Marred by gray issues governing its practices, methods for obtaining consent, and balancing the approach to bias and risk of deception, the marketing research profession finds itself in a conundrum. The profession must examine and challenge whether or not they are balancing business practices, ethical compliance, and legal due diligence in a manner to entice an individual to participate in a survey. The “pickings” of research participants are slim, and among those participants, the niche areas of survey research require access to top experts in various career fields, particularly healthcare. To obtain the elite (or any participants at all), the best method for survey research professionals is to offer a reimbursement for survey completion.
Survey research participants are classified as independent contractors(1) and those who rely on the services provided by independent contractors may want to offer a means for thanking them for sharing their expertise and voluntary opinions for completion of a survey. Though the research community has referred to this service as an “incentive” or “honoraria”, it is often referenced as a factor indicative of the independent contractor relationship if it is provided as a form of “reimbursement” or “allowance”. Therefore, references to incentives or honoraria should be classified as reimbursements or allowances.
Using these terms does not limit the ability of the survey research profession to use any form of recruitment practice. The profession, however, should be mindful of the language chosen to induce participation since other terms such as “compensation” or “get paid” have been considered a form of wage or compensation.
A reimbursement is a benefit or consideration, financial or otherwise, given to induce research participants to cooperate in a survey. There are three basic types of reimbursements:
- Pre-completion reimbursements are offered to research participants before they agree to do a survey. This type of reimbursement is usually used in mail surveys and can be a crisp, new dollar bill, a pen, or some other type of small gift. A letter is often provided to the participant that says, “We know your time is valuable, and we can’t begin to compensate you appropriately. However, we are enclosing this small gift as way to say thank you…”
- Post-completion reimbursements are offered to research participants upon completion of the survey or study project. These are almost always associated with in-person, phone or Internet methodologies. The research participant is told up-front that they will be rewarded for taking the survey, but they may or may not be told the type reimbursement.
- Ongoing reimbursements are most often used with panels or with research participants who are committed to long-term or longitudinal studies. Portions of the reimbursement are doled out as each phase of the study is completed. This reimbursement may be cash, but “point” accrual systems are also very popular and allow the research participant a choice of how they will spend their points. Often a bonus award is given to research participants who remain in the study for its full duration.
The use of reimbursements can be a cost-effective technique in increasing research participation. There are, however, considerations that every survey researcher should practice when discussing the scope and type of reimbursement to consider:
- Offering too large a reimbursement;
- Offering a reimbursement that can skew the sample;
- Offering a drawing or sweepstakes entry without knowing the laws;
- Offering a reimbursement to a research participant that is prohibited because of gift laws; and
- Offering a reimbursement to some research participants and not others.
Healthcare Professionals and Survey Research
Reimbursements for research participants may also be provided to those in niche career areas where the importance of the expertise is critical. The current laws on providing gifts to healthcare professionals create a challenging environment for survey research professionals. Critics of pharmaceutical and medical device company “gifts” to healthcare professionals, which includes reimbursements, are concerned about any form of influence or coercion that can occur by the healthcare professional. For survey researchers, however, the only influence sought through reimbursements is to influence a difficult to reach, but highly important community. The right balance must be achieved in providing a satisfying reimbursement that entices healthcare professionals to participate, while not appearing coercive in nature as to be deemed an undue influence on a healthcare professional’s opinion.
What is an Appropriate Reimbursement Amount for Healthcare Professionals?
Healthcare professionals are an important and highly selected demographic for survey research studies. Providing reimbursements are a key component for physician participation(2)
Policies on the scope of reimbursements will vary between each survey research company. Guidelines on the scope of an acceptable reimbursement specifically provide that “compensation should not be of a nature that it interferes with the ability of potential subjects to give informed consent, without the possibility of coercion or undue influence.”(3)
Furthermore, the Compliance Guide for Pharmaceutical Manufacturers, as provided by the Department of Health and Human Services, provides that “payment for research services should be fair market value for legitimate, reasonable and necessary services.”(4) The Code on Interactions with Healthcare Professionals from PhRMA also supports this perspective and provides: “[i]t is appropriate for consultants who provide advisory services to be offered reasonable compensation for [consulting] services…Any compensation or reimbursement made in conjunction with a consulting arrangement should be reasonable and based on fair market value.”(5) The AMA Code of Medical Ethics Opinion 8.061 provides that focus groups may compensate physicians for time and travel when they participate in focus groups “as long as the focus groups serve a genuine and exclusive research purpose and are not used for promotional purposes.”(6)
What is Fair Market Value?
