Page 8 - OctSam2019

PRESIDENT’S
MESSAGE

CPOM:

Are you a Physician or a Widget?

By Adam Ratner, MD, 2019 BCMS President

The inherent conflict between non- mine with those who follow, so long as such second guess benefit managers, administra-
physician control of the practice of medi- knowledge and practice do not impair the tors, regulators, and third-party payors.
cine was recognized in the state of Texas in revenue cycle performance of my institu- I will remember that I do not treat a fever
the last century, resulting in the passage of tion and its third-party payors. chart, a cancerous growth, or a sick human
the Texas Medical Practice Act, among I will apply, for the benefit of the sick, all being who does not have insurance cover-
other statutes. It has long been recognized measures which are approved by the benefit age or cash.
that the incentive malalignment created by managers, administrators and regulators, I will prevent disease whenever I can, for
non-physician control of medical decision avoiding those twin traps of spending too prevention is preferable to cure, as long as
making is bad for patients. Over time, these much time with a patient or customizing there is a reimbursable CPT code for such
protections for patients have been eroded care for a patient if it reduces operational activity.
by the lack of enforcement of current laws efficiency and net revenue. I will remember that I remain a member
and growing asymmetrical power of corpo- I will remember that while there is art to of a profession whose activities are now
rate interests not controlled by practicing medicine as well as science, that warmth, controlled by those who do not understand
physicians. sympathy, and understanding have no CPT the needs of individual patients or do not
We now know this incentive malalign- codes and are not reimbursed. care.
ment is also bad for physicians. I will not be ashamed to say “I know If I do not violate this oath, may I receive
In 1964, dr. louis lasagna, dean of the not” nor will I fail to call in my colleagues enough money to pay my student loans, my
Tufts University School of Medicine, wrote when the skills of another are needed for a therapists and the army of administrators
a wonderful modern version of the timeless patient’s recovery unless such colleague is and practice consultants I must support be-
Hippocratic Oath. In the intervening half out of network. fore I die.
century, radical changes in the practice of I will respect the privacy of my patients,
medicine have sadly created the need for an for their problems are not disclosed to me If this satirical “oath” too closely reflects
updated “corporate” version. With deepest that the world may know except for your actual practice life, perhaps it’s time for
apologies to dr. lasagna and modern billing, collection, research and marketing you to act to change your circumstances.
physicians… purposes. You don’t have to settle. We at bCMS are
Most especially must I tread carefully here to help. let us know.
The “Oath” of the with matters of life and death, particularly
Corporate Physician of our corporation. Dr. Adam Ratner is President of the Bexar
I swear to fulfill, to the best of my ability While it may be within my power to take County Medical Society and serves as Professor and
and judgment, this covenant: a life or perform a non-reimbursed proce- Assistant Dean of the University of the Incarnate
I will respect the hard-won scientific dure, this responsibility must be faced with Word School of Osteopathic Medicine and Chair
gains of those physicians in whose steps I great humbleness and awareness of my own of The Patient Institute.
walk, and gladly share such knowledge as is frailty. Above all, I must never play God or

8 San Antonio Medicine • October 2019