July/August Ethics Reader Poll Results
Noam Stadlan, MD
Chair, NASS Committee on Ethics & Professionalism Department of Neurosurgery, North Shore Hospital Evanston, IL
Below are the results from the July/August Ethics poll.
Have you ever felt pressured to code a procedure in a way that maximizes reimbursement but may stretch clinical justification?
No, I have not done it
I have done it for my own benefit (direct reimbursement or RVU based salary/bonus)
I have done it at the behest (blatant or perhaps only implied) of my employers
Other reason to have done it
Response from Dr. Stadlan
It is normal and understandable to want to maximize income. This desire can be amplified if one feels that they are not adequately compensated for their work, or that others, such as insurance companies, unfairly limit income or unjustifiably benefit from one’s work.
In this sort of situation, one can become convinced that it is morally or ethically appropriate to bend rules that one is obligated to follow (contract with insurance companies). Whether or not one does so depends not only on the incentives and moral position, but on practical issues such as the likelihood of getting caught and/or punished.
I think that it is important for us to be honest with ourselves regarding what our motives may be and what actually is the proper ethical approach. While it may sometimes be ethically appropriate to bend rules for the benefit of a patient, I do not think the same applies when it comes to our own benefit. On the other hand, given the somewhat confrontational relationship between insurance companies and providers, I believe it is ethical to maximize reimbursement as long as it is reasonable and remains within the rules.