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In a controversial move, earlier this year Cincinnati’s Queen City Physicians group told drug company representatives calling on the practice that it would no longer be accepting traditional company-sponsored gifts.
Instead, if a pharmaceutical firm wants to pitch its products to anyone in the 56-physician multispecialty practice, it would have to pay $65 for a 10-minute visit.
"Some doctors would like to have that information but don’t have two hours to go to a dinner meeting," explains Queen City internist G. Stephen Cleves, MD. "Rather than getting a free gift from a pharmaceutical rep, I’d personally rather see that money put to use to directly benefit the patient."
Under the group’s plan, drug representatives or their companies sign up for appointments through a for-profit company, Physician Access Management Ltd. It was set up by the practice, with the doctors wanting to participate in the pay-to-pitch program.
None of this money goes directly to individual physicians. Rather, Queen City plans to use this money to help finance a new $1 million computerized medical records system for the practice.
Under the American Medical Association’s guidelines on gifts to physicians, individual gifts "of minimal value" are permitted provided they are related to the physician’s work.
As such, modest meals and other gifts are appropriate if they serve a genuine educational function. Cash payments should not be accepted.
However, a fee-based system like Queen City’s strips the physician-drug representative meetings of any pretense, argues Frank A. Reddick, MD, chairman of the AMA’s Council on Ethical and Judicial Affairs.
"This is setting up a commercial relationship, and it might prove a refreshing approach in that it’s a straightforward transaction," says Reddick, an endocrinologist in New Orleans. "Whatever the pharmaceutical reps would have you say about their role, they have to admit it is a fundamentally a commercial one."
Leonard Nelson, a lawyer in the AMA’s health law division, is more cautious. While not saying the arrangement is illegal, he says this is a radical new approach that could tread on the border of the law. His worry is that once hard cash starts changing hands, some physicians might start wanting more money in exchange for their business.
Others note that drug companies spend an average of $1,500 on marketing per physician per year. That’s not chicken feed, but it’s certainly not enough to corrupt most providers.
"You’re not talking about astronomical amounts of money," observes Neil Carrey, a health care attorney with the Jenkens & Gilchrist law firm in Los Angeles. "But if innovative, it could make this whole marketing thing more upfront, not less, so that everyone — doctors, patients and the reps — end up winning."