Assignment: Commercial Insurance Companies

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Assignment: Commercial Insurance Companies

Assignment: Commercial Insurance Companies

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have long emphasized organizational ethics. Sev- eral Joint Commission standards require health- care organizations to have mechanisms in place to address ethical issues related to such topics as patient rights and management responsibilities. Ethical issues concerning patient rights include informed consent, patient confidentiality, and the patient’s right to participate in care decisions and end-of-life decisions. Ethical issues concern- ing management responsibilities include resource allocation, conflicts of interest, and patient billing practices.

Resource allocation decisions by managers often conflict with the decisions made by physicians and other clinicians. Managers typically represent a utilitarian view of ethics, best represented by the phrase “the greatest good for the greatest number.” This view allows managers to sacrifice the use of resources for one patient to maintain resources for other patients, given the assumption that resources for the healthcare organization are limited. Clinicians typically represent a deontological view of ethics, which means that their deci- sions are governed by their duties to patients, which take precedence over the ends-based decision making of the manager. This continuous conflict seems to keep resource allocation decisions somewhat balanced.

Conflicts of interest occur when an individual owes duties to two or more persons or organizations and when meeting a duty to one somehow harms the other (Darr 2011). Perhaps the worst examples of conflict of interest involve the conflict between a manager’s duties to the organization and a manager’s duties to self, such as when managers use their positions of authority for personal gain. Even the perception of impropriety may cause a loss of credibility (Nowicki and Summers 2001). This is especially true in financial manage- ment, where contracts for services and products are awarded to vendors who may attempt to buy influence with a lunch or a gift.

For the most part, patient billing practices, especially for Medicare and Medicaid, are covered by law; however, even certain legal practices have ethical ramifications. For instance, how long should a healthcare organization hold a patient’s deposit after the insurance company pays in full? State law on this issue and overpayments by commercial insurance companies is nonexistent or varies widely. Although a healthcare organization may be under no legal obligation to refund overpayments by insurance companies, is keep- ing someone else’s money ethical? Many healthcare organizations use ethics committees to provide answers to these and other billing questions. Although healthcare organizations are not required to organize ethics committees, committees are a useful way to solicit com- munity input on billing issues.

MINI-CASE STUDY✓

Imagine➤that➤you➤manage➤a➤four-physician➤office➤practice➤in➤a➤

competitive➤neighborhood.➤Vendors➤often➤bring➤ lunches➤and➤

gifts➤ for➤ your➤ staff➤ and➤ samples➤ of➤ prescription➤ medications➤

that➤the➤physicians➤then➤give➤to➤patients.➤Could➤any➤of➤these➤

practices➤pose➤a➤problem?➤If➤so,➤why?

00_Nowicki (2339) Book.indb 14 5/17/17 10:57 AM

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