The Danger of Healthcare Conflicts of Interest and How to Identify and Prevent Them
March 01, 2019
This blog post is the third of three examining a recent high-visibility conflict of interest (COI) problem at a major national cancer research institution, with lessons for other healthcare organizations about dealing with similar compliance problems.
The impact of a public conflict of interest scandal can be significant and damaging. In the case of Memorial Sloan Kettering Cancer Center in New York, The New York Times and ProPublica revealed in September 2018 that its medical director, Dr. José Baselga, had failed to disclose his substantial financial ties and involvement with corporate pharmaceutical companies related to appearances at medical conferences and in scientific journal articles of which he was part author. His lack of disclosure could strike one as questionable, given that in some instances his co-authors disclosed their own connected financial interests when applicable. Not only did Dr. Baselga end up resigning from Memorial Sloan Kettering, after first committing to make the appropriate article disclosures, but this scandal has widened to touch other executives at the organization and elsewhere in academic and research medicine.
As a result of this scandal, Memorial Sloan Kettering has announced a large-scale change in policy. Now, the institution “would bar its top executives from serving on corporate boards of drug and health care companies that, in some cases, had paid them hundreds of thousands of dollars a year” (Thomas & Ornstein, 2019). Other similar organizations are examining their own policies and are expected to follow suit.
Why a Change in Policy Is Necessary
Perhaps it is long overdue for leading healthcare institutions to admit that “When doctors enter into financial relationships with companies, the concern is that these ties can shape the way studies are designed and medications are prescribed to patients, potentially allowing bias to influence medical practice” (Thomas & Ornstein, 2019). By enacting their policy limiting the extent to which leading doctors can benefit financially for their work with private companies, Memorial Sloan Kettering has “intended to emphasize the hospital’s focus on education, research and treatment of patients” (Thomas & Ornstein, 2019) and get away from an unsavory image of leaders who were profiting in unethical ways as a result of their entanglement with the corporate healthcare industry. Not only is this meant to mollify the public; internal staff morale is also a concern. The New York Times shares that “Dr. Nadeem R. Abu-Rustum, who is president of Memorial Sloan Kettering’s medical staff, said the policy changes were “well-received” by employees” (Thomas & Ornstein, 2019).
Leadership Can Set the Tone for COI Compliance
The scandal at Memorial Sloan Kettering makes it obvious that healthcare executives have significant responsibility to their organizations when it comes to reporting and avoiding any conflict of interest. In a recent article, Bill Sacks, former Vice President of COI Management at HCCS, A HealthStream Company, writes that “the tone from the top of the organization, (usually the Dean or Chief Medical Officer) was one of the most, if not the most important determining factor in how seriously conflicts of interest were taken at an institution” (Sacks, 2019). He adds, “Even with high level support, the degree to which conflicts are taken seriously can depend on how evolved or mature a compliance program is” (Sacks, 2019). In addition to COI training for executives who may have never received it, Sacks advises “it is important that fair and reasonable policies are developed, in collaboration with the professional staff” (Sacks, 2019).
How to Manage and Improve Healthcare COI Compliance
Sacks offers the following advice for Improving COI Compliance:
- Use surveys and questionnaires, supplemented by the Open Payments Database, which contains information “about payments or other transfers of value between applicable manufacturers and GPOs and physicians or teaching hospitals” (CMS, n.d.).
- Google your physicians to identify compliance issues that have not been reported.
- Investigate leads from compliance hotlines and workplace rumors.
- Maintain an open door policy for the compliance office.
- Look for unusual prescribing patterns for pharmaceuticals or device use.
Remember that only a small percentage of financial relationships and reported payments are problematic. Sacks offers that “Most potential conflicts are addressed by the disclosure itself or by agreements for additional oversight” (Sacks, 2019).
CMS, Open Payments Data Overview, Retrieved at https://www.cms.gov/OpenPayments/Explore-the-Data/Data-Overview.html.
Sacks, B., “Where We Stand with Healthcare Conflict of Interest (COI) Compliance,” Retrieved at https://www.healthstream.com/resources/discovery-papers/articles/2019/01/18/where-we-stand-with-healthcare-conflict-of-interest-(coi)-compliance.
Thomas, K., and Ornstein, C., “Memorial Sloan Kettering Curbs Executives’ Ties to Industry After Conflict-of-Interest Scandals,” The New York Times, January 11, 2019, Retrieved at https://www.nytimes.com/2019/01/11/science/memorial-sloan-kettering-conflicts-boards.html?action=click&module=Associated&pgtype=Article®ion=Footer&contentCollection=Medicine%20and%20Conflicts