PROFESSIONAL ISSUES

AMA says doctors can levy extra charges

But Medicare and Medicaid patients should be exempted from surcharges to cover medical liability insurance costs, a Board of Trustees report cautioned.

By Mike Norbut, AMNews staff. July 11, 2005.

Chicago --The American Medical Association supports physicians who want to assess a surcharge to patients to help pay their liability premiums or to cover administrative work.

Delegates at the AMA Annual Meeting in June voted to support surcharges as one of a number of policies related to the medical liability crisis.

A Board of Trustees report, however, cautioned physicians that some fees, especially if charged to Medicare and Medicaid patients, may run afoul of the law. Physicians are only allowed to charge for administrative services not covered by reimbursements by public insurers, and discerning what fees are included in those reimbursements is not always easy.

Liability costs already are factored into reimbursements made by public payers, and many managed care contracts prohibit physicians from charging patients supplementary fees, according to the report.

"In short, substantial legal barriers exist to implementing liability surcharges on patients except for those who are uninsured or pay out of pocket," the report states.

Some physicians had concerns about the practice, especially in helping to pay for liability premiums.

"One of the unintended consequences may be that it puts [filing a lawsuit] in the patient's mind," said David Ross, MD, a family physician in Topeka, Kan., who is president of the Kansas Medical Mutual Insurance Co., a physician-owned liability insurance company. "I don't think it's too much of a stretch to think, 'The doctor must be thinking it's OK for me to sue, or else he wouldn't be making me pay for this.' "

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