SVS: Academic providers shouldnt be exempt from transparency rules

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If employees at academic medical centers "don’t eat anything and tell everything" with regards to industry interactions, and will keep them out of trouble, said Julie A. Freischlag, MD, who explained that this is the catchphrase learned by Johns Hopkins after evaluating its industry policies, at a presentation at last week’s Society of Vascular Surgery (SVS) annual meeting in Boston.

After Johns Hopkins School of Medicine received a “D” for its policy on interactions with industry, Freischlag, who is chair of the surgery department at Johns Hopkins Hospital in Baltimore, said that the provider decided to revamp its set of policies.

“We also were motivated by the perception of trust from patients,” she said. “Because of media exposure, we need to foster a culture where all of us feel comfortable, including physicians, staff and students or trainees.”

Compared with their interaction and decision making with patients, healthcare providers have much more independence in their interactions with the medical industry, explained Freischlag, who added that some of these relationships remain important for patient care.

In fact, she credited the medical device makers and pharmaceutical companies with developing new therapies and technologies, as well as their assistance in deploying them. “We don’t want to eliminate these fruitful relationships, but we want to ensure they are clean as a whistle,” she said.

As part of its overhaul, Johns Hopkins posted its new policy on its website, including that employees cannot receive any gifts from industry. The only exception, according to Freischlag, is educational material, but even those cannot have too much promotional content.

Consulting has been the most complicated aspect for department chairs to track. “It’s not only how much our employees receive in compensation, but also how much time is being committed to this company, compared with how much time is being spent at the hospital or in the classroom,” Freischlag added.

Johns Hopkins eliminated food and meals either onsite or offsite. However, she noted that food can be accepted at certain programs if it is “modest and provided for everyone.”

Also, unrestricted gifts need to be filtered through a division chair or chair of a department, who determines where the money gets directed. Freischlag said that there are no limitations on the amount that can be donated to Johns Hopkins in unrestricted grants, and they get deposited into specified accounts. These grants can support faculty, staff, research and patient education. They also can be used for prizes and awards, as long as the funding originates from the unrestricted account.

“Industry now is learning that this is the proper way to donate to the provider setting,” she added.

Another large change that the facility undertook was the decision to stop the free sample handouts to patients, which was particularly hard in the free clinics, and for diabetics in those clinics.

Also, industry representatives can no longer be on Johns Hopkins campuses unless they are invited for the purposes of training and evaluation. “Their visit needs to be on a calendar. They can’t just drop by,” Freischlag added. “Also, invited reps can be present in non-patient care areas, or need to be supervised and properly credentialed to be in patient care areas.”

She noted that by keeping the patient at the center of why new rules should be undertaken, compliance is easier.

However, if someone breaks the “don’t eat/tell everything” policy, it is the department chair’s job to reprimand the individual; and if it happens, the case will be sent to a review board, where the action could be deemed professional misconduct, Freischlag concluded.

Having the policy clearly laid out for the employees can be as important as the policy, and therefore, Freischlag reported that she has never had to send one of her staff to the review board.