Competitors & Conflicts of Interest on the Medical Staff Competitors & Conflicts of Interest on the Medical Staff Charlotte Jefferies Horty, Springer & Mattern Be Sensitive to, and Manage, “Conflict of Interest” Situations! 1
Competitors & Conflicts of Interest on the Medical Staff 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 2
Competitors & Conflicts of Interest on the Medical Staff 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. 3
Competitors & Conflicts of Interest on the Medical Staff Conflicts of interest are inherent in all human relationships. Conflicts of interest are inevitable on every Medical Staff! 4
Competitors & Conflicts of Interest on the Medical Staff 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 or reasonably appear to impair independent, unbiased judgment in the discharge of an individual’s responsibilities to patients, institution and/or profession. Charlotte Jefferies 5
Competitors & Conflicts of Interest on the Medical Staff In a profit-driven capitalistic society, the typical motive for COI is usually related to financial considerations. In medicine, decision-making is often made in best interest of: • physician • hospital • third-party payor • government 6
Competitors & Conflicts of Interest on the Medical Staff 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 7
Competitors & Conflicts of Interest on the Medical Staff 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 8
Competitors & Conflicts of Interest on the Medical Staff 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. 9
Competitors & Conflicts of Interest on the Medical Staff Safeguards 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 Minutes should reflect the individual with the COI left the meeting before discussion and did not vote. 10
Competitors & Conflicts of Interest on the Medical Staff Additional Practical Tips No staff member has a RIGHT to demand recusal – within the discretion of leadership Additional Practical Tips Choosing to refrain from participation is not a finding of actual conflict! 11
Competitors & Conflicts of Interest on the Medical Staff Routine disclosure of potential COI should be a basic inherent ethical responsibility. 12
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