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While acknowledging patients' freedom to enter into specialized care arrangements with their physicians, the AMA House of Delegates warned that retainer contracts raise "ethical concerns that warrant careful attention."
Meeting June 14 - 19 in Chicago, the delegates adopted guidelines developed by the AMA Council on Ethical and Judicial Affairs for physicians who offer retainer services, also known as "boutique care."
Retainer fees are those paid by patients over and above the cost of their regular health insurance for more individualized health services, such as longer office visits or guaranteed access to the physician by phone or pager.
On the one hand, patients should be free to "select and supplement insurance for their health care on the basis of what appears to them to be an acceptable trade-off between quality and cost," the delegates agreed at their annual meeting. Yet they also recognized a need to reassure the public and health policy-makers that proliferation of such practices would not hamper patients' access to quality health care services.
"Retainer practices provide an opportunity for patients to develop a more personalized relationship with their physicians," said CEJA Chair Leonard Morse, M.D., regarding the guidelines. "But physicians should also make sure that all patients -- including those who do and do not pay retainer fees -- continue to receive the same quality of care."
The guidelines remind physicians of their professional obligation to provide care to those who need it, regardless of their ability to pay. "Physicians who engage in retainer practices should seek specific opportunities to fulfill this obligation," the guidelines conclude.
Patient privacy concerns should oust drug reps
Responding to growing concerns about drug sales representatives vying for ringside seats during interactions between physicians and patients, AMA delegates also voted to "oppose the presence, inclusion or involvement of pharmaceutical sales representatives in clinical situations without the full knowledge and informed consent of patients."
Proponents of a resolution introduced by the American Psychiatric Association and American Academy of Child and Adolescent Psychiatry claimed that such incidents -- referred to as "shadowing" -- raise serious questions about patient privacy and confidentiality. In reference committee testimony, a former drug sales representative pointed out that as nonclinicians, reps are not bound by ethical or legal constraints to safeguard patients' medical information. In addition, many times the patients involved are not told who the rep is or why he or she is present.
Delegates further directed the AMA to work with the pharmaceutical industry to develop and promulgate meaningful guidelines protecting patient privacy and prohibiting intrusion on the physician-patient relationship.
Spare docs the burden of paying for interpreters
At the December 2001 interim meeting of the AMA House of Delegates, delegates voted to continue to oppose requirements holding physicians responsible for medical interpreter services for patients with limited English proficiency, or LEP. Under those requirements, developed by the HHS Office of Civil Rights in August 2000, physicians received an unfunded mandate to provide a clinical interpreter for each LEP patient if the physician receives any federal financial assistance, such as Medicare or Medicaid payments.
An AMA Board of Trustees report reviewed at that interim meeting recommended that the AMA actively oppose the inappropriate extension of the Office of Civil Rights' LEP requirements to physicians in private practice.
At this year's annual meeting, delegates again confronted the medical interpreter issue, this time calling for the AMA to "seek legislation to eliminate the financial burden to physicians, hospitals and health care providers for the cost of interpretive services for patients who are hearing-impaired or who do not speak English."
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