The IRS Revenue Ruling 59-60 defines fair market value (FMV) as “the price at which property would change hands between a willing buyer and willing seller when the former is not under any compulsion to buy and the latter is not under any compulsion to sell, both parties have reasonable knowledge of relevant facts.”(7)
Determining the fair market value for a healthcare professional participating in survey research is not an easy calculation. Fair market value can be determined based on the market, income or cost approaches. Various survey research companies determine a reimbursement amount based on the actual cost of participation and compensation for time and personal information.(8) Another survey research company recommends that in order to determine the reimbursement amount, conduct the following:
- Determine an hourly base rate;
- Collect internal information; and
- Create an FMV formula.(9)
An additional perspective recommends a modified marketing research approach where salary data is considered for the previous two years, excluding payroll taxes and benefits. The results are then adjusted based on the factors of:
1. The specific requirements and nature of the duties associated with the consultant’s contemplated services;
2. The specific skills and unique qualifications that a specific physician candidate may bring to a consulting position; and
3. The extent of time requirements associated with the contemplated position.” (10)
The approaches for survey research companies will vary according to their needs. MRA reminds survey research professionals that when reimbursements provided in the aggregate exceed $600, a 1099 form must be completed.
Laws on Healthcare Professional Gifts
Laws on physician gifts also create challenges for survey researchers. These laws either ban all gifts or create reporting obligations for the public reporting of any reimbursement to healthcare professionals. Survey researchers have exemptions from some of the laws that deal with this issue.
Survey researchers should also be aware of the restriction of reimbursements to Medicare or Medicaid patients. These restrictions apply to all survey research companies and limit gift values to no more than $10 individually or $50 annually in the aggregate per patient.
Survey research professionals must balance the needs of obtaining a selective demographic and providing reimbursements that are reasonable and based on fair market value. A number of factors within the survey research profession are taken into consideration when creating a reimbursement amount, including time for survey completion and other personal information related expertise, in mastering a sound calculation. The result is that participants need motivation, and survey research professionals devote a great deal of time to mastering the challenge of how to create survey research involvement.
- See LaToya Rembert-Lang, Are Respondents Employees? A Survey Researcher’s Guide on the Independent Contractor, Alert!, August 2011.
- See Sean O. Hogan, Ph.D. and Melanie LaForce, Ph.D., Incentives in Physician Surveys: An Experiment Using Gift Cards and Checks, available online at http://www.amstat.org/sections/srms/proceedings/y2008/Files/hogan.pdf.
- See Sandra H. Berry, Jennifer S. Pevar, and Megan Zander-Cutugno, The User of Incentives in Surveys Supported by Federal Grants, available online at http://www.copafs.org/seminars/use_of_incentives_in_surveys.aspx.
- AMA Code of Ethics (f),http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8061.page
- See http://www.copafs.org/seminars/use_of_incentives_in_surveys.aspx.
- See Andy Bender, Tamsen de Raat, Nicole Gray, Demystifying Fair Market Value Determination: A Proposed Methodology for Determining FMV of Physician Honoraria, http://www.polarismanagement.com/Publications/15%20-%20Demystifying%20Fair%20Market%20Value%20Determination%20-%20A%20Proposed%20Methodology%20For%20Determining%20FMV%20of%20Physician%20Honoraria%20-%20RXComp%20July%2004.pdf.
- See Andrea M. Ferrari, Ann Brandt, Scott Safriet, Determining “Fair Market Value” for Physician Consulting Services: The New ‘Big Question’ for Life Sciences Companies, http://www.healthcareappraisers.com/AHLA_LifeSciences_0409.pdf.