Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence

Gonzales v. Raich, 545 U.S. 1, 31, 125 S. Ct. 2195, 2214, 162 L. Ed. 2d 1 (2005) (citing United States v. Moore, 423 U.S. 122, 96 S.Ct. 335, 46 L.Ed.2d 333 (1975);

United States v. Doremus, 249 U.S. 86, 39 S.Ct. 214, 63 L.Ed. 493 (1919)).

American Medical Association Code of Medical Ethics § 8.03, available at <http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.shtml>(last visited July 12, 2012) [hereinafter AMA CODE].

Ubel P. A. , “Commentary: How Did We Get into This Mess?” in Moore D. A. , eds., Conflicts of Interests: Challenges and Solutions in Business, Law, Medicine, and Public Policy (New York: Cambridge University Press, 2005): 142–151, at 143–149.

“The Association Between Physician Reimbursement in the US and Use of Hematopoietic Colony Stimulating Factors as Adjunct Therapy for Older Patients with Acute Myeloid Leukemia: Results from the 1997 American Society of Clinical Oncology Survey,” Annals Of Oncology 10, no. 11 (1999): 1355–1359 (finding that “reimbursement considerations are one of the most consistent determinants of use of” colony stimulating factors for treatment of leukemia).

Elliott S. P. , “Reduction in Physician Reimbursement and Use of Hormone Therapy in Prostate Cancer,” Journal of the National Cancer Institute 102, no. 24 (2010): 1826–1834 (finding that excessive use of androgen suppression therapy was reduced when the 2003 Medicare Modernization Act reduced reimbursement for such therapy).

Mitchell J. , “Urologists' Self-Referral for Pathology Of Biopsy Specimens Linked to Increased Use and Lower Prostate Cancer Detection,” Health Affairs 31, no. 7 (2012): 741.

Id., at 741.

Id.

Id., at 744.

For additional research examining self-referrals in the urology specialty see Tan H. J. , “Use of Ureteroscopy Before and After Expansion of Lithotripter Ownership in Michigan,” Urology 78, no. 6 (2011): 1287–1291 (finding that physician ownership of lithiotripters did not decrease utilization of the substitute procedure, ureteroscpy).

Hollingsworth J. M. Krein S. L. Birkmeyer J. D. , “Opening Ambulatory Surgery Centers and Stone Surgery Rates in Health Care Markets,” Journal of Urology 184, no. 3 (2010): 967–971.

Hollingsworth J. M. Ye Z. Strope S. A. , “Urologist Ownership of Ambulatory Surgery Centers and Urinary Stone Surgery Use,” Health Service Research 44, no. 4 (2009): 1370–1384.

Mitchell J. M. Scott E. , “Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics,” JAMA 268, no. 15 (1992): 2055–2059.

In another study, drawing from two surveys of physical therapists, Mitchell and Sass sought to explore two alternative explanations as to why physicians purchase shares in physical therapy providers – to control the quality of services provided to the patients they refer or to profit from the physician's ability to steer patients by artificially inflating demand for a particular provider. Mitchell J. M. Sass T. R. , “Physician Ownership of Ancillary Services: Indirect Demand Inducement or Quality Assurance?” Journal of Health Economics 14, no. 3 (1995): 263–289.

The researchers found that “a physical therapy clinic that receives all of its referrals from physician owners treats a patient for approximately 50 percent more visits than a clinic that receives no referrals from owners.” Id., at 285. Mitchell and Sass also observed that the differential is directly related to “increases in physician density, decreases in population density, and increases in the total number of owners,” which they argued were factors facilitating demand inducement.

Swedlow A. , “Increased Costs and Rates of Use in the California Workers' Compensation System as a Result of Self-Referral by Physicians,” New England Journal of Medicine 327, no. 21 (1992): 1502–1506.

Mitchell J. M. , “Do Financial Incentives Linked to Ownership of Specialty Hospitals Affect Physicians' Practice Patterns?” Medical Care 46, no. 7 (2008): 732–737.

Id.

Id.

Id., at 735.

