Question

Instructions: Read the following case and ASCP Statement on code of Medical Ethics. Then, respond to the question outlined below.

Making ethical decisions Charlie Anderson recently began a new job as the office manager for a prominent medical clinic. He has just received a bill from MedCount, one of the labs that performs tests for the clinic. In reviewing the bill, Charlie notices that the lab has charged the clinic $25 for a complete blood count test. The clinic, however, bills patients or their insurance companies $90 for the test, and that is the amount that most insurance companies will pay on the patient's behalf. Thus, the clinic is earning a $65 profit on each blood test it orders. After a bit more investigation, Charlie finds similar profit margins on several other lab tests. He is concerned about the billing practice and suspects the clinic may have selected the lab based on its low cost rather than on the lab's qualifications and the accuracy of its test results. He also wonders if the tests' profit potential is driving doctors to order unnecessary tests.

American Medical Association (AMA) Code of Medical Ethics:

AMA Opinion E-8.09(2) states, “[a] physician should not charge a markup, commission, or profit on the services rendered by others.” This opinion describes a markup as “an excessive charge that exploits patients if it is nothing more than a tacked on amount for a service already provided and accounted for by the laboratory.” The opinion does allow the clinician to bill “an acquisition charge or processing charge” but that the “patient should be notified of any such charge in advance.” Moreover, this opinions states that a “physician who disregards quality as the primary criterion or who chooses a laboratory solely because it provides low-cost laboratory services on which the patient is charged a profit, is not acting in the best interests of the patient.”

1. Based on the information provided above, do you believe that the clinic's billing for lab tests is an acceptable business practice? Why or why not? How could a proper code of ethics help the medical clinic from avoiding an ethical violation? What standard does it fall under I. COMPETENCE, II. CONFIDENTIALITY,  III. INTEGRITY, or IV. CREDIBILITY?

Answer 1

Given that Charlie Anderson has observed that for a blood test done by an outside lab (charged at $25 to medical clinic) the medical clinic is adding extra profit of nearly 250% more than the cost as profit and charging it's Patients and Insurance companies. The low fee charged by lab may be due to its low quality in tests. Also, he finds similar profits on several other lab tests.

The medical clinic's billing for lab tests is not acceptable business practice. As per American Medical Association (AMA) code of ethics, no physician should charge markup or commission or profit on the servicea rendered by others. In the given case, the lab tests are done by an outside lab named Medcount, so the medical clinic has no right to charge excess markup or commission to charge on such price as they are not giving any excess service in regarding to that tests.(which they are currently charge at $90, with nearly 250% markup). If the medical institution wants to charge any extra amount for acquisition of test results or processing charges, then the patient must be informed in advance.

The medical professionals must abide to moral principles and ethics, code of conduct given by the organisation head of medical associations. Apart from that, a company or medical clinic may have its own code of ethics which every employee or professional working in such organization must abide to. The organization's code of ethics and code of conduct regulations given by medical association will guide the medical professionals to act in an ethical manner. They also penalize the wrongdoers and thus making the professionals to adhere to the ethical principles. This act as a check to the medical clinic unethical pricing and thereby reducing the extra price it charged from patients and selecting the better equipped lab for giving more accurate results to the patients.

Integrity means quality of being honest and having strong moral principles. Integrity is fundamental to medical professionals. Integrity helps in keeping our actions honest and trustworthy. So the given situation fall under Integrity violation.

"Relationship between medical ethics and professionalism may be what it is considered as Integrity". Medical professionals are asked to do right while using professional judgement.