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• W3210139573 abstract "Dear Dr Dermatoethicist: I prescribe medications through an online pharmacy that compounds topical medications and distributes directly to patients providing access to reasonably priced treatments not covered by insurance. The pharmacy has offered compensation for time spent entering patient information into their portal. If I opt-in, they will provide a $10 “data entry fee” for each new patient. What are the ethical implications of accepting this payment?—A Concerned Dermatologist Dear Dr Dermatoethicist: I prescribe medications through an online pharmacy that compounds topical medications and distributes directly to patients providing access to reasonably priced treatments not covered by insurance. The pharmacy has offered compensation for time spent entering patient information into their portal. If I opt-in, they will provide a $10 “data entry fee” for each new patient. What are the ethical implications of accepting this payment? —A Concerned Dermatologist Dear Concerned Dermatologist: Accepting payment for “administrative data entry” has ethical considerations involving beneficence, transparency, and nonmaleficence. Physician-industry relationships are ubiquitous in medicine, ranging from lunches to multimillion-dollar research grants.1Rosenbaum L. Conflicts of interest: part 1: reconnecting the dots-reinterpreting industry-physician relations.N Engl J Med. 2015; 372: 1860-1864Google Scholar Reducing the bias introduced by these relationships is essential for objective patient care. Any compensation by pharmacies could prejudice prescribers, and therefore, is inherently unethical. Physicians may be inclined to prescribe from this pharmacy for monetary gain, without regard for optimal therapy for the patient resulting in a breach of beneficence. By declining payment, you eliminate any external perception that financial benefits are influencing decision-making. Notably, the pharmacy states that payment acceptance is optional and only intended to compensate for the time spent performing administrative tasks for new patients by clinical staff. Physicians will not receive payments for individual prescriptions; payment is intended solely as administrative compensation, not to bias management decisions. Disclosing any potentially perceived conflicts of interest will ensure that patients feel they are receiving unbiased care. If physicians do not disclose their professional financial interactions, distrust may undermine this relationship. Patients may believe that financial incentives, rather than patient well-being, are guiding physician decisions. Physicians experience professional burnout due in part to the burden of administrative tasks.2Shanafelt T.D. Hasan O. Dyrbye L.N. et al.Changes in burnout and satisfaction with work-life balance in physicians and the general US Working population between 2011 and 2014.Mayo Clin Proc. 2015; 90: 1600-1613Google Scholar,3Rao S.K. Kimball A.B. Lehrhoff S.R. et al.The impact of administrative burden on academic physicians: results of a hospital-wide physician survey.Acad Med. 2017; 92: 237-243Google Scholar Additional administrative requirements may deter physicians from using this pharmacy, despite the convenience, effectiveness, and affordability of the medications. Mounting clerical obligations may harm patients, as physicians are required to devote more time to these tasks, diverting time and focus from direct patient care, which could result in a breach of nonmaleficence. The burden of administrative tasks decreases revenue and may negatively impact patient care.4Dunn A. Gottlieb J.D. Shapiro A. Sonnenstuhl D.J. Tebaldi P. A denial a day keeps the doctor away. NBER Working Paper 29010.https://users.nber.org/∼jdgottl/BillingCostsPaper.pdf or https://bfi.uchicago.edu/wp-content/uploads/2021/07/BFI_WP_2021-80.pdfDate accessed: October 24, 2021Google Scholar By offering payments for the time spent fulfilling these requirements, the online pharmacy acknowledges and attempts to offset this incumbrance. An alternative would be for the pharmacy to offer patients the option to either enter their information directly or provide the “data entry fee” to the physician's office to enter it on their behalf, creating transparency and alleviating the physician's administrative burden. Compensation to physicians for clerical tasks seems fair and appropriate. However, disclosing potential conflicts of interest to patients is essential to the integrity of the physician-patient relationship. The patient's perspective is vital. Any financial reward from a pharmacy may bias medical decision-making, including prescribing practices, breeding patient skepticism and weakening the physician-patient relationship. An alternative option is for the pharmacy to offer a charitable donation on behalf of the provider in lieu of direct physician compensation. Disclose this administrative payment to the patient if accepted. Even if your practice is unaltered by this payment, the perception of bias may undermine the physician-patient relationship, which ultimately takes precedence. —Dr Dermatoethicist None disclosed." @default.
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• W3210139573 date "2022-04-01" @default.
• W3210139573 modified "2023-09-23" @default.
• W3210139573 title "Kickback or compensation? The ethics of accepting payment for administrative tasks from pharmaceutical companies" @default.
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