Today, I was interviewed on CBS This Morning about whether the government’s Open Payments website should be delayed. This is part of the Physician Payment Sunshine Act that will provide public access to payments made to physicians by pharmaceutical and medical device companies.
Over the years, I have become
increasingly concerned about the harmful effects of financial conflicts of
interest on patient care. Dozens of studies have shown that financial relationships between doctors and
drug/medical device companies influence physician prescription practices.
My research on patient-centered
care also shows that patients are concerned about these potential conflicts of
interest and how they may affect their care. Our patients deserve to know how
their doctors are paid and whether this may affect them. The Sunshine Act will
provide much-needed, critical tools for increasing transparency and accountability,
and will help exert pressure to prevent inappropriate financial relationships
between doctors and industry in the future.
The Open Payments website
that will display the payments to doctors has already been delayed by more than
a year. Now, in light of some technical problems, physician groups including
the American Medical Association are arguing that there should be another
six-month waiting period. While it is important to provide doctors an
opportunity to review and dispute payments to them, this should not delay
timely release of physician payments data to the public.
The American Medical Association argues that inaccurate information could undermine trust. If
physicians want to improve trust, they can take a proactive approach and begin
conversations with patients. They can send out an email or letter clarifying their
affiliations with drug companies. They can participate in Who’s My
Doctor and explain their philosophy
publicly, online. They can have one-on-one conversations with those who have
questions. Such openness will only improve the doctor-patient relationship,
improve trust, and increase accountability.
For those doctors who truly
are ashamed of their payment history, perhaps they can reevaluate their
financial relationships. As former Supreme Court Justice William O. Douglas
said, “Sunlight is the best disinfectant.” The sunlight is available now.
Physicians and patients alike should embrace it,
now.
Parts of this post were part of an open letter I sent to Ms. Marilyn
Tavenner, CMS administrator, on May 27th 2014 with the subject of “Revision of a currently approved collection; Title of Information Collection: Registration, Attestation,
Dispute & Resolution, Assumptions Document and Data Retention Requirements
for Open Payments (CMS-10495).”
6 comments:
Financial conflicts of interest take various forms and can appear where one least expects them. One insidious development has been that they are camouflaged as 'quality improvement' incentives.
Medicine is being urged to move from a volume- to a value-based compensation system. A payor (CMS or private) decides to incentivize quality. A group of relatively arbitrary metrics are picked for ease of tracking from sometimes already obsolete guidelines. Institutions are either rewarded or punished financially based on how well they achieve 'targets' and then these institutions 'incentivize' their clinicians, rewarding or punishing them financially based on how many widgets they can sell to patients. In this case, the widgets are not office visits but mammograms,influenza vaccines, statins in diabetics, Pap smears, pneumococcal vaccines.
The goal of quality is hard to argue against, but the potential for conflicts of interest should be obvious. My often heated conversations with hospital management teams tells me they simply do not get it. Or perhaps, they are comfortable with clinicians acting like car salesmen.
Instead of seeing my role as educating my patients and helping them use the evidence, my clinical experience and their personal values and preferences to make an individual decision, I am being paid to convince them to buy what someone else thinks is best. If this undermines patient centered care or shared decision making, so be it.
I agree that sunlight is a fantastic disinfectant, which is why I have information posted in my exam rooms explaining that my institution pays me differently based on what my patients decide to do. (When I spoke up within our institution challenging the ethics of this form of P4P, I was punished fairly severely.)
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