Conflict of Interest FAQs

FAQs: Conflict of Interest

• What is a conflict of interest?

  A conflict of interest arises when the PT’s professional judgment and decision making may be biased as the result of a competing financial interest (perceived, potential or real). Examples of conflict of interest are receiving or giving payment or gift cards for patient referrals.

  Be sure to have a quick look at the Conflict of Interest Standard.

  If in doubt, get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org.

• What should I do if a conflict of interest is unavoidable?

  There are three steps to take:

  1. Discuss and disclose the conflict with the patient before providing the service or product

  2. Make the patient aware of any other practical alternatives

  3. Document the discussion in the patient record

  Definitely have a good look at the Conflict of Interest Standard.

  Why not get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org?

• Can a PT use incentives to promote their practice?

  The College of Physiotherapists of Ontario does not have a specific rule about the use of incentives. Incentives may include things like discounts, rewards, gift cards, points programs or free parking or discounts for example. 
  
  If you are a physiotherapist considering offering incentives or the practice where you work is considering offering incentives, you should reflect on the following things before making a decision. 

   •  Your professional judgment should not be compromised when offering incentives. 
  
   •  You should only provide care that is clinically indicated regardless of whether an incentive is offered.

   •  The cost of the incentive cannot be added to the cost of the service / invoice which is then provided to a third-party payor 

   •  You must protect patients who are vulnerable to unethical business practices when offering incentives

  A conflict of interest of any kind (including the use of incentives) has the potential to compromise the trust that a patient has placed in their physiotherapist and, on a wider scale, the confidence that the public has placed in the physiotherapy profession. 

  Offering incentives comes with risks. When making the decision as to what incentive you might offer patients you must ensure that incentives provided for patients’ benefits (things like free parking or a $10 discount on assessment) do not affect your clinical decision-making when recommending ongoing treatment. 
  
  Incentives linked to ongoing care may present an opportunity for certain patients with high or unlimited extended health benefits, and low personal income, to be taken advantage of should you offer goods in exchange for physiotherapy services. Doing this would be inappropriate. At no time should a physiotherapist provide care based on the patient’s benefits rather than objective findings and clinical reasoning.
  
  Although there is no specific rule related to incentives, it is imperative that you make your decisions after having reviewed the Advertising Standard, Fees, Billing and Accounts Standard and Conflict of Interest Standard when considering business models and introducing incentives into your practice. 
  
  While the College does not have a list of specific incentives that may be appropriate or inappropriate you should be aware that third party payors may have different positions regarding the use of incentives. Any decision made by a third-party payor to delist a clinic or a physiotherapist based on the use of incentives is made independent of the College.
  
  Resources: 
  
  Advertising Standard
  
  Fees, Billing & Accounts Standard
  
  Conflict of Interest Standard
  
  Code of Ethics
  
  Professional Misconduct Regulation
  
  Exploring the Practice of Offering Incentives (CHLIA)

• Can I thank patients by giving them a $20 gift card every time they refer somebody new to my clinic?

  No, this is giving a benefit to someone for your financial gain. Physiotherapists should avoid conflicts of interest, or the appearance of conflicts of interest. This is clearly outlined in the Professional Misconduct Regulation and the Conflict of Interest Standard.

   

• Can I recommend a product or service to a patient that is offered within the clinic I work at?

  Yes, although remember PT’s should only recommend products or services to patients that are clinically indicated.  You should disclose the financial interest to the patient in advance, make the patient aware of any practical alternatives, and assure the patient if they choose an alternate supplier that care will not be affected. Document the discussions in the clinical record.

  Be sure to re-read the Conflict of Interest Standard so you have a solid understanding of what the rules say.

  Why not get in touch with the Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org?

• I am setting up a business co-owned by myself (PT), a surgeon, and a registered massage therapist. How do I manage the conflict of interest that exists when referring patients to the massage therapist or surgeon within the co-owned practice?

  Obviously, any services recommended to the patients must be clinically indicated.

  You must also:

  - Disclose to the patient, in advance, that you have a financial interest in the business

  - Make the patient aware of any other options for receiving the recommended services

  - Assure the patient that if they choose another surgeon or RMT, it will not adversely affect their physiotherapy care

  - Document the discussion in the patient’s record 

  There are similar conflicts of interest obligations for the surgeon and RMT when referring patients to you. Be sure to check with the respective colleges to learn the details. 

• Can I reward patients with free treatments in exchange for a positive review of our physiotherapy clinic on social media?

  No, physiotherapists cannot offer benefits or rewards in exchange for positive reviews.

  Consider the following three Standards:

  The Conflict of Interest Standard states that PTs must recognize and manage situations that may result in a real, potential, or perceived conflict of interest. A PT is in a conflict of interest if their professional actions or decisions result in a benefit to them and are not in the best interest of the patient.

  The College's Boundaries and Sexual Abuse Standard requires that physiotherapists always act in the patient's best interest to manage boundaries in the therapeutic relationship. Patients and others may perceive that they are being pressured or bribed to leave a positive review, which is not only unethical, but blurs those boundaries.

  Additionally, the Advertising Standard requires that all advertising be true, accurate and verifiable. Patients may be encouraged to submit positive reviews based on the desire for a discount rather than their actual experience and opinion. 

  Physiotherapists can solicit positive reviews in ways that do not cross boundaries or present a potential conflict of interest. Consider inviting patients who have had a positive experience to leave a review by putting up a sign in your clinic or including the information in a newsletter that goes out to patients who have signed up to receive it.

• Can I provide gift cards for free assessments?

  Giving a gift card for the value of a free assessment carries significant risks. It should not be provided to patients or anyone else who refers patients to you. This could be considered a benefit for referral and would put you in a conflict of interest.
  
  Additional information about conflicts can be found in the Conflict of Interest Standard. 
  
  It would not be acceptable to provide a shortened or incomplete version of an assessment based on the fee charged or waived to the patient. As a reminder, physiotherapists can never delegate the performance of the assessment to another individual. Any treatment plan determined by the assessment must be clinically indicated. You cannot invoice a third-party payor for the value of the gift card.
   
  A physiotherapy assessment should be comprehensive and must include the following elements: 
  
   •  Relevant information about the health condition, personal and environmental factors 
   •  Subjective and objective findings 
   •  A physiotherapy diagnosis 
   •  Goals of treatment 
   •  Treatment plan 
   •  Plans for reassessment and discharge 
  
  A PT can waive their fee for the physiotherapy assessment. The Fees, Billing and Accounts Standard states that “any departure from the established fee schedule can only be to reduce fees.”