I was shocked at the sheer magnitude of the payments. They are excessive by any measureeven if a physician had a role in a products development. How could any physician receiving such an immense sum from a supplier retain objectivity in choosing a product? Even if doctors receiving these massive payments truly believed they were making purchasing decisions in good faiththat is, in the best interests of not only themselves as medical professionals but also of hospitals and patients as wellhistory has shown that even the most nominal of gifts can influence ones choices and loyalty.
And if a physician receiving lavish fees from a supplier is far more likely to use that suppliers products, it follows that a hospitalno matter how effective its group purchasing organization, or GPOis making purchasing decisions without the full information necessary to make the most objective decision possible. This unsettling dynamic is amplified by the fact that it is the hospital, not the physician, that pays for the products. Physicians must develop a greater sensitivity to and understanding of the cost implications of supplies, and should strive to be a partner to hospitals in obtaining the highest-quality products at the lowest prices.
This will be a difficult goal to achieve as long as exorbitant confidential payments exist, and hospitals will continue to pay top dollar for devices that may have no greater clinical value than a competitive, less-expensive product.
These difficulties highlight the critical importance of GPOs, especially at a time when so many hospitals struggle just to break even. GPOs help healthcare providers save hundreds of millions by aggregating purchasing volume and using that leverage to negotiate discounts with manufacturers, distributors and other vendors. They help balance the negotiating equation between purchasers and vendors. GPOs do not purchase or buy any products. Rather, and very simply, they help hospitals and other providers obtain the right products at the very best price, and confidential payments by suppliers to physicians compromise that unambiguous goal.
Fortunately, as the orthopedic-device makers settlement demonstrated, there is a growing movement toward greater transparency and disclosure. Hospital compliance programs requiring physicians to disclose payments made to them are one reason, and the medias increased focus on the issue another. In addition, several members of Congress recently introduced bills that would require manufacturers to disclose all payments made to physicians.
The GPO community strongly supports these developments. We believe that full disclosure would deter the most egregious payment arrangements and train a spotlight on ambiguous supplier-physician arrangements already in place. We urge physicians to consider how supplier fees may influence or simply appear to influence their judgment and objectivity.
A few years ago, most GPOs made the bold and correct decision to be transparent in their business practices and finances, and have taken a leadership role in eliminating conflicts of interest. I call upon the nations medical device companies to do the same by listing on their Web sites all payments to physicians, including training, in-kind services and consulting fees. Such an important step would greatly increase public confidence that clinical decisions are being made solely on the best evidence and information.
GPOs believe that transparency and disclosure are better for everyone in the healthcare community. Better for patients, better for physicians facing growing scrutiny and better for hospitals trying desperately to manage costs while simultaneously improving quality.