Autonomy

Establishing and maintaining autonomy in clinical matters and in your business practice.

The ability of physicians to act in their patients' best interests must not be compromised by outside, and sometimes competing, economic, political and social pressures. However, physicians are facing increasing attempts to mandate what information, tests, procedures, and treatments they must or must not provide to their patients. They also are looking for ways to enhance practice revenue and determine what practice model works best for them.

Clinical Autonomy - Medical Decision Making

Protecting the patient-physician relationship is of vital importance. Patients place their lives in their physician's hands, so not only must they trust their physician's knowledge, experience and skill, they also must trust that their physician is acting in their best interests. In return, the physician is responsible for recommending and applying the most appropriate, science-based treatments for the patient's individual circumstances and medical conditions.

Patient-Physician Relations

See our Patient-Physician Relationship page for information on establishing and terminating the relationship.

American Medical Association (AMA) Resources

AMA Code of Medical Ethics - As a member of the profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. These are principles adopted by the AMA, not laws, but are standards of conduct which define the essentials of honorable behavior for the physician.

Texas Medical Association (TMA) Resources

TMA Board of Councilors Current Opinions - The Board of Councilors is the ethical policy making body of the TMA. The board provides opinions in response to various inquiries regarding ethical issues and current events affecting the practice of medicine that supplement the current opinions of the AMA Council on Ethical and Judicial Affairs.

TMA Healthy Vision 2025-Section 9: Don't Let Corporations Play Doctor - Strategic road map for TMA's state and federal advocacy - TMA has several recommendations to reinforce the state's ban on the corporate practice of medicine, or infringement upon the physician's clinical judgment and paramount responsibility to the patient.

TMA also has adopted policy on physician autonomy, including:

245.020 Physicians Retaining Autonomous Clinical Decision-Making Authority
245.021 Patient-Doctor Privileged Communication
250.003 Limiting Physician and Patient Conversations
130.020 Ensuring Physician Autonomy
130.026 Medical Staff Rights and Responsibilities Bill of Rights
160.006 Corporate Practice of Medicine
115.017 Protections of Non-employment Physicians Extended to 501(a)s
160.008 Nonprofit Health Corporations
160.012 Antitrust Laws
120.00 Health System Reform Managed Care

Physician access to and ownership of medical records

Know your rights to your patients' PHI (TMA) - Your EHR vendor cannot block or terminate your access to your patients' records.

Access to Medical Records (TMA) (members only) - Be aware of clauses in employment or managed care contracts.

Who Owns the Medical Record? (TMA) - Physicians should agree about ownership up front before entering into a multiple-physician arrangement to avoid any ambiguity over medical records ownership.

Complaints

If you feel there are violations or other concerns with a nonprofit health corporation/organization, see our NPHC page regarding filing a complaint.


Financial Autonomy in a Business Setting - Enhancing Practice Revenue

Enhancing practice revenue helps to facilitate financial autonomy. Non-physician revenue producers, such as nurse practitioners or physician extenders, help to increase patient volume and flow. Adding ancillary services also increases revenue generating opportunities. Revenue can be further enhanced by negotiating better fees from payers by providing sufficient data to show how services provided in a physician-owned facility cost the payer less than if done at a hospital facility. Another option is to develop a new business model or participate in an emerging payment model.

Tools and Resources

HCMS: Misc: Marketing
Marketing not only allows for potential growth of the practice, but it also helps physicians maintain autonomy. Development of a mission statement, vision, and values will assist in forming a marketing strategy. There are several effective marketing methods available to practices:
  • Relationship marketing - Enhancing patient-physician experiences.
  • Community involvement - Participate in community events as a practice; set up information booths at local health fairs.
  • Traditional advertising - Local newspapers, circulars, and other print media.
  • Internet advertising - Develop a website for the practice and market through social media.
  • HCMS Branch Meetings - Providing networking opportunities.
  • Marketing 101: HCMS Resources to Develop Your Patient Base
Management Services Organization (MSO)
An MSO is a separate legal entity (hospital owned or hospital/physician joint venture) that is formed to provide administrative and practice management services to physicians without providing medical services. Utilizing an MSO can help expand clinical services, staff or operations, and provides comprehensive patient services that manage care. The MSO provides physicians with professional management expertise, can improve productivity, preserves physician autonomy regarding medical decisions, and facilitates development, retention and recruitment, as well as increasing the practice's growth potential. The MSO assists in management services such as:
  • Practice operations
  • Billing/electronic claims submission
  • Marketing
  • Facility management
  • Personnel/Human Resources
  • Collections
  • Accounting and M.I.S.
  • Managed care contract negotiations
  • Purchasing
  • Recruitment assistance
  • Asset purchase