Emergency physicians denounce corporate management

The American College of Emergency Physicians has updated its position on non-physician-led emergency medical practices, stating physicians — not corporations — should make medical and business decisions. 

"Medical decisions must be made by physicians, and any practice structure that threatens physician autonomy, the patient physician relationship, or the ability of the physician to place the needs of patients over profits should be opposed," the organization wrote in a July 14 policy statement. "Corporate practice of medicine prohibitions are intended to prevent nonphysicians from interfering with or influencing the emergency physician’s professional medical judgment." 

The organization said certain clinical decisions should only be made by an emergency physician, a supervised nurse practitioner or a supervised physician assistant. These decisions include determining which tests and treatments are suitable for a patient, as well as the need for referrals. 

Emergency physicians can consult with non-physicians on certain business and management decisions, but the physicians should have the final say, according to the College. For example, only emergency physicians should decide how many patients they will see, how their practice will enter into contractual relationships with third-party payers and oversight of revenue cycle management policies and procedures. 

"Ownership of medical practices, operating structures and models should be physician-led and free of corporate influence that impacts the physician-patient relationship," the College said. 

Ownership of an emergency medicine practice or group by non-physicians or by physicians who do not have responsibility for the management, leadership and clinical care of the practice would fall under prohibited corporate practice of medicine, per the College. As would the restriction of emergency physicians' access to information and accountings of billings and collections in their name. 

This could lead to the censure of some practices, emergency medicine physician Leon Adelman, MD, wrote in a July 15 LinkedIn post. He noted the new statement opposes the so-called "friendly physician" model, where a physician "owns" an emergency medicine practice as an LLC on paper, although a large company actually runs it. 

"After years of tension over the corporate practice of medicine, the American College of Emergency Physicians and American Academy of Emergency Medicine (AAEM) now have the same position," Dr. Adelman wrote. "The question is whether (and how) ACEP & AAEM will enforce this policy — possibly via censures of 'friendly physicians.'"

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