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December 22, 2010
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Re: gifting
New rules govern how faculty members must report and distribute personal gifts related to their school of medicine activities.

Suppose that a patient decides to say thanks to a faculty physician by handing over a cash-filled envelope. Maybe a potential donor offers use of the family’s vacation home. How should faculty members respond? This summer, the school of medicine, as part of its new Code of Professional Conduct for Faculty, approved policies governing how such personal gifts should be disclosed, handled and distributed. Starting Jan. 1, faculty will be required to visit eOPC, the online disclosure system, to report gifts valued at $2,500 and above. Change spoke with George Dover, chairman of Pediatrics, and Sheila Garrity, senior policy associate in the Office of Policy Coordination, to learn what this policy means to faculty.

What led to the policy?

DOVER: We learned that some faculty members were getting rather elaborate gifts—cash or in-kind—in lieu of payment for clinical services delivered outside of the Hopkins Health System. In the process, they were bypassing the clinical practice plan as well as institutional taxes, such as the dean’s tax, that apply to clinical income and charitable gifts. [These taxes are used for such purposes as administration, academic facilities costs and strategic initiatives.]

Did you have other concerns?

GARRITY: A gift implies access. If you as a patient give your doctor a Rolex watch, that doctor might just pick up the phone when you call, whereas the patient who doesn’t give a gift might not get the same treatment. Everyone should have equal access.

DOVER: Another issue is equal treatment of faculty. There have been certain faculty physicians who seem to be called on all of the time to see patients around the world. This enhances Hopkins’ reputation and does many positive things for the institution. However, other physicians have to cover for them in clinic. These cases can sometimes create the perception that there are special doctors around Hopkins who are allowed to cater to the carriage trade outside of their clinical services here.

What should faculty delivering care outside of Hopkins do?

DOVER: First, you have to get approval of your department director. Then, arrangements should be made for reimbursement for those services to come through the same channels, such as the Clinical Practice Association, as fees for seeing patients in a Hopkins clinic.

We have resources here to help faculty make these arrangements. For example, we would prefer that any overseas medical care be turned over to Johns Hopkins International, which has guidelines for what to charge for clinical services.

How would you advise faculty to respond if someone still wants to give a personal gift?

DOVER: You should decline, tell them that you’re very honored, and then direct them to a development officer. You might ask them to consider supporting your research or give money to a special fund that helps underprivileged children.

However, we know that in some cultures, it’s customary to provide gifts for services, and that not accepting a gift is considered an insult to the person offering it. So the policy didn’t explicitly forbid accepting personal gifts.

What types of gifts are not covered by this policy?

DOVER: Gifts from industry and vendors are already prohibited under other Hopkins policies.

A gray area is fundraising. If a potential donor gives us an expensive dinner or a weekend getaway, is that a gift? When this donor is present, it’s probably considered development and doesn’t fall under the gift policy. But if that person says, Take my beach cottage for a week, and they’re not going to be there, that’s a gift.

Will faculty members be allowed to keep personal gifts?

GARRITY: Gifts of up to $2,500 belong to the faculty member, who should report the money to the IRS as income. Anything in excess of that amount would be subject to the same institutional taxes that apply to any charitable gift. What’s left after those taxes are taken out will be distributed according to guidelines that each department will create and submit to the dean for approval. These guidelines can indicate what percentage of the remaining amount goes to departmental discretionary funds, to the faculty member, or to other clinicians who covered the faculty member’s practice while he or she was away.

How did you reach the figure of $2,500?

DOVER: It was the product of deliberations by the Advisory Board of the Medical Faculty. Our draft policy set the limit at $500, to make it clear that we wanted to discourage gifts. But the board had a very wide range of suggestions for what that threshold should be.

Will faculty need to report all personal gifts through eOPC?

GARRITY: No. Only gifts of $2,500 and above must be reported.

How should faculty determine the value of non-cash gifts?

GARRITY: They can use manufacturer’s suggested retail price, if it’s available. You can get a pretty good idea of the price of a Rolex watch, for example, by performing an online search. When that retail price isn’t available, faculty members are responsible for estimating a fair market value.

We’ve decided to value travel and entertainment gifts at $500 a day, whether it’s a vacation or tickets to the Super Bowl. While the true cost of these activities can vary widely, we realized that it could be cumbersome to calculate the value of travel for each trip, so we agreed upon a uniform dollar amount.

What has been the reaction to the policy?

GARRITY: It has been mixed. The Advisory Board of the Medical Faculty approved the code of conduct by a pretty clear majority. However, some department directors are concerned that they will lose faculty members due to what they term an inability to practice medicine overseas to supplement a salary that’s below market value.

George and I don’t agree with that thinking. We think that there is still a way to supplement income. For example, the fees that are negotiated for physicians by Johns Hopkins International make it well worth their while.

There really is not another reason to accept an envelope of cash or a gift. We just want to make sure that the process is transparent and that every faculty member is treated the same. There also are faculty members who are very pleased that there is a way to address these gifts. Some of these people are very uncomfortable accepting gifts, so now they have policy support to say no and put the person in touch with a development officer.

– Interview by Jamie Manfuso

To comment on this article, e-mail change@jhmi.edu.

 
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