Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-06T06:13:12.093Z Has data issue: false hasContentIssue false

Just What the Patient Ordered: The Case for Result-Based Compensation Arrangements

Published online by Cambridge University Press:  01 January 2021

Extract

For more than twenty years, Opinion 6.01 of the American Medical Association's (AMA) Code of Medical Ethics has specified that “a physician's fee for medical services should be based on the value of the service provided by the physician to the patient.” In 1994, the AMA amended Opinion 6.01, adding a new statement that “a physician's fee should not be made contingent on the successful outcome of medical treatment.”

We believe that the amendment is wholly indefensible. Therefore, in this essay, we argue that the AMA should lift this prohibition and encourage the use of result-based compensation for medical services in appropriate circumstances.

The 1994 amendment dramatically changed the significance and scope of Opinion 6.01. Result-based compensation arrangements clearly satisfy the original version of Opinion 6.01 because they base compensation on the “value of the services provided … to the patient.” Yet, it is equally clear that result-based compensation arrangements violate the amended version of Opinion 6.01 because they necessarily make compensation “contingent on the successful outcome of medical treatment.”

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schneyer, T., “Legal Process Constraints on the Regulation of Lawyers' Contingent Fee Contracts,” DePaul Law Review, 47 (1998): 371412.Google Scholar
President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, Quality First: Better Health Care For All Americans (Washington, D.C.: U.S. Gov't Printing Office, 1998).Google Scholar
Braddock, C.H. et al., “Informed Decision Making in Outpatient Practice: Time to Get Back to Basics,” JAMA, 282 (1999): 2313–20; Bogardus, S.P. et al., “Perils, Pitfalls, and Possibilities in Talking About Medical Risk,” JAMA, 281 (1999): 1037–41.CrossRefGoogle Scholar
Selker, H.P., “Capitated Payment for Medical Care and the Role of the Physician,” Annals of Internal Medicine, 124 (1996): 449–51; Kao, A.C. et al., “The Relationship Between Method of Physician Payment and Patient Trust,” JAMA, 280 (1998): 1708–14.Google Scholar
Boyce, J.M., “It Is Time For Action: Improving Hand Hygiene in Hospitals,” Annals of Internal Medicine, 130 (1999): 153–55.CrossRefGoogle Scholar
Hyman, D.A. and Silver, C., “You Get What You Pay For: Result-Based Compensation for Health Care,” Washington and Lee Law Review, 58 (2001, forthcoming).Google Scholar
Hyman, and Silver, supra note 6; Schauffler, H.H., Brown, C., and Milstein, A., “Raising the Bar: The Use of Performance Guarantees by the Pacific Business Group on Health,” Health Affairs, 18 (1999): 134–42; Meyer, J. et al., Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers, AHCPR Pub. No. 98-0004 (Nov. 1997): at 4 (visited June 12, 2001) <http://www.ahrq.gov/qual/meyerrpt.htm>; Prager, L.O., “Coalition Proposes Pay Based on Quality,” American Medical News, June 19, 2000.Google Scholar
Shortell, S.M. et al., “Physicians as Double Agents: Maintaining Trust in an Era of Multiple Accountabilities,” JAMA, 280 (1998):1102–08;. Schauffler, , Brown, , Milstein, supra note 7, at 134–38.Google Scholar
Silver, C., “Flat Fees and Staff Attorneys: Unnecessary Casualties in the Continuing Battle over the Law Governing Insurance Defense Lawyers,” Connecticut Insurance Law Journal, 4 (1998): 205–45.Google Scholar
Sage, W.M., “Physicians as Advocates,” Houston Law Review, 35 (1999): 1529–630.Google Scholar
Committee on Quality of Health Care in America, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, D.C.: National Academy Press, 2001).Google Scholar
Robinson, J.C., “Blended Payment Methods in Physician Organizations under Managed Care,” JAMA, 282 (1999): 1258–63.Google Scholar
Kindig, D.A., “Purchasing Population Health: Aligning Financial Incentives to Improve Health Outcomes,” Health Services Research, 33 (1988): 223–42.Google Scholar