With the Boston Business Journal publishing a four page spread on payments to physicians – using exclusively Open Payments data – it seemed the right time to point out this trend from across the country. If this has not yet come to your area, it will.
Behind the Curtain: Industry is spending millions on Massachusetts doctors and hospitals. Is it necessary for Medicine – or Marketing?
http://www.bizjournals.com/boston/news/2016/10/13/behind-the-curtaincare-centers-surgeons-garner.html (Note: Most of article is subscriber access only)
State Doctors Take Millions From Drug Companies For Consulting, Meals, Speeches
RI Doctors Paid Over $9 Million by Drug Companies
Kane In Your Corner: NJ doctors got $50M from drug companies
These 10 Philly Docs Received $12.8 Million from Medical Device and Pharmaceutical Companies Last Yearhttp://www.phillymag.com/news/2015/07/09/dollars-for-docs-propublica/
Ten Triangle doctors received $8.3 million from pharmaceutical and medical devices companies last year
Doctors in San Diego County received $84 million in payouts from drug and medical device companies last year, according to federal data.
Doctors Earn $3.5 Billion in Kickbacks from Pharmaceutical Companies
Top row, from left: 1. Alexander Vaccaro, Rothman Institute, 2. William Hozack, Rothman, 3. Richard Rothman, Rothman, 4. Joel Cooper, Penn Medicine, 5. Peter Sharkey, Rothman. Bottom row, from left: 6. David Nash, Jefferson, 7. Demetrius Bagley, Jefferson, 8. Robert Booth, Aria, 9. David Anderson, Rothman, 10. Gerald Williams, Rothman
Update: This post has been clarified to more accurately characterize the nature of some of the payments these doctors receive. The payment totals listed are from device makers as well as from pharmaceutical companies.
Original: Last week, the federal government released 11.4 million records detailing $6.49 billion in payments from drug companies to United States doctors between August 2013 and December 2014, as required by 2010’s Physician Payment Sunshine Act. Thanks to non-profit investigative journalism outfit ProPublica, which each year compiles the data into an easier-to-read format, we were able to get a look at some of the doctors in Philadelphia who receive a significant amount of money from drug and medical device companies.
These payments can include things like royalties, promotional speaking fees, consulting work, meals, travel and entertainment. And there’s certainly nothing illegal about a doctor getting paid by a medical device or drug company, assuming that the payments are not kickbacks for using the device company’s devices or prescribing the drug company’s products.
“We fully support the transparency,” says Michael DellaVecchia, president of the Philadelphia County Medical Society. “It’s easy to be for transparency, because we believe that the vast majority of doctors earn their money both in a worthwhile way for society and in an honest way. If someone is working with a pharmaceutical company for a cure for cancer, what’s that worth? What’s the cure for AIDS worth? What’s the cure for hepatitis worth?”
ProPublica reporter Charles Ornstein, who worked on the organization’s Dollars for Docs project, says that for the most part, when patients make changes after reading the data, it’s because they already had concerns about their doctors.
“It comes down to the patient’s gut,” he adds. “Do you trust your doctor? Do you feel like you are getting good advice.”
Pennsylvania is in sixth place in the nation for total disbursements to doctors, with $143 million in payments, falling behind California ($806 million), New York ($312 million), Texas ($243 million), Florida ($188 million) and Massachusetts ($170 million), according to ProPublica’s database. And the biggest earners in the state are here in Philadelphia.
We compiled the 10 Philadelphia doctors with the largest total payments from pharmaceutical and medical device companies. It appears that many big payments to these doctors are for devices*. Click on a doctor’s name to get more information on the doctor and for details on the payments made. Payments are rounded to the nearest thousand.
1. Alexander Vaccaro, Rothman Institute, $2,840,000
2. William Hozack, Rothman Institute, $1,540,000
3. Richard Rothman, Rothman Institute, $1,500,000
4. Joel Cooper, Penn Medicine, $1,420,000
5. Peter Sharkey, Rothman Institute, $1,250,000
6. David Nash, Jefferson, $1,160,000
7. Demetrius Bagley, Jefferson, $934,000
8. Robert Booth, Aria, $760,000
9. David Anderson, Rothman Institute, $729,000
10. Gerald Williams, Rothman Institute, $691,000
To see what your doctor took home from drug companies last year, search by name here.
*This paragraph has been edited for clarity.
Follow @VictorFiorillo on Twitter.
BIG PHARMA SHOWERS MILLIONS ON CALIFORNIA DOCTORS
Payments Cloud California Medical Association’s Decision to Oppose Prop. 61
SACRAMENTO, CA – Federal records show drug and medical-device manufacturers in 2015 made payments of more than a quarter of a billion dollars that – in one way or another – went directly or indirectly into the pockets of tens of thousands of California doctors, even as the leadership of the California Medical Association decided to oppose Prop. 61, the November ballot measure to cap prescription drug prices.
“The cozy and incestuous financial ties between the drug industry and California doctors raise troubling questions about the California Medical Association’s (CMA) decision to oppose Prop. 61,” said Garry South, chief strategist for the Yes on Prop. 61/Californians for Lower Drug Prices campaign.
“The CMA leadership voted behind closed doors to oppose Prop. 61, even though Prop. 61 would represent a start in making prescription drugs more affordable and accessible to the very patients doctors are supposed to care for,” said South. “This was not the CMA’s finest hour. A free lunch from Pharma shouldn’t be more important to doctors than affordable meds for their patients.”
DIRECT PHARMA PAYMENTS CMA OFFICERS AND DIRECTORS
CMA President Steve Larson has been quoted publicly criticizing Prop. 61, while at least four doctors in Larson’s private practice (the Riverside Medical Clinic) have received a total of $1.6 million in payments from drug or medical-device manufacturers between Aug. 2013 and Dec. 31, 2015. One of these four, Dr. Anil Garde, was paid a whopping $1.18 million by Abbott Laboratories in 2014 in royalties or licensing fees. Five drug makers paid $64,746 for various services (meals, food and lodging) provided to Dr. Ronald Bailey, another member of Larson’s medical group.
In addition, at least five doctors on the CMA’s board of trustees received sizeable payments from manufacturers:
- CMA executive committee member Dr. Lee Snook was paid $36,549 by medical- device maker Boston Scientific to determine if 37 of his patients benefited from treatment with Boston Scientific’s neuromodulation spinal cord stimulation device. Snook gave the treatment a positive grade.
- In 2015 CMA trustee Dr. Victor Ching was paid $156,695.91 by Medtronic Vascular Inc. to purchase Ching’s interest in a medical-device company.
- CMA trustee Dr. David Friscia received $129,571 in royalties or licensing fees from three medical-technology companies, including Wright Medical Technology, Inc. Drug and medical-device manufacturers spent another $53,000 paying for Friscia’s food, entertainment, beverages and lodging between Aug. 2013 and Dec. 31, 2015. In addition, six other doctors in Friscia’s practice (Desert Orthopedic Center, A Medical Group Inc.) received payments and services valued at $685,000 from drug companies and medical-device manufacturers during the same period.
- Various medical-device and drug manufacturers also paid CMA trustees Dr. Christopher Hancock and Dr. Robert Pugach $63,578 and $54,743 respectively during the Aug. 2013 to Dec. 31, 2015 period.
Snook and Friscia also sit on the board of directors of the CMA’s political action committee, which presumably played a role in the group’s decision to oppose Prop. 61 . Three other members of that committee received sizeable payments from drug companies and medical-device manufacturers between Aug. 2013 and Dec. 31, 2015. One of those three, Dr. Ramin Manshadi, received more than $200,000 in such payments.
