MMS Develops Guidelines on Ethics in Managed Care and Patient Privacy

The MMS House of Delegates approved two sets of sweeping principles, establishing a clear set of ethical guidelines to protect the rights of patients enrolled in managed care health plans, providing guidance to physicians who treat such patients, and reaffirming the patient's right to privacy and confidentiality of medical records.

The guidelines were developed over the past year by a presidential task force on ethics in managed care and a separate presidential task force on patient privacy and confidentiality, and were approved with some amendments at the Interim Meeting on November 8.

The principles proposed by the Presidential Task Force on Ethics in Managed Care included:

• Physicians must continue to place the interest of their patients first, regardless of any guidelines or directives issued by health plans;

• Patients have the right to know any financial arrangements that may tend to limit the diagnostic or therapeutic alternatives that are offered to patients or restrict referral or treatment options; and

• Health plans should not establish financial incentives or quotas that interfere with appropriate clinical management such as limiting diagnostic tests, services, referrals or access to care.

The principles proposed by the Presidential Task Force on Patient Privacy and Confidentiality included:

• The patient has a fundamental right to privacy and confidentiality in his/her relationship with a physician. Only the patient may waive that right, in a meaningful and non-coerced fashion;

• Any conflict between a patient's right to privacy and a third party's need to know should be resolved in favor of the patient's privacy, except where that may result in serious harm to the patient or others;

• The development of new technologies should include measures that strengthen, not jeopardize, patient privacy and confidentiality;

• The results of genetic testing should only be disclosed to the tested individual, unless the individual gives separate and explicit consent for each disclosure; and

• Patient health information should not be a commodity in the marketplace, and should not be made available for purchase or sale by any individual or entity.

In other action, the House of Delegates approved resolutions:

• Supporting a policy on how insurers deny coverage for a service and how they communicate that denial to patients, as well requiring insurers to provide physicians with ready access to those who have denied the care;

• Opposing the direct advertising of prescription drugs to the general public;

• Supporting the formation of a national registry or hotline to identify unlicensed clinical health care job applicants who have a history of criminal activities or patient abuse;

• Helping physicians screen and assist women who suffer, or could suffer, from postpartum depression;

• Seeking to limit the Board of Registration in Medicine's access to physician medical and mental health records "when they are irrelevant to the matter under investigation";

• Advocating for functioning passenger seat belts in all taxis.

- Frank Fortin