California law prevents the practice of medicine by anyone but a person licensed to practice medicine.
With the increasing integration of healthcare, new systems need to be created to make sure that physicians continue to fulfill their duties.
A licensed physician must:
* Make all decisions regarding the care of patients.
* Decide the diagnostic tests which are appropriate for a particular condition.
* Determine the need for referrals to, or consultation with, another physician or specialist.
* Responsibility for the ultimate overall care of the patient, including treatment options available to the patient.
* Determine how many patients a physician must see in a given period of time or how many hours a physician must work.
* Keep accurate records of a patient and to make sure such records are private.
* Bill appropriately for all services rendered.
Under many models of integrated care, including ACOs and IPAs, physicians give up considerable control over many of these required functions. For instance, physicians are usually required under such contracts to assign all rights to bill medicare and medicaid, as well as private payers.
Under the law, however, the physician, not his or her group, is responsible for the accuracy of these bills.
A good lawyer is needed if you are entering into a contract with any healthcare provider. The lawyer should assure that the healthcare professional keeps his/her rights under the new legal framework.
Written by Matthew L. Kinley