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Physician Conflicts of Interest
Recent studies have focused an intense light on two conflict-of-interest areas for physicians and one common sense solution for both — simple disclosure.
Data from a University of Michigan Health System study released in April 2010 found that physicians with investments in outpatient surgery centers perform on average double the number of surgeries as those who do not have such business interests.
The study points out that in such a scenario — where doctors have a stake in a surgical facility — they profit from their services, the services of the surgical center, and increases to the facility’s value over time as the business matures. The concern is that surgery-center physician owners are, either consciously or subconsciously, more apt to recommend a surgical procedure due to their financial bottom line.
While study author John Hollingsworth, M.D., M.S., a Robert Wood Johnson Clinical Scholar from the University of Michigan Medical School, pointed to numerous advantages of physician-owned surgical center for both patients and doctors, he also called for more scrutiny of study implications and suggested that lawmakers consider requiring physicians to disclose any surgery center financial stake to patients.
Influencing an Industry
In the same vein, September 2010 study findings concerning health industry influence on medicine and medical journal content found that only five of 32 physicians who received at least $1 million from medical device makers in 2007 revealed the financial connection in their published medical journal writings the following year. In such instances, the issue is the potential persuasive powers of journal content on the medical community linked with the possible bias of the writer.
As was the case with the surgery center study, this study’s author — David J. Rothman, professor and president of the Institute on Medicine as a Profession at Columbia University — pushed for full disclosure. In fact, Professor Rothman and Dr. Hollingsworth are not alone in this school of thought. The majority of Congress also favors funding visibility, as evidenced in the health care reform act’s Sunshine Provision. Per this stipulation, payments from medical manufacturers to qualifying physicians and teaching hospitals are required to be reported to the U.S. Secretary of Health and Human Services and made publicly available via a website. Steep penalties are in place to thwart noncompliance.
In this era of enlightened health care consumers and sunshine provisions, how can physicians avoid the appearance of impropriety? Perhaps the most prudent posture is adopting a practice of disclosure sooner rather than later.
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Here are recently received perspectives on other topics from the MDNews.com inbox:
About U.S. Secretary of HHS Kathleen Sebelius’ Message to Health Insurers
[From “Sebelius and Berwick Deliver Messages to Health Insurers”]
I think Secretary Sebelius is dreaming when she speculates that the reversal of “cost shifting” is going to favorably impact premiums since there will be less need for cost shifting when fewer uninsured patients receive care. The free market forces have been neutralized long ago in health facility reimbursement as a result of contracted prices whether private insurance or any of the government plans. So, the little positive effect of using the cost-shifted dollars built into the fees will quickly be absorbed into the operating and capital budgets of large health facilities.
The only way we will see decreasing pressure on premiums will be to decrease total care provided — fewer visits, scans, lab studies, etc. — per population. And that is very unlikely to occur for a number of reasons, including the “entitlement” mentality we have created in each successive generation, advancing life expectancy, better technology with better results, and the ever-present defensive medicine when concerned about malpractice suits.
More mandates and the threat by Secretary Sebelius about having “zero tolerance” for unnecessary premium increases just further interferes with the free market system. Basically, Medicare made a promise 45 years ago to cover the health care of seniors. Several other programs have been added, and the original strategy to cover the cost is now inadequate. So, the promise needs to be pared down (no one wants that), or we have to accept “it is going to cost whatever it costs;” so quit making a big deal about how it compares to GDP, etc. Either accept that the best care in the world comes with a price tag or decrease the promise of what is going to be provided. — Anthony Johnson, M.D., President and Managing Partner, Jervey Eye Group, P.A., Greenville, SC
And Another Thing: Electronic Health Records
The comment by Jim Diegel [from the AHA Summit Voices: Implementing EHR video clip] deserves further discussion. EHR is expensive, it is very unforgiving when it comes to inter-connectivity, it does not speed patient throughput, does not increase revenue, and likely does not improve safety, although that is difficult to measure. It can increase liability when the plaintiff's attorney sees the templates that look identical for several patients with very little unique information force typed for a particular record. There is much misinformation about EHR, and the flames are further fanned by the carrot that someone is going to help pay for this with the stimulus money. If the right system is not out there that interconnects, is affordable, is reliable, and the company sustainable, then it does not matter who pays for it...it is still a bad buy! Buying and implementing the wrong system is way worse than no system at all, even if it costs 1 to 2% penalty from Medicare. — Anthony Johnson, M.D., President and Managing Partner, Jervey Eye Group, P.A., Greenville, SC