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Learn MoreThis blog post is the first of three examining a recent high-visibility conflict of interest (COI) problem at a major national cancer research institution, with lessons for healthcare organizations about avoiding similar compliance problems.
Avoiding and preventing conflicts of interest is an important focus of healthcare compliance. Unknown and undisclosed conflicts can threaten an institution’s tax-exempt status, reputation, research funding, and most importantly, patient safety. They can also undermine the valuable trust that a patient must have in his or her healthcare provider and the institution where care is being received. The uproar over a recent COI lapse at the executive level of Memorial Sloan Kettering Cancer Center, a preeminent New York research hospital and institution, underscores just how important COI prevention can be. The resulting scandal may help end the common, questionable situation where leaders at prominent healthcare educational and research institutions also have been affiliated with private healthcare companies, whether as members of corporate boards or advisers.
What Happened at Memorial Sloan Kettering?
The COI issue at Memorial Sloan Kettering occurred at the highest level of the organization. Dr. José Baselga, the organization’s chief medical officer, failed to report his extensive healthcare and pharmaceutical industry relationships in conjunction with the numerous research articles he has published during the past decade. This lapse was brought to light in an article by The New York Times and ProPublica that uncovered how “Dr. Baselga had received millions of dollars in consulting fees and in ownership interests in health care companies, but had often failed to disclose those ties in appearances at scientific conferences and in journal articles. His reporting failures included articles in prestigious publications like The New England Journal of Medicine and The Lancet as well as in Cancer Discovery, a journal for which he serves as one of two editors in chief” (Thomas, K. and Ornstein, C., 2018).
In addition to these lapses, Dr. Baselga was a board member of cancer drug-maker Bristol-Myers Squibb, as well as Varian Medical Systems, a seller of radiation equipment for cancer treatment. He is known to have received “nearly $3.5 million in payments from drug, medical equipment and diagnostic companies from August 2013 through 2017, according to Open Payments, a federal database that tracks payments to physicians from health care companies.” In the aftermath of these disclosures, Dr. Baselga resigned from Memorial Sloan Kettering, as well as from the boards on which he served.
As reported more recently in The New York Times, Dr. Baselga was asked to resign as editor of the medical journal Cancer Discovery, which is published by the American Association for Cancer Research. The organization stated that “he did ‘not adhere to the high standards’ of conflict-of-interest disclosures that the group expects of its leaders. Some of his omissions involved articles that were published in Cancer Discovery while he was an editor-in-chief” (Thomas and Ornstein, 2019).
Managing COI Risk
Regulatory compliance requires that healthcare organizations secure annual conflict of interest disclosures from physicians, APPs, board members, and hospital leaders at the director level and above. Why are these disclosures important? Perhaps a physician is involved in the decision process about selecting and purchasing a medical device for use in a hospital. It is important to know that the doctor is making his recommendation as the best possible choice. Or, did he make it because he receives speaking fees from the device’s manufacturer? The goal here is to remove any question about influence on this decision that would challenge its being made in the best interest of patients only.
Effective disclosure about any possible conflict of interest requires a thorough questionnaire to guide discernment of any conflicts. The questionnaire must walk individuals through all their relevant business relationships, revealing the potential for COI. Conflicts must then be reported on a disclosure form.
Not All COIs Result in Biased Decision-Making
A conflict of interest exists when a person could derive personal benefit from actions or decisions that he or she makes in an official capacity. According to Bill Sacks, co-founder of HCCS, “Relationships among physicians, hospitals and the medical industry are important. Industry contributes to medical education, funds clinical trials, and provides medications for the indigent. In short, they support the teaching, research and clinical missions of academic medicine.”
In the case of Dr. Baselga, it was reported in early January that he has been hired by the British-Swedish pharmaceutical giant AstraZeneca to lead research and development in oncology, as part of the company’s expansion in cancer treatments (Thomas and Ornstein, 2019).
References
Thomas, K., and Ornstein, C., “MSK Cancer Center Orders Staff to ‘Do a Better Job’ of Disclosing Industry Ties,” The New York Times, September 9, 2018, Retrieved at https://www.nytimes.com/2018/09/09/health/cancer-memorial-sloan-kettering-disclosure.html.
Thomas, K., and Ornstein, C., “Top Cancer Doctor, Forced Out Over Ties to Drug Makers, Joins Their Ranks,” The New York Times, January 7, 2019, Retrieved at https://www.nytimes.com/2019/01/07/health/baselga-sloan-kettering-astrazeneca.html.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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