Following is a checklist you may wish to review as you enter into your next doctor’s appointment.
- If your doctor accepts insurance for payment, he/she is contracted by the company and thus has a conflict of interest. These arrangements result in additional insurance rules for care, recommended procedures, simple medication decisions and more.
- If your doctor accepts Medicare, he/she is being dictated pricing of services and has a conflict of interest. Additionally future work orders and payment are unpredictable and at the whim of government.
- If your doctor works for a hospital system, he/she is an employee of the institution and thus has a conflict of interest. He or she may be contracted such that if they try to leave the arrangement they have to leave the area. This provides significant leverage for the hospital employer to abuse their physician’s employment agreement.
- If your doctor is supervising non-physician providers for additional payments, he/she has a conflict of interest. Such an arrangement falsely suggests you are being cared for by an actual doctor. For this the physician does potentially earn more personal revenue.
- If your doctor is providing an Accountable Care Organization network that involves your Medicare life, he/she has a conflict of interest. The organization will receive bonus money from Medicare IF they cut expenses in total for the group of lives enrolled. There is a built in incentive to limit services provided.
- If your doctor is provided a lunch from a drug rep there was monetary value provided indirectly in exchange for learning about new or old brand name medications and thus has a potential conflict of interest. Device companies offer these lunches as well.
- If your doctor sells supplements or dispenses medication, he/she has a conflict of interest. This comes as revenue to the physician via commissions or retail sales profits.
The above list is not exhaustive but it is a good reference point for patients to consider. Having a conflict of interest is potentially unavoidable as we all have various interests with different weights of influence.
Take my practice for instance. The last two items on the list clearly apply to my practice. The others do not. How much of a conflict against patient interests is there when considering my care? Over a year a recent government site suggested I got around 95 dollars of “drug rep” gifts. In exchange for that I obtained medication procedure information that may help my patient care BUT potentially could compel me to recommend a referral to be considered for this technology. I don’t get a referral payment by any doctor for making such a referral BUT we might just develop an actual working professional relationship which could add value to each other’s patients in the future. In the case of a drug rep lunch many people don’t understand that doctors don’t get any payment or commissions from prescribing name brand medications. Still, the decision to prescribe an expensive/novel medication does affect the cost of the patient’s care.
Regarding my providing generic dispensing services I have informed my clients what my price conflict is- $8 per prescription filled to cover paper and printing materials, inventory, prescription label management and staff time dedicated to the project. The benefit the patients experience from my conflict in dollars in most cases far outweigh my “conflict cost”. A similar analysis can be applied to the small profit margin provided for recommending top of the line supplements. If your physician is willing to explain to you in dollars and cents what these conflicts amount to, then you can decide if the conflicts to the doctor outweigh the benefits you derive from their recommendations, care and the value experience you get from the relationship.
When it comes to third party payers paying for you and your doctor’s relationship things get murky very quickly. Not only are the fee for service payment terms not clarified with you but regulatory costs, hidden fees such as facility fees and even gag clauses that don’t allow the doctor to provide you a cash price is also part of the conflict. In the case of Medicare, most enrollees who are part of a conflict laden payment scheme called an Accountable Care Organization aren’t even being clearly informed they are part of these experiments. The bipartisan Medicare Access and Chip Reform Act passed in 2015 is saddling your doctors with unprecedented non-care regulatory expenses, time and abounding conflicts of interest due to the payment scheme that was put together.
After 25 years in medical practice and having been in various conflict of interest payment arrangements, I have to conclude that the private medical practice is clearly less conflicted than 3rd party employment. Going further a transparent cash price or membership arrangement is the most conflict free and cost-effective for patients. Medicare has become the most conflicted and toxic arrangement for you and your doctor. I am totally flabbergasted that a potential majority of citizens are placing any credence to political dimwits who are pushing for government controlled/universal health care as the solution to cost effective let alone economically optimal health care. It is beyond the pale that any doctor would advocate for such a model.