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September 20, 2000

Should Physicians Manipulate Reimbursement Rules to Benefit Patients?

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1382-1383. doi:10.1001/jama.284.11.1378

To the Editor: Even though many physicians have not actually sworn the Hippocratic oath, the concept "first do no harm" is still impressed on all those who study medicine, or so I thought. Thus, I read the article by Dr Wynia and colleagues1 with much sadness on behalf of our profession.

Stated bluntly, the article reveals widespread lying, cheating, and stealing in the name of patient care. It reveals the decline of a noble profession in which physicians were once pillars of respectability in their communities. The behaviors described in the article also may augment physicians' income. While patient advocacy is noble and in keeping with the high ideals of our profession, absconding with illicitly gained professional fees is not.

Is it any wonder that third-party payers require so much documentation of medical necessity? They, and the patients and employers whose insurance money is being spent, must be protected against false claims and payment for services excluded by a patient's contract.

If physicians are truly concerned about patients, they can lobby for broader insurance coverage for benefits that are currently not covered, knowing that such care will ultimately raise premiums. However, then at least physicians will not become hawkers of "tainted" services. We should work with patients, employers, the insurance industry, and insurance regulators to ensure that covert issues of insurance coverage are uncovered. We must realize, however, that no insurer can be all things to all patients or physicians.

Professional acts of mercy can be performed with fairness and justice toward each concerned party. Wynia et al reveal professional ignobility found only in dark and shadowy corners and expressed through the deceiving contrivances of ambiguous words meant to unfairly disarm the fiduciary agents of patients. This short-term gain is our profession's long-term loss. Together, we must advocate not only for patients but also for our profession.

Wynia  MKCummins  DSVanGeest  JBWilson  IB Physician manipulation of reimbursement rules for patients: between a rock and a hard place.  JAMA. 2000;283:1858-1865.Google Scholar