The American Medical Association House of Delegates (HOD) adopted important new ethical guidelines last month for physicians providing "boutique care" services that is special services to patients who pay additional fees as retainers.
The delegates adopted the ethical guidelines presented by the AMA's Council on Ethical and Judicial Affairs, which built on the work of the AMA's Council on Medical Service. The recommendations are based on an in-depth analysis of the patient-physician relationship and the implications of providing special additional services including; longer visits, guaranteed availability by phone or pager, counseling for healthy lifestyles and various other personalized services.
The guidelines passed by the HOD are:
* The patient has the freedom to select and supplement insurance for their health care on the basis of what appears to them to be an acceptable tradeoff between quality and cost;
* When entering into a retainer contract, both parties must be clear about the terms of the relationship and must agree to them. Patients must be able to opt out of a retainer contract without undue inconveniences or financial penalties;
* Physicians must always ensure that medical care is provided only on the basis of scientific evidence, sound medical judgment, relevant professional guidelines and concern for economic prudence. A retainer contract is not to be promoted as a promise for more or better diagnostic and therapeutic services;
* Physicians converting their traditional practices into retainer practices must facilitate the transfer of their non-participating patients to other physicians, with no extra fee for transmission of their medical records. If no other physicians are available to care for non-retainer patients in the local community, the physician may be ethically obligated to continue caring for such patients;
* Physicians who enter into retainer contracts will usually receive reimbursement from their patients' health care plans for medical services. Physicians are ethically required to be honest in billing for reimbursement;
* Physicians have a professional obligation to provide care to those in need, particularly those in need of urgent care. Physicians who engage in retainer practices should seek specific opportunities to fulfill this obligation.
"Retainer practices provide an opportunity for patients to develop a more personalized relationship with their physician," said Leonard Morse, MD, Chair, Council on Ethical and Judicial Affairs. "But physicians should also make sure that all patients including those who do and do not pay retainer fees continue to receive the same quality of care."
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