AMA meeting: Doctors told to reveal financial stake in referrals

Orlando, Fla. -- Physicians who refer patients for services at facilities in which they have a financial interest should disclose the conflict to patients, according to ethical guidelines on physician self-referral adopted at the AMA Interim Meeting in November.

The new ethics policy goes beyond restrictions laid out in federal anti-kickback laws and regulations, and declares that physicians must put patients first when making referrals. In addition to disclosing self-referrals, doctors should assure patients that their ongoing care is not in jeopardy if they decide to refuse recommended referrals.

"The physician should be up front and tell the patient first that he or she may have an interest in a facility," said William A. Dolan, MD, an orthopedic surgeon in Rochester, N.Y., and a member of the AMA Board of Trustees. "The patient can then trust the physician -- that he or she is doing the best thing for the patient."

The AMA says doctors should not refer patients to outside facilities in which they have financial interests but where they do not directly provide care. Doctors should not buy into or invest in health facilities, equipment or products, or enter into group practice contracts, if doing so is contingent upon making referrals or if the agreement means barring referrals to competitors.

The income doctors receive from the arrangements should not be contingent on the volume of referrals, states the AMA Council on Ethical and Judicial Affairs opinion adopted by the House of Delegates.

Regular reviews should be done to monitor referral patterns. Doctors should base referrals on "objective, medically relevant criteria" and enter financial arrangements primarily to improve patients' access to high-quality care.

The policy replaces three older CEJA opinions on managing physician conflicts of interest in health facility ownership, medical imaging leasing and home health care arrangements.

While innovative business arrangements can improve both quality and access to health care, the CEJA opinion says, they "can also be ethically challenging when they create opportunities for self-referral in which patients' medical interests can be in tension with physicians' financial interests."

The CEJA report says these self-referral arrangements "can undermine a robust commitment to professionalism in medicine as well as trust in the profession."

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