Capitation and Thought Leaders

Industry Insights from Paul Meade, M. Sc, MPH

Academic institutions across the United States are placing physicians affiliated with those institutions under an “industry capitation.” What this essentially means is that there are limits to what such physicians can accept from biopharmaceutical companies for services rendered to those companies.

In other words, a physician working with an academic medical institution can only accept a specified amount of remuneration from a biopharmaceutical company for participating in company-sponsored activities, such as advisory boards, speaking engagements, consultative sessions, and travel reimbursement to scientific conferences. Therefore, when an internationally renowned thought leader reaches that maximum allowable limit, he can no longer provide any consultative services for the company.

What’s next? Deciding how many automobiles a thought leader can personally own? Limiting the number of secondary residences a physician can purchase? Deciding which companies they are permitted to work with?

To be sure, an academic institution wants to establish some ethical rules for their affiliated physicians and have some reasonable assurances that these physicians do not compromise their objectivity by exhibiting a conflict of interest, especially one that appears in the front page of a nationally recognized newspaper. But where do you draw the limits? Who decides what the right amount of remuneration is for services rendered for a known thought leader interacting with a biopharmaceutical company?

As long as physicians do not compromise their objectivity and integrity, what does it matter how much consulting work is done for a company? Could the academic medical institutions be telling their thought leaders they simply do not trust them to make the right decisions on “how much is too much” money to take from a biopharmaceutical company, regardless of the services provided? Are institutions concerned that physicians might make too much money from a company even if these physicians believe what they are doing is for the greatest well-being of their patients? Perhaps there should be more stringent ethical guidelines and tests for objectivity administered by an academic institution rather than place an artificial capitation on the level of consultative remuneration.

So what is a thought leader to do? Use sophisticated tracking tools to monitor the amount of money received from all industry sources? And how does one decide what activities should be engaged in to optimize the capitation? Undoubtedly, many physicians simply decide it is easier to take no money at all than to try and keep a running total, and some may fear the wrath of their institution should they inadvertently exceed the capitation limit. And, of course, others have found a way around such restrictions by having industry funds come into a general education fund without any one person’s name associated with it.

I am reminded of an edict promulgated by the King of England several hundred years ago that decided to tax the wealthy by instituting a window tax, which was based on the number and size of windows in a given house. People continued to build large houses, but simply put fewer windows in them. Instituting rules and regulations that fail to get at the heart of the matter often end up being ineffective and ineptly enforced. As long as thought leaders maintain objectivity and follows sound ethical principles, they should be free to interact with the biopharmaceutical industry in an unrestricted manner.

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