| 20. Dr. Jones believes that two treatments are of equal value to his patients. He chooses the one for which he will receive the higher reimbursement. |
| # | Response Date | Comment |
| 1. | Tue, 3/13/07 10:57 PM | on whether or not it is more expensive for the patient. |
| 2. | Tue, 3/13/07 11:07 PM | Is the the higher reimbursement procedure more detrimental to the patient in any way? Equal value does not mean equal patient ease. If the higher reimbursement tx. is more difficult for the patient in any way then a conflict of interest is present. |
| 3. | Tue, 3/13/07 11:29 PM | No conflict if the cost to the patient is the same. |
| 4. | Wed, 3/14/07 12:23 AM | Depends on overall cost to system. If the same or lower, no COI. If higher and attributable to the higher reimbursement to Dr. Jones, then moderate. |
| 5. | Wed, 3/14/07 2:23 AM | As long as there is no increased cost to the patient |
| 6. | Wed, 3/14/07 12:53 PM | on the value to the patient - if it was no more expensive and just as beneficial to the patient then ok - this is a systems based effect |
| 7. | Wed, 3/14/07 2:46 PM | Unethical, but not a COI |
| 8. | Wed, 3/14/07 2:56 PM | Are the costs to the patient/insurer the same or different |
| 9. | Wed, 3/14/07 4:48 PM | On the cost of the two treatments to the patient. If the cost to patient is equal, then there is no COI, but if the higher reimbursement treatment has a higher pt cost, then there is definitely a COI. |
| 10. | Wed, 3/14/07 10:10 PM | Is the patient part of this decison-making? (Including the cost/reimbursement discussion). If it is explicit and patient concurs theb this may be okay for the patient. |
| 11. | Thu, 3/15/07 8:19 PM | If the cost to the patient is the same for both,then it is ok. |
| 12. | Fri, 3/16/07 2:35 PM | This seems a COI, but sometimes insurance companies give incentives for prescribing the lower cost medication with higher reimbursement to the provider and no difference to the patient. |
| 13. | Fri, 3/16/07 2:39 PM | If the drug in which he receives reimbursement from is cheaper for his patients, that would be ok. |
| 14. | Sat, 3/17/07 6:47 PM | Does this come at a higher cost to the patient? |
| 15. | Sun, 3/18/07 6:34 PM | Depends on whether his patients will be affected by the cost (i.e. whether they can afford it). |
| 16. | Mon, 3/19/07 1:46 PM | on whether he discloses this to his patients. |
| 17. | Mon, 3/19/07 4:58 PM | A very serious COI. The treatment receiving higher reimbursement will almost invariably involve greater cost to the patient and is therefore a breach of ethics. The physican should explain both options to the patient, including the less expensive generic option, provide impartial information about efficacy, and leave the decision to the patient. |
| 18. | Mon, 3/19/07 5:30 PM | Did he have the higher reimbursement in mind? Does the higher reimbursement support those services that are inadequately reimbursed? |
| 19. | Mon, 3/19/07 6:55 PM | Shouldn't the patient chose? I guess it depends on the treatment. |
| 20. | Wed, 4/25/07 12:53 AM | if they are of equal cost to the patient, I don't have a problem with this |
| 21. | Sun, 4/29/07 9:23 PM | It depends on the impact on the patient. Dr Jones should choose the treatment that has the best balance between cost to the patient (physical, emotional, financial, etc) and benefit to the patient. If choosing the treatment with the higher reimbursement has the same impact on the patient as the one with lower reimbursement, then there is only a small-moderate COI based on the long term effects on insurance rates. |
| 22. | Tue, 5/8/07 3:29 PM | .... |