Examining Revenue Cycle Management Ethics Questions
A new study asked 21,000 physicians a number of ethics questions, several of which directly impact the revenue cycle.
- Recently, Medscape released the results of its annual Ethics Report. It is available in two parts. The first focused on issues under the “Life, Death and Pain” umbrella. This includes physician-assisted suicide, life-sustaining therapy, abortion and the handling of terminally-ill patients. Part two is of more interest to revenue cycle management ethics as it covers questions about money, patients and interpersonal relationships.
The study features responses from more than 21,000 physicians, 17,000 of which are from the United States. The additional 4,000 are European physicians. Aside from answering the question, the study also provides anonymous quotes from physicians surveyed. The topics covered in part two include upcoding to help a patient get treatment, performing unnecessary tests to make extra money and not ordering tests because of hospital cost-restrictions.
In many cases, the actions taken by physicians in the events covered can have a major impact on the revenue cycle. Not only does it directly influence the amount of money that hospitals are bringing in, but being on the non-ethical side of things can also put a practice on the wrong side of an audit. Some of the key questions about revenue cycle management ethics include:
Would you upcode or overstate a patient’s condition to get treatment cover?
66 percent – No
25 percent – Yes
9 percent – It Depends
A quarter of the physicians interviewed said they would help patients by circumventing unrealistic and incorrect guidelines by insurers, even if it meant severely harming their own careers. The number of doctors willing to take this step has also increased from 17 percent in 2010 to 25 percent now.
“There are times when prior authorizations are nothing but a blatant attempt on the part of the insurance company to deny a legitimate claim, and in those cases I’m going to go to town for my patients,” one physician said.
Would you perform a not-medically necessary procedure just to generate income?
91 percent – No
15 percent – It Depends
3 percent – Yes
In many instances, this can be the definition of unethical – doing an unnecessary procedure purely to boost income. Some physicians did make a distinction, however, between cosmetic procedures that may not be medically necessary but can improve quality of life and other procedures.
“That is the definition of immoral, to get income from unneeded treatment. I make much less money than my unethical colleagues who do this frequently,” one physician said. Another added that they had left hospitals because of the encouragement of this practice.
If your healthcare group will be penalized for exceeding its care budget, would you avoid or deny treating some patients?
74 percent – No
19 percent – It Depends
8 percent – Yes
With more hospitals and healthcare systems implementing gainsharing programs or systems that penalize exceeding budgets, there is more pressure to withhold elements of care because of the bottom line. This is the antithesis of ethical practice. Despite this, some physicians said that while they would not deny treatment to a current patient, they would consider avoiding a new, high-cost patient.
Would you feel conflicted about dropping poor paying insurers, even though longtime patients would be affected?
58 percent – Yes
29 percent – No
13 percent – It Depends
This is one of the realities of being in business and dealing with insurances companies. The doctor/patient relationship can be key to a strong practice, but in the end it comes down to being able to pay the bills and keep the doors open. Sometimes, hard choices are made.
“This is a no-win situation. If you don’t survive financially, you won’t be seeing any of your patients. I am certain I am not the only physician who could help them,” one physician said.
