment part put aside, there have not been significant improvements in their reported quality of life or anxiety or depression symptoms.

Inspite of the fact that there are some issues which are yet to be addressed in this approach, there is a widespread belief that Telemedicine is one of those new ideas whose time has come. There might be loopholes which are identifiable, but there is enough scope for them to be plugged. Telehealth is going to thrive because there are perennial issues which it addresses like the rise in the care costs, shortage of good quality providers and the ever increasing demand for care. Going by the recent news available telehealth is becoming more of a priority for several states across the United States of America. Infact a Bill has been introduced which plans to expand reimbursement for telehealth services in federal programs. A standard is also to be created for medical software development licensure in telehealth. This will be done to ensure that no medical benefit is excluded solely because it is furnished via a telecommunications system. It is also to allows insurance companies to reimburse physicians who consult with rural doctors using telemedicine.

Like with all new approaches there are areas which need attention and problems which need addressing in order to derive the best benefits out of the system. But that the widespread use of telehealth and telemedicine will bring about a major change in the field of healthcare and medicine – making it affordable and convenient besides bringing about tremendous improvements in reach in the remotest of locations. The federal and state governments on their part should now do everything in their capacity to help the sector draw the fullest benefit out of this approach and change its stance of becoming a roadblock in its progress which it has to a large extent till now.

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