99% Of Teaching Hospitals Lack Clinical Care Conflict Of Interest Policies
p>"If you were a hospital, or an ACO that was focusing on high quality, low-cost care, you're going to pick a really good partner because you don't want your patients getting infections or bedsores and you want them to have adequate professional staffing to accelerate the discharge process to home. But then what do you do about offering patients choices?
"The patients (or their families) may say 'No, I don't want to go there. I want to go to this facility that's only five minutes away from my daughter.' Patient choice will be the driver of that decision." What sorts of financial relationships should the doctor and hospital have to disclose then?
The Centers for Medicare and Medicaid Services requires that clinicians disclose to their patients any ownership or investment in a hospital, the report says. But disclosure that is commonly required is "frequently insufficient method of management."
According to one report, when research participants were told about financial interests of clinicians running a clinical trial, "some people may not have the baseline understanding necessary to judge the risks posed by financial interests, (a finding that calls) "into question whether simple disclosure to prospective research participants is an effective strategy, standing alone, for managing conflicts of interest in research."
The AAMC report says medical centers should take an additional step and adopt procedures that "call for explicit evaluation of relevant financial relationships" by an appointed committee which would determine if there is a significant conflict of interest, and whether it should be eliminated.
One institution's policy the AAMC included as an example calls for:
- Verbal disclosure to patient with documentation in medical record
- Corroboration by colleague of any prescription involving a product from the commercial entity
- Corroboration by colleague documented in medical record of any prescription involving a product from the commercial entity
- Appointment of an oversight committee to monitor practice patterns
- Transfer of patient care to another colleague
- Cessation or modification of relationship with commercial entity if necessary.
Enforcement of the policy is important as well. The AAMC report gives an example of how one hospital might take remedial actions if a conflict of interest can't be resolved such as:
- Suspend the faculty member's clinical privileges
- Withdraw the faculty member's professional liability insurance coverage
- Reduce the faculty member's salary or bonus
The task force also suggests that hospitals create transparent Web sites to disclose physician conflicts and financial relationships, and do so in such a way that is consistent and understandable.
In its seven recommendations, the AAMC report suggests that conflict of interest and transparency policies should extend to regional medical societies, as well as community practitioners outside of academic settings.
"Though the task force was charged with addressing clinical conflicts of interests only in academic medicine, it believes that the principles that have guided its work and that shape its report are applicable generally to the practice of medicine."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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