How to leverage industry relationships while avoiding risks

March 6, 2019
Robert A. Dowling, MD
Volume 47, Issue 3

In this article, Robert A. Dowling, MD, examines some common issues in the office pertaining to industry reps and some possible solutions.

When I was in training many years ago, a major pharmaceutical company sponsored a trip for senior residents from urology programs across the country-usually to a nice resort. The company understood the value of forming relationships with physicians early in their professional career, and this meeting probably helped develop loyalty among future prescribers.

The relationship between physicians and industry has certainly changed since then, and there is persistent academic and regulatory interest in whether these relationships are always proper and influence prescribing habits (Ochsner J 2015; 15:403-4; bit.ly/industryrelationships). The Open Payments program (www.cms.gov/openpayments) has introduced new transparency into payments to physicians, and as I have written in the past (“CMS data breaks down industry payments to urologists,” August 2018, page 34), the amount of dollars being reported per individual urologist is quite small-but may not tell the whole story.

The AUA has outlined principles to guide its members on interactions with industry (bit.ly/industryprinciples). Yet while the rules of engagement have become stricter, pharmaceutical companies continue to fund important clinical research, sponsor educational meetings not tied to their product, and try to develop direct customer relationships to build loyalty. While much has changed, much remains the same, especially in the area of pharmaceutical representatives in your office. In this article, I will examine some common issues in the office pertaining to industry reps and some possible solutions.

Also by Dr. Dowling - Cybersecurity: How to safeguard your practice against threats

Drug samples. Pharma reps use samples to get access to physicians and influence prescribing habits (PLoS Med 2007; 4:e150). Urologists value drug samples because they can start treatment immediately at no cost, test how a patient will tolerate a drug, and give their patient a free present.

Samples create a liability for recordkeeping, inventory control, and patient safety. Consider the recent nationwide recall of a common blood pressure medication due to a cancer-causing impurity (bit.ly/medicationrecall). Would your practice have been able to easily identify all of the patients who had been given a sample of, say, an overactive bladder medication? By lot number?

Best practices in this area include:

  • Always enter the medication into your electronic health record, which will then perform important safety checks like drug-drug, drug-disease, and drug-allergy interactions as well as populate the patient’s medication list.

  • Enter the lot number of any medications injected, administered, or sampled in the office-so the patient can be identified by lot number in the event of a recall.

  • Provide the patient with printed instructions, warnings, and other information just as they would receive if they went to a retail pharmacy.

  • Maintain an inventory log of samples, control access to those samples, and dispose of expired medications.

If you aren’t willing to follow these best practices, maybe it is time to consider whether the value of samples to your patients and your practice is worth the liability.

Education. It is important to acknowledge that there is a role for industry-sponsored education of physicians, and that many busy urologists receive some or even most of their knowledge about new procedures, products, or new indications from industry sources: sponsored meetings, manufacturer’s websites, prescribing literature, or even pharmaceutical salespersons and “leave behinds.” Those same reps may be the sole source of training and education on new products for your clinical staff and assistants. Some device manufacturers separate the role of sales and training of physicians, and until recently a different set of rules characterized relationships between drug and device manufacturers and their physician customers.

Best practices in this area include:

  • Do not finish your education of novel therapies and treatments with sales materials, but possibly begin there.

  • Do not challenge pharmaceutical representatives about the accuracy of their claims-they likely know more than you do about any research that supports their product; supplement the information targeted at you with continuing education from an objective source.

  • Supervise any education of your clinical staff and keep them aligned with your prescribing patterns and habits, minimizing the chance that your patients will hear different messages from you and your staff.

If you follow these best practices, you can realize the advantage of industry-sponsored education and avoid the pitfalls that could affect your professional practice.

Next:Privacy, schedulingPrivacy. Most urology offices were not designed beyond the requirement for patient care, and many were not built to accommodate growth in volume and staff. The conditions are ripe in many practices for conversations to be overheard, for bystanders to be exposed to personal information, and even for proprietary information to be shared unintentionally.

A vendor representative is frequently a repeat guest who knows your front staff, brings food, and is welcomed through the reception room door into a busy corridor or checkout area where he or she is exposed directly to protected health information and the inner workings of your practice. Most are honest professionals who want to build trust and understand the sensitivity of the business of urology, but they are guests. They are not usually bound by a confidentiality agreement with you, and they may also call on your referral sources, competitors, and local hospitals and health systems.

Read: What 2019 MIPS changes mean for your practice

In some cases, physicians may also develop a relationship outside of the office with a sales representative who is a neighbor, parent at your child’s school, or on the same sports team-sharing even personal information.

Best practices in this area include:

  • Meet with industry outside of the clinical care area, and avoid exposing them to patients or their records altogether.

  • Do not discuss any proprietary information with a guest; for example, how many patients you see, whether you are successfully getting reimbursed by a payer, or where your referrals come from or go to.

  • Have industry representatives who may be exposed to proprietary information sign a confidentiality agreement, just as a third party who handles protected health information must sign a business associates agreement.

If you respect the privacy of your patients, your staff, and yourself, you will enjoy the professional respect of industry reps.

Scheduling. Urology practice policies regarding industry rep visits range from completely open access to no access, and in a group there are often a range of preferences by individual physicians. In some practices, it may be easier for an industry rep to see a physician than it is for a patient! Sales representatives do not want to be perceived as an interruption in the busy day of a physician, and they prefer more than a 30-second pitch in the hallway-but given a choice they prefer random access over no access.

Best practice is to schedule meetings with industry representatives-just as you do with patients, hospitals, vacation, or any other block of your valuable time. You are actually doing a service to everyone involved by setting an expectation and being predictable. As this practice becomes more common, if you do not schedule meetings, you are the exception.

There is at least one vendor in this space-RxVantage (www.rxvantage.com)-that offers a platform that includes a rules-based shared scheduling module, on-demand messaging application (to request samples, for example), patient assistance module, and more. Most of the major manufacturers participate in RxVantage, it is paid for by the Pharmaceutical Research and Manufacturers of America, and is free to practices. Lunches and other meetings can be scheduled months or even years in advance, and according to rules set by the practice.

 

Bottom line: It is possible to leverage the advantages of relationship with industry while avoiding the risks. Take a look and see whether you need to make some changes to keep the relationships valuable, compliant, and professional.

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