Can Providers Lawfully Boycott a Healthplan? - Ethical Reasons to Boycott a Healthplan
Many Providers are Already Involved in “Soft-Boycotts”
Based on legal advice from two attorneys, a group of individual healthcare providers can boycott a Healthplan if the reasons are not financial, and the reason is NOT intended to interfere with competition. Many providers are already engaged (for ethical reasons and to avoid moral injury) in what this paper defines as a “soft-boycott.” A brief survey of providers indicates that the number of providers engaged in “soft boycotts” is increasing in self-defense and defense of their patients.
Legal Considerations before Boycott of a Healthplan
Antitrust Laws: Providers must be aware of antitrust laws, which are designed to prevent practices that could restrict competition. Boycotting a health plan for financial reasons can be seen as an attempt to manipulate the market, particularly if the boycott aims to coerce the health plan into changing how it does business. However, if a boycott is done for ethical and moral reasons, such as protesting a Healthplan’s restriction of patient care or interference with patients’ treatment, a boycott may be permissible and impossible to prove.
Contractual Obligations: Providers must consider their existing contractual obligations with the health plan. Engaging in a boycott while under contract might lead to legal repercussions depending upon the terms of the contract. If this is the case, providers can limit their practice to patients they are able to treat and not violate the terms of their contract (i.e., a soft boycott).
Professional Ethics: Medical professionals are bound by ethical codes that prioritize patient welfare. Any action that could potentially harm patients, such as limiting their access to care through a boycott, must be carefully considered. A soft boycott would not harm patients. Referring patients back to their Healthplan for a referral is permissible if the providers practices’ case-mix severity is is high, their physical resources are low, or the providers resilience or well-being is waning.
Ethical and practical considerations before any boycott of a Healthplan
Patient Care: The primary concern for healthcare providers should always be patient care. Any decision to boycott should carefully evaluate how it will impact patients, including potential disruptions to their access to medical services. If a therapist is exercising a soft boycott for their own mental health, patients can be referred to an ethical “provider list” website or to the provider list of their health plan.
Public Perception: Reasons behind a boycott and how it is conducted can significantly effect public perception of the involved providers. A boycott for non-financial reasons, such as protesting inadequate patient care standards, might garner public support if it were well-justified and well communicated. Licensed professionals have responsibility to the public but are not required to garner public support.
Alternative Avenues: Before initiating a boycott, providers should explore all other avenues for resolving their grievances with a Healthplan. This might include negotiations, using dispute resolution mechanisms provided in the contract, or engaging professional or regulatory bodies to mediate. If alternative methods are not available, a soft boycott is permissible, but only if this does not violate their contract and/or is not done for financial reasons.
Solidarity and Collective Action: For a boycott to be effective and ethically justified, there should be a consensus among the participating providers. The decision ideally should be supported by a professional association or a similar collective group that can and does articulate the reasons for the boycott and negotiate on behalf of the providers taking action.
Sole Provider Passive Boycott: A passive-boycott would be a sole providers decision based on the “Quadruple Aim”.
The Quadruple Aim
The Quadruple Aim is a framework that expands on the original Triple Aim of healthcare, which was developed by the Institute for Healthcare Improvement (IHI). The Quadruple Aim adds a fourth dimension to better address the needs of healthcare providers. The four aims are:
Improving Population Health: This aim focuses on enhancing the overall health of a population by addressing the wide range of factors that influence health, including medical care, public health interventions, social determinants of health, and individual behaviors.
Enhancing the Patient Experience: This aim is about improving the quality of care from the patient's perspective. It includes providing care that is respectful, responsive to patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. It also encompasses factors such as access to care, effective communication, and emotional support.
Reducing Per Capita Healthcare Costs: This aim focuses on lowering the cost of healthcare on a per-person basis without compromising quality. The goal is to make healthcare more affordable and sustainable by reducing unnecessary procedures, avoiding hospital readmissions, and promoting cost-effective treatments.