“These millions in payments to key CMA players and/or their business partners call into question whether the CMA decision to oppose Prop. 61 was based on serving the best interests of patients or serving the best financial interests of the doctors themselves,” said South, who noted that independent studies have concluded that doctors can be influenced even by small payments from drug companies.
A study published by JAMA Internal Medicine – as reported by the Wall Street Journal – recently found that even small drug company perks, like a meal, could influence doctors’ decisions. The study found, for example, that when a drug company sales representative paid for a doctor’s meal – with an average meal valued at $20 – while pitching one of their drug products, the doctor was much more likely to prescribe that drug than a doctor who did not get a meal. For example, a doctor who got a free meal from an Allergan PLC sales rep promoting the heart medicine Bystolic was 70 percent more likely to prescribe the drug than a doctor who did not get a free meal.
PHARMA PAYMENTS DIRECTLY TO CMA AND CMA’S FOUNDATION
In addition, CMA and its separate non-profit foundation also appear to be significantly subsidized by drug companies.
The website of the California Medical Assn. Foundation (CMAF) currently lists drug giants AstraZeneca, Genentech, Lilly, Johnson & Johnson, Novo Nordisk and Pfizer among its 11 “corporate sponsors.” These six drug companies, not coincidentally, have collectively contributed $23.75 million to the campaign to defeat Prop. 61. The drug industry’s trade association and lobbying arm, the Pharmaceutical Research and Manufacturers of America (PhRMA), which is running the campaign against Prop. 61, also made more than $240,000 of in-kind contributions to the anti-Prop. 61 campaign.
Meanwhile, the CMA’s website says both it and the foundation welcome corporate sponsors. In this regard, the website says: “Learn how joining the CMA & CMAF Corporate Sponsorship Program will benefit you and your company.” Then the website indicates that corporate sponsorship status comes with a minimum $100,000 contribution.
The CMA website outlines in detail the perks a corporate sponsor will receive, including “recognition of corporate partnership in all CMA/CMAF’s annual promotional materials…private lunch and meeting with CEO’s of the CMA and CMAF up to three times annually.” However, the CMA website does not identify such sponsors on the part of its website that is accessible to the public.
TOTAL PHARMA PAYMENTS TO CALIFORNIA DOCTORS IN JUST ONE YEAR
Federal records reveal that in 2015 California doctors received $264.3 million in direct and indirect financial benefits from the drug and medical-device industries. Direct payments to doctors included speaking and consulting fees, research grants, licensing fees and royalties. Indirect payments included paying for doctors’ meals, beverages and lodging.
These payment records can be found on the “Open Payments” website maintained by the federal Centers for Medicare & Medicaid Services
In 2014, almost one thousand California doctors received $50,000 or more in financial benefits from drug and medical-device manufacturers, according to a review of the CMS database.
Proposition 61, on the November ballot, would require the state of California to negotiate with drug companies for drug prices that are no more than is paid for the same drugs by the U.S. Department of Veterans Affairs (DVA). Unlike Medicare, the DVA negotiates for drug prices on behalf of the millions of veterans it serves, and pays on average 20-24 percent less for medications than other government agencies, and up to 40 percent less than Medicare Part D. Prop. 61 empowers the state, as the healthcare buyer for millions of Californians, to negotiate the same or an even better deal for taxpayers, saving the state billions.
Iowa doctors get more than $12.6 million in outside payments
Payments from pharmaceutical, medical manufacturing companies include lunches, royalties
Iowa doctors received more than $12.6 million in payments from pharmaceutical companies and medical manufacturers in 2015 — with one Iowa City doctor’s payments accounting for about a third of overall payments — according to data recently released by the federal government.
The payments range from a $15 lunch to thousands in consulting fees and royalties. Some Iowa doctors were given thousands of dollars to travel internationally to places including Frankfurt, Germany, Dubai, United Arab Emirates, and Bangkok, Thailand, while others were given gifts valued at anywhere from $2,000 to more than $43,000.
