Page 24 - OctSam2019

CORPORATE
MEDICINE

The prohibition against the Corporate Practice of Medicine (CPOM)
has been a medical doctrine for many years, dating back to the mid-
The Corporate 1800s. And like most doctrines, the root of this prohibition made sense.
The practice of medicine way back then was just getting organized, so
Practice of Medicine: it was necessary to differentiate between those who were schooled in
medicine vs. those who were selling snake oil. The AMA was instru-
Remaining an mental in passing a number of laws that restricted the CPOM in an ef-
fort to allow physicians the autonomy and authority to make patient
Independent Physician medical decisions without the interference of corporations. Most would
agree that the doctrine of placing the practice of medicine in the hands
of physicians and not bureaucrats is sound judgment.
by Adopting a Fast forward to 2019; medicine is now big business. The estimates
of the total cost for healthcare in the USA exceeds $3.5 trillion annually.
Value-Based Many large companies, as well as mom and pop shops, are involved in

managing various aspects of healthcare. The question is whether com-
Care Model panies that control the many tangents of healthcare are practicing med-
icine? The short answer is some are (hospitals and physician offices),

By Alan Preston, MHA, Sc. and some are not (call centers, billing companies, dME companies,
etc.). Compelling arguments can be made either way as to whether a
corporation is "practicing" medicine, examples being insurance carriers
or Medicare or Medicaid. With the increasing number of laws dictating
aspects of the regulation of medicine, one could argue legislators and
members of Congress are buying into the CPOM.
It is a challenge to define CPOM. For example, in the case where a
physician has autonomy over medical decisions in his/her practice,
but decides to grant payor contracting and other administrative func-
tions to a Management Services Organization (MSO), or pays the
MSO some percentage of their fees, some courts have ruled that
model tantamount to the corporate practice of medicine and a viola-
tion of the Texas Administrative Code (TAC).

The tenets, according to the AMA of the corporate
practice of medicine, have these characteristics attached:
1. Commercialization of the practice of medicine,
2. A corporation’s obligation to its shareholders which therefore
may not align with a physician’s obligation to patients, and
3. Employment of a physician by a corporation that may interfere
with the physician’s independent medical judgment.

Many independent physicians feel the protections against the
CPOM have been diminished and are eroding physician independence
and autonomy. laws, lawsuits and regulations are all attempting to in-
fluence the physician. Some of it may be beneficial to physicians, and,
much of it is not.
On another side, CMS is trying to influence the control of physi-
cians with more money for better outcomes. It is called value-based
Care (vbC). Is CMS in violation of the Corporate Practice of Medi-

24 San Antonio Medicine • October 2019