It's All About Integrity: AAEM - Dr. Blumstein

Integrity - EM physician integrity is under attack

• Professional integrity
• Personal integrity
• Academic integrity

Hospital system

-Hospital is venue to admit and provide tools and tech for doctors to work.

-Need hospital based specialists (such as ER physician)

    -Older system - sign exclusive contract to allow doc to see patients in hospital; hospital provides space and support staff.

    -Contract holders: Small group, single person, corporation

Potential for trouble: Contract holder wants to pay physicians as little as possible, hire the most unqualified physician, and control doctors with ability to fire troublemakers and incur penalties for leaving.

•     Admission quotas
•     Demands for more advanced testing
•     Limit care for uninsured patients

Coercion

• Due Process: Many employees require due process for job actions. Physicians often sign contracts that explicitly give up due process!
• Termination without cause: Employer needs no reason to fire.
• Restriction covenant = non-compete clause (geographic, time restrictions) This doesn't make much sense in the EM setting but many EM contracts have this clause.  This is actually illegal in many states including NC.
• Trade secrets: Similar to non-compete, used as a way to avoid restrictions on restrictive covenants
• Malpractice tails: Cover events that take place after leaving a practice.  Are expensive.  Many contracts will state that employer will not purchase tails.

Corporate Practice of Medicine

•     Technically illegal for corporation to hire physicians, this is commonly violated.
•     Difficult to discipline anyone but the physician... so corporations don't have a disincentive.
•     According to CMS, physician is responsible for all billing and collection of payments.
•     Fee splitting is illegal: splitting fees for referrals.  Happens commonly, such as physician paying hospital for right to practice

How to protect EM Physicians

• Physician education
• Promotion of board certification

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