The partnering of physicians and vendors has created and improved modern medicine. Collaborations have dawned new devices, systems, drugs, innovations and ways of diagnosing, treating and managing patients. Every day these advancements help to save and improve patient lives. But as we well know, partnership over the years also has overly feathered the pockets of some and bred a fair amount of fraud.
Rules on and scrutiny of relationships between industry promotion and clinical practice have elevated of late. Partnerships are much more defined.
When it comes to cardiology, an analysis of Open Payments shows that in 2015 some 75 percent of U.S. cardiologists received industry-related payments—representing the highest proportion within physician specialties, according to data published online May 2 in JAMA.
The Open Payments program was created by the federal government as part as the Affordable Care Act. The program requires pharmaceutical companies and group purchasing organizations to report all payments and ownership interests made to physicians starting in 2013. CMS manages the programs and makes the data available to the public.
The JAMA article reiterates the importance of rules.
“Although physicians may consider themselves committed to ethical practice and professionalism, many do not recognize the subconscious bias that industry relationships have on their decision making,” the researchers wrote. “Companies may preferentially market to profitable specialties such as cardiologists because these physicians influence the prescribing practices of nonspecialists. However, industry also appears to target and influence primary care physicians who accepted frequent low-value payments.”
The American Bar Association Health Law Section has some good questions for physicians to ask themselves prior to partnering with a vendor:
- Would I be OK if this agreement were on the front page of my newspaper?
- Would I be OK if this agreement were shared with my patients?
- Did I prescribe this drug/product to this patient before this arrangement was in place? Would I be doing it without the arrangement?
- If another physician looked at this medical record, would they agree that this product/service was medically necessary for my patient?
- Do you have to fulfill a quota of ordering/referrals to get paid or to get increased pay?
- Does the vendor's rep want to complete your ordering forms or CMNs? Is he/she medically qualified to do so?
Every rule has a reason and it is rules that interject reason into collaboration. We need to be sure collaboration continues with ethics as the great overseer.