The Association of American Medical Colleges recently released a new report focusing on identifying potential conflicts of interest in the academic medical clinic care world.
While academic medical center partnerships with the pharmaceutical industry are necessary for innovation that ultimately benefits patients, the financial implications can create “real or perceived” conflicts of interest when it comes to patient care according to the report.
It calls for academic medical centers to examine how they pay physicians and whether their compensation system influences physician patient care. The report also recommends ways to identify, assess, and disclose potential conflicts of interest and recommends that thresholds be set for reporting those interests.
The latest in an age-old debate
Patrick J. Brennan, MD, chair of the AAMC’s task force that authored the report, indicated that this is not just a problem for academic clinical settings.
In fact, it’s just the latest development in a decades-long debate about the relationships between the pharmaceutical/medical equipment industries and physicians across all settings.
A study published in the April 2007 New England Journal of Medicine showed that 94% of physicians reported having at least some type of financial relationship with the pharmaceutical industry—anything from free food to CME reimbursement . . . even paid consulting gigs.
And opinions range from insisting that even the acceptance of an ink pen will sway physician’s actions with patients to the view that physicians would never allow any type of financial relationship to come between them and their patients.
At the former end of the spectrum is the National Academy of Science’s Institute of Medicine, which called for a total abolition of physician/industry relationships that hold any potential to influence prescribing behavior.
The New Law
The Institute of Medicine was also a proponent of a new federal government-hosted website where pharmaceutical and medical device manufacturers would report payments made to medical industry professionals.
On that point, they got their wish. In March 2010, the Physician Payment Sunshine Provision was passed into law. It requires that pharmaceutical companies report every transfer of an item worth more than $10 if the total value transferred to a physician exceeds $100 annually. The recording will begin Jan 1, 2012 and reporting will begin March 31, 2013. A database is slated to be available to the public starting September 30, 2013 and updated every June after that.
Eli Lilly, Merck, Pfizer, and others have already started to voluntarily disclose payments to physicians. And several states have passed laws in advance of this legislation as well.
Does it really matter?
But how much do these relationships really influence patient care?
In its report, the AAMC had this to say: “Physicians treating patients insured by capitated (pay per patient) systems ‘appear’ more likely than those in fee-for-service models to restrict the volume of diagnostic services, referrals, and office visits. Unfortunately, the evidence does not clarify whether physician responses to these different systems are motivated significantly by personal financial considerations. Yet physicians have long expressed concerns about the impact managed care has on patient care, clinical autonomy, and practice income. The evidence, though, does not support clear conclusions.”
So the jury’s still out on that one.
I still believe, however, based on my experience that most physicians would make the right decision for their patients, no matter whether they stand to lose or gain financially by the decision.
However, this is not the overriding issue driving this train. It’s the perception of the patient—and in some unfortunate cases, the reality, too.
So what is the answer? There is no easy one. But yet the debate and the legislation are likely to continue to have real effects on physician income.
Overheard Thoughts