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

10/3/2013

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Picture
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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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction