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Opinion 8.043 - Ethical Implications of Surgical Co-Management

For the purpose of this report, the term "surgical co-management" refers to the practice of allotting specific responsibilities of patient care to designated caregivers. The following guidelines stem from this understanding:

(1) Physicians should engage in co-management arrangements only to assure the highest quality of care.

(2) When surgical co-management arrangements are made between duly licensed physicians, their responsibilities should be delineated according to the scope of the physicians’ expertise. Likewise, when physicians enter into surgical co-management arrangements with allied health professionals, each caregiver’s responsibility should correspond to his or her qualifications.

(3) Even though different caregivers will be responsible for rendering specific portions of the patient’s care, a single physician should be ultimately responsible for ensuring that the care is delivered in a coordinated and appropriate manner. Other caregivers should support this obligation by communicating with this physician.

(4) The treating physicians are responsible for ensuring that the patient has consented not only to take part in the surgical co-management arrangement but also to the services that will be provided within the arrangement. In addition to disclosing medical facts to the patient, the patient should also be informed of other significant aspects of the surgical co-management arrangement such as the credentials of the other caregivers, the specific services each will provide, and the billing arrangement.

(5) Physicians should ensure that their surgical co-management arrangements do not violate the ethical or legal restrictions on self-referral.

(6) Referrals to another caregiver should be based only on that caregiver’s skill and ability to meet the patient’s needs and not on expected further referrals or other self-serving bases. Physicians who participate in surgical co-management arrangements must avoid such financial agreements as fee-splitting, which are both unethical and illegal. Physicians who participate in surgical co-management arrangements should employ appropriate safeguards to ensure that confidential information is protected. (I, II, IV, V, VI)

Issued June 2000 based on the report "Ethical Implications of Surgical Co-Management," adopted December 1999