Competition
The WSMA strongly believes that competition between and among physicians
and other health care practitioners on the basis of competitive factors
such as quality of services, skill, experience, miscellaneous conveniences
offered to patients, credit terms, fees charged, etc..., is not only
ethical but is encouraged. Ethical medical practice thrives best under
free market conditions when prospective patients have adequate information
and opportunity to choose freely between and among competing physicians
and alternate systems of medical care. (JC 6.13-87; Res C-12, A-04)
(Reaffirmed A-17)
The WSMA: (1) encourages the growth and development of the
physician/patient contract; (2) favors a pluralistic health care delivery
system which includes fee-for-service medicine, and will lobby for the
elimination of any restrictions and physician penalties for provision of
fee-for-service medicine by a physician to a consenting patient; including
patients covered under Medicare; and (3) defends fee-for-service payment
as a reasonable, cost-effective way of reimbursing for medical services
when the fee is paid by the recipient of the service with insurance
reimbursement to the patient. (Res C-12, A-04) (Reaffirmed A-17)
The WSMA: (1) supports a pluralistic approach to third-party payment
methodology under fee-for-service, and does not support a preference for
"usual and customary or reasonable" or any other specific payment
methodology; (2) affirms the following four principles: (a) Physicians
have the right to establish their fees at a level which they believe
fairly reflects the costs of providing a service and the value of their
professional judgment. (b) Physicians should continue to volunteer fee
information to patients, to discuss fees in advance of service where
feasible, to expand the practice of accepting any third-party allowances
as payment in full in cases of financial hardship, and to communicate
voluntarily to their patients their willingness to make appropriate
arrangements in cases of financial need. (c) Physicians should have the
right to choose the basic mechanism of payment for their services, and
specifically to choose whether or not to participate in a particular
insurance plan or method of payment, and to accept or decline a
third-party allowance as payment in full for a service. (d) All methods of
physician payment should incorporate mechanisms to foster increased
cost-awareness by both providers and recipients of service; and (3)
supports modification of current legal restrictions, so as to allow
meaningful involvement by physician groups in: (a) negotiations on behalf
of those physicians who do not choose to accept third-party allowances as
full payment, so that the amount of such allowances can be more equitably
determined; (b) establishing additional limits on the amount or the rate
of increase in charge-related payment levels when appropriate. (Reaffirmed
A-19)
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Abbreviations for House of Delegates report origination:
EC – Executive Committee; BT – Board of Trustees; CPA – Council on
Professional Affairs; JC – Judicial Council; CHS – Community and Health
Services