FINANCIAL INCENTIVES: Trend Favors Mandatory Disclosure
In the debate over physician financial incentives, recent court rulings and regulatory efforts have swung "the pendulum ... decisively in favor of disclosure," but "significant conceptual and practical questions remain about implementing" a mandate to force the issue, according to a policy brief in today's Journal of the American Medical Association. On one hand, authors Tracey Miller of Mount Sinai School of Medicine and William Sage of Columbia Law School argue that physicians have an ethical requirement to share information with their patients. Indeed, the AMA's Council on Ethical and Judicial Affairs has opined that physicians must disclose financial incentives that create "the potential for underutilization of health care services." Miller and Sage argue that such a duty to disclose incentives to patients might discourage the physicians from accepting the financial rewards in the first place. On the other hand, they say, formal disclosure "could have a negative impact on patients' perceptions of individual physicians and of the medical profession as a whole."
A second alternative is to follow the lead of the 20 states that have enacted laws requiring HMOs to disclose physician compensation methods. Noting that this might be the best means to "improve market performance" and ensure that enrollees receive the information, the authors say the disclosure rules could work to generate adverse publicity for those "plans and physicians whose contracting practices appear extreme."
The challenge in implementing disclosure mandates, the authors conclude, is to ensure that information is accessible and strikes a "balance between educating patients and alarming them," and that dissemination can be enforced. Equally important, they add, the disclosure mandates should not become a "legal shield" that absolves health plans of responsibility for "any negative effect of the incentives on patient care" (4/21 issue).