Be Sensitive to, and Manage, Conflict of Interest Situations! 1 - - PDF document

Competitors & Conflicts of Interest

• n the Medical Staff

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Competitors & Conflicts of Interest on the Medical Staff

Charlotte Jefferies Horty, Springer & Mattern

Be Sensitive to, and Manage, “Conflict of Interest” Situations!

Competitors & Conflicts of Interest

• n the Medical Staff

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Change turning points:

• Military use of hospitals in WWII
• Hill-Burton Program
• Demise of charitable immunity
• Corporate liability theory
• Medicare and Medicaid programs

Change turning points:

• Civil rights movement
• Application of antitrust laws
• Demise of “learned physician”

exemption

• Prospective payment system
• Credentialing and practice evaluation

requirements

• Reporting and public access to reports

Competitors & Conflicts of Interest

• n the Medical Staff

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Change turning points:

• Employment of physicians
• Roles of non-physician practitioners
• Triple aim
• Payment reform demonstrations
• Technological explosions
• Mergers/consolidations

Health care is a combination of regulation and competition.

Competitors & Conflicts of Interest

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Conflicts of interest are inherent in all human relationships. Conflicts of interest are inevitable on every Medical Staff!

Competitors & Conflicts of Interest

• n the Medical Staff

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Definition of COI: A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.

Institute of Medicine

Personal interest that might impair

• r reasonably appear to impair

independent, unbiased judgment in the discharge of an individual’s responsibilities to patients, institution and/or profession.

Charlotte Jefferies

Competitors & Conflicts of Interest

• n the Medical Staff

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In a profit-driven capitalistic society, the typical motive for COI is usually related to financial considerations.

In medicine, decision-making is

• ften made in best interest of:
• physician
• hospital
• third-party payor
• government

Competitors & Conflicts of Interest

• n the Medical Staff

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Conflicts Are Inevitable

• Family member
• Partner
• Direct or indirect financial relationship
• Competitor
• History of conflict/acrimony
• Close friends
• Personally involved in care of patient
• Reviewed case at prior level
• Raised the concern
• Employment relationship/contract with hospital?

COI in dual role - professional and businessperson:

• Physician payment arrangements
• Self-referrals
• Physician ownerships
• Promotional activities
• Participation in industry-sponsored

clinical trials

Competitors & Conflicts of Interest

• n the Medical Staff

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Managing conflicts of interest is essential to:

• Be fair to the physician under review
• Protect integrity of the process
• Protect person with COI

Adopt Conflict of Interest Policy

Competitors & Conflicts of Interest

• n the Medical Staff

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Whenever possible COI should be raised and resolved before meeting.

Policy Should

• Require disclosure (“Sunshine Principle”)
• Authorize Chair (or committee) to resolve

dispute over conflict.

• Allow individual with a COI to

provide information.

Competitors & Conflicts of Interest

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 Committee Chair always has discretion

to recuse member in particular situation if the Chair determines that the conflicted member’s presence would:

 Inhibit the full and fair discussion of

the issue

 Skew the recommendation or

determination of the committee, or

 Otherwise be unfair to the practitioner

under review

Safeguards

Minutes should reflect the individual with the COI left the meeting before discussion and did not vote.

Competitors & Conflicts of Interest

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Additional Practical Tips

No staff member has a RIGHT to demand recusal – within the discretion

• f leadership

Additional Practical Tips

Choosing to refrain from participation is not a finding of actual conflict!

Competitors & Conflicts of Interest

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Routine disclosure of potential COI should be a basic inherent ethical responsibility.