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.
See our Patient-Physician Relationship page for information on establishing and terminating the relationship.
American Medical Association (AMA) Resources and Guidance
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 and Policy
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:
Patient-Physician Relationship -
245.003 Protections Against Interference in the Practice of Medicine and the Patient-Physician Relationship
245.021 Patient-Doctor Privileged Communication
245.020 Physicians Retaining Autonomous Clinical Decision-Making Authority
250.003 Limiting Physician and Patient Conversations
260.078 Mandated Patient Information
250.002 Ethical Practice of Medicine for Physicians Participating in the State's Women's Health Programs
85.019 Physician's Role in the End-of-Life Process
60.010 Opposing Legislation that Mandates Physician Discrimination
55.066 Opposition to Criminalization of Gender-Affirming Care for Transgender Youth
10.003 Patient Autonomy and Accuracy of Information in Informed Consent for Abortion
10.004 Addressing the Impact of Abortion Restrictions in Texas
155.010 HIT, Physician Access to Clinical Laboratory Reports
Evidence-Based Programs and Health Care Delivery -
265.018 Evidence-Based Medicine and Practice
145.024 Medical Decision Makers Licensed in Texas
155.012 Pharmacy Benefit Managers
115.018 Overwhelming Compliance Mandates and Payment Uncertainty
265.017 Pay-for-Performance Principles and Guidelines
120.010 Principles for Evaluating Health System Reform
120.003 Health System Reform Managed Care
Medical Staff, Corporate Practice of Medicine and Employment -
130.020 Ensuring Physician Autonomy
130.026 Medical Staff Rights and Responsibilities Bill of Rights
265.032 Physicians Orders
160.006 Corporate Practice of Medicine
160.008 Nonprofit Health Corporations
160.012 Antitrust Laws
165.007 Whistle-Blower Protections for Physicians
115.017 Protections of Non-employment Physician Extended to501(a)s
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.
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.
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
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:
Management Services Organization (MSO)
- 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
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
- Facility management
- Personnel/Human Resources
- Accounting and M.I.S.
- Managed care contract negotiations
- Recruitment assistance
- Asset purchase