Establishing the need and identifying goals for a curriculum in medical business ethics: a survey of students and residents at two medical centers in Missouri

Abstract

BackgroundIn recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encourage self-regulation and impose rules to limit physician relationships with for-profit entities. Nevertheless, no published curricula exist in the area of MBE. This study aimed to establish a baseline level of knowledge and the educational goals medical students and residents prioritize in the area of MBE.Methods732 medical students and 380 residents at two academic medical centers in the state of Missouri, USA, completed a brief survey indicating their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about.ResultsMedical students and residents had little awareness of recent and major reports on MBE topics, and had minimal knowledge of basic MBE facts. Residents scored statistically better than medical students in both of these areas. Medical students and residents were in close agreement regarding the goals of an MBE curriculum. Both groups showed significant interest in learning more about MBE topics with an emphasis on background topics such as “the business aspects of medicine” and “health care delivery systems”.ConclusionsThe content of major reports by professional associations and expert bodies has not trickled down to medical students and residents, yet both groups are interested in learning more about MBE topics. Our survey suggests potentially beneficial ways to frame and embed MBE topics into the larger framework of medical education.

What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse?

“…Billing errors and mistakes, misclassification of a diagnosis or procedure, or improper documentation can indicate lack of program integrity education. 16,17,18 Inaccurate coding or errors in documentation can result from improper or incomplete interaction with the patient's electronic health record (EHR) if the physician merely copies and pastes text, if the EHR self-populates from previous encounters, or if the algorithm prompts the physician to offer the patient potentially unnecessary or inappropriate services. 16,17 When do these types of behaviors become fraud?…”

“…17 In response, some stakeholders recommend resident physician education that would cover issues pertaining to compliance, billing, appropriate documentation, adequate supervision, and potential civil and criminal liability. 16,17,18 A variety of training models exist, and several commentators suggest integrating program integrity training as part of the physician onboarding process. 16 Front-end analytics.…”

Teaching Medical Business Ethics: An Introduction to the Bander Center’s Casebook

“…In 2013 the Bander Center surveyed medical students and residents at two academic medical centers in Missouri on "their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about" [2]. The results revealed that "medical students and residents had little awareness of recent and major reports on MBE topics and had minimal knowledge of basic MBE facts" [2], such as what percentage of academic physicians have a financial relationship with industry. However, "both groups showed significant interest in learning more about MBE topics…such as 'the business aspects of medicine' and 'health care delivery systems'" [2].…”

“…The results revealed that "medical students and residents had little awareness of recent and major reports on MBE topics and had minimal knowledge of basic MBE facts" [2], such as what percentage of academic physicians have a financial relationship with industry. However, "both groups showed significant interest in learning more about MBE topics…such as 'the business aspects of medicine' and 'health care delivery systems'" [2].…”

“…Many of physicians' decisions related to clinical practice or medical research have a business component. In the market context of medicine in the United States, issues in MBE "such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems" affect the integrity of medical practice and research [2]. Preserving trust in the institution of medicine as it operates in an increasingly complex environment is challenging.…”