The federal Open Payments program, which put out new data last week by the Centers for Medicare and Medicaid Services, requires drug and medical manufacturers to release details of the payments they make to physicians and teaching hospitals for services such as promotional talks, consulting, and research and royalty agreements.
CMS has released data twice — the first data collection detailed payment made between August 2013 through the end of 2014. The most recent data release included payments made from Jan. 1, 2015, to Dec. 31, 2015
Health care industry manufacturers nationwide reported $7.52 billion in payments in 2015. About 618,000 physicians and 1,110 hospitals from across the country received payments, according to CMS data.
That breaks down to about:
• $2.6 billion in general payments, including food, travel and consulting fees
• $3.89 billion in research payments
• $1.03 billion in ownership or investment interests.
These payments are not inherently bad or illegal, experts have said, but relationships between doctors and medical manufacturers can produce conflicts of interest, which is why it is important to disclose these relationships.
“Transparency is empowering physicians to be purposeful about their financial relationships with companies, and there is a notable shift toward charitable contributions and away from other interactions such as honoraria and gifts,” said Dr. Shantanu Agrawal, a CMS deputy administrator and director of the Center for Program Integrity, in a news release.
In Iowa in 2014, physicians were given more than $69,200 in charitable contributions compared with more than $70,000 in 2015.
A Gazette analysis of the data revealed that while some doctors receive only a handful of small payments, others are paid millions of dollars.
Dr. John Callaghan, an orthopedic surgeon at the University of Iowa Hospitals and Clinics, received more payments than any other doctor in the state. Callaghan was paid more than $4.27 million in 2015 from Massachusetts-based DePuy Synthes Products and related companies, and has been paid more than $10 million since August 2013.
Data shows that Callaghan received about $63,000 worth of consulting fees and about $4,654 for travel, lodging and food. But the vast majority of payments were from royalties and licensing — $4,220,719.
Callaghan said the payments are related to intellectual property transfer and design of 10 to 15 hip and knee implants over a 20-year period, adding the money has allowed him to give back to the University of Iowa.
After Callaghan, the physician to bring in the second largest sum of payments was UIHC’s Dr. Annunziato Amendola, who was paid more $943,929 from August 2013 to the end of 2015. Amendola recently took a position at Duke University Hospital in Durham, N.C.
• Iowa medical doctors brought in the most payments — more than $25,100,000 since 2013.
• The state’s dentists received more than $1,330,000.
• Doctors of osteopathy more than $1,200,000.
• Podiatrists received more than $603,000.
Pharmaceutical giants, including New Jersey-based Novartis Pharmaceuticals Corp. — the country’s largest in sales of prescription medicine — and New York-based Pfizer Inc. — No. 2 — are among the top payers in the state. Novartis paid out more than $3.6 million to doctors, and Pfizer paid doctors more than $2.6 million between August 2013 to December 2015.
The top payer in Iowa was orthopedics manufacturer and designer DePuy Synthes Products, which paid about $9.9 million during that same time period.
By the numbers
Health care industry manufacturers nationwide reported in 2015:
• $7.52 billion were made in payments to approximately 618,000 physicians and 1,110 hospitals.
• $2.6 billion were made in general payments, including food, travel and consulting fees.
• $3.89 billion were made in research payments.
• $1.03 billion were made in ownership or investment interests.
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• In 2014, physicians were given more than $69,200 in charitable contributions.
• In 2015, they received more than $70,000.
Companies that gave the most money:
1 DePuy Synthes Products — $9,945,141
2 Novartis Pharmaceuticals — $3,637,624
3 Amgen Inc. — $2,800,774
4 Eli Lilly and Co. — $2,727,036
5 Pfizer — $2,655,450
Source: Open Payments
CREDIT NIGHTRYDER84 / WIKIMEDIA–CC
By MEGAN HART & DAN MARGOLIES
Physicians associated with Kansas and Missouri hospitals received about $46 million in payments from drug and medical device companies in 2014, with about 9 percent going to providers in the Kansas City area.
