The prohibition on the corporate practice of medicine is intended to prevent non-physicians from interfering with or influencing the physician’s professional judgment*. The intent is to keep the business interest out of the patient-physician relationship. In Emergency Medicine the need for these controls is heightened as we encounter vulnerable patients who may not have adequate health care coverage. The following health care decisions should be made by a physician and would constitute the unlicensed practice of medicine if performed by a non-physician:
- Determining how many patients a physician must see in a given period of time or how many hours a physician must work.
- Determining what diagnostic tests or treatments are appropriate for a particular condition.
- Determining the need for discharge, admission or transfer of a patient.
- Determining which patients will be seen by a physician or a non-physician practitioner.
- Determining how a physician will interface with a non-physician practitioner.
In addition, the following “business” or “management” decisions and activities, resulting in control over the physician’s practice of medicine, should be made by a licensed physician(s) and not by an unlicensed person or entity:
- Selection and the hiring/firing of physicians.
- Setting the parameters under which the physician will enter into contractual relationships with third-party payers.
- Decisions regarding coding and billing procedures for patient care services.
*The prohibition exists in most states and these often contain exemptions for hospitals/health systems.