Ethical & Practical Implications of Provider Contracts
Each provider contract you sign will have slightly different terms; each managed care company will have different policies and impose different limitations. We will review some implications of various written and unwritten understandings, consider their ethical implications, and use case examples to discuss how we can avoid some of the potential ethical pitfalls.
OUTLINE:
I. Ethics Codes & Professional Standards
Fees & Reimbursement
Continuity of Care
Confidentiality & Disclosure
Informed Consent
II. Contracted Understandings
Actual Words vs Hidden Meanings & Unwritten Rules
III. Practical Issues
Fee Setting; Private Fee Agreements
Appealing Adverse Decisions
Standards of Care
One-Sided Indemnification
Reimbursement Limitations
Gag Clauses
Restrictive Covenants
Term-Of-Contract Considerations
Causes for Termination of Contract
Performance Evaluations
IV. Ethical Implications & Pitfalls
Informed Consent Complications
Confidentiality Limitations
Capitations & Other Financial Incentives
Ethical Responses to Potential Liability Issues
Potential Abandonment Issues