A database compiled by ProPublica shows the companies paid about $4.1 million to physicians associated with hospitals in greater Kansas City, and $1.7 million to those working with hospitals in the greater Wichita area.
It isn’t illegal for doctors to accept meals, speaking fees and other forms of compensation from drug and medical device companies, as long as they don’t receive kickbacks for prescribing certain medications or devices. Some studies have found, however, that doctors who accept payments tend to prescribe more expensive drugs more frequently than generics, at least in certain cases.
Doctors who received more payments were more likely to prescribe the expensive drugs than those who received smaller amounts, though that doesn’t prove the payments caused the prescribing, or that doctors who received payments intentionally did anything differently.
In addition to being geographically concentrated, most of the money went to relatively few physicians. About $2.7 million, or more than a third of the money the industry spent on doctors in Kansas, went to the top 15 recipients – or 0.5 percent of the roughly 2,800 doctors who received some form of payment. Similarly, nearly $20 million, or about half the money the industry spent on doctors in Missouri, went to the top 15 Missouri recipients — out of a total of more than 7,000 who accepted payments.
The Missouri numbers, to be sure, were skewed by one huge outlier – $9million to Roger Jackson, who specializes in orthopedic surgery and invented a surgical table for which he receives royalties. Jackson was far and away the top recipient of industry money in either Kansas or Missouri.
While sorting doctors by the hospital where they work can be instructive, the hospital may not be directly affected by what doctors choose to accept. For example, Steven M. Simon, a physical medicine and rehabilitation specialist, received nearly $542,000 in industry payments – making him one of top recipients of industry money in the Kansas City area. But most of the money was related to his private practice, Mid-America Physiatrists in Overland Park, and not to his affiliation with Shawnee Mission Medical Center.
In a telephone interview, Simon said half or more of the money he received was reimbursement for expenses like air fare and hotels. He said he frequently lectures on medications to other providers, necessitating frequent travel.
“These are FDA-approved programs sponsored by the pharmaceutical company to familiarize physicians with product,” he said.
Similarly, David Michael Wichman, a Wamego, Kansas, psychiatrist who accepted $137,239 in payments, mostly for speaking, said he speaks at continuing education events on his own time and doesn’t consider it related to his affiliation with Wamego Health Center.
Wichman said most of his presentations are to physicians working in rural areas of Kansas and Nebraska. The presentations cover newer psychiatric medications, including antipsychotics and antidepressants, he said.
“A lot of it is going out and talking to family physicians that are struggling to treat psychiatric patients,” he said.
The Food and Drug Administration regulates what information can be included in presentations and requires the speaker to cover how the medication works, side effects and studies the FDA used when deciding whether to approve the drug, Wichman said. Half of the presentation can’t be about a specific drug, but must include general information like how to manage bipolar disorder, for example, he said.
“You can only give that unbiased, this is what the drug is, this is what it does” information, he said.
Wichman said he had done some teaching since he was chief resident at University of Kansas Medical Center in 2008, and gradually been speaking at continuing education events and events discussing pharmaceuticals. He said he supports publishing information about physicians’ finances and prescribing patterns, but thinks concerns about pharmaceutical payments influencing physician behavior may be overblown.
Doctors who attend a presentation about a new drug typically are interested in what it could do for their patients, Wichman said. If that drug offers an advantage, such as reduced metabolic side effects from new antipsychotic drugs, patients benefit, he said.
Doctors “didn’t go to that many years of schooling to be ‘bought’ for a $20 meal,” he said.
The insurance system also limits doctors’ ability to get too eager about a new drug, Wichman said. Most insurers use a form of step therapy, so doctors have to show that their patients aren’t doing well on a cheaper generic before trying a more expensive brand-name drug, he said.
“A lot of these patients that are on the brand-name medications are patients that have failed on two or three non-branded generic medications,” he said.
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.