Similarly, in a 2005 article, Iglehart offered a case study documenting the impact of the opening of a specialty hospital in Oklahoma, near a university hospital. Iglehart reports that “the number of inpatients admitted for cardiac care plummeted at the university hospital after 16 surgeons and cardiologists on the clinical faculty began to refer all their patients to the specialty hospital as soon as it opened,” resulting over $11.6 million in lost income for the university hospital over two years. Iglehart J. K. , “The Emergence of Physician-Owned Specialty Hospitals,” New England Journal of Medicine 352, no. 1 (2005): 78–84.

Gabel J. R. , “Where Do I Send Thee? Does Physician-Ownership Affect Referral Patterns to Ambulatory Surgery Centers?” Health Affairs 27, no. 3 (2008): W165.

Ellis R. P. McGuire T. G. , “Provider Behavior Under Prospective Reimbursement: Cost Sharing and Supply,” Journal of Health Economics 5, no. 2 (1986): 129–151.

See also, McGuire T. , “Physician Agency,” in Cuyler A. C. Newhouse J. P. , eds., Handbook of Health Economics (Amsterdam: North-Holland, 2000).

Rodwin M. A. , Conflicts of Interest and the Future of Medicine: The United States, France, and (Japan. Oxford: Oxford University Press, 2011).

Id.

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Institute of Medicine, Rewarding Provider Performance: Aligning Incentives in Medicare, Washington D.C., 2006.

See Flodgren G. , “An Overview of Reviews Evaluating the Effectiveness of Financial Incentives in Changing Healthcare Professional Behaviours and Patient outcomes,” Cochrane Database of Systematic Reviews, the Cochrane Library (2011);

see Mullen Frank Rosenthal , supra note 49, at 85;.

See Flodgren , supra note 51, at 2.

See Van Herck P. , “Systematic Review: Effects, Design Choices, and Context of Pay-For-Performance in Health Care,” Boston Medical Center Health Services Research 10 (2010): 247.

Serumaga B. , “Effect of Pay for Performance on The Management and, Outcomes of Hypertension in the United Kingdom: Interrupted Time Series Study,” Boston Medical Journal 342 (2011): D108;

see Scott , supra note 47, at 3.

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Alshamsan R. , “Impact of Pay for Performance on Inequalities in Health Care: Systematic Review,” Journal of Health Services Research Policy 15, no. 3 (2010): 178–184.

See Mullen Frank Rosenthal , supra note 49, at 85.

In addition to the foregoing sources, see Peterson L. , “Does Pay-for-Performance Improve the Quality of Health Care*?” Annals of Internal Medicine 145, no. 4 (2006): At 265–272.

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See also, Peay M. Y. Peay E. R. , “Innovation in High Risk Drug Therapy,” Social Science in Medicine 39, no. 1, (1994): 39–52.

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Halperin E. C. Hutchison P. Barrier R. C. Jr. “A Population-Based Study of the Prevalence and Influence of Gifts to Radiation Oncologists from Pharmaceutical Companies and Medical Equipment Manufacturers,” International Journal of Radiation Oncology, Biology, Physics 59, no. 5 (2004): 1477–1483.

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Peay M. Y. Peay E. R. , “The Role of Commercial Sources in the Adoption of a New Drug,” Social Science in Medicine 26, no. 12 (1998): 1183–1189.

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See e.g., Shreibati Baker supra note 15.

See Sohn S. , “Intrinsic Motivational Drivers in Medical Networks from a Neuroscientific Perspective,” Journal of Neuroscience Psychology and Economics 4 no. 3, (2011): 192 (studying physicians and finding four different primary motivational factors).

See supra notes 3–5.

For an analysis of this dynamic in the context of legal professionalism, see Bradley Wendell W. , “Nonlegal Regulation of the Legal Profession: Social Norms in Professional Communities,” Vanderbilt Law Review 54, no. 5 (2001): 1955.

See generally, Mechanic D. Schlesinger M. , “The Impact of Managed Care on Patients' Trust in Medical Care and Their Physicians,” JAMA 275, no. 21 (1996): 1693–1697.

See generally, Robertson C. T. , “Biased Advice,” Emory Law Journal 60, no. 3 (2011): 653.