Beware of gifts: Why a cigar isn't just a cigar

'Tis the season of giving--and receiving. As hospital staff and leadership spread merriment and joy, they should use caution in accepting gifts, particularly prevalent during the holiday season.

Should a physician accept a box of imported cigars from a patient? What about a $200 hot tub? Dr. Richard Kovar, a Virginia family physician, once received a patient's offer to pay for a hot tub. The doctor said he could have used one at the time, but Dr. Kovar declined, according to American Medical News. "That would have been totally inappropriate," he said. "I told him I just really wouldn't feel comfortable taking it."

Even though there are no definite rules for providers to determine whether to accept a gift from patients, according to the American Medical Association (AMA) policy, the AMA does offer guidance about how to approach gift-receiving between providers and patients; gifts should not be "disproportionately or inappropriately large." Pricey gifts could either influence providers or give the appearance of doing so.

"No fixed value determines the appropriateness or inappropriateness of a gift from a patient," the policy states. One way to think about it is whether the provider would feel comfortable if colleagues or the public knew about the gift. If not, chances are accepting the gift isn't a good idea.

Drawing from my own experience, some journalists have a no-more-than-a-coffee rule, meaning that reporters voluntarily (although sometimes mandated by their news organization) reject gifts that are worth more than the cost of a coffee at $5. I've known journalists who have taken this informal policy to heart and even turned down appetizers, alcoholic drinks, books, and computer memory cards, among other things, to resist even the appearance of bias or preference.

And although the AMA does not put a price tag cap on the gift amount, there will be strict rules regarding gifts from drug and device manufacturers, with a proposed rule released by the Centers for Medicare & Medicaid Services (CMS) this week.

Under the Physician Payment Sunshine Act, gifts to providers that are worth more than $10 will soon be a matter of public record. With this transparency rule, drug and device manufacturers must report items they give providers, such as expensive dinners, golf vacations, and consulting and speaker fees, or else face penalties of up to $1 million if the manufacturers knowingly fail to report such payments or gifts.

In a win for consumer rights, CMS said it would post the payment information on a public, searchable website of aggregated data, reports Reuters UK.

But the drug and device makers got the gift of time this week with CMS' delayed rule. They now have until sometime in 2012 (when the final rule publishes) instead of the originally planned Jan. 1, 2012 to report such data.

As CMS collects incoming comments, its final rule could affect the way providers and manufacturers conduct relationships (some of them, too close for comfort) and the way they give gifts for holiday seasons to come.

Will the new CMS rule affect what gifts you take? Have any stories about gifts from patients or manufacturers? How did you handle them? Let us know! - Karen (@FierceHealthcare)