Deeper Than the Headlines: Conflicts of Interest

When you discuss the compliance aspect of conflicts of interests with physicians, if it’s anything like my experience, it might go something like this:

Compliance Officer: "Dr. X, I am just following up on the completion of your annual conflicts of interest disclosure statement and I..".

Dr. X: "Let me stop you right there, I don’t have any conflicts and I am bothered that this institution would question my integrity with this annual annoyance…"

Not all physicians react this way, but conflicts of interest (COI) discussions just seem to be more sensitive of a topic than other compliance topics such as billing or HIPAA.

Part of the reason, in my opinion, that this subject wasn’t really covered much in medical school or residency from a standard of medical care perspective.

Well, the Journal of the American Medical Association (JAMA) has devoted its May 2, 2017 issue to the topic (May 2, 2017. Vol 317. No. 17. Pages 1707-1812). For you compliance folks who have struggled to have conversations with physicians about COI, you might this issue helpful. Some of the articles offer great ways to approach the subject. And it doesn’t hurt that this reputable medical journal has devoted such significant space to the topic.

For example, the opening paragraph of the Viewpoint piece of the issue by Dr. Harvey V. Fineberg, MD, PhD begins by trying to place a framework around why COI should matter at all to physicians:

"Preservation of trust is the essential purpose of policies about conflict of interest. Physicians have many important roles including caring for individual patients, protecting the public’s health, engaging in research, reporting scientific and clinical discoveries, crafting professional guidelines, and advising policy makers and regulatory bodies. Success in all these functions depends on others—laypersons, professional peers, and policy leaders—believing and acting on the word of physicians. Therefore, the confidence of others in physician judgment is of paramount importance. When trust in physician judgment is impaired, the role of physicians is diminished.”

For years now, the transparency (e.g., “Sunshine”) initiatives among both the state and federal government that surround the sharing of data, and transfers of value from industry to physicians, has been raising awareness about COI. This “Sunshine” trend has become a significant movement that appears to be staying for the long-haul.

Any of us can look up what our personal physician has accepted by way of transfers of value (see here). To be fair, just because a transfer of value occurred, doesn’t automatically mean something nefarious is going on, but the point is the patient should have sunshine, or transparency, on the transactions so they can decide for themselves.

Medical students, too, have been on this band wagon for years. Their “Just Medicine” campaign encourages medical schools to be free of financial or other transfer of value-type influences on faculty and hospitals associated with medical schools. They even have a grading function, where they rank or grade various medical schools’ policies in these matters.

Many times, people shrug off any concerns about the smaller payments. One of the articles in the JAMA issue tries to address this. It cites a study that tried to assess the effect that even small value meals could have on the prescribing habits of physicians. The study reviewed a total of 279,669 physicians and 63,524 payments associated with 4 drugs. Ninety-five percent of the payments were for meals, with a mean value of less than $20. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing the drugs. Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates. The study concluded that receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted and that the findings represented an association, not a cause-and-effect relationship.

While COI is likely to remain a sensitive topic for compliance officers, society and regulators are focusing more and more on COI compliance. And COI is an area where even if you’re not being audited or investigated by a government agency, the press and reputational damage can almost be worse. COI is a good example where compliance officers are helping the organization manage reputational risk. If you haven’t reviewed your COI policies and procedures in a while, you should consider doing so. And probably more importantly, you should actually be auditing those COI disclosures against publicly available data. It’s better than you know about any financial ties or disclosure discrepancies before the local newspaper or investigative journalist do.