Improving the Work Life of Healthcare Providers: The fourth aim addresses the well-being and satisfaction of healthcare providers. It recognizes that the stress and burnout experienced by healthcare professionals can negatively impact patient care, and that creating a supportive work environment is crucial for achieving the other three aims. This includes promoting work-life balance, reducing administrative burdens, and ensuring that healthcare workers have the resources they need to provide high-quality care.
Examples of Non-Financial Reasons to Boycott a Healthplan
Quality of Care
Providers might boycott a Healthplan that fails to meet acceptable standards of patient care or refuses to incorporate evidence-based practices. Limiting the number of sessions would be one example of failure to meet acceptable standards
Ethical Practices: Providers might oppose a Healthplan that engages in discriminatory practices or unethical behavior.
Privacy and Confidentiality Concerns: A boycott could be initiated against a Healthplan that does not adequately protect patient data or does not have adequately privacy policies and oversite controls.
Many Providers are Already Involved in Soft-Boycotts
Defining a "soft boycott" as prioritizing provider self-care and high level care of existing patients over taking on new patients based on a risk analysis and the concerns above. This perspective centers the issue clearly within the ethical and practical obligations of healthcare providers to ensure quality care.
1. Ethical Justifications
Quality of Care: The primary ethical duty of healthcare providers is to ensure high-quality care for their patients. If taking on new patients would compromise the quality of care for existing patients due to overburdening, prioritizing current patients can be ethically justified.
Provider Well-being: The health and well-being of providers are crucial for sustaining the quality of patient care. Overworked healthcare providers can experience burnout, which negatively impacts patient care outcomes. Prioritizing provider health is both ethical and practical to maintain a sustainable healthcare practice.
2. Reduced Risk of Legal and Contractual Issues
Contractual Clarity: If the decision not to take on new patients is clearly communicated as a measure to maintain high standards of care (rather than as a means to influence or protest against the health plan's policies), it is less likely to be seen as a breach of contract.
Documentation and Communication: Clear documentation of why new patients are not being accepted (e.g., capacity limits, necessity to maintain quality of care) provides a strong defense if questioned by a health plan or regulatory body.
3. Patient Access and Equity
Impact on Patient Access: This approach should be managed to ensure that it does not systematically deny access to care for certain groups. Equal treatment and nondiscrimination are crucial.
Communications with Patients: Transparent communication with potential new patients about why they cannot be accepted at a particular time helps maintain trust and understanding, mitigating the risk of complaints.
4. Market and Competitive Impact
Non-competitive Behavior: By framing the decision as a measure to ensure quality care rather than an attempt to manipulate market dynamics or protest specific administrative policies, the action is less likely to attract antitrust scrutiny.
Review of Practice Impact: Regular review of how this policy affects the healthcare market and access to care can help ensure that it remains justifiable and ethical.
5. Professional and Peer Perception
Community Standards: Aligning actions with widely accepted medical and professional standards, and possibly discussing these practices in professional forums or with peer groups, can help validate the approach and ensure it is in line with community norms.
6. Long-term Sustainability and Strategic Planning
Sustainability: Carefully managing patient load to ensure sustainable practice operations helps prevent provider burnout and service degradation over time.
Strategic Acceptance of New Patients: Developing a strategic plan for gradually increasing capacity or managing patient intake can help balance provider well-being with community healthcare needs.
7. Legal and Regulatory Compliance
Compliance Review: Continually reviewing legal and regulatory compliance, especially in relation to healthcare access laws and patient care standards, is vital. This includes ensuring that any policies about patient acceptance do not inadvertently violate laws concerning patient discrimination or access to care.
By redefining an “ethical boycott” and "soft boycott" in appropriate terms, the emphasis shifts more toward ethical practice management and away from the potentially contentious issues of market manipulation or direct protest against Healthplans. This framing nearly eliminated legal risks and focuses the risk on the consequence of failing to uphold the quality of patient care, patient safety, and aligning providers actions more closely with their fundamental professional obligations.
DISCLAIMER and PURPOSE: This discussion document is intended for training, educational, and or research purposes only. The information contained herein is based on the data and perspectives available at the time of writing. It is subject to revision as new information and viewpoints emerge.
For more information see: https://www.mentorresearch.org/disclaimer-and-purpose