Coherent and Noncollusive Compensation

Coherent and Noncollusive Compensation

Although there are rewards to be obtained from working in an interesting and creative profession, this is best applied to one’s collective professional endeavors. With a specific patient, monetary compensation is the only gratification psychiatrists should realistically expect (Epstein and Simon, 1990). When compensation is direct, there should be a set fee, and the patient should be responsible for the scheduled appointment time. When compensation is indirect or salaried, the psychiatrist must avoid colluding either with the patient against the party paying for the treatment or with the third party against the patient. Whatever method is being used for paying for mental health treatment, a coherent and noncollusive arrangement imparts the message to the patient:

The doctor has needs of his/her own, but they are limited to a salary or fee. Aside from financial obligations, I don’t have to please, gratify, or nurture my doctor.

The practice of charging for missed appointments under the traditional fee-for-service paradigm is often misunderstood by patients because their experience with physicians in other branches of medicine has usually been that they were charged on a fee-for-procedure, rather than fee-for-time, basis. Charging for missed appointments is justifiable from an ethical standpoint as long as the rationale is clearly explained to the patient at the beginning of treatment and the patient agrees to it. In addition, no attempt should be made to hide the fact of billing for missed appointments from third-party payers. Some states have an ab-solute prohibition against billing for missed appointments under entitlement programs such as Medicaid and Medicare (Epstein, 1994, p. 169). Within certain guidelines, it is permissible to bill the patient (but not Medicare) for missed appointments under the Medicare program (Epstein, 1994, pp. 169–170). Readers are cautioned that regulations regarding Medicaid and Medicare are subject to periodic legislative revisions and may vary according to jurisdiction.

Generally risky compensation arrangements include work-ing for a treatment organization one perceives to be financially exploitive, accepting inexpensive gifts from patients especially when such gifts are not part of a culturally expected mode of behavior, bartering goods or services in return for treatment, referring patients for treatments or procedures in which one has a proprietary financial interest, and neglecting the patient’s failure to adhere to the original agreement regarding payment of fees. Certain practices are absolutely contraindicated and likely to be destructive, including fraudulent billing, accepting expensive gifts, fee splitting, colluding with the patient or third party, and use of financial insider information. referring patients for treatments or procedures in which one has a proprietary financial interest, and neglecting the patient’s failure to adhere to the original agreement regarding payment of fees. Certain practices are absolutely contraindicated and likely to be destructive, including fraudulent billing, accepting expensive gifts, fee splitting, colluding with the patient or third party, and use of financial insider information.