New ACP ethics guide urges greater cost focus

Physicians need to be more cost-conscious, but not at patients’ expense, according to the new edition of the American College of Physicians (ACP) Ethics Manual.

“We have to consider cost as one of the factors when we make medical decisions, because that’s in the best interest of our patients,” Virginia Hood,  MBBS, MPH, FACP, an internist and nephrologist and president of the ACP, tells eConsult. “It shouldn’t ever be an overriding part of a decision, but physicians need to take it into consideration.”

Cost was addressed in previous ethics manual editions. The manual has been updated approximately every 5 years since the first edition in 1984. Due to the increased public policy focus on cost reduction, however, the ACP expanded the topic for the most recent edition.

“We have been advocating for efficient care since 1984, but it’s been given a slightly greater emphasis because the costs of care are so much higher,” says Hood, who is the former chairwoman of ACP's Ethics, Professionalism, and Human Rights Committee. “We have to look at the fact that in this country the cost of healthcare is rising at an unsustainable rate. If it keeps going up at this rate there won’t be enough money for anything else.”

The manual includes an expanded section about physicians offering uncompensated care in different scenarios, whether for an economically struggling patient or as a favor for a colleague.

“It’s not a good idea to forgive certain people copayments, because that is considered fraud, especially for Medicare patients,” Hood says. “In some cases, courtesy care by charging some people less for some forms of care is not considered professional or allowed by the law in a number of instances, because it may be linked to the concept of a kickback.”

The manual also has a new section about social media, including guidelines for physicians using Web sites such as Facebook and Twitter and interacting with patients online.

“Physicians have the right to post their holiday photos on Facebook,” Hood says, “but they need to maintain professional boundaries with patients.”

Reading the ACP ethics manual is eligible for CME credit, according to the Annals of Internal Medicine.

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