Table 5 Frequency and definitions of variables that provided opportunity
Lack of oversighta | The environment did not afford the ordinary oversight of Centers for Medicare and Medicaid Services- or Joint Commission-mandated processes or Internal Auditing for billing. E.g., physician owned small outpatient surgery center. | 40.5% |
Oversight failure | Oversight mechanisms existed or should have existed, but were so deficient that opportunity for unnecessary procedures was established. E.g., unnecessary procedures were performed for 5 years amidst complaints. | 39.2% |
Corrupt moral climate | A corrupt moral climate contributed to the unnecessary procedures, e.g., institutional officials collaborated in or encouraged the procedures. This variable was not used in addition to oversight failure, but it could be a cause of a lack of oversight. | 26.6% |
Vulnerable patients | Patients belonged to a protected class (e.g., children or older adults) or had cognitive deficits, and this appeared to create opportunity for unnecessary procedures. | 20.3% |
Financial conflict of interest | The physician had relationship to industry (e.g., consulting contracts) and this appeared to contribute to unnecessary procedures. | 13.9% |
Ambiguous norms | The standard of practice was not well established, and this “gray area” created opportunity for unnecessary procedures. | 5.1% |
Other | An environmental factor, not listed above, appeared to create opportunity for unnecessary procedures. | 3.8% |
Conflicting roles | The physician played conflicting roles, e.g., treating physician and chair of the patient care review committee, and this created opportunity for unnecessary procedures. | 0% |
None | No environmental factor presenting opportunity could be identified or reasonably inferred. | 13.9% |