Diabetes Self-Management Blog

Here at Diabetes Flashpoints, we have discussed both how financial conflicts of interest among doctors may affect their behavior and what might be done to remedy the situation. Due to a provision in last year’s Affordable Care Act (“health care reform”), however, the landscape of payments and gifts to doctors is about to change.

Last week, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule, mandated by the Affordable Care Act, that will require pharmaceutical companies and makers of medical supplies and devices to report all payments and gifts to doctors and medical schools in excess of $10. According to an article on the proposed rule at MassDevice.com, the text of the rule states that “while some collaboration is beneficial to the continued innovation and improvement if our health care system, payments… can also introduce conflicts of interest that may influence research, education, and clinical decision-making.” After a comment period lasting until February 17, 2012, CMS plans to issue a final rule, after which companies will be required to begin reporting payments in a number of categories, including consulting or speaking fees, honoraria, gifts, entertainment, food, travel, education, or research grants. Companies must also report any royalties or license payments made to doctors and any “current or prospective ownership or investment interest” of a doctor in the company. Upon collection and review, CMS will make reported data available to the public.

Penalties for failing to report payments include a possible fine of $150,000 per year, or up to $1 million for knowingly concealing payments. As it notes in the proposed rules, CMS hopes that the new reporting requirement will lead companies to rethink some of their payments and gifts, lest a relationship appear inappropriate. Right now, however, it is unclear whether or how the new rule will change the behavior of companies and doctors. It is possible that some doctors and companies will rethink their relationships, while others will calculate that not enough of their patients pay attention to gifts and payments for these transactions to negatively affect their image. And, of course, whether a transaction is potentially corrupting is largely in the eye of the beholder.

What do you think — does this proposed rule go far enough in addressing potential conflicts of interest among doctors? Too far? When does a financial relationship between a drug or medical device company and a doctor become inappropriate, and when is it all right? Would you second guess a doctor, or not visit one, based on his or her financial connections to companies? Leave a comment below!

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