Relationships and Compliance
By Anu Bajaj
This post originally appeared on PRSonally Speaking, the official blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons.
I read with interest the editorial summarizing the compliance summit. At the end of the article, the authors’ state that most plastic surgeons in private practice don’t quite understand the implications of the federal anti-kickback statutes…I would have to agree…. I don’t understand them completely and what they mean for me on a day-to-day basis. When exactly are we, as surgeons, breaking the law? Are we supposed to interpret the rules in the strictest sense and not have any dealings with industry? Or can we maintain the relationships that we have developed? What is permissible?
The first example in the article of a speaker discussing off-label use of a product doesn’t directly apply to most of us. The reality is that most of us – meaning surgeons in private practice — aren’t consultants or paid speakers for drug or device companies, but we do partake in the educational opportunities offered by many companies and may solicit their support for educational activities – money is tight for everyone, and state, local, and national societies depend on industry support for some events. Is this support still allowed? Each company has a different interpretation of the rules and of the type of support that it can legally provide, confusing the issue even more.
Many of our interactions with industry representatives are also on a much more basic level and are related to our personal relationships with people. To a certain degree, we have cultivated these relationships with industry for many reasons, and we have done so since very early in our training. As residents, many of us remember trying to coordinate grand rounds and journal clubs – there was almost always a rep who was willing to sponsor and provide some food – a real treat for cash-starved and time-starved residents. My understanding is that in most academic centers, this type of sponsorship for the residents is no longer allowed.
Once we started practice, we continued to develop those relationships. Some companies had start-up or new practice programs so that we could purchase implants at a discounted price – an important thing when you have no cash flow. And occasionally we may speak with a sales representative to obtain a better, lower price on an implant or device for a specific patient? Is this allowed? Sometimes, we may even interact with our representatives socially. Everything is based on relationships – we rely on those relationships with reps to help our patients and us.
As I think about these rules, I do believe that they need to exist, but the rules have to be clearly defined. I would also hope for a consequence of these rules that would have direct benefit for our patients. That is, if companies spent less money trying to convince us to use their product – less money on meals, trips, and even lavish educational opportunities – it would be great if the cost to the patients of these products would decrease and reflect these savings. But I think that I’m dreaming.