February 28, 2017
By: Finney Gilbert

Three achievable ways to balance patient needs while managing cost

A critical conflict of interest is emerging for medical professionals between fiduciary responsibility and their patients’ best interests. What to do?

Recently, my colleague Kaveh Safavi laid out the dilemma. How can a doctor honor their Hippocratic oath of putting the patient first while at the same time adhering to cost management requirements inherent with the advent of Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs)?

Patients usually make decisions about their health based on the advice of medical professionals. This is especially true in significant, high acuity cases—where there is both a lack of information and greater imbalance between the knowledge and skills levels of patient and physician.

Here is where direction is most clearly needed. There are three ways this can be done most effectively.

First, new governance models are needed that allow for a medical professional to navigate their dual conflicting fiduciary duties. This tension needs to be explicitly understood and incorporated because it cannot be eliminated. “Either-or” models will ultimately fail to meet any parties’ interests.

Second, prices need to be made transparent to patients. Ensuring patients have a full understanding of the price of services involved in every option will reassure and empower them. Costs are a function of the price and use of services. Clinical judgment goes into the use of these services. Price of services can and should be provided to patients in the interest of minimizing perceived conflict.

The third piece is full disclosure. Full disclosure of compensation arrangements is a necessary part of a patient-first framework. This is no different than expectations already placed on physicians with respect to drug or device promotion. Complex payment models increase the risk of fiduciary tension compared to a basic fee-for-service payment model and place a higher burden on disclosure.

These steps, initiated individually or together, have the potential for helping avoid not only dangerous conflicts of interest but a resulting corrosion of trust between caregivers and their patients.

What is your take on how to resolve this conflict? I would like to hear from you.

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